Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

What motives underlie the ways humans interact socially? Are these the same for all societies? Are these part of our nature, or influenced by our environments?Over the last decade, research in experimental economics has emphatically falsified the textbook representation of Homo economicus. Literally hundreds of experiments suggest that people care not only about their own material payoffs, but also about such things as fairness, equity and reciprocity. However, this research left fundamental questions unanswered: Are such social preferences stable components of (...) human nature; or, are they modulated by economic, social and cultural environments? Until now, experimental research could not address this question because virtually all subjects had been university students, and while there are cultural differences among student populations throughout the world, these differences are small compared to the full range of human social and cultural environments. A vast amount of ethnographic and historical research suggests that people's motives are influenced by economic, social, and cultural environments, yet such methods can only yield circumstantial evidence about human motives. Combining ethnographic and experimental approaches to fill this gap, this book breaks new ground in reporting the results of a large cross-cultural study aimed at determining the sources of social preferences that underlie the diversity of human sociality. The same experiments which provided evidence for social preferences among university students were performed in fifteen small-scale societies exhibiting a wide variety of social, economic and cultural conditions by experienced field researchers who had also done long-term ethnographic field work in these societies. The findings of these experiments demonstrated that no society in which experimental behaviour is consistent with the canonical model of self-interest. Indeed, results showed that the variation in behaviour is far greater than previously thought, and that the differences between societies in market integration and the importance of cooperation explain a substantial portion of this variation, which individual-level economic and demographic variables could not. Finally, the extent to which experimental play mirrors patterns of interaction found in everyday life is traced.The book starts with a succinct but substantive introduction to the use of game theory as an analytical tool and its use in the social sciences for the rigorous testing of hypotheses about fundamental aspects of social behaviour outside artificially constructed laboratories. The results of the fifteen case studies are summarized in a suggestive chapter about the scope of the project. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 545 Haroutunian, would have balked at the notion that their " empiricism " could be abstracted from the christological and trinitarian confession 0£ the church. In general, it would seem that a genuinely " empirical" approach would seek to engage the actual truth claims of religious com· munities on their own terms-even when those claims conflict with historicist suppositions. Second, in so far as Dean thinks there (...) is a uniquely American reli· gious experience or style of thought, privileging that style seems a dangerous move indeed. Dean is not unaware of the dangers. He specifically denies that he is engaging in any form of " American exceptionalism " (p. 25) ; it is simply that an " appropriately American historicism, centering on American culture, would have a greater chance of suggesting practices that work for and are true for America " (p. 24). But I am skeptical that such disclaimers address the real problem. Near the very end of the book, Dean suggests that a modi· fied naturalism might lead to " a notion of God that was more genuinely American than anything earlier," culminating in the recognition that " American thought about God is really the thought of a national com· munity" (p. 144). Descriptively that may well be the case; but then the Christian theologian must seek norms elsewhere. History Making History does not show us how historicist insigh~ might be incorporated into ecumenical, trinitarian theology, but that does not mean the attempt will prove unfruitful. Meanwhile, this bit of philosophical tale-telling will hold the interest of readers theological and otherwise. JOSEPH L. MANCINA Yale University New Haven, Connecticut Medical Ethics: Sources of Catholic Teaching. By KEVIN D. O'ROURKE, O.P. and PHILIP BOYLE, O.P. St. Louis: Catholic Health Associa· tion, 1989. Medical Ethics: Common Ground for Understanding. By KEVIN D. O'RouRKE, O.P. and DENNIS BRODEUR. St. Louis: Catholic Health Association, 1989. Healthcare Ethics: A Theological Analysis. By KEVIN D. O'RouRKE, O.P. and BENEDICT ASHLEY, O.P. 3rd ed. St. Louis: Catholic Health Association, 1989. Sources of Catholic Teaching is a compendium of recent "official" statements by Roman Catholic ecclesiastical bodies on issues concern· ing medical ethics. Arranged alphabetically according to topics, this col- 546 BOOK REVIEWS lection of statements from the papacy, the Roman Congregations, and the conferences of Catholic bishops could prove to he a very helpful reference tool. It contains a brief introduction which seeks to explain the role of these statements in the Catholic moral theology and Catholic medical ethics, a table of contents of the statements included, and then the statements themselves. In most instances it does not contain the entire document or statement hut only excerpts therefrom. There are some weaknesses in this work. First, these statements are not self-explanatory; they are in need of interpretation and explanation in many instances. But the authors present only the bald text and do not offer any explanatory comments. They apparently presume that these statements are pellucid to the reader, hut this is an unwarranted pre· sumption. For example, clarifying comments should have been added to the statement from the Declaration on Euthanasia because the allocution of Pius XII about giving lethal doses of analgesia is not entirely clear. A second difficulty with this work is the brief and somewhat insubstantial introduction on conscience and the role these statements should play in the formation of conscience. This sort of work invites a substantial and extended commentary on the nature of moral judgments, the relationship of conscience to the natural law, and the authority of these statements. The authors note that not all of the official statements issued by various organs of the Church are of equal authority, hut they do not try to identify the specific authoritative status of the various statements they include in their work. The reader is thus left to his or her own devices to determine, for example, the relative weight of statements of the administrative hoard of the NCCB versus statements of state episcopal conferences. A still further problem is that some of the statements are of virtually no significant authority for Catholics. For example, the statement of the administrative hoard of the NCCB on AIDS is of questionable... (shrink)

Beyond Reason and Tolerance argues that to prepare students to engage political, ethnic, and religious differences, higher education must adopt a developmental model for a formative and liberal undergraduate education as a process of growth involving empathy as well as reasoning, values as well as knowledge, and identity as well as competencies.

This article argues against the relevance of the enhancement/treatment and biomedical/non-biomedical enhancement distinctions by analysing their validity in two ways: their clarity and whether they track our intuitions regarding what is permissible and impermissible. The treatment/enhancement distinction is found to be deficient in both respects. The biomedical/non-biomedical distinction, whilst clear, does not track our intuitions regarding what is permissible and impermissible. The article concludes that, in order to help the enhancement medicine debate, the distinctions should be abandoned due to the (...) fact they hinder clear ethical analysis. (shrink)

In light of the variety of uses of the term autonomy in recent bioethics literature, in this paper, I suggest that competence, not being as contested, is better placed to play the anti-paternalistic role currently assigned to autonomy. The demonstration of competence, I will argue, can provide individuals with robust spheres of non-interference in which they can pursue their lives in accordance with their own values. This protection from paternalism is achieved by granting individuals rights to non-interference upon demonstration of (...) competence. In this paper, I present a risk-sensitive account of competence as a means of grounding rights to non-interference. On a risk-sensitive account of competence individuals demonstrate their competence by exercising three capacities to the extent necessary to meet a threshold determined by the riskiness of the decision. These three capacities are the capacity to acquire knowledge, use instrumental rationality, and form and revise a life plan. (shrink)

In _Pharmaceutical Freedom_ Professor Flanigan argues we ought to grant people self-medication rights for the same reasons we respect people’s right to give (or refuse to give) informed consent to treatment. Despite being the most comprehensive argument in favour of self-medication written to date, Flanigan’s _Pharmaceutical Freedom_ leaves a number of questions unanswered, making it unclear how the safe-guards Flanigan incorporates to protect people from harming themselves would work in practice. In this paper, I extend Professor Flanigan’s account by discussing (...) a hypothetical case to illustrate how these safe-guards could work together to protect people from harms caused by their own ignorance or incompetence. (shrink)

“Racial Justice Requires Ending the War on Drugs” is an impressively well evidenced argument for the need for drug reform. The authors outline how the war on drugs caus...

The state currently grants the medical profession a monopolistic entitlement on the legal use of medical technology. As physicians are duty bound to not expose people to medically unnecessary harm, individuals who wish to engage in Body Modification Practices are effectively precluded from doing so as only physicians are legally entitled to use medical technology. In this article, I argue this is incompatible with respect for persons. Abolishing the medical monopoly allows us to meet the demands of respect for persons (...) by granting access to technology, whilst still upholding physicians’ right to refuse to provide requested services and thereby determine the boundaries of their profession according to what they consider to be the internal morality of medicine. (shrink)

It is a common refrain amongst phenomenologists, disability theorists, and feminist legal theorists that medical practice pays insufficient attention to people’s embodiment. The complaint that we take insufficient account of people’s embodiment isn’t limited to the clinical interaction. It has also been directed at healthcare regulation and welfare policy. In this paper, I examine the arguments for taking embodiment seriously in both medical practice and welfare policy, concluding we have good reasons to take better account of people’s embodiment. I then (...) set out two challenges to taking embodiment seriously in public policy. First, given the amount of variation in how people are embodied, there is strong possibility that adjusting policy to benefit particular individuals based on an appreciation of their embodied experiences could be detrimental towards other individuals. The second challenge concerns how to ensure that people’s testimony about their first-person embodied experience is subject to adequate scrutiny without this resulting in epistemic injustice. I argue that the solution to both of these challenges is to devise a just procedure for soliciting people’s testimony and taking it into account in the policy development process. As such, I also provide an outline of what a just procedure should look like. (shrink)

This essay maintains that the logical distinction between ‘is’ and ‘ought’ does not amount to a dichotomy between the natural order and the moral, or between speculative knowledge and practical. This essay thus clarifies an important and often misunderstood aspect of the natural law theory advanced by the Grisez School. While affirming the logical distinction of ‘is’ from ‘ought’, this essay attempts to argue that the principles of the moral order have a basis in human nature insofar as human nature (...) delimits the parameters of what is fulfilling for human persons. Furthermore, it is through the experience of one’s nature that one inductively grasps by a non-inferential insight the practical principles whose integral directiveness leads one to human fulfillment. The non-practical awareness of factual data one grasps in experience and which ground such a non-inferential practical insight is distinct from and more basic than reflexive, propositional, speculative knowledge (‘speculative knowledge proper’). Thus, practical understanding supposes some non-practical knowledge, although the non-practical knowledge supposed differs from speculative knowledge as ordinarily understood. Still, while the understanding of practical principles does not presuppose speculative knowledge proper, such speculative knowledge does contribute to practical reasoning in significant ways by supplying content crucial for adequate deliberation. (shrink)

Public education is not just a way to organise and fund education. It is also the expression of a particular ideal about education and of a particular way to conceive of the relationship between education and society. The ideal of public education sees education as an important dimension of the common good and as an important institution in securing the common good. The common good is never what individuals or particular groups want or desire, but always reaches beyond such particular (...) desires towards that which societies as a whole should consider as desirable. This does, of course, put the common good in tension with the desires of individuals and groups. Neo-liberal modes of governance have, over the past decades, put this particular educational set up under pressure and have, according to some, eroded the very idea of the common good. This set of contributions reflects on this state of affairs, partly through an exploration of the idea of publicness itself – how it can be rearticulated and regained – and partly through reflections on the current state of education in the ‘north’ and the ‘south.’. (shrink)

Most lymphocytes of the T cell lineage develop along the CD4/CD8 pathway and express antigen receptors on their surfaces consisting of clonotypic αβ chains associated with invariant CD3‐γδε components and ζ chains, collectively referred to as the T cell antigen receptor complex (TCR). Expression of the TCR complex is dynamically regulated during T cell development, with immature CD4+CD8+ thymocytes expressing only 10% of the number of αβ TCR complexes on their surfaces expressed by mature CD4+ and CD8+ T cells. Recent (...) evidence demonstrates that low surface TCR density on CD4+CD8+ thymocytes results from the limited survival of a single TCR component within the ER, the TCRα chain, which has a half life of only 15 minutes in immature thymocytes, compared to >75 minutes in mature T cells. Instability of TCRα proteins in immature CD4+CD8+ thymocytes represents a novel mechanism by which expression of the multisubunit TCR complex is quantitatively regulated during T cell development. In the current review we discuss our recent findings concerning the assembly, intracellular transport, and expression of αβ TCR complexes in CD4+CD8+ thymocytes and comment on the functional significance of TCRα instability during T cell development. (shrink)

This collection of recent articles by leading scholars is designed to illuminate one of the greatest and most influential philosophical books of all time. It includes incisive commentary on every major theme and argument in the Meditations, and will be valuable not only to philosophers but to historians, theologians, literary scholars, and interested general readers.

Why does performing certain tasks cause the aversive experience of mental effort and concomitant deterioration in task performance? One explanation posits a physical resource that is depleted over time. We propose an alternative explanation that centers on mental representations of the costs and benefits associated with task performance. Specifically, certain computational mechanisms, especially those associated with executive function, can be deployed for only a limited number of simultaneous tasks at any given moment. Consequently, the deployment of these computational mechanisms carries (...) an opportunity cost – that is, the next-best use to which these systems might be put. We argue that the phenomenology of effort can be understood as the felt output of these cost/benefit computations. In turn, the subjective experience of effort motivates reduced deployment of these computational mechanisms in the service of the present task. These opportunity cost representations, then, together with other cost/benefit calculations, determine effort expended and, everything else equal, result in performance reductions. In making our case for this position, we review alternative explanations for both the phenomenology of effort associated with these tasks and for performance reductions over time. Likewise, we review the broad range of relevant empirical results from across sub-disciplines, especially psychology and neuroscience. We hope that our proposal will help to build links among the diverse fields that have been addressing similar questions from different perspectives, and we emphasize ways in which alternative models might be empirically distinguished. (shrink)

Jerry Fodor has consistently cited the persistence of illusions--especially the M.

8.3 The consistency proof -- 8.4 Applications of the consistency proof -- 8.5 Second-order arithmetic -- Problems -- Chapter 9: Set Theory -- 9.1 Axioms for sets -- 9.2 Development of set theory -- 9.3 Ordinals -- 9.4 Cardinals -- 9.5 Interpretations of set theory -- 9.6 Constructible sets -- 9.7 The axiom of constructibility -- 9.8 Forcing -- 9.9 The independence proofs -- 9.10 Large cardinals -- Problems -- Appendix The Word Problem -- Index.

Many large corporations now have written codes of ethics to guide the business/marketing activities of employees. The purpose of this study was to determine the frequency and types of topics which are covered in the ethics policy statements of large U.S. corporations. The results indicated that the topics covered most often (respectively) were: misuse of funds/improper accounting, conflicts of interest, political contributions, and confidential information. It is concluded that in addition to written ethics policy statements, top management should communicate ethical (...) values and demonstrate by example. (shrink)

In 1960, E. P. Wigner, a joint winner of the 1963 Nobel Prize for Physics, published a paper titled On the Unreasonable Effectiveness of Mathematics in the Natural Sciences [61]. This paper can be construed as an examination and affirmation of Galileo's tenet that “The book of nature is written in the language of mathematics”. To this effect, Wigner presented a large number of examples that demonstrate the effectiveness of mathematics in accurately describing physical phenomena. Wigner viewed these examples as (...) illustrations of what he called the empirical law of epistemology, which asserts that the mathematical formulation of the laws of nature is both appropriate and accurate, and that mathematics is actually the correct language for formulating the laws of nature. At the same time, Wigner pointed out that the reasons for the success of mathematics in the natural sciences are not completely understood; in fact, he went as far as asserting that “… the enormous usefulness of mathematics in the natural sciences is something bordering on the mysterious and there is no rational explanation for it.”. (shrink)

Many of Tarski’s better known papers are either about or include lengthy discussions of how to properly define various concepts: truth, logical consequence, semantic concepts, or definability. In general, these papers identify two primary conditions for successful definitions: formal correctness and material adequacy. Material adequacy requires that the concept expressed by the formal definition capture the intuitive content of truth. Our primary interest in this paper is to better understand Tarski’s thinking about material adequacy, and whether components of his view (...) developed over time. More precisely, we are concerned with how Tarski’s understanding of the content of the common-sense, every-day usage of truth may have developed over time. We distinguish this concern from the character of the extensional criterion of adequacy Tarski proposes: that a materially adequate definition must entail all instances of Convention T. We will develop our reading of Tarski as follows: first, we will review the “Polemical Remarks,” focusing primarily on §§14 and 17, and Tarski’s references to Naess’ empirical research. Next, we will provide a summary and discussion of Naess’ work, especially his findings with respect to Tarski’s definition of truth and his research that suggests there is no single common or everyday concept of truth. Third, we will consider several possible objections to our interpretation of the Tarski–Naess dialectic. We will conclude that Tarski’s conception of material adequacy developed over time, potentially because of what he had learned through his interactions with Naess. (shrink)

Recent stories of corporate insiders avoiding losses and, in some cases, generating enormous personal profits as their companies crumbled have led investors to question the integrity of American business and the fairness of the United States stock markets. The SEC tries to ensure the fairness of the stock markets by making and enforcing laws against unfair practices such as insider trading. In the United States, when insiders trade stock based on non-public information, they have broken the law and betrayed the (...) trust that has been placed in them.This study used student subjects to test the relationship between the likelihood of trading based on insider information and subjective probabilities of deterrents and motivations for insider trading. Expected gain, guilt, cynicism, and fairness of laws were the determinants that had a significant relationship with the intent to trade based on insider information. This study also found support for prospect theory with regard to insider trading. The results indicate that subjects are more likely to trade based on insider information to avoid a loss than to achieve an abnormal gain. The study also finds evidence of social desirability response bias. (shrink)

This paper presents a simple mathematical model that shows how economic inequality between social groups can arise and be maintained even when the only adaptive learning process driving cultural evolution increases individuals’ economic gains. The key assumptions are that human populations are structured into groups and that cultural learning is more likely to occur within than between groups. Then, if groups are sufficiently isolated and there are potential gains from specialization and exchange, stable stratification can sometimes result. This model predicts (...) that stratification is favored, ceteris paribus, by (1) greater surplus production, (2) more equitable divisions of the surplus among specialists, (3) greater cultural isolation among subpopulations within a society, and (4) more weight given to economic success by cultural learners. (shrink)

We would like to thank the commentators for their generous comments, valuable insights and helpful suggestions. We begin this response by discussing the selfishness axiom and the importance of the preferences, beliefs, and constraints framework as a way of modeling some of the proximate influences on human behavior. Next, we broaden the discussion to ultimate-level (that is evolutionary) explanations, where we review and clarify gene-culture coevolutionary theory, and then tackle the possibility that evolutionary approaches that exclude culture might be sufficient (...) to explain the data. Finally, we consider various methodological and epistemological concerns expressed by our commentators. (shrink)

Theories of discourse bring to realism new ideas about how knowledge develops and how representations of reality are influenced. We gain an understanding of the conceptual aspect of social life and the processes by which meaning is produced. This collection reflects the growing interest realist critics have shown towards forms of discourse theory and deconstruction. The diverse range of contributions address such issues as the work of Derrida and deconstruction, discourse theory, Eurocentrism and poststructuralism. What unites all of the contributions (...) is a sense that it is essential to provide a realist alternative to the hitherto dominance of social constructionism, hermeneutics and postmodernism, over many of the issues discussed. By developing a realist perspective the different authors attempt to embed discourse within the structured nature of the reality of the world. Realism can situate language, discourse and ideology within context specific, or 'causally efficacious' circumstances. Realism can help to uncover issues of power, representation, and subjectivity and how discursive and other social practices produce real effects. This can help us understand the manner in which social structures are reproduced through various forms of ideology and discourse. And by knowing this, we can start to address questions concerning human emancipation and how the world is to be transformed. (shrink)

Kirk’s aim in this book is to bridge what he calls “the intelligibility gap,” expressed in the question, “How could complex patterns of neural firing amount to this?”. He defends a position that he describes as “broadly functionalist,” which consists of several theses. I will briefly review them.

7 What Ss Counter- Enlightenment? Mark Cilia i. The critique of the modern age is as old as the age itself. Ever since men began seeking distinction by ...

A typical guiding principle of an account of truth is: “truth is objective,” or, to be clear, judging whether an assertion is true or false depends upon how things are in the world rather than how someone or some community believes it to be. Accordingly, whenever a claim is objectively true, its truth conditions ought not depend upon the context in which it is uttered or the utterer making the claim. Part of our ongoing empirical studies surveying people’s responses to (...) questions about truth involved prompts on objectivity. Our studies suggest the following: overall, individuals tend to endorse claims that are consistent with the objectivity of truth; not all conceptions of objectivity are equal, even people who endorse the objectivity of truth sometimes assent to one form of truth’s objectivity over other forms; philosophers and non-philosophers both endorse the objectivity of truth, but the apparent commitment of philosophers is stronger. (shrink)