Background: This study attempts to understand if medical providers beliefs about the moral permissibility of honoring patient-directed refusals of life-sustaining treatment (LST) are tied to their beliefs about the patient’s decision-making capacity. The study aims to answer: 1) does concern about a patient’s treatment decision-making capacity relate to beliefs about whether it is morally acceptable to honor a refusal of LST, 2) are there differences between provider types in assessments of decision-making capacity and the moral permissibility to refuse LST, and (...) 3) do provider demographics impact beliefs about decision-making capacity and the moral permissibility to refuse LST. Methods: A mixed-methods survey using Likert assessment and vignette-based questions was administered to medical providers within a single health system in the upper Midwest (N = 714) to assess their perspectives on the moral acceptance and decision-making capacity in cases of withholding and withdrawing treatment and suicide. Results: Behavioral health providers report accepting of the moral permissibility of suicide (91.2%) more than either medical providers (77.2%) or surgeons (74.4%) (n = 283). Decision-making capacity was questioned more in the vignettes of the patients refusing life-saving surgery (36%) and voluntarily starvation (40.8%) than in the vignette of the patient requesting to deactivate a pacemaker (13%) (n = 283). Behavioral health providers were more concerned about the capacity to refuse life-saving surgery (55.9%) than medical providers (33.8%) or surgeons (23.1%) (n = 283). Conclusions: Respondents endorse the moral permissibility of persons to withhold or withdraw from treatment regardless of motive. Clinical concerns about a patient’s treatment decision-making capacity do not strongly correlate to views about the moral permissibility of honoring refusals of LST. Different provider types appear to have different thresholds for when to question treatment decision-making capacity. Behavioral health providers tend to question treatment decision-making capacity to refuse LST more than non-behavioral health providers. (shrink)

The ‘buck-passing’ account equates the value of an object with the existence of reasons to favour it. As we argued in an earlier paper, this analysis faces the ‘wrong kind of reasons’ problem: there may be reasons for pro-attitudes towards worthless objects, in particular if it is the pro-attitudes, rather than their objects, that are valuable. Jonas Olson has recently suggested how to resolve this difficulty: a reason to favour an object is of the right kind only if its formulation (...) does not involve any reference to the attitudes for which it provides a reason. We argue that despite its merits, Olson's solution is unsatisfactory. We go on to suggest that the buck-passing account might be acceptable even if the problem in question turns out to be insoluble. (shrink)

Section 2.1 identifies three notions of intrinsic value: the finality sense understands it as value for its own sake, the supervenience sense identifies it with value that depends exclusively on the bearer’s internal properties, and the nonderivative sense describes intrinsic value as value that provides justification for other values and is not justified by any other value. A distinction between final intrinsic and final extrinsic value in terms of supervenience is subsequently introduced. Section 2.2 contains a discussion of the debate (...) about instrumental value and other varieties of nonfinal extrinsic value. Finally, section 2.3 focuses on recent attacks on the very coherence of the intrinsic/extrinsic distinction and its role as a demarcation line between fundamental and nonfundamental value. (shrink)

It is argued that the so-called fitting attitude- or buck-passing pattern of analysis may be applied to personal values too if the analysans is fine-tuned in the following way: An object has personal value for a person a, if and only if there is reason to favour it for a’s sake. One benefit with it is its wide range: different kinds of values are analysable by the same general formula. Moreover, by situating the distinguishing quality in the attitude rather than (...) the reason part, the analysis admits that personal value is recognizable as a value not only by the person for whom it has personal value, but for everyone else too. We thereby avoid facing two completely different notions of value, viz., one pertaining to impersonal value, and another to personal value. The analysis also elucidates why we are justified in our concern for objects that are valuable for us; if value just is, as it is suggested, the existence of reasons for such a concern, the justification is immediately forthcoming. (shrink)

The paper presents main conceptual distinctions underlying much of modern philosophical thinking about value. The introductory Section 1 is followed in Section 2 by an outline of the contrast between non-relational value and relational value. In Section 3, the focus is on the distinction between final and non-final value as well as on different kinds of final value. In Section 4, we consider value relations, such as being better/worse/equally good/on a par. Recent discussions suggest that we might need to considerably (...) extend traditional taxonomies of value relations. (shrink)

The paper presents main conceptual distinctions underlying much of modern philosophical thinking about value. The introductory Section 1 is followed in Section 2 by an outline of the contrast between non-relational value and relational value. In Section 3, the focus is on the distinction between final and non-final value as well as on different kinds of final value. In Section 4, we consider value relations, such as being better/worse/equally good/on a par. Recent discussions suggest that we might need to considerably (...) extend traditional taxonomies of value relations. (shrink)

This article traces the historical origins of the modern concept of a private inner self., with precursors in Plato and Plotinus, its first full appearance in Augustine, its classic modern form in Locke, and its dissolution in postmodernism. The article elaborates the historical narrative given in my Augustine's Invention of the Inner Self (Oxford University Press, 2000).

Modern thought typically opposes the authority of tradition in the name of universal reason. Postmodernism begins with the insight that the sociohistorical context of tradition and its authority is inevitable, even in modernity. Modernity can no longer take itself for granted when it recognizes itself as a tradition that is opposed to traditions. The left-wing postmodernist response to this insight is to conclude that because tradition is inevitable, irrationality is inevitable. The right-wing postmodernist response is to see traditions as the (...) home of diverse forms of rationality. This requires an understanding of the Socratic, self-critical aspect of intellectual traditions, which include both modern sciences and the great world religions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Amazing Grace: Fortune, God, and Free Will in Machiavelli’s ThoughtCary J. Nederman*Machiavelli and ReligionSurely there is no political theorist about whom scholarly opinion is more divided than Niccolò Machiavelli. The subject of intense and continuous examination almost from the time of his death, Machiavelli has become if anything more enigmatic with the passage of time and the proliferation of interpretations. Although one might argue that this fact reflects the (...) highly unsystematic and context-bound nature of his thought, the now well-established consistencies in his linguistic usage and narrative style suggest that certain principles inform his writings across genre and circumstance. 1One of the most contentious aspects of Machiavelli’s writing has been his attitude towards religion, in particular, Christianity. 2 To be sure, Machiavelli [End Page 617] was no friend of the institutionalized Christian Church as he knew it. The Discourses makes clear that conventional Christianity saps from human beings the vigor required for active civil life. 3 And the Prince speaks with equal parts disdain and admiration about the contemporary condition of the Church and its Pope. 4 Many scholars have taken such evidence to indicate that Machiavelli was himself profoundly anti-Christian, preferring the pagan civil religions of ancient societies such as Rome, which he regarded to be more suitable for a city endowed with virtù. 5 At best Machiavelli has been described as a man of conventional, if unenthusiastic, piety, prepared to bow to the externalities of worship but not deeply devoted in either soul or mind to the tenets of Christian faith. 6In recent times, the only dissenting voice of note has been Sebastian de Grazia, whose Pulitzer Prize-winning intellectual biography, Machiavelli in Hell, attempts to rescue Machiavelli’s reputation from those who view him as deeply hostile to Christianity. 7 De Grazia argues that not only do central biblical themes run throughout Machiavelli’s writings but that these works reveal a coherent conception of a divinely-centered and ordered cosmos in which other forces (“the heavens,” “fortune,” and the like) are subsumed under a divine will and plan. Machiavelli in Hell points to evidence from throughout the Machiavellian corpus supporting an idea of divine ordination of earthly events, especially in the case of the accomplishments of extraordinary individuals. For de Grazia’s Machiavelli success in human affairs depends primarily upon the friendship of God.De Grazia’s interpretation of Machiavelli’s religious faith has, of course, proven controversial, not least because he introduces his case in a fairly unsystematic and speculative way. 8 But while de Grazia’s presentation may be somewhat haphazard, the general reading he defends has important merits that ought [End Page 618] not to be overlooked. Machiavelli does make reference to a monotheistic divinity, as well as to central elements of Christianity theology, rather more often in his corpus than most scholarship might lead one to believe. Moreover, the passages in which these references occur are often among the most important and troubling sections of his work. De Grazia would seem, then, to be correct in asserting that we must grasp Machiavelli’s idea of God and the divine role in earthly affairs if we are to understand the basic principles of Machiavellian political theory.If de Grazia’s basic observation is indeed persuasive, why have Machiavelli’s religious ideas been so widely overlooked (or indeed dismissed) by recent scholars? To explain this we have to take into account Machiavelli’s own exaggerated statements regarding the originality of his teachings, as well as his already mentioned antipathy towards the institutions and officials of the Roman Church. But perhaps more important has been the reluctance to read Machiavelli in conjunction with many central cultural and intellectual features of his time, especially in terms of persisting patterns and traditions of medieval Latin thought. One of the most striking developments in the study of Western intellectual history in recent years has been the recognition of important continuities between the ideas of the late medieval and the early modern periods. Scholars have come to realize that many of the supposed innovations of the Renaissance, the Reformation, and even the early Enlightenment had clear roots or antecedents in... (shrink)

Invited talk at the so-called Thursday Lecture, Oct 25, at the Hoger Instituut voor Wijsbegeerte the International Programme at the Institute of Philosophy at the University of Leuven, Belgium. Focus was on the distinction between good and good-for.

In lieu of an abstract, here is a brief excerpt of the content:The Meaning of “Aristotelianism” in Medieval Moral and Political ThoughtCary J. NedermanI. “Aristotelian” and “Aristotelianism” are words that students of medieval ideas use constantly and almost inescapably. 1 The widespread usage of these terms by scholars in turn reflects the popularity of Aristotle’s thought itself during the Latin Middle Ages: Aristotle provided many of the raw materials with which educated Christians of the Middle Ages built up the edifice (...) of medieval thought. From 1100 it was difficult to receive a good education in Europe without reading at least some Aristotle, along with authors such as Boethius and Cicero who were heavily indebted to the Philosopher’s teachings. After 1200 no university-trained cleric was likely to be wholly unfamiliar with the essential characteristics of the Aristotelian world-view. 2 Thus, Aristotelianism constituted an indispensable common currency of intellectual intercourse during the Middle Ages.Yet at the same time medieval Aristotelianism could never be all-embracing or complete. Given the centrality of Christian religion to medieval Latin thought, it was effectively impossible for Western thinkers to accept basic tenets of Aristotle’s philosophy, such as the nature of the soul, the powers of God, and the source of ultimate human happiness. 3 In view of the [End Page 563] incompatibility of primary Aristotelian and Christian doctrines, no author in medieval Europe could faithfully or safely espouse an unalloyed Aristotelianism.The “Aristotelianism” of the Middle Ages thus possesses something of a paradoxical quality: it is everywhere and yet nowhere. Such uncertainty about the precise meaning and appropriate application of the ascriptions “Aristotelian” and “Aristotelianism” has led some intellectual historians to raise fundamental questions about the validity of these classifications. In a provocative article on the interpretation of “Aristotelianism” in medieval and Renaissance natural philosophy, Edward Grant poses this problem quite pointedly: “What criteria have to be met for one to be considered, say an Aristotelian...? Can such criteria even be formulated? Is there an essence of Aristotelianism... that might provide a means of determining who is, and who is not, a legitimate member of [this group?]” 4 Grant’s own attempts to solve this problem are geared to the particular circumstances of medieval cosmology and physics, fields in which the Aristotelian paradigm entered Latin thought rapidly and reigned unchallenged for three centuries. 5 Consequently, his solutions do not generalize well to other areas of philosophical discourse, such as moral and political philosophy, which experienced rather different processes of Aristotelian transmission and reception.It may therefore be fruitful to examine more carefully the meaning of Aristotelianism as applied specifically to the fields of ethics and politics, and indeed to question whether (or in what ways) the ascription of an Aristotelian outlook to medieval moral and political thought is warranted. In particular I propose to consider the two standard definitions of “Aristotelianism” that have emerged from the literature on the moral and political ideas of the Latin Middle Ages: a strict, essentialist account which holds that Aristotelianism requires endorsement of some salient core of Aristotelian writing or doctrine; and a looser approach which maintains that mere citation of Aristotle’s work or adoption of his language is sufficient to earn the label “Aristotelian” for a medieval text or thinker. While both of these conceptions of Aristotelianism enjoy certain distinct merits, each ultimately proves inadequate to cope with the complexities of the use of Aristotle’s moral and political ideas and texts during the Middle Ages.Does the failure of attempts to define “Aristotelianism” coherently mean that the term itself is a spurious or irrelevant category for the analysis of medieval ethics and political philosophy? I shall ultimately argue that it is possible to identify a coherent meaning of Aristotelianism in the political and moral realms that avoids the shortcomings associated with previous interpretations. Specifically, I claim that the medieval “Aristotelian” tradition is [End Page 564] held together by a particular organization of and orientation towards the kind of knowledge necessary for achieving human good in its moral and political dimensions. Stated succinctly, Aristotelianism posits the practical quality of the study of ethics and politics and hence the value of such knowledge insofar as it guides action. In my view the Aristotelianism... (shrink)

Personal value, i.e., what is valuable for us, has recently been analysed in terms of so- called for-someone's-sake attitudes. This paper is an attempt to add flesh to the bone of these attitudes that have not yet been properly analysed in the philosophical literature. By employing a distinction between justifiers and identifiers, which corresponds to two roles a property may play in the intentional content of an attitude, two different kinds of for-someone's-sake attitudes can be identified. Moreover, it is argued (...) that one of these kinds is particularly difficult to include in an analysis of value simpliciter but not in an analysis of value for. (shrink)

This paper is a response to John Arthos' book, The Inner Word in Gadamer's Hermeneutics. I show that Arthos and Gadamer are both mistaken in thinking that Augustine's concept of the inner word supports the notion that language and thought are inseparable. On the contrary, tThe "inner word" in Augustine is not a word in any human language, but the mind's act of intellectual understanding, which is logically prior to and independent of all language.

John Pocock's The First Decline and Fall (2003) presents a novel argument for drawing a clear distinction between medieval and early modern varieties of political thinking and writing that implicitly challenges the current historiographical trend that "softens" the dividing line between the two. The present paper critically examines Pocock's claim, which is based on the appearance of the theme of the historicity of the Roman Empire (imperial decline and fall) in early modern (and especially Florentine) political theory. In particular, the (...) works of Marsiglio of Padua and Nicholas of Cusa are surveyed to demonstrate that Pocock's thesis, while useful, fails to capture fully the historical complexity of the medieval / modern divide in European thought. (shrink)

It is a familiar story that on April 5, 56 B.C., Cicero made a motion in the Senate concerning Caesar's Campanian land law, and that this action of his was one of the reasons for the conference of Luca. Query: What were the terms of the motion?

The peace concluded between Athens and Persia at the close of the Persian Wars , and usually known as the Peace of Callias, has been the subject of a new investigation by Wade-Gery, which is clearly destined to serve as the basis of further discussion of its problems. In the present article I shall confine myself to one point of special interest arising out of a novel clause which Wade-Gery reads into the treaty and formulates, exempli gratia, as follows: ‘In (...) the area west of Sardis inhabited by Greeks, the King shall send no functionaries nor exercise any authority: his sole right shall be a yearly tribute of a fixed amount based on the survey of Artaphernes in 493.’. (shrink)