Intuition in medical and moral reasoning -- Moral intuitionism -- The place of Aristotelian phronesis in clinical reasoning -- Aristotle's practical syllogism: accounting for the individual through a theory of action and cognition -- Individual and statistical physiognomy: the art and science of making the invisible visible -- Clinical intuition versus statistical reasoning -- Contingency and correlation: the significance of modeling clinical reasoning on statistics -- Abduction: the intuitive support of clinical induction -- Conclusion: medical ethics beyond ontology.

Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is demonstrated through (...) analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine’s epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi’s theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine. (shrink)

I will apply dietetic measures for the benefit of the sick according to my ability and judgment. I will keep them from harm and injustice. The Hippocratic Oath formulates the ethical principle of medical beneficence and its negative formulation non-maleficence. It relates medical ethics to the traditional end of medicine, that is, to heal, or to make whole. First and foremost, the duty of the physician is to heal, and if this is not possible at least not to harm. This (...) ethical principle helped to establish the necessary trust between physician and patient in the pre-modern era when most of medicine was nothing more than a set of placebos (Shapiro 1960). Beginning in the seventeenth-century, Western .. (shrink)

This article applies the anthropological concept of liminality to reconceptualize palliative care ethics. Liminality possesses both spatial and temporal dimensions. Both these aspects are analyzed to provide insight into the intersubjective relationship between patient and caregiver in the context of palliative care. Aristotelian practical wisdom, or phronesis, is considered to be the appropriate model for palliative care ethics, provided it is able to account for liminality. Moreover, this article argues for the importance of liminality for providing an ethical structure that (...) grounds the doctrine of double effect and overcomes the impasse of phronesis in the treatment of the terminally ill. (shrink)

Over the past several decades the ‘affective revolution’ in cognitive psychology has emphasized the critical role affect and emotion play in human decision-making. Drawing on this affective literature, various commentators have recently proposed strategies for managing therapeutic expectation that use contextual, symbolic, or emotive interventions in the consent process to convey information or enhance comprehension. In this paper, we examine whether affective consent interventions that target affect and emotion can be reconciled with widely accepted standards for autonomous action. More specifically, (...) the ethics of affective consent interventions is assessed in terms of key elements of autonomy, comprehension and voluntariness. While there may appear to be a moral obligation to manage the affective environment to ensure valid informed consent, in circumstances where volunteers may be prone to problematic therapeutic expectancy, this moral obligation needs to be weighed against the potential risks of human instrumentalization. At this point in time we do not have enough information to be able to justify clearly the programmatic manipulation of human subjects' affective states. The lack of knowledge about affective interventions requires corresponding caution in its ethical justification. (shrink)

Neil Levy (2011) argues that neuroethics as a new discipline distinct from bioethics provides methodological tools to evaluate the validity of our moral intuitions. This naturalistic claim that mor...

The title of my paper, “Affecting the Body and Transforming Desire,” (Braude 2012a) is inspired from Plato’s Symposium, where the physician Eryximachus presents a purely neurophysiological discourse on love. James Giordano’s and Gerrit Glas’s commentaries on my paper have the timbre of a contemporary symposium, in this instance to discern the nature of suffering. Thus, I take Giordano’s and Glas’s commentaries to be generally sympathetic to my offering, although providing further critical insights that deepen the multidimensional understanding of suffering (...) and the correct ethical and medical response. From different perspectives both commentators zone in on one central aspect of my analysis, that is .. (shrink)

The book starts with a scandal, that is, Socrates’s mortality as entailed in the Aristotelian syllogism,All men are mortal,Socrates is a man,Therefore, Socrates is mortal. The scandal pertains to the deduction of Socrates’s death from the logical connections of premises, which, according to Braude, renders it “meaningless.” But, what does this scandal have to do with a philosophical defense of intuition in medicine? For Braude, the scandal is emblematic of a crisis in medicine and philosophy—a crisis in which (...) human mortality is severed from its morality. Braude articulates the crisis with the following question:Where, therefore, between the cracks of universal logic and reifying medicine is there a place for the individual patient, for a response to the cry of pain to which medicine responds, or to the voice of injustice upon which moral philosophy is founded? For him, intuition provides a means to answer the question and thereby to resolve the crisis. It serves as “a bridge be .. (shrink)

This book addresses the perennial question: What is justice?

This work was the first sustained philosophical study of psychic phenomena to follow C.D. Broad's LECTURES ON PSYCHICAL RESEARCH, written nearly twenty years ...

Keith Augustine’s critical evaluation of the essay contest sponsored by the Bigelow Institute of Consciousness Studies (BICS) is an interesting but problematic review. It mixes reasonable and detailed criticisms of the contest and many of the winning essays with a disappointing reliance on some of the most trite and superficial criticisms of parapsychological research. Ironically, Augustine criticizes the winning essays for using straw-man arguments and cherry-picked evidence even though many of his own arguments commit these same errors.

INTRODUCTION Back in the good old days of philosophy — say, around 400 BC, philosophers played a rather prominent role in the community at large. ...

In his study “Facial Expression Theory from Romanticism to the Present,” Alan Richardson reminds us that “successful social communication” would be greatly impoverished if “we did not have a reasonably reliable and speedy, and therefore largely unconscious, cognitive mechanism for gauging the emotions and intentions of others through reading their faces.”1 This innately sympathetic capacity for “mind-reading”—that is, for interpreting others’ facial expressions as indicative of internal states of mind—is historically termed “Theory of Mind” (ToM) by cognitive psychologists, philosophers, and (...) primatologists.2Notably, discussion of ToM has mostly revolved around the question of successful or failed empathy, with .. (shrink)

This study focuses on how Israeli Arab citizens perceive their media representations on Israeli television and why they consume television broadcasts even though they are marked mostly by negative representations. A new concept – “Communication Boundary Situation” – a development of Jaspers’ “Boundary Situation” theory, is the theoretical framework for the article. The empirical data was collected by conducting semi-structured in-depth interviews. The findings point to different attitudes among the interviewees towards their representation in various television genres, in particular, in (...) advertising as compared to satire and drama. The suggested theoretical framework and its empirical implementation might be useful in examining how various minorities perceive their media representations in other countries. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Multiple Personality and Moral ResponsibilityStephen E. Braude (bio)AbstractThe philosophical literature on multiple personality has focused primarily on problems about personal identity and psychological explanation. But multiple personality and other dissociative phenomena raise equally important and even more urgent questions about moral responsibility, in particular: In what respect(s) and to what extent should a multiple be held responsible for the actions of his/her alternate personalities? Cases of dreaming help (...) illustrate why attributions of responsibility in cases of dissociation do not turn on putative changes in identity, as some have supposed. Instead, it is argued that traditional criteria of rationality and behavioral control apply also to cases of dissociation. It is noted, however, that one can distinguish different kinds of responsibility in cases of dissociation, and that one is responsible for one’s dreams in a different sense from that in which one is responsible for actions one can control and evaluate. It is also argued that in cases of multiple personality it is important to distinguish control over switching of personalities from an alter’s control over its own behavior. Moreover, the author considers reasons for thinking that amnesia is less relevant to attributions of responsibility than many have supposed.Keywordsdissociation, dreaming, rationality, amnesiaIntroductionThe philosophical literature on MPD/DID 1 has focused primarily on problems about personhood, personal identity, and the nature of psychological explanation. Presumably, that is because multiples appear to be (or to harbor) more than one person or more than one distinct moral or prudential agent. But philosophers have had almost nothing to say about problems of responsibility in these cases—in particular, the question: In what respect(s) and to what extent should a multiple be held responsible for the actions of his/her alternate personalities (or alters)?Unlike questions about personhood and identity, this question is not simply an abstract matter that we may ponder at our leisure. Clinicians treating multiples must decide whether it is appropriate—or even just therapeutically beneficial—to hold their patients (or specific alters) responsible for behaviors which they seem unable to control or remember. Similarly, and with increasing frequency, our courts must decide whether a defendant claiming to be a multiple may be held guilty for the actions of one or more alters. In fact, the legal issues can be quite dramatic, and even bizarre. Consider: What sort of individual is standing trial? An alter or the multiple as a whole? Should courts accept the claim that the subject being questioned on the stand is not the same as the subject who committed the crime? If so, other questions come immediately to mind. For example, would it be appropriate for each alter of a criminal defendant to have separate legal council?Undoubtedly, some will have trouble taking that last question seriously. But no matter how [End Page 37] clear its solution may appear to one’s moral or legal intuitions, those intuitions are seldom as straightforward as they seem. Indeed, one cannot explain or defend them without taking a stand, at least provisionally, on a wide range of thorny philosophical problems. Moreover, the aforementioned questions are merely the tip of the iceberg, and our answers to them have implications extending beyond the courtroom. For example, with regard to forensic contexts Slovenko (1991) asks,Should a search or arrest warrant be issued for each personality? Must a Miranda warning be given to each personality of a suspect with MPD? May the other personalities exclude evidence on the ground that they were not properly read their rights at the time of the arrest? Would each one of the personalities have to waive his or her rights, or would one waiver be sufficient? Does the doctrine of double jeopardy bar the trial of a personality when another has been put to trial? Must each personality testifying at trial be sworn in and administered the oath?(22, 25)These questions have obvious analogues in clinical situations, and also in personal contexts, say, between friends or members of a family, one of whom is a multiple. For example, to what extent should a DID patient be held responsible for the sociopathic (or simply counter-therapeutic) behavior of... (shrink)

The philosophical literature on multiple personality has focused primarily on problems about personal identity and psychological explanation. But multiple personality and other dissociative phenomena raise equally important and even more urgent questions about moral responsibility, in particular: In what respect(s) and to what extent should a multiple be held responsible for the actions of his/her alternate personalities? Cases of dreaming help illustrate why attributions of responsibility in cases of dissociation do not turn on putative changes in identity, as some have (...) supposed. Instead, it is argued that traditional criteria of rationality and behavioral control apply also to cases of dissociation. It is noted, however, that one can distinguish different kinds of responsibility in cases of dissociation, and that one is responsible for one's dreams in a different sense from that in which one is responsible for actions one can control and evaluate. It is also argued that in cases of multiple personality it is important to distinguish control over switching of personalities from an alter's control over its own behavior. Moreover, the author considers reasons for thinking that amnesia is less relevant to attributions of responsibility than many have supposed. (shrink)

ḥeleḳ 1. A-Ṭ -- ḥeleḳ 2. Y-P -- ḥeleḳ 3. Ts-T.

This paper compares clinical intuition and phenomenological intuition. I begin with a brief analysis of Husserl’s conception of intuition. Second, I review the attitude toward clinical intuition by physicians and philosophers. Third, I discuss the Aristotelian conception of intellectual intuition or nous and its relation to phronesis. Phronesis provides a philosophical ground for clinical intuition by linking medicine as both a techné and praxis. Considering medicine as a techné, Pellegrino and Thomasma exclude clinical intuitions from their philosophy of medicine. However, (...) in modeling clinical reasoning on phronesis, they link Aristotelian nous with clinical reasoning. While supporting the application of phronesis to clinical reasoning, I consider Pellegrino and Thomasma’s model deficient for eliminating intuition as an inalienable element of clinical reasoning. Rather, clinical intuitions are necessary in linking medicine as both art and practice. This becomes more obvious through the phenomenological analysis of clinical intuitions. Clinical reasoning and phenomenological intuitions are similar in joining the perceptual and intellectual aspects of human judgment. Furthermore, clinical intuitions can be extended to become phenomenological intuitions through phenomenological reflection. Clinical intuitions may be examined phenomenologically for their originary foundations. In this way, medicine acts as a phenomenological clue. Phenomenology provides a method to restore the Hippocratic synthesis of empirical observation and wholism associated with clinical intuitions. (shrink)

The so-called “problem of personal identity” can be viewed as either a metaphysical or an epistemological issue. Metaphysicians want to know what it is for one individual to be the same person as another. Epistemologists want to know how to decide if an individual is the same person as someone else. These two problems converge around evidence from mediumship and apparent reincarnation cases, suggesting personal survival of bodily death and dissolution. These cases make us wonder how it might be possible (...) for a person to survive death and either temporarily or permanently animate another body. And they make us wonder how we could decide if such postmortem survival has actually occurred. In this essay I argue, first, that metaphysical worries about postmortem survival are less important than many have supposed. Next, I'll consider briefly why cases suggesting postmortem survival can be so intriguing and compelling, and I'll survey our principal explanatory options and challenges. Then, I'll consider why we need to be circumspect in our appraisal of evidence for mind-body correlations. And finally, I'll try to draw a few tentative and provocative conclusions. (shrink)

“Business,” wrote a professor of marketing in 1929, “is the work of the world, humanity's chiefest task.” On the doorstep of the Depression, Prof. George R. Collins was selling business, by which he meant the business economy, an economic order based on the systematic management of money. I do not intend to enter the volatile controversy between Collins and those like Aldous Huxley who accused business people of being venal and crass. Rather, I intend to trace one likely path by (...) which many in 1929 had come to regard business as a redemptive activity and the business person as a redeemer. (shrink)

During the Renaissance, the su was regarded primarily as a source of light which gave form to all things*; during the Enlightenment, paradoxically, the sun was regarded primarily as a source of heat. Paracelsian chemistry of the 1500s introduced salt as a third principle which embodied the other two, mercury and sulphur; salt was that universal mediating presence which represented earth. By the late 1700s salt was no longer a metaphysical principle but an acid-base compound, and volatile salts aroused most (...) interest. These changes in scientific perceptions of sun and salt ran parallel to one another: beginning as transcendent sources of form, sun and salt came to be considered manipulable sources of energy. Our r-;odern approach to energy derives from a period during which Europeans gradually lost their belief in the creative agency of two essentials to human life. (shrink)