Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if (...) the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)

Physicians frequently ask whether they should give patients what they want, usually when there are considerations pointing against doing so, such as medicine’s values and physicians’ obligations. It has been argued that the source of medicine’s values and physicians’ obligations lies in what has been dubbed “the internal morality of medicine”: medicine is a practice with an end and norms that are definitive of this practice and that determine what physicians ought to do qua physicians. In this paper, I defend (...) the claim that medicine requires a morality that is internal to its practice, while rejecting the prevalent characterization of this morality and offering an alternative one. My approach to the internal morality of medicine is constructivist in nature: the norms of medicine are constructed by medical professionals, other professionals, and patients, given medicine’s end of “benefitting patients in need of prima facie medical treatment and care.” I make the case that patients should be involved in the construction of medicine’s morality not only because they have knowledge that is relevant to the internal morality of medicine—namely, their own values and preferences—but also because medicine is an inherently relational enterprise: in medicine the relationship between physician and patient is a constitutive component of the craft itself. The framework I propose provides an authoritative morality for medicine, while allowing for the incorporation, into that very morality, of qualified deference to patient values. (shrink)

Two problems seem to plague Adam Smith’s account of sympathy and approbation in The Theory of Moral Sentiments (TMS). First, Smith’s account of sympathy at the beginning of TMS appears to be inconsistent with the account of sympathy at the end of TMS. In particular, it seems that Smith did not appreciate the distinction between ‘self-oriented sympathy’ and ‘other-oriented sympathy’, that is, between imagining being oneself in the actor’s situation and imagining being the actor in the actor’s situation. Second, Smith’s (...) account of approbation, according to which a sentiment of approval arises when there is recognition of concordance between the spectator’s sympathetic passion and the actor’s original passion, seems to face the following problem: since the spectator attains both his own sympathetic passion and the actor’s original passion by sympathizing with the actor, the sympathetic passion of the spectator and the original passion of the actor will necessarily be identical. Therefore, Smith’s account of approbation requires that the spectator utilize both self-oriented and other-oriented sympathy (‘the double-sympathy model of approbation’). I offer a novel developmental account of sympathy in TMS that renders Smith’s account of sympathy consistent and allows for the utilization of the double-sympathy model of approbation. (shrink)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, by bringing (...) medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

I offer a novel two-stage reconstruction of Hume’s general-point-of-view account, modeled in part on his qualified-judges account in ‘Of the Standard of Taste.’ In particular, I argue that the general point of view needs to be jointly constructed by spectators who have sympathized with (at least some of) the agents in (at least some of) the actor’s circles of influence. The upshot of the account is two-fold. First, Hume’s later thought developed in such a way that it can rectify the (...) problems inherent in his Treatise account of the general point of view. Second, the proposed account provides the grounds for an adequate and well-motivated modest ideal observer theory of the standard of virtue. (shrink)

John Rawls raises three challenges – to which one can add a fourth challenge – to an impartial spectator account: (a) the impartial spectator is a utility-maximizing device that does not take seriously the distinction between persons; (b) the account does not guarantee that the principles of justice will be derived from it; (c) the notion of impartiality in the account is the wrong one, since it does not define impartiality from the standpoint of the litigants themselves; (d) the account (...) would offer a comprehensive, rather than a political, form of liberalism. The narrow aim of the article is to demonstrate that Adam Smith's impartial spectator account can rise to Rawls's challenges. The broader aim is to demonstrate that the impartial spectator account offers the basis for a novel and alternative framework for developing principles of justice, and does so in the context of a political form of liberalism. (shrink)

My question in the chapter is this: could (and should) the role of the physician be construed as that of a friend to the patient? I begin by briefly discussing the “friendship model” of the physician-patient relationship—according to which physicians and patients could, and perhaps should, be friends—as well as its history and limitations. Given these limitations, I focus on the more one-sided idea that the physician could, and perhaps should, be a friend to the patient (a “physician-qua-friend model” of (...) the physician-patient relationship). I show that given recent developments in our understanding of the physician-patient relationship, this idea is far from asinine. I then make the case that the most plausible conception of the physician-qua-friend model incorporates the following components: (a) a common goal, that is, one that physician and patient share; (b) certain forms of equality between physician and patient; (c) an ideal of a caring physician. Finally, I show how the model can be instantiated in a certain type of physician-patient interaction, namely, in physician-assisted dying. (shrink)

The Humean Theory of Reasons, according to which all of our reasons for action are explained by our desires, has been criticized for not being able to account for “moral reasons,” namely, overriding reasons to act on moral demands regardless of one's desires. My aim in this paper is to utilize ideas from Adam Smith's moral philosophy in order to offer a novel and alternative account of moral reasons that is both desire-based and accommodating of an adequate version of the (...) requirement that moral demands have overriding reason-giving force. In particular, I argue that the standpoint of what Smith calls “the impartial spectator” can both determine what is morally appropriate and inappropriate and provide the basis for normative reasons for action—including reasons to act on moral demands—to nearly all reason-responsive agents and, furthermore, that these reasons have the correct weight. The upshot of the proposed account is that it offers an interesting middle road out of a dilemma pertaining to the explanatory and normative dimensions of reasons for informed-desire Humean theorists. (shrink)

I defend the feasibility of a medical conscience in the following sense: a medical professional can object to the prevailing medical norms because they are incorrect as medical norms. In other words, I provide an account of conscientious objection that makes use of the idea that the conscience can issue true normative claims, but the claims in question are claims about medical norms rather than about general moral norms. I further argue that in order for this line of reasoning to (...) succeed, there needs to be an internal morality of medicine that determines what medical professionals ought to do qua medical professionals. I utilize a constructivist approach to the internal morality of medicine and argue that medical professionals can conscientiously object to providing treatment X, if providing treatment X is not in accordance with norms that would have been constructed, in light of the end of medicine, by the appropriate agents under the appropriate conditions. (shrink)

I build on Adam Smith’s account of the impartial spectator in The Theory of Moral Sentiments in order to offer a modest ideal observer theory of moral judgment that is adequate in the following sense: the account specifies the hypothetical conditions that guarantee the authoritativeness of an agent’s (or agents’) responses in constituting the standard in question, and, if an actual agent or an actual community of agents are not under those conditions, their responses are not authoritative in setting this (...) standard. However, in the account that I provide, the hypothetical conditions can themselves be constructed from the psychology and interactions of actual human beings. In other words, facts about the morally appropriate and inappropriate are determined from hypothetical conditions that––while agents in a given society might have yet to attain them––can be constructed from those agents’ shared experiences. Thus, the account offers both an attainable standard of moral judgment and a standard that can transcend the biases of the society which gave rise to it. I also defend the account against three challenges: (a) ideal observer theories do not offer the right kind of motivation to act on the verdicts of the ideal observer; (b) ideal observer theories cannot explain why the idealization in question is well-motivated and not objectionably ad hoc; (c) the standard used in ideal observer theories cannot be defended upon further reflection, because we would need a non-arbitrary, second-order standard to govern our reflection on the first-order standard of moral judgment. (shrink)

In The Sources of Normativity, Korsgaard argues for what can be called “The Universality of Humanity Claim” (UHC), according to which valuing humanity in one’s own person entails valuing it in that of others. However, Korsgaard’s reliance on the claim that reasons are essentially public in her attempt to demonstrate the truth of UHC has been repeatedly criticized. I offer a sentimentalist defense, based on Adam Smith’s moral philosophy, of a qualified, albeit adequate, version of UHC. In particular, valuing my (...) humanity, understood as (my awareness of) my perspective and the reasons determined from within it, entails valuing your humanity, understood as (your awareness of) your perspective and the reasons determined from within it. Given Korsgaard’s emphasis on the publicity of reasons in her argument for UHC, I also discuss the role of reasons in my account. I argue that the relative weights of (at least some of) an agent’s reasons are determined from within a shared evaluative point of view, namely, the standpoint of what Smith calls “the impartial spectator.” These reasons have normative authority over and constrain the agent’s private reasons, that is, those that are determined from within her own particular evaluative point of view. (shrink)

I demonstrate that analogies, both explicit and implicit, between Wittgenstein’s discussion of rituals, aesthetics, and psychoanalysis (and, indeed, his own philosophical methodology) suggest that he entertained the idea that Freud’s psychoanalytic project, when understood correctly—that is, as a descriptive project rather than an explanatory-hypothetical one—provides a “surveyable representation” (übersichtliche Darstellung) of certain psychological facts (as opposed to psychological concepts). The consequences of this account are that it offers an explanation of Wittgenstein’s admiration for and self-perceived affinity to Freud, as well (...) as of his apparent “know-nothing approach” to empirical psychology. (shrink)

In this paper, we illustrate some serious difficulties involved in conveying information about uncertain risks and securing informed consent for risky interventions in a clinical setting. We argue that in order to secure informed consent for a medical intervention, physicians often need to do more than report a bare, numerical probability value. When probabilities are given, securing informed consent generally requires communicating how probability expressions are to be interpreted and communicating something about the quality and quantity of the evidence for (...) the probabilities reported. Patients may also require guidance on how probability claims may or may not be relevant to their decisions, and physicians should be ready to help patients understand these issues. (shrink)

I demonstrate that analogies, both explicit and implicit, between Wittgenstein’s discussions of rituals, aesthetics, and aspect-perception, have important payoffs in terms of understanding his notion of a “surveyable representation” (übersichtliche Darstellung) as it applies to phenomena that are not exclusively grammatical in nature. In particular, I argue that a surveyable representation of certain anthropological and aesthetic facts allows us to see, qua form of aspect-perception, internal relations and formal connections, so that the inner nature of a ritual or the solution (...) of an aesthetic puzzle is exhibited. This particular form of seeing both explains why Wittgenstein thought that hypothetical explanations about the origins of a ritual are irrelevant to appreciating its meaning and elucidates his understanding of rituals, which involves seeing “internal relations” and “formal connections.” The upshots of the account for work in anthropology are discussed. (shrink)

I introduce a new distinction between two types of paternalism, which I call ‘internal’ and ‘external’ paternalism. The distinction pertains to the question of whether the paternalized subject’s current evaluative judgments are mistaken relative to a standard of correctness that is internal to her evaluative point of view—which includes her ‘true’ or ‘ideal’ self—as opposed to one that is wholly external. I argue that this distinction has important implications for (a) the distinction between weak and strong paternalism; (b) the distinction (...) between soft and hard paternalism; and (c) medical practice, where internal paternalism can, and probably often does, occur. (shrink)

Samuel Fleischacker’s Being Me Being You: Adam Smith & Empathy offers a new interpretation of Adam Smith’s conception of empathy—or ‘sympathy’, as Smith referred to the phenomenon in The Theory of...

Models are being used extensively for practicing and understanding scientific, engineering and mathematical subjects, but are rarely used as art analyzing tools, particularly, in learning environments. Contrarily, using art to explain mathematical ideas is not unprecedented. Strogatz (1988), for example, built a model based on Romeo and Juliet’s love story and used it to explain the idea of differential mathematics, and system dynamics. Artwork, specially written and plastic classics, is a fixed form of art. We frame them and put them (...) in a gallery, or a book (digital or physical). We don’t try to “fix” them or optimize their functioning, we analyze them to find meaning, intention, and patterns. In this article, we aim to show how, by building models combined with simple mathematical representations and analogies, it is possible to understand literary texts, from the prism of system and complexity theories, which emphasize the dynamic, non-linear, and non-reductionist aspects of the observed. We’ll demonstrate how modeling processes of three cultural assets, allow active correspondence with the original textual art, by treating them as systemic objects with interactions and dynamics. They will be analyzed while raising questions about the significance of modeling as a cognitive learning process. (shrink)

What is the relation between knowledge and orientation? How does being disoriented lead one to new knowledge or/and to being humbled about not knowing? How can not knowing aid in liberatory struggles, in alleviating oppression or even in being in community with like-minded people in an ethical manner? These are some of the questions that Ami Harbin’s work “Disorientation and Moral Life” brought up for me and which I would like to explore below, using prison abolition as one brief example.

ʻEdut be-Hosef -- Derekh ʻets ha-ḥayim -- Refuʼat ha-nefesh -- ha-Tapuaḥ.

This article takes a birds-eye view of equity in action, showcasing efforts to embed an equity lens in legislated and non-legislated policies and practices in three states. Authors from California, Colorado, and Minnesota provide state-specific examples of how equity has been advanced and operationalized in state-level governance. The article describes progress and lessons learned and offers guidance to others.

This paper is motivated by the increasing popularity of efficient designs for stated choice experiments. The objective in efficient designs is to create a stated choice experiment that minimizes the standard errors of the estimated parameters. In order to do so, such designs require specifying prior values for the parameters to be estimated. While there is significant literature demonstrating the efficiency improvements of employing efficient designs, the bulk of the literature tests conditions where the priors used to generate the efficient (...) design are assumed to be accurate. However, there is substantially less literature that compares how different design types perform under varying degree of error of the prior. The literature that does exist assumes small fractions are used, which is in contrast to computer-aided surveys that readily allow for large fractions. Further, the results in the literature are abstract in that there is no reference point to provide clear insight on the magnitude of any issue. Our objective is to analyze the robustness of different designs within a typical stated choice experiment context of a trade-off between price and quality. We use as an example transportation mode choice, where the key parameter to estimate is the value of time. Within this context, we test many designs to examine how robust efficient designs are against a misspecification of the prior parameters. The simple mode choice setting allows for insightful visualizations of the designs themselves and also an interpretable reference point for the range in which each design is robust. Not surprisingly, the D-efficient design is most efficient in the region where the true population VOT is near the prior used to generate the design: the prior is $20/h and the efficient range is $10–$30/h. However, the D-efficient design quickly becomes the most inefficient outside of this range, and the estimation significantly degrades above $50/h. The orthogonal and random designs are robust for a much larger range of VOT. The robustness of Bayesian efficient designs varies depending on the variance that the prior assumes. Implementing two-stage designs that first use a small sample to estimate priors are also not robust relative to uninformative designs. Arguably, the random design performs as well as any design, and it will perform even better if data cleaning is done to remove choice tasks where one alternative dominates the other. (shrink)

In the latter part of the fifteenth century, a Jewish translator, working together with a Slavic amanuensis, translated into the East Slavic language of the Grand Duchy of Lithuania three medieval Hebrew translations of Arabic philosophical texts: the Logical Terminology, a short work on logic attributed to Maimonides (but probably by a different medieval Jewish author); and two sections of the Muslim theologian Al-Ghazali's famous Intentions of the Philosophers. Highlighting the unexpected role played by Jewish translators as agents of cultural (...) transmission in the heady messianic atmosphere leading up to the year 1492, these texts drew the attention of the Orthodox Church authorities as being in the possession of the enlightened heretical sect known as the Judaizers, which had emerged in Novgorod and spread to Moscow. Reflecting three and even four layers of translation, Prof. Moshe Taube's new triple-language critical edition of the Logika of the Judaizers displays the Slavic texts alongside the Hebrew translations on which they are based and accompanies them with a modern English translation. In his comprehensive introduction and commentary, Taube surveys earlier scholarly efforts to identify the provenance and purport of the translations, discusses the linguistic and textological issues raised by these early Ruthenian texts, puts forward the likely dissimilar motivations of the Jewish translator and the Christians who commissioned the work, and reveals the translator's probable identity. The present publication, a long-awaited desideratum, will be of interest not only to historians of the Great Duchy of Lithuania and of the principality of Muscovy, but also to scholars of Jewish history and of the history of philosophy and science, as well as to linguists studying the history of the Belorussian, Ukrainian and Russian languages. (shrink)

Hillel Zeitlin was a noted journalist, poet, liturgist, publicist, neo-Hasidic historian and phenomenologist of the Jewish religious experience. This study deals with his early years in his White Russian birthplace, his itinerancy in the Pale of Settlement in the 1890's, his entry into Hebrew belles-lettres at the turn of the century, and his subsequent participation in the Hebrew and Yiddish press. ;We examine not only Zeitlin's intellectual biography, but three specific areas of interest during this developmental period: theodicy, the history (...) of Hasidic doctrine and the phenomenology of Jewish religious experience. Theodicy is the subject of his first published work, a compendium HaTov VehaRa {Good and Evil, 1898}. This work was followed by monographs on Spinoza and Neitzsche in 1900 and 1905, respectively. ;Zeitlin's move to Vilna in 1904, via Homel and Roslavl, provided him with his first journalistic platform in Ben-Zion Katz's Hebrew daily HaZeman. During this period Zeitlin was an advocate of Israel Zangwill's territorialism, a product of a schism within the World Zionist Organization over the Uganda proposal of 1903. These events were played out on the background of antisemitic pogroms in 1903, and in the wake of the aborted Russian Revolution of 1905. Zeitlin emerged as a staunch critic of Jewish participation in revolutionary movements, a characteristic of his thought throughout his journalistic career. In Vilna Zeitlin debuted as a Yiddish writer. ;In 1907 Zeitlin moved to Warsaw, where he participated in the founding of two major Yiddish dailies, the Haynt and Der Moment. He would remain in Warsaw till his murder at the hands of the Nazis and their accomplices during the liquidation of the Warsaw Ghetto in 1942. In Warsaw Zeitlin embarked on his exploration into his life-long interest in Hasidic doctrine. In 1910 he published monographs on Hasidism, the Ba'al Shem Tov, and Rabbi Nahman of Brazlav. In the same year Zeitlin published a lengthy prose poem, Zimaon {Thirst}, that articulated an agenda for religious search that would prompt an unfinished phenomenology of Jewish religious experience, B'hevyon HaNeshama {In the Hiding Place of the Soul, 1913}, and a dream diary depicting his spiritual transformation during the First World War, Al Gvul Shnei Olamot {On the Border of Two Worlds, 1919}. . . . UMI. (shrink)

Abraham Abulafia, the founder of the ecstatic Kabbalah, exposed a mysticism that includes a deep interest in language as a universe in itself, to be studied as the philosophers study nature, in order to attain higher knowledge than natural science and speculative philosophy. The status of Hebrew as the natural, intellectual, and primordial language is discussed against the background of the medieval speculations regarding this topic. Abulafia proposed an elaborate hermeneutical system, unique in the whole Kabbalistic literature, for both its (...) systematic exposition and the eccentric exegetical devices it describes. Various versions of this sevenfold system occur in several manuscripts that are collected and analyzed here in detail for the first time. Torah was regarded by Abulafia as the most important text, reflecting the constitution of the intellectual world and being identical with the Active intellect and even to God Himself. On the other hand, Torah was interpreted in Abulafia's Kabbalah as an allegory to the psychological processes of the mystic, an approach different from the regular Kabbalistic interpretation of this text as a symbolic corpus reflecting the divine intrasefirotic life. (shrink)

[Rabbi Moshe ben Maimon's “Eight chapters on the human soul and moral action”].

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that (...) draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

In his paper ‘The truth behind conscientious objection’ Nir Ben-Moshe develops a new approach aimed at justifying conscientious objection without relying on respect of moral integrity of the conscientious objector or tolerance towards her moral views.1 According to Ben-Moshe, the problem with justifications of CO based on moral integrity and tolerance is that ‘truth of conscience’s claims is irrelevant to their justification’. He argues, to the contrary, that whether the claims of the conscientious objector are true or false (...) makes a difference in assessing whether their objection is justifiable or not. He goes on explaining that someone’s CO can be justified if it can be proved that ‘conscience can express true moral claims’. Ben-Moshe then proceeds to explain how one can determine true moral claims. He develops an account of conscience that is modelled on that of Adam Smith. In particular, he uses the idea of the ‘impartial spectator’ to show how a true claim of conscience can emerge after careful thinking from the point of view of an impartial perspective. So, if the healthcare practitioner wants to object to a certain medical procedure after considering the issue at hand from the moral standpoint of such impartial spectator, then her claims of conscience are true (or …. (shrink)

In his recent article, Ben-Moshe offers an account of conscientious objection in terms of the truth of the underlying moral objections, as judged by the standards of an impartial spectator. He seems to advocate for the view that having a valid moral objection to X is the sole criteria for the instantiation of a right to conscientiously object to X, and seems indifferent to the moral status of the prevailing moral attitudes. I argue that the moral status of the (...) prevailing moral attitudes is relevant, and that a good faith disagreement between those who condone the relevant act and those who object to it is a criterion for CO. In this light, I suggest that CO is a sociopolitical device for managing differing ethical perspectives, particularly in the context of collective moral change. Thus, it is misguided to equate having a valid moral objection with the recognition of a CO. (shrink)

Claims concerning processes, claims of the form “xisφing”, have been the subject of renewed interest in recent years in the philosophy of action. However, this interest has frequently limited itself to noting certain formal features such claims have, and has not extended to a discussion of when they are true. This article argues that a claim of the form “xisφing” is true when what is happening withxis such that, if it is not interrupted, a φing will occur. It then applies (...) itself more directly to the case of action, arguing that when “xisφing” describesx's intentional action, it is true iffxis acting from a method she knows to be sufficient to φ, in the sense that if she is not interrupted in carrying out this method, she will φ. I use this criterion to argue that the carbon‐copier example Donald Davidson gives in “Intending” fails to refute Elizabeth Anscombe's claim that an agent who is φing intentionally knows that she is, because the agent in Davidson's example is not intentionally making the copies. (shrink)