Using a real-life case involving an accidental discovery of misattributed paternity as a springboard for discussion, I reflect on several practical and theoretical issues surrounding truth-telling in the doctor-patient relationship. I present the moral dilemma and identify arguments in favour of and against disclosure. I then examine the theoretical difficulties in balancing conflicting reasons and in establishing what constitutes the 'truth'. I conclude that withholding the information from the patients would be ethically permissible and, more generally, that honesty is not (...) always the best policy. (shrink)

This volume of essays examines key themes in Jewish philosophy and ethics from the rigorous perspective of philosophical analysis. The first set of essays takes up the challenge of living a Jewish life, and includes essays on pleasure, joy, human suffering, Jewish ritual practice and the philosophical life. The second set of essays analyzes the value and meaning of autonomy, human freedom and tolerance in Jewish thought, crucial themes in western political thought and life. Other essays in the volume examine (...) the many meanings of Jewish texts, and such crucial issues in applied Jewish ethics as ecology, medical ethics, and justified homicide. Finally, a number of essays plumb the depths of one of the most influential and creative Jewish thinkers of the twentieth century, Rabbi Joseph B. Soloveitchik. Taken as a whole, this volume advances the engagement of classical Jewish themes with Anglo-American philosophy, shedding new light both on the Jewish tradition, and on the western philosophical enterprise. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

As I write this, in November 1971, people are dying in East Bengal from lack of food, shelter, and medical caxc. The suffering and death that are occurring there now axe not inevitable, 1101; unavoidable in any fatalistic sense of the term. Constant poverty, a cyclone, and a civil war have turned at least nine million people into destitute refugees; nevertheless, it is not beyond Lhe capacity of the richer nations to give enough assistance to reduce any further suffering to (...) very small proportions. The decisions arid actions of human beings can prevent this kind of suffering. Unfortunately, human beings have not made the necessary decisions. At the individual level, people have, with very few exceptions, not responded to the situation in any signihczmt way. Generally speaking, people have not given large sums to relief funds; they have not written t0 their parliamentaxy representatives demanding increased government assistance; they have not demonstrated in the streets, held symbolic fasts, or done anything else directed toward providing thc refugees with the means to satisfy their essential needs. At thc government level, no govcrmmcnt has given the sort of massive aid that would enable the refugees to survive fm: more than a few days. Britain, for instance, has given rather more than most countries. It has, to date, given £14,750,000. For comparative purposes, B1~itain’s share of thc nonreccverabla development costs of the Anglo-French Concorde project is already in excess of £275,000,000, and on present estimates will reach £440,000,¤00. The implication is that the British government values a supersonic transport more than thirty times as.. (shrink)

The medical profession’s role should be limited to advice and informationThe medical establishment’s desire to interfere with the autonomous wishes of boxers seems at odds with the principle of respect for autonomy prevalent in contemporary biomedical practice. I argue that the role of the medical profession in boxing should be solely an advisory and informational one. In addition, the distinctions made between boxing and other high risk sports often rely on an insufficient knowledge of the sport. This leads to misdirected (...) criticisms and excessive emphasis on the colourful discourse of boxing, as opposed to the practice of boxing itself. Dr Herrera’s claim in his article that boxing differs from other sports in the acceptability of its acts outside the realm of sport is refuted.1 The importance of consent as a legitimising factor is highlighted, and a number of possible solutions to improve safety within the sport are tentatively suggested.In the United Kingdom, a competent adult may legally refuse medical treatment, irrespective of the severity of his condition or the validity of his reasons. With the pre-eminence of an autonomy based model of bioethics, respecting a patient’s wishes forms an integral part of acting in his best interests. It is puzzling, then, to find that the Australian Medical Association have called for a ban on boxing on the grounds that the activity is excessively hazardous to the health of boxers. The often mentioned principle of respect for autonomy is abandoned once the person drops the privileged title of “patient”. This suggests that being a patient …. (shrink)

Case 1 reminds us that patients have duties too, while case 2 presents an instance of justified withholding of informationHow refreshing to read these two cases! No conjoined twins, fantastical chimeras, or other incredible scenarios at the fringes of medical reality. Each case highlights the practical and theoretical difficulties that doctors face in their everyday practice.Case 1: In case 1, the patient, who had declined an HIV test, changed his mind and requested an HIV test on the request form without (...) informing the doctor. The pathologist performed the tests and returned the results to the unsuspecting doctor, who duly investigated the matter. The doctor’s anxiety at the situation, as well as the worries of the entire practice and pathology laboratory, must have been deeply unpleasant. Thus the patient, no doubt unintentionally, caused much distress by requesting the HIV test. He was, at the very least, guilty of a lack of foresight and consideration. As a minimum, he should have informed the doctor of his last minute alteration. This would have enabled the doctor to discuss the implications of the test, to organise appropriate counselling, and, most importantly, to receive the results in full knowledge of the situation.As Dr Fraser points out, the experience of case 1 reinforces the importance of taking good medical notes. Even if the patient’s refusal had been documented in the notes, however, this would not have prevented him from requesting the HIV test, and indeed other tests, on the blood form. Pharmacists may still occasionally be faced with situations when they are unsure whether the doctor prescribed 10 capsules of a drug, or 110 capsules, as the patient may have added a “1” in front of the doctor’s original prescription. Similarly, how …. (shrink)

The public revelation in 2003 that medical students perform intimate examinations without patient consent has engendered much debate in the press and scientific journals. Using this case as a springboard for discussion, I will argue that medical schools should encourage students to raise their ethical concerns and call for a change of policy making it easier for students to do so. I will also address the question of medical students’ moral obligations towards their patients, and conclude that medical students ought (...) to express their discontent when faced with unethical practices or attitudes.In early January 2003, a study appeared in the British Medical Journal revealing that nearly a quarter of rectal and vaginal examinations on anaesthetised patients were performed by medical students without patient consent.1 Although the study did not generate the firestorm of controversy many expected, it engendered much discussion on ethical issues surrounding informed consent and patient autonomy, as well as stressing the need for greater ethics training for medical students. As an ethical problem, however, the case of intimate examinations is, to my mind, relatively uninteresting. If we agree that it is wrong for doctors to perform a vaginal examination on a conscious person without their consent, then it follows that it will still be …. (shrink)

Although telephone consultations are widely used in the delivery of healthcare, they are vulnerable to breaches of patient confidentiality. Current guidelines on telephone consultations do not address adequately the issue of confidentiality. In this paper, we propose a solution to the problem: a password system to control access to patient information. Authorised persons will be offered the option of selecting a password which they will use to validate their request for information over the telephone. This simple yet stringent method of (...) access control should improve security while allowing the continuing evolution of telephone consultations. (shrink)

Case presentations, esthetics, insurance considerations, communicable diseases, referral questions, dental phobia, and legal concerns all play a role in doctor-patient relationships. These topics, and many others, are the subject of this one-of-a-kind resource, designed to show dental students and practitioners how to approach patient relationships.

This paper argues that a set of questioning attitudes are among the foundations of human and animal minds. While both verbal questioning and states of curiosity are generally explained in terms of metacognitive desires for knowledge or true belief, I argue that each is better explained by a prelinguistic sui generis type of mental attitude of questioning. I review a range of considerations in support of such a proposal and improve on previous characterizations of the nature of these attitudes. I (...) then broaden their explanatory scope to include a number of forms of exploratory search. The paper has three main goals: to characterize the nature of the questioning attitudes, outlining their causal role and type of content; to argue that they are fundamental components of the mind, being widespread among animals and not constructed during ontogeny out of other attitudes; and to suggest that they explain a great deal more behavior than one might think. (shrink)

We propose a solution to the problem of logical omniscience in what we take to be its fundamental version: as concerning arbitrary agents and the knowledge attitude per se. Our logic of knowledge is a spin-off from a general theory of thick content, whereby the content of a sentence has two components: an intension, taking care of truth conditions; and a topic, taking care of subject matter. We present a list of plausible logical validities and invalidities for the logic of (...) knowledge per se for arbitrary agents, and isolate three explanatory factors for them: the topic-sensitivity of content; the fragmentation of knowledge states; the defeasibility of knowledge acquisition. We then present a novel dynamic epistemic logic that yields precisely the desired validities and invalidities, for which we provide expressivity and completeness results. We contrast this with related systems and address possible objections. (shrink)

What is ethics? Where do moral standards come from? Are they based on emotions, reason, or some innate sense of right and wrong? For many scientists, the key lies entirely in biology---especially in Darwinian theories of evolution and self-preservation. But if evolution is a struggle for survival, why are we still capable of altruism? In his classic study The Expanding Circle, Peter Singer argues that altruism began as a genetically based drive to protect one's kin and community members but (...) has developed into a consciously chosen ethic with an expanding circle of moral concern. Drawing on philosophy and evolutionary psychology, he demonstrates that human ethics cannot be explained by biology alone. Rather, it is our capacity for reasoning that makes moral progress possible. In a new afterword, Singer takes stock of his argument in light or recent research on the evolution of morality.--Publisher's description. (shrink)

Single-premise epistemic closure is the principle that: if one is in an evidential position to know that P where P entails Q, then one is in an evidential position to know that Q. In this paper, I defend the viability of opposition to closure. A key task for such an opponent is to precisely formulate a restricted closure principle that remains true to the motivations for abandoning unrestricted closure but does not endorse particularly egregious instances of closure violation. I focus (...) on two brands of epistemic theory that naturally incorporate closure restrictions. The first type holds that the truth value of a knowledge ascription is relative to a relevant question. The second holds that the truth value of a knowledge ascription is relative to a relevant topic. For each approach, I offer a formalization of a leading theory from the literature and use this formalization to evaluate the theory’s adequacy in terms of a precise set of desiderata. I conclude that neither theory succeeds in meeting these desiderata, casting doubt on the viability of the underlying approaches. Finally, I offer a novel variant of the topic-sensitive approach that fares better. (shrink)

Narrative thinking -- Narrative thinking about one's past -- Grief : a case study -- Narrative thinking about one's future -- Self-forgiveness : a case study -- The narrative sense of self -- Narrative, truth, life, and fiction.

This chapter provides an introduction to higher-order metaphysics as well as to the contributions to this volume. We discuss five topics, corresponding to the five parts of this volume, and summarize the contributions to each part. First, we motivate the usefulness of higher-order quantification in metaphysics using a number of examples, and discuss the question of how such quantifiers should be interpreted. We provide a brief introduction to the most common forms of higher-order logics used in metaphysics, and indicate a (...) number of questions which can be raised in such systems using logical vocabulary alone. Using a further example, we return to applications of higher-order logics in metaphysics. We also mention key developments in the history of higher-order logic as it pertains to metaphysics. Finally, we mention certain arguments which have been raised against the use of higher-order logic, and some ways of responding to them. (shrink)

In preparing for a lecture on the ethics of surgical complications, it became apparent that confusion exists about the definition of a ‘‘surgical complication.’’ Is it, as one medical website states, ‘‘any undesirable result of surgery?’’ [1]. In the European Journal of Surgery, Veen et al. [2] provide a more elaborate definition: ‘‘every unwanted development in the illness of the patient or in the treatment of the patient’s illness that occurs in the clinic’’ [2]. An esteemed historian of science suggests (...) yet another definition in a recent volume on surgical complications: ‘‘a complication, in any sphere of endeavour, is something out of the norm, and the product of extraneous and unexpected factors’’ [3]. Such is the discrepancy in definitions that Rampersaud et al. [4] declared in 2006 that ‘‘presently, there is no clear or consistent definition of a complication in the surgical literature.’’ Much research in surgery aims to reduce the risk of surgical complications. However, until we have a stable and agreed definition of what counts as a surgical complication, we cannot reliably compare different studies to discover what best reduces the chance of surgical complications [5]. Therefore, the topic is more than mere pedantry; defining surgical complications will help us with the broader question of how to improve surgical practice. A basic PubMed search returned nearly 800 articles with the phrases ‘‘surgical complications’’ or ‘‘surgical complication’’ in the title. But unlike the sources above. (shrink)

Introduction These essays have been written over a period of about ten years and have already been published separately in various places. ...

First published in 1987. Routledge is an imprint of Taylor & Francis, an informa company.

Since its original publication in 1975, this groundbreaking work has awakened millions of people to the existence of "speciesism"—our systematic disregard of nonhuman animals—inspiring a worldwide movement to transform our attitudes to animals and eliminate the cruelty we inflict on them. In Animal Liberation, author Peter Singer exposes the chilling realities of today’s "factory farms" and product-testing procedures—destroying the spurious justifications behind them, and offering alternatives to what has become a profound environmental and social as well as moral issue. (...) An important and persuasive appeal to conscience, fairness, decency, and justice, it is essential reading for the supporter and the skeptic alike. (shrink)

I lay out the framework for my theory of sensory imagination in “Imagining as a guide to possibility.” Sensory imagining involves mental imagery , and crucially, in describing the content of imagining, I distinguish between qualitative content and assigned content. Qualitative content derives from the mental image itself; for visual imaginings, it is what is “pictured.” For example, visually imagine the Philadelphia Eagles defeating the Pittsburgh Steelers to win their first Super Bowl. You picture the greenness of the field and (...) the football’s brown oblong shape. Some of what you imagine isn’t explicitly pictured, however. That it is Sunday, that it is the Super Bowl: these facts are assigned. (shrink)

Political decisions have the potential to greatly impact our lives. Think of decisions in relation to abortion or climate change, for example. This makes political legitimacy an important normative concern. But what makes political decisions legitimate? Are they legitimate in virtue of having support from the citizens? Democratic conceptions of political legitimacy answer in the affirmative. Such conceptions righly highlight that legitimate political decision-making must be sensitive to disagreements among the citizens. But what if democratic decisions fail to track what (...) there is most reason to do? What if a democratically elected government fails to take measures necessary to protect its population from threats related to climate change? Peter argues that the legitimacy of political decisions doesn't just depend on respect for the citizens' will; and defends a novel hybrid conception of political legitimacy, called the Epistemic Accountability conception. According to this conception, political legitimacy also depends on how political decision-making responds to evidence for what there is most reason to do. Grounds for Political Legitmacy starts with an overview of the main ways in which philosophers have thought about political legitimacy, and identifies the epistemic accountability conception as an overlooked alternative. It then develops the epistemic accountability conception of political legitimacy and discusses its implications for legitimate political decision-making. Considering the norms that should govern political debate, it examines the role of experts in politics, and probes the responsibilities of democratically elected political leaders and as well as of citizens. (shrink)

In February 1828 a Royal Commission was appointed to examine the law of Real Property of England and Wales. The Commission sat for four years and examined a vast amount of material, recommended certain changes in the law, and drafted several bills for consideration by parliament. Four massive reports were eventually presented to parliament in May 1829, June 1830, May 1832, and lastly in April 1833. As a result parliament enacted a limited number of piecemeal reforms, but did not attempt (...) a major revision of the law. (shrink)

This volume explores the use of higher-order logics in metaphysics. Seventeen original essays trace the development of higher-order metaphysics, discuss different ways in which higher-order languages and logics may be used, and consider their application to various central topics of metaphysics.

In the Western world it is usually taken as given that we all want happiness, and our educational arrangements tacitly acknowledge this. Happiness, Hope, and Despair argues, however, that education has an important role to play in deepening our understanding of suffering and despair as well as happiness and joy. Education can be uncomfortable, unpredictable, and unsettling; it can lead to greater uncertainty and unhappiness. Drawing on the work of Søren Kierkegaard, Miguel de Unamuno, Fyodor Dostoevsky, Simone Weil, Paulo Freire, (...) and others, Peter Roberts shows why these features of educational life need not be feared; to the contrary, they can be seen as a source of hope and human fulfilment. After years of negotiating an education system dominated by the language of competition, performance, and economic advancement, students and teachers often long for something different; they seek not just measurable success but also opportunities to ask searching questions of themselves and the world they encounter. Happiness, Hope, and Despair makes an important contribution toward meeting this need. It fosters a rethinking of the nature, purpose, and value of education, and opens up possibilities for further scholarly and professional inquiry. (shrink)

In 1982, Jonsen, Siegler and Winslade published Clinical Ethics, in which they described the “four quadrants” approach, a new method of analysing clinical ethics cases. Although the book is now in its 6th edition, a literature search has revealed only one academic paper demonstrating the method at work. This paper is an attempt to start filling this gap. As a way of describing and testing the approach, I apply the four quadrants method to a detailed clinical ethics case. The analysis (...) is interspersed with reflections on the method itself. It is hoped that this experiment will encourage ethicists and clinicians to devote more attention to this neglected approach. (shrink)

This chapter contains sections titled: References.

Much research in the field of emotions has shown that people differ in the cues that they use to perceive their own emotions. People who are more responsive to personal cues (personal cuers) make use of cues arising from their own bodies and behavior; people who are less responsive to personal cues (situational cuers) make use of cues arising from the world around them. An evolutionary explanation of this well-documented phenomenon is that it occurs because of the operation of a (...) cognitive module designed to enable the organism to predict its own impending behavior. This theory suggests that situational cuers would be people for whom external factors are the best source of information about their own future behavior, whereas personal cuers are people for whom cues about themselves are the best source of information about their own future behavior. Such a view is founded in the New Realist philosophy of the early twentieth century, a philosophy that affected psychology through the work of E. C. Tolman and J. J. Gibson. (shrink)

We find the idea that infant crying arises from thermoregulation more consistent with a coregulatory account of its evolutionary history than it is with the informational account advocated in the target article.

Peter Anstey presents a thorough and innovative study of John Locke's views on the method and content of natural philosophy. Focusing on Locke's Essay concerning Human Understanding, but also drawing extensively from his other writings and manuscript remains, Anstey argues that Locke was an advocate of the Experimental Philosophy: the new approach to natural philosophy championed by Robert Boyle and the early Royal Society who were opposed to speculative philosophy. On the question of method, Anstey shows how Locke's pessimism (...) about the prospects for a demonstrative science of nature led him, in the Essay, to promote Francis Bacon's method of natural history, and to downplay the value of hypotheses and analogical reasoning in science. But, according to Anstey, Locke never abandoned the ideal of a demonstrative natural philosophy, for he believed that if we could discover the primary qualities of the tiny corpuscles that constitute material bodies, we could then establish a kind of corpuscular metric that would allow us a genuine science of nature. It was only after the publication of the Essay, however, that Locke came to realize that Newton's Principia provided a model for the role of demonstrative reasoning in science based on principles established upon observation, and this led him to make significant revisions to his views in the 1690s. On the content of Locke's natural philosophy, it is argued that even though Locke adhered to the Experimental Philosophy, he was not averse to speculation about the corpuscular nature of matter. Anstey takes us into new terrain and new interpretations of Locke's thought in his explorations of his mercurialist transmutational chymistry, his theory of generation by seminal principles, and his conventionalism about species. (shrink)

In 1982, Jonsen, Siegler and Winslade published Clinical Ethics, in which they described the “four quadrants” approach, a new method of analysing clinical ethics cases. Although the book is now in its 6th edition, a literature search has revealed only one academic paper demonstrating the method at work. This paper is an attempt to start filling this gap. As a way of describing and testing the approach, I apply the four quadrants method to a detailed clinical ethics case. The analysis (...) is interspersed with reflections on the method itself. It is hoped that this experiment will encourage ethicists and clinicians to devote more attention to this neglected approach. (shrink)

In at least some cases of justified perceptual belief, our perceptual experience itself, as opposed to beliefs about it, evidences and thereby justifies our belief. While the phenomenon is common, it is also mysterious. There are good reasons to think that perceptions cannot justify beliefs directly, and there is a significant challenge in explaining how they do. After explaining just how direct perceptual justification is mysterious, I considerMichael Huemers (Skepticism and the Veil of Perception, 2001) and Bill Brewers (Perception and (...) Reason, 1999) recent, but radically different, attempts to eliminate it. I argue that both are unsuccessful, though a consideration of their mistakes deepens our appreciation of the mystery. (shrink)

This book offers a reassessment of the political philosophy of the British Idealists, a group of once influential and now neglected nineteenth-century Hegelian philosophers, whose work has been much misunderstood. Peter Nicholson focuses on F. H. Bradley's idea of morality and moral philosophy; T. H. Green's theory of the Common Good, of the social nature of rights, of freedom, and of state interference; and Bernard Bosanquet's notorious theory of the General Will. By examining the arguments offered by the Idealists (...) and by their critics the author is able to penetrate the deep layers of hostile comment laid down by several generations of later writers and to show that these ideas, once properly understood, are not only defensible but interesting and important. (shrink)

This is the first volume of a projected three-volume set on the subject of innateness. The extent to which the mind is innate is one of the central questions in the human sciences, with important implications for many surrounding debates. By bringing together the top nativist scholars in philosophy, psychology, and allied disciplines these volumes provide a comprehensive assessment of nativist thought and a definitive reference point for future nativist inquiry. The Innate Mind: Structure and Content, concerns the fundamental architecture (...) of the mind, addressing such question as: What capacities, processes, representations, biases, and connections are innate? How do these innate elements feed into a story about the development of our mature cognitive capacities, and which of them are shared with other members of the animal kingdom? The editors have provided an introduction giving some of the background to debates about innateness and introducing each of the subsequent essays, as well as a consolidated bibliography that will be a valuable reference resource for all those interested in this area. The volume will be of great importance to all researchers and students interested in the fundamental nature and powers of the human mind. Together, the three volumes in the series will provide the most intensive and richly cross-disciplinary investigation of nativism ever undertaken. They point the way toward a synthesis of nativist work that promises to provide a new understanding of our minds and their place in the natural order. (shrink)

Our topic is the theory of topics. My goal is to clarify and evaluate three competing traditions: what I call the way-based approach, the atom-based approach, and the subject-predicate approach. I develop criteria for adequacy using robust linguistic intuitions that feature prominently in the literature. Then I evaluate the extent to which various existing theories satisfy these constraints. I conclude that recent theories due to Parry, Perry, Lewis, and Yablo do not meet the constraints in total. I then introduce the (...) issue-based theory—a novel and natural entry in the atom-based tradition that meets our constraints. In a coda, I categorize a recent theory from Fine as atom-based, and contrast it to the issue-based theory, concluding that they are evenly matched, relative to our main criteria of adequacy. I offer tentative reasons to nevertheless favour the issue-based theory. (shrink)

This book presents and evaluates the late philosophy (Spätphilosophie) of F. W. J. Schelling (1775-1854) across a wide range of issues, ranging from relation between pure thinking and being, to the philosophy of mythology and religion, to the philosophy of history, to questions concerning the philosophy of nature and freedom. Simultaneously, it discusses Hegel's treatment of similar issues, and systematically compares the two thinkers. This is the first time, in an English-language publication, that these two major German Idealists have been (...) compared in such detail along such a broad front. The book begins with three chapters exploring the development of Schelling's thinking concerning transcendental philosophy, nature and teleology, human freedom, and the theory of history, from his earliest publications up to his middle years. Against this background, the book then presents Schelling's distinction between "positive" and "negative" philosophy, the defining mark of his late philosophy. It explores his theory of pure a priori thinking (negative philosophy), and his account of the transition from negative to positive philosophy. The major components of Schelling's positive philosophy, including his conception of "un-pre-thinkable being", and his theories of mythology and revelation, are then discussed. Throughout, a comparative assessment of Hegel's approach similar issues is sustained. Schelling emerges as a philosopher who traced his own highly distinctive path through the thicket of problems bequeathed by Kant, and whose systematic responses to these problems still merit serious consideration as alternatives to those of Hegel. (shrink)