The Sutra of Golden Light. Translated by R. E. Emmerick. Second revised edition, Pali Text Society, Oxford 1990. xvi, 116 pp. £10.00.

“To whom is the Consecration of Medal, Stature or even Pyramid more jusly due, than to … the late Illustraious Boyle? … for the happy Improvement of Otto Guericks Magdeburg Exhausterm and for his Profound and Noble Researches into all the abstruser Parts and Recesses of the most useful Philosophy … I have named the Illustrious Boyle, and fix his Trophy here.”John Evelyn, Numismata, 1697.

The thesis of this article is that there has never been any ground for the controversy between the doctrine of free will and determinism, that it is based upon a misapprehension, that the two assertions are entirely consistent, that one of them strictly implies the other, that they have been opposed only because of our natural want of the analytical imagination. In so saying I do not tamper with the meaning of either phrase. That would be unpardonable. I mean free (...) will in the natural and usual sense, in the fullest, the most absolute sense in which for the purposes of the personal and moral life the term is ever employed. I mean it as implying responsibility, merit and demerit, guilt and desert. I mean it as implying, after an act has been performed, that one " could have done otherwise " than one did. I mean it as conveying these things also, not in any subtly modified sense but in exactly the sense in which we conceive them in life and in law and in ethics. These two doctrines have been opposed because we have not realised that free will can be analysed without being destroyed, and that determinism is merely a feature of the analysis of it. And if we are tempted to take refuge in the thought of an "ultimate ", an "innermost" liberty that eludes the analysis, then we have implied a deterministic basis and constitution for this liberty as well. For such a basis and constitution lie in the idea of liberty. -/- The thesis is not, like that of Green or Bradley, that the contending opinions are reconciled if we adopt a certain metaphysic of the ego, as that it is timeless, and identifies itself with a desire by a " timeless act". This is to say that the two are irreconcilable, as they are popularly supposed to be, except by a theory that delivers us from the conflict by taking us out of time. Our view on the contrary is that from the natural and temporal point of view itself there never was any need of a reconciliation but only of a comprehension of the meaning of terms. (The metaphysical nature of the self and its identity through time is a problem for all who confront memory, anticipation, etc.; it has no peculiar difficulties arising from the present problem.) -/- I am not maintaining that determinism is true; only that it is true insofar as we have free will. That we are free in willing is, broadly speaking, a fact of experience. That broad fact is more assured than any philosophical analysis. It is therefore surer than the deterministic analysis of it, entirely adequate as that in the end appears to be. But it is not here affirmed that there are no small exceptions, no slight undetermined swervings, no ingredient of absolute chance. All that is here said is that such absence of determination, if and so far as it exists, is no gain to freedom, but sheer loss of it; no advantage to the moral life, but blank subtraction from it. -- When I speak below of "the indeterminist" I mean the libertarian indeterminist, that is, him who believes in free will and holds that it involves indetermination. (shrink)

Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined. Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. (...) Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions. Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8). Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature. (shrink)

This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.

Volume 20, Issue 4, May 2020, Page 71-73.

In this book, R.E. Allen provides a translation of the 'Parmenides' along with a structural analysis that procedes on the assumption that formal elements, logical and dramatic, are important to its interpretation and that the argument of the Parmenides is aporetic, a statement of metaphysical perplexities.

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

Denne artikkelen tar utgangspunkt i et skille mellom samfunnsstrukturer som avgrenser legers skjønnsmessige utfoldelse på den ene siden, og profesjonens tilrettelegging for kultiveringen av erkjennelsesmessige ferdigheter på den annen. Ved å videreføre H. Grimen og A. Molanders anvendelse av S.E. Toulmins modell for praktisk resonnering i en klinisk kontekst redegjør jeg for legeskjønnets multidimensjonale, epistemiske struktur. Gjennomgangen viser hvordan skjønnsanvendelse i legerollen kan analyseres i henhold til en fagteknisk, en distributiv og en relasjonell dimensjon. Mot denne bakgrunnen diskuterer jeg så (...) spenninger som oppstår i skjæringspunktet mellom strukturering og kultivering av skjønnets ulike dimensjoner. Diskusjonen tydeliggjør at den medisinske profesjonen ikke kan betraktes som en selvtilstrekkelig premissleverandør når det gjelder å sikre adekvat kultivering av medlemmenes skjønnsutøvelse i en klinisk kontekst. Ved å synliggjøre og vektlegge de relevante profesjonseksterne bidragene i profesjonens pågående selvregulering kan befolkningens berettigete tillit til profesjonen styrkes ytterligere.Nøkkelord: strukturelt skjønn, epistemisk skjønn, profesjon, selvregulering, tillitEnglish summary: In Between Structures of Society and Profession: On Delimitation, Cultivation and Premises for Adequately Exercising Judgment in the Role as PhysicianThe point of departure of this article is a distinction between societal structures that delimit the discretion of the physician on the one hand and the profession's arrangements for the cultivation of the physician's judgment on the other. By developing H. Grimen and A. Molander's application of S.E. Toulmin's model for practical reasoning in a clinical context, the multi-dimensional epistemic structure of the physician's judgment in terms of technical, distributive, and relational judgment is accounted for. Against this backdrop, tensions emerging in the intersection between delimitation and cultivation of professional judgment in its various dimensions are discussed. The discussion clarifies that the medical profession is not a self-sufficient provider when it comes to ensuring an adequate cultivation of its members' judgment in a clinical context. It is argued that by emphasising and implementing the relevant external contributions to the profession's ongoing self-regulation, the public's justified trust in the medical profession can be strengthened. (shrink)

Hume's is/ought distinction has long limited the role of empirical research in ethics, saying that data about what something is cannot yield conclusions about the way things ought to be. However, interest in empirical research in ethics has been growing despite this countervailing principle. We attribute some of this increased interest to a conceptual breakdown of the is/ought distinction. MacIntyre, in reviewing the history of the is/ought distinction, argues that is and ought are not strictly separate realms but exist in (...) a close relationship that is clarified by adopting a teleological orientation. We propose that, instead of recovering a teleological orientation, society tends to generate its own goals via democratic methods like those described by Rousseau or adopt agnosticism about teleology such as described by Richard Rorty. In both latter scenarios, the distinction between is and ought is obscured, and the role for empirical research grows, but for controversial reasons. MacIntyre warns that the is/ought distinction should remain, but reminds ethicists to make careful arguments about when and why it is legitimate to move from is to ought. (shrink)

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a model (...) to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

Background Informed consent is a requirement for all research. It is not, however, clear how much information is sufficient to make an informed decision about participation in research. Information on an online questionnaire about childhood development was provided through an unfolding electronic participant sheet in three levels of information. Methods 552 participants, who completed the web-based survey, accessed and spent time reading the participant information sheet (PIS) between July 2008 and November 2009. The information behaviour of the participants was investigated. (...) The first level contained less information than might be found on a standard PIS, the second level corresponded to a standard PIS, and the third contained more information than on a standard PIS. The actual time spent on reading the information provided in three incremental levels and the participants' evaluation of the information were calculated. Results 77% of the participants chose to access the first level of information, whereas 12% accessed the first two levels, 6% accessed all three levels of information and 23% participated without accessing information. The most accessed levels of information were those that corresponded to the average reading times. Conclusion The brief information provided in the first level was sufficient for participants to make informed decisions, while a sizeable minority of the participants chose not to access any information at all. This study adds to the debate about how much information is required to make a decision about participation in research and the results may help inform the future development of information sheets by providing data on participants' actual needs when deciding about questionnaire surveys. (shrink)

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

Shoemaker (1996) presenteda prioriarguments against the possibility of ‘self‐blindness’, or the inability of someone, otherwise intelligent and possessed of mental concepts, to introspect any of her concurrent attitude states. Ironically enough, this seems to be a position that Gopnik (1993) and Carruthers (2006, 2008, 2009a,b) have proposed as not only possible, but as the actual human condition generally! According to this ‘Objectivist’ view, supposed introspection of one's attitudes is not ‘direct’, but an ‘inference’ of precisely the sort we make about (...) the attitudes of others, an inference that has the advantage in our own case ofonlyour own sensory data and memories, our behavior, and of the context we are in; i.e. we are all substantially self‐ blind. After sorting out a number of methodological and verbal issues, I argue, first, that thea prioriarguments against Objectivism don't succeed, and that Gopnik and Carruthers are right to regard the issue as an empirical one. On the other hand, I think they seriously underestimate the difficulty of establishing Objectivism. It is unlikely there is an inferential procedure from the data of pure sensation, behavior and context to the relevant self‐attributions that would be as spectacularly reliable as people manifestly seem to be. Moreover, there is a simpler model: the mind very likely consists of a panoply of sub‐routines some of whose outputs are ‘tagged’ for their having been so processed, rather in the way that software ‘documents’ are on standard computers. Introspection plausibly consists in a person's simply attending to distinctive constellations of these tags, even though they may lack phenomenal feels. This draws attention to an important independent fact: that much of phenomenology (or ‘what it's like’ to be in a certain state) may be constituted by facts that are not phenomenal. (shrink)

BackgroundFreezing of gait is a disabling burden for Parkinson’s disease patients with poor response to conventional therapies. Combined deep brain stimulation of the subthalamic nucleus and substantia nigra moved into focus as a potential therapeutic option to treat the parkinsonian gait disorder and refractory FoG. The mechanisms of action of DBS within the cortical-subcortical-basal ganglia network on gait, particularly at the cortical level, remain unclear.MethodsTwelve patients with idiopathic PD and chronically-implanted DBS electrodes were assessed on their regular dopaminergic medication in (...) a standardized stepping in place paradigm. Patients executed the task with DBS switched off, conventional STN DBS and combined STN+SN DBS and were compared to healthy matched controls. Simultaneous high-density EEG and kinematic measurements were recorded during resting-state, effective stepping, and freezing episodes.ResultsClinically, STN+SN DBS was superior to conventional STN DBS in improving temporal stepping variability of the more affected leg. During resting-state and effective stepping, the cortical activity of PD patients in STIM OFF was characterized by excessive over-synchronization in the theta, alpha, and high-beta band compared to healthy controls. Both active DBS settings similarly decreased resting-state alpha power and reduced pathologically enhanced high-beta activity during resting-state and effective stepping compared to STIM OFF. Freezing episodes during STN DBS and STN+SN DBS showed spectrally and spatially distinct cortical activity patterns when compared to effective stepping. During STN DBS, FoG was associated with an increase in cortical alpha and low-beta activity over central cortical areas, while with STN+SN DBS, an increase in high-beta was prominent over more frontal areas.ConclusionsSTN+SN DBS improved temporal aspects of parkinsonian gait impairment compared to conventional STN DBS and differentially affected cortical oscillatory patterns during regular locomotion and freezing suggesting a potential modulatory effect on dysfunctional cortical-subcortical communication in PD. (shrink)

No one is excused from doing what he ought to do merely because he is unwilling to do it. But what if others are unwilling to play their necessary role in some joint venture that you all ought to undertake: might that excuse you from doing what you yourself ought to do as part of that? It would, if you were genuinely willing to play your necessary part if they were. But the unwillingness of everyone involved cannot reciprocally serve to (...) excuse one another from doing what they ought to do. (shrink)

Char et al. describe an interesting and useful approach in their paper, “Identifying ethical considerations for machine learning healthcare applications.” Their proposed framework, which see...

J. Krishnamurti (1895-1986) was thought by many to be a modern-day equivalent of the Buddha. In fact, he was once even considered to be the second coming of Christ. While many think it wonderful to live and work in close proximity with such a person, it's difficult to understand the depth of what this means and how challenging this might be. In Knocking at the Open Door, author R.E. Mark Lee provides an ordinary person view of what being close-up and (...) working together with such a man means, how it challenges one at every turn, and how it causes one to question ceaselessly, even more deeply than one ordinarily would. Lee offers an insightful, candid, and heartfelt narrative that reveals various unknown facets of the eminent world teacher J. Krishnamurti and highlights his distinctive vision for education worldwide. This comprehensive volume brings alive the practical and everyday interactions Lee had with Krishnamurti during a twenty-year period in India and the United Sates. Knocking at the Open Door shares a clear and honest account that demonstrates the challenges of working with Krishnamurti in running a school that is true to the teaching and yet able to function in the reality of modern parental, student, and educational establishment expectations. (shrink)

Scientific authority and physician authority are both challenged by Thomas Kuhn's concept of incommensurability. If competing “paradigms” or “world views” cannot rationally be compared, we have no means to judge the truth of any particular view. However, the notion of local or partial incommensurability might provide a framework for understanding the implications of contemporary philosophy of science for medicine. We distinguish four steps in the process of translating medical science into clinical decisions: the doing of the science, the appropriation of (...) the scientific findings by the clinician, the transfer of the findings from the clinician to the patient, and the choice of a treatment regimen. Incommensurability can play a role in each stage. There is at least some theory- and value-ladenness in science that is dependent on the world view of those who construct the scientific theories. Clinicians who must use the results of scientific research will inevitably interpret the research from the standpoint of their own world view. There may be further incommensurability when these data are communicated to the patient. Finally, clinician and patient values must come into play in any decision about choice of treatment. No stage of medical research or practice is value-free. This position does not imply relativism; some scientific accounts are better than others. However, the challenge of the incommensurabilists shows that further analysis is needed to establish how particular accounts are better or worse. (shrink)

As health care embraces the tenets of evidence-based medicine it is important to ask questions about how evidence is produced and interpreted. This essay explores normative dimensions of evidence production, particularly around issues of setting the tolerable level of uncertainty of results. Four specific aspects are explored: what health care providers know about statistics, why alpha levels have been set at 0.05, the role of randomization in the generation of sufficient grounds of belief, and the role of observational studies. The (...) essay concludes with recommendations to acknowledge the value permeation of outcome measures and suggests that attention to reasoning and argument analysis can augment traditional evidence-based approaches in providing a robust critical approach to medical knowledge. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

Rich with historical and cultural value, these works are published unaltered from the original University of Minnesota Press editions.