A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics (...) of health care. The moral status of any system of managed care ought to be judged with respect to its congruence with Gospel teachings about the care of the sick, Papal Encyclicals, and the documents of the Second Vatican Council. In this essay, I look at the important conceptual or definitional issues of managed care, assess these concerns over against the source and content of a Catholic ethic of health care, and outline the necessary moral requirements of any licit system of health care. (shrink)

Following up on a 1989 paper on the subject, this essay revisits the question of ethical expertise in the court room. Informed by recent developments in the use of ethics experts, the authors argue 1) that the adversarial nature of court proceedings challenges the integrity of the ethicist's pedagogical role; 2) that the use of ethics experts as normative authorities remains dubious; 3) that clarification of the State's interest in “protecting the ethical integrity of the medical profession” is urgently required; (...) and 4) that the expertise of the ethicist may be more appropriately used in advising the legislature than in influencing the court. (shrink)

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. (...) The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary. (shrink)

The moral authority for professional ethics in medicine customarily rests in some source external to medicine, i.e., a pre-existing philosophical system of ethics or some form of social construction, like consensus or dialogue. Rather, internal morality is grounded in the phenomena of medicine, i.e., in the nature of the clinical encounter between physician and patient. From this, a philosophy of medicine is derived which gives moral force to the duties, virtues and obligations of physicians qua physicians. Similarly, an ethic specific (...) to the other healing professions, law, teaching or ministry, can be derived from the specific ends to telos of each of these professions, which like medicine, are focused on a special type of human relationship. (shrink)

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. (...) The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary. (shrink)

: Artificial intelligences and robots increasingly mimic human mental powers and intelligent behaviour. However, many authors claim that ascribing human mental powers to them is both conceptually mistaken and morally dangerous. This article defends the view that artificial intelligences can have human-like mental powers, by claiming that both human and artificial minds can be seen as extended minds – along the lines of Chalmers and Clark’s view of mind and cognition. The main idea of this article is that the Extended (...) Mind Model is independently plausible and can easily be extended to artificial intelligences, providing a solid base for concluding that artificial intelligences possess minds. This may warrant viewing them as morally responsible agents. Keywords: Artificial Intelligence; Mind; Moral Responsibility; Extended Cognition Intelligenze artificiali come menti estese. Perché no? Riassunto: Intelligenze artificiali e robot simulano in misura sempre crescente le capacità mentali e i comportamenti intelligenti umani. Molti autori, tuttavia, sostengono che attribuire loro capacità mentali umane sia concettualmente errato e moralmente pericoloso. In questo lavoro si difende l’idea per cui le intelligenze artificiali possano avere capacità mentali simili a quelle umane, sostenendo che menti umane e artificiali possano essere considerate come menti estese – sulla scorta della prospettiva di Chalmers e Clark circa la mente e la cognizione. L’idea principale alla base di questo lavoro è che il Modello della Mente Estesa abbia plausibilità a prescindere e che possa essere facilmente esteso alle intelligenze artificiali, fornendo una base solida per concludere che le intelligenze artificiali possiedano delle menti e si possano considerare come agenti moralmente responsabili. Parole chiave: Intelligenza artificiale; Mente; Responsabilità morale; Conoscenza estesa. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Origins and Evolution of Bioethics: Some Personal ReflectionsEdmund D. Pellegrino (bio)AbstractBioethics was officially baptized in 1972, but its birth took place a decade or so before that date. Since its birth, what is known today as bioethics has undergone a complex conceptual metamorphosis. This essay loosely divides that metamorphosis into three stages: an educational, an ethical, and a global stage. In the educational era, bioethics focused on (...) a perceived “dehumanization” of medicine by the rising power of science and technology. Remedies were sought by introducing humanities, ethics, and human “values” into the medical curriculum. Ethics was one among the humanistic disciplines, but not the dominant one. In the second era, ethics assumed a dominant role as ever more complex dilemmas emerged from the rapid pace of biological research. As such dilemmas were applied to medical practice, the need for a more rigorous and more formal analysis of their moral status was clear. Philosophically-trained ethicists had an obvious role. They began to teach, write, and profoundly influence medical education and practice. In the third—and present—period, the breadth of problems has become so broad that ethicists must, themselves, draw on disciplines well beyond their expertise—e.g., law, religion, anthropology, economics, political science, psychology, and the like. The era of bioethics as a global enterprise is upon us. The original hope for humanizing medicine has not been overtly successful; however, much has been accomplished of value to patients, the profession, and society. Medical morality has been transformed into a formal, systematic study of a whole range of issues of the greatest significance to humanity. Now the major challenge is one of identity, or inter-relationships and connections between the theoretical and the practical. Bioethics has outgrown its beginnings.I have been invited to give a “personal recollection” of the early development of bioethics. Such invitations are notoriously hard to resist, but also problematic when they are the recollections of a participant [End Page 73] in the events to be described. We need only be reminded of the vagaries common to the plethora of memoirs on the book stands today. Few have escaped the perils of selective memory, self-promotion, or the settling of old scores. Yet their perils notwithstanding, memoirs may serve some useful purpose. They are the raw material—verbal kitchen middens so to speak—out of which historians can later sift fact from fancy. They enable “tribal elders” to give witness to the past from which the present can fashion some sense of continuity.I will organize my reflections around three very arbitrary time periods that represent my own way of thinking about the evolution of bioethics: (1) an era of “proto-bioethics” (1960–1972), (2) an era of philosophical bioethics (1972–1985), and (3) an era of global bioethics (1985-present). Each era, of course, overlaps with the others, and the dominant strand of each runs through the others as well.In the proto-bioethics period, the language of human values predominated; in the era of bioethics philosophically construed, it was the language of philosophical ethics; and in the era of bioethics globally construed, the social and behavioral sciences have gained greater prominence. In each period, interest in the traditional humanities other than philosophy waxed and waned. In the earlier years, religion and theology predominated. Beginning in the 1970s, philosophy took a dominant role. In the last two decades, other disciplines, like law, literature, and the social sciences, have exerted more and more influence (McNeur 1963; Pellegrino 1997; Barker 1987).I make no pretense here of writing any part of the formal “history” of bioethics. Works of this nature are beginning to appear (Rothman 1991; Jonsen 1998 ; Dell’Oro and Viafora 1996). Thomas McElhinney and I are preparing our own account of the work and influence of the Institute on Human Values in Medicine, one of the influential programs of the Society for Health and Human Values (Pellegrino and McElhinney, n.d.). Space limitations as well as prudence preclude any attempt to do justice to all the events, institutions, and people who have made the field of bioethics what it is today. I apologize for these omissions, for any unintentional lapses of... (shrink)

O presente artigo tem como objetivo analisar a cooperação militar entre Brasil e Suriname. Nas últimas décadas a América do Sul tornou-se plataforma estratégica de inserção internacional, modernização da defesa nacional e amadurecimento das relações regionais nos temas de segurança e defesa. Nosso recorte temporal é entre o ano de 1975, ano de independência do Suriname e de inicio de suas relações diplomáticas com o Brasil, até o ano de 2014, final do primeiro mandato da presidente Dilma Rousseff. A metodologia (...) consistiu em análise bibliográfica, levantamento e análise dos acordos de cooperação militar entre o Brasil e Suriname, análise documental e de declarações oficiais, discursos e posicionamentos dos atores sociais e políticos da região sobrea cooperação militar. Nossa análise demonstra que mesmo o Suriname apresentando uma baixa interação diplomática com o Brasil, o país ocupa posição de destaque na cooperação militar. (shrink)

Le projet de recherche collaborative intitulé TRACS ( Transatlantic Cultures. Cultural Histories of the Atlantic World 18th – 21st Centuries ) vise à élaborer une plate-forme numérique encyclopédique afin de mettre en œuvre une histoire des circulations culturelles dans l’espace atlantique à l’époque contemporaine dans une perspective pluridisciplinaire associant historiens, anthropologues, sociologues, géographes, musicologues, spécialistes de littérature, d’arts, de théâtre ou encore de cinéma. Si le premier objectif du projet est de décrypter l’économie complexe des échanges entre l’Europe, l’Afrique et (...) les Amériques entre la fin du XVIII et le début du XXI siècles en partant du postulat selon lequel le monde atlantique a été un laboratoire privilégié de la mondialisation culturelle, il propose également une réflexion sur les processus identitaires et les frontières qui ont contribué à l’établissement et à la reconfiguration des grandes aires culturelles, ainsi que sur les régimes circulatoires des pratiques, des savoirs et des représentations d’une rive à l’autre de l’océan sur le temps long des 250 dernières années. Pour mener à bien notre démonstration, nous aborderons trois aspects essentiels : le premier tient à la définition même de l’espace atlantique, à ses lignes de forces et à ses frontières ; le second concerne les temporalités de son histoire, longtemps restreinte à l’époque moderne ; le troisième relève des objets étudiés et de la spécificité de l’histoire culturelle, conçue comme une histoire sociale des représentations, des pratiques et des productions symboliques, face à des approches de nature géopolitique et aux Cultural Studies. (shrink)

Le projet de recherche collaborative intitulé TRACS ( Transatlantic Cultures. Cultural Histories of the Atlantic World 18th – 21st Centuries ) vise à élaborer une plate-forme numérique encyclopédique afin de mettre en œuvre une histoire des circulations culturelles dans l’espace atlantique à l’époque contemporaine dans une perspective pluridisciplinaire associant historiens, anthropologues, sociologues, géographes, musicologues, spécialistes de littérature, d’arts, de théâtre ou encore de cinéma. Si le premier objectif du projet est de décrypter l’économie complexe des échanges entre l’Europe, l’Afrique et (...) les Amériques entre la fin du XVIII et le début du XXI siècles en partant du postulat selon lequel le monde atlantique a été un laboratoire privilégié de la mondialisation culturelle, il propose également une réflexion sur les processus identitaires et les frontières qui ont contribué à l’établissement et à la reconfiguration des grandes aires culturelles, ainsi que sur les régimes circulatoires des pratiques, des savoirs et des représentations d’une rive à l’autre de l’océan sur le temps long des 250 dernières années. Pour mener à bien notre démonstration, nous aborderons trois aspects essentiels : le premier tient à la définition même de l’espace atlantique, à ses lignes de forces et à ses frontières ; le second concerne les temporalités de son histoire, longtemps restreinte à l’époque moderne ; le troisième relève des objets étudiés et de la spécificité de l’histoire culturelle, conçue comme une histoire sociale des représentations, des pratiques et des productions symboliques, face à des approches de nature géopolitique et aux Cultural Studies. (shrink)

Questo saggio ha come oggetto di riflessione i conflitti ambientali, i nuovi soggetti politici che ne sono protagonisti e le visioni collettive che paiono centrarsi in maniera inedita sulla cattiva gestione delle risorse locali e sui conseguenti rischi per la salute pubblica. Nuovi soggetti politici appunto che operano l'articolazione fra discorsi scientifici e discorsi politici. A partire da alcuni casi di studio l'articolo conduce una breve analisi sulle forme argomentative adottate da questi gruppi, sulle modalitÀ di intendere il rapporto con (...) le istituzioni democratiche e con la scienza, sui processi interni di leadership e sull'idea di ‘rivolta' da condurre. (shrink)

Il saggio introduce le tematiche di questo numero, soffermandosi in particolare sulla rilevanza etica e politica del cambiamento climatico. Dopo una rapida spiegazione dell'effetto serra naturale e artificiale, si ripercorrono le teorie che concepiscono il cambiamento climatico come un problema di giustizia distributiva. Secondo alcuni autori queste teorie non sono sufficienti per dare strumenti adeguati, perché il cambiamento climatico rappresenta un problema etico nuovo, che richiede una strumentazione etica inedita. Il saggio approfondisce alcune delle caratteristiche nuove dell'etica del cambiamento climatico, (...) soprattutto in relazione all'impatto che le scelte presenti avranno sulla qualitÀ della vita delle generazioni future. (shrink)

The article offers an approach to inquiry about, the foundation of medical ethics by addressing three areas of conceptual presupposition basic to medical ethical theory. First, medical ethics must presuppose a view about the nature of medicine. it is argued that the view required by a cogent medical morality entails that medicine be seen both as a healing relationship and as a practical art. Three ways in which medicine inherently involves values and valuation are presented as important, i.e., in being (...) aimed at the good of health, in being a cognitive art evaluating towards that good, and as a manifestation of a virtuous disposition concerning that good. Finally, a value ontology drawn from these considerations is seen as necessarily underlying medical ethics. A set of three such basic values are promoted as crucial: the value of health; the value of the individual patient; and the value of altruism that mediates the class of potential patients. (shrink)

In this paper, two different axiologies of pleasure are attributed to Hutcheson and Mill. Hutcheson endorsed a hedonist axiology, where quality of pleasure works as a still quantitative factor, able to counterbalance other quantitative features of pleasurable mental states - such as intensity and duration. By contrast, in Mill's view of value, the quality of pleasures is the only value-making feature, silencing any contribution from other quantitative elements. Therefore, the presence of certain qualitative characteristics - namely, the connection of certain (...) pleasures with human active faculties - becomes a necessary and sufficient condition of value. Due to this unique role of quality, Mill's axiology opens the way to non-pleasurable experiences being valuable - for non-pleasurable exercises of the human active faculties meet the condition to be valuable states. Thus, Mill's theory of value is declared non-hedonistic - against the recent claims to the contrary put forth by W. Donner. (shrink)

Observing averted eye gaze results in the automatic allocation of attention to the gazed-at location. The role of the orientation of the face that produces the gaze cue was investigated. The eyes in the face could look left or right in a head-centred frame, but the face itself could be oriented 90 degrees clockwise or anticlockwise such that the eyes were gazing up or down. Significant cueing effects to targets presented to the left or right of the screen were found (...) in these head orientation conditions. This suggests that attention was directed to the side to which the eyes would have been looking towards, had the face been presented upright. This finding provides evidence that head orientation can affect gaze following, even when the head orientation alone is not a social cue. It also shows that the mechanism responsible for the allocation of attention following a gaze cue can be influenced by intrinsic object-based (i.e. head-centred) properties of the task-irrelevant cue. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Ethics: Balancing Praxis and TheoryEdmund D. Pellegrino (bio)When André Hellegers founded the Kennedy Institute, he envisioned a close collaboration between ethics and clinical practice. He even called for physician specialists whose expertise would be in both fields (Reich 1994, p. 324). A quarter of a century later, his vision and prediction have become realities. Clinical ethics is today a thriving entity with its own literature, practitioners, and (...) methodology.This clinical turn has, on the whole, been salutary. The abstractness of ethical theory has been tempered by the concreteness of clinical realities; clinicians have been helped to make bedside decisions even in the face of theoretical uncertainty and dissonance; and a variety of disciplines besides theology and philosophy have entered ethical discourse and enriched it.These advantages notwithstanding, clinical ethics has certain inherent traits that make it problematical. Some seek its norms in what “works” in practice or in paradigm cases (Jonsen and Toulmin 1988); others shape it to achieve consensus or satisfy the needs of public policy (Meilaender 1995); still others reduce bioethics to merely a method for the resolution of moral conflict. Rather than simply modulating theory by practice, clinical ethics can end up by repudiating theory entirely (Toulmin, in press). Taken to their logical conclusion, these tendencies make clinical ethics a species of the antifoundationalism that has strongly influenced moral philosophy in the last decade (Tollefsen 1995, pp. 3–18; Rockmore and Singer 1992). But antifoundationalism itself is a theory of ethics even though it supposedly denies the validity of any overarching theories.Antifoundationalism presents its own difficulties. For one thing it begs important questions that will not go away: for example, how do we know that a decision is a good one? what does it mean to say that a decision “works”? is the [End Page 347] outcome of a good decisional procedure itself a good decision? and to what extent are compromise and exigency admissible in moral decisions? Theoretical and “foundational” questions of this sort will not evaporate because they are ignored. They inevitably will be answered by begging the essential questions or grounding them solely in prelogical presuppositions.To avoid these difficulties, the advantages of clinical ethics must be retained without capitulation to the anti-theory bias of contemporary philosophy. This means that theory and practice must both be retained and be conceptually related to each other. To effect this we must take account of the long intellectual history of the relationship between the speculative and the practical intellect—i.e., between knowledge sought for its own sake and knowledge sought for some use beyond simply the possession of it (Lobkowicz 1967, pp. 78–81). Suffice it to say that medicine has long been the paradigm case for the union of theory and praxis. Relating them conceptually is an essential propaedeutic to any theory of moral praxis in medicine.The rest of this essay examines the inextricability of theory and practice in two of the three major branches of clinical ethics—the substantive and the professional. The third branch, procedural ethics—i.e., the ethics of the process of decision making—deals with informed consent, with respect for persons, professional colleagues, and families, and with the ethics of conflict resolution. Obviously, there are theoretical issues here as well. For want of space, procedural ethics will not be discussed, but it presents the same conjunction of theory and practice encountered in professional and substantive ethics.Substantive EthicsSubstantive ethics refers to the moral content rather than the process of moral decisions, to the moral status and permissibility of the specific clinical medical acts themselves—e.g., abortion, euthanasia, pre-implantation diagnosis, surrogate motherhood, withholding and withdrawing treatment, the physician as gatekeeper, and the like—the whole range of moral questions clinicians face in treating patients. Moral diversity and plurality on these issues is the most powerful force behind the dominance of procedural ethics. But, unfortunately, a morally valid decision-making procedure does not confer normative validity on the decision itself. Moral validity rests on questions that go beyond prevailing practices, on what we take to be the nature and moral status of persons, fetuses, and brain-damaged humans, the value or disvalue of... (shrink)

ABSTRACT The paper shows textual and non-textual evidence that Henry Sidgwick endorses a version of the guise of the good doctrine and a version of the guise of the reasons view. He also rejects the guise of the pleasant doctrine, criticizing Mill’s views of the relations between pleasure, desire and desirability. Sidgwick also anticipates the guise of the apparent good view, i.e. the claim that desire connects with evaluative appearances, not with evaluative full-fledged judgments.

This paper focuses on a specific proposal connected with the issue of mitigating climate change by reducing GHG concentrations in the atmosphere. The idea of campaigning in favour of a temporary reproductive suspension, to be addressed to a range of citizens of developed countries , is explored. Some details of the proposal are specified, and the proposal itself is defended against four objec- tions: 1. that it encroaches reproductive freedom; 2. that it subtracts from the overall value the value of (...) future lives; 3. that it is costly and ineffectual; 4. that it is unfair, especially when women are considered. (shrink)