Throughout the animal kingdom, p53 genes function to restrain mobile elements and recent observations indicate that transposons become derepressed in human cancers. Together, these emerging lines of evidence suggest that cancers driven by p53 mutations could represent “transpospoathies,” i.e. disease states linked to eruptions of mobile elements. The transposopathy hypothesis predicts that p53 acts through conserved mechanisms to contain transposon movement, and in this way, prevents tumor formation. How transposon eruptions provoke neoplasias is not well understood but, from a broader (...) perspective, this hypothesis also provides an attractive framework to explore unrestrained mobile elements as inciters of late‐onset idiopathic disease.Also see the video abstract here. (shrink)

An accountability-based privacy governance model is one where organizations are charged with societal objectives, such as using personal information in a manner that maintains individual autonomy and which protects individuals from social, financial and physical harms, while leaving the actual mechanisms for achieving those objectives to the organization. This paper discusses the essential elements of accountability identified by the Galway Accountability Project, with scholarship from the Centre for Information Policy Leadership at Hunton & Williams LLP. Conceptual _Privacy by Design_ principles (...) are offered as criteria for building privacy and accountability into organizational information management practices. The authors then provide an example of an organizational control process that uses the principles to implement the essential elements. Initially developed in the ‘90s to advance privacy-enhancing information and communication technologies, Dr. Ann Cavoukian has since expanded the application of _Privacy by Design_ principles to include business processes. (shrink)

Abstractabstract:Vaccine hesitancy continues to pose a formidable obstacle to increasing national COVID-19 vaccination rates in the US, but this is not the first time that American vaccination efforts have confronted resistance and apathy. This study examines the history of US vaccination efforts against smallpox, polio, and measles, highlighting persistent drivers of vaccine hesitancy as well as factors that helped overcome it. The research reveals that logistical barriers, negative portrayals in the media, and fears about safety stymied inoculation efforts as early (...) as the 18th century and continue to do so. However, vaccine hesitancy has been markedly diminished when trusted community leaders have guided efforts, when ordinary citizens have felt personally invested in the success of the vaccine, and when vaccination efforts have been tied to broader projects to improve public health and social cohesion. Deliberately cultivating such factors could be an effective strategy for lessening opposition today, when COVID-19's distinctive characteristics make addressing vaccine hesitancy more urgent than it has ever been. (shrink)

Robert Abrams argues that new concepts of space and landscape emerged in mid-nineteenth-century American writing, marking a linguistic and interpretative limit to American expansion. Abrams supports the radical elements of antebellum writing, where writers from Hawthorne to Rebecca Harding Davis disputed the naturalizing discourses of mid-nineteenth century society. Whereas previous critics find in antebellum writing a desire to convert chaos into an affirmative, liberal agenda, Abrams contends that authors of the 1840s and 50s deconstructed more than they (...) constructed. (shrink)

Analyses of factual causation face perennial problems, including preemption, overdetermination, and omissions. Arguably, the thorniest, are cases of omissive overdetermination, involving two independent omissions, each sufficient for the harm, and neither, independently, making a difference. A famous example is Saunders, where pedestrian was hit by a driver of a rental car who never pressed on the (unbeknownst to the driver) defective (and, negligently, never inspected) brakes. Causal intuitions in such cases are messy, reflected in disagreement about which omission mattered. What (...) these analyses mistakenly take for granted, is that at issue is the 'efficacy' of each omission. I argue, on the contrary, the puzzle of omissive overdetermination favors taking the act/omission distinction seriously. Factual causation, properly understood precludes omissions (i.e. omissions are not causal). Of course, the law also attaches liability to omissions, but this works differently from liability for real causes (e.g. omissions have a duty requirement, they also respond differentially to difference-making considerations). The manner in which liability attaches for omissions differs from that of straightforward causal liability, and is entirely dependent on the underlying causal structure. Attention to that structure (e.g. that the driver's hitting the pedestrian with his car is what actually caused the injury) sheds light on which omissions matter (e.g. driver's failure to press on the brakes) and why (because that failure removes a defense the driver would have to liability for the accident he caused). Other cases, where the parties' connection is entirely omissive (e.g. two physicians fail to detect independently lethal conditions), come out differently (tracking moralized elements). The analysis offered makes better sense of both why omissive determination cases are puzzling and how to resolve them. (shrink)

One controversy about the existence of so called evolutionary forces such as natural selection and random genetic drift concerns the sense in which such “forces” can be said to interact. In this paper I explain how natural selection and random drift can interact. In particular, I show how population-level probabilities can be derived from individual-level probabilities, and explain the sense in which natural selection and drift are embodied in these population-level probabilities. I argue that whatever causal character the individual-level probabilities (...) have is then shared by the population-level probabilities, and that natural selection and random drift then have that same causal character. Moreover, natural selection and drift can then be viewed as two aspects of probability distributions over frequencies in populations of organisms. My characterization of population-level probabilities is largely neutral about what interpretation of probability is required, allowing my approach to support various positions on biological probabilities, including those which give biological probabilities one or another sort of causal character. ‡This paper has benefited from feedback on and discussions of this and earlier work. I want to thank André Ariew, Matt Barker, Lindley Darden, Patrick Forber, Nancy Hall, Mohan Matthen, Samir Okasha, Jeremy Pober, Robert Richardson, Alex Rosenberg, Eric Seidel, Denis Walsh, and Bill Wimsatt. †To contact the author, please write to: Department of Philosophy, University of Alabama at Birmingham, HB 414A, 900 13th Street South, Birmingham, AL 35294-1260; e-mail: [email protected]. (shrink)

It has been argued that biological fitness cannot be defined as expected number of offspring in all contexts. Some authors argue that fitness therefore merely satisfies a common schema or that no unified mathematical characterization of fitness is possible. I argue that comparative fitness must be relativized to an evolutionary effect; thus relativized, fitness can be given a unitary mathematical characterization in terms of probabilities of producing offspring and other effects. Such fitnesses will sometimes be defined in terms of probabilities (...) of effects occurring over the long term, but these probabilities nevertheless concern effects occurring over the short term. †To contact the author, please write to: Department of Philosophy, University of Alabama at Birmingham, HB 414A, 900 13th Street South, Birmingham, AL 35294‐1260; e‐mail: [email protected]. (shrink)

Ruth Millikan and others advocate theories which attempt to naturalize wide mental content (e.g. beliefs.

We describe a case of parents refusing a tracheostomy for an otherwise healthy newborn. The refusal was not honored because permitting the refusal would have violated state law, which required a child to have a qualifying condition (e.g. a terminal diagnosis, permanent unconsciousness, incurable condition with severe suffering) to remove or withhold life-sustaining treatment. However, this case strained the relationship between the parents and medical staff, who worried about sending the newborn home with a tracheostomy where she was not wanted. (...) While many ethical issues arise in treatment refusal cases like this, we focus on the opportunity for ethicists to help the medical staff reflect on the technological alienation of the parents, which may help foster empathy, reduce moral distress, and strengthen the quality of the doctor-parent-patient triad. (shrink)

David McClean’s book Richard Rorty, Liberalism and Cosmopolitanism is an excellent contribution to Rorty scholarship and pragmatism in general. The book begins with a masterful reconstruction of the tradition of American philosophy from Emerson and Thoreau to Peirce and James and Dewey, culminating in Rorty. This beginning, from the Preface entitled “Rorty’s ‘Violence of Direction’” to Chapter 1 entitled “From Pragmatism to Rortyism” occupies almost the first third, and seems to establish a three-part structure, of the book. The second part (...) of the book, also very well done, critically engages Rorty’s pragmatist cosmopolitanism, finding the outlines... (shrink)

We examine the influence of word choices on mathematical practice, i.e. in developing definitions, theorems, and proofs. As a case study, we consider Euclid’s and Euler’s word choices in their influential developments of geometry and, in particular, their use of the term ‘polyhedron’. Then, jumping to the twentieth century, we look at word choices surrounding the use of the term ‘polyhedron’ in the work of Coxeter and of Grünbaum. We also consider a recent and explicit conflict of approach between Grünbaum (...) and Shephard on the one hand and that of Hilton and Pedersen on the other, elucidating that the conflict was engendered by disagreement over the proper conceptualization, and so also the appropriate word choices, in the study of polyhedra. (shrink)

In this paper I attempt to develop several ways Merleau-Ponty's ontology might contribute to an environmental ethic through a redefinition of his concept of flesh in terms of a general theory of affectivity. Currently accepted interpretations of the concept such as those in Abram, Toadvine, Barbaras, and Dastur rely upon conceiving flesh as a perceptual experience. I contest this interpretation and argue that a more productive conception of flesh emerges when understood in terms of Heidegger's philosophy. The paper concludes with (...) a consideration of the normative significance of flesh by examining the role of “wildness“ within a place-based ethic. (shrink)

This monograph consists of five parts: (1) introductory material including a conference overview; (2) papers presented at an international symposium on the topic of ethical issues in disability and rehabilitation as a section of the Annual Conference of the Society for Disability Studies; (3) responses to the symposium, prepared by four of the participants; (4) selected additional papers which offer views from perspectives or cultures not represented at the Denver conference; and (5) an annotated international bibliography. Representatives from 10 countries (...) discussed ethical issues and decision making in disability and rehabilitation. Conference papers include: "Genetic Engineering--The New Eugenics? Evolving Medical Attitudes towards the Quality of Life" (Hugh Gallagher);"Description of the Decision-Making Project" (Daryl Evans); "Treatment and Nontreatment Decisions with Respect to Extremely Premature, Very Low Birthweight Infants (500-750g)" (Ernle Young); "Allocation of Resources and Distributive Justice" (John Mather); "Quality Assurance as an Aid to Ethical Decision Making in Disability Management: Lessons from Recent Ethical Issues Involving Disadvantaged Groups in New Zealand" (Peter Gow); "Disability and Ethical Issues: A Point of View from the Netherlands" (Yolan Koster-Dreese); "Who Shall Live or How Shall They Live? Consumer and Professional Perspectives on Treatment/Non-Treatment Decisions" (Joseph Kaufert and Patricia Kaufert); and "Debates across Social Movements on Reproductive Technologies, Genetic Engineering, and Eugenics" (Theresia Degener). Conference commentaries include: "The Meeting of Disability and Bioethics: A Beginning Rapprochement" (Adrienne Asch); "A Plea for More Dialogue: Commentary on Ethics Conference" (Robert Slater); "Healing Our Wounds" (Martha Lentz Walker); "Theories and Values: Ethics and Contrasting Perspectives on Disability" (Harlan Hahn); and "Current Example of Ethical Dilemma" (Susan Lacetti). Selected additional papers include: "High-tech Medicine Is Basic Care" (Frederick Abrams); "Prevention of Disabilities as a Medical Question" (G. Schioler); "The Ethics of Disability Prevention: A Parent's Point of View" (Mrs. J. Baker); "A Reference Matrix for Issues of Life and Personhood" (Mike Miles); "Nazi Scientists and Ethics of Today" (Isabel Wilkerson); "Ethical and Policy Issues in Rehabilitation Medicine (Hastings Center Report)" (Arthur Caplan et al.); and "Differing Approaches to Prevention of Disability and Treatment of Impaired Infants Creates Controversies Worldwide" (Barbara Duncan). (JDD). (shrink)

Para que um livro chegue às mãos de seus leitores, há uma série de processos e procedimentos editoriais, que se iniciam na escrita, passam pela revisão, diagramação, impressão e distribuição dos exemplares. Esses processos são os mesmos, guardadas as diferenças de escala, para todos os livros, incluindo os best-sellers como S., obra de J. J. Abrams e Doug Dorst, objeto de nosso estudo. Nestes breves parágrafos, pretendemos descrever a campanha de marketing liderada pela editora Intrínseca, analisando o caminho traçado (...) para o lançamento da obra no Brasil e nos Estados Unidos, a fim de que o livro figurasse nas listas dos mais vendidos da editora nesses países. Para isso, fazemos uso do método midiológico, recuperando seus vestígios de circulação à época de seu lançamento para compor as considerações de análise.Palavras-chave:Mediação editorial. Humanidades digitais. Objetos editoriais. Literatura contemporânea. Indústrias criativas. (shrink)

When M. H. Abrams published a defense, in 1972, of "theorizing about the arts,"1 some of his critics accused him, of falling into subjectivism. He had made his case so forcefully against "the confrontation model of aesthetic criticism," and so effectively argued against "simplified" and "invariable" models of the art work and of "the function of criticism," that some readers thought he had thrown overboard the very possibility of a rational criticism tested by objective criteria. In his recent reply (...) to these critics,2 Abrams concentrates almost entirely on whether his critical pluralism is finally a skeptical relativism. He does not even mention his great historical works, The Mirror and the Lamp and Natural Supernaturalism, and he has nothing to say about how his pluralistic theories would be applied to the writing of history. But then, surprising as it seems once we think about it, neither of the two histories has much about his method either. What is the true achievement of these aggressive raids into our past, and how does Abrams see them in relation to other possible histories of the same subjects? Knowing in advance that he has agreed to reply to my nudging, I should like both to propose that everyone has—with Abrams' own encouragement—understated the importance of what he has done and to ask: What kind of pluralist is he? · 1. "What's the Use of Theorizing about the Arts," In Search of Literary Theory, ed. Morton Bloomfield , pp. 3-54. · 2. "A Note on Wittgenstein and Literary Criticism," ELH 41 : 541-54. Wayne C. Booth's other contributions to Critical Inquiry include "Kenneth Burke's Way of Knowing" , "Irony and Pity Once Again: Thais Revisited" , >"Preserving the Exemplar: Or, How Not to Dig our Own Graves" , "Notes and Exchanges" , "Metaphor as Rhetoric: The Problem of Evaluation" ,"Ten Literal 'Theses" , with Wright Morris: "The Writing of Organic Fiction: A Conversation" , and with Robert E. Streeter, W.J.T. Mitchell: “Sheldon Sacks 1930-1979”. (shrink)

In a recent paper in Psychological Science, Kouider and Dupoux reported obtaining unconscious Stroop priming only when subjects had partial awareness of the masked distractor words . Kouider and Dupoux conjectured that semantic priming occurs only when such partial awareness is present. The present experiments tested this conjecture in an affective categorization priming task that differed from Kouider and Dupoux’s in using masked distractors that subjects had practiced earlier as visible words. Experiment 1 showed priming from practiced words when subjects (...) had no partial awareness of those words. Experiment 2 showed that, in the absence of partial awareness, practiced words yielded priming but not-practiced words did not. Experiment 3 corroborated Experiment 1 and 2s results using a different test of partial awareness. These results suggest that unconscious processing of subword elements drives masked semantic priming by practiced words. (shrink)

A collection of dramatic accounts about doctors who have faced the moral dilemma of choosing between obeying rules and doing what is best for a patient offers insight into the essential principles of medical ethics and their impact on ...

In the debate over clinicians’ conscience, there is a greater ethical, legal, and scholarly focus on negative, rather than positive, claims of conscience. This asymmetry produces a seemingly unjustified double standard with respect to clinicians’ conscience under the law. For example, a Roman Catholic physician working at a secular institution may refuse to provide physician-aid-in-dying on the basis of conscience, but a secular physician working at a Roman Catholic institution may not insist on providing physician-aid-in-dying on the basis of conscience. (...) This article outlines arguments against this asymmetry and critiques them for failing to distinguish between positive claims of conscience as positive or negative rights. I suggest the asymmetry debate should be focused on whether positive claims of conscience as positive rights ought to enjoy the same protections as negative claims of conscience. Clarifying the debate in this way helps elucidate some of the best reasons for the asymmetry, which these arguments have not addressed. This article does not take a definitive position on whether the asymmetry is justified, but attempts to bring some focus to the debate by directing arguments against the asymmetry to address the significant differences between positive claims of conscience as positive rights and negative claims of conscience. (shrink)

Moral pluralism poses a foundational problem for secular clinical ethics: How can ethical dilemmas be resolved in a context where there is disagreement not only on particular cases, but further, on...

What is the proper role of a clinical ethics consultant’s religious beliefs in forming recommendations for clinical ethics consultation? Where Janet Malek has argued that religious belief should have no influence on the formation of a CEC’s recommendations, Clint Parker has argued a CEC should freely appeal to all their background beliefs, including religious beliefs, in formulating their recommendations. In this paper, I critique both their views by arguing the position envisioned by Malek puts the CEC too far from religion (...) and the position envisioned by Parker puts the CEC too close. For a CEC to give recommendations about what is morally prohibited, permissible, or obligatory in the clinic, I propose a view of the CEC that is neither religious nor non-religious but quasi-religious. I argue that a quasi-religious approach avoids the problems of both religious and non-religious views while preserving their benefits. Additionally, a quasi-religious view resists the marginalization of “religious” traditions that occurs when secular ethicists come to think of their approach as somehow distinctly non-religious. (shrink)

This paper provides a close reading of Erwin Straus’ “The Upright Posture” from a disability studies perspective. Straus argues that the upright posture dominates the human world. But he excludes those who dwell in it otherwise. By reviewing phenomenological disability literature, this paper asks what a disabled phenomenology would look like, one rooted in the problem of inclusion from the outset. Disabled phenomenology addresses ‘subjectivity’ critically, asking: what socio-material arrangements make subjectivity possible in the first place? This project is, I (...) argue, equal parts political economy and existential phenomenology. I conclude with some suggestions for future research. (shrink)

Legal precedent, professional‐society statements, and even many medical ethicists agree that some situations may call for a clinician to engage in an act of lying or nonlying deception of a patient or patient's family member. Still, the moral terrain of clinical deception is largely uncharted, and when it comes to practical guidance for clinicians, many might think that ethicists offer nothing more than the rule never to deceive. This guidance is insufficient to meet the real‐world demands of clinical practice, and (...) this article endeavors to articulate a framework to help clinicians better navigate the ethics of clinical deceit. The framework articulates four morally relevant dimensions of a potential deceptive act that should be examined to better determine the moral justification that might be required: the target of the act, the nature of the information, the nature of the act, and the context of the act. (shrink)

In a recent issue of the Journal of Medicine and Philosophy, several scholars wrote on the topic of ethics expertise in clinical ethics consultation. The articles in this issue exemplified what we consider to be two troubling trends in the quest to articulate a unique expertise for clinical ethicists. The first trend, exemplified in the work of Lisa Rasmussen, is an attempt to define a role for clinical ethicists that denies they have ethics expertise. Rasmussen cites the dependence of ethical (...) expertise on irresolvable meta-ethical debates as the reason for this move. We argue against this deflationary strategy because it ends up smuggling in meta-ethical assumptions it claims to avoid. Specifically, we critique Rasmussen’s distinction between the ethical and normative features of clinical ethics cases. The second trend, exemplified in the work of Dien Ho, also attempts to avoid meta-ethics. However, unlike Rasmussen, Ho tries to articulate a notion of ethics expertise that does not rely upon meta-ethics. Specifically, we critique Ho’s attempts to explain how clinical ethicists can resolve moral disputes using what he calls the “Default Principle” and “arguments by parity.” We show that these strategies do not work unless those with the moral disagreement already share certain meta-ethical assumptions. Ultimately, we argue that the two trends of attempting to avoid meta-ethics by denying that clinical ethicists have ethics expertise, and attempting to articulate how ethics expertise can be used to resolve disputes without meta-ethics both fail because they do not, in fact, avoid doing meta-ethics. We conclude that these trends detract from what clinical ethics consultation was founded to do and ought to still be doing—provide moral guidance, which requires ethics expertise, and engagement with meta-ethics. To speak of ethicists without ethics expertise leaves their role in the clinic dangerously unclear and unjustified. (shrink)

The national standards for clinical ethics consultation set forth by the American Society for Bioethics and Humanities endorse an “ethics facilitation” approach, which characterizes the role of the ethicist as one skilled at facilitating consensus within the range of ethically acceptable options. To determine the range of ethically acceptable options, ASBH recommends the standard model of decision-making, which is grounded in the values of autonomy, beneficence, nonmaleficence, and justice. H. Tristram Engelhardt Jr. has sharply criticized the standard model for presuming (...) contentful moral claims in circumscribing the range of ethically acceptable options, which, he argues, cannot be rationally justified in a pluralistic context. Engelhardt’s solution is a secular clinical ethics based on a contentless principle of permission. The first part of this article lays out Engelhardt’s negative claim, that reason cannot establish contentful moral claims, and his positive claim, that secular clinical ethics ought to be based on a contentless principle of permission. The second part critiques these negative and positive claims. The purpose of this paper is to defend secular clinical ethics expertise—defined as the ability of ethicists to offer justified moral recommendations grounded in consensus positions endorsed by the American Society for Bioethics and Humanities—from the radical critiques of Engelhardt, who argues that no moral or metaphysical claims, and hence no bioethical consensus, can be rationally justified. Engelhardt’s critiques have caused some to worry that secular clinical ethics is in a state of theoretical crisis; this article concludes that Engelhardt’s view is an unstable basis for that worry. (shrink)

While many Catholic hospitals permit the prescription of the emergency contraception drug levonorgestrel for rape victims, some continue to prohibit this practice as a matter of institutional conscience. While the standard approach to this issue has been to offer an argument that levonorgestrel either is or is not morally permissible, we have taken a different tack. We begin by briefly describing and acknowledging that reasonable disagreement exists on this question (part one), and then arguing that the reasonable disagreement itself can (...) serve as a compelling basis for Catholic leadership at hospitals that prohibit emergency contraception for rape victims to accommodate physicians who wish to provide levonorgestrel as a matter of conscience (part two). We end by anticipating and responding to some objections. (shrink)

Given recent legal developments in the United States, now is a critical time to draw attention to how ‘conscientious objection’ is sometimes used by health care providers to discriminate against the LGBTQ community. We review legal developments from 2019 and present several cases where health care providers used conscientious objection in ways that discriminate against the LGBTQ community, resulting in damaged trust by this underserved population. We then discuss two important conceptual points in this debate. The first involves the interpretation (...) of discrimination (provider versus patient-centered views), and we argue for a patient-centered view; the second involves the use of the people versus procedure distinction to reach a compromise between LGBTQ individuals and the clinicians who do not want to treat them. We argue the distinction is problematic when applied to treatment of the LGBTQ population. (shrink)

The legal and ethical asymmetry between honoring positive claims of conscience versus negative claims of conscience was recently analyzed by several articles in this journal. The first author of this article (ALB) identified unique but defeasible reasons against honoring positive claims of conscience, such as the greater threat they post to institutional values and institutional resources than negative claims of conscience. However, ALB wrote, when these reasons can be overcome, positive claims of conscience should enjoy the same ethical and legal (...) respect as negative claims of conscience. This article argues that the prescription of birth control by non-Roman Catholic physicians in Roman Catholic institutions is an example of a positive claim of conscience that can overcome concerns of institutional values and resources, and therefore ought to receive the same ethical respect and legal protection as negative claims of conscience. In making this argument, this article also responds to several of the thoughtful comments raised by Alberto Giubilini and Dominic Wilkinson. (shrink)

Em sua última obra, As Duas Fontes da Moral e da Religião, Henri Bergson investiga as origens, o desenvolvimento e a manutenção da sociedade humana por meio da distinção entre a sociedade fechada, baseada nos instintos primitivos de conservação da vida, e a sociedade aberta, fundada sobre a aspiração que impulsiona o homem à construção de uma vida em sociedade mais harmoniosa. Segundo o autor, os ideais democráticos são frutos da abertura de que as sociedades necessitam para seu progresso, o (...) qual, aos poucos, abrandaria a pressão das exigências impostas pela natureza para a conservação da vida em sociedade e possibilitaria aos homens conviverem mais livremente e mais afetuosamente com vistas a uma sociedade mais justa e sem tantos conflitos e mortes. Contudo, como escapar às determinações que a natureza impôs para que a vida em sociedade se mantivesse e conseguir que os homens se abram a outro tipo de vivência em conjunto? É esta a questão que o presente artigo procura investigar. Palavras-chave: Bergson, moral, política, mística. (shrink)

The place of science.--The structure of science.--Nature: occurrents.--Nature: complexes.--Awareness.--Operations.--Meaning.--Meaning: correlational symbols.--Meaning: constructs and hypotheses.--The development of knowledge.--Models.--Description.--Explanation.--Quantitative methods.

Our aim in this article is to bring some clarity to the clinical ethics expertise debate by critiquing and replacing the taxonomy offered by the Core Competencies report. The orienting question for our taxonomy is: Can clinical ethicists offer justified, normative recommendations for active patient cases? Views that answer “no” are characterized as a “negative” view of clinical ethics expertise and are further differentiated based on (a) why they think ethicists cannot give justified normative recommendations and (b) what they think (...) ethicists can offer, if they cannot offer recommendations. Views that answer “yes” to the orienting question are characterized as a “positive” view of clinical ethics expertise. Positive views are distinguished according to four additional questions. First (P1), how are those recommendations generated? Second (P2), what is the nature of the recommendations? Third (P3), we ask, how are the recommendations justified? And finally (P4), how are the recommendations communicated? (shrink)

This article describes and rejects three standard views of reason in secular clinical ethics. The first, instrumental reason view, affirms that reason may be used to draw conceptual distinctions, map moral geography, and identify invalid forms of argumentation, but prohibits recommendations because reason cannot justify any content-full moral or metaphysical commitments. The second, public reason view, affirms instrumental reason, and claims ethicists may make recommendations grounded in the moral and metaphysical commitments of bioethical consensus. The third, comprehensive reason view, also (...) affirms instrumental reason, but encourages ethicists to make recommendations grounded in the moral and metaphysical commitments of their private worldviews. A compatibilist view of public reason is then defended, which holds that each standard view captures an important role for reason in different aspects of secular clinical ethics. The article ends by identifying three implications for enduring theoretical debates in clinical ethics. (shrink)