Buddhist teachings and modern science are analogous both in their approach to the search for truth and in some of the discoveries of contemporary physics, biology, and psychology. However, despite these congruencies and the recognized benefits of science, Buddhism reminds us of the dangers of a tendency toward scientific reductionism and imperialism and of the sciences’ inability to deal with human moral and spiritual values and needs. Buddhism and science have human concerns and final goals that are different, but as (...) long as the boundaries between them are not trespassed, they can be mutually corrective and allied to benefit humankind. Buddhism must be open to the discoveries of science about the physical world as must all religions today, but no matter how much it may have to modify some of its ancient beliefs, its basic truths—the truths about human suffering and its release—will remain untouched. (shrink)

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour (...) could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others. (shrink)

The question 'Why should I obey the law?' introduces a contemporary puzzle that is as old as philosophy itself. The puzzle is especially troublesome if we think of cases in which breaking the law is not otherwise wrongful, and in which the chances of getting caught are negligible. Philosophers from Socrates to H.L.A. Hart have struggled to give reasoned support to the idea that we do have a general moral duty to obey the law but, more recently, the greater number (...) of learned voices has expressed doubt that there is any such duty, at least as traditionally conceived. (shrink)

Overview * Part I: Introduction * Philip Appleman, Darwin: On Changing the Mind * Part II: Darwin’s Life * Ernst Mayr, Who Is Darwin? * Part III: Scientific Thought: Just before Darwin * Sir Gavin de Beer, Biology before the Beagle * Thomas Robert Malthus, An Essay on the Principle of Population * William Paley, Natural Theology * Jean Baptiste Pierre Antoine de Monet Lamarck, Zoological Philisophy * Charles Lyell, Principles of Geology * John Herschell, The Study of Natural Philosophy (...) * William Whewell, Astronomy and General Physics Considered with Reference to Natural Theology * Alfred Russel Wallace, On the Tendency of Varieties to Depart Indefinitely from the Original Type * Part IV: Selections from Darwin’s Work * The Voyage of the Beagle * o Chapter I. St. Jago-Cape de Verd Island o Chapter XVII. Galapagos Archipelago * On the Tendency of Species to Form Varieties; and On the Perpetuation of Varieties and Species by Natural Means of Selection * o I. Extract from an unpublished Work on Species, by C. Darwin, Esq.... o II.of Letter from C. Darwin, Esq., to Prof. Asa Gray, Boston, U.S., dated Down, September 5th, 1857 * An Historical Sketch of the Progress of Opinion on the Origin of Species, previously to the : Publication of This Work The Origin of Species * o Introduction o Chapter I. Variation under Domestication o Chapter II. Variation under Nature o Chapter III. Struggle for Existence o Chapter IV. Natural Selection o Chapter VI. Difficulties on Theory o Chapter IX. On the Imperfections of the Geological Record o Chapter XIII. Mutual Affinities of Organic Beings: Morphology: Embryology: Rudimentary Organs o Chapter XIV. Recapitulation and Conclusion * The Descent of Man * o Introduction o Chapter I. The Evidence of the Descent of Man from Some Lower Form o Chapter II. On the Manner of Development of Man from Some Lower Form o Chapter III. Comparison of the Mental Powers of Man and the Lower Animals o Chapter VI. On the Affinities and Genealogy of Man o Chapter VIII. Principles of Sexual Selection o Chapter XIX. Secondary Sexual Characters of Man o Chapter XX. Secondary Sexual Characters of Man-continued o Chapter XXI. General Summary and Conclusion * Part V: Darwin’s Influence on Science * THE VICTORIAN OPPOSITION TO DARWIN * o David L. Hull, Darwin and His Critics o Adam Sedgwick, Objections to Mr. Darwin’s Theory of the Origin of Species o Sir Richard Owen, Darwin on the Origin of Species o Fleeming Jenkin, Review of the Origin of Species * VICTORIAN SUPPORTERS OF DARWIN * o Joseph Dalton Hooker, Flora Tasmaniae o Thomas Henry Huxley, On the Relations of Man to the Lowe Animals o Charles Lyell, Principles of Geology o Alfred Russel Wallace, The Debt of Science to Darwin * DARWIN AND THE SHAPING OF MODERN SCIENCE * o Scientific Method in Evolution o National Academy of Sciences, Evolution and the Nature of Science o Richard Dawkins, Explaining the Very Improbable o Lewis Thomas, On the Uncertainty of Science o Noretta Koetge, Postmodernisms and the Problem of Scientific Literary o Richard Dawkins, Science and Sensibility o The Neo-Darwinian Synthesis o Peter Bowler, The Evolutionary Synthesis o The Human Genealogy o Adam Kuper, The Chosen Primate o Ian Tattersall, Out of Africa Again... and Again? o Stephen Jay Gould, The Human Difference o Punctuated Equilibrium o Stephen Jay Gould, [On Punctuated Equilibrium] o Niles Eldredge, The Great Stasis Debate o Rethinking Taxonomy o Kevin Padian, Darwin’s Views of Classification o David L. Hull, Cladistic Analysis o Kevin Padian and Luis M. Chiappe, Cladistics in Action: The Origin of Birds and Their Flight o Evolution as Observable Fact o James L. Gould and William T. Keeton with Carol Grant Gould, How Natural Selection Operates o Peter r. Grant, Natural Selection and Darwin’s Finches o John A. Endler, Natural Selection in the Wild * Part VI: Darwinian Patterns in Social Thought * COMPETITION AND COOPERATION * o Richard Hofstadter, The Vogue of Spencer o Andrew Carnegie, The Gospel of Wealth o Peter Kropotkin, Mutual Aid o Martin A. Nowak, Robert M. May, and Karl Sigmund, The Arithmetics of Mutual Help * NATURE AND NURTURE * o Edward O. Wilson, Sociobiology: The New Synthesis o Stephen Jay Gould, Biological Potentiality vs. Biological Determination o Barbara Ehrenreich and Janet McIntosh, The New Creationism: Biology under Attack * EVOLUTION AND GENDER * o Elizabeth Cady Stanton, The Woman’s Bible o Nancy Makepeace Tanner, On Becoming Human o Evelleen Richards, Darwin and the Descent of Woman o James Eli Adams, Woman Red in Tooth and Claw * EVOLUTION AND OTHER DISCIPLINES * o Edward O. Wilson, [On Consilience] o Randolph H. Nesse and George C. Williams, Evolution and the Origin of Disease o Steven Pinker, How the Mind Works o Steve Jones, The Set within the Skull * Part VII: Darwinian Influences in Philosophy and Ethics * John Dewey, The Influence of Darwin on Philosophy * Daniel C. Dennett, Darwin’s Dangerous Idea: Natural Selection as an Algorithmic Process * Michael Ruse Darwinian Epistemology * Thomas Henry Huxley, Evolution and Ethics * Julian Huxley, Evolutionary Ethics * Michael Ruse and Edward O. Wilson, The Evolution of Ethics * Frans de Waal, Good Natured: The Origin of Right and Wrong in Humans and Other Animals * Matt Ridley, The Origins of Virtue * Part VIII: Evolutionary Theory and Religious Theory * MAINSTREAM RELIGIOUS SUPPORT FOR EVOLUTION * o Pope John Paul II, Message to the Pontifical Academy of Sciences o Central Conference of American Rabbis, On Creationism in School Textbooks o United Presbyterian Church in the U.S.A., Evolution and Creationsim o The Lutheran World Federation, [Statement on Evolution] o The General Convention of the Episcopal Church, Resolution on Evolutionism and Creationism o Unitariuan Universalist Association, Resolution Opposing "Scientific Creationism" * FUNDAMENTALIST CREATIONISM * o Eugene C. Scott, Antievolution and Creationism in the United States o The Scopes Trial o Thomas McIver, Orthodox Jewish Creationists o Harun Yahya, [Islamic Creationism] o Seami Srila Prabhupada, [A Hare Krishna on Darwinian Evolution] o Institute for Creation Research, Tenets of Creationism o Henry M. Morris, Scientific Creationism o Thomas J. Wheeler, Review of Morris o Richard D. Sjolund and Betty McCollister, Evolution at the Grass Roots o Richard D. Sjolund, [Creationism versus Biotechnology] o Betty McCollister, [The Politics of Creationism] o Molleen Matsumara, What Do Christians Really Believe about Evolution? o National Center for Science Education, Seven Significant Court Decisions Regarding Evolution/Creation Issues * PERSONAL INCREDULITY AND ANTIEVOLUTIONISM * o Richard Dawkins, [The Argument from Personal Incredulity] o Phillip E. Johnson, Darwin on Trial o Eugenie C. Scott, Review of Johnson o Michael Behe, Darwin’s Black Box o Robert Dorit, Review of Behe o Michael Ruse, Darwin’s New Critics on Trial * SCIENTISTS’ OPPOSITION TO CREATIONISM * o American Association for the Advancement of Science, Forced Teaching of Creationist Beliefs in Public School Science Education o American Institute of Biological Sciences, Resolution Oposing Creationism in Science Courses o National Association of Biology Teachers, Statement on Teaching Evolution o National Academy of Sciences, Frequently Asked Questions about Evolution and the Nature of Science * FUNDAMENTALIST CREATIONISM AND THE VALUE OF SATIRE * o Michael Shermer, Genesis Revisted: A Scientific Creation Story o Philip Appleman, Darwin’s Ark * Part IX: Darwin and the Literary Mind * DARWIN’S LITERARY SENSIBILITY * o Charles Darwin, Autobiography o L. Robert Stevens, Darwin’s Humane Reading o George Levine, Darwin and Pain: Why Science Made Shakespeare Nauseating o Gillian Beer, Darwin’s Plots * DARWIN’S INFLUENCE ON LITERATURE * o Lionel Stevenson, Darwin among the Poets o George Levine, Darwin among the Novelists o Joseph Wood Krutch, The Tragic Fallacy o Herbert J. Muller, Modern Tragedy o Philip Appleman, Darwin-Sightings in Recent Literature. (shrink)

It is perhaps fitting that some of Brand Blanshard’s last writings were on F.H. Bradley for they brought his career, and to some extent his philosophy, full circle. When Blanshard died on November 18, 1987, the last surviving person to have talked philosophy with Bradley, and one of only a handful to have conversed face-to-face with him at all, departed this world. Blanshard met Bradley twice while he was completing a B.S. degree at Merton College, Oxford. Until that time, Blanshard (...) really had nothing to do with Bradley at Oxford, aside from struggling, like so many other students, with his Appearance and Reality and the first edition of the Principles of Logic. His tutor was Harold Joachim and his B.S. thesis, entitled “Some Metaphysical Implications of Judgment,” was a critical examination of the theories of judgment of Bosanquet, Russell, and the pragmatists. The examiners were Sir William Ross and H.W.B. Joseph. F.C.S. Schiller, the Oxford exponent of pragmatism who was almost alone in his irreverence for Bradley and issued the famous comic edition of Mind depicting in its frontpiece a portrait of the Absolute as a large blank circle of pale pink, also read the thesis and inserted some complimentary comments at the end. (shrink)

Moral philosophy and education, by H. D. Aiken.--The moral sense and contributory values, by C. I. Lewis.--Realms of value, by P. W. Taylor.--The role of value theory in education, by J. D. Butler.--Does ethics make a difference? By K. Price.--Educational value statements, by C. Beck.--Educational values and goals, by W. K. Frankena.--Conflicts in values, by H. S. Broudy.--Levels of valuational discourse in education, by J. F. Perry and P. G. Smith.--Education and some moves toward a value methodology, by A. S. (...) Clayton.--You can't pray a lie, by M. Twain.--Men, machines, and morality, by J. F. Soltis.--Teaching and telling, by I. Scheffler.--Reason and habit, by R. S. Peters.--The two moralists of the child, by J. Piaget.--Causes and morality, by R. S. Peters.--On education and morals, by R. W. Sleeper.--Moral autonomy and reasonableness, by T. D. Perry. (shrink)

Both Carnap and Quine made significant contributions to the philosophy of mathematics despite their diversedviews. Carnap endorsed the dichotomy between analytic and synthetic knowledge and classified certainmathematical questions as internal questions appealing to logic and convention. On the contrary, Quine wasopposed to the analytic-synthetic distinction and promoted a holistic view of scientific inquiry. The purpose of thispaper is to argue that in light of the recent advancement of experimental mathematics such as Monte Carlosimulations, limiting mathematical inquiry to the domain of (...) logic is unjustified. Robustness studies implemented inMonte Carlo Studies demonstrate that mathematics is on par with other experimental-based sciences. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Minor Socratics* PHILIP MERLAN OF MEN MORE OR LESS DECISIVELY influenced by Socrates, three--Antisthenes (c. 455-360), Aristippus of Cyrene (c. 435-356), and Eucleides of Megara (c. 450380 )--became founders of schools (or sects) often referred to as "minor Socratic schools." These schools are the Cynic, the Cyrenaic, and the Megaric, respectively. The names of the last two are self-explanatory. That of the first sounds somewhat like "dog (kytn)-like." By (...) some it is assumed to have been derived from the meeting place of Antisthenes with his followers, the gymnasium of Kynosarges; x others believe it to be contemptuously indicative of the dog-like life of the members of the sect (shamelessness, begging, barking, biting). 2 In this sense it was proudly and defiantly accepted by the members themselves, a What we know of the ethical teachings of the Megaric school amounts to hardly more than one sentence, in which the Good seems to have been identified with the One. 4 All we can say of this formula is that it, in some way, links the * Size (very limited), scope (ethical doctrines only), manner of presentation (for the general reader and rather dogmatic), etc., of this article were determined by the character of the Encyclopedia of Morals, in which it originally appeared. The present footnotes try to make up for some of the shortcomings unavoidable in this kind of article. [The Journal is grateful to Philosophical Library, Inc. for permission to reprint this article. The footnotes were subsequently added by Professor Merlan and appear here for the first time.] As the only collection of fragments of Cynics (Antisthenes, Diogenes, Crates, Monimus, Demonax, Oenomaus, Teles, Bion) is that contained in F. W. A. Mullach, Fragmenta philosophorum graecorum (Paris: 1865), vol. II, pp. 274-429, which is hard to obtain (the collection of fragments by A. W. Winekelmann, Antisthenis fragmenta [1842] even harder), I shall quote them directly from the sources. There was no need to do so with the Cyrenaics, as we have two recent collections of their fragments: G. Giannantoni, 1 Cirenaici (Florence, n.d.: [1958])--they will be quoted as G--and E. Mannebach, Aristippi et Cyrenaicorum fragmenta (K~51n-Leiden: 1961), which will be quoted as Ma. A generous selection of fragments of Megarians, Cynics and Cyrenaics in German translation with introduction and notes is contained in W. Nestle, Die Sokratiker (Jena: 1922), pp. 79-177. Our knowledge of Antisthenes would considerably be enriched if we could follow H. Kesters, who, in a number of publications (one of them: Plaidoyer d'un Socratique... [Louvain: 1959]) ascribes Themistius, Or. XXVI to Antisthenes. However, the ascription is doubtful. i I.e., Whitehound: D.L. VI 13. Elias, In Cat. (CAG XVIII/I, Berlin: 1908), p. Ill, 2-29. Busse has a fourfold explanation of the name, all connected with the word Kt~v. Cf. K. v. Fritz, Quellenuntersuchungen zu Leben und Philosophie des Diogenes von Sinope (Leipzig: 1926), pp. 47-49. D.L. VI 60. 55; Stob. vol. III, p. 462, 16 W.-H. Quotations from Stobaeus refer to: K. Wachsmuth, O. Hense, loannis Stobaei Anthologium, 5 vol. (Berlin: 1884-1902); they are by volume, page, and line of this edition. 4 Eus. PE XIV 17, 1; D.L. II 106 (~v x6 dtTu06v). [143] 144 HISTORY OF PHILOSOPHY Megarians to the Eleatic school 5 but also to some aspects of Plato's Philebus and his Laws, and also to the Epinomis, and, above all, to his lecture or course of lectures "The Good," the conclusion of which was that it is the One which is the Good. 6 And though we know that many Megarians were engaged in political activities,7 we do not know in what way, if any, that highly abstract ethical doctrine was linked to practice. It is entirely different with the other two schools, in which ethical theory is immediately applied to life and theoretical aspects of philosophy are often neglected or even absent. However, there is some doubt as to whether Antisthenes can actually be considered the fountainhead of Cynicism. He seems to have undergone the influence of Socrates late in his life, when he had already been active as a... (shrink)

Ebbhinghaus, H., J. Flum, and W. Thomas. 1984. Mathematical Logic. New York, NY: Springer-Verlag. Forster, T. Typescript. The significance of Yablo’s paradox without self-reference. Available from http://www.dpmms.cam.ac.uk. Gold, M. 1965. Limiting recursion. Journal of Symbolic Logic 30: 28–47. Karp, C. 1964. Languages with Expressions of Infinite Length. Amsterdam.

Ebbhinghaus, H., J. Flum, and W. Thomas. 1984. Mathematical Logic. New York, NY: Springer-Verlag. Forster, T. Typescript. The significance of Yablo’s paradox without self-reference. Available from http://www.dpmms.cam.ac.uk. Gold, M. 1965. Limiting recursion. Journal of Symbolic Logic 30: 28–47. Karp, C. 1964. Languages with Expressions of Infinite Length. Amsterdam.

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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Historical works on Hitler and Stalin or on specific aspects of their regimes reveal how historians differ in their treatment of individual agency. Historians' practices are examined in the light of W. H. Dray's findings about historians' concepts of causation and A. Giddens's structuration theory. Marxist and revisionist historians rejected approaches that endowed Hitler and Stalin with immense power and personal control over events. Works by Isaac Deutscher, A. J. P. Taylor, and J. Arch Getty exhibit historians' methods for reducing (...) or nullifying agential power. Robert C. Tucker's work on Stalin offers a different approach to the problem of the interaction of structure and individual agency. Allan Bullock may be correct in his view that historians are now less likely to exaggerate or underestimate either individual agency or structure when dealing with Hitler and Stalin; and Christopher Lloyd may be correct to say that historians' practices suggest a tacit acceptance of structuration theory in some form, but it does not follow that historians are now more likely to agree about the agential power of individuals. The assessment of agential power still requires interpretation, and it is doubtful that consensus about structuration theory would affect the range of interpretation very much. However, theories of cultural evolution and comparative investigation of the "selection" of political-cultural "genes" at certain historical junctures might provide a useful framework for studying how individuals like Hitler and Stalin acquire an unusual degree of power and authority. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:April 3, 2010 (11:17 am) C:\Users\Milt\Desktop\backup copy of Ken's G\WPData\TYPE2902\russell 29,2 050 red.wpd Reviews 181 MARRIAGE AND MORALSy REVISITED Philip Ebersole Greater Rochester Russell Set Rochester, ny 14607, usa [email protected] Timothy J. Madigan Philosophy / St. John Fisher College Rochester, ny 14618, usa [email protected] Katie Roiphe. Uncommon Arrangements: Seven Portraits of Married Life in London Literary Circles, 1910–1939. New York: The Dial Press, 2007. Pp. 343. isbn 978-0-385-33937-7 (hb). (...) us$26; cdn$34. There is a spectre haunting Katie Roiphe’s exploration of Edwardian/Georgian marriage in literary London circles: the spectre of Bertrand Russell, most especially the author of Marriage and Moralsz (1929), a work written in the middle of the period she examines. While Russell makes a few guest appearances in April 3, 2010 (11:17 am) C:\Users\Milt\Desktop\backup copy of Ken's G\WPData\TYPE2902\russell 29,2 050 red.wpd 182 Reviews the text, and while he knew almost everyone in the book (sometimes biblically), it is surprising that Roiphe does not take the opportunity to connect the rather disparate couples she discusses with Russell’s contemporary exploration of the meaning of marriage in the post-Victorian era. She focuses on couples living together from directly before the First World War to directly before the Second World War, a period of tremendous change and radical social movements: Modernism, Socialism, Freudianism,and, perhaps most important to the overall structure of the book, SuTragism/Feminism. One of the most telling aspects of Uncommon Arrangements is the focus on somez—zfor the timesz—zuncommonly liberated women. Katie Roiphe is a journalist and an instructor at New York University who has written extensively about modern marriage. Her Uncommon Arrangements tells the story of seven married couples in early twentieth-century England, all of whom tried to live outside the framework of conventional society. They revolted against Victorian values and sought to establish relations between men and women on an equal basis. Most of these couples travelled in the same circles as Russell, and were subject to the same intellectual inXuences. In Marriage and Moralsz—zwritten, ironically, during the time of the slow and painful dissolution of his own second marriagez—zRussell attempted to advocate a rational code of sexual ethics. He believed in openness and honesty about sex and denied that marital Wdelity was the be-all and end-all of morality. The true basis of morality, he said, was respect for the rights and feelings of your partner. Marriage and Morals was far ahead of its time in arguing that so-called “open marriages” (as well as couples living together without going through a marriage ceremony)were perfectly moral, so longas both partners accepted the conditions and did not engage in any deceptive acts. The couples discussed in Uncommon Arrangementsz—zwhile all were involved in relationships that could charitably be called “open”z—zdid not necessarily adhere to Russell’s “no deception” rule. Still, they provide interesting test cases for the idea that you can create a lasting marriage based on your own feelings and ideas without regard for convention. Interestingly, Roiphe does not deal with some likely suspects from this time period: the Lawrences, Woolfs, Eliots, and Bertrand and Dora Russell. In the Wrst chapter, Roiphe deals with the “modus vivendiy” between Wells and his second wife, Jane. Wells rebelled against his convention by Wrst of all divorcing his Wrst wife, Isabel, in 1895, and marrying his cousin Mary Catherine shortly thereafter. As a sign of his domineering personality, he renamed her “Jane”. Wells refused to accept limits on his sexual ambitions. As he put it once, “Except insofar as aTection put barriers around me, I have done what I pleased so that every bit of sexual impulse in me has expressed itselfz” (p. 36). In 1901, Jane gave birth to their son George Philip Wells. It was a troubled birth, and H.yG. ran oT. Instead of becoming angry, Jane understood and promised not to make too many demands on him. Thus their modus vivendiy. H.yG. April 3, 2010 (11:17 am) C:\Users... (shrink)

It is traditionally believed that cerebral activation (the presence of low voltage fast electrical activity in the neocortex and rhythmical slow activity in the hippocampus) is correlated with arousal, while deactivation (the presence of large amplitude irregular slow waves or spindles in both the neocortex and the hippocampus) is correlated with sleep or coma. However, since there are many exceptions, these generalizations have only limited validity. Activated patterns occur in normal sleep (active or paradoxical sleep) and during states of anesthesia (...) and coma. Deactivated patterns occur, at times, during normal waking, or during behavior in awake animals treated with atropinic drugs. Also, the fact that patterns characteristic of sleep, arousal, and waking behavior continue in decorticate animals indicates that reticulo-cortical mechanisms are not essential for these aspects of behavior. (shrink)

In an increasingly diverse America, the experience of race and racial discrimination is too often described as if it is the same for all racial and ethnic groups. Utilizing the perspective on ethnic and racial groups developed by Zolberg that stresses their contingent and dynamic nature, we explore ethnic and racial discrimination in depth. Drawing on data from the New York Second Generation Study we describe the experience of prejudice and discrimination among eight groups of young adults-native born whites, native (...) born blacks, native born Puerto Ricans, and second generation Dominicans, South Americans, Chinese, West Indians and Russian Jews. While the experience of racial discrimination is common to many Americans, the nature and severity of that experience varies widely among the increasingly diverse people that are now often lumped together as "minorities" in the popular imagination. African Americans, and those who most often confused with African Americans have different kinds of experiences than other non white groups. They face more systematic and brighter racial boundaries than do Asians and light-skinned Latinos. This creates more formidable obstacles for those defined as black, as opposed to those who are just "nonwhite" to full incorporation into American society. We propose a typology of types of discrimination that begins to unpack this complex phenomena. (shrink)