We argue that the fragility of contemporary marriages—and the corresponding high rates of divorce—can be explained (in large part) by a three-part mismatch: between our relationship values, our evolved psychobiological natures, and our modern social, physical, and technological environment. “Love drugs” could help address this mismatch by boosting our psychobiologies while keeping our values and our environment intact. While individual couples should be free to use pharmacological interventions to sustain and improve their romantic connection, we suggest that they may have (...) an obligation to do so as well, in certain cases. Specifically, we argue that couples with offspring may have a special responsibility to enhance their relationships for the sake of their children. We outline an evolutionarily informed research program for identifying promising biomedical enhancements of love and commitment. (shrink)

Kant’s account of “the radical evil in human nature” in the 1793 Religion within the Bounds of Reason Alone is typically interpreted as a reworking of the Augustinian doctrine of original sin. But Kant doesn’t talk about Augustine explicitly there, and if he is rehabilitating the doctrine of original sin, the result is not obviously Augustinian. Instead Kant talks about Stoic ethics in a pair of passages on either end of his account of radical evil, and leaves other clues (...) that his argument is a reworking of an old Stoic problem. “Radical evil” refers to the idea that our moral condition is — by default and yet by our own deed — bad or corrupt; and that this corruption is the root (radix) of human badness in all its variety, ubiquity, and sheer ordinariness. Kant takes as his premise a version of the Stoic idea that nature gives us “uncorrupted starting points” (Diogenes Laertius 7.89). What sense can be made of the origin of human badness, given such a premise? Kant’s account of radical evil is an answer to this old Stoic problem, which requires a conception of freedom that is not available in his Stoic sources. (shrink)

This paper addresses a recent suggestion that moral particularists can extend their view to countenance default reasons (at a first stab, reasons that are pro tanto unless undermined) by relying on certain background expectations of normality. I first argue that normality must be understood non-extensionally. Thus if default reasons rest on normality claims, those claims won't bestow upon default reasons any definite degree of extensional generality. Their generality depends rather on the contingent distributional aspects of the world, (...) which no theory of reasons should purport to settle. Appeals to default reasons cannot therefore uniquely support particularism. But this argument also implies that if moral generalism entailed that moral reasons by necessity have invariant valence (in the natural extensional sense), it would be a non-starter. Since generalism is not a non-starter, my argument forces us to rethink the parameters of the generalism-particularism debate. Here I propose to clarify the debate by focusing on its modal rather than extensional aspects. In closing, I outline the sort of generalism that I think is motivated by my discussion, and then articulate some worries this view raises about the theoretical usefulness of the label ‘default reason’. -/- [Note: The outline of moral generalism provided in this paper is superseded by those in "Moral Generalism: Enjoy in Moderation" and "A Theory of Hedged Moral Principles".]. (shrink)

Empathy is a familiar form of emotionally charged imaginative perspective taking. In this dissertation I offer an account of empathy’s moral importance that emphasizes the special value of its unique epistemic functions. Specifically, I defend what I call the humane understanding thesis: empathy is the source of a distinct epistemic good, humane understanding, which consists in the appreciation of the intelligibility of others’ emotional perceptions, and humane understanding is necessary for fully virtuous relations with other people. Adam Smith held that (...) empathy is the unique means by which we judge the propriety of other’s emotions. I draw out the kernel of truth in this surprising claim. Emotions inevitably present the world in a certain evaluative light. When I see my situation as calling out for my anger, or fear, or adoration, my emotion appears to me to be properly responsive to my situation. I can judge my emotion to be inappropriate, all things considered. However, I cannot both be angry at your betrayal and be totally mystified by my own anger, or resent you but see no absolutely nothing in your conduct that appears to call out for my resentment. This insight applies to empathy. When we empathize, we feel genuine emotions. And when we feel these emotions, we cannot fail to appreciate the intelligibility of the other’s original emotion first-hand. This appreciation constitutes humane understanding of the other’s emotion. I further clarify the nature of this epistemic achievement by distinguishing it from two other nearby forms of understanding, one that is achieved through narrative rather than perspective taking, and one that is achieved through unemotional perspective taking. Empathy has recently come in for some heavy criticism. It has been described as not only morally unnecessary, but positively morally corrosive. Recognizing that empathy is the unique means by which we secure humane understanding of others’ emotional perceptions enables us to appreciate aspects of empathy’s moral significance that its most prominent detractors have neglected. Humane understanding is a powerful way of being close to another person, and closeness is something that social beings like ourselves crave, not for any further or deeper purpose, but just because it is valuable to us in and of itself. People have a powerful need to be empathized with because empathy relieves a painful form of loneliness. Empathy can be a way of caring, rather than just a means of getting us to care. In further defense of empathy’s moral significance, I also argue that empathy has a meaningful role to play in the development of both our reflective beliefs about moral properties and our emotional sensitivity to those same properties. Empathy can allow us to discover new moral distinctions through imaginative emotional experience, and it can also help us to shape and sharpen our moral emotional perception. Finally, I round out my review of empathy’s moral significance with an argument that empathy with others makes it very difficult to intend to treat them in certain immoral ways. We cannot both empathize with someone and see them as unfeeling, as unthinking, or as lacking a normative perspective on the world. Consequently, empathizing with someone is at least not compatible with treating them as a mere object. I offer my Smithian picture of empathy’s moral and epistemic functions as an alternative to the popular Humean view that empathy moves us from our default position of solipsism and egoism to knowledge of and care for other’ inner lives. That view’s ambition is tantalizing, but it distorts both the nature of empathy and the nature of our other-oriented concern and understanding. Hume’s account of empathy’s significance, and the more recent accounts that take after it, end up making it look as though empathy simply contributes to the expansion of egoism, and/or as though empathy depends for its motivational efficacy on a kind of epistemic mistake. (shrink)

The concept of distributed moral responsibility (DMR) has a long history. When it is understood as being entirely reducible to the sum of (some) human, individual and already morally loaded actions, then the allocation of DMR, and hence of praise and reward or blame and punishment, may be pragmatically difficult, but not conceptually problematic. However, in distributed environments, it is increasingly possible that a network of agents, some human, some artificial (e.g. a program) and some hybrid (e.g. a group of (...) people working as a team thanks to a software platform), may cause distributed moral actions (DMAs). These are morally good or evil (i.e. morally loaded) actions caused by local interactions that are in themselves neither good nor evil (morally neutral). In this article, I analyse DMRs that are due to DMAs, and argue in favour of the allocation, by default and overridably, of full moral responsibility (faultless responsibility) to all the nodes/agents in the network causally relevant for bringing about the DMA in question, independently of intentionality. The mechanism proposed is inspired by, and adapts, three concepts: back propagation from network theory, strict liability from jurisprudence and common knowledge from epistemic logic. (shrink)

Cardiopulmonary resuscitation is frequently performed on patients who, in retrospect, had a very low chance of survival. This is because all patients are ‘For cardiopulmonary resuscitation’ on admission to hospital by default, and delays occur before cardiopulmonary resuscitation can be ‘de-prescribed’. This article reviews the nature of potential harms caused by futile cardiopulmonary resuscitation, the reasons why de-prescription may be delayed, recent legal judgements relevant to timely do not attempt cardiopulmonary resuscitation decision making, and the possible detrimental effects of (...) do not attempt cardiopulmonary resuscitation discussions on end of life care. The moral and operational feasibility of a model in which informed consent must be obtained before cardiopulmonary resuscitation is attempted in some patient groups is then explored. (shrink)

In Natural Ethical Facts William Casebeer argues that we can articulate a fully naturalized ethical theory using concepts from evolutionary biology and cognitive science, and that we can study moral cognition just as we study other forms of cognition. His goal is to show that we have "softly fixed" human natures, that these natures are evolved, and that our lives go well or badly depending on how we satisfy the functional demands of these natures. Natural Ethical Facts is (...) a comprehensive examination of what a plausible moral science would look like.Casebeer begins by discussing the nature of ethics and the possible relationship between science and ethics. He then addresses David Hume's naturalistic fallacy and G. E. Moore's open-question argument, drawing on the work of John Dewey and W. V. O. Quine. He then proposes a functional account of ethics, offering corresponding biological and moral descriptions. Discussing in detail the neural correlates of moral cognition, he argues that neural networks can be used to model ethical function. He then discusses the impact his views of moral epistemology and ontology will have on traditional ethical theory and moral education, concluding that there is room for other moral theories as long as they take into consideration the functional aspect of ethics; the pragmatic neo-Aristotelian virtue theory he proposes thus serves as a moral "big tent." Finally, he addresses objections to ethical naturalism that may arise, and calls for a reconciliation of the sciences and the humanities. "Living well," Casebeer writes, "depends upon reweaving our ethical theories into the warp and woof of our scientific heritage, attending to the myriad consequences such a project will have for the way we live our lives and the manner in which we structure our collective moral institutions.". (shrink)

In Natural Ethical Facts William Casebeer argues that we can articulate a fully naturalized ethical theory using concepts from evolutionary biology and cognitive science, and that we can study moral cognition just as we study other forms of cognition. His goal is to show that we have "softly fixed" human natures, that these natures are evolved, and that our lives go well or badly depending on how we satisfy the functional demands of these natures. Natural Ethical Facts is (...) a comprehensive examination of what a plausible moral science would look like.Casebeer begins by discussing the nature of ethics and the possible relationship between science and ethics. He then addresses David Hume's naturalistic fallacy and G. E. Moore's open-question argument, drawing on the work of John Dewey and W. V. O. Quine. He then proposes a functional account of ethics, offering corresponding biological and moral descriptions. Discussing in detail the neural correlates of moral cognition, he argues that neural networks can be used to model ethical function. He then discusses the impact his views of moral epistemology and ontology will have on traditional ethical theory and moral education, concluding that there is room for other moral theories as long as they take into consideration the functional aspect of ethics; the pragmatic neo-Aristotelian virtue theory he proposes thus serves as a moral "big tent." Finally, he addresses objections to ethical naturalism that may arise, and calls for a reconciliation of the sciences and the humanities. "Living well," Casebeer writes, "depends upon reweaving our ethical theories into the warp and woof of our scientific heritage, attending to the myriad consequences such a project will have for the way we live our lives and the manner in which we structure our collective moral institutions.". (shrink)

The body and bodily experience make little appearance in analytic moral philosophy. This is true even of analytic sexual ethics—the one area of ethical inquiry we might have expected to give a starring role to bodily experience. I take a small step toward remedying that by identifying one way in which the bodily experience of sex is ethically significant: some of the physical actions of sex have a default expressive significance, conveying trust, affection, care, sensitivity, enjoyment, and pleasure. (...) When people having sex don't in fact have these feelings, the sex can be misleading, even if they've antecedently communicated that they don't have these feelings. This account of how sex can mislead is inspired by a perhaps surprising source, Catholic sexual morality. Analytic sexual ethicists could benefit from emulating Catholic sexual morality's attentiveness to the bodily nature of sex and its ethical significance. (shrink)

In this essay we provide (1) an argument for why ethics should be naturalized, (2) an analysis of why it is not yet naturalized, (3) a defense of ethical naturalism against two fallacies—Hume’s and Moore’s—that ethical naturalism allegedly commits, and (4) a proposal that normative ethics is best conceived as part of human ecology committed to pluralistic relativism. We explain why naturalizing ethics both entails relativism and also constrains it, and why nihilism about value is not an (...) especially worrisome for ethical naturalists. The substantive view we put forth constitutes the essence of Duke Naturalism. (NOTE: This is a slightly modified reprint of Flangan et al 2007 of the same title.). (shrink)

In this essay we provide (1) an argument for why ethics should be naturalized, (2) an analysis of why it is not yet naturalized, (3) a defense of ethical naturalism against two fallacies—Hume’s and Moore’s—that ethical naturalism allegedly commits, and (4) a proposal that normative ethics is best conceived as part of human ecology committed to pluralistic relativism. We explain why naturalizing ethics both entails relativism and also constrains it, and why nihilism about value is not an (...) especially worrisome for ethical naturalists. The substantive view we put forth constitutes the essence of Duke Naturalism. (shrink)

Making research data readily accessible during a public health emergency can have profound effects on our response capabilities. The moral milieu of this data sharing has not yet been adequately explored. This article explores the foundation and nature of a duty, if any, that researchers have to share data, specifically in the context of public health emergencies. There are three notable reasons that stand in opposition to a duty to share one’s data, relating to: (i) data property and ownership, (ii) (...) just distribution of benefits and burdens and (iii) the contemporary ethos of science. We argue each reason can be successfully met with corresponding rationale in favour of data sharing. Further support for data sharing has been echoed in policies of health agencies, funding bodies and academic institutions; in documents on the ethical conduct of biomedical research; and in discussions on the nature of public health. From this, we ascertain that sharing data is the morally sound default position. This article then highlights the key roles reciprocity and solidarity play in supporting the practice of data sharing. We conclude with recommendations to regard public health research data as a common-pool resource in order to build a framework for stable data sharing management. (shrink)

The COVID-19 pandemic has, of necessity, demanded the rapid incorporation of virtual technologies which, suddenly, have superseded the physical medical encounter. These imperatives have been implemented in advance of evaluation, with unclear risks to patient care and the nature of medical practice that might be justifiable in the context of a pandemic but cannot be extrapolated as a new standard of care. Models of care fit for purpose in a pandemic should not be generalized to reconfigure medical care as virtual (...) by default, and personal by exception at the conclusion of the emergency. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might (...) be causing them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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In Nature Ethics: An Ecofeminist Perspective, Marti Kheel explores the underlying worldview of "nature ethics," offering an alternative ecofeminist approach. Seeking to heal the divisions between the seemingly disparate movements and philosophies of feminism, animal advocacy, environmental ethics, and holistic health, Kheel proposes an ecofeminist philosophy that underscores the importance of empathy and care for individual beings as well as larger wholes.

This essay argues against Richard Joyce, using him as an exemplar of a number of writers who purport to show that the best a naturalized ethics can provide are demands that we can hold only as moral agnostics; that is, that no moral claims can be shown to be epistemically warranted, hence no moral claims have the property of “inescapable authority” necessary for real moral discourse or deliberation. The prudent course of action is therefore to act as if moral (...) claims had categorical standing, knowing full well that we cannot, in principle, know this. The essay proposes instead that a fully naturalized account of moral reasoning and sentiments, compatible with the commitment to understanding human beings as products of evolutionary processes, can provide “existence imperatives” necessarily implicated in our being social animals. It argues that, on the one hand, we're mistaken in believing that real moral discourse must include imperatives that hold with inescapable authority as a foundation and, on the other, that a naturalistic perspective can offer demands that are authoritative enough to make moral judgment sound. (shrink)

Moral agency is a central feature of both religious and secular conceptions of human beings. In this paper I outline a scientific naturalistic model of moral agency making use of current findings and theories in sociobiology,developmental psychology, and social cognitive theory. The model provides answers to four central questions about moral agency: what it is, how it is acquired, how it is put to work, and how it is justified. I suggest that this model can provide religious and secular moral (...) theories with a basis for a common understanding of moral agency. (shrink)

The error theory of moral judgment says that moral judgments, though often believed to be objectively true, never are. The tendency to believe in the objectivity of our moral beliefs, like the beliefs themselves, is rooted in objective features of human psychology, and not in objective features of the natural world that might exist apart from human psychology. In naturalized epistemology, it is tempting to take this view as the default hypothesis. It appears to make the fewest assumptions (...) in accounting for the fact that humans not only make moral judgments, but believe them to be, at least some of the time, objectively true. In this paper I argue that from an evolutionary perspective, the error theory is not the most parsimonious alternative. It is simpler to suppose that mental representations with moral content arose as direct cognitive and motivational responses to independent moral facts. (shrink)

As the vulgar generally look no higher for the original of moral good and evil, just and unjust, than the codes and pandects, the tables and laws of their country and religion, so there have not wanted pretended philosophers in all ages who have asserted nothing to be good and evil, just and unjust, naturally and immutably; but that these things were positive, arbitrary and factitious only.1 In this short presentation I want to propose a sketch of what “naturalizing (...) class='Hi'>ethics from a Girardian perspective” would look like. My goal is not to engage in a Girardian tentative at naturalizing ethics, but rather to contrast what such a project entails in comparison with some of the current attempts at .. (shrink)

The reticence of scholars of ethics to enter into fundamental moral reasoning is well known. William Casebeer’s ambitious new book, Natural Ethical Facts: Evolution, Connectionism, and Moral Cognition, which is the publication of his 2001 University of California, San Diego, Ph.D. dissertation, stands in stark contrast. Casebeer, who teaches philosophy at the U.S. Air Force Academy, has undertaken the project of developing a comprehensive moral theory derived from what he terms “methodological naturalism.” Methodological naturalism, he explains, is a (...) system of moral reasoning derived exclusively from the empirically verifiable claims of science. His ethic starts with the materialist premise that all reality is reducible to matter and energy; since matter and energy are sufficiently explainable in terms of facts derived from the scientific method; morality too, as real—he is undeniably a moral realist—must be sufficiently explained in terms of such facts. With particular attention given to the cognitive sciences and evolutionary biology, Casebeer’s naturalism boldly asserts that ethics is reducible to science, moral norms to empirical facts, and practical judgments to theoretical propositions. This of course implicates the author in what critics refer to as the “naturalistic fallacy,” that is, the illicit inference from facts to norms. Aware of this, Casebeer attempts to show that such an inference is not only not illicit but itself the substance of fundamental moral reasoning. Unfortunately his refutation of the naturalistic fallacy is selective. He reduces the entire complex discussion to a distinction between analytic and synthetic statements, then successfully throws into doubt the existence of such a distinction and judges himself done with the whole question. Using David Hume and G. E. Moore as his principal foils, his refutation entirely ignores the most enduring and plausible argument against deriving “ought” from “is,” proposed by the great medieval philosopher Thomas Aquinas and his contemporary expositor, the Oxford philosopher John Finnis. (shrink)

This book offers a unique account of the development of thinking about nature from Early German Romanticism into the philosophies of nature of Schelling, Hegel, and beyond. Alison Stone explores the ethical and political implications of German Romantic and Idealist ideas about nature, including for gender, race, and environmentalism.

This article argues that underlying Thomas Hobbes' prescription for concentrated power is system of ethics based on his understanding of human nature and the biological processes that govern natural human function. His thesis in Leviathan is not so much an argument for how rulers should rule as much as it is an argument for why individuals should allow themselves to be ruled in a specific manner. The justification for accepting rule comes from right reason which, in turn, comes (...) to us from the dictates of the biological organism. If the biological organism is functioning correctly, it supports those processes and impulses which drive self-preservation. Anything that corrupts these natural processes and impulses are said to contravene right reason. Ultimately, the author believes that theoretical discourse concerning the essential interplay between political ethics and human nature should include consideration of Hobbes alongside Aristotle, David Hume, and others. (shrink)

This paper argues that Aristotelian ethical naturalism can combine two commitments that are often held to be incompatible: (a) a commitment to a strong form of ethical objectivity and (b) a thoroughgoing historicism about ethical value. The notions of species and life-form invoked by ethical naturalism do not, I argue, rely upon an ahistorical picture of human nature. I develop this idea by building upon Philippa Foot's defence of ethical naturalism in Natural Goodness. I go on to argue that (...) linguistic changes in the ways we articulate the conditions of human flourishing can be understood, in some cases, as transforming those very conditions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Considering AnimalsKheel's Nature Ethics and Animal Debates in EcofeminismNoël Sturgeon (bio)How we treat the use of animals by humans for sport, experimentation or food has been controversial within ecofeminism. While it is fair to say that all ecofeminists agree that factory farming and cruel treatment of animals is morally wrong, universal arguments for vegetarianism or veganism have been, if one forgives the metaphor, a bone of contention. Attached (...) to these disagreements are important philosophical and political debates about ecological holism, individualistic frameworks, cultural difference, social privilege and ethics of care, which are consequential above and beyond evaluating our treatment of animals. Thus, ecofeminist discussions of animal issues have been formative for environmental ethics and politics, while remaining a delicate matter when disagreement occurs among a relatively small group of thinkers, activists and scholars who tend towards solidarity.Val Plumwood, the important Australian philosopher whose work and life are celebrated in this volume, was especially cognizant of all of this. In April 1998, Plumwood presented an early version of what became two articles on animal/human relationships (Plumwood 1999, 2000) at the Ecofeminist Perspectives Conference at the University of Montana. [End Page 153] The presentation, which occurred early in the conference, was, typical of Plumwood, straightforwardly contentious, a bold challenge to the position of some ecofeminists at the time that veganism was the only morally acceptable diet. In it, she suggested that what she called "ontological veganism" was a position that was both culturally ethnocentric and dualistic, two accusations guaranteed to deeply disturb this particular audience. The conference, organized by Deborah Slicer (whose 1996 article, "Your Daughter or Your Dog?" argued against animal experimentation), was also attended by Marti Kheel (who, along with Carol Adams, was an early proponent of "ontological veganism"). Present also were thinkers with more nuanced positions on the issue, such as Lori Gruen, Greta Gaard, and Karen Warren. Thus, Plumwood's provocation felt personal, and produced lively debate at the conference, and an even livelier argument on email afterwards.1 Stung by being portrayed as racist, several ecofeminists reacted with anger at Plumwood, with the result that she publicly rejected the label "ecofeminist," and from then until her untimely death, preferred the category "critical feminist eco-socialism" to describe her framework.Despite the hurt feelings, this debate (and Plumwood's subsequent articles and sections in her 2002 book, Environmental Culture: The Ecological Crisis of Reason), moved ecofeminist treatment of the issues of animals and morally sound eating practices considerably forward. Plumwood argued that to avoid the dualism of human/nature, humans should recognize themselves as prey as well as predator, an approach she brilliantly portrayed in her article on the experience of surviving a crocodile attack. (Plumwood 1995) In her view, any position that eliminated the possibility of using some animals as food necessarily relied upon a rights-based, individualistic approach that retained the status of some living beings as excluded from moral consideration. Yet, Plumwood argued, from a contextualized moral position, which respected both continuity and difference between different groups of living beings, one could make ethical claims about the moral problems of eating animals. She was particularly interested, both philosophically and from a politically strategic perspective, in arguing against the practice of factory farming. Karen Warren, in her book Ecofeminist Philosophy (2000), also followed and expanded Plumwood's discussion by emphasizing the advantages of a contextualized ethic of care in the treatment of animals as food, arguing (and as such agreeing with Plumwood's conference presentation), that it was ethnocentric [End Page 154] to insist on universal standards in evaluating whether some cultural groups, such as the Inuit, could morally refrain from eating animals. Greta Gaard's thoughtful article on the indigenous Makah whale hunt (2001) took on the charge of ethnocentrism directly, as in some ways an answer to Plumwood's provocation.Given this background, it is interesting to read Marti Kheel's important new book and see how her promotion of veganism as a moral position is articulated. A longtime feminist, vegan, and animal advocate, Kheel is a co-founder of the activist group Feminists for Animal Rights, and the author of an important early critique of deep... (shrink)

I offer several reasons for rejecting naturalism as a philosophical viewpoint or program envisaged for two paradigm cases: the case of mathematics and the case of ethics. Semantical, epistemological and metaphysical similarities between the two are investigated and assessed. I then offer a sketch of a different way of understanding the nature of mathematical difficulties and that of ethical puzzles.

Default positions, predetermined starting points that aid in complex decision-making, are common in clinical medicine. In this article, we identify and critically examine common default positions in clinical ethics practice. Whether default positions ought to be held is an important normative question, but here we are primarily interested in the descriptive, rather than normative, properties of default positions. We argue that default positions in clinical ethics function to protect and promote important values in (...) medicine—respect for persons, utility, and justice. Further, default positions in clinical ethics may also guard against harm. Where default positions exist, there are epistemic burdens to overturn them. The person wishing to reject the default position, rather than the person endorsing it, bears this burden. The person who bears the burden of meeting the epistemic requirements must provide evidence proportional to the degree of harm the default position protects against. Default positions that protect against significant harm impose significant epistemic requirements to overturn. This asymmetry not only makes medical decision-making more economical but also serves to promote and protect certain values. The identification and analysis of common and recognizable default positions can help to identify other default positions and the conditions under which their associated epistemic requirements are met. The article concludes with considerations of potential problems with the use of default positions in clinical ethics. (shrink)

Ethical naturalism is an ethical theory that holds that practical norms are a species of natural norms. It was a position held by almost all ancient ethical theorists, but despite a renaissance among some in the past three quarters of a century, it fell by and large into ill repute centuries ago. This dissertation aims to assess contemporary naturalism in light of that history. In chapter two, I note that contemporary ethical naturalism has had little interest in the historical (...) background of their own theorizing, and I try to fill that gap. The remaining chapters contribute to this task. In chapter three, I explore the concepts of nature at work in some of the writings of Aristotle and Cicero, suggesting that Aristotle has a richer conceptual repertory than usually realised, which could be of use to contemporary ethical naturalists, and that Cicero is needlessly neglected by them. In chapter four, I consider two significant historical developments that make the use of nature concepts difficult today. First, I consider the rise of the empirical human sciences. Second, I consider a line of thinking that concerns nature’s relation to history and society, a line that moves from Rousseau through Kant. I consider too the legacy of this line of thought among neo-Kantians. In chapter five, I consider a final challenge for ethical naturalists, that of genealogy and reflection. Certain kinds of genealogies have been put forth to show the irrelevance of concepts of nature to ethics, but I try to vindicate the notion that ethical naturalism not only can but must be vindicated using a kind of genealogical method. In conclusion, I remark on the prospects of an ethical naturalism more explicitly in conversation with the human sciences and with the history of nature concepts in ethical life. (shrink)