David Lewis's work is of fundamental importance in many areas of philosophical inquiry and there are few areas of Anglo-American philosophy where his impact has not been felt. Lewis's philosophy also has a rare unity: his views form a comprehensive philosophical system, answering a broad range of questions in metaphysics, philosophy of mind, philosophy of language, philosophy of action and many other areas. This breadth of Lewis's work, however, has meant that it is difficult to know where to start in (...) Lewis's work and a casual reader may often miss some of the illuminating connections between apparently quite disparate pieces of Lewis's work. This book aims to make this body of work more accessible to a general philosophical readership, while also providing a unified overview of the many contributions Lewis has made to contemporary Anglo-American philosophy. The book can be divided into four parts. The first part examines Lewis's metaphysical picture - one of the areas where he has had the greatest impact and also the framework for the rest of his theories. The second section discusses Lewis's important contributions in the philosophy of mind, language and meaning. The third part explores some of Lewis's work in decision theory, metaethics and applied ethics, areas where his work in not necessarily as widely appreciated, but in which he has done a range of work that is both accessible and important. The final section focuses on Lewis's distinctive philosophical method, perhaps one of his most significant legacies, which combines naturalism with "common-sense" theorizing. (shrink)

This book discusses a range of important issues in current philosophical work on the nature of possible worlds. Areas investigated include the theories of the nature of possible worlds, general questions about metaphysical analysis and questions about the direction of dependence between what is necessary or possible and what could be.

In this book, Daniel Patrick Kelly examines Kant's Critique of Pure Reason through the lens of historical contextualization and highlights the importance of Kant's "Transcendental Dialectic" in the greater justification of his overarching transcendental idealism.

Christian Smith has described the religious attitudes of American youth and many adults as Moralistic Therapeutic Deism. In this formulation the word “therapeutic” does much work, and is meant to indicate that the goal of life is to be happy, to which end religion is instrumental. Martha Nussbaum has argued that Hellenistic schools of philosophy were therapeutic and instrumental in much the same way, and that this is a possible mode of philosophy even today. Appealing to the historical investigations of (...) Pierre Hadot and Giovanni Reale, this paper shows that Neoplatonism was an even more successful form of therapeutic philosophy, a fact which Augustine recognized and to which he responded in his therapeutic masterpiece Confessions, through his depiction of his mother as a sage. This suggests that Catholicism can be powerful when presented therapeutically, which might be a more appropriate mode for evangelism in our therapeutic age. (shrink)

The successful specification of the definition of art has so far proven elusive. Discouraged by repeated failed attempts at the definition of art, numerous anti-essentialist philosophers have suggested alternative accounts. In this paper I defend the project of the definition of art by arguing that the strongest anti-essentialist arguments are unsuccessful in ruling out either the possibility or the value of a definition of art. Based on my observations regarding a blind spot in Wittgenstein’s anti-essentialist “look and see” approach, I (...) conclude by suggesting a new avenue of investigation for essentialism regarding art. (shrink)

The Cambridge History of Science, vol. 1, Ancient Science. Edited by Alexander Jones and Liba Taub. Cambridge: Cambridge University Press, 2018. Pp. xix + 642. $160.

This article takes stock of the seeming wealth of visual and material sources concerning stars and numbers that has come down to us from early imperial China (221 BCE–755 CE) and their minimal impact on how we write the history of astronomy and mathematics in this period. My goal is to offer ideas about how we might better engage with these sources and work across ancient and modern disciplines. I begin by outlining the conceptual categories into which our historical subjects (...) divided these sciences, followed by an overview of those visual and material sources we know from textual sources to have once existed versus those that are currently extant. The historiographic disconnect, I argue, is due in part to an inherent disconnect in the sources that have survived and, in some degree, to terminological and categorical confusion between those working in the history of science, divination, and art. Pointing to what are, in my opinion, good examples of how we might move forward and beyond the limits imposed by our sources and disciplinary boundaries, I then end on a list of questions I think fruitful to explore. What, for example, do we mean by “accuracy” when speaking of how constellations are represented in technical literature and tomb murals? (shrink)

This article takes stock of the seeming wealth of visual and material sources concerning stars and numbers that has come down to us from early imperial China (221 BCE–755 CE) and their minimal impact on how we write the history of astronomy and mathematics in this period. My goal is to offer ideas about how we might better engage with these sources and work across ancient and modern disciplines. I begin by outlining the conceptual categories into which our historical subjects (...) divided these sciences, followed by an overview of those visual and material sources we know from textual sources to have once existed versus those that are currently extant. The historiographic disconnect, I argue, is due in part to an inherent disconnect in the sources that have survived and, in some degree, to terminological and categorical confusion between those working in the history of science, divination, and art. Pointing to what are, in my opinion, good examples of how we might move forward and beyond the limits imposed by our sources and disciplinary boundaries, I then end on a list of questions I think fruitful to explore. What, for example, do we mean by “accuracy” when speaking of how constellations are represented in technical literature and tomb murals? (shrink)

In this study Daniel Lister assesses the radical critiques of state schooling in America and criticises reliance on functional explanations to articulate the connection between schools and society.

Pellegrino was there at the beginning of the field. In the 1950s and 60s, before there was a Kennedy Institute of Ethics or a Hastings Center; before the word ‘bioethics’ itself was coined, Pellegrino was writing articles such as "Ethical Considerations in the Practice of Medicine and Nursing," published in 1964. He was among those who started the Society for Health and Human Values—a precursor organization to the American Society for Bioethics and Humanities. He was the founding editor of the (...) Journal of Medicine and Philosophy at a time when the notion that there was a relationship between philosophy and medicine was foreign to both physicians and philosophers. The authors of the articles published in the very .. (shrink)

For decades, physicians, philosophers, theologians, lawyers, and the public considered brain death a settled issue. However, a series of recent cases in which individuals were declared brain dead yet physiologically maintained for prolonged periods of time has challenged the status quo. This signals a need for deeper reflection and reexamination of the underlying philosophical, scientific, and clinical issues at stake in defining death. In this paper, I consider four levels of philosophical inquiry regarding death: the ontological basis, actual states of (...) affairs, epistemological standards, and clinical criteria for brain death. I outline several candidates for the states of affairs that may constitute death, arguing that we should strive for a single, unified ontological definition of death as a loss of integrated functioning as a unified organism, while acknowledging that two states of affairs may satisfy this concept. I argue that the clinical criteria for determining whole-brain death should be bolstered to meet the epistemic demand of sufficient certainty in defining death by adding indicators of cerebro-somatic dis-integration to the traditional triad of loss of consciousness, loss of brainstem function, and absence of confounding explanations. (shrink)

A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: double-effect sedation, parsimonious direct sedation, and sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices (...) are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient’s consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected. (shrink)

Increasingly, physicians are being asked to provide technical services that many believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, (...) I endeavor, firstly, to clarify the meaning of some of these terms: conscience, conscientious action, professional judgment, conscientious objection, conscience clauses, civil disobedience, and tolerance. I argue that use of the term conscientious objection to describe these refusals by health care professionals is mistaken and confusing. Secondly, relying on a proper understanding of the moral and technical character of medical judgment, the optimal deference that the state and markets ought to have toward professions, and general principles of Lockean tolerance for a diversity of practices and persons in a flourishing, pluralistic, democratic society, I offer a defense of tolerance with respect to the deeply held convictions of physicians and other health care professionals who hold minority views on contested but legal medical practices. (shrink)

In 1957, Feyerabend delivered a paper titled ‘On the Quantum-Theory of Measurement’ at the Colston Research Symposium in Bristol to sketch a completion of von Neumann's measurement scheme without collapse, using only unitary quantum dynamics and well-motivated statistical assumptions about macroscopic quantum systems. Feyerabend's paper has been recognised as an early contribution to quantum measurement, anticipating certain aspects of decoherence. Our paper reassesses the physical and philosophical content of Feyerabend's contribution, detailing the technical steps as well as its overall philosophical (...) motivations and consequences. Summarising our results, Feyerabend interpreted collapse as a positivist assumption in quantum mechanics leading to a strict distinction between the uninterpreted formalism of unitary evolution in quantum mechanics and the classically interpreted observational language describing post-measurement outcomes. Thus Feyerabend took the no-collapse completion of the von Neumann measurement scheme to show the dispensability of the positivist assumption, leading the way to a realistic interpretation of quantum theory. We note, however, that there are substantial problems with his account of measurement that bring into question its viability as a legitimate foil to the orthodox view. We further argue that his dissatisfaction with the von Neumann measurement scheme is indicative of early views on theoretical pluralism. (shrink)

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating (...) would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed. (shrink)

We thank Nielsen Busch and Mjaaland for their article on the dead donor rule (Nielsen Busch and Mjaaland 2023). We would like to take this opportunity to go beyond the dead donor rule in order to r...

The Hong and Page ‘diversity trumps ability’ result has been used to argue for the more general claim that a diverse set of agents is epistemically superior to a comparable group of experts. Here we extend Hong and Page’s model to landscapes of different degrees of randomness and demonstrate the sensitivity of the ‘diversity trumps ability’ result. This analysis offers a more nuanced picture of how diversity, ability, and expertise may relate. Although models of this sort can indeed be suggestive (...) for diversity policies, we advise against interpreting such results overly broadly. (shrink)

Public discussions of political and social issues are often characterized by deep and persistent polarization. In social psychology, it’s standard to treat belief polarization as the product of epistemic irrationality. In contrast, we argue that the persistent disagreement that grounds political and social polarization can be produced by epistemically rational agents, when those agents have limited cognitive resources. Using an agent-based model of group deliberation, we show that groups of deliberating agents using coherence-based strategies for managing their limited resources tend (...) to polarize into different subgroups. We argue that using that strategy is epistemically rational for limited agents. So even though group polarization looks like it must be the product of human irrationality, polarization can be the result of fully rational deliberation with natural human limitations. (shrink)

One major argument against prohibiting euthanasia and physician-assisted suicide (PAS) is that there is no rational basis for distinguishing between killing and allowing to die: if we permit patients to die by forgoing life-sustaining treatments, then we also ought to permit euthanasia and PAS. In this paper, the author argues, contra this claim, that it is in fact coherent to differentiate between killing and allowing to die. To develop this argument, the author provides an analysis of Saint Augustine’s distinction between (...) martyrdom and suicide, highlighting the relevance of intention in the assessment of an agent’s actions. As a general matter of ethics, the intentions of agents, not just the outcomes of their actions, matter enormously for drawing distinctions between what is permissible and what is impermissible. Constructing an Augustinian account of this distinction between killing and allowing to die, the author argues that it is coherent to hold that assisted suicide is wrong, while also accepting that it is permissible to withhold or withdraw life-sustaining treatments. (shrink)

Abstract:Arguments against physicians’ claims of a right to refuse to provide tests or treatments to patients based on conscientious objection often depend on two premises that are rarely made explicit. The first is that the protection of religious liberty (broadly construed) should be limited to freedom of worship, assembly, and belief. The second is that because professions are licensed by the state, any citizen who practices a licensed profession is required to provide all the goods and services determined by the (...) profession to fall within the scope of practice of that professional specialty and permitted by the state, regardless of any personal religious, philosophical, or moral objection. In this article, I argue that these premises ought to be rejected, and therefore the arguments that depend on them ought also to be rejected. The first premise is incompatible with Locke’s conception of tolerance, which recognizes that fundamental, self-identifying beliefs affect public as well as private acts and deserve a broad measure of tolerance. The second premise unduly (and unrealistically) narrows the discretionary space of professional practice to an extent that undermines the contributions professions ought to be permitted to make to the common good. Tolerance for conscientious objection in the public sphere of professional practice should not be unlimited, however, and the article proposes several commonsense, Lockean limits to tolerance for physician claims of conscientious objection. (shrink)

Prestigious University is a large, private educational institution with a medical school, a university hospital, a law school, and graduate and undergraduate colleges all on a single campus. In the face of the Covid‐19 pandemic, students were told during spring break to return to campus only briefly to retrieve their belongings. Classes then went online. On March 23, 2020, the faculty, students, and staff were emailed the following by the university's director of infection control and public health: We have become (...) aware that a Prestigious University staff member has tested positive for the virus that causes Covid‐19. The individual, who was last on campus on March 16, is now in isolation at their permanent residence and is doing well clinically. The university has already identified those members of our community who may have been in close contact with this individual, and we are working to notify them. Further, this individual's local health department has a protocol for identifying people who have been in direct contact with anyone testing positive for Covid‐19 (such as this Prestigious University staff member) so that they can self‐quarantine and watch for COVID‐19 symptoms for a period of 14 days from their last contact with the infected individual.A professor in the Philosophy Department has asked the ethicists at the medical school whether such contact tracing suffices. “Don't the members of the community deserve to know who this is? Isn't there a mandate to identify this person in order to maximize public health benefits and slow the spread of this deadly virus?”. (shrink)

Virtue ethics seems to be a promising moral theory for understanding and interpreting the development and behavior of artificial moral agents. Virtuous artificial agents would blur traditional distinctions between different sorts of moral machines and could make a claim to membership in the moral community. Accordingly, we investigate the “machine question” by studying whether virtue or vice can be attributed to artificial intelligence; that is, are people willing to judge machines as possessing moral character? An experiment describes situations where either (...) human or AI agents engage in virtuous or vicious behavior and experiment participants then judge their level of virtue or vice. The scenarios represent different virtue ethics domains of truth, justice, fear, wealth, and honor. Quantitative and qualitative analyses show that moral attributions are weakened for AIs compared to humans, and the reasoning and explanations for the attributions are varied and more complex. On “relational” views of membership in the moral community, virtuous machines would indeed be included, even if they are indeed weakened. Hence, while our moral relationships with artificial agents may be of the same types, they may yet remain substantively different than our relationships to human beings. (shrink)

The word ‘dignity’ is used in a variety of ways in bioethics, and this ambiguity has led some to argue that the term must be expunged from the bioethical lexicon. Such a judgment is far too hasty, however. In this article, the various uses of the word are classified into three serviceable categories: intrinsic, attributed, and inflorescent dignity. It is then demonstrated that, logically and linguistically, the attributed and inflorescent meanings of the word presuppose the intrinsic meaning. Thus, one cannot (...) conclude that these meanings are arbitrary and unrelated. This categorization and logical and linguistic analysis helps to unravel what seem to be contradictions in discourse about dignity and bioethics, and provides a hierarchy of meaning that has potential normative implications. (shrink)

This article traces the history of the concept of dignity in Western thought, arguing that it became a formal Catholic theological concept only in the late nineteenth century. Three uses of the word are distinguished: intrinsic, attributed, and inflorescent dignity, of which, it is argued, the intrinsic conception is foundational. The moral norms associated with respect for intrinsic dignity are discussed briefly. The scriptural and theological bases for adopting the concept of dignity as a Christian idea are elucidated. The article (...) concludes by discussing the relevance of this concept of dignity to the spiritual and ethical care of the dying. (shrink)

Euthanasia and rational suicide were acceptable practices in some quarters in antiquity. These practices all but disappeared as Hippocratic, Jewish, Christian, and Muslim beliefs took hold in Europe and the Near East. By the late nineteenth century, however, a political movement to legalize euthanasia and physician-assisted suicide (PAS) began in Europe and the United States. Initially, the path to legalization was filled with obstacles, especially in the United States. In the last few decades, however, several Western nations have legalized euthanasia, (...) and several US jurisdictions have now legalized PAS, giving state sanction to these once forbidden practices. With increasing social and political pressure to accept PAS, Christians need to understand how to think about this issue from an explicitly Christian perspective. Independent of the question of legalization, there are significant theological and ethical questions. This special issue aims to address those concerns, including: how does the practice of PAS or euthanasia impact our attitudes toward death, and what does it mean to “die well?” Should physicians, as healers, be involved in assisting patients who wish to bring about their own death? Are these methods significantly distinguished from other ethically justified practices in end-of-life care that also lead to a person’s death? Can Christians, both as patients and practitioners, justify the use of these methods to relieve suffering in this manner as compatible with the faith? Although these questions are not new to the debate, it is increasingly important that these controversies are addressed as the practice of PAS is popularized. (shrink)

One of the most important questions in the debate over the morality of euthanasia and assisted suicide is whether an important distinction between killing patients and allowing them to die exists. The U.S. Supreme Court, in rejecting challenges to the constitutionality of laws prohibiting physician-assisted suicide, explicitly invoked this distinction, but did not explicate or defend it. The Second Circuit of the U.S. Court of Appeals had previously asserted, also without argument, that no meaningful distinction exists between killing and allowing (...) to die. That court had reasoned that if this were so, it would be discriminatory to allow persons on life support to end their lives by removing such treatment, while those who are not connected to life support would be denied similar access to death. (shrink)

Towards the end of the last century, bioethics underwent an “empirical turn,” characterized by an increasing number of empirical studies about issues of bioethical concern. Taking a cue from the evidence-based medicine movement, some heralded this as a turn toward evidence-based ethics. However, it has never been clear what this means, and the strategies and goals of evidence-based ethics remain ambiguous. In this article, the author explores what the potential aims of this movement might be, ultimately arguing that, while the (...) development of good empirical research can and should aid in ethical deliberation, one ought to avoid assuming or suggesting that empirical studies themselves determine normative prescriptions and proscriptions. The limits of the use of empirical studies in bioethics are explored in detail, and 10 potential ways that such studies can soundly contribute to bioethics are described. Good ethics depends upon sound facts, but ethics cannot be based on evidence alone. (shrink)

This special issue of Theoretical Medicine and Bioethics takes up the question of palliative sedation as a source of potential concern or controversy among Christian clinicians and thinkers. Christianity affirms a duty to relieve unnecessary suffering yet also proscribes euthanasia. Accordingly, the question arises as to whether it is ever morally permissible to render dying patients unconscious in order to relieve their suffering. If so, under what conditions? Is this practice genuinely morally distinguishable from euthanasia? Can one ever aim directly (...) at making a dying person unconscious, or is it only permissible to tolerate unconsciousness as an unintended side effect of treating specific symptoms? What role does the rule of double effect play in making such decisions? Does spiritual or psychological suffering ever justify sedation to unconsciousness? What are the theological and spiritual aspects of such care? This introduction describes how the authors in this special issue wrestle with such questions and shows how each essay relates to the author’s individual position on palliative sedation, as developed in greater detail within his contribution. (shrink)

The dead donor rule (DDR) originally stated that organ donors must not be killed by and for organ donation. Scholars later added the requirement that vital organs should not be procured before death. Some now argue that the DDR is breached in donation after circulatory determination of death (DCDD) programs. DCDD programs do not breach the original version of the DDR because vital organs are procured only after circulation has ceased permanently as a consequence of withdrawal of life-sustaining therapy. We (...) hold that the original rendition of the DDR banning killing by and for organ donation is the fundamental norm that should be maintained in transplantation ethics. We propose separating the DDR from two other fundamental normative rules: the duties to prevent harm and to obtain informed consent. (shrink)

While there has been much discussion about the role of oaths in medical ethics, this discussion has previously centered on the content of various oaths. Little conceptual work has been done to clarify what an oath is, or to show how an oath differs from a promise or a code of ethics, or to explore what general role oath-taking by physicians might play in medical ethics. Oaths, like promises, are performative utterances. But oaths are generally characterized by their greater moral (...) weight compared with promises, their public character, their validation by transcendent appeal, the involvement of the personhood of the swearer, the prescription of consequences for failure to uphold their contents, the generality of the scope of their contents, the prolonged time frame of the commitment, the fact that their moral force remains binding in spite of failures on the part of those to whom the swearer makes the commitment, and the fact that interpersonal fidelity is the moral hallmark of the commitment of the swearer. Oaths are also distinct from codes. Codes are collections of specific moral rules. Codes are not performative utterances. They do not commit future intentions and do not involve the personhood of the one enjoined by the code. Recent attacks on oath-taking by physicians are discussed. Two arguments in favor of oath-taking are presented: one on the basis of the nature of medicine as a profession and the other on the basis of rule-utilitarian considerations. No attempt is made to define which oath a physician should swear. (shrink)

Dear Norm,Thank you for sharing such a personal and heartfelt essay. I have been asked by the editors to comment. Reading it inspires me to do so in a similarly heartfelt way. Although I don't know you well, I thought I'd write to you as if you were my patient.I share your sense that Alzheimer disease is a terrible scourge. I've seen much of this disease over a lifetime of practice, and I deeply understand its ravages and the debility and (...) suffering it causes. But what you propose is not a good solution for the problems that Alzheimer disease poses for patients, families, and society. It will ultimately do far more harm than good. Please let me try to explain. (shrink)