: Dr. Smith is an internist in private practice who works at an inner city clinic affiliated with a university hospital. He is also a member of the university faculty. Many of Dr. Smith’s patients have type 2 diabetes mellitus and struggle with health care and other costs. Thinking about opportunities to better serve his patients and advance his career, Dr. Smith considers conducting clinical research in his office. ACME is a respected pharmaceutical company that for decades has engaged in (...) research, development, and production of widely used drugs. Several of ACME’s oral agents for type 2 diabetes will soon go off patent. In an effort to retain its market share in this class of drugs, ACME wants to complete clinical trials expeditiously and obtain approval for its new oral hypoglycemic medicine. The company approaches Dr. Smith to be a coinvestigator in its multicenter clinical trial. (shrink)

The fifth edition of the Ethics Manual examines emerging issues in medical ethics faced by internists and their patients and revisits older issues that are ...

The AMA Council on Ethical and Judicial Affairs (CEJA) has initiated an important discussion on medical professionalism and the use of social media by issuing thoughtful and practical guidance for physicians and medical students. The implications of online activities for trust in the profession, as well as for trust between patient and doctor, however, will need further exploration as digital life expands and evolves.

The concept of minimal risk has been used to regulate and limit participation by adolescents in clinical trials. It can be understood as setting an absolute standard of what risks are considered minimal or it can be interpreted as relative to the actual risks faced by members of the host community for the trial. While commentators have almost universally opposed a relative interpretation of the environmental risks faced by potential adolescent trial participants, we argue that the ethical concerns against the (...) relative standard may not be as convincing as these commentators believe. Our aim is to present the case for a relative standard of environmental risk in order to open a debate on this subject. We conclude by discussing how a relative standard of environmental risk could be defended in the specific case of an HIV vaccine trial among adolescents in South Africa. (shrink)

Purpose: Physicians are often reluctant to discuss “Do Not Resuscitate” orders with patients. Although perceived self-efficacy is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions.Subjects and methods: A survey of 217 internal medicine attendings and 132 housestaff at two teaching hospitals about their attitudes and confidence regarding DNR discussions.Results: Participants were significantly less confident about their ability to discuss DNR orders than to discuss consent for medical procedures , and this was (...) true for both attendings and housestaff . In a multivariate logistic model of confidence regarding DNR discussions, women were less confident than men ; house officers were less confident than attendings , those who were less confident of their ability to discuss medical procedures were less confident discussing DNR , and those who found talking to patients about DNR orders very difficult reported less confidence than those who did not .Conclusion: We conclude that physicians’ confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics. (shrink)

Basic concepts -- Identifying arguments -- Logic and language -- Informal fallacies -- Categorical logic: statements -- Categorical logic: syllogisms -- Statement logic: truth tables -- Statement logic: proofs -- Predicate logic -- Induction -- Probability.

Contemporary accounts of the concept of exploitation can be grouped into camps that tie the wrongness of taking advantage of another person to: (1) the unfair division of benefits resulting from an interaction; (2) excessive benefits resulting from structural injustice; and (3) a failure of respect for others’ humanity. In practice, accounts of exploitation that focus on the fairness of benefits resulting from individual transactions and, to a lesser degree, unjust social and economic institutions have dominated the applied ethics literature (...) using the concept of exploitation. However, fairness-based accounts of exploitation have a difficult time explaining a common dimension of purportedly exploitative cases in the press and academic literature—namely the absolute deprivation of and/or experience of injustice by victims of exploitation. In this paper, I argue that a respect-based account can explain how exploitation arises both from individual interactions and against a backdrop of injustice. Specifically, our connections with one another and social and economic institutions specify the duty of beneficence and political responsibility to promote just institutions. Exploitation takes place when people fail to act on these specified obligations in favor of their own benefit. (shrink)

The ethical treatment of cancer patientsparticipating in clinical trials requiresthat patients are well-informed about thepotential benefits and risks associated withparticipation. When patients enrolled in phaseI clinical trials report that their chance ofbenefit is very high, this is often taken as evidence of a failure of the informed consent process. We argue, however, that some simple themes from the philosophy of language may make such a conclusion less certain. First, the patient may receive conflicting statements from multiple speakers about the expected (...) outcome of the trial. Patients may be reporting the message they like best. Second, there is a potential problem of multivocality. Expressions of uncertainty of the frequency type can be confused with expressionsof uncertainty of the belief type. Patients may be informed using frequency-type statements and respond using belief-type statements. Third, each speech episode involving the investigator and the patient regarding outcomes may subservemultiple speech acts, some of which may beindirect. For example, a patient reporting ahigh expected benefit may be reporting a beliefabout the future, reassuring family members,and/or attempting to improve his or her outcome by apublic assertion of optimism. These sources oflinguistic confusion should be considered injudging whether the patient's reported expectation isgrounds for a bioethical concern that there hasbeen a failure in the informed consent process. (shrink)

The dead donor rule (DDR) originally stated that organ donors must not be killed by and for organ donation. Scholars later added the requirement that vital organs should not be procured before death. Some now argue that the DDR is breached in donation after circulatory determination of death (DCDD) programs. DCDD programs do not breach the original version of the DDR because vital organs are procured only after circulation has ceased permanently as a consequence of withdrawal of life-sustaining therapy. We (...) hold that the original rendition of the DDR banning killing by and for organ donation is the fundamental norm that should be maintained in transplantation ethics. We propose separating the DDR from two other fundamental normative rules: the duties to prevent harm and to obtain informed consent. (shrink)

On doxastic theories of propositional faith,necessarily,S has faith that p only if S believes that p. On nondoxastic theories of propositional faith, it’s false that,necessarily,S has faith that p only if S believes that p. In this article, I defend three arguments for nondoxastic theories of faith and I respond to published criticisms of them.

The idea that ethics can be derived from a common morality, while controversial, has become very influential in biomedical ethics. Although the concept is employed by several theories, it has most prominently been given a central role in principlism, an ethical theory endorsed by Tom Beauchamp and James Childress in Principles of Biomedical Ethics (2009).1 This text has become a cornerstone of medical ethics education, an achievement that has been commended by critics and supporters alike. It articulates a system of (...) ethical decision making that is firmly rooted in claims about the common morality. Beauchamp and Childress’s theory of common morality has been both defended and criticized in the bioethics .. (shrink)

During the mid 1980s, the renowned American documentary filmmaker Fred Wiseman produced a four-part series of films that sought to record the operations of institutions in Talladega, Alabama, devoted to the care and training of people with disabilities. These films—designated as the Multi-handicapped Series—have received much less attention than Wiseman's earlier work, as if films about disability mark a drastic departure from his previous award-winning productions, such as Titicut Follies (1965) and Hospital (1970). The Multi-handicapped Series takes up general categories (...) of disabled populations as discrete documentary topics, Deaf (1986), Blind (1986), Multi-handicapped (1986) and Adjustment & Work (1986) as opposed to a specific location as in his earlier films. As a result, the latter series of films identify social and interpersonal structures developed in the name of specific conditions. Like Foucault's research on disciplinary tactics, Wiseman's films seek out many of the segregated social spaces typically occupied by persons classified as deviant: prisons, hospitals, charity networks, sheltered workshops, resident facilities, and vocational training structures. The Multi-handicapped Series focuses on the activities of professions and practitioners in education, administration, and therapy, as well as the institutional roles designed for bodies marked as disabled. Unlike its 19th century predecessor classification, feebleminded, the latter twentieth century U.S. policy answer has been waged as a matter of dividing disabilities into a binary structure of orthopedic or cognitive categories. Such a development has left many crossover bodies in a diagnostic no-body's-land. To analyze the history of these developments, this essay recognizes the formation of today's disability category as an effect of new regimes of power; a form of domination based upon the application of particularized diagnostic pathologies that provide the basis for cordoning off bodies which fail to fit neatly within the cognitive/orthopedic binary. As documents of the social spaces that are occupied by disabled people, Wiseman's films offer a rare contemplation of institutional practices and their application to populations viewed as nonnormative. (shrink)

Is evil evidence against the existence of God? Even if God and evil are compatible, it remains hotly contested whether evil renders belief in God unreasonable. The Evidential Argument from Evil presents five classic statements on this issue by eminent philosophers and theologians and places them in dialogue with eleven original essays reflecting new thinking by these and other scholars. The volume focuses on two versions of the argument. The first affirms that there is no reason for God to permit (...) either certain specific horrors or the variety and profusion of undeserved suffering. The second asserts that pleasure and pain, given their biological role, are better explained by hypotheses other than theism. -/- Contributors include William P. Alston, Paul Draper, Richard M. Gale, Daniel Howard-Snyder, Alvin Plantinga, William L. Rowe, Bruce Russell, Eleonore Stump, Richard G. Swinburne, Peter van Inwagen, and Stephen John Wykstra. (shrink)

What is faith? Lara Buchak has done as much as anyone recently to answer our question in a sensible and instructive fashion. As it turns out, her writings reveal two theories of faith, an early one and a later one (or, if you like, two versions of the same theory). In what follows, we aim to do three things. First, we will state and assess Buchak’s early theory, highlighting both its good-making and bad-making features. Second, we will do the same (...) for her later theory, noting improvements on the early one. Third, we will mark various choice points in theorizing about faith, and we will argue for specific choices at those points, culminating in what we regard as a better, alternative theory of faith. Our critical aims, therefore, are ultimately constructive. By theorizing about faith with Lara Buchak, we aim to contribute to our common understanding of what faith is. (shrink)

Reprinted in Philosophy of Religion: An Anthology, Wadsworth 2015, 6th edition, eds Michael Rea and Louis Pojman. What is propositional faith? At a first approximation, we might answer that it is the psychological attitude picked out by standard uses of the English locution “S has faith that p,” where p takes declarative sentences as instances, as in “He has faith that they’ll win”. Although correct, this answer is not nearly as informative as we might like. Many people say that there (...) is a more informative answer. They say that, at the very least, propositional faith requires propositional belief. More precisely, they say that faith that p requires belief that p or that it must be partly constituted by belief that p. This view is common enough; call it the Common View. I have two main aims in this paper: (i) to exhibit the falsity of the Common View and the paucity of reasons for it, and (ii) to sketch a more accurate and comprehensive account of what propositional faith is. (shrink)

Important discussions about limiting care based on professional judgment often devolve into heated debates over the place of physicians in bedside rationing. Politics, loaded rhetoric, and ideological caricature from both sides of the rationing debate obscure precise points of disagreement and consensus, and hinder critical dialogue around the obligations and boundaries of professional practice. We propose a way forward by reframing the rationing conversation, distinguishing between the scale of the decision and its context avoiding the word “rationing.” We propose to (...) shift the terminology, using specific, descriptive words to defuse conflict and re-focus the debate towards substantive issues. These distinctions can clarify the real ethical differences at stake and facilitate a more constructive conversation about the clinical and social responsibilities of physicians to use resources ethically at the bedside and their role in allocating medical resources at a societal level. (shrink)

Important discussions about limiting care based on professional judgment often devolve into heated debates over the place of physicians in bedside rationing. Politics, loaded rhetoric, and ideological caricature from both sides of the rationing debate obscure precise points of disagreement and consensus, and hinder critical dialogue around the obligations and boundaries of professional practice. We propose a way forward by reframing the rationing conversation, distinguishing between the scale of the decision and its context avoiding the word “rationing.” We propose to (...) shift the terminology, using specific, descriptive words to defuse conflict and re-focus the debate towards substantive issues. These distinctions can clarify the real ethical differences at stake and facilitate a more constructive conversation about the clinical and social responsibilities of physicians to use resources ethically at the bedside and their role in allocating medical resources at a societal level. (shrink)

This Element, written for researchers and students in philosophy and the behavioral sciences, reviews and critically assesses extant work on number concepts in developmental psychology and cognitive science. It has four main aims. First, it characterizes the core commitments of mainstream number cognition research, including the commitment to representationalism, the hypothesis that there exist certain number-specific cognitive systems, and the key milestones in the development of number cognition. Second, it provides a taxonomy of influential views within mainstream number cognition research, (...) along with the central challenges these views face. Third, it identifies and critically assesses a series of core philosophical assumptions often adopted by number cognition researchers. Finally, the Element articulates and defends a novel version of pluralism about number concepts. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page W1-W3, June 2011.

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating (...) would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed. (shrink)

This essay is a detailed study of William P. Alston’s view on the nature of Christian faith, which I assess in the context of three problems: the problem of the skeptical Christian, the problem of faith and reason, and the problem of the trajectory. Although Alston intended a view that would solve these problems, it does so only superficially. Fortunately, we can distinguish Alston’s view, on the one hand, from Alston’s illustrations of it, on the other hand. I argue that, (...) although Alston’s view only superficially solves these problems, Alston’s illustrations of it suggest a substantive way to solve them, a way that I sketch briefly. (shrink)

In this short essay, we sketch a theory of faith that features resilience in the face of challenges to relying on those in whom you have faith. We argue that it handles a variety of both religious and secular faith-data, e.g., the value of faith in relationships of mutual faith and faithfulness, how the Christian and Hebrew scriptures portray pístis and ʾĕmûnāh, and the character of faith as it is often expressed in popular secular venues.

The Renaissance was a period of great intellectual change and innovation as philosophers rediscovered the philosophy of classical antiquity and passed it on to the modern age. Renaissance philosophy is distinct both from the medieval scholasticism, based on revelation and authority, and from philosophers of the seventeenth and eighteenth centuries who transformed it into new philosophical systems. Despite the importance of the Renaissance to the development of philosophy over time, it has remained largely understudied by historians of philosophy and professional (...) philosophers. This anthology aims to correct this by providing scholars and students of philosophy with representative translations of the most important philosophers of the Renaissance. Its purpose is to help readers appreciate philosophy in the Renaissance and its importance in the history of philosophy. The anthology includes translations from philosophers from the thirteenth to the seventeenth centuries, and it ranges from works on moral and political philosophy, to metaphysics, epistemology, and natural philosophy, thereby providing historians and students of philosophy with a sense for the nature, breadth, and complexity of philosophy in the Renaissance. Each translation is accompanied by an introduction by a historian of Renaissance philosophy, as well as select secondary sources, in order to encourage further study. (shrink)

Does faith that p entail belief that p? If faith that p is identical with belief that p, it does. But it isn’t. Even so, faith that p might be necessarily partly constituted by belief that p, or at least entail it. Of course, even if faith that p entails belief that p, it does not follow that faith that p is necessarily partly constituted by belief that p. Still, showing that faith that p entails belief that p would be (...) a significant step in that direction. Can we take that step? In this essay, I assess, and reject, seven reasons to think we can. Along the way, I discuss having faith in a person, being a person of faith, believing something by faith, and believing a person. (shrink)

D‐amino acids are being recognized as functionally important molecules in mammals. We recently identified endogenous D‐cysteine in mammalian brain. D‐cysteine is present in neonatal brain in substantial amounts (mM) and decreases with postnatal development. D‐cysteine binds to MARCKS and a host of proteins implicated in cell division and neurodevelopmental disorders. D‐cysteine decreases phosphorylation of MARCKS in neural progenitor cells (NPCs) affecting its translocation. D‐cysteine controls NPC proliferation by inhibiting AKT signaling. Exogenous D‐cysteine inhibits AKT phosphorylation at Thr 308 and Ser (...) 473 in NPCs. D‐cysteine treatment of NPCs led to 50% reduction in phosphorylation of Foxo1 at Ser 256 and Foxo3a at Ser 253. We hypothesize that in the developing brain endogenous D‐cysteine is as a physiologic regulator of NPC proliferation by inhibiting AKT signaling mediated by Foxo1 and Foxo3a. Endogenous D‐cysteine may regulate mammalian neurodevelopment with roles in schizophrenia and Alzheimer's disease (AD). (shrink)

Objective consequentialism is often criticized because it is impossible to know which of our actions will have the best consequences. Why exactly does this undermine objective consequentialism? I offer a new link between the claim that our knowledge of the future is limited and the rejection of objective consequentialism: that ‘ought’ implies ‘can’ and we cannot produce the best consequences available to us. I support this apparently paradoxical contention by way of an analogy. I cannot beat Karpov at chess in (...) spite of the fact that I can make each of many series of moves, at least one of which would beat him. I then respond to a series of objections. In the process I develop an account of the ‘can’ of ability. I conclude with some remarks about the bearing this attack has on subjective consequentialism. (shrink)

Schlusslogische Letztbegründung is a collection of essays in honor of Kurt Walter Zeidler. Mr. Zeidler is a distinguished Kant- and Neo-Kantian-scholar who has reconstructed Kant's concept of transcendental logic in connection with the logic of the concept of Hegel and the logic of symbolization of Peirce. (cf. Zeidler: Grundriss der transzendentalen Logik, 3rd ed., Wien 2017) He has most notably inquired intensively into the relation of transcendental logic to philosophy of science (cf. Zeidler: Prolegomena zur Wissenschaftstheorie, Wien 2000) and to (...) phenomenology (cf. Zeidler: Vermittlungen. Zum antiken und neueren Idealismus, Wien 2016). He has also published several studies on Neo-Kantianism (cf. Zeidler: Provokationen. Zu Problemen des Neukantianismus, Wien 2018). This is refelected in the collection of essays by distinguished scholars who discuss and critically examine Zeidler's work. It includes contributions by Steinar Mathisen (Oslo), Wolfdietrich Schmied-Kowarzik (Vienna), Werner Flach (Lichtenau), Thomas Knoppe (Straberg), Geert Edel (Wyk/Föhr), Martin Bunte (Münster), Reinhard Hiltscher (Dresden), Walter Tydecks (Bensheim), Christian Krijnen (Amsterdam), Hartwig Wiedebach (Zürich), Max Gottschlich (Linz), Thomas Sören Hoffmann (Hagen), Rudolf Meer (Kaliningrad), Hans-Jürgen Müller (Frankfurt am Main), Robert König (Vienna), Ulrich Blau (Marburg), Karen Gloy (Luzern/Munich), Reinhold Breil (Aachen), Erhard Oeser (Vienna), Hans-Dieter Klein (Vienna), Hans Martin Dober (Tübingen), Kurt Walter Zeidler (Vienna) and Lois Marie Rendl (Vienna). (shrink)

According to many accounts of faith—where faith is thought of as something psychological, e.g., an attitude, state, or trait—one cannot have faith without belief of the relevant propositions. According to other accounts of faith, one can have faith without belief of the relevant propositions. Call the first sort of account doxasticism since it insists that faith requires belief; call the second nondoxasticism since it allows faith without belief. The New Testament may seem to favor doxasticism over nondoxasticism. For it may (...) seem that, according to the NT authors, one can have faith in God, as providential, or faith that Jesus is the Messiah, or be a person of Christian faith, and the like only if one believes the relevant propositions. In this essay, I propose to assess this tension, as it pertains to the Gospel of Mark. The upshot of my assessment is that, while it may well appear that, according to Mark, one can have faith only if one believes the relevant propositions, appearances are deceiving. Mark said no such thing. Rather, what Mark said—by way of story—about faith fits nondoxasticism at least as well as doxasticism, arguably better. More importantly, the account of faith that emerges from Mark is that faith consists in resilience in the face of challenges to living in light of the overall positive stance to the object of faith, where that stance consists in certain conative, cognitive, and behavioral-dispositional elements. (shrink)

Faith in God conflicts with reason—or so we’re told. We focus on two arguments for this conclusion. After evaluating three criticisms of them, we identify an assumption they share, namely that faith in God requires belief that God exists. Whether the assumption is true depends on what faith is. We sketch a theory of faith that allows for both faith in God without belief that God exists, and faith in God while in belief-cancelling doubt God’s existence. We then argue that (...) our theory, unlike the theory of Thomas Aquinas, makes sense of four central items of faith-data: (i) pístis in the Synoptics, (ii) ʾemunāh in the Hebrew scriptures, (iii) exemplars of faith in God, including Abraham, Jesus, and Mother Teresa, and (iv) the widespread experience of people of faith today. We close by assessing revisions of the two arguments we began with, revisions that align with our theory of faith, and find them dubious, at best. (shrink)

Do we rightly expect a perfectly loving God to bring it about that, right now, we reasonably believe that He exists? It seems so. For love at its best desires the well-being of the beloved, not from a distance, but up close, explicitly participating in her life in a personal fashion, allowing her to draw from that relationship what she may need to flourish. But why suppose that we would be significantly better off were God to engage in an explicit, (...) personal relationship with us? Well, first, there would be broadly moral benefits. We would be able to draw on the resources of that relationship to overcome seemingly everpresent flaws in our character. And we would be more likely to emulate the self-giving love with which we were loved. So loved, we would be more likely to flourish as human beings. Secondly, there would be experiential benefits. We would be, for example, more likely to experience peace and joy stemming from the strong conviction that we were properly related to our Maker, security in suffering knowing that, ultimately, all shall be well, and there would be the sheer pleasure of God's loving presence. As a consequence of these moral and experiential benefits, our relationships with others would likely improve. Thirdly, to be personally related to God is intrinsically valuable, indeed, according to the Christian tradition, the greatest intrinsic good. In these ways our well-being would be enhanced if God were to relate personally to us. Moreover, the best love does not seek a personal relationship only for the sake of the beloved. As Robert Adams rightly notes, "It is an abuse of the word 'love' to say that one loves a person, or any other object, if one does not care, except instrumentally, about one's relation to that object."1 Thus, God would want a personal relationship with us not only for the benefit we would receive from it but for its own sake as well. So, if a perfectly loving God exists, He wants a personal relationship with us, or more accurately, every capable creature, those cognitively and affectively equipped to relate personally with Him.. (shrink)

This paper assesses J. L. Schellenberg’s account of propositional faith and, in light of that assessment, sketches an alternative that avoids certain objections and coheres better with Schellenberg’s aims.

J.L. Mackie’s version of the logical problem of evil is a failure, as even he came to recognize. Contrary to current mythology, however, its failure was not established by Alvin Plantinga’s Free Will Defense. That’s because a defense is successful only if it is not reasonable to refrain from believing any of the claims that constitute it, but it is reasonable to refrain from believing the central claim of Plantinga’s Free Will Defense, namely the claim that, possibly, every essence suffers (...) from transworld depravity. (shrink)