The past two decades have been a time of heightened interest in the moral aspects of the practice of medicine. This interest has been reflected in medical education by the establishment of medical humanities programs in both preclinical and clinical education in many medical schools. It has also been reflected in the literature with a dramatic increase in journal articles on medical ethics as well as the development of medical ethics in textbooks. A number of journals have developed that are (...) specifically devoted to medical ethics, including The Journal of Medical Ethics, The Journal of Medicine and Philosophy, The Journal of Medical Humanities, Theoretical Medicine, Cambridge Quarterly of Healthcare Ethics, just to name a few. The literature includes both theoretical foundations and conceptual analyses of particular issues as well as practical advice and general suggestions for how to implement programs in medical humanities. (shrink)

In the wake of a pilot study that indicated that the experience of medical education appears to Inhibit moral development In medical students, increased attention needs to be given to the structure of medical education and the Influence it has on medical students. Interest in ethics and moral reasoning has become widespread in many aspects of professional and public life. Society has exhibited great interest in the ethical issues confronting physicians today. Considerable effort has been undertaken to train medical students, (...) interns, and residents In how to reason through medical-ethical dilemmas. Media attention has focused on Issues such as abortion, euthanasia, care of severely handicapped infants, organ transplantation, and so forth, producing heated debates in both the professional and lay literature over the morality of the various positions. The curriculum of medical education has paralleled and reflected this general Interest in medical ethics. Most medical schools now offer, and frequently require, course work in ethics. However, further research Is needed to better characterize and understand the relationship of medical education to moral development. (shrink)

High moral standards and adherence to a moral code have long been strong tenets of the profession of medicine, even though there have been occasional lapses that have led to renewed calls for a revitalization of moral integrity in medicine. Certainly, a moral component has generally been held to be an important aspect of the concept of a physician.

The Norman Rockwell image of the American physician who fixed the broken arm of a child, treated the father for hypertension, and brought an unborn child into this world is now almost nonexistent. Since the time of the Rockwell portrait, a highly technical medical industry has evolved. Now two-thirds of physicians are board certified in subspecialties, and patients visit an average of 3–4 different physicians per year. Today's physicians see themselves less as “benevolent and wise counselors overseeing the patient's welfare (...) and more as objective scientists applying the latest technical methods to bring about the desired end.” The intimate patient-physician relationship that was once the norm in our society is rapidly disappearing. (shrink)

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while (...) nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way they function as clinical ethicists. (shrink)

The medical ethicist is a fairly recent addition to the clinical setting. The following four potential roles of the clinical ethicist are identified and discussed: consultant in difficult cases, educator of health care providers, counselor for health care providers and finally patient advocate to protect the interests of patients. While the various roles may sometimes overlap, the roles of educator and counselor are viewed as being more congruent with the education and training of medical ethicists than are the roles of (...) consultant and patient advocate. (shrink)

In recent years, the theoretical work of Gilligan in women's psychological development has led to the development of the concept of moral orientation or moral voice in contrast to the concept of moral reasoning or moral judgment developed by Kohlberg. These concepts have been of particular interest in gender studies, especially as applied to adolescence. These concepts of moral orientation and moral reasoning are being increasingly employed in healthcare ethics studies in a wide variety of settings. The recent work has (...) included studies of physicians, nurses, dentists, veterinarians, social workers, teachers of medical ethics, and hospital ethics committees. However, the study of moral development in healthcare providers has been hampered because collecting the necessary data from healthcare workers has been labor intensive and extremely time consuming. More efficient methods are needed. (shrink)

This study investigates the three major educational philosophies behind the medical humanities programs in the United States. It summarizes the characteristics of the Cultural Transmission Approach, the Affective Developmental Approach, and the Cognitive Developmental Approach. A questionnaire was sent to 415 teachers of medical humanities asking for their perceptions of the amount of time and effort devoted by their programs to these three philosophical approaches. The 234 responses constituted a 54.6% return. The approximately 80:20 gender ratio of males to females (...) and other demographic data on age and educational background were consistent with other studies of the field of medical humanities.Reflections on the results in Table II indicate that some changes need to take place in the teaching of the medical humanities if the perceived ideal is to be achieved. In order for the current teachers of the medical humanities to think that the appropriate philosophies behind the teaching of the medical humanities are being implemented as they should be, much less time and effort need to be devoted to the Cultural Transmission Approach. With no other published reports on the educational philosophies behind the medical humanities programs, this study created a new knowledge base about this relatively young and rapidly emerging field. (shrink)

Following a brief consideration of two contrasting purposes for teaching the medical humanities, a description is given of a film discussion elective course. In contrast to the usual teaching of medical ethics which is primarily a cognitive activity emphasizing the development of a code of principles such as justice, autonomy, and beneficence, the film discussion elective was primarily an affective activity emphasizing the development of an ethical ideal of caring, relatedness, and sensitivity to others. The pass/fail elective, offered for one (...) credit each quarter for two quarters, met once a week for one hour for twenty-four weeks. Each week a film was shown followed by a group discussion. A wide variety of social issues were covered. The objective of the course was to increase the ethical sensitivity of the medical students through promotion of introspection and reflection on social issues. A brief discussion is given of the importance and appropriateness of using film to promote the affective focus of medicine on the relief of suffering. Examples are given of how the course achieved its objective. A detailed description of the resource materials is provided. (shrink)

The most important distinction in value theory is the subjective-objective distinction which determines the epistemological status of value judgments about medical intervention. Ethical decisions in medical intervention presuppose one of three structures of justification — namely, an inductive approach, a deductive approach which can be either consequentialist or non-consequentialist, and a uniquely ethical approach. Inductivism and deductivism have been discussed extensively in the literature and are only briefly described here. The uniquely ethical approach which presupposes value objectivism is analyzed in (...) detail. This method involves a purely ethical inference which moves from facts to values directly with an emphasis on reason which involves a non-logical justification (as opposed to illogical). It involves the use of natural practical arguments which have an imperative conclusion but no imperative premise and exhibit a value-requiredness between two states of affairs. (shrink)

A study of physicians and medical students was conducted to determine the various philosophical positions they hold with respect to ethical decision-making in medicine and their epistemological presuppositions in relationship to the subjective-objective controversy in value theory. The study revealed that most physicians and medical students tend to be objectivists in value theory, i.e., believe that value judgements are knowledge claims capable of being true or false and are expressions of moral requirements and normative imperatives emanating from an external value (...) structure or moral order in the world, but that most physicians and medical students are inconsistent in the philosophical foundations of their medical ethical decision-making, i.e., in decision-making regarding values they tend to hold beliefs which are incompatible with other beliefs they hold about values. The study also revealed that most physicians and medical students think more emphasis should be placed upon medical ethics in medical education. (shrink)

A study of nurses and nursing students was conducted to determine the various philosophical positions they hold with respect to ethical decision-making in nursing and their relationship to the subjective-objective controversy in value theory. The study revealed that most nurses and nursing students tend to be subjectivists in value theory, i.e., believe that value judgments are purely personal, private expressions of one's own opinion or inner-feelings and not believe that value judgments are knowledge claims capable of being true or false (...) and therefore not expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most nurses and nursing students are inconsistent in the philosophical foundations of their ethical decision-making, i.e., in decision-making regarding values they tend to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value (...) judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

On May 11th a round table discussion was held on the subject "The Interactions of Science and Art under the Conditions of the Revolution in Science and Technology ," organized by the editorial boards of the journals Voprosy filosofii and Voprosy literatury.

After noting why the issue of the use of animals in medical education and research needs to be addressed, this article briefly reviews the historical positions on the role of animals in society and describes in more detail the current positions in the wide spectrum of positions regarding the role of animals in society. The spectrum ranges from the extremes of the animal exploitation position to the animal liberation position with several more moderate positions in between these two extremes. Then (...) the philosophical issue of the moral agency of animals is discussed in terms of an explication of the concept of rights and the concept of personhood. Further research is suggested concerning institutional policies regarding medical students who refuse to do physiology dog labs or other assignments which involve the suffering and/or death of animals. (shrink)

This descriptive study is an attempt to characterize the field known as clinical ethics, with regard to the function of humanities scholars in the clinical setting, e.g., hospitals and ambulatory care clinics. It is not a strict epidemiological study but a qualitative survey, although it reports some empirical data. Most discussions of medical humanities in the literature are conceptual analyses of particular issues, such as informed consent, abortion, confidentiality, etc. Virtually no empirical studies with data on how many clinical ethicists (...) function in what roles and with what educational backgrounds have been reported. This is the first such study of humanities scholars in clinical ethics and will be followed by companion reports of physicians and hospital chaplains who are, by self-report, involved in clinical ethics. This report is an effort to stimulate and encourage dialogue and is in no way definitive. It is a preliminary study, and other needed studies are already underway. (shrink)

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether (...) there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults. (shrink)

Whether ethics is too important to be left to the experts or so important that it must be is an age-old question. The emergence of clinical ethicists raises it again, as a question about professionalism. What role clinical ethicists should play in healthcare decision making – teacher, mediator, or consultant – is a question that has generated considerable debate but no consensus.

This study investigated gender related moral reasoning in student essays containing arguments on moral issues. Undergraduate students in a medical ethics course viewed two films on morally controversial issues. The students wrote brief essays about the films which were transcribed and numerically coded to conceal the author's gender from the evaluator. Using a coding scheme originated by Lyons, the evaluator classified each essay as a justice/right essay or a care/response essay or an equal response essay. Subsequently, calculations were made to (...) determine the percentage of male authored essays that were justice/rights essays or care/response essays and the percentage of female authored essays that were justice/rights or care/response essays. The males (87.7%) tended to exhibit the justice/rights moral orientation, and the females (69.4%) exhibited the care/response moral orientation. Several different calculations were made to determine various degrees of gender related orientations also. The difference in orientation was highly statistically significant (p≤0.001). These data contribute to understanding moral orientation and development. Interpretations are given to explain some differences between the genders and help explain the traditional roles in society that males and females have played historically. (shrink)

The enormous growth in medical humanities programs during the past decade has resulted in an extensive literature concerning the content of the discipline and the issues that have been addressed. Comparatively little attention, however, has been devoted to the structure of the discipline of medical humanities concerning the process or the theoretical aspects of the pedagogy of teaching the discipline. This report explicitly addresses the pedagogical aspects of the discipline by comparing and contrasting two different basic approaches to the discipline (...) referred to as the classical humanities approach and the humanistic psychology approach which roughly approximate the cognitive and affective approaches respectively. These two approaches are compared and contrasted in terms of their goals, objectives, methods of implementation, philosophical assumptions and evaluational techniques. (shrink)

This paper provides a philosophical critique of professional stereotypes in medicine. In the course of this critique, we also offer a detailed analysis of the concept of care in health care. The paper first considers possible explanations for the traditional stereotype that caring is a province of nurses and women, while curing is an arena suited for physicians and men. It then dispels this stereotype and fine tunes the concept of care. A distinction between ‘caring for’ and ‘caring about’ is (...) made, and concomitant notions of parentalism are elaborated. Finally, the paper illustrates, through the use of cases, diverse models of caring. Our discussion reveals the complexity of care and the alternative modes of caring in health care. (shrink)

Abstract I argue that meaning in life is importantly influenced by bioloical ties. More specifically, I maintain that knowing one's relatives and especially one's parents provides a kind of self-knowledge that is of irreplaceable value in the life-task of identity formation. These claims lead me to the conclusion that it is immoral to create children with the intention that they be alienated from their bioloical relatives?for example, by donor conception.

Lanczos, C. Einstein's path from special to general relativity.--Balazs, N. L. The acceptability of physical theories: Poincaré versus Einstein.--Ellis, G. F. R. Global and non-global problems in cosmology, by G. F. R. Ellis and D. W. Sciama.--Ehlers, J. The geometry of free fall and light propagation, by J. Ehlers, F. A. E. Pirani and A. Schild.--Trautman, A. Invariance of Lagrangian systems.--Penrose, R. The geometry of impulsive gravitational waves.--Exact solutions of the Einstein-Maxwell equations for an accelerated charge.--Taub, A. H. Plane-symmetric similarity (...) solutions for self-gravitating fluids.--Robinson, I. Equations of motion in the linear approximation, by I. Robinson and J. R. Robinson.--Florides, P. W. Rotating bodies in general relativity.--Chandrasekhar, S. A limiting case of relativistic equilibrium.--Israel, W. The relativistic Boltzmann equation.--Thompson, W. B. The self-consistent test-particle approach to relativistic kinetic theory. (shrink)

Behavioral scientists routinely publish broad claims about human psychology and behavior in the world's top journals based on samples drawn entirely from Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies. Researchers – often implicitly – assume that either there is little variation across human populations, or that these “standard subjects” are as representative of the species as any other population. Are these assumptions justified? Here, our review of the comparative database from across the behavioral sciences suggests both that there is (...) substantial variability in experimental results across populations and that WEIRD subjects are particularly unusual compared with the rest of the species – frequent outliers. The domains reviewed include visual perception, fairness, cooperation, spatial reasoning, categorization and inferential induction, moral reasoning, reasoning styles, self-concepts and related motivations, and the heritability of IQ. The findings suggest that members of WEIRD societies, including young children, are among the least representative populations one could find for generalizing about humans. Many of these findings involve domains that are associated with fundamental aspects of psychology, motivation, and behavior – hence, there are no obviousa priorigrounds for claiming that a particular behavioral phenomenon is universal based on sampling from a single subpopulation. Overall, these empirical patterns suggests that we need to be less cavalier in addressing questions ofhumannature on the basis of data drawn from this particularly thin, and rather unusual, slice of humanity. We close by proposing ways to structurally re-organize the behavioral sciences to best tackle these challenges. (shrink)

The thesis of instrumental convergence holds that a wide range of ends have common means: for instance, self preservation, desire preservation, self improvement, and resource acquisition. Bostrom contends that instrumental convergence gives us reason to think that "the default outcome of the creation of machine superintelligence is existential catastrophe". I use the tools of decision theory to investigate whether this thesis is true. I find that, even if intrinsic desires are randomly selected, instrumental rationality induces biases towards certain (...) kinds of choices. Firstly, a bias towards choices which leave less up to chance. Secondly, a bias towards desire preservation, in line with Bostrom's conjecture. And thirdly, a bias towards choices which afford more choices later on. I do not find biases towards any other of the convergent instrumental means on Bostrom's list. I conclude that the biases induced by instrumental rationality at best weakly support Bostrom's conclusion that machine superintelligence is likely to lead to existential catastrophe. (shrink)

In this new work, political theorist Michael J. Thompson argues that modern societies are witnessing a decline in one of the core building blocks of modernity: the autonomous self. Far from being an illusion of the Enlightenment, Thompson contends that the individual is a defining feature of the project to build a modern democratic culture and polity. One of the central reasons for its demise in recent decades has been the emergence of what he calls the cybernetic society, a (...) cohesive totalization of the social logics of the institutional spheres of economy, culture and polity. These logics have been progressively defined by the imperatives of economic growth and technical-administrative management of labor and consumption, routinizing patterns of life, practices, and consciousness throughout the culture. Evolving out of the neoliberal transformation of economy and society since the 1980s, the cybernetic society has transformed how that the individual is articulated in contemporary society. Thompson examines the various pathologies of the self and consciousness that result from this form of socialization--such as hyper-reification, alienated moral cognition, false consciousness, and the withered ego--in new ways to demonstrate the extent of deformation of modern selfhood. Only with a more robust, more socially embedded concept of autonomy as critical agency can we begin to reconstruct the principles of democratic individuality and community. (shrink)

A number of cases involving self-locating beliefs have been discussed in the Bayesian literature. I suggest that many of these cases, such as the sleeping beauty case, are entangled with issues that are independent of self-locating beliefs per se. In light of this, I propose a division of labor: we should address each of these issues separately before we try to provide a comprehensive account of belief updating. By way of example, I sketch some ways of extending Bayesianism (...) in order to accommodate these issues. Then, putting these other issues aside, I sketch some ways of extending Bayesianism in order to accommodate self-locating beliefs. Finally, I propose a constraint on updating rules, the "Learning Principle", which rules out certain kinds of troubling belief changes, and I use this principle to assess some of the available options. (shrink)

J.W. Olson addresses the Christian doctrine of revelation by asking how theological truth claims can possibly be rooted in God’s incarnational self-communication. Engaging with the phenomenology of Martin Heidegger, Olson offers an interpretation of the Eucharist that grounds Christian knowledge in an embodied understanding of the sacrament.

A careful reading of Plato's works show that Thrasymachus and Callicles, his famous immoralists, are unselfconsciously devoted to virtue as they see it. They thereby offer surprising support for the view that people are not simply self-interested, and they cast light on the beliefs and hopes we all have of justice.

Some philosophers have thought that life could only be meaningful if there is no God. For Sartre and Nagel, for example, a God of the traditional classical theistic sort would constrain our powers of self-creative autonomy in ways that would severely detract from the meaning of our lives, possibly even evacuate our lives of all meaning. Some philosophers, by contrast, have thought that life could only be meaningful if there is a God. God and the Meanings of Life is (...) interested in exploring the truth in both these schools of thought, seeking to discover what God could and couldn't do to make life meaningful (as well as what he would and wouldn't do). Mawson espouses a version of the 'amalgam' or 'pluralism' thesis about the issue of life's meaning – in essence, that there are a number of different legitimate meanings of 'meaning' (and indeed 'life') in the question of life's meaning. According to Mawson, God, were he to exist, would help make life meaningful in some of these senses and hinder in some others. He argues that whilst there could be meaning in a Godless universe, there could be other sorts of meaning in a Godly one and that these would be deeper. (shrink)

“WALL.E” stands for Waste Allocated Load Lifter Earth‐class. The last robot on planet Earth, WALL.E is programmed by the Buy n Large Corporation to clean up the environment. With this depiction of a world in which only a single green plant survives, WALL.E offers a brilliant look at environmental devastation. One way to overcome the tendency to shortchange future generations is to focus on the intrinsic value of nature. In WALL.E, the animators attempt to overcome the defects of one's own (...) self‐interest by illustrating the love and care for the plant. He/she can see this depiction of love of the environment as an effort to prompt him/her to think more about the environment as if nature is a person. The ending of WALL.E is suggestive along the lines of sustainability, but it does not come out and directly advocate for solutions. (shrink)

Excerpt from A Primer of Right and Wrong: For Young People in Schools and Families But we can be puppet-like Self-mastery never impossible Habits, and their power Habit-making in childhood Habit-cultivation. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged (...) copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. (shrink)

Both early and later forms of Buddhism developed a set of arguments to demonstrate that the self is an illusion. This article begins with a brief review of some of the arguments but then proceeds to show that these arguments are not themselves sufficient to dispel the illusion. It analyzes three ways in which the illusion of self manifests itself – as wish fulfillment, as a cognitive illusion, and as a phenomenal illusion. With respect to this last, the (...) article reviews some recent developments in cognitive neuropsychology and neuroscience to discuss the way in which the phenomenal illusion of self is encoded within our brain processes. This article also considers the way in which the illusion of self is constructed through social interaction, by episodic memory, and by narrative construction. Finally, it focuses on how the illusion of self developed as an evolutionary necessity to make it possible for the human organism to navigate physical and social reality; and that it continues to be useful today. This poses a dilemma for the Buddhist soteriological project of extinguishing the illusion of self. Specifically, while it is possible to develop a non-self perspective though the continued practice of vipassanā, it is not possible to maintain it consistently. The article concludes that even fully enlightened individuals must sometimes oscillate between a non-self perspective and a self-perspective and suggests an analogy between this oscillation and what occurs in the Kanizsa square illusion. (shrink)

Just-war theory has a long and distinguished history that stretches back to the Christian theologians of medieval Europe. Yet principles of just war must develop alongside social norms, standards of military practice and technology, and civilian-military relationships. Since World War II, and especially since American involvement in Vietnam, military ethics has developed into an academic cottage industry. As commonly taught to undergraduates and military practitioners, contemporary just-war theory seeks to ensure the political sovereignty and territorial integrity of nation-states. The theory (...) insists that the only just wars are defensive ones and forbids wars of national aggrandizement. On this view, because of the right to collective self-determination, wars must not seek to remake the world order, as that would undermine state sovereignty.In recent decades, however, cosmopolitan philosophers have challenged various aspects of the traditional edifice in an attempt to use just-war theory to enhance the protection of human rights around the world. Scholars have argued for greater scope for humanitarian intervention to protect individuals against their own government, for principles of justice after war to ensure that all states are legitimate, and most radically, for the responsibility of ordinary combatants to assess for themselves the justice of their military's cause. On this last argument, because combatants whose cause is just have done nothing to lose their immunity from harm, attacking them is unjust, and combatants whose cause is unjust cannot fight with discrimination.This publication surveys these recent developments, and it finds that they provide a radical challenge to both the theory and the practice of contemporary warfare. Of particular importance is its insistence on the need to strengthen international institutions, so as to provide combatants with an impartial perspective on their side's cause, and to strengthen military ethics education; and its suggestion that policies on dishonorable discharge be rethought. However, this monograph also challenges certain aspects of the new approach, suggesting important connections between military ethics and democratic theory and practice. (shrink)

This volume argues that Bonhoeffer's early work, particularly his Christocentric anthropology, grounds his later expressed commitments to responsibility and faithfulness in a ""world come of age."" Ellison suggests, in fact, that a concern for otherness permeates all of Bonhoeffer's work: a Christian self-defined by its orientation towards otherness.