Advance care planning allows patients to articulate preferences for their medical treatment, lifestyle, and surrogate decision-makers in order to anticipate and mitigate their potential loss of decision-making capacity. Written advance directives are often emphasized in this regard. While these directives contain important information, there are several barriers to consider: veracity and accuracy of surrogate decision-makers in making choices consistent with the substituted judgement standard, state-to-state variability in regulations, literacy issues, lack of access to legal resources, lack of understanding of medical (...) options, and cultural disparities. Given these issues, it is vital to increase the use of patient and healthcare provider conversations as an advance care planning tool and to increase integration of such discourse into advance care planning policy as adjuncts and complements to written advance directives. This paper reviews current legislation about written advance directives and dissects how documentation of spoken interactions might be integrated and considered. We discuss specific institutional policy changes required to facilitate implementation. Finally, we explore the ethical issues surrounding the increased usage and recognition of clinician–patient conversations in advance care planning. (shrink)

Part I. Philosophy of novels. 1. Introduction: philosophical content and literary value -- 2. Interpreting novels -- 3. The sun also rises: incompatible interpretations -- 4. The appeal of the mystery -- Part II. Philosophy in novels. 5. Moral development in Pride and prejudice -- 6. Huckleberry Finn and moral motivation -- 7. What we learn about rules from The cider house rules -- 8. Nostromo and the fragility of the self.

Genuine rules cannot capture our intuitive moral judgments because, if usable, they mention only a limited number of factors as relevant to decisions. But morally relevant factors are both numerous and unpredictable in the ways they interact to change priorities among them. Particularists have pointed this out, but their account of moral judgment is also inadequate, leaving no room for genuine reasoning or argument. Reasons must be general even if not universal. Particularists can insist that our judgments be reflective, unbiased, (...) informed, and sensitive, requiring a background of experiences that expand sympathy and empathy for others. But beyond this, our judgments must be coherent. This requirement provides a way to reason to the correct answer to a controversial issue—the answer most coherent with or body of settled judgments. Rawls' account of coherence in terms of reflective equilibrium, where we adjust particular judgments to match rules and adjust rules to match judgments, is rejected since rules have no independent force. Instead, the central requirement is that we not judge cases differently without being able to cite a morally relevant difference between them. Such differences must make a difference else-where as well, although they need not do so universally. Factors cannot be relevant in only one context because they reflect values that must recur to be maintained. The method of moral reasoning based on this requirement is specified as follows: first, the specification of competing values or interests in the problematic case; second, the location of paradigm cases in which these competing values are prioritized, making sure that these settled judgments are reflective, informed, and sensitive; third, the search for relevant differences between the settled and problematic cases or the location of alternative, more closely analogous paradigms. The paper ends with an illustration of the method applied to the issue of doctor assisted suicide. (shrink)

Alan H. Goldman argues for the internalist or subjectivist view of practical reasons on the grounds that it is simpler, more unified, and more comprehensible ...

In this concise survey, intended for advanced undergraduate students of aesthetics, Alan Goldman focuses on the question of aesthetic value, using many practical examples from painting, music, and literature to make his case. Although he treats a wide variety of views, he argues for a nonrealist view of aesthetic value, showing that the personal element can never be factored out of evaluative aesthetic judgments and explaining why this is so.

Life's Values offers new analyses of the nature of pleasure, happiness, well-being, and meaning in life. Recognizing how individuals have different priorities, Goldman explains what is of ultimate value in our lives and argues that making our desires rational - relevantly informed of what it's like to satisfy them - maximizes well-being.

This books examines the fundamental values and principles of conduct in the professions, focusing specifically on four areas: law, politics, medicine and business. One central question unifies its inquiry into the different professions: should the principles for judging the actions of professionals be the same as those used to judge private individuals, or do these professions require special moral principles to guide their conduct. The author considers arguments deriving from the underlying institutional goals of each profession in turn.

This remarkably clear and comprehensive account of empirical knowledge will be valuable to all students of epistemology and philosophy. The author begins from an explanationist analysis of knowing—a belief counts as knowledge if, and only if, its truth enters into the best explanation for its being held. Defending common sense and scientific realism within the explanationist framework, Alan Goldman provides a new foundational approach to justification. The view that emerges is broadly empiricist, counteracting the recently dominant trend that rejects (...) that framework entirely. Topics treated include the Gettier problem, the nature of explanation and inductive inference, the justification of foundations for knowledge in terms of inference to the best explanation, the possibility of realist interpretations of contemporary science, reference, and the relations between empirical psychology and epistemology. Professor Goldman defends the need for a foundational theory of justification and presents a version that refutes standard criticisms of that doctrine. His defense of realism takes into account contemporary advances in semantics and philosophy of science. It attempts to clarify the kinds of skeptical argument the philosopher must take seriously, without succumbing to them. While recent epistemology has tended to dismiss the traditional foundational approach, it has not provided a suitable alternative. Goldman breaks new ground by adapting that approach within his explanationist, inductive theory. (shrink)

To say that an object is beautiful or ugly is seemingly to refer to a property of the object. But it is also to express a positive or negative response to it, a set of aesthetic values, and to suggest that others ought to respond in the same way. Such judg- ments are descriptive, expressive, and normative or prescriptive at once. These multiple features are captured well by Humean accounts that analyze the judgments as ascribing relational properties. To say that (...) an object is beautiful is to say, in part, that it is such as to elicit a response expressing pleasure in certain observers. The observers in question must not be ignorant, biased, insensitive, or of poor taste, and they must not base their evaluations on aesthetically irrelevant properties of the objects they judge. The reference to the object's "being such . . ." captures the objective side of the relation; refer- ence to the pleasurable response captures the expressive function of these judgments; and the ideal properties of the observers suggest that others ought to judge in the same way. (shrink)

Originally published in 1988, this book discusses if moral knowledge exists, and if so, if it is similar to other forms of knowledge. This book approaches the issues from both historical and contemporary perspectives and in order to determine whether there is a real property of rightness, looks to the ethical theories of Hobbes, Hume and Kant. This historical analysis leads to a systematic comparison of three theories of the nature of ethics: realism, emotivism and coherentism. The nature of coherence (...) is explained using legal reasoning as a model. Moral reasoning is compared and contrasted with reasoning both in science and law, showing how ethics differs from science and empirical disciplines. (shrink)

Peter Kivy and Noël Carroll advocate a narrow view of aesthetic experience according to which it consists mainly in attention to formal properties. Excluded are cognitive and moral properties. I defend the broader view that includes the latter properties. I argue first that cognition and moral assessment can be inseparable in experience from grasp of form and expressiveness. Second, Kivy and Carroll must extend the notion of form itself beyond ordinary usage to accommodate acknowledged aesthetic experience. Third, the broad view (...) has a more impressive historical lineage than the narrow view. Fourth, aesthetic experience is appreciation of aesthetic value, and the latter is more plausibly analyzed in a broad way. (shrink)

Book reviewed in this article: The Moral Foundations of Professional Ethics. By Alan H. Goldman.

This paper defends strong internalism about reasons, the view that reasons must relate to pre-existing motivational states, from several kinds of counterexamples, supposed desire independent reasons, that have been proposed. A central distinction drawn is that between there being a reason and an agent's having a reason. For an agent to have an F reason, she must be F-minded. Reasons, as what motivate us, are states of affairs and not themselves desires or motivational states, but they must connect to existing (...) motivational states. It has been claimed that rationality itself requires us to recognize certain reasons independent of our desires, that we acquire new desires by learning what is valuable, by acquiring desire-independent reasons to pursue certain values. It is claimed also that prudential and moral reasons are desire independent. By offering an account of rationality as coherence, by appealing to broader concerns as opposed to specific desires, and by appealing to the distinction noted above, the paper exposes weaknesses in recent arguments for desire independent reasons by Millgram, Smith, Korsgaard, and Searle. the reasons they propose can be interpreted as internal (not desire independent) or dismissed as nonexistent. (shrink)

Robert Nozick argued that we would not plug into his machine that could give us any experiences we chose. More recently Richard Kraut has argued that it would be prudentially rational to plug into the machine, since only experiences count for personal welfare. I argue that both are wrong, that either choice can be rational or not, depending on the central desires of the subjects choosing. This claim is supported by the empirical evidence, which shows an almost even split between (...) those who would enter and those who would not. If we interpret those on both sides as making rational choices to maximize their personal well-being, and if such rational choice tends to enhance well-being, then the experience machine thought experiment supports neither experientialism nor its denial, but instead a rational desire satisfaction account of personal well-being. Unlike objective list and perfectionist accounts, the desire satisfaction account of well-being easily accommodates rational choices on both sides, depending on the motivational sets of the choosers. (shrink)

This paper criticizes the account of desire defended by Nomy Arpaly and Timothy Schroeder in their recent book, In Praise of Desire. It contrasts their account with one that I favor, a cluster analysis listing various criteria that are together sufficient for having paradigm desires, but none of which is necessary or sufficient for desiring. I argue that their account fails to state necessary or sufficient conditions, that it is explanatorily weaker than the cluster account, that it fails to provide (...) a neat reduction of desires to neurophysical terms, and that in any case such a reduction is not required for the preservation of the concept of desire in mature psychology. Implications are drawn for the broader debate between reductionists, eliminativists, and defenders of folk psychological concepts. (shrink)

Criteria for a successful theory of punishment include first, that it specify a reasonable limit to punishments in particular cases, and second, that it allow benefits to outweigh costs in a penal institution.It is argued that traditional utilitarian and retributive theories fail to satisfy both criteria, and that they cannot be coherently combined so as to do so. Retributivism specifies a reasonable limit in its demand that punishment equal crime, but this limit fails to allow benefits to outweigh costs of (...) punishing. Utilitarians demand the latter but cannot guarantee the former. Combinations continue to violate one requirement or the other. (shrink)