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.

Organ transplantation remains one of modern medicine's remarkable achievements. It saves lives, improves quality of life, diminishes healthcare expenditures in end-stage renal patients, and enjoys high success rates. Yet the promise of transplantation is substantially compromised by the scarcity of organs. The gap between the number of patients on waiting lists and the number of available organs continues to grow. As of January 2006, the combined waiting list for all organs in the United States was 90,284. Unfortunately, thousands of potential (...) organs are lost each year, primarily due to lack of consent to donation from the deceased before death, or from the family thereafter. Only fifty percent of potential donors – the “conversion” rate – become actual donors. The costs attributed to organ shortage are substantial – Medicare paid over $15.5 billion in 2002 for treating patients with end-stage renal-disease, who predominate on organ waiting lists. (shrink)

Healing Emotions is the record of an extraordinary series of encounters between the Dalai Lama and prominent Western psychologists, physicians, and meditation teachers that sheds new light on the mind-body connection. Edited by Pulitzer Prize nominee and best-selling author Daniel Goleman.

In an explicit attempt to reduce physician paternalism and encourage patient participation in making health care decisions, the informed consent doctrine has become a foundational precept in medical ethics and health law. The underlying ethical principle on which informed consent rests — autonomy — embodies the idea that as rational moral agents, patients should be in command of decisions that relate to their bodies and lives. The corollary obligation of physicians to respect and facilitate patient autonomy is reflected in the (...) rules that have been created to implement consent procedures, especially those requiring disclosure of relevant information.However, there are many practical impediments to patient self-determination in health care decisionmaking. Well-meaning physicians often lack the time to live up to the ideal of facilitating genuine, informed deliberation with and by their patients, and many lack the motivation or skill to do so successfully. (shrink)

In this article, we argue that science textbooks do not present an accurate account of how scientific inquiry has been conducted and is conducted now. The chemistry textbooks that are used in middle school and high school use a “Great Man” theory in which all scientific discovery is attributed to a single man. However, scientific inquiry is a cooperative, collaborative effort, and it has been that sort of activity for at least the last 150 years. If girls, in general, tend (...) toward greater cooperation, as many social scientists suggest, a more accurate account of how science is done would bring more girls into the study of science. These authors suggest that science textbooks used during the times at which girls are formulating their opinions of science (the middle and high school years) should be modified to correctly reflect the fact that science and scientists are cooperative. (shrink)

Nietzsche announces his intentions to publish a “physiology of aesthetics”, namely a naturalistic explanation for how aesthetic judgements are grounded in the physiology of both the one experiencing the work, and the creator of it. But as well as the physiological reduction of aesthetic judgements, Nietzsche in many places across his oeuvre frames the apparatus of physiology, especially the prescriptive dimension of self-cultivation, in terms amenable to being treated as ‘aesthetic’. The first section will mount a (re-) defense of the (...) use of aestheticized language for discussing Nietzschean self-cultivation. The second section demonstrates an aesthetic evaluation of capacities that make possible the acquisition and removal of instinctual components, ultimately arguing for Nietzsche’s qualified indeterminism regarding the capacity for self-cultivation. The third section will assess the pres- ence of another aesthetic measure, this time in terms of envisaging one’s psycho-physiology by reference to an external spectacle. The final section discusses metaethical questions stemming from Nietzsche’s prescriptive language regarding the aestheticization of our physiology. (shrink)

With Slowing Metaphor Down: Elaborating Deliberate Metaphor Theory (henceforth SMD), Gerard J. Steen has given us a remarkable book, teeming with insights about metaphor use. The volume provides a...

Let us assume that some organisms, humans at least and the other higher animals, have internal states and behavioral states that represent things external to themselves. One of the questions that everyone would like answered about these states is: In virtue of what does such a representational state get the specific content that it has? An answer to this question that’s popular just now is: In virtue of its biological function. I believe there is a deep reason why such an (...) answer can’t work. I shall present that reason in this paper.First, we need to be clear about the notion of biological function that’s being appealed to here. In particular, we need to distinguish two fairly different ways of thinking about function. We could think of something’s function as what it contributes to the present functioning or output of some complex system of which it is a part. Roughly, this is Cummins’ view in (Cummins 1984). (shrink)

Roberto Frega & Giovanni Maddelena – Can you recollect what the situation was concerning the study of pragmatism when you were in college? Richard J. Bernstein – I was an undergraduate at the University of Chicago from 1949 to 1951. At the time the “Hutchins College” was an unusual institution. The entire curriculum was fixed and it was organized around reading many of the great books of the Western tradition. From the time I arrived, I was reading Plato, Aristotle, (...) Galileo, Darwin, Herodotus... (shrink)

In Achieving Our Country, Richard Rorty pauses to explain what it was like to be “a red diaper anticommunist baby” and to become a “teenage Cold War liberal.” Rorty's political allegiances were virtually unknown until the 1980s. The trouble with Rorty's “inspirational” liberalism is that, at best, it tends to become merely inspirational and sentimental, without much bite. There once was a time when the work of liberal metaphysicians and theorists was important, especially when liberalism was a novelty and (...) liberal societies were just coming into existence. Indeed, economic trends suggest that there may be a collapse of liberalism and pragmatism in America. Inspirational liberalism may be a healthy antidote to legalistic rights‐based liberalism and to the abuses of the infatuation with theorizing by postmodern cultural critics. But without pragmatic toughness and a concrete program for reform, patriotic inspirational liberalism too easily degenerates into an empty rhetorical hand waving. (shrink)

The complexities of Heidegger’s early accounts of nature provide a privileged perspective from which to understand the evolution of his thought into the 1930s and beyond. This movement seems largely driven by his response to what Karsten Harries has called “the antinomy of being”. In Heidegger’s early writings, Natur is associated with the “theoretical” and the “intraworldly.” However, less attested is an “unworlded” and thus intrinsically “incomprehensible” sense of nature, as the abyssal ground of worlding. This thread is traced through (...) key Marburg period texts, into Being and Time, and beyond it into the 1928 “metontology” appendix and its surprising transformation in the 1929 inaugural lecture. Finally, some cursory observations are made about how this trajectory unfolds in later Heideggerian thought, taking the 1936 Artwork essay as an example, showing how both sides of the antinomy of being come to be incorporated within a more comprehensive framing of the Seinsfrage. (shrink)

Recent years have seen an accentuation in claims that early Heideggerian works are infected with totalitarian ideas that came to full realisation in the early 1930s. In challenging this claim, I suggest that the trajectory from Geschichtlichkeit and Mitsein in Being and Time to Heidegger’s later lamentable political involvements is both complicated and tenuous. After first defending this stance with reference to the account of Schuld in Being and Time, I draw substantively on the work of Jean-Luc Nancy in arguing (...) that Heidegger’s later political thought amounts to a perversion of his earlier admittedly under-developed accounts of Geschichtlichkeit and Mitsein. Further, with Nancy, I suggest there is much to be learned here more generally—both by Heidegger’s great insights and great failures—concerning the dialectic of self and community. (shrink)

This chapter contains section titled: I The Challenge Model II Challenge Versus Impact III Parameters and Limitations IV Tolerance, Neutrality, and Antipaternalism V Equality VI Resources Versus Welfare VII Conclusion Acknowledgement.

A Christian Cosmology studies the two books of God, the Bible and nature, to discern their consistent reading for our age. This volume, an expanded version of Volume 1, offers a framework of illuminating concepts of philosophy and theology, in which it develops in rich detail the author's crystallized vision. Richard Pendergast sees the world as a hierarchy of irreducible elements, the highest level being that of the Logos. From the search of ancient Greek philosophy for a unifying principle (...) and its integration with Jewish thought in the Hellenistic era, he relates the emergence of the Christian doctrine of the Trinity and its study to the present day. Using scriptural sources, he makes explicit the concept of "incosmation," preceding that of the Incarnation, and presents to us an immanent and transcendent Logos as head of the universe. (shrink)

Richard J. Bernstein argues that many of the important themes in philosophy during the past 150 years are variations and developments of ideas that were prominent in the classical American pragmatists: Charles S. Peirce, William James, John Dewey, and George H. Mead. The pragmatic thinkers reject a sharp dichotomy between subject and object, mind-body dualism, the quest for certainty, and the spectator theory of knowledge. They seek to bring about a sea change in philosophy that highlights the social character (...) of human experience and normative social practices, the self-correcting nature of all inquiry, and the continuity of theory and practice. And they - especially James, Dewey, and Mead - emphasize the democratic ethical-political consequences of a pragmatic orientation. Many of the themes developed by the pragmatic thinkers were central to the work of major twentieth-century philosophers such as Wittgenstein and Heidegger, but the so-called analytic/Continental split obscures this underlying continuity. Bernstein develops an alternative reading of contemporary philosophy that brings out the persistence and continuity of pragmatic themes. He explains why the discussion of pragmatism is alive, varied, and widespread"--Jacket. (shrink)

Richard Rorty (1931–2007) was one of the most provocative and controversial philosophers of the past 50 years. He had a rare ability to combine sophisticated arguments with wit, charm, and humor. He was never dull – and he reached a wide public throughout the world. Originally trained in the history of philosophy and the grand tradition of metaphysics, he became fascinated with the linguistic turn in philosophy. During his early philosophical career, he wrote articles that were at the cutting (...) edge of analytic philosophy. He developed a new approach to the mind-body problem and raised troubling questions about the viability of the conceptual analysis of ordinary language. Soon, he began to question what he called the “Kantian foundations” of analytic philosophy. In 1979, he published Philosophy and the Mirror of Nature, a book that became an immediate sensation. Rorty, employing ingenious arguments, questioned the basis of analytic philosophy, and more generally the very idea of systematic philosophy. He called into question the Descartes-Locke-Kant tradition and claimed that the metaphor of the “mirror of nature” had misled philosophers into thinking that the task of philosophy is to “get things right” by representing objective reality. In the mid-twentieth century, the analytic-continental split in philosophy became bitterly entrenched. Many Anglo-American philosophers were convinced that linguistic analytic philosophy is “the only game in town.” They disdained what they took to be the lack of clarity and argumentative rigor among continental thinkers. The “compliment” was returned by continental thinkers who thought that much of analytic philosophy was trivial and insignificant. Rorty employed clever analytic techniques to challenge the pretentions of analytic philosophy. Many of his professional colleagues were furious. At the same time, Rorty engaged thinkers like Sartre, Heidegger, Gadamer, Habermas, Derrida, and Foucault. This delighted aficionados of continental philosophy – although they frequently judged his interpretations of these thinkers to be distorted caricatures. Rorty was one of the rare philosophers who transcended the analytic-continental split. At the same time, Rorty increasingly identified himself with the American pragmatic tradition. He entitled his 1982 collection of essays, “Consequences of Pragmatism,” which included his famous 1979 presidential address to the American Philosophical Association: “‘Pragmatism’ is a vague, ambiguous, and overworked word. Nevertheless it names the glory of our country’s intellectual tradition. No other American writers have offered so radical suggestion for making our future different from the past, as have James and Dewey” (Rorty 1982, p. 160). Rorty helped to revive a serious interest in James and Dewey. In the Introduction to Philosophy and the Mirror of Nature, he declared that the three most important philosophers of the twentieth century were Wittgenstein, Heidegger, and Dewey. Analytic philosophers might agree about the importance of Wittgenstein; continental thinkers might acknowledge the importance of Heidegger; but virtually no professional philosopher (except devotees of Dewey) would have ranked Dewey with the other two. Rorty claimed that each of these three thinkers had originally sought to find a new way to make philosophy “foundational,” but they came to realize that their earlier work was self-deceptive and they spent the rest of their time warning us against the temptations to which they had succumbed. “Their later work is therapeutic rather than constructive, edifying rather than systematic, designed to make the reader question his own motives for philosophizing rather than supply him with a new philosophical program.” (Rorty 1979, pp. 5–6) Rorty acknowledged that Dewey lacked Wittgenstein’s “dialectical acuity” and Heidegger’s “historical learning,” but Dewey articulated a vision of a new type of society. “In his ideal society, culture is no longer dominated by the ideal of objective cognition but by that of aesthetic enhancement. In that culture, as he said, the arts and sciences would be the ‘unforced flowers of life.” (Rorty 1979, p. 13) This was also Rorty’s vision of a liberal utopia. He developed this vision in Contingency, Irony, and Solidarity, where the central figure becomes the liberal ironist. Whereas Philosophy and the Mirror and Nature was filled with brilliant (although controversial) arguments, Rorty now debunked the role of argument in philosophy. “On the view of philosophy which I am offering, philosophers should not be asked for arguments against, for example, the correspondence theory of truth or the idea of the ‘intrinsic nature of reality’.” (Rorty 1989, p. 8) He favored redescription rather than argument. “I am not going to offer arguments against the vocabulary I want to replace. Instead, I am going to try to make the vocabulary I favor look attractive by showing how it may redescribe a variety of topics.” (Rorty 1989, p. 9) Interesting philosophy is not really a matter of argument at all but rather “a contrast between an entrenched vocabulary which has become a nuisance and a half-formed vocabulary which vaguely promises great things” (Rorty 1989, p. 9). Rorty deflated what many philosophers took to be the central concerns of philosophy, the nature of truth, reality, objectivity, knowledge, and morality. He sought to replace the appeal to objectivity with the appeal of solidarity. He is famous for his slogan “Take care of freedom and truth will take care of itself” (Rorty 1989, p. 176). Even admirers of Philosophy and the Mirror of Nature were distressed by the radical turn of Contingency where he suggested that novels, journalism, and literary reflection might be more effective than philosophical argumentation in bringing about his liberal utopia. Some of his fiercest critics claimed that Rorty could no longer be taken seriously as a philosopher. Contingency was savagely criticized and ridiculed, so much so that Rorty was provoked to write his revealing and delightful autobiographical sketch, “Trotsky and the Wild Orchids.” “I am sometimes told, by critics from both ends of the political spectrum, that my views are so weird as to be merely frivolous. They suspect that I will say anything to get a gasp, that I am just amusing myself by contradicting everybody else. This hurts. So I have tried, in what follows, to say something about how I got into my present position—how I got into philosophy, and then found myself unable to use philosophy for the purpose I had originally in mind.” (Rorty 1999, p. 5) What follows is an account of how Rorty grew up in a family that was deeply committed to furthering social justice. (“Trotsky” is a synecdoche for social justice.) Rorty also tells of his early nerdish love of the wild orchids of New Jersey. (“Wild orchids” is the synecdoche for private pleasures.) When Rorty became interested in philosophy, he wanted to find some intellectual or esthetic framework that would hold reality and justice in a single vision – one that would integrate social justice and private idiosyncratic pleasures. He tells the story of his eventual discovery that there was no such overarching framework and his growing realization that there was no need for such a framework. As a public citizen, one can be deeply committed to advancing social justice and at the same time, as a private person, enjoy idiosyncratic pleasures. There is no need to reconcile or synthesize these two incommensurable dimensions of human life. (shrink)

The functional basis of disgust in disease avoidance is widely accepted; however, there is disagreement over what disgust is. This is a significant problem, as basic questions about disgust require...

To what extent are people able to make predictions about other people’s preferences and values? We report two experiments that present a novel method assessing some of the basic processes in surrogate decision-making, namely surrogate-utility estimation. In each experiment participants formed dyads who were asked to assign utilities to health related items and commodity items, and to predict their partner’s utility judgments for the same items. In experiment one we showed that older adults in long-term relationships were able to accurately (...) predict their partner’s wishes. In experiment two we showed that younger adults who were relatively unfamiliar with one another were also able to predict other people’s wishes. Crucially we demonstrated that these judgments were accurate even after partialling out each participant’s own preferences indicating that in order to make surrogate utility estimations people engage in perspective-taking rather than simple anchoring and adjustment, suggesting that utility estimation is not the cause of inaccuracy in surrogate decision-making. The data and implications are discussed with respect to theories of surrogate decision-making. (shrink)

Leading philosophers and social thinkers, including Richard Rorty, Jacques Derrida, and Jurgen Habermas, pay tribute to the influential American philosopher Richard J. Bernstein.