Almost every contemporary theory of knowledge is a version of fallibilism, yet an adequate statement of fallibilism has not yet been provided. Standard definitions cannot account for fallibilistic knowledge of necessary truths. I consider and reject several attempts to resolve this difficulty before arguing that a belief is an instance of fallibilistic knowledge when it could have failed to be knowledge. This is a fully general account of fallibilism that applies to knowledge of necessary truths. Moreover, it reveals, not only (...) the connection between fallibility and error, but the connection between fallibility and accidental truth as well. (shrink)

Plato seems to have been pessimistic about how most people stand with regard to virtue. However, unlike the Stoics, he did not conclude that most people are vicious. Rather, as we know from discussions across several dialogues, he countenanced decent ethical conditions that fall short of genuine virtue, which he limited to the philosopher. Despite Plato's obvious interest in this issue, commentators rarely follow his lead by investigating in detail such conditions in the dialogues. When scholars do investigate what kind (...) of virtue, if any, Plato thinks is open to non-philosophers, they typically look to the Republic. But in the Republic Plato sets out an ideal city; therefore, the virtue available to non-philosophers there is likely different from what he thinks is available to them in the real world. If we want to determine Plato's thoughts about the virtue of actual non-philosophers, we must look elsewhere. In this paper, I set my sights on the Phaedo. (shrink)

Some disability rights advocates criticise prenatal testing and selective abortion on the grounds that these practices express negative attitudes towards existing persons with disabilities. Disability rights advocates also commonly criticise and oppose physician-assisted suicide (PAS) and euthanasia on the same grounds. Despite the structural and motivational similarity of these two kinds of arguments, there is no literature comparing and contrasting their relative merits and the merits of responses to them with respect to each of these specific medical practices. This paper (...) undertakes such a comparison. My thesis is that a number of potentially significant weaknesses of the expressivist argument against reproductive technologies are avoided when the argument is used against PAS. In particular, I try to show that three common criticisms of the expressivist argument applied to reproductive technologies, whatever merit they have, have even less merit when they are used to reply to the expressivist argument applied to PAS. This is important because the expressivist argument applied to the end of life scenario does not get as much attention as the argument applied to the beginning of life scenario, and yet it has a relatively stronger position. (shrink)

Although recent epistemology has been marked by several prominent disagreements – e.g., between foundationalists and coherentists, internalists and externalists – there has been widespread agreement that some form of fallibilism must be correct. According to a rough formulation of this view, it is possible for a subject to have knowledge even in cases where the justification or grounding for the knowledge is compatible with the subject’s being mistaken. In this paper, I examine the motivation for fallibilism before providing a fully (...) general account of the view. I conclude by looking at the two major difficulties for fallibilism: the Gettier problem and the lottery paradox. (shrink)

I argue that Aristotle believes that virtue comes in degrees. After dispatching with initial concerns for the view, I argue that we should accept it because Aristotle conceives of heroic virtue as the highest degree of virtue. I support this interpretation of heroic virtue by considering and rejecting alternative readings, then showing that heroic virtue characterized as the highest degree of virtue is consistent with the doctrine of the mean.

Epistemic circularity occurs when a subject forms the belief that a faculty F is reliable through the use of F. Although this is often thought to be vicious, externalist theories generally don't rule it out. For some philosophers, this is a reason to reject externalism. However, Michael Bergmann defends externalism by drawing on the tradition of common sense in two ways. First, he concedes that epistemically circular beliefs cannot answer a subject's doubts about her cognitive faculties. But, he argues, subjects (...) don't have such doubts, so epistemically circular beliefs are rarely called upon to play this role. Second, following Thomas Reid, Bergmann argues that we have noninferential, though epistemically circular, knowledge that our faculties are reliable. I argue, however, that Bergmann's view is undermined by doubts a subject should have and that there is no plausible explanation for how we can have noninferential knowledge that our faculties are reliable. (shrink)

Although the use of stakeholder analysis to investigate corporate responsibilities has burgeoned over the past two decades, there has been relatively little workon howcorporate responsibilities may change for firms with operations in developing countries. This article argues, from a critical theory perspective, that two sets of factors tend to come together to increase the responsibilities of corporations active in developing countries to a full range of stakeholder groups: (a) the different (economic, political, and sociocultural) circumstances under which corporations have to (...) operate in developing countries and (b) several key normative principles, which typically do not come into play in the context of developed countries. (shrink)

Corporate governance reforms are occurring in countries around the globe. In developing countries, such reforms occur in a context that is primarily defined by previous attempts at promoting "development" and recent processes of economic globalization. This context has resulted in the adoption of reforms that move developing countries in the direction of an Anglo-American model of governance. The most basic questions that arise with respect to these governance reforms are what prospects they entail for traditional development goals and whether alternatives (...) should be considered. This paper offers a framework for addressing these basic questions by providing an account of: 1) previous development strategies and efforts; 2) the nature and causes of the reform processes; 3) the development potential of the reforms and concerns associated with them; 4) the (potential) responsibilities of corporate governance, including the (possible) responsibilities to promote development, and; 5) different approaches to promoting governance reforms with an eye to promoting development. (shrink)

This article draws on the conceptual link between power and causality to develop an account of the relational, discursive, and performative dimensions of power. Each proposed dimension of power is grounded in a different understanding of social causes: relational-realist, discursive-hermeneutic, and performative-pragmatic. For the purposes of empirical analysis, this dimensional schema crosscuts the classic sources of power typology developed by Michael Mann and others, thus rendering the conceptual apparatus for pursuing sociological research on power more complex and explanatorily effective. The (...) schema is illustrated by an example from comparative-historical sociology: explaining the storming of the Bastille and its effects. A series of research questions for investigating the relative autonomy of performative power is proposed. Finally, the current schema is situated vis-à-vis classic sociological theories of power, including the arguments of Steven Lukes, Michel Foucault, and Pierre Bourdieu, among others. (shrink)

This study examines how individual members of the public make moral sense of the potentially conflicting “economic problem” or “public health problem” representations of the COVID-19 crisis when judging responsible business behavior. The data are based on a qualitative survey involving a thought experiment with 119 participants in the United States conducted at the initial stage of the pandemic. This article proposes a typology matrix using the theories of cognitive polyphasia and cognitive dissonance to understand better individual moral sensemaking of (...) responsible business behavior in the context of a societal paradox in which there are contradictory and interdependent demands between important social objectives. The typology, referred to as the 4R Model of Moral Sensemaking of Competing Social Problems, provides insights for how companies may be perceived when responding to competing social problems, expanding the micro-CSR (corporate social responsibility) and paradox literatures. (shrink)

Epistemic circularity occurs when a subject forms the belief that a faculty F is reliable through the use of F. Although this is often thought to be vicious, externalist theories generally don't rule it out. For some philosophers, this is a reason to reject externalism. However, Michael Bergmann defends externalism by drawing on the tradition of common sense in two ways. First, he concedes that epistemically circular beliefs cannot answer a subject's doubts about her cognitive faculties. But, he argues, subjects (...) don't have such doubts, so epistemically circular beliefs are rarely called upon to play this role. Second, following Thomas Reid, Bergmann argues that we have noninferential, though epistemically circular, knowledge that our faculties are reliable. I argue, however, that Bergmann's view is undermined by doubts a subject should have and that there is no plausible explanation for how we can have noninferential knowledge that our faculties are reliable. (shrink)

Ernest Sosa's virtue perspectivism can be thought of as an attempt to capture as much as possible of the Cartesian project in epistemology while remaining within the framework of externalist fallibilism. I argue (a) that Descartes's project was motivated by a desire for intellectual stability and (b) that his project does not suffer from epistemic circularity. By contrast, Sosa's epistemology does entail epistemic circularity and, for this reason, proves unable to secure the sort of intellectual stability Descartes wanted. I then (...) argue that this leaves Sosa's epistemology vulnerable to an important kind of skepticism. (shrink)

Most commentators assume (a) that the affirmation of life can be defined univocally, as an act the success of which can be assessed by means of the test of the eternal return in GS341; and (b), that the affirmation of life is synonymous with what Nietzsche calls amor fati, and thus singlehandedly encapsulates Nietzsche’s ethical ideal. I take issue with both assumptions and develop an alternative view. I argue that for Nietzsche there are two ways to affirm life ethically. The (...) first is unreflective and piecemeal. I propose a substantive modification to Bernard Reginster’s (2014) procedural approach by suggesting that life is affirmed each time an agent seeks to overcome, and succeeds in overcoming, resistance in the pursuit of a first order desire expressive of love for life – the last clause being mine. I further argue that even with this added clause this first form cannot defeat what Reginster calls the ‘normative core of nihilism’, namely the experiencing of suffering as an objection to life. I identify in Nietzsche’s later work a second form of ethical life affirmation: a holistic, ecstatic act, a Dionysian blessing which ‘calls good’ life as a whole and thus redeems it by making it fully desirable on erotic grounds. Yet even in its two ethical forms the affirmation of life does not suffice to define Nietzsche’s ethical ideal. The very perspective of life affirmation is limited because it remains beholden to the very framework Nietzsche sought to escape: the Christian overarching concern for redemption and preoccupation with theodicic narratives. By contrast, I argue that amor fati, as agapic love of life, affords Nietzsche with a distinct resource to go beyond theodicic prospects and examine its relation to the erotic love of life, which is at the core of both forms of ethical life affirmation. I offer a pluralistic reading of GS341, not simply as a test of life affirmation, but as articulating Nietzsche’s two ethical ideals, amor fati on the one hand, and the affirmation of life in both its forms, on the other. (shrink)

One of the main strands of the Cartesian tradition is the view that the mental realm is cognitively accessible to us in a special way: whenever one is in a mental state of a certain sort, one can know it just by considering the matter. In that sense, the mental realm is thought to be a cognitive home for us, and the mental states it comprises are luminous. Recently, however, Timothy Williamson has argued that we are cognitively homeless: no mental (...) state is in fact luminous. But his argument depends on an excessively strong account of luminosity. I formulate a weaker conception of luminosity that is unaffected by Williamson’s argument and yet is substantial enough to satisfy those who wish to retain this part of the Cartesian tradition. (shrink)

In this article, I examine the relation between phenomenology and anthropology by placing Foucault's first published piece, “Introduction to Binswanger's Dream and Existence“ in dialectical tension with The Order of Things. I argue that the early work, which so far hasn't received much critical attention, is of particular interest because, whereas OT is notoriously critical of anthropological confusions in general, and of “Man” as an empirico‐transcendental double in particular, IB views “existential anthropology” as a unique opportunity to establish a new (...) and fruitful relation between transcendental forms and empirical contents. This is because IB focuses on a specific object, “Menschsein”, which is neither the transcendental subject nor an empirical being. Thus for the young Foucault, existential anthropology occupies a fertile methodological middle ground between transcendental approaches and empirical forms of analysis. I first interpret anthropology in the light of phenomenology and defend the view that Menschsein is neither a transcendental structure nor a concrete particular, but the instantiation of the first in the second. I argue that for anthropology to yield the full theoretical benefits Foucault claims for it, the particular cases of Menschsein examined in existential analysis have to be regarded as exemplary. I then read phenomenology back in the light of anthropology and examine how, for Foucault, the analysis of Menschsein in dreams benefits fundamental ontology by affording us a clearer view of some of the main existentiale than the focus on everyday waking experience in Being and Time. Finally, I turn to the limits and difficulties of this early position and my reading of it, and to their consequences for Foucault's later view. (shrink)

Building on the storytelling, political storytelling, and religious storytelling literatures, I examined the role religious stories play in the formation of revolutionary convictions. This study’s primary sources of data are volumes I, II, and III of The Gospel in Solentiname, a historical record of religious discussions that took place in an isolated campesino community at a seminary-like setting under a growing national revolutionary scenario in 1970s Nicaragua. My analysis of these discussions reveals that religious discourse based on stories of prophecy, (...) Christian virtue, miracles, and social challenges to revolutionary action allowed story-users to assert, explore, and promote models of action and moral orientation consistent with the making of revolution. (shrink)

The Stoics claim that the sage is free from emotions, experiencing instead εὐπάθειαι (‘good feelings’). It is, however, unclear whether the sage experiences εὐπάθειαι about virtue/vice only, indifferents only, or both. Here, I argue that εὐπάθειαι are exclusively about virtue/vice by showing that this reading alone accommodates the Stoic claim that there is not a εὐπάθειαι corresponding to emotional pain. I close by considering the consequences of this view for the coherence and viability of Stoic ethics.

Four of the commentaries criticised my claim that assisted suicide for the terminally ill is discriminatory. 1 They were united in this judgement roughly because they insisted that assisted suicide is in fact a benefit and not a harm. I concede that if it is a benefit, then there is no way in which the terminally ill can be disadvantaged by it and hence no way it can be an instance of discrimination. I pointed out in the article that this (...) issue is controversial and could not be settled in my article, nor can it be settled in this brief response. Assisted suicide harms the terminally ill in several ways. First, it harms the people who do not adopt it by forcing them to defend their continued existence. Second, it harms many of the people who adopt it in so far as they are deprived of a life... (shrink)

In one of his last texts, Foucault defined his philosophical enterprise as an “analysis of the conditions in which certain relations between subject and object are formed or modified, insofar as they are constitutive of a possible knowledge”1, or again as “the manner in which the emergence of games of truth constituted, for a particular time and place and certain individuals, the historical a priori of a possible experience”2. Despite its eclipse during the genealogical period, the notion of the historical (...) a priori is thus reaffirmed as central by later Foucault. There is, however, an essential modification with respect to its archaeological problematisation: in The Order of Things, the various historical a priori were characterized by a specific relation between being and language, a relation in which the subject of knowledge did not always nor necessarily have a place. The Renaissance episteme was defined by the homogeneity of words and things, and its Classical counterpart, by the transparent distance between being and representation, which excluded any positioning for the subject (the “place of the king”). Thus within the archaeological configuration, only the contemporary historical a priori was characterized by the invention of a new position for the subject of knowledge, that of Man, which generated the Analytic of Finitude and ultimately resulted in the “anthropological sleep” criticised at the end of The Order of Things. So although later Foucault re-focuses his work around the notion of the historical a priori, he gives the notion a considerable twist whereby the conditions of truth saying are no longer referred back to an implicit connection between being and language, but to the various relations historically established between “modes of subjectivation”3 and “modes of objectification”4. Correspondingly, these relations are not to be analysed from discourse, as in archaeology, nor from the constituting structures of subjectivity, as in phenomenology, but genealogically, i.e.. (shrink)

This essay addresses moral hazards associated with the emerging doctrine of the Responsibility to Protect (R2P). It reviews the broad acceptance by the Vatican and the World Council of Churches of the doctrine between September 2003 and September 2008, and attempts to identify grounds for more adequate investigation of the moral issues arising. Three themes are pursued: how a changing political context is affecting notions of sovereignty; the authority that can approve or refuse the use of force; and plural foundations (...) for human rights in a religiously and otherwise plural world such that the human rights protection does not become tyrannical. (shrink)

When comparing alternative courses of action, modern military decision makers often must consider both the military effectiveness and the ethical consequences of the available alternatives. The basis, design, calibration, and performance of a principles-based computational model of ethical considerations in military decision making are reported in this article. The relative ethical violation (REV) model comparatively evaluates alternative military actions based upon the degree to which they violate contextually relevant ethical principles. It is based on a set of specific ethical principles (...) deemed by philosophers and ethicists to be relevant to military courses of action. A survey of expert and non-expert human decision makers regarding the relative ethical violation of alternative actions for a set of specially designed calibration scenarios was conducted to collect data that was used to calibrate the REV model. Perhaps unsurprisingly, the survey showed that people, even experts, disagreed greatly amongst themselves regarding the scenarios’ ethical considerations. Despite this disagreement, two significant results emerged. First, after calibration the REV model performed very well in terms of replicating the ethical assessments of human experts for the calibration scenarios. The REV model outperformed an earlier model that was based on tangible consequences rather than ethical principles, that earlier model performed comparably to human experts, the experts outperformed human non-experts, and the non-experts outperformed random selection of actions. All of these performance comparisons were measured quantitatively and confirmed with suitable statistical tests. Second, although humans tended to value some principles over others, none of the ethical principles involved—even the principle of not harming civilians—completely overshadowed all of the other principles. (shrink)

I argue that Plato distinguishes between personal immortality and immortality of the soul. I begin by criticizing the consensus view that Plato identifies the person and the soul. I then turn to the issue of immortality. By considering passages from 'Symposium' and 'Timaeus', I make the case that Plato thinks that while the soul is immortal by nature, if a person is going to be immortal, they must become so. Finally, I argue that Plato has a psychological continuity approach to (...) personal identity. Thus, for Plato, a person becomes immortal by avoiding reincarnation and securing for themselves psychological continuity forever. (shrink)

The philosophical or metaphysical architecture of Darwin's theory of evolution by natural selection is analyzed and diflussed. It is argued that natural selection was for Darwin a paradigmatic case of a natural law of change — an exemplar of what Ghiselin (1969) has called selective retention laws. These selective retention laws lie at the basis of Darwin's revolutionary world view. In this essay special attention is paid to the consequences for Darwin's concept of species of his selective retention laws. Although (...) Darwin himself explicity supported a variety of nominalism, implicit in the theory of natural selection is a solution to the dispute between nominalism and realism. It is argued that, although implicit, this view plays a very important role in Darwin's theory of natural selection as the means for the origin of species. It is in the context of these selective retention laws and their philosophical implications that Darwin's method is appraised in the light of recent criticisms, and the conclusion drawn that he successfully treated some philosophical problems by approaching them through natural history. Following this an outline of natural selection theory is presented in which all these philosophical issues are highlighted. (shrink)

In response to the Eighth Amendment to the Constitution of Ireland, which states that the fetus and the mother have equal rights to life and that nearly all abortions are therefore illegal, many Irish feminists sported luggage tags that read “HEALTHCARE NOT AIRFARE.” The expression—which recently became a popular twitter hashtag for pro‐choice citizens of Ireland leading up to the historic referendum to repeal that abortion ban—refers to the fact that pregnant women from Ireland have long been forced to travel (...) to other European countries in order to legally terminate their pregnancies. In the United States, there is also a deep and challenging relationship between borders and reproductive health. However, that relationship is not understood as clearly as it appears to be in the Irish context. We urgently need to pay careful attention to the interconnections between U.S. border politics and reproductive health care access and to take concrete steps to address resultant injustices. (shrink)

Writers, philosophers, and theologians have oft made the comparison between being a mature human being and a masterpiece work of art or design. Employing the analogy between the creation of artistic value and the creation of full-fledged human value, this paper stakes out a middle ground between pro-choice and pro-life by considering a more general account of value and the relationship between being a potential X and a mature implementation of X's potential. I argue that the value of a potential (...) X is a function of a number of factors, most importantly, what I call the "accessibility relation" between a potential X and a full-fledged instantiation of this potential. The value is as much intrinsic to the “seed” as to some future implementation of the seed’s potential. This approach inclines even a secular humanist to reasonably confer a significant degree of moral value to a human conceptus, and even more to an early term fetus. (shrink)

This paper seeks to ascertain the ways in which Adonis and his ritual lament were used by Classical men and women in their constructions of their own gender and the other. The evidence from Classical Athens turns out to originate mainly among men and thus outside the cult, from which men were excluded; the myths and descriptions of the rite that we possess say more about men's attitudes toward themselves and toward women than about the celebrants' motives. Nevertheless, women's attitudes (...) toward Adonis may be inferred from the social circumstances in which the Attic cult arose. Care must be taken to distinguish the different interests represented in the extant evidence . Marcel Detienne's influential structuralist interpretation of the cult has rightly dissociated Attic Adonis from similar Near Eastern figures and contextualized him in Classical Athenian society. Detienne's interpretation, however, has limitations, since it treats Adonis only as a representative of the unmanly and unproductive, and tends to ignore the different uses to which men and women could put Adonis and his rite. For example, the proverb "more fruitless than the gardens of Adonis" originated in male discourse, and does not necessarily reflect women's views. In comedy Adonis and the Adonia become a foil for masculine values; not only does this tell us nothing of what the celebrants thought, but awareness of the many strategies of self-definition available to Athenian men compels us to entertain other constructions of Adonis in other discursive milieus. Finally, although little testimony remains from the woman's perspective, we may speculate that in democratic Athens, restrictions on traditional female mourning rituals and the polarization of the sexes would have made such a private cult as the Adonia attractive to women. (shrink)

Research on ethical dilemmas in health care has become increasingly salient during the last two decades resulting in confusion about the concept of moral distress. The aim of the present paper is to provide an overview and a comparative analysis of the theoretical understandings of moral distress and related concepts. The focus is on five concepts: moral distress, moral stress, stress of conscience, moral sensitivity and ethical climate. It is suggested that moral distress connects mainly to a psychological perspective; stress (...) of conscience more to a theological–philosophical standpoint; and moral stress mostly to a physiological perspective. Further analysis indicates that these thoughts can be linked to the concepts of moral sensitivity and ethical climate through a relationship to moral agency. Moral agency comprises a moral awareness of moral problems and moral responsibility for others. It is suggested that moral distress may serve as a positive catalyst in exercising moral agency. An interdisciplinary approach in research and practice broadens our understanding of moral distress and its impact on health care personnel and patient care. (shrink)

In this paper I argue for the need to distinguish between being "legally undocumented" and "socially undocumented". The latter term, I argue, designates and helps us to understand the oppression associated with undocumented status.

This is an unpublished talk written for a meeting of French philosophers. The paper describes the evolution versus creationism/intelligent design controversy in the U.S. A number of philosophers and scientists try to resolve this issue by sharply distinguishing the realm of science versus any talk of the supernatural. These pro-evolutionists often appeal to science's essential commitment to "methodological naturalism," the view that scientific methodology is essentially committed to naturalism and cannot meaningfully entertain hypotheses concerning the supernatural. I criticize methodological naturalism, (...) suggesting that such an appeal is misguided and counterproductive. I suggest an alternative view of the supernatural consistent with scientific knowledge. (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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To build an argument--and particularly an argument presented as a monologue--a writer must assemble and marshal a battery of supports for a claim. Some of those supports will be arranged in convergent structures, some as linked; some will be expressed, some will be left implicit; sometimes a support will need further support of its own--and sometimes, not. This paper explores the factors which lead a writer to make particular choices, the interactions between those factors, and the constraints on a w (...) riter's freedom in exercising her power, drawing on recent findings in computational modelling of the generation process. (shrink)

In this essay I aim to broaden this discussion of positionality in Philosophy for Children in order to explore the ways that sociopolitical and philosophical context can impact the sorts of questions and discussions generated by children in P4C programs. In particular, I show how the context of Oaxaca City shapes the philosophical contributions of the children of the Oaxaca Philosophy for Children Initiative—in a way that often challenges western philosophical frameworks. I use the narrative of the Oaxaca Philosophy for (...) Children Initiative to argue for a "place-based P4C" in which the instructor often learns far more philosophy than she teaches. (shrink)

Abstract:“Black art” is often understood as being inherently political. In examining two major Black arts movements, the Harlem Renaissance and the Black Arts movement, many of the works attributed to those periods fit the description of “political art” but not all of them. Black art movements are not defined exclusively by similar styles or methodologies, like Expressionism or Surrealism, either. Instead, Black art movements are complex movements that blend social, political, and aesthetic criteria. In this article, I list seven conditions (...) that I take to be jointly sufficient for a Black art movement to be signified as such. In this assertion, I also argue that this current era, paralleling the Black Lives Matter movement, is worthy of Black art movement signification, if we update the mediums by which the conditions are met in the Harlem Renaissance and the Black Arts movement. (shrink)

Abstract:In this discussion I revisit the animal welfare-environmental ethics debate, including a recent argument by Ian Campbell in this journal, that its underlying values are incommensurable at the level of principle, making them hard to reconcile, even in practice. By relying on the geocentric framework of William Lynn and the capabilities approach of Martha Nussbaum, as well as a place-specific example of wild horse protection policies, I argue that it is possible to balance these competing values. In light of the (...) pervasive presence of non-native animals, as well as habitat loss and other threats to self-sustaining ecosystems, binary choices are fast becoming anachronistic. Case-by-case analyses are necessary in order to assess how to grant equitable consideration to complex claims. (shrink)