The paper is written in response to those who fail to recognize the relation between a patient's mental competency and her state of pain. Some clinicians claim that a proper diagnosis can only be made in the absent of analgesia. Rather, the patient's state of pain directly affects her mental competency and thus her ability to give valid consent. Clinicians should rethink their approach to diagnosis when the patient is in pain.

At least four different frameworks — psychiatric, cognitive, functional and decision-making — are used in the evaluation of competence, all of which remain more or less unrelated in the literature. In the first section of this paper we consider various meanings of competence, in order to arrive at a definition of the term relevant to the medical and legal setting. Patient or client competence, we conclude, refers to the practical abilities that individuals employ in pursuing their own autonomous goals in (...) life. We then show how a systematic categorization of these practical abilities — which we call a taxonomy of practical judgment — allows us to show when the traditional frameworks for the evaluation of competence may or may not be useful in the evaluation of a particular competence.In the final section we explore some of the normative considerations underlying the taxonomy. For instance, competence is not only related to intrinsic abilities but to resources available in the community. Here we touch on questions related to the fair distribution of community resources. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

This book is a collection of secondary essays on America's most important philosophic thinkers—statesmen, judges, writers, educators, and activists—from the colonial period to the present. Each essay is a comprehensive introduction to the thought of a noted American on the fundamental meaning of the American regime.

Charles R. Kesler, an eminent scholar and prodigious editor, has exerted a profound influence on the study of American politics and the practice of American conservatism. A precocious high-school student, he impressed a visiting William F. Buckley Jr. who, before becoming a life-long friend, wrote him a recommendation letter to Yale. Kesler asked for another--to Harvard, where he completed his undergraduate degree and earned a PhD under the legendary professor Harvey C. Mansfield. An early passion for political journalism, (...) played out largely on the pages of National Review, led Kesler to author an NR cover story on his third great influence, Harry V. Jaffa. Kesler became a faculty colleague of Jaffa's at Claremont McKenna College and Claremont Graduate University and is perhaps best known as the editorial helmsman of the Claremont Review of Books. The author of I Am the Change: Barack Obama and the Crisis of Liberalism and Crisis of the Two Constitutions: The Rise, Decline, and Recovery of American Greatness, Kesler also co-edited (with William F. Buckley Jr.) Keeping the Tablets: Modern American Conservative Thought. His edited volume of The Federalist Papers is the best-selling edition version in the country. In this volume, Kesler's students, friends, and colleagues commemorate his four-decade career as a teacher, mentor, and scholar. (shrink)

During the past few decades a growing interest in what is often called the ‘Kyoto School’ of philosophy has evidenced itself here and there in the West, especially in discussions of comparative religious thought and in the pages of journals which are sensitive, in the post-colonial world, to the value of giving attention to contemporary thought that originates outside the Anglo-American and continental contexts. What has made the so-called Kyoto School especially interesting is the fact that those thinkers identified with (...) it obviously possess a wide acquaintance with Western thought but also have a programme of clarifying points at which they, as Japanese philosophers, find Western philosophy either in sum or in its parts inadequate or objectionable. Moreover, inasmuch as the philosophers of the Kyoto School have deliberately reached back into the Mahayana Buddhist component in Japanese civilization in order to find terms, perspectives, and even foundations for their own analyses and constructions, Western students of comparative religion and comparative thought have in the study of this school a unique aperture for observing how a group of thinkers, while sharing modernity and its problems with us, reates both of these to a religious tradition which is in many ways strikingly different from that of the West. (shrink)

William Uttal is concerned that in an effort to prove itself a hard science, psychology may have thrown away one of its most important methodological tools—a critical analysis of the fundamental assumptions that underlie day-to-day empirical research. In this book Uttal addresses the question of localization: whether psychological processes can be defined and isolated in a way that permits them to be associated with particular brain regions. New, noninvasive imaging technologies allow us to observe the brain while it is (...) actively engaged in mental activities. Uttal cautions, however, that the excitement of these new research tools can lead to a neuroreductionist wild goose chase. With more and more cognitive neuroscientific data forthcoming, it becomes critical to question their limitations as well as their potential. Uttal reviews the history of localization theory, presents the difficulties of defining cognitive processes, and examines the conceptual and technical difficulties that should make us cautious about falling victim to what may be a "neo-phrenological" fad. (shrink)

Despite the fact that psychedelics were proscribed from medical research half a century ago, recent, early-phase trials on psychedelics have suggested that they bring novel benefits to patients in the treatment of several mental and substance use disorders. When beneficial, the psychedelic experience is characterized by features unlike those of other psychiatric and medical treatments. These include senses of losing self-importance, ineffable knowledge, feelings of unity and connection with others and encountering ‘deep’ reality or God. In addition to symptom relief, (...) psychedelic experiences often lead to significant changes in a patient’s personality and worldview. Focusing on the case of psilocybin, we argue that the peculiar features of psychedelics pose certain novel risks, which warrant an enhanced informed consent process–one that is more comprehensive than what may be typical for other psychiatric medications. We highlight key issues that should be focused on during the consent process and suggest discussion prompts for enhanced consent in psychedelic psychiatry. Finally, we respond to potential objections before concluding with a discussion of ethical considerations that will arise as psychedelics proceed from highly controlled research environments into mainstream clinical psychiatry. (shrink)

Why would a country strongly influenced by Buddhism's reverence for life allow legalized, widely used abortion? Equally puzzling to many Westerners is the Japanese practice of mizuko rites, in which the parents of aborted fetuses pray for the well-being of these rejected "lives." In this provocative investigation, William LaFleur examines abortion as a window on the culture and ethics of Japan. At the same time he contributes to the Western debate on abortion, exploring how the Japanese resolve their conflicting (...) emotions privately and avoid the pro-life/pro-choice politics that sharply divide Americans on the issue. (shrink)

Skepticism about ethical expertise has grown common, raising concerns that bioethicists’ roles are inappropriate or depend on something other than expertise in ethics. While these roles may depend on skills other than those of expertise, overlooking the role of expertise in ethics distorts our conception of moral advising. This paper argues that motivations to reject ethical expertise often stem from concerns about elitism: either an intellectualist elitism, where some privileged elite have supposedly special access in virtue of expertise in moral (...) theory; or an authoritarian elitism, where our reliance on experts in ethics risks violation of autonomy and democracy. The paper sketches an anti-elitist conception of ethics expertise in bioethics as continuous with an anti-elitist conception of ethics expertise in common moral practice, undercutting the intellectualism, and then uses this anti-elitist conception to reject arguments that ethical expertise violates autonomy or democracy. An anti-elitist picture of ethical expertise both renders it consistent with our general moral practice and allows us to resist skeptical concerns. (shrink)

Sections include: experiments and generalised causal inference; statistical conclusion validity and internal validity; construct validity and external validity; quasi-experimental designs that either lack a control group or lack pretest observations on the outcome; quasi-experimental designs that use both control groups and pretests; quasi-experiments: interrupted time-series designs; regresssion discontinuity designs; randomised experiments: rationale, designs, and conditions conducive to doing them; practical problems 1: ethics, participation recruitment and random assignment; practical problems 2: treatment implementation and attrition; generalised causal inference: a grounded theory; (...) generalised causal inference: methods for single studies; generalised causal inference: methods for multiple studies; a critical assessment of our assumptions. (shrink)

In a recent essay review of William R. Newman, Atoms and Alchemy (2006), Ursula Klein defends her position that philosophically informed corpuscularian theories of matter contributed little to the growing knowledge of "reversible reactions" and robust chemical species in the early modern period. Newman responds here by providing further evidence that an experimental, scholastic tradition of alchemy extending well into the Middle Ages had already argued extensively for the persistence of ingredients during processes of "mixture" (e.g. chemical reactions), and (...) that this corpuscular alchemical tradition bore important fruit in the work of early modern chymists such as Daniel Sennert and Robert Boyle. (shrink)

It no longer is true in a metaphorical sense only that a person can have a change of heart. We might grant this much — allow that a person may have one heart at one time and have another heart at still another time — and also resist the idea that a person can have a change of mind in anything other than a qualitative sense. In the discussion that follows, this standard view of the matter is called into question. (...) If the argument presented here is sound, it can happen both that one person has numerically different minds at different times and that different people have the same mind at different times. These possibilities, as I take them to be, call for reassessment of some well entrenched assumptions concerning personal identity and responsibility. In particular, they suggest that it may not be true that person A bears responsibility for making decisions person B previously made only on the condition that A is the same person as B. (shrink)

Several prominent writers including Norman Daniels, James Sabin, Amy Gutmann, Dennis Thompson and Leonard Fleck advance a view of legitimacy according to which, roughly, policies are legitimate if and only if they result from democratic deliberation, which employs only public reasons that are publicised to stakeholders. Yet, the process described by this view contrasts with the actual processes involved in creating the Affordable Care Act and in attempting to pass the Health Securities Act. Since the ACA seems to be legitimate, (...) as the HSA would have been had it passed, there seem to be counterexamples to this view. In this essay, I clarify the concept of legitimacy as employed in bioethics discourse. I then use that clarification to develop these examples into a criticism of the orthodox view–that it implies that legitimacy requires counterintuitively large sacrifices of justice in cases where important advancement of healthcare rights depends on violations of publicity. Finally, I reply to three responses to this challenge: that some revision to the orthodox view salvages its core commitments, that its views of publicity and substantive considerations do not have the implications that I claim and that arguments for it are strong enough to support even counterintuitive results. My arguments suggest a greater role for substantive considerations than the orthodox view allows. (shrink)

This essay argues that Japan's resistance to the practice of transplanting organs from persons deemed “brain dead” may not be the result, as some claim, of that society's religions being not yet sufficiently expressive of love and altruism. The violence to the body necessary for the excision of transplantable organs seems to have been made acceptable to American Christians at a unique historical “window of opportunity” for acceptance of that new form of medical technology. Traditional reserve about corpse mutilation had (...) weakened and, especially as presented by the theologian Joseph Fletcher, organ donation was touted as both expressive of agape and a way of “updating” Christianity via the ethics of Utilitarianism. Many Japanese, largely Buddhist and Confucian in their orientation, view these changed valorizations as neither necessary nor patently more ethical than those of their own traditions. (shrink)

Debates about the ethics of health care and medical research in contemporary pluralistic democracies often arise partly from competing religious and secular values. Such disagreements raise challenges of balancing claims of religious liberty with claims to equal treatment in health care. This paper proposes several mid-level principles to help in framing sound policies for resolving such disputes. We develop and illustrate these principles, exploring their application to conscientious objection by religious providers and religious institutions, accommodation of religious priorities in biomedical (...) research, and treatment of patients’ religious views in doctor–patient encounters. Given that no sound set of guiding principles yields precise solutions for every policy dispute, we explore how morally sound democracies might deliberatively resolve such policy issues, following our proposed principles. Taken together and carefully interpreted, these principles may help in guiding difficult decision making in the indefinitely large realm where government, medical providers, and patients encounter problems concerning religion and medicine. (shrink)

Alan Chalmers uses Robert Boyle’s mechanical philosophy as an example of the irrelevance of ‘philosophy’ to ‘science’ and criticizes my 2006 book Atoms and alchemy for overemphasizing Boyle’s successes. The present paper responds as follows: first, it argues that Chalmers employs an overly simplistic methodology insensitive to the distinction between historical and philosophical claims; second, it shows that the central theses of Atoms and alchemy are untouched by Chalmers’s criticisms; and third, it uses Boyle’s analysis of subordinate causes and his (...) debate with Henry More in the 1670s to demonstrate the inadequacy of Chalmers’s construal of the mechanical philosophy.Keywords: Robert Boyle; Alan Chalmers; Geber; Paul of Taranto; Daniel Sennert; Alchemy; Chymistry; Mechanical philosophy; Reduction to the pristine state. (shrink)

William R. Caspary makes the case for Dewey as a more discerning and challenging political theorist than this.

We investigate the role of personal values in an investment decision in a controlled experimental setting. Participants were asked to choose an investment in a bond issued by a tobacco company or a bond issued by a non-tobacco company that offered an equal or sometimes lower yield. We then surveyed the participants regarding their feelings toward tobacco use to determine whether these values influenced their investment decision. Using factor analysis, we identified investment- and tobacco-related dimensions on which participants’ responses tended (...) to load. Two of these factors, relating to the societal impact of investment decisions and the health effects of tobacco, were highly significant in determining whether participants selected a tobacco or non-tobacco related investment. More importantly, we found that when the rate of return on a tobacco-related investment exceeds the rate of return on an investment not involving tobacco by 1%, the intensity of participant concerns about the societal effects of their investment decisions was especially important in determining investment choices. This finding indicates that traditional wealth-maximization approaches, which do not consider the personal values of the investor, omit an important factor that affects investment decisions. (shrink)

Part of the ambiguity lies in the various points of view from which this question might be considered. The crudest di erence lies between the point of view of the working mathematician and that of the logician concerned with the foundations of mathematics. Now some of my fellow mathematical logicians might protest this distinction, since they consider themselves to be just more of those \working mathematicians". Certainly, modern logic has established itself as a very respectable branch of mathematics, and there (...) are quite a few highly technical journals in logic, such as The Journal of Sym-. (shrink)

William R. Stirton; III*—The Logical Status of ‘Exists’, Proceedings of the Aristotelian Society, Volume 95, Issue 1, 1 June 1995, Pages 37–50, https://doi.org/.

Japan's Buddhists view bodily enhancement neither negatively in terms of sin nor positively as repairing the world. They prefer prudence, however, due to the fact that human desires will be enflamed by proffered new biotechnologies and ironically increase psychosocial dissatisfaction. In spite of great pressures for bodily enhancements within in East Asian societies, bioethicists issue strong cautions.

In what follows, I draw on things I have found in Japanese discussions of bioethics in order to clarify some aspects of the ethics of biotechnological enhancement. In doing so it will, I hope, become evident that what we might call a “religious” component is in Japan somewhat differently construed than in the contexts with which we are more likely to be familiar in North America. And in the end an attempt will be made here to show that the materials (...) considered give us all – not just the Japanese – reasons for going forward with biological enhancement technologies only on condition that extreme caution be exercised. The fast-moving, oncoming traffic in this domain ought to be forced, these materials suggest, to come up to a caution-demanding signal – not a green light but one that is unambiguously amber. Caution and perhaps even a full stop appear to be in order. (shrink)

In this volume Loader examines three substantial and historically important sets of documents the writings of Philo of Alexandria, the histories of Josephus, ...

In lieu of an abstract, here is a brief excerpt of the content:Unconventional Guest: Masao Abe’s Dialogue with the American AcademyWilliam R. LaFleurDuring the two years we were together at Princeton I once took Masao Abe to meet my parents, then alive and living in New Jersey. I had told them some things in advance about Abe, about Zen, and about what in Abe’s ways could at times be unconventional. My mother, I knew, would put lots of effort into preparing (...) the Sunday dinner we ate on the day of our visit. At the meal’s conclusion Abe turned to my mother and declared: “Mrs. LaFleur, this meal has been simply outrageous! ” For a moment I thought he might have meant “delicious” and had landed on the wrong word. But then I saw his smiling eyes and mouth. He had meant what he said. Everyone laughed and my mother promptly thanked him for his “compliment.”Being at times a genially unconventional guest, one who also in academic or dialogic contexts would say surprising or even unsettling things, was something at which Abe excelled. He was also unconventional in his teaching. He frustrated us when we expected the usual approach. In the book edited by Donald Mitchell I told how in 1969 at the University of Chicago Abe aggravated those of us graduate students who wanted to do a survey of all of modern Japanese philosophy; Abe forced us to stay with certain sentences in Nishida, wanting our minds to be changed. He would not budge.1Some years later at Princeton he proved to be maddeningly insistent on this. Reading The Platform Sutra of the Sixth Patriarch with graduate students in 1977 who knew some Chinese and Japanese was not for Professor Abe going to be exercise in the usual historico-textual excavation; all that was available, he said, in the introduction and notes to Philip Yampolsky’s translation of that text. He was not interested in an “objectification” that put distance between the voice speaking through the text and the person being addressed by it today. For him the ancient text must read as if written for us and for us today. With Abe as teacher the dialogic mode of the seminar room had to replicate in its own way the lecture hall of the Ta-fan Temple! But graduate students at Princeton, inured as they were to the conventional mode of textual-historical analysis, were made clearly uncomfortable by this. Therefore, hoping I might serve as a mediator, they asked me to ask Abe if we might be more historical and move on more quickly. When, with some trepidation, I transmitted this request [End Page 127] to Abe, he merely chuckled and smiled, leaving me to guess why we should expect no change in his emphasis. What follows is my attempt to unpack what was involved in this... and why it remains relevant today.Even some more recent scholars of East Asian Buddhism in our academy today resemble those graduate students back then in Princeton. They, too, have been suggesting that there was something “behind the times” or in need of being updated in the dialogic teaching mode used so brilliantly by Abe—as well as by Hisamatsu Shin’ichi and D. T. Suzuki. However, there is, I think, something both laughably conventional and arrogantly neocolonialist in these critics’ assumptions. They believe that textual and historicist methods (of which Ideologiekritik is an extension) remain something that the West still needs to teach to the non-West, that these render all other methods outdated and irrelevant, and that they can be deployed to expose what remains flawed in the way that, for instance, Japanese such as Abe study and teach Buddhism and Zen.Ironically, this presumptuous stance itself crumbles under historical and textual analysis—at least when applied to Japan. In various studies, Michael Pye has shown that Tominaga Nakamoto’s studies of Buddhist texts, historical and critical to the core, were done in the early seventeenth century and show a solid tradition of scholarship in this mode arising there without any influence from Europe. As Pye shows, interest in the plurality of religions and an early stage of a “science of religions” were present in Japan... (shrink)