For forty years, successive editions of Ethical Theory and Business have helped to define the field of business ethics. The 10th edition reflects the current, multidisciplinary nature of the field by explicitly embracing a variety of perspectives on business ethics, including philosophy, management, and legal studies. Chapters integrate theoretical readings, case studies, and summaries of key legal cases to guide students to a rich understanding of business ethics, corporate responsibility, and sustainability. The 10th edition has been entirely updated, ensuring that (...) students are exposed to key ethical questions in the current business environment. New chapters cover the ethics of IT, ethical markets, and ethical management and leadership. Coverage includes climate change, sustainability, international business ethics, sexual harassment, diversity, and LGBTQ discrimination. New case studies draw students directly into recent business ethics controversies, such as sexual harassment at Fox News, consumer fraud at Wells Fargo, and business practices at Uber. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Imperfect Men in Perfect Societies:Human Nature in UtopiaGorman BeauchampIUtopists view man as a product of his social environment. Nothing innate in the psychic make-up of man—no inherent flaw in his nature, no inheritance of original sin—prevents his being perfected, or at least radically ameliorated, once the social structure that shapes character can be properly reordered. Utopists, in short, deny that there is such a thing as "human nature"—if, as (...) John Plamenatz suggests, to say that something is human nature is just another way of saying that it cannot be changed.1 To accept the psychic constitution of man as fixed, immutable, is anathema to utopists, who agree rather with Ortega y Gasset: "Man has no nature. What he has is history."2 The social conditions that have obtained historically, that is to say, have made man what he has been—anything but utopian; but if man's history could be changed, so could his "nature." The idea of Progress, so pervasive in the West from the seventeenth century on, lends some credence to this contention. W. D. Howells's Altrurians, their creator notes, "get some sad amusement out of the fact that the capitalist world believes human nature cannot be changed, though cannibalism and slavery and polygamy have all been extirpated in the so-called Christian countries, and these things were once human nature, which is always changing...."3 Utopia is merely a means, then, of imaginatively expediting, directing, culminating the historically progressive creation of a morally exemplary race of men.The environmentalist psychology espoused by utopists springs from one of two anterior assumptions (although in the creation of many fictional idola the distinction between them is often blurred). The first [End Page 280] assumption is formulated most famously by Rousseau in the Discourse on Inequality: that "man is naturally good, and only by his institutions is he made bad."4 The second assumption is formulated most famously by Locke in the Essay Concerning Human Understanding: that the mind—and by extension the character—is a tabula rasa that takes impression from the stimuli exerted by the external world and thus is neither innately good or bad, but plastic, malleable.5 An intriguing conflation of these two theories operates, for instance, in the psyche of the monster in Mary Shelley's Frankenstein. In the long middle section of the book, where the monster's side of the story is presented sympathetically, his character develops in a text-book demonstration of Lockean psychology; yet, at the same time, this lumbering tabula rasa quivers with enough benevolence (the implausible provenance of which mystifies) to put most saints to shame. He becomes evil and destructive only after being persecuted unmercifully for his misshapen appearance.6 Indeed, the criminal career of Mary Shelley's monster rehearses the common utopian argument that society's injustice to man (or monster) is the source of his crimes. "With our present state of society," writes James Casey in A New Moral World (1885), "we manufacture criminals and then punish them for being so."7 H. G. Wells, in A Modern Utopia (1905), concurs: "Crime and bad lives are the measure of the State's failure, all crime in the end is the crime of the community."8 And both are but restating the charge of Sir Thomas More's Raphael Hytholoday, leveled several centuries earlier in the original Utopia (1519): "If you allow people to be badly brought up and their habits to be corrupted little by little from childhood and if you then punish them for crimes to which their early training has disposed them, what else is this, I ask, but first making them thieves and then punishing them for it?"9 Evil deeds, then, to reiterate the utopist's point, result not from some vicious mole in human nature, but from the malfunctioning of society itself. Utopia, by contrast, is—or theoretically ought to be—a world without crime.Rousseau's concept of the innate goodness of man and the evil of his institutions most often informs primitivist models of utopia, exotic worlds inhabited by noble savages uncorrupted by civilization. The idealized Indians of Montaigne's essay... (shrink)

In banning religious symbols for civil servants in a position of authority, Québec's laicity law disproportionately burdens religious minorities. Nevertheless, politicians seem to somehow avoid this problem, and the law is largely supported by the population. This insensibility to religious discrimination calls for an explanation. I argue that part of the explanation for this unequal treatment of religion in secular society lies in active religious ignorance. Drawing a parallel from how white ignorance functions to protect racial inequalities, I argue that (...) a kind of active ignorance in the religious domain – that I name post-Christendom ignorance – makes it difficult to comprehend alternative understandings of religious experience and allows the majority to deny its religious positionality. Applying this framework, I criticize Québec's laicity law for wrongfully relying on inadequate hermeneutical resources about religion. Further, the failure to see that targeting only religious symbols worn by individuals is discriminatory is the result of the epistemic vice of closed-mindedness. This article aims to show how religious persons in secular society can suffer hermeneutical wrongs because of their religious identity, and it aims to show that this injustice in the epistemic domain can help explain the unequal treatment of religious minorities while providing grounds for criticism. (shrink)

Chris Durante’s comments on my article about the compatibility of universal morality, particular moralities and multiculturalism indicate that we have very different approaches to and understandings of these three notions. Durante investigates multiculturalism from the perspective of political philosophy, whereas my approach is grounded in moral rather than political philosophy. Since he refers to his framework as an ‘ethico-political theory’, he may regard his account as a synthesis of moral and political philosophy, but this representation seems incorrect. He repeatedly refers (...) to his discussions of multiculturalism using the language of ‘political ethics’, ‘political theory’, ‘political philosophy’, ‘political system’, ‘political ramifications’, ‘political order’, ‘political liberalism’, ‘political community’, ‘political society’, ‘political principles’ and related concepts. He bluntly states his view about the centrality of political theory: ‘Multiculturalism…is primarily concerned with establishing a political system with moral undertones rather than a moral system with political ramifications’. I take the reverse view. Durante assumes without argument that multiculturalism finds its origins and home in political philosophy; by contrast, I envision multiculturalism as primarily a moral theory about obligations to tolerate moral differences in the face of conflicts between cultural groups. I do not deny that political philosophy is relevant to the resolution of various problems of multicultural …. (shrink)

Hume notoriously maintains that contiguity, succession, and constant conjunction are individually necessary and jointly sufficient conditions of causation. While his arguments for the necessity of constant conjunction have been thoroughly dissected, his arguments for contiguity and succession have generally been either ignored or misstated. I hope both to correct this unfortunate state of affairs and to show some fatal defects in Hume's account.The pertinent passages in Hume's writings acknowledge three conceivable ways in which the temporal relation between causes and effects (...) might be construed: as separated by some interval; as perfectly contiguous, so that the effect succeeds the cause in the very next moment; as perfectly contemporaneous, existing at the same moment. Hume defends the correctness of and denies the tenability of both and. (shrink)

: Phenomena of moral conflict and disagreement have led writers in ethics to two antithetical conclusions: Either valid moral distinctions hold universally or they hold relative to a particular and contingent moral framework, and so cannot be applied with universal validly. Responding to three articles in this issue of the Journal that criticize his previously published views on the common morality, the author maintains that one can consistently deny universality to some justified moral norms and claim universality for others. Universality (...) is located in the common morality and nonuniversality in other parts of the moral life, called "particular moralities." The existence of universal moral standards is defended in terms of: (1) a theory of the objectives of morality, (2) an account of the norms that achieve those objectives, and (3) an account of normative justification (both pragmatic and coherentist). (shrink)

After briefly sketching common-morality principlism, as presented in Principles of Biomedical Ethics, this paper responds to two recent sets of challenges to this framework. The first challenge claims that medical ethics is autonomous and unique and thus not a form of, or justified or guided by, a common morality or by any external morality or moral theory. The second challenge denies that there is a common morality and insists that futile efforts to develop common-morality approaches to bioethics limit diversity and (...) prevent needed moral change. This paper argues that these two critiques fundamentally fail because they significantly misunderstand their target and because their proposed alternatives have major deficiencies and encounter insurmountable problems. (shrink)

Medical professionals often deny patients who inject opioids a second or third heart valve replacement, even if such a surgery is medically indicated. However, such a position is not well defended. As this paper demonstrates, the ethical literature on the topic too often fails to develop and apply an ethical lens to analyse the issue of multiple valve replacements. This paper addresses this lacuna by analysing the case of Mr Walsh, a composite case which protects the identity of any one (...) patient, through the principlist approach of Beauchamp and Childress. It argues that the hospital should offer Mr Walsh, a second valve replacement because the procedure is: medically indicated, autonomously requested, non-maleficent, beneficent and does not violate a formal account of justice. The paper concludes with clinical ethical guidelines for valve surgery for patients with opioid use disorder. (shrink)

We distinguish dynamical and statistical interpretations of evolutionary theory. We argue that only the statistical interpretation preserves the presumed relation between natural selection and drift. On these grounds we claim that the dynamical conception of evolutionary theory as a theory of forces is mistaken. Selection and drift are not forces. Nor do selection and drift explanations appeal to the (sub-population-level) causes of population level change. Instead they explain by appeal to the statistical structure of populations. We briefly discuss the implications (...) of the statistical interpretation of selection for various debates within the philosophy of biologythe `explananda of selection' debate and the `units of selection' debate. (shrink)

What is Life? To answer this question, Denis Noble argues that we must look beyond the gene's eye view. For modern 'systems biology' considers life on a variety of levels, as an intricate web of feedback between gene, cell, organ, body, and environment. He shows how it is both a biologically rigorous and richly rewarding way of understanding life.

Einstein’s theory of Special relativity is founded on an error made by Hendrick Lorentz. It is not necessary to expose the mathematical inconsistencies of special relativity, since the theory collapses by simply exposing the error made by Lorentz. In doing so, it not only causes special relativity to collapse, but also general relativity, and the many theories built upon these two deceptive theories. There are many claims of tests made which supposedly prove SR or GR, such as the eclipse of (...) 1919, the Hafele-Keating experiment, GPS, the orbit of Mercury, and muons. The error of these will also be shown as well as an area of astronomy which has been negatively impacted by SR. The epistemology approach to special relativity: you can know it is a false theory when the theory requires deceiving the student for acceptance and the tests which support the theory can be proven false. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.3 (2003) 189-192 [Access article in PDF] Is There a Common Morality? Robert M. VeatchSenior EditorOne of the most exciting and important developments in recent ethical theory—especially bioethical theory—is the emergence of the concept of "common morality." Some of the most influential theories in bioethics have endorsed the notion using it as the starting point of their systems. This issue of the Journal is (...) devoted to these developments.The core idea of a common morality is that all humans—at least all morally serious humans—have a pretheoretical awareness of certain moral norms. The claim is that normal humans intuit or in some other way know that there is something wrong with things like lying or breaking promises or killing people. These purportedly universally shared insights can provide the raw data from which ethical theories are constructed. As such, they are perhaps analogous to the raw sense data that are relied on in the natural sciences to launch the construction of scientific theories and accounts of the nature of reality. Some common morality theorists suggest an analogy between the natural and the moral sciences.In the natural sciences there is a widely shared belief that some raw sensory data are perceived by all normal humans and provide the basis for the construction of various scientific theories. For example, it is widely believed that all normal humans looking at the top light on a traffic signal perceive something that in English is called "red." Of course, different cultures will use different language to describe this experience. They may parse the boundaries differently (varying on the exact borderline between red and orange), provide widely differing accounts of why the experience of "red" occurs, and eventually generate significantly different theoretical formulations to explain the experience of redness. Moreover, some individuals may look at that top light of the traffic signal and not see color at all. One generally, however, does not account for this by denying there is any objective, generally shared basis for the experience that produces a sensation of redness in normal people. One simply explains the experience of the one who fails to see color by positing a defect in perception, called "color-blindness."Some moral theorists suggest that something analogous happens when humans look at the moral scene. The claim is that all normal humans in all places and cultures "see" certain moral requiredness. They see that some behaviors are, in some sense, generally wrong; that other behaviors are generally right; that [End Page 189] some character traits are generally praiseworthy, others blameworthy. No sophisticated common morality theorist denies that, as with color-blindness, there may be occasional outliers who for one reason or another fail to intuit or perceive these simple, abstract moral norms. Certainly, people in different cultures will define the terms differently, will recognize different limits on the norms, and will construct different theories to account for their experience. The primitive idea that there is something generally wrong with killing other humans will be articulated very differently in different cultures—some referring to the "sacredness of life;" others to a duty not to kill, a right to life, or a prohibition on killing the innocent. Some may extend the insight to a duty to prolong living, others limit it merely to a prohibition of direct, active killing. Some may endorse more exceptions—for killing of unjust aggressors, for killing in just war, for killing in self-defense; others, such as pacifists, will be much more stingy in doling out exceptions. Certainly, people at different times and places will articulate the norms in different language and embed them in different theories. The basic claim of common morality theorists, however, is that there is some primitive, pretheoretical insight that is shared by all normal, morally serious persons.Recently, the notion of a common morality has served as a starting point for bioethical theories as diverse as Bernard Gert, Charles Culver, and Danner Clouser's Bioethics: A Return to Fundamentals (1997) and the latest edition of Tom Beauchamp and James Childress's Principles of Biomedical Ethics... (shrink)

There has recently been much interest in the role of attention in controlling action. The role has been mischaracterized as an element in necessary and sufficient conditions on agential control. In this paper I attempt a new characterization of the role. I argue that we need to understand attentional control in order to fully understand agential control. To fully understand agential control we must understand paradigm exercises of agential control. Three important accounts of agential control—intentional, reflective, and goal-represented control—do not (...) fully explain such exercises. I argue that understanding them requires understanding how deployments of visual attention implement flexible occurrent control, or a capacity to flexibly adjust the degree of control that individuals exercise over their actions. While such deployments of attention are neither necessary nor sufficient for exercising agential control, they constitute an attentional skill for controlling action, understanding which is central to fully understanding agential control. We can appreciate its centrality if we appreciate that this attentional skill for controlling action is plausibly crucial to acting non-negligently. (shrink)

This paper investigates the nature and foundation of duties to oneself in Kant's moral theory. Duties to oneself embody the requirement of the formula of humanity that agents respect rational nature in them-selves as well as in others. So understood, duties to oneself are not subject to the sorts of conceptual objections often raised against duties to oneself; nor do these duties support objections that Kant's moral theory is overly demanding or produces agents who are preoccupied with their own virtue. (...) Duties to oneself emerge as an essential and compelling part of Kant's moral theory. (shrink)

Robert Pippin's new book, The Culmination, examines Heidegger's reading and critique of Kant and Hegel. Since Pippin is perhaps best known as one of the most influential contemporary advocates for the importance of engaging with the difficult work of Hegel in particular, it will no doubt surprise quite a few of his readers that, on some fundamental points, the book concludes that “Heidegger is right” (p. xi). In the present piece, I explore some intriguing issues that Pippin's book raises. Although (...) the disagreement between his principal parties is obviously central to his discussion, my main focus is on a possible point of important agreement that that discussion also opens up, in light of which Heidegger might be fruitfully interpreted as pursuing a variant of a Kantian/Hegelian project, though this will also lead me to make a number of critical points about Pippin's reading of Heidegger: although there are grounds for thinking that Pippin's Heidegger does subscribe to such a project, some of the considerations that Pippin advances in arguing that “Heidegger is right” sit uncomfortably—it seems to me—with that project. (shrink)

April 15, 2024: This article published in Early View in error. The article will republish shortly.

It is human nature to wonder how things might have turned out differently--either for the better or for the worse. For the past two decades psychologists have been intrigued by this phenomenon, which they call counterfactual thinking. Specifically, researchers have sought to answer the "big" questions: Why do people have such a strong propensity to generate counterfactuals, and what functions does counterfactual thinking serve? What are the determinants of counterfactual thinking, and what are its adaptive and psychological consequences? This important (...) work brings together a collection of thought-provoking papers by social and cognitive psychologists who have made important theoretical and empirical contributions to our understanding of this topic. The essays in this volume contain novel theoretical insights, and, in many cases descriptions of previously unpublished empirical studies. The Psychology of Counterfactual Thinking provides an excellent overview of this fascinating topic for researchers, as well as advanced undergraduates and graduates in psychology--particularly those with an interest in social cognition, social judgment, decision judgment, decision making, thinking and reasoning. (shrink)

In Kant’s moral theory, we do not have duties to animals, though we have duties with regard to them. I reconstruct Kant’s arguments for several types of duties with regard to animals and show that Kant’s theory imposes far more robust requirements on our treatment of animals than one would expect. Kant’s duties regarding animals are perfect and imperfect; they are primarily but not exclusively duties to oneself; and they condemn not merely cruelty to animals for its own sake, but (...) also, such things as killing them for food when our health does not require it and ingratitude to service animals. Central to understanding these duties is appreciating Kant’s concern for our morally useful emotions, for it is primarily because of the effect that cruelty to animals has on our sympathetic emotions—which greatly help us treat other rational beings appropriately—that we have duties not to be cruel to animals. Yet cruelty and callousness toward animals are not problematic only because they may weaken some of our morally useful emotions. Cruelty and callousness toward animals are problematic also because they oppose our morally useful emotions; these emotions, as part of the perfection of our nature, should be honored, supported, and furthered, unless there are compelling reasons not to do so in particular cases. (shrink)

Meu principal objetivo, neste artigo, é analisar o problema da justificação moral para John Rawls, caracterizando a teoria da justiça como equidade como um sistema coerentista de justificação que conta com uma epistemologia coerentista holística, uma teoria do contrato social que introduz uma ontologia social e uma estratégia pragmatista de justificação na teoria contratualista. No escopo deste trabalho, examinarei o pressuposto pragmatista de justificação na teoria do contrato social, o qual faz uso do argumento da estabilidade social e legitimidade política (...) para garantir a validade da regra, isto é, dos princípios de justiça, a partir de dois artigos centrais para este debate: "Justice as Fairness: Political not Metaphysical" e "Reply to Habermas" § 1, 2. Um objetivo específico será o de mostrar a complementaridade entre o descritivismo e o prescritivismo nessa estratégia de justificação que possibilita a superação da dicotomia entre fato e valor. My main aim in this paper is to analyze the problem of moral justification in John Rawls, characterizing the theory of justice as fairness as a coherentist system of justification that relies on a holistic coherentist epistemology, a social contract theory that introduces a social ontology, and a pragmatist strategy of justification in contractarian theory. I will analyze the core characteristics of the pragmatic presupposition of justification in social contract theory, which uses the argument of social stability and political legitimacy as a guarantee of the legitimacy of the rules, that is, of the principles of justice. I will mainly make use of two articles relevant to this debate: "Justice as Fairness: Political not Metaphysical" and "Reply to Habermas" § 1, 2. A specific objective here is to show the complementarity between descriptivism and prescriptivism in this strategy of justification that allows an overcoming the fact/value dichotomy. (shrink)

Introduction In ancient rome, legend has it, a plebeian revolt was once quelled when the tribune Menenius Agrippa argued ...

Kant’s ethics conceives of rational beings as autonomous–capable of legislating the moral law, and of motivating themselves to act out of respect for that law. Kant’s ethics also includes a notion of the highest good, the union of virtue with happiness proportional to, and consequent on, virtue. According to Kant, morality sets forth the highest good as an object of the totality of all things good as ends. Much about Kant’s conception of the highest good is controversial. This paper focuses (...) on the apparent conflict between Kant’s claim that we are autonomous, and passages in which he seems to suggest that we require belief in the possibility of the highest good to motivate moral action. I distinguish three distinct versions of these problematic claims that seem to be present in Kant’s texts: that the highest good serves as (1) a motivational supplement to respect for the moral law, (2) a fundamental spring of right action, and (3) a condition of the bindingness of moral requirements. I argue that the texts are better interpreted to yield alternatives to (2) and (3) that do not conflict with our autonomy. I also argue that, properly understood, (1) does not conflict with our autonomy. In arguing for the last claim, I explore Kant’s notion of radical evil and its implications for human agency and virtue. (shrink)

This paper explores two models using which we might understand Heidegger's notion of ‘Eigentlichkeit’. Although typically translated as ‘authenticity’, a more literal construal of this term would be ‘ownness’ or ‘ownedness’; and in addition to the paper's exegetical value, it also develops two interestingly different understandings of what it is to have a judgment of one's own. The first model understands Heideggerian authenticity as the owning of what I call a ‘standpoint’. Although this model provides an understanding of a number (...) of key features of authenticity, it also invites an important objection—which I call ‘the closure objection’—that can be found in, for example, the work of Steven Galt Crowell and Tony Fisher. Although I argue that this objection can be met, the response for which it calls reveals that the feat of authenticity as understood through the standpoint model rests upon a further feat, and one which may itself have a stronger claim to be identified with Heideggerian authenticity. I develop this thought, introducing what I call the ‘all-things-considered judgment model’ of authenticity, the basis of which lies in, among other sources, Heidegger's appropriation of themes from Aristotle's discussion of phronesis. I explain the exegetical benefits of adopting this model and consider some objections that it invites, before closing with a discussion of how the two models understand the notion of ‘a judgment of one's own’. (shrink)

How can we argue, from neural facts, that representational states exhibit some specific representational structure? This paper approaches the question through a case study on the priority map-mechanism that underlies our capacity to orient visual attention. Computational models from cognitive neuroscience describe this mechanism as operating over neural topographic structures. These neural structures exhibit the functional profile of topographic representational structure. I argue that this fact warrants attributing topographic structure to the priority map mechanism’s representational states.

In this dissertation I develop a general theory of coercion that allows one to distinguish cases of interpersonal coercion from cases of persuasion or manipulation, and cases of institutional coercion from cases of oppression. The general theory of coercion that I develop includes as one component a theory of second-order coercion. Second-order coercion takes place whenever one person intentionally impairs the formation of the second-order desires of another person, or constrains them after their formation, in a way that frustrates or (...) eliminates the possibility of the victim fulfilling certain of his or her first-order desires. The concept of second-order coercion is important because it suggests that a person's autonomy may be violated in ways that have not been previously recognized. In this dissertation I argue that the unique feature of all cases of coercion is that the alternatives available to the victim, with regard to the formation of his or her will, are intentionally constrained by another person in a way that violates the victim's autonomy. A general theory of coercion should be able to explain how institutions may be understood as coercive. I argue that if institutions are understood as social practices maintained for the purpose of achieving some end, then they may be properly understood as capable of coercion. ;This theory of coercion allows me to make two arguments concerning moral responsibility. First, I argue that current discussions of moral responsibility are inadequate because they fail to take seriously the claim that a person may be responsible, at least in part, for having the beliefs and desires that make a particular action a case of coercion. Second, I argue that discussions of moral responsibility are inadequate because they fail to recognize that an agent may not be responsible for the state of his or her will because he or she may have been coerced in a way that has not been previously recognized. (shrink)

The standard semantic definition of consequence with respect to a selected set X of symbols, in terms of truth preservation under replacement (Bolzano) or reinterpretation (Tarski) of symbols outside X, yields a function mapping X to a consequence relation ⇒x. We investigate a function going in the other direction, thus extracting the constants of a given consequence relation, and we show that this function (a) retrieves the usual logical constants from the usual logical consequence relations, and (b) is an inverse (...) to—more precisely, forms a Galois connection with—the Bolzano-Tarski function. (shrink)

We show that for every c.e. degree a > 0 there exists an intrinsically c.e. relation on the domain of a computable structure whose degree spectrum is {0, a}. This result can be extended in two directions. First we show that for every uniformly c.e. collection of sets S there exists an intrinsically c.e. relation on the domain of a computable structure whose degree spectrum is the set of degrees of elements of S. Then we show that if α ∈ (...) ω∪{ω } then for any α-c.e. degree a > 0 there exists an intrinsically α-c.e. relation on the domain of a computable structure whose degree spectrum is {0, a}. All of these results also hold for m-degree spectra of relations. (shrink)

There has been increasing interest over the last few decades in the study of the effective content of Mathematics. One field whose effective content has been the subject of a large body of work, dating back at least to the early 1960s, is model theory. Several different notions of effectiveness of model-theoretic structures have been investigated. This communication is concerned withcomputablestructures, that is, structures with computable domains whose constants, functions, and relations are uniformly computable.In model theory, we identify isomorphic structures. (...) From the point of view of computable model theory, however, two isomorphic structures might be very different. For example, under the standard ordering of ω the success or relation is computable, but it is not hard to construct a computable linear ordering of type ω in which the successor relation is not computable. In fact, for every computably enumerable degree a, we can construct a computable linear ordering of type ω in which the successor relation has degree a. It is also possible to build two isomorphic computable groups, only one of which has a computable center, or two isomorphic Boolean algebras, only one of which has a computable set of atoms. Thus, for the purposes of computable model theory, studying structures up to isomorphism is not enough. (shrink)

writings, however, reveals a profoundly medieval outlook. Smith is preoccupied with the need to preserve order in society. His scientific methodology emphasises reconciliation with the world we live in rather than investigation of it. He invokes a version of natural law in which the universe is a harmonious machine administered by a providential deity. Nobody is uncared for and, in real happiness, we are all substantially equal. No action is without its appropriate reward – in this life or the next. (...) The social desirability of individual self-seeking activity is ensured by the ‘invisible hand’, that is, the hand of a god who has moulded us so to behave, that the quantity of happiness in the world is always maximised. (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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Kant’s _Groundwork for the Metaphysics of Morals_, first published in 1785, is still one of the most widely read and influential works of moral philosophy. This Broadview edition combines a newly revised version of T.K. Abbott’s respected translation with material crucial for placing the _Groundwork_ in the context of Kant’s broader moral thought. A varied selection of other ethical writings by Kant on subjects including our moral duties, fundamental principles of justice, the concept of happiness, and the relation of morality (...) to religion are included, along with important criticisms of Kant’s ethics by Fichte, Schiller, Hegel, and Sidgwick. (shrink)

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Around sixty years ago, Martin and Deutscher (1966) published a paper about the conditions under which an occurring mental state qualifies as episodically remembering. Recent philosophy of memory has developed this ontological interrogation in depth. But while it has significantly contributed to the ontological characterisation of episodic memory, it has also left aside an important part of it. Our memories not only occur, they also reoccur: we re-remember. This raises the ontological issue of their identity over time, along with the (...) related issue of their individuation. In the present paper, I explore this as yet uncharted territory of the ontology of episodic memories. I show first that the notion of re-remembering refers to a genuine mnemic phenomenon, and as such requires a theoretical account. I then proceed to design candidate accounts of said phenomenon, two of which, I claim, are particularly promising. (shrink)

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