What the philosophy of medicine is -- Philosophy of medicine: should it be teleologically or socially construed? -- The internal morality of clinical medicine: a paradigm for the ethics of the helping and healing professions -- Humanistic basis of professional ethics -- The commodification of medical and health care: the moral consequences of a paradigm shift from a professional to a market ethic -- Medicine today: its identity, its role, and the role of physicians -- From medical ethics to a (...) moral philosophy of the professions -- Moral choice, the good of the patient, and the patient's good -- The four principles and the doctor-patient relationship: the need for a better linkage -- Patient and physician autonomy: conflicting rights and obligations in the physician-patient relationship -- Character, virtue, and self-interest in the ethics of the professions -- Toward a virtue-based normative ethics for the health professions -- The physician's conscience, conscience clauses, and religious belief: a Catholic perspective -- The most humane of the sciences, the most scientific of the humanities -- The humanities in medical education: entering the post-evangelical era -- Agape and ethics: some reflections on medical morals from a catholic christian perspective -- Bioethics at century's turn: can normative ethics be retrieved? -- Hippocratic tradition -- Toward an expanded medical ethics: the Hippocratic ethic revisited -- Medical ethics: entering the post-Hippocratic era. (shrink)
: Although the exclusion of LGBTs from the rites and rights of marriage is arbitrary and unjust, the legal institution of marriage is itself so riddled with injustice that it would be better to create alternative forms of durable intimate partnership that do not invoke the power of the state. Card's essay develops a case for this position, taking up an injustice sufficiently serious to constitute an evil: the sheltering of domestic violence.
What distinguishes evils from ordinary wrongs? Is hatred a necessarily evil? Are some evils unforgivable? Are there evils we should tolerate? What can make evils hard to recognize? Are evils inevitable? How can we best respond to and live with evils? Claudia Card offers a secular theory of evil that responds to these questions and more. Evils, according to her theory, have two fundamental components. One component is reasonably foreseeable intolerable harm -- harm that makes a life indecent and (...) impossible or that makes a death indecent. The other component is culpable wrongdoing. Atrocities, such as genocides, slavery, war rape, torture, and severe child abuse, are Card's paradigms because in them these key elements are writ large. Atrocities deserve more attention than secular philosophers have so far paid them. They are distinguished from ordinary wrongs not by the psychological states of evildoers but by the seriousness of the harm that is done. Evildoers need not be sadistic:they may simply be negligent or unscrupulous in pursuing their goals. Card's theory represents a compromise between classic utilitarian and stoic alternatives (including Kant's theory of radical evil). Utilitarians tend to reduce evils to their harms; Stoics tend to reduce evils to the wickedness of perpetrators: Card accepts neither reduction. She also responds to Nietzsche's challenges about the worth of the concept of evil, and she uses her theory to argue that evils are more important than merely unjust inequalities. She applies the theory in explorations of war rape and violence against intimates. She also takes up what Primo Levi called "the gray zone", where victims become complicit in perpetrating on others evils that threaten to engulf themselves. While most past accounts of evil have focused on perpetrators, Card begins instead from the position of the victims, but then considers more generally how to respond to -- and live with -- evils, as victims, as perpetrators, and as those who have become both. (shrink)
In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life (...) determinations, the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence (re-interpreted as beneficence-in-trust) to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient's values. In order to act in the patient's best interests, or the patient's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician-patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today. (shrink)
A relativized version of Tarski’s T-scheme is introduced as a new principle of the truth predicate. Under the relativized T-scheme, the paradoxical objects, such as the Liar sentence and Jourdain’s card sequence, are found to have certain relative contradictoriness. That is, they are contradictory only in some frames in the sense that any valuation admissible for them in these frames will lead to a contradiction. It is proved that for any positive integer n , the n -jump liar sentence (...) is contradictory in and only in those frames containing at least an n -jump odd cycle. In particular, the Liar sentence is contradictory in and only in those frames containing at least an odd cycle. The Liar sentence is also proved to be less contradictory than Jourdain’s card sequence: the latter must be contradictory in those frames where the former is so, but not vice versa . Generally, the relative contradictoriness is the common characteristic of the paradoxical objects, but different paradoxical objects may have different relative contradictoriness. (shrink)
This chapter provides an analysis of the long process of introducing an electronic identity for online authentication in Germany. This process is described as a multi-facet innovation, involving actors from different policy fields shifting over time. The eID process started in the late ‘90s in the context of eGovernment and eCommerce with the legislation on e-signatures, which were supposed to allow for online authentication of citizens. When after 5 years it was recognized that this was not the case, a new (...) digital ID card, which had meanwhile been announced, was chosen as token for the eID. This process was dominated by the concerns for visual inspection and border control, including the storage of digital fingerprints. Under the leadership of the Ministry of the Interior (BMI) and technical guidance of the Federal Agency for Information Security (BSI), technical specifications have to a large extent been adopted from the electronic passport, which had been smoothly introduced 2 years before. However, in the legislative process some concern regarding digital fingerprints on the eID card was raised and led to an opt-in solution. In 2009, a bill on the new ID card was passed which regulates the eID function for online authentication as well. This is characterized as a radical innovation by introducing a double-sided, mutual authentication of the citizen and the service provider and implementing the principle of proportionality regarding the access of service providers to data on the chip. At the time of writing, field tests are conducted. Roll-out of the new eID card is to start in November 2010. Therefore no figures about adoption can be provided here. (shrink)
Rule-consequentialism has been accused of either collapsing into act-consequentialism or being internally inconsistent. I have tried to develop a form of rule-consequentialism without these flaws. In this June's issue of Utilitas, Robert Card argued that I have failed. Here I assess his arguments.
In terms of Aristotle's intellectual virtues, the process of clinical reasoning and the discipline of clinical medicine are often construed as techne (art), as episteme (science), or as an amalgam or composite of techne and episteme. Although dimensions of process and discipline are appropriately described in these terms, I argue that phronesis (practical reasoning) provides the most compelling paradigm, particularly of the rationality of the physician's knowing and doing in the clinical encounter with the patient. I anchor this argument, moreover, (...) in Pellegrino's philosophy of medicine as a healing relationship, oriented to the end of a right and good healing action for the individual patient. (shrink)
Pellegrino's philosophy of medicine is explored in categories such as the motivation in constructing a philosophy of medicine, the method, the starting point of the doctor-patient relationship, negotiation about values in this relationship, the goal of the relationship, the moral basis of medicine, and additional concerns in the relationship (concerns such as gatekeeping, philosophical anthropology, axiology, philosophy of the body, and the general disjunction between science and morals). A critique of this philosophy is presented in the following areas: methodology, (...) relation to ontology and sociology, the dynamic of individual and social concerns, and the new social condition of medicine. Finally, some suggestions for the future revitalization of philosophy of medicine are made based on Pellegrino's ideas. The focus throughout is on the moral basis and moral consequences of the philosophy of medicine, and not on other important themes. Keywords: doctor-patient relationship, goal of medicine, medical ethics, philosophical method, philosophy of medicine, philosophy of the body, values in medicine CiteULike Connotea Del.icio.us What's this? (shrink)
My response addresses a few technical problems raised by Card-the function of chains in extending caring, a constructivist interpretation of formal relations, a variation of reciprocity-and then concentrates on the major charges of unidirectionality and continued exploitation of women. Caring is not construed as an individual virtue that makes continuous demands on one party, but as a relational attribute. An ethic of caring is liberational rather than exploitative because the expectation is that all people, not just women, should act (...) as carers. (shrink)
The probabilistic approach to human reasoning is exemplified by the information gain model for the Wason card selection task. Although the model is elegant and original, several key aspects of the model warrant further discussion, particularly those concerning the scope of the task and the choice process of individuals.
Family medicine has grown as a specialty from its early days of general practice. It was established as a Board Certified specialty in 1969. This growth and maturation can be traced in the philosophy of family medicine as articulated by Edmund D. Pellegrino, M.D. Long before it was popular to do so, Pellegrino supported the development of family medicine. In this essay I examine the development of Pellegrino's philosophical thought about family practice, and contrast it to other (...) thinkers like Ian McWhinney, Kerr White, Walter Spitzer, Donald Ransom, and Hebert Vandervoort. The arguments focus on whether the goals of family medicine and family practice (possibly two distinct entities) can be articulated, especially considering the definitional problems of family and community. I conclude by echoing Pellegrino's hope that family medicine can contribute a fresh alternative to isolated, individualistic and technological thinking in medicine. (shrink)
Some problems that arise in the account given by Thomasma and Pellegrino  of the foundations of medical ethics in a philosophy of medicine are addressed, in particular questions of a conceptual character about treating therelatum of medicine as health. Which concept of health is appropriate and which will bear the burden of the position thomasma and Pellegrino advance? It is argued that the proper relationship of medicine is one between a healer and developing embodied minds. As a (...) consequence, the project of providing a univocal account of the nature of medicine fails. Instead, pluralism infects philosophy and medicine, resulting in different philosophies of medicine. From these philosophies of medicine will follow not a single medical ethics but a variety. (shrink)
: Card argues that we should not give injustice priority over evil. I agree. But I think Card sets us up for some difficult balances, for example of small evils against middle-sized injustices. I suggest some ways of staying off the tightrope.
Edmund Pellegrino has pioneered work in medical ethics calling for a reconstruction of Hippocratic ethics. In particular, he has spoken of incorporating principles that concern justice and the common good. This article traces his commitment to the common good, concern for the poor, opposition to libertarianism, acknowledgement of the necessity of rationing, and reluctance to give clinicians social allocational tasks. It asks how Pellegrino relates distributive justice to the common good. Drawing on his theory relating autonomy to patient-centered (...) beneficence (in which autonomy is one element of the good rather than a side constraint on the good), the author argues that Pellegrino appears to make justice one element of the common good rather than a distributional moral constraint on promoting the good. He suggests that Pellegrino stands in three consequentialist or teleological moral traditions: professional physician ethics, Aristotelianism, and Catholic moral theology, but that there are the makings of a more independent, more egalitarian theory of justice in his writings. Keywords: autonomy, common good, consequentialism, Edmund Pellegrino, justice CiteULike Connotea Del.icio.us What's this? (shrink)
We take a fresh look at the concerns about credit card pricing and empirically investigate whether the Credit CARD Act of 2009 has been successful in addressing those concerns. The rational choice theory of credit card pricing, which posits that issuers use back-end fees to adjust the price of credit to reflect new information about borrowers’ credit risk, predicts that issuers will respond to the Act by using alternative ways to price risk. In contrast, the behavioral economics (...) theory, which posits that issuers use back-end fees because they are not salient to consumers, predicts that issuers will respond by increasing unregulated non-salient prices. If the market is competitive, we argue that the CARD Act should also result in increases in some salient, up-front prices. But we show that if issuers have market power, reductions in non-salient fees may not result in concomitant increases in salient charges. We test these predictions using two datasets on credit card contract terms before and after the CARD Act rules went into effect. We find that the rules have substantially reduced the back-end fees directly regulated by the Act, including late fees and over-the-limit fees. However, unregulated contract terms, such as annual fees and purchase interest rates, have changed little. Post-CARD Act, consumers continue to face high long-term prices and low short-term prices, and imperfectly rational consumers still find it difficult to understand the cost of credit card borrowing. We thus consider potential improvements to the regulatory framework. We argue that improved disclosures that present to consumers the aggregate cost of credit under the contract, based on information about the borrower’s likely use of credit, would improve consumer outcomes. Furthermore, we suggest that regulators, rather than focusing on prices that are “too high,” should consider limiting the ability of issuers to charge introductory teaser interest rates that are in a sense “too low. (shrink)
In his writings, Edmund Pellegrino analyzes four deficiencies in the humanity of those who fall ill: the loss of (1) freedom of action, (2) freedom to make rational choices, (3) freedom from the power of others, and (4) a sense of the integrity of the self. Since Pellegrino's analysis and commitment to virtuebased ethics preceded much of the attention later given by philosophers to the importance of the moral principle of autonomy (in contrast to beneficence ) in patient (...) care, it is helpful to trace the source of his commitment to virtue-based ethics and his account of freedom to Aristotle's analysis of the human soul, as an entelechy of an intact and healthy living organism that, unimpeded by illness, moves itself to act, to actualize its intellectual potential in the form of making rational choices, and to free itself from the power of others by remaining independent and without need of continuous assistance, while at the same time retaining the integrity of a unified self that can act, think, and choose for itself autonomously. Keywords: autonomy, form, humanism, lived body, matter, virtue-based ethics, Scribonius Largus CiteULike Connotea Del.icio.us What's this? (shrink)
This chapter describes the introduction and diffusion of the Finnish Electronic Identity Card (FINEID card). FINEID establishes an electronic identity (eID), based on the civil registry and placed on an identity chip card issued by Finnish government to Finnish citizens and permanent residents from age 18 and older. It is a non-mandatory electronic identity card introduced in 1999 in order to replace the older citizen ID card. It serves as a travel document and is intended (...) to facilitate access to eGovernment services as well as offering a possibility to sign electronically. Therefore the chip contains two certificates: one for authentication purposes, and one for qualified signatures. The eID function had to compete with the already existing PIN/TAN based TUPAS standard for online authentication for eBanking, eCommerce and eGovernment applications, and has lost this battle by reaching less than one percent of all online authentications. The history, actor constellation, time line and barriers will be described and a few communalities and differences to other countries under study in this special issue will be highlighted. (shrink)
: This paper deals with Claudia Card's important contributions to a theory of evil that steps out from traditional models of thinking about this problem (theodicies, metaphysical theories, etc.). Instead, our author seeks to explore important elements from other theorists (such as Kant and Nietzsche) in order to build up her ideas of what she calls the "atrocity paradigm." This critical essay focuses mainly in the spaces where Card's conclusions need to rethink the limits and constraints of her (...) theory. (shrink)
This paper deals with Claudia Card's important contributions to a theory of evil that steps out from traditional models of thinking about this problem (theodicies, metaphysical theories, etc.). Instead, our author seeks to explore important elements from other theorists (such as Kant and Nietzsche) in order to build up her ideas of what she calls the "atrocity paradigm." This critical essay focuses mainly in the spaces where Card's conclusions need to rethink the limits and constraints of her theory.
This commentary, while sympathetic to Thomasma and Pellegrino , raises three sets of questions concerning the adequacy of their view of medicine as a foundation for medical ethical decision-making. The first set of questions concerns the account of the nature of medicine presented by Thomasma and Pellegrino. It is argued that the account is not clearly univocal and that even the most important description offered requires further clarification. Questioned, secondly, is the reasoning used by Thomasma and Pellegrino (...) to propel their movement from establishing an evaluative component in medicine to asserting an ethical dimension to medical judgment. It is argued that the authors equivocate in their presentation between the medical and moral uses of value terms. Finally, the role of the living body as a foundation for medical ethics is questioned, both in terms of the normative force such a ground can generate, and in terms of the range of duties to which this foundation must commit the profession. (shrink)
In this article, I examine Michele Moody-Adams’ critique of the ‘inability thesis’, according to which some cultures make the resources for criticizing injustice ‘unavailable’ to their members. I investigate Moody-Adams’ alternative ‘affected ignorance’ thesis. Using the example of slavery in ancient Greece, I consider two potential candidates for affected ignorance which involve, respectively, ‘unawareness’ and ‘mistaken moral weighing’; in neither, I hold, may one ascribe culpability to those involved.
In this paper I discuss card games designed to supplement or replace exercise sets on derivability and entailment in propositional logic. I present rules for two propositional logic card games that introduce chance and competition into discussions of propositional logic. The latter sections provide brief practical and theoretical notes on this kind of game, including ways courses that use these games can be more effective than courses that do not.
National electronic identity (e-ID) card schemes and electronic identity management systems (e-IDMS) in Europe are characterised by considerable diversity. This contribution analyses the creation of a national e-IDMS in Austria with the aim of improving our understanding of the reasons behind the genesis of particular designs of national e-IDMS. It seeks to explain how the system’s specific design evolved and which factors shaped its appearance. Being part of a comparative four country study, a common theoretical framework is employed to (...) allow for a comparison of national e-IDMS in Austria, Belgium, Germany and Spain. It combines the approach of actor-centred institutionalism and the concept of path dependence in order to analyse the innovation process and to explain resulting key characteristics of the e-IDMS in Austria: a technology-neutral system with multiple tokens; an ID model based on the Central Register of Residents; a privacy concept using sector-specific personal identifiers. It is shown that innovation process and outcome are not only shaped by specific actor constellations dominated by strategic e-government bodies, but also by path dependence at three levels: technological, institutional and organisational. (shrink)
This essay explores several moral issues raised by global warming through the lens of Claudia Card's theory of evil. I focus on Alaskan villages in the sub-Arctic whose residents must relocate owing to extreme erosion, melting sea ice, and rising water levels. I use Card's discussion of genocide as social death to argue that failure to help these groups maintain their unique cultural identities can be thought of as genocidal.
Because we are often nagged by the thought that we might not have behaved any differently than those good citizens whose respect for the law and fear of punishment led them to support the Nazi regime, we are fascinated with the behavior of ordinary Germans. Careful to first strip away the pathological explanations of German behavior, Pellegrino and Thomasma ask simply whether ordinary Germans could have reasoned and, by implication, acted differently. Although their affirmative answer is consistent with the (...) activism we have all come to demand of the Germans, it is not clear whether we, ourselves, can lay full claim to the moral high ground. (shrink)
This paper analyses the current organ donor card system in Switzerland and identifies five problems that may be partially responsible for the country’s low deceased organ donation rates. There are two minor issues concerning the process of obtaining a donor card: the Swisstransplant website understates the prospective benefits of donation, and the ease with which donor cards can be obtained raises questions regarding whether any consent to donation provided is truly informed. Furthermore, there are two major practical problems (...) that might affect those who carry an organ donor card: the lack of a central donor registry increases the likelihood that donors’ wishes will be “lost”, and there is a high probability that family members will veto organ donation. The fact that these two practical problems are not mentioned to potential donors by Swisstransplant constitutes the fifth problem. Donation rates would probably improve if more accurate information about the benefits of donation was provided to potential donors, a central donor registry was created, and families were not permitted to veto donation from those on the registry. (shrink)
This paper describes the introduction of a new electronic identity card including an electronic identity (EID) for local physical and online authentication in 2006. The most significant difference to any European country is the decentralized issuing at 256 police stations employing an automatic printing machine. This is the most visible element in a high degree continuation, as the previous paper based ID cards were also personalized and issued at the police stations. Similarly the attributes defining the identity and the (...) legal framework were not changed either. While there was some delay in the planning phase, the role-out of the new eID cards was rather smooth. At the end of 2009, approx. 13 Mio Spanish citizens out of more than 46.5 Mio inhabitants (www.ine.es) were in possession of an eID card. But this does not necessarily mean that they are using the eID function for online authentication. The reasons for this application gap will be discussed with reference to online tax declaration, where the eID so far covers less than one percent of all online declarations while authentication by software certificates still make up for 98 percent. (shrink)
For Michele Tosini, the baptism of Christ has profound allusions to Christ's suffering and death. In the Baptism of Christ and Temptations, Tosini is creative in his placement of the temptation narratives and in his selection of the Lukan account.
In The Atrocity Paradigm, Claudia Card suggests we forgiveness as a potentially valuable exercise of a victim's moral powers. Yet Card never makes explicit just what 'moral powers' are, or how to understand their grounding or scope. I draw out unacknowledged implications of her framework: namely, that others than the primary victim may forgive, and -- conversely -- that some victims may find themselves morally dis-empowered. Furthermore, talk of "moral powers" allows us to appropriately acknowledge the value of (...) refusals to forgive and the issue of "forgivable" evils, in ways that talk of forgiveness as a duty or virtue cannot. (shrink)
In his writings, Edmund Pellegrino analyzes four deficiencies in the humanity of those who fall ill: the loss of (1) freedom of action, (2) freedom to make rational choices, (3) freedom from the power of others, and (4) a sense of the integrity of the self. Since Pellegrino's analysis and commitment to virtuebased ethics preceded much of the attention later given by philosophers to the importance of the moral principle of autonomy (in contrast to beneficence) in patient care, (...) it is helpful to trace the source of his commitment to virtue-based ethics and his account of freedom to Aristotle's analysis of the human soul, as an entelechy of an intact and healthy living organism that, unimpeded by illness, moves itself to act, to actualize its intellectual potential in the form of making rational choices, and to free itself from the power of others by remaining independent and without need of continuous assistance, while at the same time retaining the integrity of a unified self that can act, think, and choose for itself autonomously. (shrink)