This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Modern science developed in the interflow of culture between west and east. Combing of pratice technology with philosophic thoughts formed experimental method. Holistic views contacting atomism produced system theory. System thoughts are applicated in the science and engineering of biosystems, and the cencepts of system biomedicine (Kamada T.1992), systems biology (Zieglgansberger W, Tolle TR.1993), system bioengineering and system genetics (Zeng BJ. 1994) were established. From positive to synthetic thoughts, philosophy have been developed ontology, cosmology, organism theories. Structurity is structure logic (...) system founded on entity, develop, exist axioms, tolerance, adaptation, fluctuate, interweave, transform theorems and integrate, adaptation, construct laws. Structurity be discussed on the cosmos, life, culture system, creation, hologram theories of structure ontology, construct mutation, simi-structure organism and entity emergence, symbol implication. From the relation of structure, function and development, the structurity put forward the cycle, spiral, triangle structure stability patterns of self-organization in structure complement each other and stratification, functional couple and interflow bounds growth, coordinativetransformation and holographic symmetry. (shrink)

In common with traditional forms of epistemic internalism, epistemological disjunctivism attempts to incorporate an awareness condition on justification. Unlike traditional forms of internalism, however, epistemological disjunctivism rejects the so-called New Evil Genius thesis. In so far as epistemological disjunctivism rejects the New Evil Genius thesis, it is revisionary. -/- After explaining what epistemological disjunctivism is, and how it relates to traditional forms of epistemic internalism / externalism, I shall argue that the epistemological disjunctivist’s account of the intuitions underlying the New (...) Evil Genius thought experiment is at best incomplete. As presented, therefore, epistemological disjunctivism is unable to accommodate the core guiding intuitions of epistemic internalism. Given the stated aim of not being revisionary on this score, the view is at a dialectical disadvantage over the traditional forms of epistemic internalism the position is meant to replace. Unfortunately, therefore, at present, the impasse between internalism and externalism remains. (shrink)

The New Evil Demon problem has been hotly debated since the case was introduced in the early 1980’s (e.g. Lehrer and Cohen 1983; Cohen 1984), and there seems to be recent increased interest in the topic. In a forthcoming collection of papers on the New Evil Demon problem (Dutant and Dorsch, forthcoming), at least two of the papers, both by prominent epistemologists, attempt to resist the problem by appealing to the distinction between justification and excuses. My primary aim here is (...) to critically evaluate this new excuse maneuver as a response to the New Evil Demon problem. -/- Their response attempts to give us reason to reject the idea that victims of the New Evil Demon have justification for believing as they do. I shall argue that this approach is ultimately unsuccessful, however much of value can be learned from these attempts. In particular, progress in the debate can be made by following those who advance the excuse maneuver and make explicit the connection between epistemic justification and epistemic norms. By doing so, the questions being debated are clarified, as is the methodology being used to attempt to answer them. (shrink)

In this article I argue that the value of epistemic justification cannot be adequately explained as being instrumental to truth. I intend to show that false belief, which is no means to truth, can nevertheless still be of epistemic value. This in turn will make a good prima facie case that justification is valuable for its own sake. If this is right, we will have also found reason to think that truth value monism is false: assuming that true belief does (...) have value, there is more of final epistemic value than mere true belief. (shrink)

Background: Recent research demonstrates that people sometimes make different medical decisions for others than they would make for themselves. This finding is particularly relevant to end-of-life decisions, which are often made by surrogates and require a trade-off between prolonging life and maintaining quality of life. We examine the impact of decision role, patient age, decision maker age and multiple individual differences on these treatment decisions. Methods: Participants read a scenario about a terminally ill cancer patient faced with a choice between (...) an aggressive chemotherapy regimen that will extend life by two years and palliative treatments to control discomfort for one remaining month. Participants were randomly assigned to one of three decision roles (patient, physician, or an abstract other) and the scenario randomly varied whether the patient was described as 25 or 65-years old. Results: When deciding for a 65-year old patient, approximately 60% of participants selected aggressive chemotherapy regardless of decision role. When deciding for a 25-year old patient, however, participants were more likely to select chemotherapy for a patient (physician role) or another person (abstract other) than for themselves (70%, 67%, and 59%, respectively). In addition, confidence that powerful others (eg, physicians) control one’s health, as well as respondents’ age and race, consistently predicted treatment choices. Conclusions: Patient age appears to influence medical decisions made for others but not those that we make for ourselves. These findings may help to explain the discord that often occurs when younger cancer patients refuse life-extending treatments. (shrink)

What makes an intellectual virtue a virtue? A straightforward and influential answer to this question has been given by virtue-reliabilists: a trait is a virtue only insofar as it is truth-conducive. In this paper I shall contend that recent arguments advanced by Jack Kwong in defence of the reliabilist view are good as far as they go, in that they advance the debate by usefully clarifying ways in how best to understand the nature of open-mindedness. But I shall argue that (...) these considerations do not establish the desired conclusions that open-mindedness is truth-conducive. To establish these much stronger conclusions we would need an adequate reply to what I shall call Montmarquet’s objection. I argue that Linda Zagzebski’s reply to Montmarquet’s objection, to which Kwong defers, is inadequate. I conclude that it is contingent if open-mindedness is truth-conducive, and if a necessary tie to truth is what makes an intellectual virtue a virtue, then the status of open-mindedness as an intellectual virtue is jeopardised. We either need an adequate reliabilist response to Montmarquet’s objection, or else seek alternative accounts of what it is that makes a virtue a virtue. I conclude by briefly outlining some alternatives. (shrink)

One thing nearly all epistemologists agree upon is that Gettier cases are decisive counterexamples to the tripartite analysis of knowledge; whatever else is true of knowledge, it is not merely belief that is both justified and true. They now agree that knowledge is not justified true belief because this is consistent with there being too much luck present in the cases, and that knowledge excludes such luck. This is to endorse what has become known as the 'anti-luck platitude'. <br /><br (...) />But what if generations of philosophers have been mistaken about this, blinded at least partially by a deeply entrenched professional bias? There has been another, albeit minority, response to Gettier: to deny that the cases are counterexamples at all. <br /><br />Stephen Hetherington, a principal and vocal proponent of this view, advances what he calls the 'Knowing Luckily Proposal'. If Hetherington is correct, this would call for a major re-evaluation and re-orientation of post-Gettier analytic epistemology, since much of it assumes the anti-luck platitude both in elucidating the concept of knowledge, and in the application of such accounts to central philosophical problems. It is therefore imperative that the Knowing Luckily Proposal be considered and evaluated in detail. <br /><br />In this paper I critically assess the Knowing Luckily Proposal. I argue that while it draws our attention to certain important features of knowledge, ultimately it fails, and the anti-luck platitude emerges unscathed. Whatever else is true of knowledge, therefore, it is non-lucky true belief. For a proposition to count as knowledge, we cannot arrive at its truth accidentally or for the wrong reason. (shrink)

In general, epistemic internalists hold that an individual’s justification for a belief is exhausted by her reflectively accessible reasons for thinking that the contents of her beliefs are true. Applying this to the epistemology of testimony, a hearer’s justification for beliefs acquired through testimony is exhausted by her reflectively accessible reasons to think that the contents of the speaker’s testimony is true. A consequence of internalism is that subjects that are alike with respect to their reflectively accessible reasons are alike (...) with respect to what they have justification to believe. Testimony should be thought no different: hearers that are alike with respect to reflectively accessible reasons to think that a speaker’s testimony is true are alike with respect to their justification for beliefs based upon that testimony. But it has been recently argued that this view faces powerful counterexamples. So the central question is this: assuming that a hearer can acquire justification to believe a proposition through the testimony of a speaker, can epistemic internalism provide the resources to explain how such justification is possible? My aim in this paper is to address these counterexamples, and in so doing, defend epistemic internalist accounts of testimony. (shrink)

In this paper I wish to propose and defend a form of the Representative Theory of Perception. According to this version of the theory, when a subject perceives some object x to be in a state P1 he does so by being aware of some modfication M1 of some object E. The subject's way of perceiving any one of a range of objects x,y,z, … is that of being aware of some modification of E. It will be a necessary condition (...) of someone's perceiving x to have property P1 that E be modified in some way. And in order for the modifications of E to be representations, a given property P1 will need to be causally related, characteristically, to one or more specific modifications, M1,M2, … Mn, of E. symbolized by ‘X'.). (shrink)

This chapter first surveys general issues in the epistemic internalism / externalism debate: what is the distinction, what motivates it, and what arguments can be given on both sides. -/- The second part of the chapter will examine the internalism / externalism debate as regards to the specific case of the epistemology of memory belief.

Epistemic internalism, by stressing the indispensability of the subject’s perspective, strikes many as plausible at first blush. However, many people have tended to reject the position because certain kinds of beliefs have been thought to pose special problems for epistemic internalism. For example, internalists tend to hold that so long as a justifier is available to the subject either immediately or upon introspection, it can serve to justify beliefs. Many have thought it obvious that no such view can be correct, (...) as it has been alleged that internalism cannot account for the possibility of the justification of beliefs stored in memory. -/- My aim in this paper is to offer a response that explains how memory justification is possible in a way that is consistent with epistemic internalism and an awareness condition on justification. Specifically, I will explore the plausibility of various options open to internalists, including both foundationalist and non-foundationalist approaches to the structure of justification. I intend to show that despite other difficult challenges that epistemic internalism might face, memory belief poses no special problems that the resources of internalism cannot adequately address. (shrink)

How do our brains make choices? How do factors such as Alzheimer's or depression impair decision-making? Presenting the latest research on 'hot' and 'cold' decision-making, Barbara Sahakian and Jamie Nicole LaBuzetta look at the therapeutic smart drugs now available, and raise concerns about their unregulated use to enhance mental performance.

The thesis that there can be vague objects is the thesis that there can be identity statements which are indeterminate in truth-value (i.e., neither true nor false) as a result of vagueness (as opposed, e.g., to reference-failure), "the singular terms of which do not have their references fixed by vague descriptive means". (if this is "not" what is meant by the thesis that there can be vague objects, it is not clear what "is" meant by it.) the possibility of vague (...) objects should not be taken, in itself, to imply the more radical thesis that the identity relation can be one of "degree". one can hold that the concept of degrees of identity is absurd (how can one thing be more or less identical to another?) "and" that indeterminacy in identity is possible; hence, any incoherence in the idea of degrees of identity does not thereby undermine the idea of indeterminate identity. (shrink)

Business theory and management practices are outgrowths of basic economic principles. To evaluate the proper place of ethics in business, the meaning of ethics as defined by economic theory must be assessed. This paper contends that classical economic thought advocates a nonethical decision-making context and is not functional for a modern complex, interdependent environment.

Although the existence of tachyons is not ruled out by special relativity, it appears that causal paradoxes will arise if there are tachyons. The usual solutions to these paradoxes employ some form of the reinterpretation principle. In this paper it is argued first that the principle is incoherent, second that even if it is not, some causal paradoxes remain, and third, the most plausible “solution,” which appeals to boundary conditions of the universe, will conflict with special relativity.

In this paper I consider a recent argument of Timothy Williamson’s that epistemic internalism and content externalism are indeed incompatible, and since he takes content externalism to be above reproach, so much the worse for epistemic internalism. However, I argue that epistemic internalism, properly understood, remains substantially unaffected no matter which view of content turns out to be correct. What is key to the New Evil Genius thought experiment is that, given everything of which the inhabitants are consciously aware, the (...) two worlds are subjectively indistinguishable for them, which is what matters on internalist accounts of epistemic justification. I argue that even if a standard moral of the New Evil Genius intuition is untenable due to considerations arising from content externalism, the case can be understood as supporting epistemic internalism in a way that is wholly compatible with content externalism. In short, epistemic internalism is committed to sameness of justificatory status between subjectively indistinguishable counterparts, not sameness of content of their justifiers. (shrink)

The ELSI Program: Closing the Loop was an interpretive policy study undertaken to identify how the research and the researchers funded through the program to study the ethical, legal, and social implications of mapping the human genome contributed to the construction of a public policy agenda. The stated goals of this federal grant program, known as ELSI and administered through the National Center for Human Genome Research within the National Institutes of Health, was to maximize the benefits and minimize the (...) harms of the genetic information developed as a result of the government supported genomic research. The purpose of the research project was to generate meaning and understanding regarding the social constructions of this community of researchers. Specifically, identifying themes in the process and outcomes of the research activity was intended to inform future public policy actions, thereby, closing the loop on the reflexive activity generated by the ELSI Program. The activities of the sixty-four researchers granted awards between 1990 and 1993 comprised the core sample for the study. The research process was embedded in a constructivist philosophy and the design included participant observation and an analysis of textual materials generated by the grantees. Data included periodical articles, authored and edited books, videos, popular print and visual media materials, conference papers and presentations, forum reports, interviews, and materials generated by the researcher in the process of the research--notes and analytic memos. Data analysis was an interpretive synthesis of a content analysis, contextual analysis, grounded theory coding categories, and the reflexive process of the researcher. ;The phenomena under investigation were the interactional activities of the ELSI group of researchers through which meaning was shaped on the ethical, legal, and social implications of genomic mapping. A theoretical model of the constructions of the researchers as developed included two core categories: "Framing Academic Constructions" and "Institutionalizing the Myth". The ELSI researchers used a variety of strategies, including rhetorical questioning, professional blocking and impersonalizing, plying a trade, and academic time in generating constructions. The research and researchers contributed to institutionalizing a myth of a genome through strategies that included being the expert, narrowing the focus, and marveling. The consequence of these social interactions was a process of "Making Points Not Meaning", participation in symbolic activities that generated few issues for the public policy agenda. The constructions of the policy study were then situated in the context of the discipline of public administration and policy studies. Significant to the impact of the research findings was understanding how the cooptation of these researchers might effect an health care delivery system dominated by commercial interests such as biotechnology and managed care organizations. The study concluded with a discussion of how situated knowledge constructions, social epistemology, interdisciplinarity, and interpretive research methods might contribute to enhanced credibility in public policy actions. (shrink)

Influential cases have been provided that seem to suggest that one can fail to have knowledge because of the social environment. If not a distinct kind of social defeater, is there a uniquely social phenomenon that defeats knowledge? My aim in this paper is to explore these questions. I shall argue that despite initial appearances to the contrary, we have no reason to accept a special class of social defeater, nor any essentially social defeat phenomenon. We can explain putative cases (...) of social defeat with our existing epistemological apparatus. (shrink)

SummaryThe writings of the very popular American poet Robert Frost (1874–1963) reveal an unusually specific and detailed knowledge of science. This was particularly evident among the poems of his penultimate volume, Steeple Bush, of 1947. Several of these poems confronted with basic insights issues raised by the period's ‘new physics’. Among those, especially Frost's epigram ‘A Wish to Comply’ wittily confronted an important epistemological difficulty in particle physics. Such science must induce a belief in the fundamental importance of entities invisible (...) to any physical human senses except those aided by complex apparatus used in abstruse experiments. Recondite scientific issues are confronted in other poems published in Steeple Bush such as ‘Skeptic’ (which meditates on the ‘red shift’ evidence for an expanding universe), but these poems are clearly derived from popular theoretical expositions, not practical experience. ‘A Wish to Comply’, on the other hand, clearly records an actual experience of a failed Millikan ‘oil drop’ experiment. This event evidently led to the poet to fake a report of his own observation of an electrically charged oil droplet, for reasons of social pressure. In meditating on these circumstances the epigram opens questions relating to scientific ‘systematic error’, the suppression, ‘trimming’ or ‘cooking’ of experimental data, and a bias toward confirmation of highly respected opinions. Although Frost did not live to know it, two of these questions have been latterly opened in regard to Millikan's own reports of his original oil drop experimental data. (shrink)

Recent influential criticisms attack the reputation of Thomas Harriot by citing the contents of his ethnographic and economic survey, A briefe and true report of the new found land of Virginia, first published in 1588. This interpretation makes Harriot, together with Shakespeare and others, agents of a colonialist project. But profound differences are indicated in the comparison of the relatively unbiased depiction and analysis by Harriot and his artist collaborator John White with the interpretations of America and Americans by some (...) of their contemporaries. A briefe and true report conveys, and John White's drawings support, insight into particular non-European features of the cultural and economic lives of the Algonquian peoples. On the contrary, Captain Arthur Barlowe's Discourse and the illustrations by Theodore de Bry for the 1600 edition of Harriot's book instance romanticizing, stereotyping, and unanalytic condescension very unlike Harriot's and White's. These differences prove the faultiness of the recent assessment. (shrink)