Clinical medicine is the application of scientific principles, rules of thumb, and a store of practical wisdom embodied in narratives of individual cases to the care of a person who is ill. Physicians are taught to observe and report the individual case both as a means of fitting nomothetic generalizations to the given circumstances and as a way of refining those generalizations. This narrative construction of illness is a principal way of knowing in medicine. In this view, disease is not (...) so much an entity as an identifiable chronological organization of the events of illness, and medicine, rather than a science, a rational science-using activity in the service of the ill. Keywords: medical epistemology, casuistry, clinical judgment, narrative CiteULike Connotea Del.icio.us What's this? (shrink)

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

How do we know what is right, or before that, how do we recognize what is morally salient? Such matters lie deeper than can be plumbed by traditional philosophical modes of inquiry alone. Careful study of them requires also the study of literature, with the meticulous appraisal that it encourages of the intricate, tangled issues involved in apprehending the world, finding our way in it, and representing it to others. In this way, the study of literature contributes to a richer (...) and more complex perspective on moral problems, and a more cautious view of the status and breadth of attempts to solve those problems. (shrink)

In this article, the authors introduce the concept of a “queer counter-mythology.” They do so by discussing a speculative song they wrote as an enactment of research-creation. Research-creation names an interdisciplinary scholarly praxis where artist-scholars create the artefacts they want to think-with, rather than analysing existing cultural productions. The song discussed in this article, “Cosmic Beavers,” proposes a queer counter-mythology that reimagines the historical, colonial archive by foregrounding the stories of giant, trans-dimensional beavers who shred Lewis and Clark and use (...) them to reinforce their Time-Dam. Drawing on this song, as well as queer theories of time and anti-colonial thinkers, the authors suggest that artistic interventions invoke speculative lures that, while not changing history, can complicate state-sanctioned archives and narratives of the past and future: they frame this intervention as a queer counter-mythology. (shrink)

The biopsychosocial model, which was deeply influential on psychiatry following its introduction by George L. Engel in 1977, has recently made a comeback. Derek Bolton and Grant Gillett have argued that Engel’s original formulation offered a promising general framework for thinking about health and disease, but that this promise requires new empirical and philosophical tools in order to be realized. In particular, Bolton and Gillett offer an original analysis of the ontological relations between Engel’s biological, social, and psychological levels of (...) analysis. I argue that Bolton and Gillett’s updated model, while providing an intriguing new metaphysical framework for medicine, cannot resolve some of the most vexing problems facing psychiatry, which have to do with how to prioritize different sorts of research. These problems are fundamentally ethical, rather than ontological. Without the right prudential motivation, in other words, the unification of psychiatry under a single conceptual framework seems doubtful, no matter how compelling the model. An updated biopsychosocial model should include explicit normative commitments about the aims of medicine that can give guidance about the sorts of causal connections to be prioritized as research and clinical targets. (shrink)

Ethics of Everyday Medicine: Explorations of Justice examines and analyses the relatively unexplored domain of ethics involved in the everyday practice of medicine. From the author's clinical experience, virtually every decision made in the day-to-day practice of medicine is fundamentally an ethical question, as virtually every decision hinge on some value judgment that goes beyond the medical facts of the matter. The first part of the book is devoted to medical decision cases in several areas of medicine. These cases highlight (...) elements of the current healthcare ecosystem, involving players other than the physician and patient. Insurers (private, commercial, and governmental), administrators, and regulators' perspectives are surfaced in point of care case analysis. Part two contributes to the development of actionable tools to develop better ethical systems for the everyday practice of medicine by providing a critical analysis of Reflective Equilibrium and ethical induction from the perspective of logic and statistics. The chapter on Justice discusses the neurophysiological representations of just and unjust behaviours. The chapter on Ethical Theories follows, describing the epistemic conundrum, principlism, reproducibility, abstraction, chaos and complexity. The following chapter approaches ethical decisions from the logic and statistic perspectives. The following chapter, The Patient as Parenthetical, the author discusses patient-centric ethics, and the rise of business- and government-cetric ethics. The final chapter, A Framework to Frame the Questions for Explore Further, proposes a working framework to deal with current ethical issues. (shrink)

Kok?Chor Tan argues for a conception of Liberal Cosmopolitanism that seeks to reconcile ideals of global justice and national partiality. I provide two objections to his luck egalitarian model of global justice: first, it fails to provide adequate space for legitimate cultural variation with respect to the understanding of and valuing of natural resources; and second, that its account of ideas of collective responsibility is restricted to a point at which it becomes unrecognizable and inefficacious. I conclude with some reflections (...) on the implications of my analysis for the more general question of whether or how national partiality and global justice can be reconciled. (shrink)

Evidence-based practice in education involves basing decisions about what to do on evidence about the relative effectiveness of available interventions (e.g. programmes, products, practices). This article considers two influential critiques of evidence-based education (EBE) pertaining to its treatment of values. The ‘general critique’ condemns EBE for excluding values from decisions about what to do in education. The ‘specific critique’ condemns EBE for relying on a deterministic view of causality in education which disregards the complex, value-laden nature of educational contexts. I (...) argue that virtually all versions of EBE escape the general critique, including the dominant intervention-centred approach that relies on experimental research to discover ‘what works’, because the predictions EBE aims to support are only one premise in a broader normative argument. Further, intervention-centred EBE can avoid much of the specific values-based critique because it is consistent with a probabilistic, rather than deterministic, understanding of causality. However, I argue that only a context-centred approach to EBE that relies on evidence about the specific target setting from local sources in addition to evidence from theory and mixed methods research can fully address the specific critique by accommodating critics’ descriptive claims about the nature of educational contexts. (shrink)

In this introductory essay, I describe feminist ethics as a kind of approach to morality that says we ought to pay attention to the facts on the ground and empirical information in order to know whether and how a moral problem is a gendered problem. One of the best accounts of feminist ethics is by Hilde Lindemann, who wrote that feminist ethics aims “to understand, criticize, and correct how gender operates within our moral and social beliefs and practices.” She doesn’t (...) define feminism as a theory about women, and neither do I. The term 'feminist' has more to do with the sources of this approach to ethics than the ultimate goals of such theorists; women were influential and early advocates of the view that sometimes a moral problem is a problem because it is gendered. (shrink)

This book is a complete re-thinking of Aristotle's metaphysical theory of material substances. The view of the author is that the 'substances' are the living things, the organisms: chiefly, the animals. There are three main parts to the book: Part I, a treatment of the concepts of substance and nonsubstance in Aristotle's Categories; Part III, which discusses some important features of biological objects as Aristotelian substances, as analysed in Aristotle's biological treatises and the de Anima; and Part V, which attempts (...) to relate the conception of substance as interpreted so far to that of the Metaphysics itself. The main aim of the study is to recreate in modern imagination a vivid, intuitive understanding of Aristotle's concept of material substance: a certain distinctive concept of what an individual material object is. (shrink)

This book is a re-thinking of Aristotle's metaphysical theory of material substances. The view of the author is that the 'substances' are the living things, the organisms: chiefly, the animals. There are three main parts to the book: Part I, a treatment of the concepts of substance and nonsubstance in Aristotle's Categories; Part III, which discusses some important features of biological objects as Aristotelian substances, as analysed in Aristotle's biological treatises and the de Anima; and Part V, which attempts to (...) relate the conception of substance as interpreted so far to that of the Metaphysics itself. The main aim of the study is to recreate in modern imagination a vivid, intuitive understanding of Aristotle's concept of material substance: a certain distinctive concept of what an individual material object is. (shrink)

The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards, to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to (...) highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research. (shrink)

Medical Professionals: Conflicts and Quandaries in Medical Practice offers a fresh approach to understanding the role-related conflicts and quandaries that pervade contemporary medical practice. While a focus on professional conflicts is not new in the literature, what is missing is a volume that delves into medical professionals' own experience of the conflicts and quandaries they face, often as a result of inhabiting multiple roles. The volume explores the ways in which these conflicts and quandaries are exacerbated by broader societal forces, (...) including changing scientific and technological paradigms, commercialization, and strengthened consumer movements, which simultaneously expand the scope of roles and responsibilities that medical professionals are expected to fulfill, and make it more difficult to do so. Several empirical chapters analyze data from qualitative interview studies with clinicians and other stakeholders. The studies highlight the burdens on clinicians who are expected to make informed and justified judgments and decisions in the midst of competing pressures; authors describe the methods that clinicians use to address the associated tensions within specific contexts. Two conceptual chapters follow and offer some innovative ways to think about the challenges facing medical professionals as they strive to make sense of the changing landscape within healthcare. The first reflects on the challenges to clinical practice in the midst of shifting and often competing definitions of disease and associated ideologies of care. The second reflects more broadly on the utility of value pluralism as a framework for conceptualizing and working through moral and professional quandaries. The book concludes with a chapter containing suggestions for how members of the medical profession might reframe their thinking about their roles, responsibilities, and decision-making in the midst of inevitable quandaries such as those presented here. This book will be of vital reading for academics, researchers, educators, postgraduate students, and interested health care practitioners and administrators. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Elements of Eleatic Ontology' MONTGOMERY FURTH THE TASKOF AN INTERPRETERof Parmenides is to find the simplest, historically most plausible, and philosophically most comprehensible set of assumptions that imply (in a suitably loose sense) the doctrine of 'being' set out in Parmenides' poem. In what follows I offer an interpretation that certainly is simple and that I think should be found comprehensible. Historically, only more cautious claims are possible, (...) for several portions of the general view from which I 'deduce the poem' are not clearly stated in the poem itself; my explanation of this is that they are operating as tac/t assumptions, and indeed that the poem is best thought of as an attempt to force these very assumptions to the surface for formulation and criticism -that the poem is a challenge. To be sure, there are dangers in pretending, as for dramatic purposes I shall, that ideas are definite and explicit which for Parmenides himself must have been tacit or vague--that Parmenides knew what he was doing as clearly as I represent him; I try to avoid them, but the risk must be taken. I even believe that not to take it, in the name of preserving his thought pure from anachronous contamination, actually prevents us from seeing the extent to which he, pioneer, was ahead of his timc the argument works both ways. So let me hedge my historical claim in this way: the view I shall discuss could have been an active-indeed a controlling---element of Eleaticism; to suppose that Parmenides held it not only explains the poem, but also helps explain the subsequent reactions to Eleaticism of Anaxagoras, Democritus, and Plato (though there is not space to elaborate this here). In addition, it brings his thought astonishingly close to some contemporary philosophical preoccupations. In the first of the following sections, I lay down some sketchy but necessary groundwork concerning the early Greek concept of 'being.' Then in Section 2 an interpretation is given of what I take to be the central Parmenidean doctrine, that 'it cannot be said that anything is not.' This section is the lengthiest and most involved, but it also contains all the moves that appear to be important. Of the remaining sections, Section 3 exp]Mn.qthe principle: 'of what is, all that can be said is: it is,' Section 4 deals briefly with the remaining cosmology of "The Way of Truth," and Section 5 considers the question whether Parmenides himself believed the fantastic conclusions of his argument. There is a short postscript on a point of methodology. 1. A Word on 6v If we are to examine Parmenides' reasoning profitably, an indispensable pre1This paper wasprepared while the author was beneficiary of a Grant-in-Aid of Research from the American Council of Learned Societies, hereby gratefully acknowledged. [111] 112 HISTORY OF PHILOSOPHY liminary is to estabhsh at least a provisional reading for the Greek words translated "is" or "it is" (tar,v), "what is" or "being" (Sv,rb 5v), "to be" (alva0. For while it is evident enough that in his poem Parmenides purports to be delivering an insight of the utmost significance concerning rb tbv (as he calls it), still the construction which he puts upon the term and its cognates, and the understanding which he expects of his listener, are not so clear and have been topics of dispute. Especially notable, and often noted, is the fact that Parmenides' discussion of 'being' shows no sign of the conceptual distinction considered elementary nowadays, between the "is" linking subject and predicate and the "is" of existence; and in fact it needs no documentation here that this distinction was not reflected in either ordinary or philosophical Greek idiom until, at least, a much later date than his, the word tare expressing both concepts. Also highly visible in the poem is the abundance of occurrences of tare used absolutely, unaccompanied by any predicate expression. As a result of this last, the poem can create in the contemporary reader the impression that r5 tSv is being used to mean what is in the existential sense only, to mean what there is; indeed some students of the poem conclude not only that Parmenides... (shrink)

In Moral Passages, Kathryn Pyne Addelson presents an original moral theory suited for contemporary life and its moral problems. Her basic principle is that knowledge and morality are generated in collective action, and she develops it through a critical examination of theories in philosophy, sociology and women's studies, most of which hide the collective nature and as a result hide the lives and knowledge of many people. At issue are the questions of what morality is, and how moral theories (...) (whether traditional or feminist) are implemented. Addelson takes up a large number of historical cases and contemporary social problems, including teen pregnancy, contraception and abortion, and gay rights. These cases allow her to see how the knowledge and lives of some people are declared deviant or immoral, while those of others appear to show the public consensus. One case she uses throughout the book is Margaret Sanger's early work on birth control with the anarcho-syndicalist movement--a revisionist history that reveals rather than hides the collective nature of morality and knowledge. Addelson shows how the usual individualist philosophies promote theories which hide the authority of the professionals who make them. A collectivist approach, she argues, must show the part professionals play in collective action. Her aim is to allow professional knowledge makers to be morally and intellectually responsible. Based on Addelson's twenty years of work in feminist philosophy and interactionist sociology as well as her long-standing involvement in women's community organization, Moral Passages investigates how morality and knowledge are collectively enacted in today's world. (shrink)

The Catholic Tradition requires the faithful to form and follow their conscience. This is the case even with the recognition that consciences can be malformed and one can make errors in practical judgments. Water Shaping Stone examines various aspects of this tradition regarding conscience by using, among other sources, twentieth-century magisterial documents, theologians' works, and Scripture. Kathryn Lilla Cox argues that while the Magisterium retains teaching authority, and a responsibility to help form consciences through its teaching, focusing only on (...) the Magisterium leads to incomplete formation. A more holistic vision of conscience formation means considering the formation of the moral agent to be a multifaceted process that draws on, for example, teaching, prayer, rituals, Scripture, practices, and virtues, along with relationships with the Triune God and communities of accountability. This vision of conscience formation retains the magisterial teaching authority while acknowledging discipleship as the theological basis for making and assessing practical judgments of conscience. (shrink)

The article “Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose,” Marshall et al. (2024) highlights the critical issue of care after an opioid overdose. “Revive and Re...

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies by Karey HarwoodKathryn Lilla CoxThe Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies Karey Harwood Chapel Hill, NC: University of North Carolina Press, 2007. 221pp. $22.00Karey Harwood’s The Infertility Treadmill, published in the University of North Carolina’s Studies in Social Medicine series, fills a lacuna in the infertility literature. Harwood takes (...) an interdisciplinary approach examining “assisted reproductive technologies” (ART) using current scientific, philosophical, theological, and—most importantly—her own ethnographic research. By way of a thick description of women’s experiences of infertility, she draws the reader into a rich ethical conversation regarding ARTs.Harwood “seeks first and foremost to offer an interpretation of the ethical significance of the increasing use of ART by bringing a particular set of normative or evaluative lenses to bear on a particular set of descriptive data” (8). She engaged in this study because of her desire to explore the connections between decisions to use ART and such factors as paid employment, delayed childbirth, and the ongoing balancing of work and family life. Harwood gathered her descriptive data by spending a year with the Atlanta chapter of RESOLVE (The National Infertility Association): attending monthly meetings and listening to speakers and participants as well as appraising RESOLVE’s national and local literature. She also conducted nine interviews with eight women and one man. Focusing on work and family conflicts in light of questions related to gender justice and the interplay between social and communal norms theories, on the one hand, and private and individual choice, on the other, Harwood teases out the ethical complexity surrounding ARTs.After surveying philosophical and theological literature relevant to her topic, Harwood names and examines existential concerns that emerged from her observations, conversations, and interviews with RESOLVE members. Clustered thematically, these concerns include the painful isolation of infertility, the stigma attached to using ARTs, people’s moralizing, how much treatment to pursue, what is the value in trying one more thing, socioeconomic status, and emotional awareness (62–97). Throughout her discussion of these concerns, [End Page 209] Harwood reminds ethicists of the importance of personal narratives for any treatment of an ethical issue like this.Moreover, her research leads Harwood to deduce that RESOLVE helps people with meaning-making, questions of purpose, language clarification, and various options surrounding infertility and ARTs. She asserts that the infertility experience can be a transformative one for the infertile. The decision-making process regarding the use of ARTs functioned as a type of ritual—albeit “a consumeristic ritual”—that aided people in working through the grief of infertility (157). Religious institutions have not always helped the infertile in these areas. Nonetheless, Harwood’s study leads her to conclude that RESOLVE members and leaders tend to be deficient in their capacities for challenging and critically examining how individual decisions intertwine with larger social contexts.Harwood acknowledges that her methodological decision to focus on one RESOLVE chapter limited her demographics (63–64). Moreover, although for the most part balanced, Harwood’s assessment of her findings is at times partial, even bordering on advocacy. For example, she clearly seeks to make the case that ethical analyses of infertility need to be more nuanced—incorporating more personal narrative—and that RESOLVE needs to be more open to critical self-reflection, especially the critical questioning of the “treadmill of infertility” (133). In her analysis of her findings, Harwood demonstrates how personal narratives help nuance ethical analysis. Less clear is whether RESOLVE can be or wants to be more self-critical and more questioning of its own core premises. Nonetheless, these limitations do not detract from Harwood’s important insights regarding “the infertility treadmill” and the host of issues related to ARTs—including consumerism, the role of rituals, meaning-making, suffering and grief, and gender justice, among others.Those struggling with infertility or considering ARTs will find Harwood to be an empathetic dialogue partner. Others will gain a deeper understanding of infertility’s toll by reading this book. Graduate and advanced undergraduate students will benefit from Harwood’s analysis of how personal decisions have wide-ranging... (shrink)

The scientific, ethical, and policy issues raised by research involving the engraftment of human neural stem cells into the brains of nonhuman primates are explored by an interdisciplinary working group in this Policy Forum. The authors consider the possibility that this research might alter the cognitive capacities of recipient great apes and monkeys, with potential significance for their moral status.

From whence spring the sparks of creativity? It is to this very question that the field of depth psychology--especially that of C.G. Jung and his intellectual descendants--has much to contribute. Just as the Muses were the offspring of Mnemosyne, the goddess of memory, our memories are the ancestors of our creativity that finds its multifaceted expression in the written word, image, theater, dance, and music. The Unconscious Roots of Creativity seeks to push the investigation into that domain of memory that (...) is beyond our conscious reach. With articles from 16 contributors, the "red thread" running through each of the offerings in this volume is that, whatever its ultimate expression, the creative impulse has its roots deep in the psyche. Edited By Kathryn Madden, Leonard Cruz and Steven Buser with articles by Linda Carter, Anna Maria Costantino, Carol Thayer Cox, Leonard Cruz, Lisa Raye Garlock, James Hollis, Naomi Ruth Lowinsky, Ian Livingston, Kathryn Madden, Jordan S. Potash, Susan Rowland, Murray Stein, Ann Ulanov, Tjeu van den Berk, Robin van Loben Sels, and Heidi S. Volf. (shrink)

"Change is not merely necessary to life--it is life." That's Alvin Toffler, characteristically stating the profound in a profoundly direct way. And yes, even when we see change coming--as we're about to graduate from school, take a new job, get married--it's still not so easy to accept. And when we don't see it coming--oof, we have an even harder time. Here to help us embrace change and defuse its unsettling power is Change Happens, a full-color illustrated gift book to consult, (...) to share, to give, and to keep on a night table. Curated by Kathryn and Ross Petras, the ultimate connoisseurs of quotes whose books and calendars have over 4.5 million copies in print, these words of wisdom inspire us to be open to change and remind us that nothing positive in life ever happens without it. Arranged alphabetically by subject--including Adapting, Curveballs, Faith, Letting Go, Regrets, Second Chances, Vulnerability--it's a book to turn to in moments of need, when offering advice to a friend or loved one, when urging a child to find the courage to take a step, when marking an important occasion. (shrink)

There is conflicting experimental evidence about whether the “stakes” or importance of being wrong affect judgments about whether a subject knows a proposition. To date, judgments about stakes effects on knowledge have been investigated using binary paradigms: responses to “low” stakes cases are compared with responses to “high stakes” cases. However, stakes or importance are not binary properties—they are scalar: whether a situation is “high” or “low” stakes is a matter of degree. So far, no experimental work has investigated the (...) scalar nature of stakes effects on knowledge: do stakes effects increase as the stakes get higher? Do stakes effects only appear once a certain threshold of stakes has been crossed? Does the effect plateau at a certain point? To address these questions, we conducted experiments that probe for the scalarity of stakes effects using several experimental approaches. We found evidence of scalar stakes effects using an “evidence seeking” experimental design, but no evidence of scalar effects using a traditional “evidence-fixed” experimental design. In addition, using the evidence-seeking design, we uncovered a large, but previously unnoticed framing effect on whether participants are skeptical about whether someone can know something, no matter how much evidence they have. The rate of skeptical responses and the rate at which participants were willing to attribute “lazy knowledge”—that someone can know something without having to check—were themselves subject to a stakes effect: participants were more skeptical when the stakes were higher, and more prone to attribute lazy knowledge when the stakes were lower. We argue that the novel skeptical stakes effect provides resources to respond to criticisms of the evidence-seeking approach that argue that it does not target knowledge. (shrink)