BackgroundFrench military doctors are currently deployed in the Sahel to support the armed forces of Operation Barkhane, in medical or surgical units. As well as supporting French soldiers, their other missions are diverse and complex: medical assistance to civilians and persons under control (PUC), advice to commanding officers. These tasks can create ethical dilemmas when decisions are forced upon doctors that may be in conflict with medical values or fundamental principles. Little is known about the specific dilemmas experienced by French (...) military doctors in overseas operations. We therefore conducted a qualitative study among doctors and surgeons recently deployed to the Sahel to explore and better understand this question.MethodSemi-structured, face-to-face interviews were conducted with 20 French military doctors or surgeons deployed since January 2016 in medical or surgical facilities in Mali and Chad.ResultsAll interviewed doctors reported having faced several ethical dilemmas during missions. All reported dilemmas involved the treatment of civilians (while delivering community medical assistance) or of PUC. The dilemmas involved choices as to which patients to treat, the use of care as a means to an end by military authorities, and the level of care attainable in the absence of any possible hospital follow-up. Questions of delivering care at the risk of their own safety or the mission’s and of treating openly hostile patients were also brought up. Several dilemmas stemmed from the dual loyalty problem, namely the conflict between military doctors’ duty of care to patients and to the military institution, but this was not the only factor involved. Contextual factors (restricted resources and security constraints) and psychological factors (especially hostility towards the enemy) were also associated with many of the reported dilemmas.ConclusionThis is the first reported study focusing on the ethical dilemmas encountered by French military doctors in overseas operations. It provides unique insights into their ethical experiences and should prove useful in improving operational training for healthcare personnel deployed on overseas missions. (shrink)

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

In November 1996, Catherine Clément and Julia Kristeva began a correspondence exploring the subject of the sacred. In this collection of those letters Catherine Clément approaches the topic from an anthropologist's point of view while Julia Kristeva responds from a psychoanalytic perspective. Their correspondence leads them to a controversial and fundamental question: is there anything sacred that can at the same time be considered strictly feminine? The two voices of the book work in tandem, fleshing out ideas and (...) blending together into a melody of experience. The result is a dialogue that delves into the mysteries of belief -- the relationship between faith and sexuality, the body and the senses -- which, Clément and Kristeva argue, women feel with special intensity. Although their discourse is not necessarily about theology, the authors consider the role of women and femininity in the religions of the world, from Christianity and Judaism to Confucianism and African animism. They are the first to admit that what they have undertaken is "as impossible to accomplish as it is fascinating." Nevertheless, their wide-ranging and exhilarating dialogue succeeds in raising questions that are perhaps more important to ask than to answer. (shrink)

The authors of the first constitutions of the Spanish-American world, in New Granada, were also scientists who published articles on geography, natural history, political economy, population or medicine. From this observation, the article seeks to show how these scholars understood how to apply the new naturalistic knowledge to the regeneration of society in their constitutional work. This ambition entailed the need to destroy the supposedly artificial and despotic hierarchies of the Ancien Régime, based on the genealogical transmission of dignities and (...) infamy, in order to replace them with others that were "natural". This device did not mean the constitutional triumph of equality, since, to take up a formula of Madame de Staël, equality before the law would mean nothing other than the reestablishment of natural inequalities. The article firstly deals with the works of the Enlightenment of New Granada and of Baron Humboldt to understand the assumptions of their naturalistic anthropology on the "American man", which later served to think, in revolutionary times, about certain political topics such as federalism, the rights of man and the limits of citizenship. It ends with a re-reading of the Discurso de Angostura by showing how this naturalistic knowledge, influenced Bolívar's constitutionalist thought. (shrink)

This article demonstrates that immoralism does not sum up the Nietzschean position. Nietzsche made use of ethical categories - notably the categories of “duty”, “virtue”, “justice” or “compassion” - in order to propose a new philosophy of the body. In this attempt to plunge morality back into the heart of organism, Nietzsche reforms morality on physiological grounds. This gesture aims at reconstructing the laws of action.

“Logic and Agon” is the text of a lecture given in Rome in 1958 by the German philosopher and mathematician Paul Lorenzen. In this inaugural text are laid the foundations of the dialogic logic, which represents an alternative approach to the question of meaning and logical truth, based on a dynamic formalism. Through the enrichment of the standard approach to logic with original tools, it allows a philosophical explanation of the foundations of the concept of formal validity. Clément Lion (...) proposes an unpublished French translation of this text as well as a presentation, in which he tries to show that the initial ambition of Paul Lorenzen was not so much to propose a new logical formalism as to question in principle any enterprise based on the use of such a formalism. (shrink)

Quiconque considère la résurgence du cynisme à la Renaissance pénètre un domaine vaste, mais laissé en friche par les philosophes et délaissé des littéraires. Quelques exemples suffisent à en évaluer l'étendue : reconnaître Diogène dans le Christ et faire - subrepticement - du premier des Adages un adage diogénique ; s'assimiler à Diogène roulant son tonneau pour illustrer la fabrique du Tiers Livre ; attaquer saint Augustin pour son incapacité à comprendre l'impudeur des cyniques ; souhaiter comme idéal pour l'homme (...) de n'être "serf de personne". Voilà quatre positions où l'on aura reconnu Erasme, Rabelais, Montaigne ainsi que La Boétie et qui attestent que, si le cynisme est bien une philosophie de la Renaissance, il a aussi été un formidable moyen de penser et de parler à neuf. Alors que le bien-dire envahit l'espace public, le dire vrai des cyniques, incisif, est apte à façonner des formes littéraires inédites et à procurer de nouveaux moyens critiques. Contre ceux qui pensent conforter la morale avec des discours bien-pensants, Diogène n'affirmait-il pas, crânement, que l'exercice de la vertu n'est pas pour les pisse-froid, qu'on peut être obscène et vertueux, violent et pédagogue, tout en restant "joyeux entre mille"? (shrink)

New Blackfriars, Volume 103, Issue 1106, Page 536-553, July 2022.

Ce travail étudie les formes de société politique et les contraintes qu'elles rencontrent pour produire leur unité collective. Il interroge le politique comme un schème générateur de toute dimension collective. Ces formes de société sont considérées depuis les enseignements apportés par l'oeuvre de Marcel Gauchet. Ses travaux ont approfondi différents modes de structuration collective, selon le déploiement des communautés humaines dites autonomes, par extraction hors de l'hétéronomie. Etudier de telles transformations internes peut se faire par un angle dynamique, en poursuivant (...) la pensée morphologique de René Thom. Un problème se découvre alors : le déploiement des collectivités humaines dans l'immanence (et non plus dans la transcendance), l'organisation symbolique de la dimension historique qui les traverse, toutes ces modifications incitent à questionner " l'historicité " interne des collectivités selon des morphologies de processus, génératrices de leur réflexivité historique. Les éclairages apportés par ces morphologies de processus indiquent l'effectivité d'un travail de la forme. Ce travail permet dès lors de scruter les morphologies du politique. (shrink)

Social learning is likely to include affective processes: it is necessary for newcomers to discover what value to attach to objects, persons, and events in a given social environment. This learning relies largely on the evaluation of others’ emotional expressions. This study has two objectives. Firstly, we compare two closely related concepts that are employed to describe the use of another person’s appraisal to make sense of a given situation: social appraisal and social referencing. We contend that social referencing constitutes (...) a type of social appraisal. Secondly, we introduce the concept of affective social learning with the hope that it may help to discriminate the different ways in which emotions play a critical role in the processes of socialization. (shrink)

La disparition conjointe, à quelques mois d’écart, de Jean-Pierre Vernant (1914-2007) et de Pierre Vidal-Naquet (1930-2006) a donné lieu à toute une série de colloques, rencontres, conférences et publications consacrés à l’apport des recherches de ces deux grands hellénistes aux études classiques et aux échos qu’elles ont reçus par-delà les frontières nationales et disciplinaires. Les Américains ont donné le nom d’« école de Paris » à la nébuleuse de chercheurs qui s’est constituée autour des...

ArgumentThe heuristic value of evolutionary biology for economics is still much under debate. We suggest that in addition to analytical considerations, socio-cultural values can well be at stake in this issue. To demonstrate it, we use a historical case and focus on the criticism of biological analogies in the theory of the firm formulated by economist Edith Penrose in postwar United States. We find that in addition to the analytical arguments developed in her paper, she perceived that biological analogies were (...) suspect of a conservative bias – as in social Darwinism. We explain this perception by documenting the broader context of Edith Penrose's personal and professional evolution, from her student days at Berkeley to her defense of Owen Lattimore against McCarthyism. We conclude that in the case under study at least, science and values were certainly intertwined in accounting for her skepticism towards biological analogies – insight we develop in the conclusion about today's relationships between biology and economics. (shrink)

Teilhard de Chardin developed an evolutionary vision of our planetary future, currently developing from a sphere of life, or biosphere towards a sphere of mind, or noosphere. As a visionary, Teilhard was not only on the brink of formulating the internet, but he also anticipated current academic efforts to understand globalization, as well as human, cultural and technological evolution. However, his ideas are sources of enduring controversies in both scientific and theological circles. Here I uncover some of the core reasons (...) why his ways of thinking and writing are often problematic, and propose a way forward. This note aims to introduce Teilhard’s central article about the noosphere, but can also be read as an independent introduction to Teilhard’s system of thought. A detailed exegesis of Teilhard’s article is available as a supplementary document. (shrink)

Psychologists have emphasized children's acquisition of information through firsthand observation. However, many beliefs are acquired from others' testimony. In two experiments, most 4yearolds displayed sceptical trust in testimony. Having heard informants' accurate or inaccurate testimony, they anticipated that informants would continue to display such differential accuracy and they trusted the hitherto reliable informant. Yet they ignored the testimony of the reliable informant if it conflicted with what they themselves had seen. By contrast, threeyearolds were less selective in trusting a reliable (...) informant. Thus, young children check testimony against their own experience and increasingly recognise that some informants are more trustworthy than others. (shrink)

Thanks to his unsurpassed eye and his fearless willingness to take a stand, Clement Greenberg (1909 1994) became one of the giants of 20th century art criticism a writer who set the terms of critical discourse from the moment he burst onto the scene with his seminal essays Avant Garde and Kitsch (1939) and Towards a Newer Laocoon (1940). In this work, which gathers previously uncollected essays and a series of seminars delivered at Bennington in 1971, Greenberg provides his most (...) expansive statement of his views on taste and quality in art, arguing for an esthetic that flies in the face of current art world fashions. Greenberg insists despite the attempts from Marcel Duchamp onwards to escape the jurisdiction of taste by producing an art so disjunctive that it cannot be judged that taste is inexorable. He argues that standards of quality in art, the artist's responsibility to seek out the hardest demands of a medium, and the critic's responsibility to discriminate, are essential conditions for great art. The obsession with innovation the epidemic of newness leads, in Greenbergs view, to the boringness of so much avant garde art. He discusses the interplay of expectation and surprise in aesthetic experience, and the exalted consciousness produced by great art. Homemade Esthetics allows us particularly in the transcribed seminar sessions, never before published to watch the critics mind at work, defending (and at times reconsidering) his theories. His views, often controversial, are the record of a lifetime of looking at and thinking about art as intensely as anyone ever has. (shrink)

El presente trabajo propone reconsiderar algunas dificultades clásicas relacionadas con la significatividad y referencia de las proposiciones religiosas y explorar la posibilidad de lidiar con ellas bajo la suposición de que ‘Dios’ es un término teórico, es decir, una palabra que nombra una entidad no susceptible de observación directa pero aun así capaz de cumplir un rol explicativo dentro de teorías que pretenden explicar el mundo disponible a nuestra experiencia. La consideración de ciertos rasgos distintivos de los términos teóricos puede (...) arrojar una luz nueva sobre varias temáticas discutidas en la filosofía de la religión contemporánea, especialmente porque entrega un marco nuevo desde el que pensar la naturaleza y funciones de la teología natural. (shrink)

In this paper I try to show that three of William L. Rowe’s criticisms of my book, Theism, are much less than conclusive.(1) Rowe agrees that I have established, via my defense of Descartes’s Meditation Five argument for God’s existence, that God is not a non-existing being. He denies, however, that it follows that God is an existing being. In reply, I reject the thesis that something might be neither an existing nor a non-existing object.(2) Rowe maintains that the impossibility (...) of God’s non-existence might consist simply of its being the case that no one can destroy God---a kind of impossibility which is not strong enough to sustain my (S5) modal argument for God’s existence. In reply, I argue that the impossibility of God’s non-existence must be logical.(3) Rowe maintains that it may well be that religious experiencers have experienced God without experiencing him qua maximally great being, so that religious experiences do not provide us with a reason to believe that a maximally great being is logically possible. I argue in reply that if religious experiencers do not experience God qua supremely perfect, then they have no reason to believe that they experience God. (shrink)

Este artículo presenta una figura clave del humanismo político. Brunetto Latini surge de un ambiente intelectual laico cuyo auge se debe a la consolidación de un ámbito político autónomo, la ciudad. La progresiva apertura del poder a un amplio espectro de ciudadanos plantea un cambio en la práctica política cotidiana. La burguesía florentina, artífice de un crecimiento económico sin precedentes, aporta nuevas reglas al juego político e intenta legitimarlas ante los ojos de los mayores actores políticos de Europa. Brunetto Latini (...) interviene en este proceso aportando un hábeas teórico en la frágil república florentina que establece las bases éticas y prácticas del vivere civile. Su obra enciclopédica se alimenta de las diversas tradiciones intelectuales con las cuales estuvo en contacto, y muestra un interés inusual por los pensadores antiguos. Latini redacta en lenguas romances y vulgariza por vez primera la Ética Nicomáquea de Aristóteles y el De inventione de Cicerón. La memoria florentina le recuerda como el maestro de toda una generación. Entre sus alumnos destacamos a Dante Alighieri, quien dedicaría a su maestro un Canto del Inferno. (shrink)

Four lectures on the Philosophy of Religion are included in this compact book along with an extra chapter on the psychology of belief in God. In a search for an acceptable theism, the author examines religious faith and human personality via many theories and facets of thinking, referring to psychologists, theologians and philosophers who have battled with similar questions. Originally published a year after the lectures were presented, this is an interesting classic volume by a well-known theorist of the early (...) Twentieth Century. (shrink)

As a maverick philosopher unafraid of challenging the ideas and methods of his colleagues, Clément Rosset's work attempts to connect sometimes-lofty academic philosophy with the concerns of everyday life. For decades, he has worked to illuminate some of the most obscure metaphysical issues, often using popular film, theatre, novels, and comic books to illustrate his ideas, and as a result he has gained a reputation as both a happy sage and a singular mind. In The Real and Its Double, (...) expertly translated by Chris Turner, Rosset takes on the question of the Real and humanity's natural ability to sidestep and bypass it. The key to this type of evasion, Rosset suggests, is a certain form of oracular thinking that lies buried in the origins of Western metaphysics and psychology. Here, Rosset eschews the prolix and paradoxical psychological theories of Derrida and Lacan in favor of an exceptional lucidity that speaks to his Nietzschean-tragic love of life. If good philosophy can be defined as expressing complicated things in a simple way, then here, in one of his best-known works, Rosset has proven himself a master. (shrink)

In this paper, we point out that explainability is useful but not sufficient to ensure the legitimacy of algorithmic decision systems. We argue that the key requirements for high-stakes decision systems should be justifiability and contestability. We highlight the conceptual differences between explanations and justifications, provide dual definitions of justifications and contestations, and suggest different ways to operationalize justifiability and contestability.

In this book, I discuss the question whether God exists, not as a Tillichian religious symbol, but as an actual person, albeit a person who is very different from you and me. My procedure is to examine arguments bdth for and against God's existence qua person and to assess their relative merits. I shall try to show that there is more evidence that God exists than that he does not. This position is, of course, rejected nowadays, even by most religious (...) thinkers, who hold, for one reason or another, that evidence has nothing to do with religious belief, properly understood. My reply to these thinkers is simply to ask them to examine what follows. A useful companion to Chapters 4, 5, 6, 7, and the Appendix of this book would be Alvin Plantinga's The Nature of Necessity.l Though I avoid technical terminology wherever possible, those chapters presuppose an elementary understanding of 'possible worlds' discourse; and a clear and concise explanation of that terminology can be found in Chapter IV of Plantinga's book. Also, I use 'logical' throughout to mean what Plantinga means by 'broadly logical' on page 2 of The Nature of Necessity. (shrink)

Cet article se propose de montrer comment la présence récurrente de chevaux périlleux auprès de nombreux personnages de récits médiévaux et du folklore contemporain participe à la mise en lumière d’une fonction expiatoire conférée au destrier merveilleux. Il s’agit d’explorer la persistance de ce rôle dans le folklore régional français, afin de tracer un schéma d’un récit-type de la mise à l’épreuve et du tourment héroïques. La démarche retenue part de l’analyse du mythème chevalin dans le contexte du récit médiéval, (...) afin d’arriver à une mythanalyse d’un cheval-passeur que le folklore conserve et décline au gré des récits. Le propos s’appuie sur l’exemple de certaines chevauchées de La Queste del Saint Graal, que l’on mettra en relation avec des récits de tradition orale issus des collectes éditées par Alice Joisten et Christian Abry ou par Dominique Saur. Les déboires des élus du Graal auprès de chevaux terribles et merveilleux semblent bien ainsi constituer un topos de la remise en cause des vertus et des vices humains, dont la permanence se retrouve au sein de témoignages régionaux plus contemporains. The purpose of this paper is to evidence that the recurring presence of dangerous horses alongside many characters in medieval and contemporaneous folk narratives shed light on the atonement function of this marvel destrier. The permanence of this role in the French folklore will be emphasized in order to support a schema for a narrative type about the heroic test and torment. The approach proceeds from the analysis of the horse mytheme in the context of medieval narratives toward the mythanalysis of the ferry horse of souls, as a reputed psychopomp animal, which was ambient in folklore under various tokens. Finally, starting from specific horseback rides, typical riding raids found in The Grail Quest, their proximity with contemporaneous oral narratives edited by Alice Joisten and Christian Abry or by Dominique Saur will be recalled. The setbacks of the chosen of the Holy Grail faced to marvel and terrific horses seem to meet a topos, a challenge about virtues and vices whose permanence is attested in the most recent surveys in folkloristics. (shrink)

Ce Précis de philosophie moderne, publié en 1968 par R. Laffont sous le pseudonyme de Roboald Marcas, suscite d'emblée la perplexité du lecteur qui ne peut manquer de se demander s'il a affaire au livre d'un fou, d'un idiot ou d'un filou. Il s'agit en fait d'un pastiche des manuels de philosophie, dans lequel l'auteur s'inspire librement des sottises qu'il y a trouvées. Estimant que cette anthologie du stupide n'avait rien perdu de son actualité, les Presses Universitaires de France ont (...) décidé d'en proposer une nouvelle publication. (shrink)

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and (...) made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

In _Rawlsian Political Analysis: Rethinking the Microfoundations of Social Science, _Paul Clements develops a new, morally grounded model of political and social analysis as a critique of and improvement on both neoclassical economics and rational choice theory. What if practical reason is based not only on interests and ideas of the good, as these theories have it, but also on principles and sentiments of right? The answer, Clements argues, requires a radical reorientation of social science from the idea of interests (...) to the idea of social justice. According to Clements, systematic weaknesses in neoclassical economics and rational choice theory are due to their limited model of choice. According to such theories in the utilitarian tradition, all our practical decisions aim to maximize the satisfaction of our interests. These neo-utilitarian approaches focus on how we promote our interests, but Clements argues, our ideas of right, cognitively represented in principles, contribute independently and no less fundamentally to our practical decisions. The most significant challenge to utilitarianism in the last half century is found in John Rawls’s _Theory of Justice _and _Political Liberalism_, in which Rawls builds on Kant's concept of practical reason. Clements extends Rawls's moral theory and his critique of utilitarianism by arguing for social analysis based on the Kantian and Rawlsian model of choice. To illustrate the explanatory power of his model, he presents three detailed case studies: a program analysis of the Grameen Bank of Bangladesh, a political economy analysis of the causes of poverty in the Indian state of Bihar, and a problem-based analysis of the ethics and politics of climate change. He concludes by exploring the broad implications of social analysis grounded in a concept of social justice. “Paul Clements’s _Rawlsian Political Analysis _mounts an important intervention into the philosophy of the social sciences, challenging the tired fact/value, empirical/normative binaries that continue to impoverish social analysis. His insistence that social analysis must engage both facts and norms, the empirical and the normative, the good and the right, interest and principle—and that empirical social scientists must engage constructively on questions of autonomy and social justice—is noble and ultimately essential if social science is to justify its place in the years to come.” —_Fonna Forman-Barzilai, University of California, San Diego_. (shrink)

En América Latina se ha levantado la demanda del reconocimiento de las labores de cuidado. Este artículo argumenta que el feminismo decolonial, en contraposición al liberalismo y al conservadurismo, ofrece el mejor sustento teórico para darle fundamento a esta demanda. Mientras que el liberalismo y el conservadurismo, como consecuencia de sus perspectivas teóricas, relegan los cuidados al ámbito privado, el feminismo decolonial entrega herramientas teóricas y metodológicas que permitirían generar reflexiones más completas respecto a cómo el cuidado se enmarca dentro (...) de sociedades poscoloniales con instituciones liberales. (shrink)