Peter Singer has argued for a radical anti-intuitionism on the basis of recent empirical research into the psychological and evolutionary origins of moral intuition. There is, however, a gap between the putative genealogy of moral intuition that Singer offers and his desired methodological claim. I explore three ways to bridge the gap, and argue that the promising way is to construe the genealogy as a debunking genealogy. I sketch an account of how debunking arguments work, and then show that this (...) causes problems for Singer, since utilitarianism itself is liable to be debunked. Finally, I suggest how we can take lessons for ethics from the empirical work, but that the result is a far more restricted kind of anti-intuitionism than Singer was hoping for. (shrink)

In this excerpt, Vladimir S. Bibler attempts to show that the initial concepts of mechanics that were formulated in the 1660s are paradoxical; they result in contradictory concepts. However, this p...

Language is the primary technology clinical ethicists use as they offer guidance about norms. Like any other piece of technology, to use the technology well requires attention, intention, skill, and knowledge. Word choice becomes a matter of professional practice. The Brief Report offers clinical ethicists several reasons for rejecting the phrase “aggressive care.” Instead, ethicists should consider replacing “aggressive care” with the adjacent concept of a “recovery-focused path.” The virtues of this neologism include: the opportunity to set aside the emotion (...) of “aggression,” the phrase’s accuracy when capturing the intention of the patient or their representative, and an unappreciated rhetorical force—and transparent logic—that arises when the patient’s recovery is unlikely. (shrink)

Here Bibler argues that the “beginning” of logic must be understood as a conjunction of the logical and extra-logical. This is in fact the justification of the logic of being, which means the conjo...

In this long excerpt, Bibler argues that, in Hegel’s logic, thinking devours the object—the Absolute is achieved—and therefore thinking itself disappears. Yet thinking necessarily involves being, e...

Using the methodologies and insights of queer theory, narrative theory and analytic philosophy, Sexual Deceit helps us to understand the issues of passing and to evaluate it from a moral point of view. Noting the importance of time and place in discussing this issue, Kelby Harrison combines the insights, key concepts, and important arguments in both traditional philosophy and queer theory in developing an ethical theory called “Gayness as Practical Identity.”.

Debunking arguments are an important species of undermining argument, in which facts about the origins of a judgement are used to explain away that judgement. There is a long history of debunking arguments in the domains of moral judgement and religious belief, from the early Christian fathers to Sigmund Freud and beyond. Debunking arguments work by offering a truth-mooting genealogy of the judgement in question, where the truth of the judgement doesn’t play a role in generating the judgement, nor does (...) the genealogy probabilify the judgement. Since debunking arguments work against judgements, we can only use them in the domains of morality and religion if we assume cognitivism for those domains. There may be, however, analogous dialectic moves if we instead assume non-cognitivism. (shrink)

In this section, Bibler once again explicates the meaning of the term “culture.” He first defines it as a form of simultaneous being and communication among people of different cultures and eras. T...

This section reproduces the part of Bibler’s book Thinking as Creative Work that discusses the subject as a “microsocium” combining the rational intellect, reason, intelligence, and intuitio...

In this excerpt, Vladimir S. Bibler attempts to demonstrate how the initial concepts of Newtonian mechanics are fraught with contradictions. The first is related to the law of inertia, which states...

The 20 sup > th /sup > century has been a tumultuous time in psychology -- a century in which the discipline struggled with basic questions about its intellectual identity, but nonetheless managed to achieve spectacular growth and maturation. It’s not surprising, then, that psychology has attracted sustained philosophical attention and stimulated rich philosophical debate. Some of this debate was aimed at understanding, and sometimes criticizing, the assumptions, concepts and explanatory strategies prevailing in the psychology of the time. But much (...) philosophical work has also been devoted to exploring the implications of psychological findings and theories for broader philosophical questions like: Are humans really rational animals? How malleable is human nature? and Do we have any innate knowledge or innate ideas? One particularly noteworthy fact about philosophy of psychology in the 20 sup > th /sup > century is that, in the last quarter of the century, the distinction between psychology and the philosophy of psychology began to dissolve as philosophers played an increasingly active role in articulating and testing empirical theories about the mind and psychologists became increasingly interested in the philosophical underpinnings and implications of their work. Our survey is divided into five sections, each focusing on an important theme in 20 sup > th /sup > century psychology which has been the focus of philosophical attention and has benefited from philosophical scrutiny. (shrink)

The Covid‐19 pandemic has brought about renewed conversation about equality and equity in the distribution of medical resources. Much of the recent conversation has focused on creating and implementing policies in times of crisis when resources are exhausted. Depending on how the pandemic develops, some communities may implement crisis measures, but many health care facilities are currently experiencing shortages of staff and materials even if the facilities have not implemented crisis standards. There is a need for shared conversation about equality (...) and equity in these times of contingency between conventional and crisis medicine. To respond well to these challenges, I recommend that institutions rely on policy, professional education, and ethics consultation. As is the case with crisis policies, creating contingency policies requires that health care professionals decide on how, specifically, to achieve equity. A policy is only as effective as its implementation; therefore, institutions should invest in context‐specific education on contingency policies. Finally, ethics consultation should be available for questions that contingency policies cannot address. (shrink)

This letter responds to the article “Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post-Dobbs Landscape,” by Anne Drapkin Lyerly, Ruth R. Faden, and Michelle M. Mello, in the May-June 2024 issue of the Hastings Center Report.

Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, “How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?” We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator's conceptions of God, community, and self. After the ethicist (...) appreciates how these concepts influence the invocator's worldview, she can begin responding to this hope with specific practices. We discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle. (shrink)

In this section, Bibler discusses the minutia of logic, specifically the development and maturation of logic as well as the self-justification of logic. Bibler points out that, in the science of lo...

The author once again offers a definition of paradox that fundamentally differs from a Hegelian notion of contradiction. In a paradox, thought should logically identify and comprehend the mental re...

Lei, a twenty‐seven‐year‐old Mandarin speaker, visits the United States seeking curative treatments for his acute myeloid leukemia. His mother, Hua, has traveled with him. Neither she nor Lei speak English, and the hospital does not have an onsite professional Mandarin‐speaking interpreter. Using a professional interpreter over the phone, Lei's oncologist, Dr. Branson, attempts to initiate a face‐to‐face goals‐of‐care conversation with Hua as the surrogate decision‐maker. Dr. Branson explains that Lei has “only weeks to months to live” and recommends initiating comfort‐care‐only (...) measures, but Hua says that she wants (and that Lei would want) continued aggressive measures. Hua says that her son might be a candidate for a phase I trial. Eventually, Dr. Branson brings in Dr. Chou, a Mandarin‐speaking resident to provide face‐to‐face interpretation. Hua insists that “there must be more standard therapies available” and says that she will wait until the trial begins. She begins crying, and the meeting disintegrates. Following this, Dr. Branson calls for an ethics consultation for “help in end‐of‐life communicating and reconciling discordance about prognostic information.”How should the ethicist use the institution's interpreter services? (shrink)

Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention—a bridge to recovery or transplant—not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of (...) withdrawal, including distributive justice, quality of life, patients’ rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned. (shrink)

Volume 25, Issue 3, March 2025, Page 85-86.

How should clinical ethicists be trained? Scholars have stated that clinical ethics fellowships create well-trained, competent ethicists. While this appears intuitive, few features of fellowship programs have been publicly discussed, let alone debated. In this paper, we examine how fellowships can foster effective mentoring relationships. These relationships provide the foundation for the fellow’s transition from novice to competent professional. In this essay, we begin by discussing our pedagogical commitments. Next, we describe the structures our program has created to assist our (...) fellows in becoming competent ethicists. We then outline the kinds of knowledge, skills, and professional attributes mentors should possess. Following this, we focus on the knowledge, skills, and professional attributes that fellows develop as they co-create effective mentoring relationships. We will not prescribe a single approach to fellowship training; instead, our perspective will, we hope, become a catalyst for further conversation on training and mentoring clinical ethics fellows. (shrink)

States that are about things are intentional, that is, they have content. The precise nature of intentional states is a matter of dispute.What makes some states, but not others, intentional? Of those states that are intentional, what makes them about what they are about as opposed to something else, i.e. what gives them their specific content?

Readers have much to consider when evaluating Greenblum and Hubbard’s conclusion that ‘physicians have no business doing theology’.1 The two central arguments the authors offer are fairly convincing within the confines they set for themselves, the provisos they stipulate and their notions of ‘privacy’ and ‘public reason’. However, I would ask readers to consider two questions, the answers to which I believe the authors leave opaque. First, what is theological negotiation? Second, what makes chaplains the singular group of healthcare professionals (...) responsible for theological negotiation? In this Commentary, I explore these questions not with the goal of rejecting the authors’ conclusion, but rather with the goal of highlighting relevant considerations when evaluating the authors’ central tenets. First, I would like readers to consider Greenblum and Hubbard’s descriptions of theological negotiation. They categorise theological negotiation into metaphysical, normative and alternative responses, and hold that this kind of negotiation is, for the most part, impermissible for healthcare professionals, save chaplains.1 The examples of Dr Chatterjee and Dr Thompson expand theological negotiation to include instances where physicians add a theological veneer to their clinical recommendations. In both the examples, the physician has made the case for accepting or rejecting a certain intervention—for Dr Chatterjee, accepting …. (shrink)

Modern logical concepts—essences, phenomena, causality, and so forth—border on medieval concepts, including the concept of man’s and, ultimately, God’s involvement in real objects. According to Bib...

In this excerpt, Bibler dissects the dual connection of past and present through sublation of the past in the present and on the basis of its preservation through their interaction. Culture is buil...

Mr. M is an eighty-five-year-old who presented to the hospital with congestive heart failure exacerbation, pneumonia, altered mental status, and sepsis. A physician determines that he lacks capacity, and the team in the intensive care unit looks to the patient's daughter, Celia, as his surrogate decision-maker because she is named as an agent in his medical power of attorney form. While in the ICU, Mr. M suffers acute respiratory distress secondary to pneumonia and thus requires intubation. Celia accepts several life-sustaining (...) interventions, but she sporadically refuses other medically indicated therapies. Although providers explain the importance of the ICU insulin regimen for glucose control, she either refuses the insulin or requests a lower dose. The health care team believes that it is providing substandard care and that Celia's medical decisions are not in the patient's best interests, so they request an ethics consultation. When the clinical ethicist attempts to talk with Celia, she refuses to speak with him, saying flatly, “I am not interested in talking with you.” The clinical ethicist meets with Celia on a couple of occasions, but she consistently refuses to have a conversation with him. He wonders if the patient's surrogate decision-maker can refuse a clinical ethics consultation and is unsure what his next steps should be. (shrink)

In this short excerpt from an Introduction to his celebrated book From the Doctrine of Science to the Logic of Culture, Bibler shows that the phenomenon of culture has shifted into the cente...

In this excerpt from his celebrated book From the Doctrine of Science to the Logic of Culture, Bibler discusses a break in historical continuity due to fundamental changes in the social sphe...

In this late story, Truman Capote celebrates a peculiar form of object relations to expand definitions of sexuality beyond conventional identity categories and thus suggest a more expansive model of social inclusion and civil rights. Building on work in animal studies, queer theory, and the new materialities, I argue that the literalism of these object relations decenters the human and reimagines a wider ethics of belonging. The story describes an elderly widow who keeps all of her deceased cats in a (...) freezer because she cannot bear to be parted from them. Although the story prepares us to expect that the frozen cats could be symbols or surrogates for her dead husband, it becomes clear that she loves her cats literally as cats and nothing more. Capote pushes us to acknowledge and accept this love for her cats just as it is. And by doing so, he invites us to imagine a more hospitable world in which we accommodate other kinds of object-choice beyond the confines of heterosexual marriage, including but certainly not limited to his own homosexuality. (shrink)

Mrs. Duong had coronary artery disease, ischemic cardiomyopathy, and mildly altered mental status when her case was presented before an advanced heart therapy medical review board. She was accepted for left ventricular assist device placement pending additional insight into her cognitive state. Before the LVAD could be implanted, however, Mrs. Duong went into cardiogenic shock, and her heart failure team placed an intra‐aortic balloon pump in her subclavian artery. Within two weeks, Mrs. Duong became IABP dependent and deconditioned. The attending (...) deemed her as lacking capacity to make complex medical decisions, and the medical review board officially declined her for LVAD placement. The heart failure and CICU teams feel that Mrs. Duong is not being helped by the care they are giving her. They recommend terminal weaning of the IABP and initiation of comfort care. Her family disagrees, pointing to activities like continued eating and interacting with family. At an impasse after yet another family meeting, the attending for the heart failure team asks the clinical ethics consultant, “Do we have to replace the balloon pump when it fails?”. (shrink)

In this article I should like briefly to ground two mutually determining propositions:1. The philosophical logic that has emerged in the twentieth century and that corresponds to contemporary culture is a logic of paradox.

Every clinical ethics consultant, no matter their own spirituality, will meet patients, families, and healthcare professionals whose spiritualities anchor their moral worldviews. How might ethicists respond to those who rely on spirituality when making medical decisions? And further, should ethicists incorporate their own spiritual commitments into their clinical analyses and recommendations? These questions prompt reflection on foundational issues in the philosophy of medicine, political and moral theory, and methods of proper clinical ethics consultation. Rather than attempting to offer definitive answers (...) to these questions, this essay prompts readers to consider their own answers to these questions. Specifically, it offers a taxonomic analysis of six (6) distinct responses: assessment, delegation, examination, translation, incorporation, and assertion. Furthermore, this essay describes the role of the ethicist’s own spiritual commitments during the responses. Each section also names several strengths and weaknesses that ethicists ought to consider when evaluating the purpose and scope of each response. This paper prompts readers to consider circumstances under which they might promote, critique, or incorporate spiritual worldviews—their own and those of their patients—when offering clinical analyses and recommendations. (shrink)

Volume 20, Issue 7, July 2020, Page 202-204.

What is moral reasoning? For that matter, what is any sort of reasoning? Let me begin by making a few distinctions. First, there is a distinction between reasoning as something that that people do and the abstract structures of proof or “argument” that are the subject matter of formal logic. I will be mainly concerned with reasoning in the first sense, reasoning that people do. Second, there is a distinction between moral reasoning with other people and moral reasoning by and (...) for yourself . Moral reasoning with others may involve discussion with them, bargaining with them, and possibly arguing with them. (shrink)

Despite the interpersonal nature of family meetings and the frequency in which they occur, the clinical ethics literature is devoid of any rich descriptions of what clinical ethicists should actually be doing during family meetings. Here, we propose a framework for describing and understanding “transitioning” facilitation skills based on a retrospective review of our internal documentation of 100 consecutive cases wherein a clinical ethicist facilitated at least one family meeting. The internal documents were analyzed using qualitative methodologies, i.e., “codes”, to (...) identify emergent themes. We identified four different transitioning strategies clinical ethicists use to reach a meaningful resolution. These transitioning strategies serve as a jumping-off point for additional analyses, future research, evaluating clinical ethics consultation, and overall performance improvement of a consultation service. (shrink)

Although shared decision-making is a standard in medical care, unilateral decisions through process-based conflict resolution policies have been defended in certain cases. In patients who do not stand to receive proportional clinical benefits, the harms involved in interventions such as cardiopulmonary resuscitation seem to run contrary to the principle of non-maleficence, and provision of such interventions may cause clinicians significant moral distress. However, because the application of these policies involves taking choices out of the domain of shared decision-making, they face (...) important ethical and legal problems, including a recent challenge to their constitutionality. In light of these concerns, we suggest a re-conceptualization of informed non-dissent as an alternative approach in cases where the application of process-based policies is being considered. This clinician-directed communication model still preserves what is valuable in such policies and salvages professional integrity, while minimising ethical and legal challenges. (shrink)

This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated (...) in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status. (shrink)

Although we are enthusiastic about a Darwinian approach to culture, we argue that the overview presented in the target article does not sufficiently emphasize the crucial explanatory role that psychology plays in the study of culture. We use a number of examples to illustrate the variety of ways by which appeal to psychological factors can help explain cultural phenomena. (Published Online November 9 2006).

Although we are enthusiastic about a Darwinian approach to culture, we argue that the overview presented in the target article does not sufficiently emphasize the crucial explanatory role that psychology plays in the study of culture. We use a number of examples to illustrate the variety of ways by which appeal to psychological factors can help explain cultural phenomena.

This article discusses a new conception of logic developed by the well-known Russian philosopher Vladimir Solomonovich Bibler. Analyzing prior methods of thinking and previous types of logics, he c...