The following article is a response to the position paper of the Hastings Center, "Ethical Challenges of Chronic Illness", a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical (...) survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. Keywords: acute, agent, autonomy, chronic, knowledge, obligations, rights CiteULike Connotea Del.icio.us What's this? (shrink)

Medicine needs our trust. We need to be able to rely on individual clinicians and researchers, and we need to be able to have confidence in hospitals and clinics. Yet the organization of our healthcare institutions is not designed to promote that trust. In fact, the structure of our medical institutions seems to undermine our faith.

As early as 1981 Gorlin and Zucker produced a film, AComplicatingFactor:Doctors'FeelingsasaFactorinMedicalCare and in a 1983 paper on the subject they described one of the important epiphenomena of the encounter between doctor and patient—namely, the reaction of the physician to the patient and how this affects both the physician and the quality of the relationship. At that time they were concerned with the physicians' ability to reckon with their own reactions to patients who presented with problems or personality traits that complicated (...) the doctor-patient relationship. Some patients were hateful or unlikable, some denied their disease state, some became unusually dependent on the physician, some were intimidating to the doctor. Their behavior evoked responses that tended to complicate the doctor-patient relationship with distancing, unusual identification, or hostility. That publication recognized and explained the problem and went on to suggest a process of achieving emotional awareness and mastery to help physicians maintain their appropriate role. (shrink)

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision‐making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found (...) in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision‐making. (shrink)

This essay challenges the dominance of the spherical earth model in fifteenth- and early-sixteenth-century Western European thought. It examines parallel strains of Latin and vernacular writing that cast doubt on the existence of the southern hemisphere. Three factors shaped the alternate accounts of the earth as a plane and disk put forward by these sources: the unsettling effects of maritime expansion on scientific thought; the revival of interest in early Christian criticism of the spherical earth; and a rigid empirical stance (...) toward entities too large to observe in their entirety, including the earth. Criticism of the spherical earth model faded in the decades after Magellan’s crew returned from circuiting the earth in 1522. (shrink)

A woman's right to know the contents of her own body, and to make a choice about whether to continue her pregnancy or not, should be defended against laws trying to stop prenatal sex selection, either in the developing world or in the developed world. Restrictions on women's reproductive freedom harm the interests of women and girls, and ignore myriad social policy solutions, such as education and income incentives to have girls and universal old age pensions, that provide better answers (...) to the strains of unbalanced sex ratios. The opponents of sex selection trumpet all accounts of increased discrimination against women resulting from unequal sex ratios while ignoring growing evidence of positive cultural change and women's empowerment fromwomen's enhanced marriage prospects. Opponents of sex selection reify a conservative heteronormative model of sexuality, gender roles and family structure, while arguing that unmarried men are social time bombs who can only be controlled by a wife. Eventually the social policy dilemma around sex selection will presumably be made moot since would-be parents will be able to use pre-conceptive technology to determine a conceptus's gender without abortion or in-vitro fertilization. But until the sex selection argument unravels before technological innovation, women's rights to control their bodies must be defended against laws banning - or requiring - prenatal ultrasound and abortion. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Comparative environmental philosophy is valuable in many ways. Perhaps it is most valuable because it reveals some of the foundational assumptions that run so deep in the poles of comparison that they might otherwise have gone unnoticed. These revelations may invite us to challenge those assumptions that have led to the kind of thinking responsible for much of the environmental degradation that we see today. Japanese Environmental Philosophy gathers papers focused on the environmental problems of the twenty-first century. Drawing from (...) Japanese philosophical traditions they investigate our relationships with other humans, nonhuman animals, and the environment. The heart of the book consists of chapters written by fifteen top scholars from Japan, the United States, Europe, and Australia. The essays cover a broad range of topics drawn from various strains of Japanese thought—including Zen Buddhism, Shintoism, the Kyoto school, and Japanese philosophy of art and aesthetics—as well as from traditional Japanese culture and the contemporary science of planning for natural disasters. These articles demonstrate that Japanese scientific, philosophical, religious, and cultural traditions can provide meaningful insight to address the current global environmental crisis. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Emotion regulation has the odd distinction of being a wildly popular construct whose scientific existence is in considerable doubt. In this article, we discuss the confusion about whether emotion generation and emotion regulation can and should be distinguished from one another. We describe a continuum of perspectives on emotion, and highlight how different (often mutually incompatible) perspectives on emotion lead to different views about whether emotion generation and emotion regulation can be usefully distinguished. We argue that making differences in perspective (...) explicit serves the function of allowing researchers with different theoretical commitments to collaborate productively despite seemingly insurmountable differences in terminology and methods. (shrink)

One of the most fundamental distinctions in the field of emotion is the distinction between emotion generation and emotion regulation. This distinction fits comfortably with folk theories, which view emotions as passions that arise unbidden and then must be controlled. But is it really helpful to distinguish between emotion generation and emotion regulation? In this article, we begin by offering working definitions of emotion generation and emotion regulation. We argue that in some circumstances, the distinction between emotion generation and emotion (...) regulation is indeed useful. We point both to citation patterns, which indicate that researchers from across a number of sub-areas within psychology are making this distinction, and to empirical studies, which indicate the utility of this distinction in many different research contexts. We then consider five ways in which the distinction between emotion generation and emotion regulation can be problematic. We suggest that it is time to move beyond debates about whether this distinction is useful to a more specific consideration of when and in what ways this distinction is useful, and in this spirit, we offer recommendations for future research. (shrink)

One of the most fundamental distinctions in the field of emotion is the distinction between emotion generation and emotion regulation. This distinction fits comfortably with folk theories, which view emotions as passions that arise unbidden and then must be controlled. But is it really helpful to distinguish between emotion generation and emotion regulation? In this article, we begin by offering working definitions of emotion generation and emotion regulation. We argue that in some circumstances, the distinction between emotion generation and emotion (...) regulation is indeed useful. We point both to citation patterns, which indicate that researchers from across a number of sub-areas within psychology are making this distinction, and to empirical studies, which indicate the utility of this distinction in many different research contexts. We then consider five ways in which the distinction between emotion generation and emotion regulation can be problematic. We suggest that it is time to move beyond debates about whether this distinction is useful to a more specific consideration of when and in what ways this distinction is useful, and in this spirit, we offer recommendations for future research. (shrink)

To the age-old debate over what it means to be human, the relatively new fields of sociobiology and artificial intelligence bring new, if not necessarily compatible, insights. What have these two fields in common? Have they affected the way we define humanity? These and other timely questions are addressed with colorful individuality by the authors of _The Boundaries of Humanity_. Leading researchers in both sociobiology and artificial intelligence combine their reflections with those of philosophers, historians, and social scientists, while the (...) editors explore the historical and contemporary contexts of the debate in their introductions. The implications of their individual arguments, and the often heated controversies generated by biological determinism or by mechanical models of mind, go to the heart of contemporary scientific, philosophical, and humanistic studies. (shrink)

This book approaches Hobbes's philosophy from a completely new perspective: his creativity. Creativity is the production of something which experts consider to be original, valuable and of high quality. James Hamilton explores Hobbes's creativity by focusing on his development, personality, and motivation in the context of his culture and environment, and on the ways in which he thought creatively, as inferred from his writings. Identification of the ideas which Hobbes drew upon is an important part of the study for (...) two reasons. First, they are necessary to determine which of Hobbes's ideas and theories are original and which are not. Second, analysis of his creativity requires an understanding of the ideas from which he drew. Hamilton concludes that Hobbes became a great philosopher because of his creative virtuosity. (shrink)

The biopolitics of intervening directly in the body with drugs, genes, and wires have always been far more fraught than the issues surrounding the use of gadgets. This chapter explores the way that conscience apps and morality software are an underexplored bridge between the traditional forms of moral enhancement and the more invasive methods that we will develop eventually. It discusses the core elements such as self‐control, caring, moral cognition, mindfulness, and wisdom or intelligence. Critics of morality apps point to (...) the alleged inauthenticity and shallowness of behavior change when it is technologically assisted. But humans have long enlisted technology in the aid of moral enhancement, from visible markers of vows like rings and uniforms, to self‐ or state‐imposed castration. The forms of pharmaceutical and genetic modification of moral behavior currently being discussed as forms of “moral enhancement.”. (shrink)

This book presents a lively and accessible way to use the ancient figure of Socrates to teach modern psychology that avoids the didactic lecture and sterile textbook. In the online age, is a living teacher even needed? What can college students learn face-to-face from a teacher they cannot learn anywhere else? The answer is what most teachers already seek to do: help students think critically, clearly define concepts, logically reason from premises to conclusions, engage in thoughtful and persuasive communication, and (...) actively engage the franchise of democratic citizenship. But achieving these outcomes requires an intimate, interpersonal learning community. This book presents a plan for using the ancient figure of Socrates and his Method to realize humane learning outcomes in the context of psychology. (shrink)

In Sensations of History, James J. Hodge argues that animation in new media art transforms historical experience in the digital age. Combining close textual analysis of experimental new media artworks with discussion of key phenomenological texts, Sensations of History argues for the broad critical significance of animation as we shift from analog to digital technologies. Hodge looks closely at animation aesthetics, which allow for a clear grasp of the ways digital technologies transform our sense of historical experience.

This is a book about how we see: the environment around us (its surfaces, their layout, and their colors and textures); where we are in the environment; whether or not we are moving and, if we are, where we are going; what things are good for; how to do things (to thread a needle or drive an automobile); or why things look as they do.The basic assumption is that vision depends on the eye which is connected to the brain. The (...) author suggests that natural vision depends on the eyes in the head on a body supported by the ground, the brain being only the central organ of a complete visual system. When no constraints are put on the visual system, people look around, walk up to something interesting and move around it so as to see it from all sides, and go from one vista to another. That is natural vision—and what this book is about. (shrink)

This volume -- a companion to Thomas Reid: Selected Philosophical Writings (2012) -- makes available material from Thomas Reid's autograph manuscripts and student notes of his lectures. It includes an introductory essay by Nicholas Wolterstorff.

This authoritative volume provides a comprehensive road map of the important and rapidly growing field of emotion regulation.

Both the psychology of perception and the philosophy of perception seem to show a new face when the process is considered at its own level, distinct from that of sensation. Unfamiliar conceptions in physics, anatomy, physiology, psychology, and phenomenology are required to clarify the separation and make it plausible. But there have been so many dead ends in the effort to solve the theoretical problems of perception that radical proposals may now be acceptable. Scientists are often more conservative than philosophers (...) of science. I end, therefore, as I began, with a plea for help. (shrink)

Modern emotion theories emphasise the adaptive value of emotions. Emotions are by no means always helpful, however. They often must be regulated. The study of emotion regulation has its origins in the psychoanalytic and stress and coping traditions. Recently, increased interest in emotion regulation has led to crucial boundary ambiguities that now threaten progress in this domain. It is argued that distinctions need to be made between (1) regulation of emotion and regulation by emotion; (2) emotion regulation in self and (...) emotion regulation in others; and (3) conscious and nonconscious emotion regulation. Using a process model of emotion generation, this review considers promising research on basic processes and individual differences in emotion regulation and poses five theoretical challenges. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Selected Letters by William, Henry JamesWilliam James EarleWilliam and Henry James. Selected Letters. Edited by Ignas K. Skrupskelis and Elizabeth M. Berkeley. Introduction by John J. McDermott. Charlottesville VA: University Press of Virginia, 1997. Pp. xxxi + 570. $ 39.95.Almost fifty years of letters to and from the very diversely brilliant James brothers: in this volume a generous, and probably ample, selection of 216 from (...) a total of 740 surviving letters or postcards, from an original total, according to the present editors, of twice as many. This volume of correspondence reflects the deep, unquestioned, unshakable familial (and virtually statutory) closeness of William and Henry who happened, as adults, to be seldom in the same place. There is, it must be said, very little explicit philosophy, narrowly or broadly defined, in these letters, but the philosophical reader will—or ought to—find much raw material for philosophical reflection. For example, a reasonable historicist thesis of how brotherhood, or family connection generally, plays itself out is supported by these documents. The nineteenth century is not the same as the twentieth. For example, here is William’s comment on the will of his sister, Alice, who left more to her companion and care-giver, Katherine Loring, a [End Page 479] women of extraordinary virtue and burden, than to her brother Robertson: “I can well sympathize with Alice’s desire to leave her something handsome; but I must say that her own consent (being apparently privy to the will) strikes me as tant soit peu lacking in delicacy. Surely no one of us would like to be in such a position in her family or any other” (271). This would be, in 1998, a rather unenlightened and ungenerous attitude, but is natural enough in 1892, even if not quite inevitable, not being shared by Alice herself. There is, incidentally, much discussion of wills and bequests, for the Jameses were of the genteel class, people with small family money and modest private incomes for whom the wherewithal to maintain homes with servants and to provide themselves with country houses and recuperative European vacations was always a faintly embarrassing, and occasionally a pressing, problem.It is probably also true that the much-discussed question of Henry’s homosexuality has, somehow, to be recast in historically relative terms. Here is an early report—1869—of Henry’s from Oxford: “As I walked along the river I saw hundreds of the mighty lads of England, clad in white flannel & blue, immense, fair-haired, magnificent in their youth, lounging down the stream in their punts or pulling in straining crews & rejoicing in their godlike strength” (41). This could not, the point is, be said by anyone, gay or straight, in 1998. Yet Henry is neither generally naive nor uncritically anglophile. He says of the Warwickshire scenery, which in a way he likes, that it is “too monotonously sweet & smooth—too comfortable, too ovine, too bovine, too English in a word.” And he adds, a little surprisingly: “It seems like a vast show region kept up at the expense of the poor” (41). This is only one of many appealing comments not sparsely scattered, but unpredictably, in letters of more ordinary news. Here’s one I liked occasioned by seeing theater in Paris: “We talk about it & write about it & criticize & dogmatize & analyse to the end of time: but those brave players stand forth & exemplify it & act—create—produce!” (66).Of course the “wit and wisdom” are not the monopoly of Henry. Here is William being wise: “We all learn sooner or later that we must gather ourselves up and more or less arbitrarily concentrate our interests, throw much overboard to save any” (55–56). Again: “It is a sweet world, in the interstices of its bedevilment & brutality” (321). And William being funny: “Boils are surely the most slowly evolving things in nature—Christian doctrine is nothing to them” (393). He is talking about his own boils and was subject, at every period, to ailments and infirmities: “Since writing to you, I have been swimming in deep seas of influenza, gout and Erysipelas of the face” (443). Or as he, in 1900, sums it up: “My... (shrink)

Individuals and businesses make numerous payments every day. They sometimes have choices about what forms of payment to make or accept, and at other times are effectively forced to use a particular form. Often there is an asymmetric power relationship between payer and payee that raises the issue of whether one side unfairly exploits the other. Is it unethical exploitation for an employer to pay employees with a fee-laden payroll card over other more convenient forms of payment? Does the fee (...) structure of payment networks such as Visa and MasterCard unfairly exploit merchants? The bitcoin payment system is an ethical as well as technological evolution as it was designed to be an electronic payment system that does not rely upon trust. Can an entire payment system like bitcoin be “evil,” as charged by Krugman? Payment tools as such are ethically neutral, but can be used in an ethical or unethical manner. (shrink)

Speakers often do not state requests directly but employ innuendos such as Would you like to see my etchings? Though such indirectness seems puzzlingly inefficient, it can be explained by a theory of the strategic speaker, who seeks plausible deniability when he or she is uncertain of whether the hearer is cooperative or antagonistic. A paradigm case is bribing a policeman who may be corrupt or honest: A veiled bribe may be accepted by the former and ignored by the latter. (...) Everyday social interactions can have a similar payoff structure (with emotional rather than legal penalties) whenever a request is implicitly forbidden by the relational model holding between speaker and hearer (e.g., bribing an honest maitre d’, where the reciprocity of the bribe clashes with his authority). Even when a hearer’s willingness is known, indirect speech offers higher-order plausible deniability by preempting certainty, gossip, and common knowledge of the request. In supporting experiments, participants judged the intentions and reactions of characters in scenarios that involved fraught requests varying in politeness and directness. (shrink)

This paper and its subsequent parts (Part II and Part III) build on an earlier publication (McKenna 1986). They suggest that important clinical data on the relationship between infantile constitutional deficits and microenvironmental factors relevant to SIDS can be acquired by examining the physiological regulatory effects (well documented among nonhuman primates) that parents assert on their infants when they sleep together.I attempt to show why access to parental sensory cues (movement, touch, smell, sound) that induce arousals in infants while they (...) sleep could possibly help one of many different subclasses of infants either to override certain kinds of sleep-induced breathing control errors suspected to be involved in SIDS or to avoid them altogether. I do not suggest that solitary nocturnal sleep “causes” SIDS, that all parents should sleep with their infants, or that traditional SIDS research strategies should be abandoned. However, using evolutionary data, I do suggest that an adaptive fit exists between parent-infant sleep contact and the natural physiological vulnerabilities of the neurologically immature human infant, whose breathing system is more complex than that of other mammals owing to its speech-breathing abilities. This “fit” is best understood, it is argued, in terms of the 4–5 million years of human evolution in which parent-infant contact was almost certainly continuous during at least the first year of an infant’s life. Thus, to dismiss the idea that solitary sleep has no physiological consequences for infants does not accord with scientific facts. (shrink)

Postnatal parent-infant physiological regulatory effects described in the previous paper (Part I) are viewed here as being biologically contiguous with events that occur prenatally, preparing and sensitizing the fetus to the average microenvironment into which the infant is expected, based on its evolutionary past, to be born. Following McKenna (1986), evidence (some of which is circumstantial) is presented concerning fetal hearing and fetal amniotic liquid breathing as they are affected both by maternal cardiovascular blood flow sounds in the uterus and (...) by fluctuating maternal blood sugar levels. These data are linked in turn to the infant’s postulated postnatal responsivity to parental sensory cues, including auditory and vestibular respiratory cues that may assist infants as they “learn” to breathe and, for some, to resist a SIDS event. Data on the respiratory and vocalizing behavior of normal and hearing-impaired persons are used to show that not all forms of human breathing are innate; some forms develop with experience. These data reveal how human infants learn, for example, to coordinate higher and lower brain respiratory nuclei in the context of learning initially to cry with intent and purpose and later to speak. Voluntary, cortex-based breathing emerges at the same time that infants are most likely to die from SIDS, between 2 and 4 months of age. This switch between voluntary and involuntary breathing during both sleep (while dreaming) and wake cycles, which depends on the integration of higher cortical and lower brain stem nuclei, is complex and is possibly the basis of the human species’ unique susceptibility to SIDS—a syndrome as yet unrecognized in other species. These human infant vulnerabilities, including delayed maturity, can explain in part why natural selection ought to favor increased infant sensitivity to parental sensory cues provided by a caregiver—stimuli available in the evolving parental care environment that included parent-infant co-sleeping for more than 4–5 million years of human evolution. (shrink)

A provocative work by medical ethicist James Hughes, Citizen Cyborg argues that technologies pushing the boundaries of humanness can radically improve our quality of life if they are controlled democratically. Hughes challenges both the technophobia of Leon Kass and Francis Fukuyama and the unchecked enthusiasm of others for limitless human enhancement. He argues instead for a third way, "democratic transhumanism," by asking the question destined to become a fundamental issue of the twenty-first century: How can we use new cybernetic (...) and biomedical technologies to make life better for everyone? These technologies hold great promise, but they also pose profound challenges to our health, our culture, and our liberal democratic political system. By allowing humans to become more than human - "posthuman" or "transhuman" - the new technologies will require new answers for the enduring issues of liberty and the common good. What limits should we place on the freedom of people to control their own bodies? Who should own genes and other living things? Which technologies should be mandatory, which voluntary, and which forbidden? For answers to these challenges, Citizen Cyborg proposes a radical return to a faith in the resilience of our democratic institutions. (shrink)