Intuition in medical and moral reasoning -- Moral intuitionism -- The place of Aristotelian phronesis in clinical reasoning -- Aristotle's practical syllogism: accounting for the individual through a theory of action and cognition -- Individual and statistical physiognomy: the art and science of making the invisible visible -- Clinical intuition versus statistical reasoning -- Contingency and correlation: the significance of modeling clinical reasoning on statistics -- Abduction: the intuitive support of clinical induction -- Conclusion: medical ethics beyond ontology.

Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is demonstrated through (...) analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine’s epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi’s theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine. (shrink)

I will apply dietetic measures for the benefit of the sick according to my ability and judgment. I will keep them from harm and injustice. The Hippocratic Oath formulates the ethical principle of medical beneficence and its negative formulation non-maleficence. It relates medical ethics to the traditional end of medicine, that is, to heal, or to make whole. First and foremost, the duty of the physician is to heal, and if this is not possible at least not to harm. This (...) ethical principle helped to establish the necessary trust between physician and patient in the pre-modern era when most of medicine was nothing more than a set of placebos (Shapiro 1960). Beginning in the seventeenth-century, Western .. (shrink)

Over the past several decades the ‘affective revolution’ in cognitive psychology has emphasized the critical role affect and emotion play in human decision-making. Drawing on this affective literature, various commentators have recently proposed strategies for managing therapeutic expectation that use contextual, symbolic, or emotive interventions in the consent process to convey information or enhance comprehension. In this paper, we examine whether affective consent interventions that target affect and emotion can be reconciled with widely accepted standards for autonomous action. More specifically, (...) the ethics of affective consent interventions is assessed in terms of key elements of autonomy, comprehension and voluntariness. While there may appear to be a moral obligation to manage the affective environment to ensure valid informed consent, in circumstances where volunteers may be prone to problematic therapeutic expectancy, this moral obligation needs to be weighed against the potential risks of human instrumentalization. At this point in time we do not have enough information to be able to justify clearly the programmatic manipulation of human subjects' affective states. The lack of knowledge about affective interventions requires corresponding caution in its ethical justification. (shrink)

The title of my paper, “Affecting the Body and Transforming Desire,” (Braude 2012a) is inspired from Plato’s Symposium, where the physician Eryximachus presents a purely neurophysiological discourse on love. James Giordano’s and Gerrit Glas’s commentaries on my paper have the timbre of a contemporary symposium, in this instance to discern the nature of suffering. Thus, I take Giordano’s and Glas’s commentaries to be generally sympathetic to my offering, although providing further critical insights that deepen the multidimensional understanding of suffering (...) and the correct ethical and medical response. From different perspectives both commentators zone in on one central aspect of my analysis, that is .. (shrink)

Neil Levy (2011) argues that neuroethics as a new discipline distinct from bioethics provides methodological tools to evaluate the validity of our moral intuitions. This naturalistic claim that mor...

This article applies the anthropological concept of liminality to reconceptualize palliative care ethics. Liminality possesses both spatial and temporal dimensions. Both these aspects are analyzed to provide insight into the intersubjective relationship between patient and caregiver in the context of palliative care. Aristotelian practical wisdom, or phronesis, is considered to be the appropriate model for palliative care ethics, provided it is able to account for liminality. Moreover, this article argues for the importance of liminality for providing an ethical structure that (...) grounds the doctrine of double effect and overcomes the impasse of phronesis in the treatment of the terminally ill. (shrink)

The book starts with a scandal, that is, Socrates’s mortality as entailed in the Aristotelian syllogism,All men are mortal,Socrates is a man,Therefore, Socrates is mortal. The scandal pertains to the deduction of Socrates’s death from the logical connections of premises, which, according to Braude, renders it “meaningless.” But, what does this scandal have to do with a philosophical defense of intuition in medicine? For Braude, the scandal is emblematic of a crisis in medicine and philosophy—a crisis in which (...) human mortality is severed from its morality. Braude articulates the crisis with the following question:Where, therefore, between the cracks of universal logic and reifying medicine is there a place for the individual patient, for a response to the cry of pain to which medicine responds, or to the voice of injustice upon which moral philosophy is founded? For him, intuition provides a means to answer the question and thereby to resolve the crisis. It serves as “a bridge be .. (shrink)

This book addresses the perennial question: What is justice?

During the Renaissance, the su was regarded primarily as a source of light which gave form to all things*; during the Enlightenment, paradoxically, the sun was regarded primarily as a source of heat. Paracelsian chemistry of the 1500s introduced salt as a third principle which embodied the other two, mercury and sulphur; salt was that universal mediating presence which represented earth. By the late 1700s salt was no longer a metaphysical principle but an acid-base compound, and volatile salts aroused most (...) interest. These changes in scientific perceptions of sun and salt ran parallel to one another: beginning as transcendent sources of form, sun and salt came to be considered manipulable sources of energy. Our r-;odern approach to energy derives from a period during which Europeans gradually lost their belief in the creative agency of two essentials to human life. (shrink)

“Business,” wrote a professor of marketing in 1929, “is the work of the world, humanity's chiefest task.” On the doorstep of the Depression, Prof. George R. Collins was selling business, by which he meant the business economy, an economic order based on the systematic management of money. I do not intend to enter the volatile controversy between Collins and those like Aldous Huxley who accused business people of being venal and crass. Rather, I intend to trace one likely path by (...) which many in 1929 had come to regard business as a redemptive activity and the business person as a redeemer. (shrink)

Historically, liberal political philosophy has had much to say about who is entitled to nationhood. But it has had rather less to say about how to determine the legitimate territorial boundaries of nations and even less to say about what some such nations, so situated, might owe to others. The object of this paper is to show that the foundational principles of liberalism can generate reasonably determinate solutions to these problems. That is, the very same set of basic rights that (...) liberalism ascribes to all persons is itself sufficient to determine which nations they are members of where those nations’ legitimate legal jurisdictions are located, and what amounts of wealth they each owe or are owed by other nations. (shrink)

ḥeleḳ 1-3. Toldot Bet Hilel -- ḥeleḳ 4. [without special title].

A rational moral code must satisfy the condition of completeness. This same condition applies to a set of moral rights, where it takes the form of requiring that all the rights in that set be compossible: that their respective correlatively entailed duties be jointly fulfillable. Such joint fulfillability is guaranteed only by a set of fully differentiated individual domains. And if moral rights are to play any independent role in moral reasoning - any role logically independent of the values that (...) bring persons into conflict - those domains must be determined by rules which are not derived from those values. (shrink)

This book contains a collection of important recent writing on left-liberalism, a political philosophy that recognizes both strong liberty rights and strong ...

In a recent review essay of a two volume anthology on left-libertarianism (edited by two of us), Barbara Fried has insightfully laid out most of the core issues that confront left-libertarianism. We are each left-libertarians, and we would like to take this opportunity to address some of the general issues that she raises. We shall focus, as Fried does much of the time, on the question of whether left-libertarianism is a well-defined and distinct alternative to existing forms of liberal egalitarianism. (...) More specifically, we shall address the following fundamental issues raised by Fried (and others): (1) Does the notion self-ownership have any determinate content? (2) What is the relation between self-ownership and world ownership? (3) How is left-libertarianism different from other forms of liberal egalitarianism (e.g., those of Rawls and Dworkin)? (shrink)

We offer a case-study in irrationality, showing that even in a high stakes context, intelligent and well trained professionals may adopt dominated practices. In multiple-choice tests one cannot distinguish lucky guesses from answers based on knowledge. Test-makers have dealt with this problem by lowering the incentive to guess, through penalizing errors (called formula scoring), and by eliminating various cues for outperforming random guessing (e.g., a preponderance of correct answers in middle positions), through key balancing. These policies, though widespread and intuitively (...) appealing, are in fact ‘‘irrational’’, and are dominated by alternative solutions. Number-right scoring is superior to formula scoring, and key randomization is superior to key balancing. We suggest that these policies have persisted since all stake-holders – test-makers, test-takers and test-coaches – share the same faulty intuitions. (shrink)

In virtue of what are later and an earlier group members of one and the numerically same tradition? Gallie was one of the few philosophers to have engaged with issues surrounding this question. My article is not a faithful exegesis of Gallie but develops a terminology in which to discuss issues surrounding the numerical identity of a tradition over time, based on some of his insights.

Tides of mind -- Three thirds of the spectrum -- Every day -- A map -- Spectrum, upper third: abstraction -- Spectrum, middle third: creativity -- Spectrum, lower third: descent into lost time -- Where it all leads.