The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

My aim is to evaluate a new realist strategy for addressing the pessimistic induction, Ludwig Fahrbach’s (Synthese 180:139–155, 2011) appeal to the exponential growth of science. Fahrbach aims to show that, given the exponential growth of science, the history of science supports realism. I argue that Fahrbach is mistaken. I aim to show that earlier generations of scientists could construct a similar argument, but one that aims to show that the theories that they accepted are likely true. The problem with (...) this is that from our perspective on the history of science we know their argument is flawed. Consequently, we should not be impressed or persuaded by Fahrbach’s argument. Fahrbach has failed to identify a difference that matters between today’s theories and past theories. But realists need to find such a difference if they are to undermine the pessimistic induction. (shrink)

The author argues for three interconnected theses which provide a cognitive account for why humans intuitively believe that others survive death. The first thesis, from which the second and third theses follow, is that the acceptance of afterlife beliefs is predisposed by a specific, and already well-documented, imaginative process - the offline social reasoning process. The second thesis is that afterlife beliefs are social in nature. The third thesis is that the living imagine the deceased as socially embodied in such (...) a way as to continue to fulfill on-going social obligations with others. The author further suggests six reasons why the fantasy/reality distinction breaks down for the imaginer such that the continued existence of the decedent in the afterlife is believed to be real. Finally, the author suggests avenues for further research which would support this cognitive account. (shrink)

This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range of delusions, (...) which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

The notion of the ‘free harmony of the faculties’ has baffled many of Kant's readers and also attracted much criticism. In this paper I attempt to shed light on this puzzling notion. By doing so, I aim to challenge some of the criticisms that this notion has attracted, and to point to its relevance to contemporary debates in aesthetics. While most of the literature on the free harmony is characterized by what I regard as an ‘extra-aesthetic approach’, I propose ‘an (...) aesthetic approach’ to the harmony. Such an aesthetic interpretation explains why aesthetic judgement, but not cognitive judgement, is based on a free agreement of the faculties in distinctively aesthetic terms. By contrast, an extra-aesthetic approach to Kant's aesthetic theory does not explain what it is in beautiful objects as beautiful that calls for a free agreement of the faculties. I argue that this approach is limited, and suggest an alternative to it by articulating the necessary reciprocity and explanatory interdependence between the form and value of beautiful objects and the form of the mental activity that underlies judgements of taste. My proposal is not only aesthetic, but also normative in its attempt to carve up a space for a distinct form of aesthetic normativity, the one that Kant describes as ‘free lawfulness’ or ‘lawfulness without a law’. I opt for a specifically normative variant of aesthetic interpretation because I believe that Kant is committed to the view of aesthetic judgement as normatively autonomous and irreducible. (shrink)

The aim of this essay is to describe and reflect upon the concrete particulars of one academician's work as an expert ethics witness. The commentary on my practices and the narrative descriptions of three cases are offered as evidence for the thesis that it is possible to act honorably within a role that some have considered to be inherently illicit. Practical measures are described for avoiding some of the best known pitfalls. The discussion concludes with a listing of the distinctive (...) competencies and understandings that are useful in serving as an expert ethics witness. (shrink)

The unknown nature of tomorrow’s research makes informed consent in biobank research a challenge. Whether the consent given by biobank participants is ‘broad’ or ‘narrow’, the ever present question remains the same: are new activities covered by the original consent? In this article, we focus on the meaning of, and the relation between, broad consent and re-consent in biobank research. We argue that broad consent should be understood as consenting to a framework—a framework which covers aims, core conditions for acceptable (...) use, governance and how these affect participants. Changes that alter the framework in a fundamental way call for re-consent. Three biobank cases of current international interest are used to debate when re-consent is an ethical necessity: whole-genome sequencing, data sharing and commercial utilization. These reflections give us a more nuanced view on what consent is for. We claim that the introduction of broad consents in biobank research has not represented a betrayal of individual participant interests, as some critics have asserted. Broad consents combined with the possible use of re-consent are in certain settings not inferior, but rather ethically superior to narrow consents. In population-based research biobanks, they allow for a reconciliation between individual interest and public matters in society at large. (shrink)

One of the main concerns in defining health is determining its status in relation to value. The main proposals in this direction generally assume a strict dichotomy between descriptive and evaluative dimensions. This essay argues that such a dichotomy leads to a theoretical inconsistency, which becomes evident once a definition of health is practically operative. A new conceptual framework uniting these two moments is proposed as an alternative, capable of preserving the fundamental insights of both descriptive and evaluative accounts of (...) health, and of avoiding the theoretical inconsistencies on the level of practical application. (shrink)

The goal is to isolate points of philosophical interest in the preceding articles on narrative medical ethics in order to focus subsequent dialogue between the two disciplines. Ethics is an enterprise that has over the centuries developed a somewhat malleable structure, comprising characteristics, methods, lines of reasoning, rules, principles, assumptions, and arguments. This structure provides the framework within which many disciplines contribute to ethics through the exercise of their particular interests, skills, and methods. Challenging or changing the structural components requires (...) arguments of a traditional sort appropriate to the discipline of ethics. Three tenets are proposed as comprising the “received view” or credo of the literature and ethics movement. Each is examined. Then the individual articles in this issue are explored to the end of ferreting out points that would be fruitful points of discussion between philosophy and literature folks pursuing their mutual interest in ethics. (shrink)

It is well documented that the higher the socioeconomic status (SES) of patients, the better their health and life expectancy. SES also influences the use of health services—the higher the patients' SES, the more time and specialised health services provided. This leads to the following question: should clinicians give priority to individual patients with low SES in order to enhance health equity? Some argue that equity is best preserved by physicians who remain loyal to ‘ordinary medical fairness’ in non-ideal circumstances (...) when health disparities persist; ie, doctors should allocate care according to needs only and treat everyone with equal regard by being neutral with respect to patients' SES. This paper furthers a discussion of this view by questioning how equitable needs relate to SES. To clarify, it distinguishes between four versions of ‘healthcare need’ and approaches an acceptable conceptualisation of the notion supported by Norman Daniels' theory on health equity. It concludes that doctors should remain neutral to patients' SES in cases in which several patients require the same health care. However, equitable health care requires considerations of the impact of socioeconomic factors (SEF) on patients' capacity to benefit from the care. Remaining neutral towards patients' SES in this respect does not promote equal regard. It follows that priority setting on the basis of SEF is required in fair clinical distribution of care, eg, through allocating more time to patients with low SES. In order to advance equity accurately, the concept of ordinary medical fairness should be amplified according to this clarification. (shrink)

I examine the value and limitations of Kuhn’s Structure of Scientific Revolutions. In the interests of developing a social epistemology of science, I argue that we should draw on Kuhn’s later work, published in The Road since Structure. There, Kuhn draws attention to the important role that specialty formation plays in resolving crises in science, a topic he did not discuss in Structure. I argue that we need to develop a better understanding of specialty research communities. Kuhn’s later work provides (...) a research agenda for those who want to study scientific specialization. I briefly discuss some recent studies that promise to provide valuable insight into the social structure of science. (shrink)

Narrative ethics taps into an inherent human need to tell our own stories centred on our own moral values and to have those stories heard and acknowledged. However, not everyone’s words are afforded equal power. The use of narrative ethics in bioethical decision-making is problematized by a disparity in whose stories are told, whose stories are heard, and whose stories are believed. Here, I conduct an analysis of narrative ethics through a critical theory lens to show how entrenched patterns of (...) narrative neglect in medicine are harming not only our capacity to make use of narrative ethics but also our capacity to deliver effective healthcare. To illustrate this point, I use three examples where the patient’s gender affects how their stories unfold: autism, weight, and pain management. From these, I argue that the use of narrative ethics without the application of a critical theory lens risks the exacerbation of what Miranda Fricker refers to as “testimonial injustice,” the prima facie harm experienced by individuals whose credibility is undermined by others’ prejudices. Finally, I suggest that narrative ethics can be a powerful tool for mitigating oppressive practices in medicine if we couple it with critical analysis that enables us to understand the power dynamics at play in storytelling. (shrink)

Many languages allow for “fake” uses of their past tense marker: the marker: can occur in certain contexts without conveying temporal pastness. Instead it appears to bear a modal meaning. Iatridou :231–270, 2000) has dubbed this phenomenon Fake Tense. Fake Tense is particularly common to conditional constructions. This paper analyzes Fake Tense in English conditional sentences as a certain kind of ambiguity: the past tense morphology can mark the presence of a temporal operator, but it can also signal a specific (...) modal operator. The ambiguity is proposed to be the result of recategorization: the Simple Past develops a second, modal meaning because of structural similarities between the temporal and the modal/epistemic domain. The proposal is spelled out in the generative semantics framework, using the restrictor approach to conditionals Semantics from different points of view, 1979; in: A. von Stechow and D. Wunderlich Semantics: an international handbook of contemporary research, 1991), and building on von Stechows et al.’s recent work on the English tense system The expression of time in language, 2010; Romero and von Stechow, Tense: introduction, 2008). (shrink)

The essays in this Journal issue offer examples of how textual analysis, literary theory, and the reading and writing of literature can contribute to an understanding of ethical issues in medicine. The editors' purpose in such an issue is to stimulate discussion between philosopher-ethicists and literary scholars whose work concerns this topic. With the concluding essays by editors Clouser and Hawkins, this discussion begins.

Open peer commentary on the article “Radical Constructivism and Radical Constructedness: Luhmann’s Sociology of Semantics, Organizations, and Self-Organization” by Loet Leydesdorff. > Upshot: Leydesdorff emphasises the uncertainties involved in the communication of meaning. Luhmann posited three types of media, each of which reduces one type of communicative improbability. The theory of cultural evolution supports Leydesdorff’s emphasis on the uncertainty of communication, and agrees that different media are needed for communication within and across social boundaries. But it highlights the distinction between (...) media and the symbolic codes that give them structure; and it raises the question whether Luhmann’s symbolically generalized communication media are really media at all. (shrink)

Maurice Merleau-Ponty enjoys a special place among contemporary French bourgeois philosophers and aestheticians. Statements by Sartre, Camus, Hyppolite, Dufrenne, Ricoeur, Geroux, Lévi-Strauss, and others show that they experienced in one way or another the influence of this philosopher. For example, all French phenomenologists and existentialists recognize that Merleau-Ponty was the first to take up and pursue, on French soil, the elaboration of the ideas of Husserlian phenomenology and German existentialism. One cannot fail to note that various kinds of antidialectical and (...) metaphysical notions have come into being under the direct and powerful influence of Merleau-Ponty. (shrink)

The 1990 Visual Artists Rights Act (VARA) is a provision of U.S. copyright law that seeks to protect the noneconomic rights of artists, called "moral rights." These rights are due to the "presumed intimate bond between artists and their works."1 In the United States it protects rights of artistic attribution and integrity: the artwork cannot be claimed as the work of another, and it cannot be distorted. In some cases VARA protects artworks from destruction. But what is the nature of (...) this intimate bond? The underlying principle behind the legal construct of artistic moral rights is that the artwork is an extension of its creator such that any harm to the work is a violation of the personhood of the artist.2 Another .. (shrink)

Introduction Substitute decision making on behalf of incapable patients is based on the ethical principle of ‘respect for autonomy’. This study was conducted to assess patients' wishes and preferences in terms of a substitute decision maker and determinants of such preferences. Methods The authors conducted a cross-sectional study and selected samples randomly from patients presenting at Farabi Eye Hospital clinics who were 18 years of age or older. Questionnaires were completed through interviews. Results 200 patients between the ages of 18 (...) and 83 years were interviewed. About 52% (N=105) were men and 73% (N=77) were married. Among married patients, the spouse was chosen as the substitute decision maker in only 51% of cases. Single men preferred their father first in 36% (N=9) of cases, while single girls chose their father in 5.6% (N=1) of cases and their most prevalent choice was other unmentioned people (33.3%, N=6). Most patients (93.5%) wished to be asked about their substitute decision maker when hospitalised. Conclusion The results of this study show that the people we usually consult for decisions concerning patient treatment are significantly different from the patients' preferred substitute decision makers. The authors suggest patients be allowed to choose their substitute decision maker while conscious. (shrink)

Open peer commentary on the target article “From Objects to Processes: A Proposal to Rewrite Radical Constructivism” by Siegfried J. Schmidt. Upshot: The subtitle of “An Austrian Contribution” emphasizes a basic distinction between German and Austrian traditions in the philosophy of fields of science. In S. J. Schmidt’s genuinely German way of writing, one can observe a high emphasis on terminology and a specific arena of heavy philosophical problems that have to be solved in a strictly philosophical manner, whereas the (...) Austrian tradition places its importance on scientific progress, especially in the natural sciences, and on the clarifying, mediating, and self-reflecting role of philosophy within the overall context of scientific evolution. (shrink)

For ages one phase of Indian thought has grappled with exactly this problem. To be in the world is to be subject to limitations--conditionings--of power, of knowledge, and of freedom. So man's suffering is a result of his being in the world--of his being a link in this chain of becomings. His suffering is tied up with temporality and illusion--with mäyä. Suffering is a cosmic necessity; it is one of the modes of reality, a law of worldly existence. If so, (...) what are the limits of the various forces that condition man--that bind and fetter him? If we know this, then man can be deconditioned, freed from suffering and temporality and taken into another mode of existence, where he enjoys spontaneity and freedom. Thus universality of suffering need not lead to a philosophy of pessimism, for realization of it is a necessary condition for emancipation. The quest for the beyond, for transcendence, will start only when this world and this mode of life are depreciated and rejected. The quest presupposes that there is something beyond becoming, temporality, and suffering; and that it is possible for man to decondition and free himself completely. The immemorial experience of the sages who have gone beyond and reached "the other shore," after discovering the ford and the ferry which will sail them across this ocean of suffering and becoming, testifies to the reality of transcendence and complete freedom. Such was the conclusion reached by one trend of Indian thought. (shrink)

Against Richard Taylor's position (Action and Purpose,Prentice Hall,1966) that there is some further factor in agency that in one of its roles supplements the contingency of an action that is freely performed.

This study asks how Sartre’s version of the dialectic of recognition is present in Kierkegaard’s works. For Sartre, the dialectic begins with an awareness that the other sees me and judges me. I experience this as a threat to my autonomy, and I fight back with a variety of strategies designed to mitigate the effects. Inter-subjective relationships are grounded in conflict from which there is no exit. Similarly, Kierkegaard characterizes the natural, self-centered way of seeing the other as inherently self-centered (...) and contentious. And yet some of Kierkegaard’s texts lay the ground for a way out. Unlike Sartre, he is sensitive to modifications to the structure of the dialectic of recognition that depend on a change in the basic mode of looking. That is, how I see, evaluate, and judge the other can alter the foundation of the interaction from something mutually contentious to something mutually edifying. (shrink)