Objectives To determine the role played by law in medical specialists9 decision-making about withholding and withdrawing life-sustaining treatment from adults who lack capacity, and the extent to which legal knowledge affects whether law is followed. Design Cross-sectional postal survey of medical specialists. Setting The two largest Australian states by population. Participants 649 medical specialists from seven specialties most likely to be involved in end-of-life decision-making in the acute setting. Main outcome measures Compliance with law and the impact of legal knowledge (...) on compliance. Results 649 medical specialists (of 2104 potential participants) completed the survey (response rate 31%). Responses to a hypothetical scenario found a potential low rate of legal compliance, 32% (95% CI 28% to 36%). Knowledge of the law and legal compliance were associated: within compliers, 86% (95% CI 83% to 91%) had specific knowledge of the relevant aspect of the law, compared with 60% (95% CI 55% to 65%) within non-compliers. However, the reasons medical specialists gave for making decisions did not vary according to legal knowledge. Conclusions Medical specialists prioritise patient-related clinical factors over law when confronted with a scenario where legal compliance is inconsistent with what they believe is clinically indicated. Although legally knowledgeable specialists were more likely to comply with the law, compliance in the scenario was not motivated by an intention to follow law. Ethical considerations (which are different from, but often align with, law) are suggested as a more important influence in clinical decision-making. More education and training of doctors is needed to demonstrate the role, relevance and utility of law in end-of-life care. (shrink)

Few studies exist which look at psychological factors associated with physician sexual misconduct. In this study, we explore family dysfunction as a possible risk factor associated with physician sexual misconduct. Six hundred thirteen physicians referred to a continuing medical education (CME) course for sexual misconduct were administered the FACES-II survey, a validated and reliable measure of family dynamics. The survey was part of a self-learning activity. We collected data from February 2000 to February 2009. Participants were predominantly white, middle-aged males (...) who represented the full range of medical specialties. Their results were compared against a sample of 177 physicians. The FACES-II is a self-report test that measures family of origin (the family in which one was raised) dynamics on two dimensions (1) flexibility, ranging from too flexible (chaotic) to not flexible enough (rigid) and (2) cohesion ranging from too close (enmeshed) to not close enough (disengaged). The most common family pattern observed among physicians accused of sexual misconduct was rigid flexibility paired with disengaged cohesion, indicative of unhealthy family functioning. This pattern was significantly different than the pattern observed in the comparison group. Physicians who engage in sexual misconduct are more likely to have family of origin dysfunction. Ethics is developmental and learned in one’s family of origin. Family of origin dynamics may be one risk factor predisposing one to ethical violations. These findings have important implications for screening, education, and treatment across the medical education continuum. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:THE VIRTUES OF MAN THE ANIMAL SOCIALE: AFFABILITAS AND VERITAS IN AQUINAS 1 KEVIN WHITE Catholic University of America Washington, D.C. XSTOTLE'S definition of man as the 'qlov '1ToAmKov 2the city-dwelling animal-undergoes an interesting transformation in the scholastic Latin of St. Thomas Aquinas : while the epithet of the definition occasionally appears in Aquinas's writings as transliterated, in animal politicum, or as thoroughly domesticated, in William of Moerbeke's (...) translation animal civile, his preferred version of the Aristotelian formula is animal sociale, though he sometimes says politicum et sociale, politicum vel sociale and sociale et politicum.8 For these uses of the term sociale, Aquinas is indebted not only to earlier writers of Latin but also to the genius of the language itself, whose words sociale and societas seem to have no equivalent in Aristotle's Greek. Less formal and explicit than the polis or civitas, what is meant by societas is rather the pervasive and mostly unacknowledged element within which cities are founded and continue, and which consists in the specifically human way of being together or, as Heidegger says, Mitsein. It is easy to discern in Aquinas's opposition between politicum and sociale the ancestor of our own commonplace and sharp contrast between " politics " and " so1 This paper was read in Buenos Aires on September 14, 1991, as a contribution to the sixteenth annual Semana Tomista of the Sociedad Tomista Argentina. 2 Politics I, 1, 1153a2-3. a For a survey of texts, see Edgar Scully, "The Place of the State in Society According to St. Thomas Aquinas," The Thomist 45 (1981): 407-429. The present discussion may be regarded as a gloss on the theme of this article that the social is prior to the political. 641 642 KEVIN WHITE ciety," though we should be careful not to identify our way of speaking with his: whereas we view " society " as a historical product, and so distinguish among different societies, societas for him, as for the ancient Romans, primarily connotes the universally human activity of coming together in association or alliance : it names that essential feature of human combination which is prior to institutions and to recognitions of special friendship, but which, just because it is a good of our nature, prevents human togetherness from being reduced to a bare co-presence. An illustration of the way in which Aristotle's reflections on human nature are both complicated and enriched, in Aquinas's appropriation of them, by the Roman notion of societas may be seen by comparing the differing treatments which the latter gives of the " social " virtues of truthfulness and friendliness in his commentary on the Nicomachean Ethics and in the Summa Theologiae. In both texts, to be sure, these virtues pale in significance beside such impressive qualities as courage and moderation; nevertheless, a notable increase in their importance seems to occur between the commentary, where, in keeping with the order of Aristotle's text, they appear as members of a series of virtues related to merely secondary matters, and the Summa, where they are elevated to a status among the " potential parts " of the virtue of justice and are distinguished by their relevance to the needs of man the animal sociale. Let us consider this difference in presentation, bearing in mind that the two texts were composed approximately simultaneously and fairly late in Aquinas's career, that is, during his second Parisian sojourn in 1269-72." I The commentary on the Ethics introduces the fourth book of the work as a sequel to the third : after discussing courage and moderation, which concern those things by which the very life of man is preserved, Aquinas says, here, in Book IV, the Philos4 For the chronology, see James A. Weisheipl, O.P., Friar Thomas d'Aquino: His Life, Thought and -YVorks, with Corrigenda and Addenda (Washington, 198~)' pp. 361, 380. AFFABILITAS AND VERITAS IN AQUINAS 643 opher treats of other "intermedaries," namely seven virtues and the feeling of shame, which are related to " certain secondary goods or evils." 5 Among the seven virtues, the first four have to do with external things, whether the external goods of wealth and honor or the external evils... (shrink)

I. INTRODUCTION: THE PROBLEMAkrasia (or, weakness of the will), often defined as “the moral state of agents who act against their better judgment”—a definition first given by Aristotle in the Nicomachean Ethics, depicts one of the most human of predicaments.Risto Sarrinen, Weakness of the Will in Medieval Thought: From Augustine to Buridan (New York: E. J. Brill, 1994), p. 1. Similar definitions can be found in, e.g., Aristotle, Nicomachean Ethics VII, 1045b10–15; Donald Davidson, “How is Weakness of the Will Possible?” (...) in Moral Concepts, ed. J. Feinberg (Oxford: Oxford University Press, 1970) p. 93; William Charlton, Weakness of Will (Oxford: Basil Blackwell, 1988), p. 1. We know what we ought to do, and we try. But, for one reason or other, we sometimes choose to act contrary to our better judgment.Being influenced by Socratic reasoning, some philosophers have argued that, in principle, one cannot freely and intentionally choose to act against one’s better judgment, if (1) one rationally judges what is best for oneself, (2) one prefers to act according to one’s rational judgment, and (3) one is free to make one’s own choice. See, e.g., Davidson, “How is Weakness,” pp. 93–113; and R. M. Hare, Freedom and Reason (Oxford: Oxford University Press, 1963), pp. 78–79. Despite the logical difficulty, many believe that weakness of the will is a fact. (shrink)

Fran Brearton: Robert Graves and The White Goddess Joyce Hill: Authority and Intertextuality in the Works of Ælfric Michael Pennington: Barnardine's Straw: The Devil in Shakespeare's Detail David Womersley: Dulness and Pope Terence Cave: Montaigne Lord Moser: The Future of Our Universities Alexander Murray: The Inquisition and the Renaissance Robert Bagley: The Prehistory of Chinese Music Theory Edwin Cameron: Patents and Public Health: Principle, Politics and Paradox Mervyn King: What Fates Impose: Facing Up to Uncertainty Dominic Lieven: Empire, History and (...) the Contemporary Global Order Joan Oates: Archaeology in Mesopotamia: Digging Deeper at Tell Brak Timothy Besley: The New Political Economy Richard Gray: 'They Worship Death Here': William Faulkner, Sanctuary and Hollywood Lord Sutherland: Nomad's Progress James Piscatori: Imagining Pan-Islam: Religious Activism and Political Utopias. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:56~ BOOK REVIEWS of the problem of free will and God's omnipotence- not a problem peculiar to evolution, to be sure, but one that nonetheless arises within the context of the emergence of living things, especially man, on earth and how that process relates to divine intervention; and Francisco J. Ayola starts everything off with a biologist's hardline defense of evolutionary theory. It may be asking too much to (...) expect original thinking on a topic that has been subjected to so much investigation and controversy over the past century. But it is reasonable to expect, in a book such as Evolution and Crea.tion, ways of approaching the topic which spark the reader's interest and furnish him with a competent and sometimes brilliant overview to it. The book fulfills this.expectation. I think it would be particularly useful as a source book and catalyst in graduate level seminars. University of San Francisco San Francisco, California RAYMOND DENNEHY God and Nature: Historical Essays on the Encounter Between Chris·tianity and Science. Edited by DAVID C. LINDBERG and RONALD L. NUMBERS. Berkeley and Los Angeles: University of California Press, 1986. Pp. xi + 516. $50.00 (cloth), $17.95 (paper). The editors tell us at the outset of this important volume that it is the outcome of two convictions that they share: (1) "that the interaction of science and Christianity has been of profound imp@tance in the shaping of Western civilization" and (2) that the results of extensive specialist work by historians of science and religion in recent decades belie widelyheld stereotypes and ought to be made generally available. The most familiar of the stereotypes is of course the Draper-White 66 warfare" thesis, the origins and continuing influence of which the editors trace in the first part of their helpful introduction. The eighteen contributors to the volume find plenty of controversies-sometimes rising to the level of conflicts-among individuals, among theological schools of thought, among scientific schools of thought, and among social groups, but at no period do they find anything that could be called an overall conflict of science and theology. They find many instances of smallerand larger-scale influences of theological developments on scientific ones, of scientific developments on theological ones, and of social developments on both. But no grand overall interpretative scheme appears in this respect either. Stanley L. Jaki's thesis, for instance, that modern science BOOK REVIEWS 563 was born of Christian theology and has prospered just insofar as it has remained faithful to its parentage, fares no better than the warfare thesis. No sweeping unitary interpretation can be expected to emerge, Lindberg and Numbers sugg.est, from historical work that " shows the respect for the particularity, individuality and value of each people and age that the canons of historical scholarship demand" (p. 10; i:r).ternal quotation from Donald Kagan). Accordingly, each essay is devoted to a particular period-some longer than others, to be sure. Nearly all are by professional historians. One author is primarily a philosopher, and several have at least secondary philosophical interests ; none are primarily scientists or theologians. Nearly all were trained and teach at secular universities, though a few have formal training from religious institutions as well. The coverage by periods is comprehensive, from Lindberg on " Science and the Early Church" to Numbers on "The Creationists" and Keith Yandell (the philosopher) on "Protestant Theology and Natural Science in the Twentieth Century." The last title calls attention, however, to one oddity in the coverage. Whereas in the essays on the sixteenth through eighteenth centuries both Protestant and Catholic figures and movements are treated, in those on the nineteenth and twentieth centuries attention is focused almost exclusively on the Protestant scene. Clearly, eighteen substantial essays cannot be analyzed in detail in a review of reasonable length. I shall indicate the main topics and theses of each with a few comments where these can be made briefly. First, however, I should stress that the book is treasure-trove of information and ideas. All the essays are good; several are superb. Each should be highly instructive for readers who are not specialists in the topic and period it deals with... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Office of Scientific IntegrityDavid P. Hamilton (bio)For most of the 1980s, the specter of scientific fraud popped into public view every few years, usually only to submerge again. Faced with several well-publicized cases of scientists who blatantly faked their data—among the best-known being Harvard cardiologist John Darsee (whose colleagues watched him forge data) (Broad and Wade 1982, p. 14) and Sloan-Kettering Institute immunologist William Summerlin (who painted (...) black spots on white mice to simulate tissue grafts) (Broad and Wade 1982, p. 155)—the scientific community as a whole tended to dismiss the phenomenon as the work of a few deviants. Called in 1981 to testify before then-Representative Albert Gore Jr.'s subcommittee on investigations and oversight, Philip Handler, then-president of the National Academy of Sciences, told the panel that science was perfectly capable of regulating itself, and that the problem of scientific fraud had been "grossly exaggerated" by the press (Broad and Wade 1982). The message was clear: Congress should stick to its knitting, and science would take care of itself.Now, however, scientists are faced with a very different situation: a permanent federal bureaucracy, known as the Office of Scientific Integrity (OSI), devoted to the investigation of alleged scientific wrongdoing. The transition from the days of laissez-faire, when universities were entrusted with all investigations unless they were handled so badly that the federal government was forced to take notice, has been an uncomfortable one for many researchers. Lately, this discomfort has taken shape as a vocal protest against OSI. Largely as a result of this protest, federal officials recently promoted a plan to restructure OSI and change some of its operating procedures, a move with unpredictable consequences for universities and researchers alike.OSI was born largely because of investigations by two influential congressmen: Representatives John Dingell of Michigan and Ted Weiss of New York. While both claimed they acted mainly to make sure taxpayer dollars were not spent on fraudulent research, both also maintained a strong interest in protecting "whistleblowers," the often vulnerable, and usually junior, scientists who first raise questions about bad research. And Dingell seemed to take special pleasure in pointing up the deficiencies of investigations run by universities and by the National Institutes of Health (NIH) itself. (For reasons that are not well understood, [End Page 171] biomedical research seems far more prone to fraud than any other field of science. As a result, NIH, which funds most biomedical research in the United States, has held ultimate responsibility for most prominent cases of fraud.) Plagued as they often were by conflicts of interest, shoddy methodologies, and, in some cases, a willingness to believe any excuse by the accused, no matter how far-fetched, these investigations made easy targets. And the notion that science could "govern itself" grew harder to sustain.In late 1988, Dingell and other congressmen began circulating draft bills that would have created a new office for investigating scientific fraud. Dingell would have placed such an office under the aegis of the Inspector General of the Department of Health and Human Services, raising the possibility that scientific fraud might be probed by the same criminal investigators who unravel Medicare fraud. Unsettled by this vision of the "science police," NIH officials moved quickly to pre-empt Congress. On March 16, 1989, they published a notice in the Federal Register announcing the creation of OSI, an office with responsibility for ensuring thorough university investigations of misconduct and the authority to conduct its own investigations when necessary.From the beginning, OSI took an unusual approach to its work. For one thing, the office had a broad mandate: Although located within NIH, it was responsible for research funded throughout the entire Public Health Service, including the Food and Drug Administration, the Alcohol, Drug, and Mental Health Administration, and the Centers for Disease Control. Furthermore, it was not restricted to scientific fraud. Departmental lawyers, wishing to avoid the legal connotations of the term "fraud"—in particular, a requirement that fraudulent actions not only mislead others but also cause them noticeable harm—decided instead to adopt the term "scientific misconduct," defined as "fabrication, falsification, plagiarism, or other practices that deviate... (shrink)

Beliefs are freely attributed to God nowadays in Anglo–American philosophical theology. This practice undoubtedly reflects the twentieth–century popularity of the view that knowledge consists of true justified belief . The connection is frequently made explicit. If knowledge is true justified belief then whatever God knows He believes. It would seem that much recent talk of divine beliefs stems from Nelson Pike's widely discussed article, ‘Divine Omniscience and Voluntary Action’. In this essay Pike develops a version of the classic argument for (...) the incompatibility of divine foreknowledge and free will in terms of divine forebelief. He introduces this shift by premising that ‘ A knows X ’ entails ‘A believes X ’. As a result of all this, philosophers have increasingly been using the concept of belief in defining ‘omniscience’. (shrink)

This work is the product of several years of intense study of the various aspects of Kant's work, and the attempt to provide insights for students both with respect to the details of the Kantian system, and into the development and implications of the system as a whole. During that time many individuals have contributed to its ultimate formulation, and I would like to express my appreciation at least to the more generous contributors. For a careful reading of the manuscript (...) in its earlier forms, and suggestions which helped in many ways to improve the work and to crystalize its thesis, I would like to thank Professors Wilbur Long, A. C. Ewing, and Richard Bosley. For their interest and encouragement in the later stages of the project, I must thank Professor Lewis White Beck, and the many students who have taken my Kant seminar at the University of Alberta, especially Mr. Dieter Hartmetz. And finally, 1 acknowledge with pleasure my longstanding debt to Professor William H. Werkmeister for his years of critical advice and encouragement. Perhaps only Kant and my wife have contributed more to my philosophic development. Acknowledgment must also be made of the permission kindly granted by various publishers for the use of material from the following works under their copyright. Kant's Critique of Practical Reason, translated by Lewis White Beck (copyright 1956, by The Liberal Arts Press, Inc. (shrink)

William P. Alston. difference in the scope of the rule reflects the fact that I-rules exist for the sake of making communication possible. Whereas their cousins are enacted and enforced for other reasons. We could distinguish I-rules just by this ...

This paper defends cognitive neuroscience’s project of developing mechanistic explan- ations of cognitive processes through decomposition and localization against objections raised by William Uttal in The New Phrenology. The key issue between Uttal and researchers pursuing cognitive neuroscience is that Uttal bets against the possibility of decomposing mental operations into component elementary operations which are localized in distinct brain regions. The paper argues that it is through advancing and revising what are likely to be overly simplistic and incorrect decompositions (...) that the goals of cognitive neuroscience are likely to be achieved. (shrink)

Introduction i. Character of the Book The central thesis of this book is that experiential awareness of God, or as I shall be saying, the perception of God, ...

" In a book that seeks to shift the ground of debate within theory of knowledge, William P. Alston finds that the century-lo.

Justification, or at least ‘justification’, bulks large in recent epistemology. The view that knowledge consists of true-justified-belief has been prominent in this century, and the justification of belief has attracted considerable attention in its own right. But it is usually not at all clear just what an epistemologist means by ‘justified’, just what concept the term is used to express. An enormous amount of energy has gone into the attempt to specify conditions under which beliefs of one or another sort (...) are justified; but relatively little has been done to explain what it is for a belief to be justified, what that is for which conditions are being sought. The most common procedure has been to proceed on the basis of a number of obvious cases of justified belief, without pausing to determine what property it is of which these cases are instances. Now even if there were some single determinate concept that all these theoriests have implicitly in mind, this procedure would be less than wholly satisfactory. For in the absence of an explicit account of the concept being applied, we lack the most fundamental basis for deciding between supposed intuitions and for evaluating proposed conditions of justification. And in any event, as philosophers we do not seek merely to speak the truth, but also to gain an explicit, reflective understanding of the matters with which we deal. We want to know not only when our beliefs are justified, but also what it is to enjoy that status. True, not every fundamental concept can be explicated, but we shall find that much can be done with this one. (shrink)

In this clear and provocative account of the epistemology of religious experience, William P. Alston argues that the perception of God—his term for direct experiential awareness of God—makes a major contribution to the grounds of religious belief. Surveying the variety of reported direct experiences of God, Alston demonstrates that a person can be justified in holding certain beliefs about God on the basis of mystical experience.

1. The Naturalistic Turn in Philosophy of Science 2. The Framework of Mechanistic Explanation: Parts, Operations, and Organization 3. Representing and Reasoning About Mechanisms 4. Mental Mechanisms: Mechanisms that Process Information 5. Discovering Mental Mechanisms 6 . Summary.

What is it for a sentence to have a certain meaning? This is the question that the distinguished analytic philosopher William P. Alston addresses in this major contribution to the philosophy of language. His answer focuses on the given sentence's potential to play the role that its speaker had in mind, what he terms the usability of the sentence to perform the illocutionary act intended by its speaker. Alston defines an illocutionary act as an act of saying something with (...) a certain "content." He develops his account of what it is to perform such acts in terms of taking responsibility, in uttering a sentence, for the existence of certain conditions. In requesting someone to open a window, for example, the speaker takes responsibility for its being the case that the window is closed and that the speaker has an interest in its being opened. In Illocutionary Acts and Sentence Meaning, Alston expands upon this concept, creating a framework of five categories of illocutionary act and going on to argue that sentence meaning is fundamentally a matter of illocutionary act potential; that is, for a sentence to have a particular meaning is for it to be usable to perform illocutionary acts of a certain type. In providing detailed and explicit patterns of analysis for the whole range of illocutionary acts, Alston makes a unique contribution to the field of philosophy of language—one that is likely to generate debate for years to come. (shrink)

William P. Alston formulates and defends a realist conception of truth, which he calls alethic realism (from "aletheia", Greek for "truth").

Introduction As the title indicates, the chief focus of this book is epistemic justification. But just what is epistemic justification and what is its place ...

Divine Nature and Human Language is a collection of twelve essays in philosophical theology by William P. Alston, one of the leading figures in the current renaissance in the philosophy of religion. Using the equipment of contemporary analytical philosophy, Alston explores, partly refashions, and defends a largely traditional conception of God and His work in the world a conception that finds its origins in medieval philosophical theology. These essays fall into two groups: those concerned with theological language and those (...) that deal with the nature, status, and activity of God. In Part 1, Alston develops a conceptual scheme for discussing the topic of theological language. He also argues that there is a core of literal talk about God and even a core of predicates univocally applicable to God and creatures. Furthermore, he shows that God can be referred to directly as well as descriptively. In Parts II and III, the author sketches out a middle way between a classical conception of God exemplified by Aquinas and the more recent “process” or “panentheist” conception exemplified by Hartshorne. Alston argues that such a God can act so as to have real effects in the world and can enter into genuine dialogue and otherwise interact with human beings. In addition, he defends the idea that God provides a foundation for morality. The first collection of Alston's ground breaking work in the philosophy of religion, Divine Nature and Human Language will be welcomed by scholars and students of the philosophy of religion, metaphysics, theology, and religious studies. (shrink)

1. A Historical Look at Unity 2. Field Guide to Modern Concepts of Reduction and Unity 3. Kitcher's Revisionist Account of Unification 4. Critics of Unity 5. Integration Instead of Unity 6. Reduction via Mechanisms 7. Case Studies in Reduction and Unification across the Disciplines.

This paper distinguishes and interrelates a number of respects in which persons have been thought to be in a specially favorable epistemic position vis-A-Vis their own mental states. The most important distinction is a six-Fold one between infallibility, Omniscience, Indubitability, Incorrigibility, Truth-Sufficiency, And self-Warrant. Each of these varieties can then be sub-Divided as the kind of modality, If any, Involved. It is also argued that discussions of self-Knowledge have been hampered by a failure to recognize these distinctions.

Internalism restricts justifiers to what is "within" the subject. two main forms of internalism are (1) perspectival internalism (pi), which restricts justifiers to what the subject knows or justifiably believes, and (2) access internalism (ai), which restricts justifiers to what is directly accessible to the subject. the two forms are analyzed and interrelated, and the grounds for each are examined. it is concluded that although pi is both unacceptable and without adequate support, a modest form of ai might be defended.