Something is not working in ethics consultation: in certain situations, relationships within families and with careproviders and surrogates have become so emotionally charged and destabilized that attention is dominated by conflict and misunderstanding, foreshadowing a loss of dignity and hope. In a compelling, urgent article, informed by events in the Schiavo case, with examples from the literature on theory, practice, and outcomes, Caplan and Bergman address this situation: redirecting our attention to what they see as “a lack of effective mechanisms” (...) for dealing with a “painful class of disputes in which families disagree with one another, or with doctors, about the care of those who cannot communicate.”1 It is no small matter that many of these cases are situated in the immediate, intense environment of end-of-life decision making. -/- How might we understand these encounters, and their limits? What can we hope? Following the tack of Caplan and Bergman, I will extend the discussion of the complex relationships between patients, families, surrogates, and physicians, and “hope for consensual resolution,” offering a somewhat different account of what is lacking. While Caplan and Bergman foreground an apparent irreconcilability of appeals to competing biomedical principles as what is lacking, I will suggest that a “salient characteristic” among participants, what Caplan and Bergman identify as a common concern for the patient’s best interests, may be far less stable and more complex, and thereby less directive, than first imagined. When Caplan and Bergman sketch their expectations for mediation and for mediators, they are right in noting that abstract principles “articulated as dispositive by designated ‘experts’ fail to capture, and arguably respect, the unique and complex nature of each such individual decision-making process,” and that “patients and families are at the extreme end of a power imbalance.” It is less clear that their descriptions — or their hope for mediation — capture this enormous challenge. (shrink)
Investigations and commentaries on domestic violence and its sequelae have been featured in several recent medical journals. For discussion purposes, I will highlight aspects from three of them. According to Megan Bair-Merritt and her colleagues, in a recent issue of the Journal of Pediatrics, screening for domestic abuse in a pediatric practice can uncover cases that otherwise might not be identified.1 Of the women who brought their children to a pediatric clinic at Johns Hopkins Children’s Center, 23 percent disclosed that (...) they had been victims of either emotional or physical abuse; 57 percent of the abused women indicated that at least one child had been exposed to this violent interaction. (shrink)
What is best for the hospitalized patient? How do we increase the prospects that a patient will receive the best care a hospital can provide, and how is this accomplished? It has been argued that what is best for the patient is to be in the care of highly functioning collaborative teams, teams with certain unique qualities, teams that have esprit de corps. But how do we get there? In furtherance of this discussion, the author, in a Quintilian-like spirit, deliberates (...) about "necessity" and "possibility" in what is best for the hospitalized patient and the challenges these teams must navigate: responsibility, accountability, team relationships, leadership, moral distress, dissent, and personal and professional risk. (shrink)
In response to the article by Scofield,1 I consider the that, how, and why of ethics consultation, moral expertise, and the rules of the game. The question still to be engaged is, how does all of this work out for patients and families?
Social media challenge--or have already redefined--conventional boundaries of public and private, personal and professional, friendship, and social relations generally. Here, I consider how these developments may affect professionalism, the physician-patient relationship, and our cultural experiences in a wholly different and unexpected way.
Recently some philosophers have proposed that the later philosophy of Wittgenstein tends towards idealism, or even solipsism. The solipsism is said to be of a peculiar kind. It is characterized as a ‘collective’ or ‘aggregative’ solipsism. The solipsism or idealism is also said to be ‘transcendental’. In the first part of this paper I will be examining a recent essay by Professor Bernard Williams, in which he presents what he takes to be the grounds for such an interpretation of Wittgenstein. (...) After that I will try to offer convincing evidence that no tendency towards any form of idealism is to be found in Wittgenstein's later philosophy. (shrink)
Recent work in the philosophy of religion has broken through disciplinary boundaries and ventured into new areas of inquiry. Examining aspects of the rationality of faith or bringing philosophical techniques to bear on particular religious texts or doctrines, this collection deepens our understanding of the connections between faith and reason.
Perhaps the most remarkable event in social thought of the last twenty years has been the resurgence of various strands of individualism as political doctrines. The term ‘individualism’ is a kind of general rubric that encompasses elements of nineteenth century classical liberalism, laissez-faire economics, the theory of the minimal state, and an extreme mutation out of this intellectual gene pool, anarcho-capitalism. The term libertarianism itself is applied indiscriminately to all of those doctrines. It has no precise meaning, except that in (...) a general sort of way libertarianism describes a more rigorous commitment to moral and economic individualism and a more ideological approach to social affairs than conventional liberalism. I suspect that its current usage largely reflects the fact that the word with the better historical pedigree, liberalism, has been associated, in America especially, with economic doctrines that are alien to the individualist tradition. (shrink)
In this book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: what is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Daniels' theory has implications for national and global health policy: can we meet health needs fairly in ageing societies? Or protect health in the workplace while respecting individual liberty? (...) Or meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? Just Health: Meeting Health Needs Fairly explores the many ways that social justice is good for the health of populations in developed and developing countries. (shrink)
This paper criticizes the conception of applied ethics as the top-down application of a theory to practical issues. It is argued that a theory such as utilitarianism cannot override our intuitive moral perceptions. We cannot be radically mistaken about the kinds of considerations which count as practical reasons, and it is the task of theoretical ethics to articulate the basic kinds of considerations which we appeal to in practical discussions. Dworkin's model of doing ethics ‘from the inside out’ is used (...) to illustrate the appropriate role for theory in a broader sense. In conclusion, some sceptical questions are raised about how far theoretical ethics can contribute to public policy, especially if this requires a consensus. (shrink)
Unified theory of cognition -- Psychological laws -- Foundations of person cognition -- Functional theory of attitudes -- Attitude integration theories -- Comparisons of attitude theories -- Moral algebra -- Group dynamics -- Cognitive theory of judgment-decision -- General theory -- Experimental methods -- Unified science of psychology.
How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of (...) health care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)
Of all the major philosophical works, Kant's Critique of Pure Reason is one of the most rewarding, yet one of the most difficult. Norman Kemp Smith's Commentary elucidates not only textural questions and minor issues, but also the central problems which arise, he contends, from the conflicting tendencies of Kant's own thinking. Kemp Smith's Commentary continues to be in demand with Kant scholars, and it is being reissued here with a new introduction by Sebastian Gardner to set it in (...) its contemporary context. (shrink)
The philosophy of memory has been largely dominated by what could be called ‘the representative theory of memory’. In trying to give an account of ‘what goes on in one's mind’ when one remembers something, or of what ‘the mental content of remembering’ consists, philosophers have usually insisted that there must be some sort of mental image, picture, or copy of what is remembered. Aristotle said that there must be ‘something like a picture or impression’; William James thought that there (...) must be in the mind 'an image or copy’ of the original event; Russell said that ‘Memory demands an image’. In addition to the image or copy a variety of other mental phenomena have been thought to be necessary. In order for a memory image to be distinguished from an expectation image, the former must be accompanied by ‘a feeling of pastness’. One has confidence that the image is of something that actually occurred because the image is attended by ‘a feeling of familiarity’. And in order that you may be sure that the past event not merely occurred but that you witnessed it, your image of the event must be presented to you with a feeling of ‘warmth and intimacy’. When all the required phenomena are put together, the mental content of remembering turns out to be, as William James says, ‘a very complex representation’. (shrink)
Wittgenstein was one of the most powerful influences on contemporary philosophy, yet he shunned publicity and was essentially a private man. This remarkable, vivid, personal memoir is written by one of his friends, the eminent philosopher Norman Malcolm. Reissued in paperback, this edition includes the complete text of fifty-seven letters which Wittgenstein wrote to Malcolm over a period of eleven years. Also included is a concise biographical sketch by another of Wittgenstein's philosopher friends, Georg Henrik von Wright. 'A reader (...) does not need to care about philosophy to be excited by Mr Malcolm's book; it is about Wittgenstein as a man, and its interest is human interest'. (shrink)
In April 1939, G. E. Moore read a paper to the Cambridge University Moral Science Club entitled ‘Certainty’. In it, amongst other things, Moore made the claims that: the phrase ‘it is certain’ could be used with sense-experience-statements, such as ‘I have a pain’, to make statements such as ‘It is certain that I have a pain’; and that sense-experience-statements can be said to be certain in the same sense as some material-thing-statements can be — namely in the sense that (...) they can be safely counted on. When Moore later read his paper to Wittgenstein, Wittgenstein took violent exception to it, and the two entered into a heated exchange. The only known notes of this exchange are a previously unpublished verbatim record of part of it, taken by Norman Malcolm. This paper is an edition of Malcolm’s notes. These notes are valuable for both philosophical and scholarly reasons. They give us a glimpse of a sustained exchange between Wittgenstein and a real-life interlocutor; they contain a defence by Wittgenstein of the idea that a word’s use can illuminate its meaning; and they provide evidence of Wittgenstein’s philosophical engagement with the topic of certainty, and with Moore’s thought on it, long before he began to write the notes which make up On Certainty, in 1949. (shrink)
This monograph treats the important topic of the epistemology of diagrams in Euclidean geometry. Norman argues that diagrams play a genuine justificatory role in traditional Euclidean arguments, and he aims to account for these roles from a modified Kantian perspective. Norman considers himself a semi-Kantian in the following broad sense: he believes that Kant was right that ostensive constructions are necessary in order to follow traditional Euclidean proofs, but he wants to avoid appealing to Kantian a priori intuition (...) as the epistemological background for these constructions.Norman's main argument is limited to the thesis that certain Euclidean arguments—in particular, that of Proposition 1.32, the internal-angle-sum theorem—require inferences from diagrams. Interestingly, Norman is not committed to the view that these arguments are proofs. This becomes clear only quite late in the book, when he distinguishes argument from proofs, remarking that the argument he has been focusing on is not rigorous, and so is not a proof. Norman does not, however, explicitly classify all Euclidean arguments as non-proofs. His view is that diagrammatic reasoning can in principle feature in rigorous proofs, but he is not committed to the thesis that any particular argument, Euclidean or otherwise, provides an example of this. Rather than proofs in particular, Norman is more interested in the general issue of justification in mathematics.The argument has three components. First, Norman argues against competing accounts of Euclidean arguments such as empiricism, and ‘Leibnizianism’—the view that diagrams play only a heuristic role. Second, he provides a more direct, or positive, argument that the way we actually follow the standard argument for 1.32 does appeal to the diagram. This is an appeal to the phenomenology of following the argument. Third, he articulates and defends his semi-Kantian position against some objections.The book has a very careful and …. (shrink)
Despite the emphasis on the state in the history of political philosophy, the twentieth century has been characterized by a remarkable lack of philosophical reflection on the concept. Until recently analytical philosophy had eschewed those evaluative arguments about political obligation and the limits of state authority that were typical of political theory in the past in favour of the explication of the meaning of the concept. However, even here the results have been disappointing. Logical Positivist attempts to locate some unique (...) empirical phenomenon which the word state described proved unsuccessful, and indeed led to the odd conclusion that there was nothing about the state that distinguished it from some other social institutions. For example, its coercive power was said to be not unique: in some circumstances trade unions and Churches exercised similar power over their members. Ordinary language philosophers were far more interested in the complexities that surround words such as law, authority and power than in the state. In all this there was perhaps the fear that to concentrate attention on the state was implicitly to give credence to the discredited doctrine that it stood for some metaphysical entity; propositions about which could not be translated into propositions about the actions of individuals , and which represented higher values than those of ordinary human agents. (shrink)
Ludwig Wittgenstein, who died in Cambridge in 1951, is one of the most powerful influences on contemporary philosophy, yet he shunned publicity and was essentially a private man. His friend Norman Malcolm (himself an eminent philosopher) wrote this remarkably vivid personal memoir ofWittgenstein, which was published in 1958 and was immediately recognized as a moving and truthful portrait of this gifted, difficult man.This edition includes also the complete text of the fifty-seven letters which Wittgenstein wrote to Malcolm over a (...) period of eleven years. Apart from the quotations in the Memoir these letters are previously unpublished. They reveal how much friendships mattered to Wittgenstein, and how concerned hewas for the health and well-being of his friends. His human qualities become evident; he advises, warns, jokes. and is grateful and affectionate.The volume also features a concise biographical sketch by another leading philosopher who was a friend of Wittgenstein, Georg Henrik von Wright.Much has been published about Wittgenstein since his death, but nothing brings us closer to the man himself than this modest classic of philosophical biography. (shrink)
Psychological egoism is, I suppose, regarded by most philosophers as one of the more simple-minded fallacies in the history of philosophy, and dangerous and seductive too, contriving as it does to combine cynicism about human ideals and a vague sense of scientific method, both of which make the ordinary reader feel sophisticated, with conceptual confusion, which he cannot resist. For all of these reasons it springs eternal, in one form or another, in the breasts of first-year students, and offers excellent (...) material for their philosophy instructors, who like nothing better than an edifice of sturdy appearance but with rotten foundations on which to display their skill as demolition experts. (shrink)
Norman Kretzmann expounds and criticizes Aquinas's theology of creation, which is `natural' in that Aquinas developed it without depending on the data of Scripture. Because of the special importance of intellective creatures like us, Aquinas's account of the divine origin and organization of the universe includes essential ingredients of his philosophy of mind. The Metaphysics of Creation is a continuation of the project Kretzmann began in The Metaphysics of Theism; as before, he not only explains Aquinas's natural theology, but (...) advocates it as the best available to us. (shrink)
Norman Kemp Smith's The Philosophy of David Hume continues to be unsurpassed in its comprehensive coverage of the ideas and issues of Hume's Treatise. Now, after years of waiting, this currently out-of-print and highly sought-after classic is being re-issued. This ground-breaking book has long been regarded as a classic study by scholars in the field, yet a new introduction by Don Garrett places the book in its contemporary context, showing Humes's continuing importance in the field.
The rapidly increasing numbers of elderly people in our society have raised some important moral questions: How should we distribute social resources among different age groups? What does justice require from both the young and the old? In this book, Norman Daniels offers the first systematic philosophical discussion of these urgent questions, advocating what he calls a "lifespan" approach to the problem: Since, as they age, people pass through a variety of institutions, the challenge of caring for the elderly (...) becomes the prudent allocation of public resources among the various stages of people's lives. Using this philosophical approach, Daniels addresses specific public policy issues such as the allocation of medical funds, the adequacy of long-term care, current Medicare cost-containment measures, and the equitable distribution of income support over the lifespan and between generations. (shrink)
First published in 1962, this book provides a systematic account of the development of Plato’s theory of knowledge. Beginning with a consideration of the Socratic and other influences which determined the form in which the problem of knowledge first presented itself to Plato, the author then works through the dialogues from the Meno to the Laws and examines in detail Plato’s progressive attempts to solve the problem.
Why do humans reason? Many animals draw inferences, but reasoning—the tendency to produce and respond to reason-giving performances—is biologically unusual, and demands evolutionary explanation. Mercier and Sperber advance our understanding of reason’s adaptive function with their argumentative theory of reason. On this account, the “function of reason is argumentative… to devise and evaluate arguments intended to persuade.” ATR, they argue, helps to explain several well-known cognitive biases. In this paper, I develop a neighboring hypothesis called the intention alignment model and (...) contrast it with ATR. I conjecture that reasoning evolved primarily because it helped social hominins more readily and fully align their intentions. We use reasons to advance various proximal ends, but in the main, we do it to overwrite the beliefs and desires of others: to get others to think like us. Reason afforded our ancestors a powerful way to build and maintain the shared outlooks necessary for a highly collaborative existence. Yes, we sometimes argue so as to gain argumentative advantage over others, or otherwise advantage ourselves at the expense of those we argue with, but more often, we reason in ways that are mutually advantageous. In fact, there are excellent reasons for thinking this must be so. IAM, I suggest, neatly explains the available evidence, while also providing a more coherent account of reason’s origins. (shrink)
Can war ever be justified? Why is it wrong to kill? In this new book Richard Norman looks at these and other related questions, and thereby examines the possibility and nature of rational moral argument. Practical examples, such as the Gulf War and the Falklands War, are used to show that, whilst moral philosophy can offer no easy answers, it is a worthwhile enterprise which sheds light on many pressing contemporary problems. A combination of lucid exposition and original argument (...) makes this the ideal introduction to both the particular debate about the ethics of killing and war, and also to the fundamental issues of moral philosophy itself. (shrink)
A Bayesian network (BN) is a graphical model of uncertainty that is especially well suited to legal arguments. It enables us to visualize and model dependencies between different hypotheses and pieces of evidence and to calculate the revised probability beliefs about all uncertain factors when any piece of new evidence is presented. Although BNs have been widely discussed and recently used in the context of legal arguments, there is no systematic, repeatable method for modeling legal arguments as BNs. Hence, where (...) BNs have been used in the legal context, they are presented as completed pieces of work, with no insights into the reasoning and working that must have gone into their construction. This means the process of building BNs for legal arguments is ad hoc, with little possibility for learning and process improvement. This article directly addresses this problem by describing a method for building useful legal arguments in a consistent and repeatable way. The method complements and extends recent work by Hepler, Dawid, and Leucari (2007) on object-oriented BNs for complex legal arguments and is based on the recognition that such arguments can be built up from a small number of basic causal structures (referred to as idioms). We present a number of examples that demonstrate the practicality and usefulness of the method. (shrink)
We argue performance in the serial reaction time task is associated with gradations of awareness that provide examples of fringe consciousness [Mangan, B. . Taking phenomenology seriously: the “fringe” and its implications for cognitive research. Consciousness and Cognition, 2, 89–108, Mangan, B. . The conscious “fringe”: Bringing William James up to date. In B. J. Baars, W. P. Banks & J. B. Newman , Essential sources in the scientific study of consciousness . Cambridge, MA: The MIT Press.], and address limitations (...) of the traditional SRT procedure, including criticism of exclusion generation tasks. Two experiments are conducted with a modified SRT procedure where irrelevant stimulus attributes obscure the sequence rule. Our modified paradigm, which includes a novel exclusion task, makes it easier to demonstrate a previously controversial influence of response stimulus interval on awareness. It also allows identification of participants showing fringe consciousness rather than explicit sequence knowledge, as reflected by dissociations between different awareness measures. The NEO-PI-R variable Openness to Feelings influenced the diversity of subjective feelings reported during two awareness measures, but not the degree of learning and awareness as previously found with traditional SRT tasks [Norman, E., Price, M. C., & Duff, S. C. . Fringe consciousness in sequence learning: the influence of individual differences. Consciousness and Cognition, 15, 723–760.]. This suggests possible distinctions between two components of fringe consciousness. (shrink)
The Concept of Physical Law is an original and creative defense of the Regularity theory of physical law, the concept that physical laws are nothing more than descriptions of whatever universal truths happen to be instanced in nature. Professor Swartz clearly identifies and analyzes the arguments and intuitions of the opposing Necessitarian theory, and argues that the standard objection to the Regularity theory turns on a mistaken view of what Regularists mean by 'physical impossibility'; that it is impossible to construct (...) an empirical test that can distinguish between events Necessitarians call 'mere accidents' and those they call 'nornologically necessary', and that the Necessitarian theory cannot account fot human beings' free wills. Other topics in this important work include: the distinction between instrumental scientific laws and true physical laws; the distinction between failure and doom; potentialities; miracles and marvels; predictability and uniformity; statistical and numerical laws; and necessity-in-praxis. (shrink)
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