Our topic here is uncertainty, especially as this arises in medicine. We are concerned with the uncertainty of diagnosis and of prognosis, and about how this should be communicated and shared between a doctor and patient. We are concerned with the idea that the doctor might rightly take responsibility for some of that uncertainty, in the sense that they may manage it when the patient is unwilling or unable to do so. And we are concerned with the implications that this (...) has for informed consent, for shared decision making, and for other normative dimensions of the doctor–patient relationship. Most centrally we argue that it is best understood, not in terms of informed consent, but in terms of informed trust. (shrink)

Academic freedom and tenure, both cherished institutions of higher education, are currently under attack by many both outside and within the academy. Richard DeGeorge argues that they can be defended on ethical grounds only if they are joined with appropriate accountability, publicly articulated and defended standards, and conscientious enforcement of these standards by academic institutions and the members of the academic community.

Michael Polanyi criticized the neo‐Darwinian synthesis on two grounds: that accidental hereditary changes bringing adaptive advantages cannot account for the rise of discontinuous new species, and that a Ideological ordering principle is needed to explain evolutionary advance. I commend the previous articles by John Apczynski and Richard Gelwick and also argue, more strongly than they, that Polanyi's critique of evolutionary theory is flawed. It relies on an inappropriate notion of progress and untenable analogies from the human process of scientific (...) discovery and the fact that in physical systems minimal potential energy is most stable. Yet within a life of commitment to transcendent values humans can directly experience purpose and meaning, and in developing this notion Polanyi makes his greatest contribution to teleology. (shrink)

The June 1975 issue of the Hastings Center Report published the Deliberations and Recommendations of the National Commission for the Protection of Human Subjects concerning the regulation of fetal experimentation. The Commission's most controversial conclusions were as follows: First, it voted to allow non‐therapeutic research on the human fetus, provided important biomedical knowledge could not be gained in any other way, proper consent had been obtained, and the research imposed “minimal or no risk to the well‐being of the fetus” (Recommendation (...) 4). Because interpretations of the last phrase varied in the case of fetuses scheduled for abortion, the Commission recommended that a national ethical review body be able to rule on disputed cases (Recommendation 5). In the case of research during abortion and research on the non‐viable fetus ex utero, the Commission's interpretation of permissible “harm” was restricted to the proviso that “no intrusion into the fetus [may be] made which alters the duration of life” (Recommendation 6). The Commission also recommended further research on abortion techniques (Recommendation 12). The Secretary of Health, Education and Welfare accepted the Commission's Recommendations almost without change—the major modification was to request paternal consent rather than to rely on the fact that “the father has not objected.” The DHEW regulations were published in the Federal Register on Friday, August 8, 1975, and written comments on them were invited. Already, however, a number of commentators including several members of the Commission had offered either dissenting or qualifying remarks. Some are printed here. (shrink)

Tested the 2-process theory of detection, search, and attention presented by the current authors in a series of experiments. The studies demonstrate the qualitative difference between 2 modes of information processing: automatic detection and controlled search; trace the course of the learning of automatic detection, of categories, and of automatic-attention responses; and show the dependence of automatic detection on attending responses and demonstrate how such responses interrupt controlled processing and interfere with the focusing of attention. The learning of categories is (...) shown to improve controlled search performance. A general framework for human information processing is proposed. The framework emphasizes the roles of automatic and controlled processing. The theory is compared to and contrasted with extant models of search and attention. (shrink)

Überblicken wir noch einmal das ganze riesige Gebiet des Geistesgeschehens vor und nach der Jahrhundertwende, soweit es darwinistische Züge erkennen läßt, so können wir eines feststellen : Ausgenommen die Konservativen und die Kirchen, die beide angesichts des stürmischen Vorwärtsdrängens darwinistischer Gedankengänge in die Defensive gehen müssen, bedienen sich so gut wie alle geistigen Strömungen des Darwinismus: Die Sozialisten, weil Darwins "Naturtheorie" mit ihrer Gesetzlichkeit des biologischen Fortschritts Gewähr zu bieten scheint, daß auch im Gesellschaftlichen eherne Gesetze des Fortschritts walten, und (...) weil sie aus dem Darwinismus den Beweis für die Gleichheit aller Menschen herauslesen. Die Sozialdarwinisten, weil ihnen Darwins Lehre vom Kampf ums Dasein und von der Auslese der Lebensfähigsten angeblich den Beweis liefert für die Ungleichheit der Menschen und für die Notwendigkeit einer Menschenzucht. Nicht zufällig sprießen um 1890 so viele Zuchtvereine aus dem Boden, weil man in Charles Darwin den großen Pflanzen-, Tier- und Menschenzüchter sah. Die Atheisten, weil mit der Affenabstammung jegliches göttliche Wirken beim Werden des Menschengeschlechts widerlegt sei. Die pantheistischen Schwärmer von Friedrichshagen, weil sie ein Entwicklungsgesetz am Werk zu sehen glauben, das ganz folgerichtig zu immer Besserem, Edlerem, Vollkommnerem, Vergeistigterem führen müsse. Die Verteidiger einer "Leistungsaristokratie". (shrink)

Frankfurt/M., Berlin, Bern, Bruxelles, New York, Oxford, Wien. Herausgegeben von Wilhelm Lutterfelds, Richard Raatzsch und Andreas Roser. The works of both Goethe and Wittgenstein are a permanent challenge. Goethe's lasting effectiveness is to be found in the alternative nature of his world-view (Weltan-Schauung), which may be characterized as a morphological access to the manifold of phenomena. Lasting in a similar way to the effect of Goethe, one could certainly say today that Wittgenstein's effect has lasted. This is no coincidence. (...) The fact that late Wittgenstein goes together with Goethe in fundamental respects, or even follows him, cannot be overseen. Wittgenstein's lasting legacy has, to a large extent, the same source as that of Goethe's. - This relation is the subject of this book. Contents: Fritz Breithaupt/Richard Raatzsch: Introduction - James C. Klagge: The Puzzle of Goethe's Influence on Wittgenstein - Matthias Kross: Engineering Phenomena: Wittgenstein and Goethe on Scientific Method - Nikos Psarros: "Water is one individual thing - it never changes." Quoting Faraday in the Philosophical Investigations: A Riddle with a Goethean Solution? - Joachim Schulte: Goethe and Wittgenstein on Morphology - Fritz Breithaupt: Non-Referentiality: A Common Strategy in Goethe's Urphanomen and Wittgenstein's Language-Game - Alfred Nordmann: "I have changed his way of seeing" -Goethe, Lichtenberg, and Wittgenstein - Garry Hagberg: The Mind shown. Wittgenstein, Goethe and the Question of Person-Perception - Richard Eldridge: Romantic Subjectivity in Goethe and Wittgenstein - Richard Raatzsch: Goethe's Wahlverwandtschaften - The Ethical Investigations of Late Wittgenstein? (shrink)

As many studies around the theme of ‘too much medicine’ attest, investigations are being ordered with increasing frequency; similarly the threshold for providing treatment has lowered. Our contention is that trust is a significant factor in influencing this, and that understanding the relationship between trust and investigations and treatments will help clinicians and policymakers ensure ethical decisions are more consistently made. Drawing on the philosophical literature, we investigate the nature of trust in the patient–doctor relationship, arguing that at its core (...) it involves a transfer of discretion. We show that there is substantial empirical support for the idea that more trust will reduce the problem of too much medicine. We then investigate ways in which trust can be built, concentrating on issues of questioning, of acknowledging uncertainty and of shouldering responsibility for it. We argue that offering investigations or treatments as a way of generating trust may itself be an untrustworthy way of proceeding, and that healthcare systems should provide the institutional support for facilitating continuity, questioning and the entrusting of uncertainty. (shrink)

Rethinking Justice lifts up and restores an idea of justice found in classical writers as well as more recent thinkers. Justice deals with righting wrongs and restoring peace to individuals and communities. We have lost sight of this and must return to it in mind and practice.

This comparative field study evaluated the moral reasoning used by U.S. and Belizean business students in resolving business-related moral dilemmas. The Belizeans, citizens of a less-developed country with Western heritage and a values-based education system, revolved the dilemmas using higher stages of moral judgment than did the U.S. business students.

This book grew out of my confusion. If logic is objective how can there be so many logics? Is there one right logic, or many right ones? Is there some underlying unity that connects them? What is the significance of the mathematical theorems about logic which I've learned if they have no connection to our everyday reasoning? The answers I propose revolve around the perception that what one pays attention to in reasoning determines which logic is appropriate. The act of (...) abstracting from our reasoning in our usual language is the stepping stone from reasoned argument to logic. We cannot take this step alone, for we reason together: logic is reasoning which has some objective value. For you to understand my answers, or perhaps better, conjectures, I have retraced my steps: from the concrete to the abstract, from examples, to general theory, to further confirming examples, to reflections on the significance of the work. (shrink)

Joshua Parker has made many interesting points, and we welcome the opportunity to develop the ideas of ‘Too Much Medicine, Not Enough Trust’. We will address: (i) the asymmetry between the trust that patients extend to doctors, and the trust that doctors extend to patients; (ii) our reasons for doubting that litigation or complaints reflect a betrayal of the patient–doctor relationship and (iii) the importance of institutional trust, both for the doctor and the patient.

The binary distinction De Neys questions has been put forward many times since the beginnings of psychology, in slightly different forms and under different names. It has proved enormously useful and has received detailed empirical support and careful modeling. At heart the distinction is that between knowledge in long-term memory and control processes in short-term memory.

The Purpose of this paper is to ask how far Locke can be said to have anticipated modern theories of number, particularly the intuitionist theory of Brouwer and Heyting. It has in mind Mr Edward E. Dawson's statement that Locke's account of number was not merely ‘a good effort in his own day’ but that ‘what Locke had to say really was quite fundamental, and a good deal of modern mathematics assumes his position, either explicitly or implicitly’. Mr Dawson thinks (...) that some of the central notions of the intuitionist theory are already present in the Essay Concerning Human Understanding , II, xvi, ‘Of Number’. We should like to examine the view. (shrink)