The principle of patient autonomy dominates the contemporary debate over medical ethics. In this examination of the doctor-patient relationship, physician and philosopher Alfred Tauber argues that the idea of patient autonomy -- which was inspired by other rights-based movements of the 1960s -- was an extrapolation from political and social philosophy that fails to ground medicine's moral philosophy. He proposes instead a reconfiguration of personal autonomy and a renewed commitment to an ethics of care. In this formulation, physician beneficence (...) and responsibility become powerful means for supporting the autonomy and dignity of patients. Beneficence, Tauber argues, should not be confused with the medical paternalism that fueled the patient rights movement. Rather, beneficence and responsibility are moral principles that not only are compatible with patient autonomy but strengthen it. Coordinating the rights of patients with the responsibilities of their caregivers will result in a more humane and robust medicine.Tauber examines the historical and philosophical competition between facts and values in medicine. He analyzes the shifting conceptions of personhood underlying the doctor-patient relationship, offers a "topology" of autonomy, from Locke and Kant to Hume and Mill, and explores both philosophical and practical strategies for reconfiguring trust and autonomy. Framing the practicalities of the clinical encounter with moral reflections, Tauber calls for an ethical medicine in which facts and values are integrated and humane values are deliberately included in the program of care. (shrink)

In Immunity, Alfred Tauber sets forth a new theory of immunology that rejects the common principle of self and non-self, and the immune system's role as a protector of the self from external threats. Rather than serving to defend an independent entity, he argues, immunity participates in a large, complex eco-system of porous and flexible boundaries. Tauber's new approach to immunology necessitates a new biology in which symbiosis is the rule, not the exception.

In Western society, weight moralization is reflected in the belief that weight is controllable across the weight spectrum. However, the effect of holding such beliefs is unclear. We therefore propose that these beliefs affect people differently depending on their BMI. When confronted with negative, self-related feedback, people’s coping strategies are often reflected in the ways they relate to their self. We examine three such self-to-self relations (i.e., reassured, inadequate, and hated self). Extending prior research, we predict that weight controllability beliefs (...) are related to positive self-to-self relations for adults with a low, and to negative self-to-self relations for adults with a high BMI. Accordingly, we expected that weight controllability beliefs would be associated with defensive avoidance among people with a high, but not with a low BMI. We tested our hypotheses in a sample of 348 adults who participated in an online survey. Weight controllability beliefs were associated with increased defensive avoidance in people with high BMI, and with decreased defensive avoidance in adults with a low BMI. Forms of self-to-self relating fully mediated this association, demonstrating positive effects on adults with a low, and negative effects on adults with a high BMI. Additionally, in an open ending section, we found seven social settings that deprive people from satisfying their need to belong and to be accepted due to their weight. We discuss our findings against a call for a less moralized public discourse about overweight and obesity that is particularly relevant in the context of the current COVID-19 pandemic. (shrink)

_Requiem for the Ego_ recounts Freud's last great attempt to 'save' the autonomy of the ego, which drew philosophical criticism from the most prominent philosophers of the period—Adorno, Heidegger, and Wittgenstein. Despite their divergent orientations, each contested the ego's capacity to represent mental states through word and symbol to an agent surveying its own cognizance. By discarding the subject-object divide as a model of the mind, they dethroned Freud's depiction of the ego as a conceit of a misleading self-consciousness and (...) a faulty metaphysics. Freud's inquisitors, while employing divergent arguments, found unacknowledged consensus in identifying the core philosophical challenges of defining agency and describing subjectivity. In _Requiem_, Tauber uniquely synthesizes these philosophical attacks against psychoanalysis and, more generally, provides a kaleidoscopic portrait of the major developments in mid-20th century philosophy that prepared the conceptual grounding for postmodernism. (shrink)

Contemporary American medical ethics was born during a period of social ferment, a key theme of which was the espousal of individual rights. Driven by complex cultural forces united in the effort to protect individuality and self-determined choices, an extrapolation from case law to rights of patients was accomplished under the philosophical auspices of ‘autonomy’. Autonomy has a complex history; arising in the modern period as the idea of self-governance, it received its most ambitious philosophical elaboration in Kant's moral philosophy. (...) In examining the Kantian construction, it is evident that neither his universal moral imperative nor his rigorous application of self-legislated ethical action can sustain our own notions of moral agency in a pragmatic, pluralistic society. But the Kantian position is useful in highlighting that self-governance is not equivalent to ‘autonomy’, and this distinction defines the limits of autonomy in the clinical setting. A critique of Engelhardt's idea of ‘principle of permission’ is used to illustrate autonomy's eclipse as a governing principle for medical ethics. (shrink)

Philosophy of immunology is a subfield of philosophy of biology dealing with ontological and epistemological issues related to the studies of the immune system. While speculative investigations and abstract analyses have always been part of immune theorizing, until recently philosophers have largely ignored immunology. Yet the implications for understanding the philosophical basis of organismal functions framed by immunity offer new perspectives on fundamental questions of biology and medicine. Developed in the context of history of medicine, theoretical biology, and medical anthropology, (...) philosophy of immunology differs from these related branches of study in its focus on traditional philosophical questions concerning identity, individuality, ecology, cognition, scientific methodology and theory construction. This broad agenda derives from immunology’s multifaceted research program that has developed from its initial clinical challenges of host defense, transplantation, autoimmunity, tumor immunology, and allergy. In addition to these well-established research areas, immunity is now understood to play a central role in other physiological functions, development, ecology, and evolutionary mechanics. Holding together these diverse domains of inquiry lie philosophical commitments oriented by organismal identity. In this regard, pertinent issues are raised concerning cognition (organization of immune perception and information processing), the character of individuality (framed by the ecological context of immune-mediated assimilation and rejection), and the dynamics of complex systems (understood as holistic systems biology). Indeed, immunology, in the context of cognitive science, evolutionary biology, environmental sciences, and development provides multi-focal perspectives for philosophy of science. (shrink)

In biology, the ‘ecological orientation' rests on a commitment to examining systems, and the conceptual challenge of defining that system now employs techniques and concepts adapted from diverse disciplines (i.e., systems philosophy, cybernetics, information theory, computer science) that are applied to biological simulations and model building. Immunology has joined these efforts, and the question posed here is whether the discipline will remain committed to its theoretical concerns framed by the notions of protecting an insular self, an entity demarcated from its (...) environment, or will shift its focus of interest to a wider context. An ecological perspective emphasizes the interchange between the organism and its environment, the processing of information, and the regulation arising from responses to this larger context. Moving from the first attempts at modeling the immune system as a closed network, immunologists have joined the general interest in systems analysis, and that move might portend a significant shift to an open, more holistic consideration of immune regulation. *Received December 2006; revised August 2007. †To contact the author, please write to: Center for Philosophy and History of Science, Boston University, 745 Commonwealth Ave., Boston, MA 02215; e-mail: [email protected]. (shrink)

This collection of essays ranges from phenomenological descriptions of the beautiful in science to analytical explorations of the philosophical conjunction of ...

Freud began university intending to study both medicine and philosophy. But he was ambivalent about philosophy, regarding it as metaphysical, too limited to the conscious mind, and ignorant of empirical knowledge. Yet his private correspondence and his writings on culture and history reveal that he never forsook his original philosophical ambitions. Indeed, while Freud remained firmly committed to positivist ideals, his thought was permeated with other aspects of German philosophy. Placed in dialogue with his intellectual contemporaries, Freud appears as a (...) reluctant philosopher who failed to recognize his own metaphysical commitments, thereby crippling the defense of his theory and misrepresenting his true achievement. Recasting Freud as an inspired humanist and reconceiving psychoanalysis as a form of moral inquiry, Alfred Tauber argues that Freudianism still offers a rich approach to self-inquiry, one that reaffirms the enduring task of philosophy and many of the abiding ethical values of Western civilization. (shrink)

This is one of the first books in a new series that will publish the very best work in the philosophy of biology. The series will be non-sectarian in character, will extend across the broadest range of topics, and will be genuinely interdisciplinary. The Immune Self is a critical study of immunology from its origins at the end of the nineteenth century to its contemporary formulation. The book offers the first extended philosophical critique of immunology, in which the function of (...) the term 'self' that underlies the structure of current immune theory is analysed. However, this analysis is carefully integrated into a broad survey of the major scientific developments in immunology, a discussion of their historical context, and a review of the conceptual arguments that have moulded this sophisticated modern science. (shrink)

Tauber, a leading figure in history and philosophy of science, offers a unique autobiographical overview of how science as a discipline of thought has been characterized by philosophers and historians over the past century. He frames his account through science’s – and his own personal – quest for explanatory certainty. During the 20th century, that goal was displaced by the probabilistic epistemologies required to characterize complex systems, whether in physics, biology, economics, or the social sciences. This “triumph of uncertainty” (...) is the inevitable outcome of irreducible chance and indeterminate causality. And beyond these epistemological limits, the interpretative faculties of the individual scientist invariably affects how data are understood. Whereas positivism had claimed radical objectivity, post-positivists have identified how a web of non-epistemic values and social forces profoundly influence the production of knowledge. Tauber presents a case study of these claims by showing how immunology has incorporated extra-curricular social elements in its theoretical development and how these in turn have influenced interpretive problems swirling around biological identity, individuality, and cognition. The correspondence between contemporary immunology and cultural notions of selfhood are strong and striking. Just as uncertainty haunts science, so too does it hover over current constructions of personal identity, self knowledge, and moral agency. Across the chasm of uncertainty, science and selfhood speak. (shrink)

Since Galileo, critics have waged a relentless assault against science, attacking it as dehumanizing, reductionist, relativistic, dominating, and imperialistic. Supporters meanwhile view science as synonymous with modernity and progress. The current debates over the role of science-- described by such headlines as Scientists are Urged to Fight Back Against `Politically Correct' Critics in The Chronicle of Higher Education--testify to how deeply divided we remain about the values and responsibilities of science in the modern age. Acknowledging the validity of a deep (...) skepticism about science but eager to preserve its strengths and values, Alfred I. Tauber's anthology seeks to avoid an either/or configuration. Science, Tauber argues, is fundamentally pluralistic and must accept detracting criticism as part of its very code in the hope that, in its defense, the scientific enterprise is strengthened and reaffirmed. Featuring essays by a wide range of interdisciplinary, classical, and contemporary thinkers such as Martin Heidegger, Thomas Kuhn, Hilary Putnam, Evelyn Fox Keller, and Max Weber, the work is divided into five parts: science and its worldview; the problem of scientific realism; the nature of scientific change; the boundaries of science; and science and values. (shrink)

Over time, there has been a steady increase of workplace health promotion programs that aim to promote employees’ health and fitness. Previous research has focused on such program’s effectiveness, cost-savings, and barriers to engaging in workplace health promotion. The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one’s health, inadvertently facilitate stigmatization and discrimination of people with (...) overweight in the workplace. Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability. Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma. Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination, Study 3 showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable. Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes. As such, we offer valuable insights for organizations who aim to design and implement workplace health promotion programs in an inclusive, non-discriminatory way that benefits all employees. (shrink)

Freud (and later commentators) have failed to explain how the origins of psychoanalytical theory began with a positivist investment without recognizing a dual epistemological commitment: simply, Freud engaged positivism because he believed it generally equated with empiricism, which he valued, and he rejected ‘philosophy’, and, more specifically, Kantianism, because of the associated transcendental qualities of its epistemology. But this simple dismissal belies a deep investment in Kant’s formulation of human reason, in which rationality escapes natural cause and thereby bestows humans (...) with cognitive and moral autonomy. Freud also segregated human rationality: he divided the mind between (1) an unconscious grounded in the biological and thus subject to its own laws, and (2) a faculty of autonomous reason, lodged in consciousness and free of natural forces to become the repository of interpretation and free will. Psychoanalysis thus rests upon a basic Kantian construction, whereby reason, through the aid of analytic techniques, provides a detached scrutiny of the natural world, i.e. the unconscious mental domain. Further, sovereign reason becomes the instrument of self-knowing in the pursuit of human perfection. Herein lies the philosophical foundation of psychoanalytic theory, a beguiling paradox in which natural cause and autonomous reason — determinism and freedom — are conjoined despite their apparent logical exclusion. (shrink)

Alfred I. Tauber (ed.), Organism and the Origins of Self. Dordrecht, Netherlands: Kluwer Academic Publishers, 1991. xix + 384 pp., US$ 110.00 (US$ 25.00 paperback). This is a fascinating book based on a 1990 symposium at Boston University. It promises to change the way one conceives of the organism. The authors start from different specializations but provide a most tantalizing feast of ideas. Richard Lewontin commences the book with a strange foreword. Lewontin submits that the concern with the "self (...) and private identity in modern biology is ... only one manifestation of the ideology of individualism that is a shibboleth of our particular [bourgeois] form of social organization" (p. xix). If this is the case, the reader should stop reading the book and ask for her money back. But I advise patience. Tauber's introduction is a mixture of the history of the medical notion of disease and the advocacy of a dialectical concept of the self as the interpenetration of part and whole. Tauber highlights Elie Metchnikoff's appealing idea of phagocytosis as just one form of the active organism striving to attain harmony among competing cells. (shrink)

Friedrich Nietzsche''s will to power, and the philosophical ediface built on this foundation, is formulated on a biologicism that is indebted to a particular post-Darwinian vision of the organism. Of the various models that attempt to formulate a comprehensive organismal biology, Nietzsche unknowingly grasped that of Elie Metchnikoff, who authored the theoretical foundation of modern immunology. Metchnikoff regarded the organism as a disharmonious entity, in constant inner strife between competing cellular activities. Immune functions were responsible for mediating harmonization, which however (...) remains an elusive ideal. This view of the organism posited an ever-changing, self-defining entity striving for self-actualization while in ceaseless inner struggle as well as in competition with the environment. The theory is no less than an epistemological response of how to establish the subject-object relation in a construct where the subject''s boundaries are dialectical and evolving. The similarity of the philosophical positions of Nietzsche and Metchnikoff regarding the Self offers rich resonance in current attempts to formulate a biomedical language appropriate to address the issues raised by these problems. (shrink)

Medicine’s fundamental moral philosophy is the responsibility of caring for the ill, yet beneficence is not under the province of the law.Indeed, fiduciary responsibilities of doctors are limited. Instead, American law is preoccupied with protecting patient rights under the precept of patient autonomy, and contemporary medical ethics is dominated by these concerns. The extrapolation of autonomy rights from the political and judicial culture to medicine is, under ordinary circumstance, non-problematic. However, in instances of conflict, the dominance of autonomy reveals a (...) hierarchy of values determining patient care. To illustrate the moral calculus of balancing competing principles, the ethical issues of involuntary treatment of psychotic patients are considered, and alternatives to the moral reasoning currently guiding the care of these individuals are offered to better solve the dilemma of respecting patient autonomy while still fulfilling the claims of physician responsibility. (shrink)

Researchers have evaluated how broad categories of emotion influence judgments of learning relative to neutral items. Specifically, JOLs are typically higher for emotional relative to neutral items. The novel goal of the present research was to evaluate JOLs for fine-grained categories of emotion. Participants studied faces with afraid, angry, sad, or neutral expressions and with afraid, angry, or sad expressions. Participants identified the expressed emotion, made a JOL for each, and completed a recognition test. JOLs were higher for the emotional (...) relative to neutral expressions. However, JOLs were insensitive to the categories of negative emotion. Using a survey design in Experiment 3, participants demonstrated idiosyncratic beliefs about emotion. Some people believed the fine-grained emotions were equally memorable, whereas others believed a specific emotion was most memorable. Thus, beliefs about emotion are nuanced, which has important implications for JOL theory. (shrink)

Acknowledging the power of the id-drives, Freud held on to the authority of reason as the ego’s best tool to control instinctual desire. He thereby placed analytic reason at the foundation of his own ambivalent social theory, which, on the one hand, held utopian promise based upon psychoanalytic insight, and, on the other hand, despaired of reason’s capacity to control the self-destructive elements of the psyche. Moving beyond the recourse of sublimation, post-Freudians attacked reason’s hegemony in quelling disruptive psycho-dynamics and, (...) focusing upon the social domain, they sought strategies to counter the oppressive (repressive) social restrictions and conformist impositions impeding individual freedom that result from thwarted desire. Postmodern celebration of desire at the expense of reason and sublimation leaves the Enlightenment prospects altogether and moves psychoanalysis into a new terrain, where the very notion of rationality and an autonomous ego upon which much of Freudianism rests has been deconstructed. Thus the debate that begins with Freud’s social theories reflects the deeper divisions, which arose with postmodern ethics and discarded Cartesian–Kantian notions of personal identity. Here we consider the moral framework in which Freudian social theory sits and a contrasting understanding of agency that confronts his modernist conception. In that debate, we discern the larger humanist confrontation with postmodernity. Yet, all who engaged Freud shared some version of his utopian ethos, albeit radically restructuring the theory upon which social reform might occur. (shrink)

In his graceful philosophical account, Alfred I. Tauber shows why Thoreau still seems so relevant today—more relevant in many respects than he seemed to his contemporaries. Although Thoreau has been skillfully and thoroughly examined as a writer, naturalist, mystic, historian, social thinker, Transcendentalist, and lifelong student, we may find in Tauber's portrait of Thoreau the moralist a characterization that binds all these aspects of his career together. Thoreau was caught at a critical turn in the history of science, (...) between the ebb of Romanticism and the rising tide of positivism. He responded to the challenges posed by the new ideal of objectivity not by rejecting the scientific worldview, but by humanizing it for himself. Tauber portrays Thoreau as a man whose moral vision guided his life's work. Each of Thoreau's projects reflected a self-proclaimed "metaphysical ethics," an articulated program of self-discovery and self-knowing. By writing, by combining precision with poetry in his naturalist pursuits and simplicity with mystical fervor in his daily activity, Thoreau sought to live a life of virtue—one he would characterize as marked by deliberate choice. This unique vision of human agency and responsibility will still seem fresh and contemporary to readers at the start of the twenty-first century. (shrink)

Emerson articulated his metaphysics of selfhood within a theistic framework; Thoreau reconfigured his ideas as a mystical pantheism. In this latter form, Transcendentalism offered twentieth century Americans a new religious sensibility based on an intimacy with nature, which became a spiritual and aesthetic resource for personal fulfillment.

This book probes the ethical structure of contemporary medicine in an argument accessible to lay readers, healthcare professionals, and ethicists alike.

Upshot: The cognitive paradigm organizes immune phenomena with an eye towards understanding the immune system as a perceptive faculty, where examination of the basic regulation of unstimulated immune activity becomes the primary investigative focus. While a fecund research program organized around the hypothesized “autonomous network theory” has yielded important insight into the “conservative physiology of the immune system,” the theoretical basis for these studies offers little more than one set of metaphors (arranged around “cognition”) challenging another (“selfhood”). However, breaking the (...) theoretical hold of protecting the immune self as the focus of immunology is no mean feat in terms of shifting research interest towards a key, but neglected aspect of immunity. (shrink)

Contemporary immunology has established its fundamental theory as a biological expression of personal identity, wherein the "immune self" is defended by the immune system. Protection of this agent putatively requires a cognitive capacity by which the self and the foreign are perceived and thereby discriminated; from such information, discernment of the environment is achieved and activation of pathways leading to an immune response may be initiated. This so-called cognitive paradigm embeds such functions as "perception," "recognition," "learning," and "memory" to characterize (...) immune processes, but the conceptual character of such functions has meanings that vary with the particular theory adopted. When different formulations of cognition are considered, immunology's conceptual infrastructure shifts: Extensions of conventional psychological understanding of representational cognition based on a subject-object dichotomy support notions of immune agency; alternatively, formulations of perception that dispense with representations and attendant notions of agency reconfigure the predicate epistemology dominating current immune theory. Reviewing immunological literature of the past five decades, these two understandings of perception – representational and non-representational – offer competing views of immune cognitive functions. These, in turn, provide competing philosophical understandings of immunology's conceptual foundations, which reflect parallel controversies dominating current debates in philosophy of mind and attendant discussions about personal identity. (shrink)

Ontologies are created to describe and reason over the knowledge of a domain of interest. This requires deep understanding of the domain, and therefore, the input and collaboration of the domain’s...

According to immunology’s prevailing paradigm, immunity is based on self/nonself discrimination and thus requires a construction of identity. Two orientations vie for dominance: The original conception, conceived in the context of infectious diseases, regards the organism as insular and autonomous, an entity that requires defense of its borders. An alternate view places the organism firmly in its environment in which both benign and onerous encounters occur. On this latter relational account, active tolerance allows for cooperative relationships with other organisms in (...) the larger ecological economy. These contending orientations —one derived from biomedicine and the other from the ecological sciences— have drawn the attention of social scientists and culture critics. On the one hand, feminists have portrayed immune theory as based upon borrowed social notions of identity that reflect male aggressive values and thus distort more balanced accounts of immunity; and, on the other hand, other commentary projects immune theory as a framework in which analysis of Western societies putatively reveals analogous patterns of ‘self’ and ‘other’ interactions, where autoimmunity and immunization are understood as expressions of the insular understanding of identity. Here, a meta-interpretation is presented that shows how these critiques place the immune self on a spectrum stretching from its formulation as an autonomous agent, a modernist conception of the independent individual, to a postmodern portrayal in which this conception of selfhood has been deconstructed. Accordingly, immunology is drawn into a wide-ranging debate about agency, where differing interpretations of immunity serves as a template in which competing understandings of human social intercourse is modeled.Según el paradigma dominante en inmunología, la inmunidad está basada en la discriminación entre yo/noyo y requiere, por tanto, una construcción de la identidad. Dos orientaciones compiten por dominar: la concepción original, concebida en el contexto de las enfermedades infecciosas contempla al organismo como aislado y autónomo, como una entidad que necesita defender sus fronteras. Una visión alternativa sitúa firmemente al organismo en su entorno, en el cual suceden tanto encuentros beneficiosos como costosos. En este enfoque relacional, la tolerancia activa permite relaciones cooperativas con otros organismos en una economía ecológica más amplia. Estas orientaciones en liza —una derivada de la biomedicina y otra de las ciencias ecológicas— han llamado la atención de los científicos sociales y de los críticos de la cultura. Por una parte, el feminismo ha descrito la teoría inmunológica como basada en nociones sociales prestadas de identidad que reflejan los valores agresivos del macho y que, de este modo, impiden una explicación más equilibrada de la inmunidad. Por otra parte, otro comentario proyecta la teoría inmunológica como un marco en el que el análisis de las sociedades occidentales revela aparentemente patrones análogos de interacciones ‘yo’ y ‘otros’, en las que la autoinmunidad y la inmunización son entendidas como expresiones de la comprensión insular de la identidad. Se ofrece aquí una meta-representación que muestra cómo estas críticas sitúan al yo inmune en un espectro que va desde su formulación cómo un agente autónomo, una concepción modernista del individuo independiente, a una visión postmoderna en la que esta concepción de la identidad ha sido deconstruida. De acuerdo con esto, la inmunología recoge un amplio debate sobre la agencia en el que diferentes interpretaciones de la inmunidad sirven como molde en el que se modelan comprensiones competidoras de la comprensión de las relaciones sociales humanas. (shrink)