Abraham Flexner delivered his eponymous report 100 years ago. The Report had an immediate and profound impact on medical education in North America that resonated for several decades afterwards. Its impact was less immediate in the United Kingdom, but over time the major principles have been assimilated (GMC 1993). However, which—if any—of these principles are still relevant today? No doubt there will be debate about this, but in my view, Flexner's principle of academic and scientific excellence as one of the (...) most fundamental underpinnings of medical education is even more relevant today than it was in 1910. To illustrate this, I shall highlight two aspects of current medical education in the United Kingdom: the .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Rhetorical Investigations: Studies in Ordinary Language Criticism, and: Ordinary Language Criticism: Literary Thinking after Cavell after WittgensteinRichard FlemingRhetorical Investigations: Studies in Ordinary Language Criticism, by Walter Jost; 368 pp. Charlottesville: University of Virginia Press, 2004, $55.00. Ordinary Language Criticism: Literary Thinking after Cavell after Wittgenstein, edited by Kenneth Dauber and Walter Jost; 353 pp. Evansville: Northwestern University Press, 2003, $29.95 paper.On the question of ordinary language criticism (...) and philosophy, "Who pleases whom?" Judging by many of the articles, essays, and books of the last decade the answer might be: almost nobody pleases anyone. Whether in appreciation or incomprehension of its importance and substance, renewed efforts at understanding, redirections of thinking, and disappointments and frustrations with the [End Page 209] subject-matter are prevalent when ordinary language is the topic of discussion. These two recent books tend to strengthen this assessment. Rhetorical Investigations is a sustained effort to "revisit" and "rethink" grammatical (conceptual) reflections on ordinary language and literature; and in so doing provide a "reinvention" of characteristics of literary theory through an extensive and detailed consideration of the work of Robert Frost. Although sometimes overreaching in its efforts (particularly when discussing logic), it imaginatively uses rhetoric and ordinary language concerns as a means of direction and focus for new, explanatory discussions in literary—philosophical analysis. Ordinary Language Criticism (part of the general series, "Rethinking Theory," edited by Gary Saul Morson) is a diverse and uneven collection of fifteen articles concerning and using ordinary language interests, several of which (R. M. Berry, Garry L. Hagberg, Richard Eldridge, Gerald L. Bruns) valuably repay the diligence needed to discover them in 350 plus pages. The text includes an editors' introduction that voices the wish to "return criticism to its grounds in the 'ordinary' or natural language we all speak" and (unsuccessfully but lustily) pronounces and explains "ordinary language criticism" as a new yet traditional area of study. ("New" in that it takes "as its point of departure" the ordinary language philosophy of Wittgenstein, and "traditional" in that "all criticism is really ordinary language criticism.") The editors further undertake in this introduction the endeavor to sketch something of a program for the book, meant to show connected promptings among the various writings, whereas the specific authors themselves settle down quickly and separately to a critical work at hand without particular references to each other. Both of these texts, like others in this field of study before, valuably raise questions and apprehensions of what use there is in talk about ordinary language. The best of such material provides provocations for thinking that are to be found nowhere else. The worst of such books and articles is that they prejudice sensible people against the study of the ordinary.Can one conceive of something to say about these two books that the authors and the current readers haven't already heard or of which they can be profitably reminded? It certainly would not be wise to presume such a grand stand. This is a large question to which only a small answer might be given here. Setting aside the perhaps undiscussable differences of what we each see of primary importance in the primary texts and how best to read them, one issue and difference of understanding, specific and plain enough to state briefly, perhaps usefully does arise. It is a lack of a clear sense of the "ordinary," its distinctiveness, its implications; and thereby a continuation of many of the confusions that have inhabited philosophical and literary writing before and after Wittgenstein turned his attention to the matter. Is this not partly why frustrations of understanding, disagreements in thinking, and displeasures in discussion remain pervasive and unrelenting?This difficulty and difference with such work can only prove worthwhile introducing, however, against a background of agreement over the centrality [End Page 210] of a cluster of issues, of which three might be specified: a first agreement concerns the sensitivity or fear that something is being missed or remains unintelligible in the culture about the ordinary; a respect for the ordinary is a needed, often unnoticed beginning of our reflections. Rhetorical Investigations importantly develops its analyses from such a perspective (Jost's... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Rhetorical Investigations: Studies in Ordinary Language Criticism, and: Ordinary Language Criticism: Literary Thinking after Cavell after WittgensteinRichard FlemingRhetorical Investigations: Studies in Ordinary Language Criticism, by Walter Jost; 368 pp. Charlottesville: University of Virginia Press, 2004, $55.00. Ordinary Language Criticism: Literary Thinking after Cavell after Wittgenstein, edited by Kenneth Dauber and Walter Jost; 353 pp. Evansville: Northwestern University Press, 2003, $29.95 paper.On the question of ordinary language criticism (...) and philosophy, "Who pleases whom?" Judging by many of the articles, essays, and books of the last decade the answer might be: almost nobody pleases anyone. Whether in appreciation or incomprehension of its importance and substance, renewed efforts at understanding, redirections of thinking, and disappointments and frustrations with the [End Page 209] subject-matter are prevalent when ordinary language is the topic of discussion. These two recent books tend to strengthen this assessment. Rhetorical Investigations is a sustained effort to "revisit" and "rethink" grammatical (conceptual) reflections on ordinary language and literature; and in so doing provide a "reinvention" of characteristics of literary theory through an extensive and detailed consideration of the work of Robert Frost. Although sometimes overreaching in its efforts (particularly when discussing logic), it imaginatively uses rhetoric and ordinary language concerns as a means of direction and focus for new, explanatory discussions in literary—philosophical analysis. Ordinary Language Criticism (part of the general series, "Rethinking Theory," edited by Gary Saul Morson) is a diverse and uneven collection of fifteen articles concerning and using ordinary language interests, several of which (R. M. Berry, Garry L. Hagberg, Richard Eldridge, Gerald L. Bruns) valuably repay the diligence needed to discover them in 350 plus pages. The text includes an editors' introduction that voices the wish to "return criticism to its grounds in the 'ordinary' or natural language we all speak" and (unsuccessfully but lustily) pronounces and explains "ordinary language criticism" as a new yet traditional area of study. ("New" in that it takes "as its point of departure" the ordinary language philosophy of Wittgenstein, and "traditional" in that "all criticism is really ordinary language criticism.") The editors further undertake in this introduction the endeavor to sketch something of a program for the book, meant to show connected promptings among the various writings, whereas the specific authors themselves settle down quickly and separately to a critical work at hand without particular references to each other. Both of these texts, like others in this field of study before, valuably raise questions and apprehensions of what use there is in talk about ordinary language. The best of such material provides provocations for thinking that are to be found nowhere else. The worst of such books and articles is that they prejudice sensible people against the study of the ordinary.Can one conceive of something to say about these two books that the authors and the current readers haven't already heard or of which they can be profitably reminded? It certainly would not be wise to presume such a grand stand. This is a large question to which only a small answer might be given here. Setting aside the perhaps undiscussable differences of what we each see of primary importance in the primary texts and how best to read them, one issue and difference of understanding, specific and plain enough to state briefly, perhaps usefully does arise. It is a lack of a clear sense of the "ordinary," its distinctiveness, its implications; and thereby a continuation of many of the confusions that have inhabited philosophical and literary writing before and after Wittgenstein turned his attention to the matter. Is this not partly why frustrations of understanding, disagreements in thinking, and displeasures in discussion remain pervasive and unrelenting?This difficulty and difference with such work can only prove worthwhile introducing, however, against a background of agreement over the centrality [End Page 210] of a cluster of issues, of which three might be specified: a first agreement concerns the sensitivity or fear that something is being missed or remains unintelligible in the culture about the ordinary; a respect for the ordinary is a needed, often unnoticed beginning of our reflections. Rhetorical Investigations importantly develops its analyses from such a perspective (Jost's... (shrink)

A sensible code of right and wrong for public officials everywhere, this book explores what ethics and the public trust mean. It includes sample codes of ethics and examines ways to improve the ethical climate of government. Excerpted and adapted from a longer work, Ethics, Conflicts, and Offices: A Guide for Local Officials, which also covers conflict of interest and office-holding laws in North Carolina.

Whether to treat autism as exculpatory in any given circumstance appears to be influenced both by models of autism and by theories of moral responsibility. This article looks at one particular combination of theories: autism as theory of mind challenges and moral responsibility as requiring appropriate experience of the reactive attitudes. In pursuing this particular combination of ideas, we do not intend to endorse them. Our goal is, instead, to explore the implications of this combination of especially prominent ideas about (...) autism and about moral responsibility. These implications can be quite serious and practical for autists and those who interact directly with autists, as well as for broader communities as they attend to the fair, compassionate, and respectful treatment of increasing numbers of autistic adults. We find that these theories point to a limited range of situations in which autists should not be blamed for transgressive actions for which neurotypical individuals should be blamed. We build on what others have written on these issues by bringing in a recent cognitive model of the role theory of mind plays in empathy, by discussing the social implications of the theoretical findings, and by raising questions about the compatibility of reactive attitude theories of moral responsibility with the neurodiversity approach to autism. (shrink)

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on (...) which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

As a neurodevelopmental condition that affects cognitive functioning, autism has been used as a test case for theories of moral responsibility. Most of the relevant literature focuses on autism’s impact on theory of mind and empathy. Here I examine aspects of autism related to executive function. I apply an account of how we might fail to be reasons responsive to argue that autism can increase the frequency of excuses for transgressive behavior, but will rarely make anyone completely exempt from moral (...) responsibility in general. On this account, although excuses may apply more often to autists than to others, the excuses that apply to autists are just the same excuses that can apply to anyone. (shrink)

McCoy, Liu, Lutz, and Sisti (2020) raise concerns about “partial representation,” in which nonelected advocates or advocacy organizations fail to engage and hold themselves accountable to the full range of people they purport to represent. They are right to point out that the autism community is vulnerable to partial representation. This open peer commentary notes some elements among those engaged with autism that may not fit under the type of “federated model” of representation McCoy, et al recommend. Advocates should tread (...) carefully to avoid some types of harm that do not arise when forming federations on other topics. The influence of antivaxxers and other questionable or harmful movements might even lead us to think, despite the value of open debate and engagement, that there is benefit to partial representation if it prevents potential harms that could arise from legitimizing dangerous practices. (shrink)

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology (...) and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness. (shrink)

This book casts the argument for personal immortality into new light as the outcome of systems processes rather than human nature. Personal immortality is the output of becoming human rather than of being human. If this is the case, then God must be seen to enter into personal relationships with us: a view that current science supports.

Michelle Garcia Winner’s Social Thinking Curriculum is widely used by schools across the USA and has garnered attention internationally. The curriculum addresses social language and behavior deficits among those on the autism spectrum. Although many embrace this curriculum without reservation, the emphasis on social conformity, including avoiding behaviors that make others uncomfortable, merits scrutiny. Individuals who have difficulty understanding social cues and conventions can derive tremendous benefit from learning to fit in, for example, or learning what is likely to make (...) others uncomfortable and why. However, too much emphasis on pleasing others can reinforce undesirable tendencies. For example, autism is already linked to avoidant personality disorder. An emphasis on avoiding making others uncomfortable may also inhibit the development of principled ethical thinking and action. Reframing social thinking to treat it not (or not only) as an end in itself, but as a way to achieve a variety of social and personal goals would go a long way toward addressing the weaknesses of the Social Thinking Curriculum. (shrink)

We suggest that there is confusion between why consciousness developed and what additional functions, through continued evolution, it has co-opted. Consider episodic memory. If we believe that episodic memory evolved solely to accurately represent past events, it seems like a terrible system—prone to forgetting and false memories. However, if we believe that episodic memory developed to flexibly and creatively combine and rearrange memories of prior events in order to plan for the future, then it is quite a good system. We (...) argue that consciousness originally developed as part of the episodic memory system—quite likely the part needed to accomplish that flexible recombining of information. We posit further that consciousness was subsequently co-opted to produce other functions that are not directly relevant to memory per se, such as problem-solving, abstract thinking, and language. We suggest that this theory is compatible with many phenomena, such as the slow speed and the after-the-fact order of consciousness, that cannot be explained well by other theories. We believe that our theory may have profound implications for understanding intentional action and consciousness in general. Moreover, we suggest that episodic memory and its associated memory systems of sensory, working, and semantic memory as a whole ought to be considered together as the conscious memory system in that they, together, give rise to the phenomenon of consciousness. Lastly, we suggest that the cerebral cortex is the part of the brain that makes consciousness possible, and that every cortical region contributes to this conscious memory system. (shrink)

This essay some first steps toward the naturalization of what I call rational intentionality or alternatively type II intentionality. By rational or type II intentionality, I mean that full combination of rational powers and content-bearing states that is paradigmatically enjoyed by mature intact human beings. The problem I set myself is to determine the extent to which the only currently extant approach to the naturalization of the intentional that has the singular virtue of not being a non-starter can be aggregated (...) up into an account of rational intentionality. I have in mind a broadly defined family of accounts whose main members are the indicator/information-theoretic approach of Dretske (1988), the asymmetric dependence theory of Jerry Fodor (1987, 1990, 1994) and the teleo-semantics of Ruth Millikan (1984, 1993). Somewhat inaccurately, I will call this family of approaches the information-theoretic family. To be sure, there is only a rough family resemblance among the members of the information-theoretic family. Indeed, several intense quarrels divide the members of that family one from another, but the precise outcome of those internecine struggles is not directly relevant to the aims of this essay. ² Taken collectively, the information-theoretic family yields a compelling picture of the place of at least a crude form of intentionality -- what I call frog-like or type I intentionality -- in the natural order. Though frog-like or type I intentionality is, I think, a genuine species of intentionality, it may subsist in the absence of rational powers. It is that species of intentionality enjoyed by irritable creatures who, following Brandom (1994). (shrink)

This paper responds to Goodwin Liu's argument in Volume II of this Journal that a pedagogy must be supported by an appropriate theory of knowledge, and that the epistemology which best supports the service-learning pedagogy is anti-foundational pragmatism. The author shows that Liu's characterization of the pragmatist model of knowledge does not avoid the dualism which he sees as a fault of the traditional epistemology. After suggesting a remedy to this, the author then extends Liu's argument by indicating the limits (...) to what the appropriately modified epistemological support will sanction. These limits are shown to be more restrictive than Liu suggests. The result is an improved philosophical justification of the service-learning pedagogy and some suggestions for evaluating proposed curriculum. (shrink)

By appealing to Paul Ricoeur’s view of interpretation as the dialectical process of understanding through explanation, Kenneth A. Reynhout contributes to the growing field of religion and science by developing an alternative understanding of interdisciplinary theology that is fundamentally hermeneutical.

By appealing to Paul Ricoeur’s view of interpretation as the dialectical process of understanding through explanation, Kenneth A. Reynhout contributes to the growing field of religion and science by developing an alternative understanding of interdisciplinary theology that is fundamentally hermeneutical.

Agricultural research raises fundamental ethical and value questions going beyond those in other fields both because of its public funding and because its results have significant impacts on habitats and other species. Questions about the sustainability of modern agriculture, which are shared with other sectors, require us to examine alternative visions and structures. These can be seen to range from status quo preserving ideologies to change-oriented utopias. It is argued that at the national level current ideologies—which include positivistic approaches and (...) belief in the neutrality of technology—mask real structural and policy choices as well as their ethical and value implications. At the international level, the export of fossil-fuel based modes of agriculture to the developing countries raises additional structural, policy, value, and ethical issues. (shrink)

In an earlier Dissecting Bioethics contribution, Debra J. H. Mathews, Joseph J. Fins, and Eric Racine challenge standard ways of thinking about the therapeutic misconception in the context of consent for research participation. They propose that instead of demanding “rational congruence” between how researchers and participants conceive of a given protocol, we should accept a less stringent standard of “reasonable coherence.” While Mathews, Fins, and Racine (MFR) provide some important insights, their proposal needs refinement. There is room for a wide (...) but not unlimited range of participant hopes and motivations. However, their model of reasonable coherence is too weak a standard for whether participants have adequate understanding of the scientific goals of a protocol. By the time participants are recruited for medical research, the goals of the protocol, having been set and agreed to through accepted scientific processes, are no longer open for alternate interpretations. This paper discusses this and other objections to MFR’s proposal. It then suggests that a concept of “deal breakers” might be useful in this context. (shrink)

Philosophers and bioethicists have mostly given up on human dignity. As a concept, dignity has seemed obscure and unintelligible, or forbidden because of its connection with theology. Here I take a fresh look, and identify two families of dignity concepts: dignity as arche and dignity as telos. Arche draws on the idea of an origin or source, as in ‘archetype’ or ‘archeology.’ Dignity as arche refers to the qualities inherent in a being that is the source (the arche) of our (...) duties to that being. Dignity as telos is the endpoint (telos) that we try to promote in our patients and in ourselves. I illustrate these ideas using examples from Frances Hodgson Burnett’s book for young readers, A Little Princess. Identifying these two families of dignity concepts helps to identify the dignity-related tasks for psychotherapists. These are to help patients recognise, connect with, and respect their own dignity as arche, and to help them realise their own dignity as telos. Revisiting Maslow’s hierarchy of needs helps us to see how these tasks also apply to the broader goals of healthcare. (shrink)

The Sustainable Development Goals have attracted both defenders and critics. Composed of seventeen goals and 169 targets, the overly broad scope of the SDGs raises the question of whether there are priorities that need to be set within them. This essay considers the SDGs from the perspective of a “basic goods approach” to development policy, which takes a needs-based and basic-subsistence-rights view on policy priorities. It focuses on a subset of SDGs that directly address the provision of nutritious food, clean (...) water, sanitation, health services, education services, and human security services. In doing so, it proposes a set of seven “basic development goals” and ten associated targets. It argues that this more focused approach can better protect basic rights, more effectively contribute to progress on human wellbeing, and make accountability more likely. (shrink)

This chapter addresses ethical issues for informed consent when recruiting autistic participants for research. The process of informed consent for participation in research involves some abilities, such as dialogue and understanding the intentions of the researchers, that can be especially challenging when autistic individuals are being asked to participate. This chapter reviews these abilities, and suggests ways to provide meaningful support to promote autonomy and help researchers meet their responsibilities. Beyond these more general challenges, it explores Hans Jonas’s suggestion that (...) true informed consent for research requires that participants identify with the goals of the researchers. Given the plurality of perspectives on how to respond to autism, Jonas’s ideas point to additional ethical concerns that can arise when autistic people are recruited for research on autism. (shrink)

This paper examines two questions. The first is what it would mean for schools to be communities. This question is pursued by examining four metaphors for community: families, congregations, guilds, and democratic polities. Three models of school communities are then sketched. The second question is whether schools that are communities are inherently illiberal. The paper distinguishes between a liberal interpretation of schools as communities, where schools are viewed as limited-purpose free associations, and a communitarian interpretation where community and polity are (...) not adequately distinguished. I argue that, within a framework of liberal pluralism, schools can be communities without being illiberal. (shrink)