In his story entitled "Toenails," the surgeon Richard Selzer (1982) warns readers that total immersion in medicine is wrongheaded. Rather, to ensure their own health, doctors should discover other passions that permit them periodically to disconnect from medical practice. Selzer's surgeon character devotes his Wednesday afternoons to the public library, where he joins "a subculture of elderly men and women who gather … to read or sleep beneath the world's newspapers" (p. 69). Among these often eccentric personages is Neckerchief, an (...) arthritic man in his 80s who suffers from severe foot pain. His toenails, never trimmed because of his inability to reach them, have grown so long that they curve beneath his toes and .. (shrink)

Hope helps alleviate suffering. In the case of terminal illness, recent experience in palliative medicine has taught physicians that hope is durable and often thrives even in the face of imminent death. In this article, I examine the perspectives of philosophers, theologians, psychologists, clinicians, neuroscientists, and poets, and provide a series of observations, connections, and gestures about hope, particularly about what I call “deep hope.” I end with some proposals about how such hope can be sustained and enhanced at the (...) end of life. Studies of terminally ill patients have revealed clusters of personal and situational factors associated with enhancement or suppression of hope at the end of life. Interpersonal connectedness, attainable goals, spiritual beliefs and practices, personal attributes of determination, courage, and serenity, lightheartedness, uplifting memories, and affirmation of personal worth enhance hope, while uncontrollable pain and discomfort, abandonment and isolation, and devaluation of personhood suppress hope. I suggest that most of these factors can be modulated by good medical care, utilizing basic interpersonal techniques that demonstrate kindness, humanity, and respect. (shrink)

Poems and Commentaries by Amit Majmudar, Kelly Sievers, Bonnie Salomon, David Watts, Paul Boor, and Beth Lown.Jack Coulehan, Editor.

Ten years ago there was little talk about adding “professionalism” to the medical curriculum. Educators seemed to believe that professionalism was like the studs of a building—the occupants assume them to be present, supporting and defining the space in which they live or work, but no one talks much about them. Similarly, educators assumed that professional values would just “happen,” as trainees spent years working with mentors and role models, as had presumably been the case in the past. To continue (...) the metaphor, when educators did discuss ethics and values, they tended to focus more on external building codes than on the nature of construction materials. Building codes are designed to ensure the public's safety by establishing procedures and standards. Likewise, the “new” bioethics of autonomy and informed consent that entered the medical curriculum in the 1970s and 1980s was oriented primarily toward protecting human rights by codification. In fact, educators explicitly warned students against acting on their personal or professional values in a misguided way—that is, in the absence of adequate ethical constraints, a type of behavior that came to be labeled, pejoratively, as paternalism. (shrink)

Robert Coles' sentiment characterizes well the moral tenor of medical education today. Indeed, medical educators are frequently “seized by spasms of genuine moral awareness,” as they try to cope with the massive social and economic problems that face medical schools and teaching hospitals. The perception among educators that we currently fail to adequately teach several core aspects of doctoring, including professional values and behavior, constitutes one such spasm. In this case, the proposed remedy has generated considerable enthusiasm, but whether the (...) “core competencies” curriculum will make a difference, or simply “accommodate to the prevailing rhythms of the world we inhabit,” remains to be seen. (shrink)

Philosophical arguments usually are and nearly always should be abductive. Across many areas, philosophers are starting to recognize that often the best we can do in theorizing some phenomena is put forward our best overall account of it, warts and all. This is especially true in esoteric areas like logic, aesthetics, mathematics, and morality where the data to be explained is often based in our stubborn intuitions. -/- While this methodological shift is welcome, it's not without problems. Abductive arguments involve (...) significant theoretical resources which themselves can be part of what's being disputed. This means that we will sometimes find otherwise good arguments which suggest their own grounds are problematic. In particular, sometimes revising our beliefs on the basis of such an argument can undermine the very justification we used in that argument. -/- This feature, which I'll call self-effacingness, occurs most dramatically in arguments against our standing views on the esoteric subject matters mentioned above: logic, mathematics, aesthetics, and morality. This is because these subject matters all play a role in how we reason abductively. This isn't an idle fact; we can resist some challenges to our standing beliefs about these subject matters exactly because the challenges are self-effacing. The self-effacing character of certain arguments is thus both a benefit and limitation of the abductive turn and deserves serious attention. I aim to give it the attention it deserves. (shrink)

This book offers solutions to two persistent and I believe closely related problems in epistemology. The first problem is that of drawing a principled distinction between perception and inference: what is the difference between seeing that something is the case and merely believing it on the basis of what we do see? The second problem is that of specifying which beliefs are epistemologically basic (i.e., directly, or noninferentially, justified) and which are not. I argue that what makes a belief a (...) perceptual belief, or a basic belief, is not any introspectible feature of the belief but rather the nature of the cognitive system, or "module", that is causally responsible for the belief. Thus, even zombies, who in the philosophical literature lack conscious experiences altogether, can have basic, justified, perceptual beliefs. -/- The theories of perceptual and basic beliefs developed in the monograph are embedded in a larger reliabilist epistemology. I use this theory of basic beliefs to develop a detailed reliabilist theory: Inferentialist Reliabilism, which offers a reliabilist theory of inferential justification and which solves some longstanding problems for other reliabilist views by demanding inferential support for some—but not all—beliefs. The book is an instance of a thoroughgoingly naturalistic approach to epistemology. Many of my arguments have an empirical basis, and the view that I endorse reserves a central role for the cognitive sciences—in particular, cognitive neuroscience—in filling in the details of an applied epistemological theory. (shrink)

This paper develops an argument against causal decision theory. I formulate a principle of preference, which I call the Guaranteed Principle. I argue that the preferences of rational agents satisfy the Guaranteed Principle, that the preferences of agents who embody causal decision theory do not, and hence that causal decision theory is false.

Domestic violence and abuse (DVA) are at last coming to be recognised as serious global public health problems. Nevertheless, many women with personal histories of DVA decline to disclose them to healthcare practitioners. In the health sciences, recent empirical work has identified many factors that impede DVA disclosure, known as barriers to disclosure. Drawing on recent work in social epistemology on testimonial silencing, we might wonder why so many people withhold their testimony and whether there is some kind of epistemic (...) injustice afoot here. In this paper, I offer some philosophical reflections on DVA disclosure in clinical contexts and the associated barriers to disclosure. I argue that women with personal histories of DVA are vulnerable to a certain form of testimonial injustice in clinical contexts, namely, testimonial smothering, and that this may help to explain why they withhold that testimony. It is my contention that this can help explain the low rates of DVA disclosure by patients to healthcare practitioners. (shrink)

This paper develops a form of moral actualism that can explain the procreative asymmetry. Along the way, it defends and explains the attractive asymmetry: the claim that although an impermissible option can be self-conditionally permissible, a permissible option cannot be self-conditionally impermissible.

Outside of philosophy, ‘intuition’ means something like ‘knowing without knowing how you know’. Intuition in this broad sense is an important epistemological category. I distinguish intuition from perception and perception from perceptual experience, in order to discuss the distinctive psychological and epistemological status of evaluative property attributions. Although it is doubtful that we perceptually experience many evaluative properties and also somewhat unlikely that we perceive many evaluative properties, it is highly plausible that we intuit many instances of evaluative properties as (...) such. The resulting epistemological status of evaluative property attributions is very much like it would be if we literally perceived such properties. (shrink)

Emotion, Social Theory, and Social Structure takes sociology in a new direction. It examines key aspects of social structure by using a fresh understanding of emotions categories. Through that synthesis emerge new perspectives on rationality, class structure, social action, conformity, basic rights, and social change. As well as giving an innovative view of social processes, J. M. Barbalet's study also reveals unappreciated aspects of emotions by considering fear, resentment, vengefulness, shame, and confidence in the context of social structure. While much (...) has been written on the social consequences of excessive or pathological emotions, this book demonstrates the centrality of emotions to routine operations of social interaction. Dr Barbalet also re-evaluates the nature of social theory, for once the importance of emotions to social processes becomes clear, the intellectual constitution of sociology, and therefore its history, must be rethought. (shrink)

A theory of customary international law -- Case studies -- A theory of international agreements -- Human rights -- International trade -- A theory of international rhetoric -- International law and moral obligation -- Liberal democracy and cosmopolitan duty.

This paper is concerned with the senses in which paintings do and do not depict various temporal phenomena, such as motion, stasis and duration. I begin by explaining the popular – though not uncontroversial – assumption that depiction, as a pictorial form of representation, is a matter of an experiential resemblance between the pictorial representation and that which it is a depiction of. Given this assumption, I illustrate a tension between two plausible claims: that paintings do not depict motion in (...) the sense that video recordings do, and that paintings do not merely depict objects but may depict those objects as engaged in various activities, such as moving. To resolve the tension, I demonstrate that we need to recognise an ambiguity in talk of the appearance of motion, and distinguish between the depiction of motion and the depiction of an object as an object that is moving. Armed with this distinction, I argue that there is an important sense in which paintings depict neither motion, duration, nor – perhaps more controversially – stasis. (shrink)

The history of the Frankfurt School cannot be fully told without examining the relationships of Critical Theorists to their Jewish family backgrounds. Jewish matters had significant effects on key figures in the Frankfurt School, including Max Horkheimer, Theodor W. Adorno, Erich Fromm, Leo Lowenthal and Herbert Marcuse. At some points, their Jewish family backgrounds clarify their life paths; at others, these backgrounds help to explain why the leaders of the School stressed the significance of antisemitism. In the post-Second World War (...) era, the differing relationships of Critical Theorists to their Jewish origins illuminate their distinctive stances toward Israel. This book investigates how the Jewish backgrounds of major Critical Theorists, and the ways in which they related to their origins, impacted upon their work, the history of the Frankfurt School, and differences that emerged among them over time. (shrink)

Cases of past absence involve agents noticing in retrospect that an object or property was absent, such as when one notices later that a colleague was not at a talk. In Sanskrit philosophy, such cases are introduced by Kumārila as counterexamples to the claim that knowledge of absence is perceptual, but further take on a life of their own as a topic of inquiry among Kumārila’s commentators and their Nyāya interlocutors. In this essay, I examine the Nyāya philosopher Gaṅgeśa’s epistemology (...) of past absence, according to which agents learn that a recollectable object or property was absent by inferring its past absence from failing to recall that object or property. Gaṅgeśa’s account is best appreciated against the backdrop of earlier theories and their shortcomings, and I begin by presenting historical views leading up to his. I identify two groups of views about the epistemology of past absence: recollection views, according to which cases of past absence involve agents recalling negative information; and recollection failure views, according to which cases of past absence involve agents failing to recall positive information. I reconstruct two early recollection views: a Bhāṭṭa view belonging to Uṃveka, and a competing Nyāya view belonging to Jayanta and Bhāsarvajña. I then examine Śālikanātha and Sucarita’s critiques of recollection views, following which I reconstruct a Bhāṭṭa recollection failure view belonging to Pārthasārathi. I then examine Gaṅgeśa’s critiques of Pārthasārathi’s account and the recollection failure view he constructs out of its shortcomings. (shrink)