Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method of (...) ethical reasoning, namely ethical analysis informed by pertinent prior work, followed by identifying the implications of clearly articulated ethical concepts, to meet these goals. The professional virtue of civility and the related concept of professional etiquette was first described by the English physician-ethicist Thomas Percival (1740–1804). Based on a historically informed philosophical account, we propose that the professional virtue of civility has cognitive, affective, behavioural and social components based on a commitment to excellence in scientific and clinical reasoning. Its practice prevents a dysfunctional organisational culture of incivility and sustains a civility-based organisational culture of professionalism. Medical educators and academic leaders are in a pivotal and powerful position to role model, promote and inculcate the professional virtue of civility as essential to an organisational culture of professionalism. Academic leaders should hold medical educators accountable for discharge of this indispensable professional responsibility. (shrink)

Bioethics has a founding story in which medical paternalism, the interference with the autonomy of patients for their own clinical benefit, was an accepted ethical norm in the history of Western medical ethics and was widespread in clinical practice until bioethics changed the ethical norms and practice of medicine. In this paper I show that the founding story of bioethics misreads major texts in the history of Western medical ethics. I also show that a major source for empirical claims about (...) the widespread practice of medical paternalism has been misread. I then show that that bioethics based on its founding story deprofessionalizes medical ethics. The result leaves the sick exposed to the predatory power of medical practitioners and healthcare organizations with only their autonomy-based rights to non-interference, expressed in contracts, to protect them. The sick are stripped of the protection afforded by a professional, fiduciary relationship of physicians to their patients. Bioethics based on its founding story reverts to the older model of a contractual relationship between the sick and medical practitioners not worthy of intellectual or moral trust (because such trust cannot be generated by what I call ‘deprofessionalizing bioethics’). On closer examination, bioethics based on its founding story, ironically, eliminates paternalism as a moral category in bioethics, thus causing bioethics to collapse on itself because it denies one of the necessary conditions for medical paternalism. Bioethics based on its founding story should be abandoned. (shrink)

In his Disrupted Dialogue: Medical Ethics and the Collapse of Physician-Humanist Communication Robert Veatch presents a scholarly tour de force of eighteenth- and nineteenth-century Anglophone medical ethics to demonstrate how the easy communication between physicians and humanists in the Scottish Enlightenment progressively dissipated as medicine became detached from humanistic disciplines. In this paper I offer two comments—that the discourse of medical ethics in the Scottish Enlightenment was a discourse of Baconian moral science and that nineteenth-century medical ethics in the United (...) States became detached from that discourse. The result was that a principal resource for physicians at the birth of bioethics, the American Medical Association’s Principles of Medicine Ethics of 1957, did not equip physicians with the conceptual tools they needed to formulate and address the ethical challenges that became the agenda of bioethics. The paper opens with a brief portrait of Robert Veatch, the author’s connections to him, and his little-known role as an impresario of the classical music of the Blue Ridge and Appalachia. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of ‘unborn patient’ has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of ‘unborn child.’ There is a long history of the descriptive use of ‘unborn child.’ Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of ‘unborn child’ should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

Some problems that arise in the account given by Thomasma and Pellegrino [6] of the foundations of medical ethics in a philosophy of medicine are addressed, in particular questions of a conceptual character about treating therelatum of medicine as health. Which concept of health is appropriate and which will bear the burden of the position thomasma and Pellegrino advance? It is argued that the proper relationship of medicine is one between a healer and developing embodied minds. As a consequence, the (...) project of providing a univocal account of the nature of medicine fails. Instead, pluralism infects philosophy and medicine, resulting in different philosophies of medicine. From these philosophies of medicine will follow not a single medical ethics but a variety. (shrink)

Nancy Jecker (2013) mounts a sustained and formidable critique of Norman Daniels's prudential lifespan account (PLA) as a reliable basis for justice between age groups in the responsible allocation...

This is the first textbook of surgical ethics. It is a practical, clinically comprehenive, well-organized guide to ethical issues in surgical practice, research, and education written by leading figures in surgery and bioethics. The authors cover the surgeon-patient relationship, the full range of surgical patients, surgical education and research, and surgery and managed care. Their chapters are not abstract discussions of ethical principles; rather, they connect directly with the everyday concerns of practicing surgeons.

The daily work of the clinical ethics teacher and clinical ethics consultant falls into the routine of classifying clinical cases by ethical type and proposing ethically justified alternatives for the professionally responsible management of a specific type of case. Settling too far into this routine creates the risk of philosophical inertia, which is not good either for the clinical ethicist or for the field of clinical ethics. The antidote to this philosophical inertia and resultant blinkered vision of clinical ethics is (...) sustained, willing exposure to philosophical provocation. The papers in this clinical ethics issue of the Journal of Medicine and Philosophy provide just such philosophical provocation related to core topics in clinical ethics: the distinction between clinical practice and clinical research; telemedicine, or medicine at a distance; illness narratives; the concept of the placebo effect; and sex reassignment. (shrink)

In our ‘The Professional Virtue of Civility and the Responsibilities of Medical Educators and Academic Leaders’,1 we provided an historically based conceptual account of the professional virtue of civility and the role of leaders of academic health centres in creating and sustaining an organisational culture of professionalism that promotes civility among healthcare professionals and between medical educators and learners. We emphasised that any adequate understanding of the virtues, including professional virtues, has cognitive, affective, behavioural and social components. Some of the (...) commentators expand on these components in important ways. Xuhao et al emphasises the importance of role models, especially in the hierarchical context of medical education.2 The hierarchy of faculty in the senior position and junior doctors and other learners below them has characterised medical education for centuries. Xuhao et al rightly call for academic leaders to shape this hierarchy in a morally responsible way, by becoming ‘exemplary role models’.2 Berry, a clinician manager, in critiquing our account, calls for an increased appreciation for the psychological and environmental factors that might explain why uncivil behaviour occurs.3 …. (shrink)

L’objet de cette contribution est de montrer comment le recours « aveugle » aux caractères et au formalisme transforme, pour Leibniz, l’exercice de l’attention. Plus précisément, il s’agira de montrer en s’appuyant sur divers opuscules que le formalisme permet à la fois d’épargner l’attention, de la concentrer, de l’élargir, de la séquencer et de la transformer en un exercice collectif.

Leibniz’s conception of the relativity of motion has been discussed at length for a very long time. This paper doesn’t aim to give a full solution to this question, but to contribute to the debate by clarifying how the principle of relativity is introduced, justified and used in the “Dynamica”. Four different principles are identified : one purely geometrical, and three (meta) physical principles, which express God’s wisdom : a principle of equivalence of hypotheses linked to the action/reaction principle, a (...) Galilean principle of relativity and a general principle which apply not only to rectilinear motions but also to circular ones. I argue that to appreciate the coherence of Leibniz’ approach, we should distinguish these principles more sharply than he himself did and pay more attention to their status : are they consequences of the definition of motion, consequences of the physical laws or necessary conditions for any physical theory? (shrink)

Cette étude s’annonce dans le prélude (p. 9-17) comme une réflexion délibérément affranchie des critères historiques et des écoles doctrinales pour dégager d’une « constellation » d’images choisies les lignes-forces de la notion complexe (« contradictoire », préfère l’auteur) de ravissement, qui épouse à la fois les termes de la dépossession et de la possession, de l’extériorité et de l’intériorité, de l’actif et du passif, de l’absence et de la présence, de la perte de soi et de sa conquête....

_From the Eye of the Storm: Regional Conflicts and the Philosophy of Peace_ presents to the reader a cross section of an emerging field of study: the philosophy of peace. The editors bring together articles that explore the philosophic implications of many recent regional conflicts. Reflecting the diversity and vitality and any new field of study, this volume contains five sections: Conceptual Foundations; America's Homefront; Desert Storm Assessments; _Jihad, Intifada_, and Other Mideast Concerns; and Latin American Issues. The topics of (...) the articles include war, militarism, patriotism, nationalism, nonviolence, conscientious objection, feminist peace, the media, the ethics of the Gulf War, the Israeli-Palestinian conflict, Islamic pacifism, and Latin American resistance. A concluding postscript assesses prospects for achieving peace and change within our fast changing international scene. This volume has an extensive bibliography of writings concerning peace and conflict and is suited to professional and student audiences. (shrink)

Emmanuel Levinas’s philosophy demonstrates that intelligence is ultimately at the behest of responsibility. He is one of a number of philosophers who made the paradigm shift from an individualized notion of self to a social conception of self. He used the language of his teachers, Husserl and Heidegger, to move beyond their philosophies to a fundamental paradigm shift, in which ethics is prior to epistemology.

Bioethics as a field began some years before it was finally named in the early 1970s. In many ways, bioethics originated in response to urgent matters of the moment, including the controversy over disconnecting Karen Quinlan's respirator, the egregious paternalism of Donald Cowart's doctors in the famous “Dax” case, the abuse of research subjects in the notorious Tuskegee Syphilis Study, and the need to devise an intellectual framework for the development of federal regulations to protect human subjects of research. The (...) phrase “new and unprecedented” became a common description of the topics and issues to which people who later came to be called “bioethicists” responded. It should come as no surprise that bioethics and its practitioners soon came to the self-understanding that their work was new and unprecedented, much as the innovations of biomedical science and their clinical applications were thought to be. (shrink)

Bioethics as a field began some years before it was finally named in the early 1970s. In many ways, bioethics originated in response to urgent matters of the moment, including the controversy over disconnecting Karen Quinlan's respirator, the egregious paternalism of Donald Cowart's doctors in the famous “Dax” case, the abuse of research subjects in the notorious Tuskegee Syphilis Study, and the need to devise an intellectual framework for the development of federal regulations to protect human subjects of research. The (...) phrase “new and unprecedented” became a common description of the topics and issues to which people who later came to be called “bioethicists” responded. It should come as no surprise that bioethics and its practitioners soon came to the self-understanding that their work was new and unprecedented, much as the innovations of biomedical science and their clinical applications were thought to be. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Innovative Interaction Between Medicine and the HumanitiesLaurence B. McCullough and Warren Thomas ReichThe past three decades have witnessed the emergence and remarkable success of the fields of bioethics and medical humanities. The intellectual landscape of medicine and that of the humanities have been remarkably altered in the process. Twenty-five to 30 years ago in the United States there existed but a few courses in what came (...) to be called “bioethics” in departments of philosophy, religious studies, and theology in colleges and universities, a handful of programs of teaching in medical schools such as the University of Texas Medical Branch at Galveston and Pennsylvania State University School of Medicine at Hershey, and but one independent research center (the Hastings Center) and one university-based research center (the Kennedy Institute of Ethics at Georgetown University). Articles on bioethics began to appear in the peer-reviewed medical, nursing, and humanities literature and some books were published. There was only one journal in bioethics, The Hastings Center Report (which consolidated two previously separate journals from the Hastings Center). Graduate programs in bioethics and medical humanities in colleges and universities and fellowship training in bioethics and medical humanities in medical schools did not exist. Very little existed in colleges, universities, and medical schools in other countries. Now, of course, everything is different.Teachers, scholars, and students of bioethics and medical humanities should not take these remarkable changes for granted, for they represent a sustained and innovative interaction between medicine and the humanities. We have chosen the metaphor of “laying medicine open” to characterize the history of bioethics and medical humanities of the past three decades. This surgical metaphor was used in eighteenth-century Britain by a number of writers who wanted to make medical science and practice more accessible to the sick and to the lay public more generally (Lawrence 1975). We use the metaphor to characterize the efforts of teachers and [End Page 1] scholars over the past three decades and more to make the value-laden dimensions of biomedical science and practice and of health care policy more accessible to patients and to the lay public more generally. The result of this laying open of medicine has gone a long way toward bringing closer together the two cultures of science and the humanities that had, as C. P. Snow famously described, become significantly isolated from each otherAlbert Jonsen (1998) has recently contributed the first book-length history of what he calls the “birth” of bioethics, adding to the work of other scholars such as Warren Reich (1994; 1995) and Robert Baker (1993) and, before them, Corrado Viafora (1990) and David Rothman (1991). The articles in this issue of the Kennedy Institute of Ethics Journal make additional contributions to the developing understanding of the history of the past thirty years of interaction between medicine and the humanities.Laurence McCullough provides an historical context for the three accounts of the recent laying open of medicine that follow. McCullough examines two times in the history of medicine when it has been laid open to accountability (in addition to its being laid open to and by bioethics and medical humanities). The first laying open occurred in the work of the eighteenth-century Scottish physician and philosopher John Gregory, who set out to create a profession of medicine in a true moral sense of a fiduciary profession by making medicine accountable for its scientific and moral quality. The second occurred in the late twentieth century in which the managed practice of medicine in general, and managed care in particular, have begun to lay medicine open to accountability for its scientific and moral quality, as well as its cost and, at least in the public sector, its accessibility. McCullough argues that, just as Gregory responded to the ethical challenges of medicine laid open more than two centuries ago, bioethics should respond to the ethical challenges in the current laying open of medicine.Warren Reich provides an account of André Hellegers, whose premature death left an enormous gap in the field that will never be filled. Reich claims that Hellegers was engaged substantially in much more than the laying open of medicine: he... (shrink)

The gathering of power unto themselves by physicians, a process supported by evidence-based practice, clinical guidelines, licensure, organizational culture, and other social factors, makes the ethics of power—the legitimation of physicians’ power—a core concept of clinical ethics. In the absence of legitimation, the physician’s power over patients becomes problematic, even predatory. As has occurred in previous issues of the Journal, the papers in the 2016 clinical ethics issue bear on the professionally responsible deployment of power by physicians. This introduction explores (...) themes of physicians’ power in papers from an international group of authors who address autonomy and trust, the virtues of perinatal hospice, conjoined twins in ethics and law, addiction and autonomy in clinical research on addicting substances, euthanasia of patients with dementia in Belgium, and a pragmatic approach to clinical futility. (shrink)

The five papers in the 2008 “Clinical Ethics” number of the journal address the conceptual and empirical foundations of clinical ethics. Three articles take up the concept of professionalism in medicine, exploring its possibilities and implications. The fourth article provides a distinctive, phenomenological account of the “placebo effect,” a vexing topic of surprising durability in the clinical setting. The final article, a systematic review of the qualitative literature on bedside rationing of resources, creates an empirical foundation for philosophical analysis and (...) argument of a distinctive kind. (shrink)

An orthodoxy has arisen which claims that there is a crisis in the United States health care system such that the system needs to be reformed. This essay challenges that orthodoxy by showing that we do not have a health care system in the United States. We have a non-system of health care, just as we do for virtually all basic social institutions. Challenging the current orthodoxy surfaces two ethical issues that have been ignored: creating a health care system will (...) (a) cause resurgent paternalism and (b) pose a threat to moral pluralism. Keywords: Health care policy, managed care, paternalism, moral pluralism, institutional integrity, total quality management, continuous quality improvement CiteULike Connotea Del.icio.us What's this? (shrink)

Cet ouvrage collectif est le fruit d'un colloque sur les philosophies du plaisir qui a réuni philologues et philosophes, spécialistes de l'Antiquité et de la Renaissance, en juin 2004, à l'Université de Lille 3.

This article argues that there is a discrepancy between Jürgen Habermas's initial plea for critical and rational identities and his more recent glorification of the European model. Initially, Constitutional Patriotism could be apprehended as a critical standard for existing political practices. However, Habermas's recent political texts tend to lose all kind of reflexive distance in their apprehension of the European identity — which is presented as distinct and even superior to its counter-model, the US. Such a `Europatriotic' temptation should be (...) resisted. The `thick' European identity advocated by Habermas has no truly federative dimension and could undermine the unique normative potential of a political entity composed of distinct identities. Consequently, the article suggests an elucidation of liberal postnationalism with a view to explaining its refusal to tie Europe's legitimacy to an identification logic. (shrink)

The relationship between empathy, understood here as a cognitive act of imaginative transposition, and reasons, has been discussed extensively by Stueber :156–180, 2011; Emot Rev 4:55–63, 2012; in: Maibom The Routledge handbook of philosophy of empathy, Routledge, New York, pp 137–147, 2017). Stueber situates his account of empathy as the reenactment of another person’s perspective within a framework of folk psychology as guided by a principle of rational agency. We argue that this view, which we call agential empathy, is not (...) satisfying for two main reasons that we will examine consecutively. First, agential empathy cannot satisfactorily account for the case of emotional actions, which requires to take into account the phenomenal dimension of the mental states they stem from. We argue that Stueber overlooks this aspect, which is not reducible to understanding the reasons behind an agent’s behavior. We introduce the notions of experiential empathy and phenomenal insight to account for the imagined representation of the subjectively felt dimension of the target’s experience. Second, in virtue of his restrictive view of empathy, Stueber partly misconstrues this process: action explanation is not all there is to say about empathy. We argue that we have to go beyond the scope of agential empathy to do justice to the epistemic richness of empathy. Experiential empathy can in principle be available independently from reasons explanations: the main epistemic achievement of empathy can be indeed a matter of phenomenal insight only. (shrink)

The relationship between empathy, understood here as a cognitive act of imaginative transposition, and reasons, has been discussed extensively by Stueber :156–180, 2011; Emot Rev 4:55–63, 2012; in: Maibom The Routledge handbook of philosophy of empathy, Routledge, New York, pp 137–147, 2017). Stueber situates his account of empathy as the reenactment of another person’s perspective within a framework of folk psychology as guided by a principle of rational agency. We argue that this view, which we call agential empathy, is not (...) satisfying for two main reasons that we will examine consecutively. First, agential empathy cannot satisfactorily account for the case of emotional actions, which requires to take into account the phenomenal dimension of the mental states they stem from. We argue that Stueber overlooks this aspect, which is not reducible to understanding the reasons behind an agent’s behavior. We introduce the notions of experiential empathy and phenomenal insight to account for the imagined representation of the subjectively felt dimension of the target’s experience. Second, in virtue of his restrictive view of empathy, Stueber partly misconstrues this process: action explanation is not all there is to say about empathy. We argue that we have to go beyond the scope of agential empathy to do justice to the epistemic richness of empathy. Experiential empathy can in principle be available independently from reasons explanations: the main epistemic achievement of empathy can be indeed a matter of phenomenal insight only. (shrink)

1 Knowledge and Justification This book is an investigation of one central problem which arises in the attempt to give a philosophical account of empirical ...

The relationship between empathy, understood here as a cognitive act of imaginative transposition, and reasons, has been discussed extensively by Stueber :156–180, 2011; Emot Rev 4:55–63, 2012; in: Maibom The Routledge handbook of philosophy of empathy, Routledge, New York, pp 137–147, 2017). Stueber situates his account of empathy as the reenactment of another person’s perspective within a framework of folk psychology as guided by a principle of rational agency. We argue that this view, which we call agential empathy, is not (...) satisfying for two main reasons that we will examine consecutively. First, agential empathy cannot satisfactorily account for the case of emotional actions, which requires to take into account the phenomenal dimension of the mental states they stem from. We argue that Stueber overlooks this aspect, which is not reducible to understanding the reasons behind an agent’s behavior. We introduce the notions of experiential empathy and phenomenal insight to account for the imagined representation of the subjectively felt dimension of the target’s experience. Second, in virtue of his restrictive view of empathy, Stueber partly misconstrues this process: action explanation is not all there is to say about empathy. We argue that we have to go beyond the scope of agential empathy to do justice to the epistemic richness of empathy. Experiential empathy can in principle be available independently from reasons explanations: the main epistemic achievement of empathy can be indeed a matter of phenomenal insight only. (shrink)

The relationship between empathy, understood here as a cognitive act of imaginative transposition, and reasons, has been discussed extensively by Stueber :156–180, 2011; Emot Rev 4:55–63, 2012; in: Maibom The Routledge handbook of philosophy of empathy, Routledge, New York, pp 137–147, 2017). Stueber situates his account of empathy as the reenactment of another person’s perspective within a framework of folk psychology as guided by a principle of rational agency. We argue that this view, which we call agential empathy, is not (...) satisfying for two main reasons that we will examine consecutively. First, agential empathy cannot satisfactorily account for the case of emotional actions, which requires to take into account the phenomenal dimension of the mental states they stem from. We argue that Stueber overlooks this aspect, which is not reducible to understanding the reasons behind an agent’s behavior. We introduce the notions of experiential empathy and phenomenal insight to account for the imagined representation of the subjectively felt dimension of the target’s experience. Second, in virtue of his restrictive view of empathy, Stueber partly misconstrues this process: action explanation is not all there is to say about empathy. We argue that we have to go beyond the scope of agential empathy to do justice to the epistemic richness of empathy. Experiential empathy can in principle be available independently from reasons explanations: the main epistemic achievement of empathy can be indeed a matter of phenomenal insight only. (shrink)