Lynne Rudder Baker, Saving Belief: A Critique of Physicalism Princeton: Princeton University Press, 1987, xii + 177 pp. Daniel C. Dennett, The Intentional Stance Cambridge: MIT Press, 1987, xi + 388 pp. Paul M. Churchland, Matter and Consciousness Cambridge: MIT Press, revised edition, 1988, xii + 184 pp.

This essay explores three issues in respect for autonomy that pose unfinished business for the concept. By this, I mean that the dialogue over them is ongoing and essentially unresolved. These are: whether we ought to respect persons or their autonomous choices; the role of relational autonomy; and whether nonhuman animals can be autonomous. In attending to this particular set of unfinished business, I highlight some critical moral work left aside by the concept of respect for autonomy as understood in (...) Beauchamp and Childress’ Principles of Biomedical Ethics. Specifically, while significant pragmatic traction is gained by the authors’ focus on autonomous choice, carving such a focus out from the broader questions of moral respect and the autonomy of the person leaves aside a number of questions that we might have thought a view about respect for autonomy in biomedicine ought to answer. These include: How should physicians respond when autonomous patients make decisions that appear nonautonomous? What is the impact of the view that autonomy is “relational” for cross-cultural differences in how autonomy is respected? If chimpanzees can be autonomous, what does that mean for how they should be treated? (shrink)

Synthetic biology is an emerging discipline that aims to apply rational engineering principles in the design and creation of organisms that are exquisitely tailored to human ends. The creation of artificial life raises conceptual, methodological and normative challenges that are ripe for philosophical investigation. This special issue examines the defining concepts and methods of synthetic biology, details the contours of the organism–artifact distinction, situates the products of synthetic biology vis-à-vis this conceptual typology and against historical human manipulation of the living (...) world, and explores the normative implications of these conclusions. In addressing the challenges posed by emerging biotechnologies, new light can be thrown on old problems in the philosophy of biology, such as the nature of the organism, the structure of biological teleology, the utility of engineering metaphors and methods in biological science, and humankind’s relationship to nature. (shrink)

The standard economic and ethical case in defense of sweatshops employs the standard of the “welfare of their workers and potential workers” to argue that sweatshop regulations harm the very people they intend to help. Scholars have recently contended that once the benefits and costs are balanced, regulations do, in fact, raise worker welfare. This paper describes the short and long-run tradeoffs associated with sweatshop regulation and then examines how reasonable constructions of measures of “worker welfare” would evaluate these tradeoffs (...) finding that the standard economic and ethical case against sweatshop regulations is well supported. (shrink)

With its rise in popularity, work in the phenomenology of medicine has also attracted its fair share of criticism. One such criticism maintains that, since the phenomenology of medicine does nothing but describe the experience of illness, it offers nothing one cannot obtain more easily by deploying simpler qualitative research methods. Fredrik Svenaeus has pushed back against this charge, insisting that the phenomenology of medicine not only describes but also _defines_ illness. Although I agree with Svenaeus’s claim that the phenomenology (...) of medicine does more than merely describe what it is like to be ill, once one acknowledges its more far-reaching theoretical aspirations, one sees that it faces an even more difficult set of objections. Taking a cue from recent work by Rebecca Kukla, Russell Powell, and Eric Scarffe, I argue that the phenomenology of medicine could answer these objections by developing an institutional definition of illness. This not only allows the phenomenology of medicine to answer its critics, but it does so in a way that preserves its major achievements and extends its reach within the philosophy of medicine. (shrink)

Any serious ethical discussion of the enhancement of human nature must begin with a reasonably accurate picture of the causal-historical structure of the living world. In this Comment, I show that even biologically sophisticated ethical discussions of the biomedical enhancement of species and speciel natures are susceptible to the kind of essentialistic thinking that Lewens cautions against. Furthermore, I argue that the same evolutionary and developmental considerations that compel Lewens to reject more plausible conceptions of human nature pose equally serious (...) problems for some prominent critiques of biomedical enhancement that presuppose the existence of a “given” biological potential that can be distorted by agentic cultural influences. (shrink)

The United States has recently made significant and positive civil rights gains for LGB people, including expanded recognition of marriages between people of the same sex. Among the central tropes that have emerged in the struggle for the rights of LGB people are that they are “born that way,” that sexual orientations cannot change, and that one's sexual orientation is not affected by choice. Writer Andrew Sullivan put it this way: “[H]omosexuality is an essentially involuntary condition that can neither be (...) denied nor permanently repressed.… [S]o long as homosexual adults as citizens insist on the involuntary nature of their condition, it becomes politically impossible to deny or ignore the fact of homosexuality.… [The strategy for obtaining LGB rights is to] seek full public equality for those who, through no fault of their own, happen to be homosexual.”This idea of linking LGB rights to empirical claims about sexual orientations has become so central that casting doubt on these claims is, in many circles, tantamount to opposing LGB rights. Nonetheless, claims about innateness, immutability, and lack of choice about sexual orientation should not be the primary basis for LGB rights. (shrink)

Recent work on inheritance systems can be divided into inclusive conceptions, according to which genetic and non-genetic inheritance are both involved in the development and transmission of nearly all animal behavioral traits, and more demanding conceptions of what it takes for non-genetic resources involved in development to qualify as a distinct inheritance system. It might be thought that, if a more stringent conception is adopted, homologies could not subsist across two distinct inheritance systems. Indeed, it is commonly assumed that homology (...) relations cannot survive a shift between genetic and cultural inheritance systems, and substantial reliance has been placed on that assumption in debates over the phylogenetic origins of hominin behavioral traits, such as male-initiated intergroup aggression. However, in the homology literature it is widely accepted that a trait can be homologous—that is, inherited continuously in two different lineages from a single common ancestor—despite divergence in the mechanisms involved in the trait’s development in the two lineages. In this paper, we argue that even on an extremely stringent understanding of what it takes for developmental resources to form a separate inheritance system, homologies can nonetheless subsist across shifts between distinct inheritance systems. We argue that this result is a merit of this way of characterizing what it is to be an inheritance system, that it has implications for adjudicating between alternative accounts of homology, and that it offers an important cautionary lesson about how to reason with the homology concept, particularly in the context of cultural species. (shrink)

A good death is hard to find. Family members tell us that loved ones die in the wrong place—the hospital—and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates is a relatively (...) new and still vulnerable aspect of medical care. For thousands of years, patients and surrogates had no say in medical decision-making. Today, standards support shared decision-making, but these articles both carve out exceptions to those standards, limiting the rights of patients and families in decisions about specific end-of-life treatments. As bioethics consultants in an acute care setting, we frequently confront conflicts similar to those described by Jeffrey Berger and by Ellen Robinson and colleagues. In such cases, our service emphasizes redoubled efforts at communication and mediation. Focusing on goals and values, rather than interventions, produces the best possible collaboration in health care decision-making. Cases in which we would overturn a surrogate's recommendations regarding palliative sedation or do-not-resuscitate orders are rare and require careful processes and clear evidence that the surrogate's choice is contrary to patient values. (shrink)

Commentators on The Evolution of Moral Progress: A Biocultural Theory raise a number of metaethical and moral concerns with our analysis, as well as some complaints regarding how we have interpreted and made use of the contemporary evolutionary and social sciences of morality. Some commentators assert that one must already presuppose a moral theory before one can even begin to theorize moral progress; others query whether the shift toward greater inclusion is really a case of moral progress, or whether our (...) theory can be properly characterized as ‘naturalistic’. Other commentators worry that we have uncritically accepted the prevailing evolutionary explanation of morality, even though it gives short shrift to the role of women or presupposes an oversimplified view of the environment in which the core elements of human moral psychology are thought to have congealed. Another commentator laments that we did not make more extensive use of data from the social sciences. In this reply, we engage with all of these constructive criticisms and show that although some of them are well taken, none undermine the core thesis of our book. (shrink)

The spiritual rewards and intellectual challenges of Eastern philosophy are revealed in this visually stunning book, illustrated by Joe Lee and with 19th-century engravings. Eastern philosophy is not only an intellectual pursuit, but one that involves one’s entire being. Much of it is so deeply entwined with the non-intellectual art of meditation, that the two are impossible to separate. In this survey of the major philosophies of India, China, Tibet and Japan, Jim Powell draws upon his knowledge of Sanskrit (...) and Chinese, as well as decades of meditation. Whether tackling Buddha, Confucius, Lao Tzu, Dogen, the Dalai Lama or Patanjal–Powell’s insights are deeply illuminating. All the major philosophies of India, China, Tibet and Japan are explained and everyone, from beginner to expert, will find Eastern Philosophy For Beginners an insightful overview. (shrink)

In writing these essays, we were asked to consider, “What makes a good life in late life?” I thought instantly, perhaps like many people, of photos and stories of older people taking up new careers and new hobbies—running marathons and soup kitchens, starting organic farms. This response is right and proper. Older people can leverage wisdom and creativity to make wonderful contributions to their communities and should be celebrated for doing so. But this happy picture is incomplete. We live longer (...) than ever before, and with that long life, many of us can expect disability. This is the product of medical success. We are less likely to die from cancer, a heart attack, or a stroke; we survive with chronic illnesses and their associated disabilities. A good life in late life, for many of us, will be a life with disability.For this essay, I focus on dementia, a common and ultimately fatal illness, and one that typically lasts many years from the start of symptoms to the end. More than five million Americans currently suffer from dementia; fifteen million paid and volunteer caregivers help support them. What would a good life with dementia look like? How would it change from the early phase, when cognitive impairment and other challenges are relatively modest, to the final phase marked by severe cognitive and physical decline? (shrink)

Compositionality and semantic innocence seem intuitively plausible constraints on a semantic theory. It has, however, proved notoriously difficult to respect both principles within a single framework. In this paper I argue that their apparent incompatibility derives from an overly-strong formulation of the principles. I propose an alternative weaker formulation which allows for both principles to be respected within a single semantic framework while satisfying the intuitions which motivate the two principles.

Research has shown that feelings of self-disgust may have a functional role in the genesis of depression by partially mediating the cross-sectional relationship between dysfunctional thoughts and depressive symptoms. However, there are many outstanding issues regarding these hypothesised associations. First, it is not yet clear whether self-disgust is a temporal antecedent, concomitant, or consequence of depressive experience. Second, it is not known whether the hypothesised mediation sequence is valid over time. Third, the relative contribution of disgust towards different aspects of (...) the self has not yet been examined. In the present longitudinal study, participants completed measures of dysfunctional cognitions, self-disgust and depressive symptoms at baseline, and at six and 12-month follow-ups. Analysis showed that self-disgust is best considered as antecedent to depressive symptoms; the hypothesised mediation model was partially supported, but is too simplistic; and disgust towards physical aspects of the self, rather than behaviour, was more important as a temporal predictor of depressive symptoms. The current results help elucidate the role of self-disgust as an antecedent of depressive experience. (shrink)

Early childhood education and care settings in England and the people who work in them constitute an important sphere of influence, shaping young children's characters and values. But the values and dispositions expected of the early years workforce are missing from statutory policy documentation despite its clear requirement that practitioners will espouse and promote particular 'universal' values in their work. The expectations for young children's achievement by the age of five also reveal a complex approach combining a structuralist and postmodern (...) duality of individualistic and collectivist values. These present challenges and dilemmas for the sector. (shrink)

A sample from the Ubatuba fragment collected in Brazil in 1957 was tested with the intent of examining the isotope ratios of its primary element, magnesium, and the trace elements strontium, barium, copper, and zinc. As background, the history of chemical testing of the Ubatuba fragments during the 1960s-1980s at multiple labs with varying capabilities is reviewed and then the remainder of the paper examines recent tests completed in 2017 and 2018 that for the first time used HR-ICPMS techniques to (...) look at the isotopic ratios of the minor constituents as well as the primary magnesium makeup of the sample. The magnesium isotope ratios were found to fall within terrestrial limits while the results on the isotope ratios of the trace elements was inconclusive. Recommendations are made for improving the process of examining the trace elements. Keywords: Ubatuba, isotope, magnesium, HR-ICPMS, UFO. (shrink)

How do we balance the rights of aging physicians against the right of the public to competent health care? This version of a classic public health ethics dilemma is here now and likely to increase as the population ages. Peer review has long been the standard mechanism for assessing physician competence, but it is subjective and too easily subverted. New options are needed, both in medicine and throughout the professions, but they are challenging to implement. Physicians have an ethical obligation (...) to protect the health of the public by acknowledging, assessing, and addressing the cognitive effects of aging on medical competence. (shrink)

This paper examines some of the key characteristics of a socialist health care system using the example of the British National Health Service (NHS). It has been claimed that the NHS has socialist principles, and represents an island of socialism in a capitalist sea. However, using historical analysis, this paper argues that while the NHS claims some socialist ends, they could never be fully achieved because of the lack of socialist means. The socialist mechanisms which were associated with earlier plans (...) for a national health service such as a salaried service, health centres, elected health authorities and divorcing private practice from the public service were discarded in negotiation. Moreover, even these would have achieved socialism merely in the sense of distributing health care, without any deeper transformation associated with doctor-patient relationships and prevention. In short, the NHS is more correctly seen as nationalised rather than socialised medicine, achieving the first three levels of a socialist health service identified here. It can be said to have socialist principles in the limited distributional sense and has some socialist means to achieve these. However, it lacks the stronger means to fully achieve its distributional goals, and is very distant from the third level of a radical transformation of health care. (shrink)

In theory, a competent patient may refuse any and all treatments, even those that sustain life. The problem with this theory, confidently and frequently asserted, is that the circumstances of real patients may so confound us with their complexity as to shake our confident assumptions to their core.For instance, it is not the case that one may always and easily know which patients are competent. Indeed, evaluation of decision-making capacity is notoriously difficult. Not only may reasonable and experienced evaluators, say (...) a judge and a psychiatrist, disagree, but also a person's capacity may change from hour to hour and may extend to some decisions yet not to others. And yet it is on this subtle art of capacity evaluation that life and death decisions often turn, especially when patients decline life-sustaining treatment.An evaluation of capacity may consider the impact of serious medical or psychiatric illness, as well as the patient's life circumstances. (shrink)

Our goal in producing this special issue is to encourage our colleagues to incorporate topics related to LGBT populations into bioethics curricula and scholarship. Bioethics has only rarely examined the ways in which law and medicine have defined, regulated, and often oppressed sexual minorities. This is an error on the part of bioethics. Medicine and law have served in the past as society's enforcement arm toward sexual minorities, in ways that robbed many people of their dignity. We feel that bioethics (...) has an obligation to discuss that history and to help us as a society take responsibility for it.We can address only a small number of topics in this special issue of the Hastings Center Report, and we selected topics we believe will stimulate discourse. Andrew Solomon offers an elegant overview of the challenges that bioethics faces in articulating a solid basis for LGBT rights. Timothy F. Murphy asks whether bioethics still faces issues related to lesbian, gay, and bisexual people, given the deletion of homosexuality as a disease and the progress toward same‐sex marriage. Jamie Lindemann Nelson's essay addresses the search for identity for transgender persons and the role of science in that search. Two articles, those by Brendan S. Abel and by Jack Drescher and Jack Pula, take up the complex issue of medical treatment for children who reject their assigned birth gender. Celia B. Fisher and Brian Mustanski address the special challenges of engaging LGBT youth in research, balancing the need for better information about this vulnerable group against the existing restrictions on research involving children. Tia Powell and Edward Stein consider the merits of legal bans on psychotherapies intended to change sexual orientation, particularly in the light of current research on orientation. Mary Beth Foglia and Karen I. Fredricksen‐Goldsen highlight health disparities and resilience among LGBT older adults and then discuss the role of nonconscious bias in perpetuating disparities. Stephan Davis and Nancy Berlinger assess the challenges of access to care and health policy for transgender persons. Edward J. Callahan et al. tackle the ways in which diverse aspects of medicine should change to better incorporate the needs of LGBT patients, including through use of the electronic medical record, education of health professionals, and recruitment efforts for LGBT health professionals. Virginia Ashby Sharpe and Uchenna S. Uchendu describe multifaceted efforts within Veterans Administration facilities to create change for LGBT veterans across the largest integrated health care network in the United States. Lance Wahlert and Autumn Fiester find a mixed record in the use of case studies in teaching about LGBT issues. (shrink)

In this unique work, Professor G.A. Powell Jr. writes: "Thinkers are different from writers—writers are prostitutes. Thinkers desire to be prostitutes." Daily Conversations with My Interloper is first and foremost a celebration of the narrative paradigm, its evolution, latitude of expression, and radical subjectivity in the forms of aphorisms and feuilletons. Following in the literary tradition of Ralph Waldo Emerson, Albert Camus, John Cage, Emile Cioran, and Susan Sontag, et al., the text chronicles Professor Powell's reflections about the (...) ongoing metamorphoses of cultures, influential literary figures, travel, film, history, ennui, quotidian, and the mundane day-to-day existence in which all people participate. Daily Conversations with my Interloper, is a provocative read for the public and private intellectual interested in a panoply of ideas. (shrink)

This essay concerns the original use of signs that is species-specifically human, namely, the awareness that results from the difference between animal estimation of objects in terms of what is to be sought (+), avoided (–), or safe to ignore (ø), and what human understanding species-specifically adds to animal awareness of objects as involving “things” existing in their own right as not wholly or simply reducible to their relations to us as objects.Powell calls the species-specfically human awareness of objects (...) the “transcendental realm”; and the ‘line of demarcation’ separating the semiosic awareness common to all animals as making use of signs from the semiotic consciousness of human animals as able to become aware of insensible relations as such triadically “considered as constituting the mode of being of a sign” (Peirce 1904: CP 8.332), Powell terms “ens primum cognitum”.Thus, Powell’s “transcendental realm” is the soil and ground common to all science, cenoscopic and ideoscopic alike, and hence the preconscious realm of metasemiosis wherein that species-specifically unique process is able to extend its roots and transform the “rational animal” of Greek and Latin thought into the “semiotic animal” of postmodern intellectual culture. “Humanesque analogy” is Powell’s term for the fact that the species-specifically human understanding is an awareness inescapably grounded in and having as its constant background and surrounding, as it were, the generically animal awareness of a world of perceptual objects related to ourselves as (+), (–), (ø). (shrink)

One popular sort of argument for the death penalty depends on the idea of possibly saving innocent lives through added deterrent value. Defenders of such arguments generally concede that: a) we do not know whether or not the death penalty actually adds marginal deterrent value beyond life in prison, and b) any actual death penalty regime is likely to include the execution of some innocent people. Use of the death penalty might save some innocent people, but it is also likely (...) that it will lead us to kill some innocent people. In the present paper, I attempt to give consideration to both sorts of innocents. I argue that it is morally more serious to intentionally kill people who are innocent than it is to fail to save innocent people whose death is in no way intended. Thus, in the absence of compelling evidence that our use of the death penalty would save significantly more innocent people than it would kill, we should err on the side of not using the death penalty as a means to try to achieve added deterrent value. (shrink)