Placebos are arguably the most commonly prescribed drug, across cultures and throughout history. Nevertheless, today many would consider their use in the clinic unethical, since placebo treatment involves deception and the violation of patients’ autonomy. We examine the placebo's definition and its clinical efficacy from a biopsychosocial perspective, and argue that the intentional use of the placebo and placebo effect, in certain circumstances and under several conditions, may be morally acceptable. We highlight the role of a virtue-based ethical orientation and (...) its implications for the beneficent use of the placebo. In addition, the definitions of lying and deception are discussed, clarified and applied to the clinical placebo dilemma. Lastly, we suggest that concerns about patient autonomy, when invoked as a further argument against administering placebos, are extended beyond their reasonable and coherent application. (shrink)

During the past few months, the discussion over the physicians' “Right of Conscience” has been on the rise. The intervention of politics in this issue shifts the discussion to a very specific and narrow area, namely the “reproductive health laws” which bear well-known predisposing attitudes.In this article, the physician's ROC is discussed in the context in which it naturally belongs: the Patient Physician Relationship . I suggest that the physicians' rights demand is a comprehensible, predictable, and even inevitable step as (...) part of the “evolution” of the PPR. Thus, the most appropriate way to comprehend and tackle the demand for physicians' ROC is within the context of medical professionalism. While searching for practical solutions to the “reproductive health” problems, there is a need to recognize the ethical and practical implications of the change in the PPR and balance between patient and physician rights. (shrink)

Recently, the discussion regarding the physicians’ “Right of Conscience” has been on the rise. This issue is often confined to the “reproductive health” arena within the political context. The recent dispute of the Bush-Obama administrations regarding the legal protections of health workers who refuse to provide care that violates their personal beliefs is an example of the political aspects of this dispute. The involvement of the political system automatically shifts the discussion regarding physicians’ ROC into the narrow area of “reproductive (...) health laws.” Indeed, the immediate association that comes to mind when thinking about the practical implications of this dispute is related to the reproductive health arena. This is partly because of the historical context of the first “conscience clauses,” initially enacted by Congress and state legislatures in the mid-1970s; in fact, most of these clauses provided specific exemptions for abortion and few exempted sterilization as well. (shrink)

The American Journal of Bioethics, Volume 12, Issue 2, Page 18-20, February 2012.

In principle, all patients deserve to receive optimal medical treatment equally. However, in situations in which there is scarcity of time or resources, medical treatment must be prioritized based on a triage. The conventional guidelines of medical triage mandate that treatment should be provided based solely on medical necessity regardless of any non-medical value-oriented considerations (“worst-first”). This study empirically examined the influence of value-oriented considerations on medical triage decision–making. Participants were asked to prioritize medical treatment relating to four case scenarios (...) of an emergency situation resulting from a car collision. The cases differ by situational characteristics pertaining to the at-fault driver, which were related to culpability attribution. In three case scenarios most participants gave priority to the most severely injured individual, unless the less severely injured individual was their brother. Nevertheless, in the aftermath of a vehicle-ramming terror attack most participants prioritized the less severely injured individual (“victim-first”). Our findings indicate that when caregivers are presented with concrete highly conflictual triage situations their choices may be based on value-oriented considerations related to contextual characteristics of the emergency situation. Philosophical and practical ramifications of our findings are discussed. (shrink)

Extreme intentional and deliberate violence against innocent people, including acts of terror and school shootings, poses various ethical challenges, some related to the practice of medicine. We discuss a dilemma relating to deliberate violence, in this case the aftermath of a terror attack, in which there are multiple injured individuals, including the terror perpetrator. Normally, the priority of medical treatment is determined based on need. However, in the case of a terror attack, there is reason to question this. Should the (...) perpetrator of extreme violence receive medical treatment on the scene before the victims if he or she is designated as the most seriously injured? Or rather, should victims receive medical care priority if they are also in some life-threatening danger, although not at the same level of severity as the perpetrator? We present two opposing approaches: the conventional ‘no-exceptions’ approach, which gives priority to the terrorist, and the justice-oriented ‘victim first’ approach, which gives priority to the victims. Invoking concepts of retributive justice, distributive justice and corrective justice, this latter approach suggests that ‘value-neutrality’ can lead to injustice. Perpetrators of terror-like violence should be treated as an act of humanism and good ethical medical practice. However, in clear and obvious terror-like situations, to treat the perpetrators of violence before their victims may be unjust. Thus, in some specific situations, the ‘victim first’ approach may be considered a legitimate alternative triage policy. (shrink)

Background Physical morbidity is rife among patients with serious mental illness. When they are involuntarily hospitalized and even treated, they may still refuse treatment for physical illness leading clinicians to wonder about the ethics of coercing such treatments. Research aim This survey study explored psychiatric caregivers’ perceptions on whether compulsory treatment of physical illness is legal and whether it is justifiable in patients with serious mental illness and under what circumstances. Research design A questionnaire that included two case vignettes of (...) an involuntarily hospitalized psychiatric patient with diabetes refusing treatment with insulin for various reasons. The cases differed in terms of diabetes severity. Participants answered questions regarding the appropriateness of involuntary treatment. Participants and research context Psychiatric medical doctors and nurses working in a mental health center. ( N = 89, 50 female, ages 26–66). Ethical considerations The study was approved by the Medical Centre Institutional Review Board (IRB) and the University Ethics Committee. The respondents’ anonymity was kept. Participation was voluntary and consent was obtained. Results The severity of the patient’s medical condition and their reason for refusing treatment were associated with participants’ willingness to give insulin despite patient objection [( F(1, 87) = 49.41, p <.01; ( F(1, 87) = 33.44, p <.01), respectively]. Participants were more inclined to support compulsory treatment if the patient’s refusal was “illness-oriented” (i.e. directly related to psychiatric illness). Participants presented diverse views regarding the perceived legality of compulsory treatment of physical illness in such situations (illegal 63.09%; legal 23.8%; 13% unsure). The majority (53.5%–55.3%) of those who thought it was illegal supported compulsory treatment in high-severity, illness-oriented refusal situations. Conclusions The severity of the medical condition and the reason for treatment refusal influence psychiatric caregivers’ willingness to provide compulsory treatment for physical illness in involuntary hospitalized psychiatric patients. Beyond the legal framework, ethical guidelines for these situations are warranted, while decisions should be made on a case-by-case basis. (shrink)

Solnica et al argue that “Jewish law and modern secular approaches based on professional responsibilities obligate physicians to care for all patients even those with communicable diseases”. The authors base their viewpoint on the opinion of Rabbi Eliezer Waldenberg and apply it to suggest that physicians are obligated to endanger themselves during epidemics, such as COVID-19. It is argued that Solnica et al’s analysis of Rabbi Waldenberg’s text and their conclusion that healthcare workers are obligated to endanger themselves while treating (...) patient who suffer from contagious illness during epidemics according to Jewish law suffer from various shortcomings. Indeed, Jewish law looks favourably on healthcare workers who take a reasonable risk in treating their patients in the context of epidemics. However, it is considered a voluntary supererogatory act—not obligatory. Solnica et al may express a legitimate ethical viewpoint. However, it does not seem to represent the mainstream approach of what Jewish law would demand as obligatory from its practitioners. (shrink)

Physician-assisted death (PAD) of patients whose suffering does not stem from terminal conditions has become more prevalent during the last few decades. This paper is focused on decision-making competence for PAD, specifically in situations in which PAD is related solely to psychiatric illness. First, a theoretical analysis presents the premises for the argument that competence for physician-assisted death for psychiatric patients (PADPP) should be determined based on a higher threshold in comparison to the required competence for conventional medical interventions. Second, (...) the higher threshold for decision-making competence for PADPP is illustrated. Third, several real PADPP cases are critically discussed, as an illustration to decision-making competence evaluations that would not have met the higher standard. Finally, a short summary of practical suggestions regarding the assessment of decision-making competence for PADPP is presented. Psychiatrists are called to address the ethical, legal, societal and clinical challenges related to PADPP and should be prepared for its probable expansion. (shrink)

Sometimes we make a decision about an action we will undertake later and form an intention, but our judgment of what it is best to do undergoes a temporary shift when the time for action comes round. What makes it rational not to give in to temptation? Many contemporary solutions privilege diachronic rationality; in some “rational non-reconsideration” (RNR) accounts once the agent forms an intention, it is rational not to reconsider. This leads to other puzzles: how can someone be motivated (...) to follow a plan that is contrary to their current judgment? How can it be rational to form a plan to resist if we can predict that our judgment will shift? I show how these puzzles can be solved in a framework where there are multiple units of agency, distinguishing between the judgments of the timeslice and those of the person over time, and allowing that the timeslice can “self identify”, taking the person over time as the relevant unit of agency and doing intrapersonal team reasoning (with a different causal role for intentions than RNR accounts). On my account, resisting temptation is compatible with synchronic rationality, so synchronic and diachronic rationality are aligned. However, either resisting or succumbing to temptation can be instrumentally rational, depending on the unit of agency that is identified with. In order to show why we ought to resist temptation, we need to draw on a non-instrumental rationale. I sketch possible routes for doing this. (shrink)

The Indian Buddhist philosopher Vasubandhu is known for his critical contribution to Buddhist Abhidharma thought, his turn to the Mahayana tradition, and his concise, influential Yogacara-Vijñanavada texts. _Paving the Great Way_ reveals another dimension of his legacy: his integration of several seemingly incompatible intellectual and scriptural traditions, with far-ranging consequences for the development of Buddhist epistemology and the theorization of tantra. Most scholars read Vasubandhu's texts in isolation and separate his intellectual development into distinct phases. Featuring close studies of Vasubandhu's (...) _Abhidharmakosabhasya_, _Vyakhyayukti_, _Vimsatika_, and _Trisvabhavanirdesa_, among other works, this book identifies recurrent treatments of causality and scriptural interpretation that unify distinct strands of thought under a single, coherent Buddhist philosophy. In Vasubandhu's hands, the Buddha's rejection of the self as a false construction provides a framework through which to clarify problematic philosophical issues, such as the nature of moral agency and subjectivity under a broadly causal worldview. Recognizing this continuity of purpose across Vasubandhu's diverse corpus recasts the interests of the philosopher and his truly innovative vision, which influenced Buddhist thought for a millennium and continues to resonate with today's philosophical issues. An appendix includes extensive English-language translations of the major texts discussed. (shrink)

Kant infamously claimed that all human beings, without exception, are evil by nature. This collection of essays critically examines and elucidates what he must have meant by this indictment. It shows the role which evil plays in his overall philosophical project and analyses its relation to individual autonomy. Furthermore, it explores the relevance of Kant's views for understanding contemporary questions such as crimes against humanity and moral reconstruction. Leading scholars in the field engage a wide range of sources from which (...) a distinctly Kantian theory of evil emerges, both subtle and robust, and capable of shedding light on the complex dynamics of human immorality. (shrink)

Demonstrates the systematic connection between Kant's ethics and his philosophy of history.

It is widely held that a successful theory of the mind will be neuroscientific. In this paper we ask, first, what this claim means, and, secondly, whether it is true. In answer to the first question, we argue that the claim is ambiguous between two views--one plausible but unsubstantive, and one substantive but highly controversial. In answer to the second question, we argue that neither the evidence from neuroscience itself nor from other scientific and philosophical considerations supports the controversial view.

The rejection of behaviorism in the 1950s and 1960s led to the view, due mainly to Noam Chomsky, that language must be studied by looking at the mind and not just at behavior. It is an understatement to say that Chomskyan linguistics dominates the field. Despite being the overwhelming majority view, it has not gone unchallenged, and the challenges have focused on different aspects of the theory. What is almost universally accepted, however, is Chomsky’s view that understanding language demands a (...) theory that posits mental states that represent rules of language. Call this claim, following Cowie (1999), Representationalism or (R). According to (R), ‘‘[e]xplaining language mastery and acquisition requires the postulation of contentful mental states and processes involving their manipulation’’ (Cowie, 1999, p. 154). Although (R) is nothing more than the general assumption on which cognitive psychology is founded applied to the case of language, even it has had its detractors. Critics have argued that linguistic competence should not in fact be thought of as based on the possession of a body of linguistic knowledge but should be thought of, rather, as a kind of skill. This is an important challenge because one might be inclined to think that no recognizable form of Chomskyan linguistics could withstand the falsification of (R). In this paper we attempt to show that in fact (R) could be false without doing much damage to Chomskyan linguistics at all. Indeed, it is possible that the Chomskyan position could be made more coherent by adopting the view we will sketch. Our claim, therefore, is that critics of (R) might be right, but that this does not obviously make them serious critics of the Chomskyan program. (shrink)

Human nature and its implications for moral philosophy has been a recurrent topic of philosophical inquiry. Thinkers from Plato to Arendt, struggling with the testimony of human experience, have attempted to explain the relation between reason and wickedness. Some have stressed the intrinsic rationality and goodness of human beings, relegating evil to the influence of factors alien to reason. Others have viewed humans as intrinsically evil, their capacity for reason a weak and inconsequential force.

If human rights express the equal claim of every person to the recognition and protection of their vital interests, they necessarily assert universal obligations of justice that cross borders. Sharon Anderson-Gold asks here whether there is a normative consensus on human rights and articulates the role of a cosmopolitan or global community in shaping the theory and practice of international politics. She considers several important works in the field of universal human rights and discusses whether a cosmopolitan system of (...) law is a necessary condition for the stable association of nation states. _Cosmopolitanism and Human Rights_ presents an ethical foundation for the idea of human development and attempts to demonstrate the normative character of universal human rights. It claims that Kant's idea of a federation of nations based upon principles of international right remains highly relevant to contemporary aspirations for global justice, and concludes by suggesting that a ‘cosmopolitan community’ is the locus of a global democratic order and is the necessary framework for the maintenance of human rights. (shrink)

Examines interrelated topics in Medieval and Renaissance Latin literature: the status of women as writers, the status of women as rhetorical figures, and the status of women in society from the fifth to the early seventeenth century.

This first volume in the four-volume series The Moral Limits of the Criminal Law focuses on the "harm principle," the commonsense view that prevention of harm to persons other than the perpetrator is a legitimate purpose of criminal legislation. Feinberg presents a detailed analysis of the concept and definition of harm and applies it to a host of practical and theoretical issues, showing how the harm principle must be interpreted if it is to be a plausible guide to the lawmaker.

Theories of collective intentions must distinguish genuinely collective intentions from coincidentally harmonized ones. Two apparently equally apt ways of doing so are the ‘neo-reductionism’ of Bacharach (2006) and Gold and Sugden (2007a) and the ‘non-reductionism’ of Searle (1990, 1995). Here, we present findings from theoretical linguistics that show that we is not a cognitive primitive, but is composed of notions of I and grouphood. The ramifications of this finding on the structure both of grammatical and lexical systems suggests that (...) an understanding of collective intentionality does not require a primitive we-intention, but the notion of grouphood implicit in team reasoning, coupled with the individual concept I. This, we argue, supports neo-reductionism but poses difficulties for non-reductionism. (shrink)

For decades American sociologists maintained that due to the elimination of their ancestral heritage under slavery, African-American shad no ethnic culture. Social segregation was due to poverty rather than racial prejudice. Social theorist Robert Blauner contests this view. The theory that black culture is only a lower class life-style is flawed because it ignores the culture-producing effects of racism which is the basis for a distinctive African-American culture. Following Blauner, this paper argues that racism is a more complex phenomenon than (...) discrimination because it asserts a type of inferiority that is not diminished by economic participation in the dominant culture. Racism encourages recurring social separations that set limits to assimilation. This paper also draws upon the work of Davis, Hacker and Winant to demonstrate how the bipolar construction of racial identity characteristic of racial relations in the United States precludes full social assimilation. (shrink)