Contemporary clinical ethics was founded on principlism, and the four principles: respect for autonomy, nonmaleficence, beneficence and justice, remain dominant in medical ethics discourse and practice. These principles are held to be expansive enough to provide the basis for the ethical practice of medicine across cultures. Although principlism remains subject to critique and revision, the four-principle model continues to be taught and applied across the world. As the practice of medicine globalizes, it remains critical to examine the extent to which (...) both the four-principle framework, and individual principles among the four, suffice patients and practitioners in different social and cultural contexts. Using the four-principle model we analyze two accounts of surrogate decision making – one from the developed and one from the developing world – in which the clinician undertakes medical decision-making with apparently little input from the patient and/or family. The purpose of this analysis is to highlight challenges in assessing ethical behaviour according to the principlist model. We next describe cultural expectations and mores that inform both patient and clinician behaviors in these scenarios in order to argue that the principle of respect for persons informed by culture-specific ideas of personhood may offer an improved ethical construct for analyzing and guiding medical practice in a globalized and plural world. (shrink)

It is often said that the world is explained by laws of nature together with initial conditions. But does that mean initial conditions don’t require further explanation? And does the explanatory role played by initial conditions entail or require that time has a preferred direction? This chapter looks at the use of the ‘initialness defence’ in physics, the idea that initial conditions are intrinsically special in that they don’t require further explanation, unlike the state of the world at other times. (...) Such defences commonly assume a primitive directionality of time to distinguish between initial and final conditions. Using the case study of the time-asymmetry of thermodynamics and the so-called ‘past hypothesis’ — the hypothesis that the early universe was in a state of very low entropy —, I outline and support a deflationary account of the initialness defence that does not pre- suppose a basic directionality of time, and argue that there is a relevant explanatory asymmetry between initial conditions and the state of systems at other times only if certain causal conditions are satisfied. Hence, the initialness defence is available to those who reject a fundamental direction of time. (shrink)

In the two feature articles for this volume, Gruber et al and Buonomano & Rovelli focus on what the former call the 'two-times problem', in short, the apparent lack of fit between time as described by physical science and our own temporal experience, where 'experience' involves things like memory, anticipation, and perception of change and motion. In this short note I'll make the case that the twotimes problem is less serious than it is often made out to be in the (...) specific case of features like 'passage ' and 'presentness' that are central to the 'A-theory' of time ---the theory that holds time to be composed of dynamic regions of 'past', 'present' and future', and for time to genuinely flow or pass.My contention is three-fold: (1) the two-times problem is better understood as a three-times problem: rather than a conflict between 'physical' and 'manifest' time, what we have in the case of time is differences between the time of physics, the time of experience, and the 'folk' concept of time. (2) Understanding the problem in this way helps deflate certain problems about the relationship of these three pictures; the time of experience and the time of physics are less obviously in a problematic conflict than often supposed; and the folk concept of time is what brings in problematic features of time hard to fit with either the time of physics of experience. (3) Understanding the time of experience as independent from the folk concept of time better fits the actual aims of the... (shrink)

Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome. Peace is wanted. Comfort is needed. Sedation appears to bring both. Yet to be sedated is to be cut off existentially from human experience, (...) to be made incapable of engaging self-consciously in any human action. To that extent, it seems that to lose consciousness is to lose something of real value. In this paper, I describe how sedation and the question of intentionally bringing about sedation arise in the care of patients with advanced illness, and I propose heuristics to guide physicians, including Christian physicians, who seek to relieve suffering without contradicting their profession to heal. (shrink)

What would it be for a process to happen backwards in time? Would such a process involve different causal relations? It is common to understand the time-reversal invariance of a physical theory in causal terms, such that whatever can happen forwards in time can also happen backwards in time. This has led many to hold that time-reversal symmetry is incompatible with the asymmetry of cause and effect. This article critiques the causal reading of time reversal. First, I argue that the (...) causal reading requires time-reversal-related models to be understood as representing distinct possible worlds and, on such a reading, causal relations are compatible with time-reversal symmetry. Second, I argue that the former approach does, however, raise serious sceptical problems regarding the causal relations of paradigm causal processes and as a consequence there are overwhelming reasons to prefer a non-causal reading of time reversal, whereby time reversal leaves causal relations invariant. On the non-causal reading, time-reversal symmetry poses no significant conceptual nor epistemological problems for causation. _1_ Introduction _1.1_ The directionality argument _1.2_ Time reversal _2_ What Does Time Reversal Reverse? _2.1_ The B- and C-theory of time _2.2_ Time reversal on the C-theory _2.3_ Answers _3_ Does Time Reversal Reverse Causal Relations? _3.1_ Causation, billiards, and snooker _3.2_ The epistemology of causal direction _3.3_ Answers _4_ Is Time-Reversal Symmetry Compatible with Causation? _4.1_ Incompatibilism _4.2_ Compatibilism _4.3_ Answers _5_ Outlook. (shrink)

Experiences of motion and change are widely taken to have a ‘flow-like’ quality. Call this ‘temporal qualia’. Temporal qualia are commonly thought to be central to the question of whether time objectively passes: (1) passage realists take temporal passage to be necessary in order for us to have the temporal qualia we do; (2) passage antirealists typically concede that time appears to pass, as though our temporal qualia falsely represent time as passing. I reject both claims and make the case (...) that passage-talk plays no useful explanatory role with respect to temporal qualia, but rather obfuscates what the philosophical problem of temporal qualia is. I offer a ‘reductionist’ account of temporal qualia that makes no reference to the concept of passage and argue that it is well motivated by empirical studies in motion perception. (shrink)

“The universe is expanding, not contracting.” Many statements of this form appear unambiguously true; after all, the discovery of the universe’s expansion is one of the great triumphs of empirical science. However, the statement is time-directed: the universe expands towards what we call the future; it contracts towards the past. If we deny that time has a direction, should we also deny that the universe is really expanding? This article draws together and discusses what I call ‘C-theories’ of time — (...) in short, philosophical positions that hold time lacks a direction — from different areas of the literature. I set out the various motivations, aims, and problems for C-theories, and outline different versions of antirealism about the direction of time. (shrink)

Modern physics has provided a range of motivations for holding time to be fundamentally undirected. But how does a temporally adirectional metaphysics, or ‘C-theory’ of time, fit with the time of experience? In this chapter, I look at what kind of problem human time poses for C-theories. First, I ask whether there is a ‘hard problem’ of human time: whether it is in principle impossible to have the kinds of experience we do in a temporally adirectional world. Second I consider (...) the ‘easy problem’: how specific directed aspects of our temporal experience are to be explained by C-theorists. This leads to a greater issue: is there such a thing as an experience of time direction at all to even be explained? I show how the kinds of experience we have that we typically associate with the idea of time being directed can be accommodated within a directionless picture of time. (shrink)

This paper assesses branching spacetime theories in light of metaphysical considerations concerning time. I present the A, B, and C series in terms of the temporal structure they impose on sets of events, and raise problems for two elements of extant branching spacetime theories—McCall’s ‘branch attrition’, and the ‘no backward branching’ feature of Belnap’s ‘branching space-time’—in terms of their respective A- and B-theoretic nature. I argue that McCall’s presentation of branch attrition can only be coherently formulated on a model with (...) at least two temporal dimensions, and that this results in severing the link between branch attrition and the flow of time. I argue that ‘no backward branching’ prohibits Belnap’s theory from capturing the modal content of indeterministic physical theories, and results in it ascribing to the world a time-asymmetric modal structure that lacks physical justification. (shrink)

In what sense is the direction of time a matter of convention? In 'The Direction of Time', Hans Reichenbach makes brief reference to parallels between his views about the status of time’s direction and his conventionalism about geometry. In this article, I: (1) provide a conventionalist account of time direction motivated by a number of Reichenbach’s claims in the book; (2) show how forwards and backwards time can give equivalent descriptions of the world despite the former being the ‘natural’ direction (...) of time; and (3) argue that this offers an important middle-ground position between existing realist and antirealist accounts of the direction of time. (shrink)

This thesis introduces and defends a ‘C theory’ of time. The metaphysics of time literature is primarily concerned with the distinction between the A and B theories of time, with the disagreement concerning whether the passage of time is an objective feature of reality. I argue that the distinction between the B and C theories—in terms of whether time has a ‘privileged’ direction—is of more obvious relevance to the philosophy of physics than is the distinction between the A and B (...) theories. The thesis has three main contentions. (1) In order to maintain a substantial metaphysical dispute between the different theories of time, they must be defined in terms of structural properties, and the naturalistic metaphysics of time direction involves the assessment of these structures in light of contemporary physics. (2) The A theory of time requires a model with two temporal dimensions, and although such a model provides a resolution to a number of problems faced by standard A theories, it is not motivated by physical theory. (3) The dispute between the B and C theories of time is of direct relevance to the philosophy of physics: the B theorist’s assumption of the existence of a privileged temporal direction is of explanatory relevance to physics; and a comparison between unidirectional and adirectional explanations in physics can in principle shed light on whether time is B- or C-theoretic. (shrink)

Audio description remains the cornerstone of accessibility for visually impaired audiences to all sorts of audiovisual content, including porn. Existing work points to the efficacy of audio description to guarantee immersion and emotional engagement, but evidence on its role in sexual arousal and engagement in porn is still scant. The present study takes on this challenge by comparing sighted and visually impaired participants’ experiences with porn in terms of their physiological response [i.e., cortisol and heart rate ] and self-report measures (...) of affect [Positive and Negative Affect Schedule ; Watson et al., 1988], anxiety [State-Trait Anxiety Inventory ; Spielberger et al., 1970], sexual reactivity and arousal [Sexual Inhibition/Sexual Excitation Scale ; Moyano and Sierra ; and the Ratings of Sexual Arousal ; Mosher ], and narrative engagement or transportation [The Transport Narrative Questionnaire, Green and Brock ]. 69 Spanish participants were allocated into three different groups: 25 sighted participants who watched and heard the porn scenes in their audio-visual version ; 22 sighted participants who listened to the audio described version without images ; and 22 visually impaired participants who also listened to the audio described version without images. Overall, results on physiological and self-report measures revealed no significant differences between groups or different versions of the clips. The analysis of cortisol reactivity to porn as the maximum increase or decrease in cortisol with respect to baseline values revealed no significant differences between the groups, but pointed to a higher percentage of non-responders than responders in the three groups, the highest being found in the ONCE group. As for participants’ cardiac response to the clips, no significant differences were found across the groups, with the highest HR levels being registered in the baseline phase. Self-report measures revealed significant between-group differences in negative affect. The ONCE group displayed the highest pre-task levels of negative affect and was the only group that showed a decrease in negative affect after exposure to the clips. Sighted and visually impaired participants reported to be moderately aroused and immersed in the films, regardless of exposure to AV or AD porn. In addition, correlations found between participants’ levels of self-report sexual arousal and transportation and post-task affect pointed to a positive relationship between exposure to porn and perceived levels of sexual arousal and affect. Results from the study reflected the efficacy of audio description in providing sighted and visually impaired audiences with a similar experience to that offered by original AV porn scenes. This study is exploratory but provides valid, initial groundwork for further research on the impact of audio description on porn reception. (shrink)

Is solidarity in bioethics or public health ethics necessary? If so, why? Is there room for a principle of obligatory solidarity in bioethics or in public health ethics? In the first part of this paper, I assess the meaning of the value of solidarity in ethics. In the second part, I propose insights into the republican interpretation of solidarity, or, more correctly, “civic” solidarity. This is crucial to be able to distinguish between different sources of, and justifications for, solidarity, some (...) legitimate and some not legitimate. In the third part of the paper, I apply the republican concept of civic solidarity to the field of bioethics and public health ethics. This is intended to show how civic republicanism can correct both liberal deficiencies and communitarian excesses in bioethics. Civic solidarity is essential to finding this middle way. It is a key concept, considering the challenges that we face as citizens, health professionals and patients. Finally, the paper concludes with a summary and a plan for further research in this area. (shrink)

Here I want to examine two different ways of viewing/reading Black Panther. I will call the first reading the Standard Morality Reading (SMR). I will call the second reading the Liberation Morality Reading (LMR). I argue that these two readings, and the forms of morality that influence them, are in tension with each other throughout the movie. They also produce a tension or moral struggle in King T’Challa and the citizens of Wakanda in general.

In this paper I will examine the ways in which concepts and ideas that are used for emancipatory purposes eventually backfire and are used to perpetuate systems of domination. Part of my argument will be based on Herbert Marcuse’s essay “Repressive Tolerance.” In this essay, Marcuse examines the way in which the concept of tolerance, which has its origin in the struggle for liberation, is used by members of dominant social groups to advocate for tolerance of their oppressive views. Following (...) Marcuse’s lead, I will argue that almost all emancipatory ideas, particularly diversity and color-blindness in this context, can be co-opted by the dominant social group and used to further domination. I will argue that even our best emancipatory concepts are formed within the context of a hegemonic discourse that alters their meaning and use. (shrink)

ABSTRACT The focus of this essay is Kant's argument in the Groundwork for the Metaphysics of Morals III that regarding oneself as rational implies regarding oneself as free. After setting out an interpretation of how the argument is meant to go, I argue that Kant fails to show that regarding oneself as free is incompatible with accepting universal causal determinism. However, I suggest that the argument succeeds in showing that regarding oneself as rational is inconsistent with accepting universal causal determinism (...) if one accepts a certain, plausible view of the explanation of events. RESUMEN El ensayo se enfoca en el argumento de Kant en la Fundamentación de la metafísica de las costumbres III según el cual considerarse racional implica verse a uno mismo como libre. Se interpreta la forma en que debe entenderse el argumento y se afirma que Kant no logra demostrar que considerarse libre es incompatible con la aceptación del determinismo casual universal. No obstante, se sugiere que el argumento sí logra demostrar que considerarse a uno mismo como racional es incompatible con la aceptación del determinismo casual universal, si se acepta una cierta versión plausible de la explicación de los eventos. (shrink)

How should we read Jürgen Habermas, and is it possible to defend a nonfoundationalist conception of communicative reason? In “‘No-Saying’ in Habermas,” Stephen K. White and Evan Robert Farr read Habermas’s writings on civil disobedience through the idea of no-saying, which they believe to be “just as primordial” as consensus or yes-saying in Habermas’s theory of communicative reason. By underlining this otherwise underdeveloped aspect of no-saying in Habermas’s work, White and Farr believe that it is possible to avoid an unwarranted (...) emphasis on consensus and to salvage a non-foundationalist conception of communicative reason. In developing their argument, White and Farr use my deconstructive reading of Habermas’s writings on civil disobedience as a point of contrast, and this gives me the opportunity to clarify the strategy of the deconstructive reading and the differences over foundationalism that divide my deconstructive approach from White and Farr’s reconstruction of Habermas’s communicative paradigm. I argue (1) that they misconceive the relationship between the deconstruction and the deconstructed text and (2) that they end up defending a view of communicative voice too uncritical of what it means to have a voice. (shrink)

Today's medicine is spiritually deflated and morally adrift; this book explains why and offers an ethical framework to renew and guide practitioners in fulfilling their profession to heal. What is medicine and what is it for? What does it mean to be a good doctor? Answers to these questions are essential both to the practice of medicine and to understanding the moral norms that shape that practice. The Way of Medicine articulates and defends an account of medicine and medical ethics (...) meant to challenge the reigning provider of services model, in which clinicians eschew any claim to know what is good for a patient and instead offer an array of "health care services" for the sake of the patient's subjective well-being. Against this trend, Farr Curlin and Christopher Tollefsen call for practitioners to recover what they call the Way of Medicine, which offers physicians both a path out of the provider of services model and also the moral resources necessary to resist the various political, institutional, and cultural forces that constantly push practitioners and patients into thinking of their relationship in terms of economic exchange. Curlin and Tollefsen offer an accessible account of the ancient ethical tradition from which contemporary medicine and bioethics has departed. Their investigation, drawing on the scholarship of Leon Kass, Alasdair MacIntyre, and John Finnis, leads them to explore the nature of medicine as a practice, health as the end of medicine, the doctor-patient relationship, the rule of double effect in medical practice, and a number of clinical ethical issues from the beginning of life to its end. In the final chapter, the authors take up debates about conscience in medicine, arguing that rather than pretending to not know what is good for patients, physicians should contend conscientiously for the patient's health and, in so doing, contend conscientiously for good medicine. The Way of Medicine is an intellectually serious yet accessible exploration of medical practice written for medical students, health care professionals, and students and scholars of bioethics and medical ethics. (shrink)

RESUMEN El artículo responde algunas críticas planteadas por Ignacio Ávila a mi interpretación de la epistemología davidsoniana. Presento argumentos en contra de: a) que sea necesario distinguir entre representaciones epistemológicamente “peligrosas”e “inofensivas”; b) que el empirismo mínimo sea un tipo de realismo directo; c) que mi uso de la expresión “evidencia distal” y el interés por la teoría de la correspondencia sean asuntos ajenos a Davidson. Finalmente, sostengo que la triangulación es un elemento fundamental de la epistemología davidsoniana, pues permite (...) sortear la ansiedad realista manteniéndose en una postura no representacionalista. ABSTRACT In this article, I respond to some of Ignacio Ávila's criticisms of my interpretation of Davidson’s epistemology. I argue against: a) the need to distinguish between epistemologically “dangerous” and “harmless” representations; b) the idea that minimal empiricism is a kind of direct realism; and c) the claim that my usage of the expression “distal evidence” and interest in the theory of correspondence are issues that do not pertain to Davidson. Finally, I claim that triangulation is a key element in Davidsonian epistemology since it allows us to deal with the realist anxiety while maintaining a non-representationalist viewpoint. (shrink)

While science is taken to differ from non-scientific activities in virtue of its methodology, metaphysics is usually defined in terms of its subject matter. However, many traditional questions of metaphysics are addressed in a variety of ways by science, making it difficult to demarcate metaphysics from science solely in terms of their subject matter. Are the methodologies of science and metaphysics sufficiently distinct to act as criteria of demarcation between the two? In this chapter we focus on several important overlaps (...) in the methodologies used within science and metaphysics in order to argue that focusing solely on methodology is insufficient to offer a sharp demarcation between metaphysics and science, and consider the consequences of this for the wider relationship between science and metaphysics. (shrink)

It is common wisdom that today’s medicine focuses too much on treating those who are sick and too little on preventing the sickness in the first place. This essay proposes that Jesus’ teaching in the Sermon on the Mount challenges that assumption and the preventive medicine to which it has given rise. In light of Jesus’ teaching, the essay identifies four apparent problems with much of preventive medicine. It then offers four heuristics that might form a basic Christian logic for (...) medicalizing risk—for discerning when and why it would be fitting, wise, and faithful for Christians to make use of medicine to avoid future illness and death. (shrink)

Pedro Cerezo ha dedicado una obra ya muy extensa al estudio del pensamiento español así como al estudio de la filosofía moderna y contemporánea, pero ha sido sobre todo en su lectura del Quijote, culminada en su reciente libro El Quijote y la aventura de la libertad, donde ha cruzado productivamente esas dos líneas de pensamiento, la que le conducía a la cuestión «pensar en español » y la que le llevaba a «la cuestión de la modernidad», aportando claves importantes (...) que ayudan a completar nuestra comprensión de la modernidad y a replantear productivamente la cuestión de la función y posibilidad de la filosofía en la actualidad. El presente artículo se ocupa de exponer el papel que, según Cerezo, tiene el Quijote en la constitución de la modernidad y reconstruyendo su idea de un «pensamiento español» de carácter literario capaz de aportar a la modernidad nuevas posibilidades. (shrink)

Uncivil behavior by leaders may be viewed as an effective way to motivate employees. However, supervisor incivility, as a form of unethical supervision, may be undercutting employees’ ability to do their jobs. We investigate linkages between workplace incivility and perceived work ability, a variable that captures employees’ appraisals of their ability to continue working in their jobs. We draw upon the appraisal theory of stress and social identity theory to examine incivility from supervisors as an antecedent to PWA, and to (...) investigate job involvement and grit as joint moderators of this association. Results from data collected in two samples of working adults provided evidence for three-way interactions in relation to PWA. Among employees with high levels of grit, there was no significant relation between supervisor incivility and PWA, regardless of employee job involvement. However, we found some evidence that for those low in grit, having high job involvement was associated with a stronger relationship between supervisor incivility and PWA. Findings attest to the importance of unethical supervisor behavior, showing the potential for supervisor incivility to erode PWA, as well as the importance of grit as a potential buffer. (shrink)

Abordaré la crítica de Axel Honneth a la primera Escuela de Frankfurt y su aparente omisión de Herbert Marcuse. Defenderé a Marcuse contra algunas de las críticas hechas por Honneth a la teoría crítica temprana de la Escuela de Frankfurt. Luego argumentaré que Marcuse siempre estuvo en busca de una subjetividad radical, incluso cuando advirtió contra los mecanismos unidimensionales en curso de producción de sujetos. Finalmente, mostraré que Honneth también construye su proyecto en torno a la búsqueda de una subjetividad (...) radical, pero aborda el problema a través de una teoría de la intersubjetividad que complementa el proyecto de Marcuse. (shrink)

The medical profession’s increasing acceptance of “physician aid-in-dying” indicates the ascendancy of what we call the provider-of-services model for medicine, in which medical “providers” offer services to help patients maximize their “well-being” according to the wishes of the patient. This model contrasts with and contradicts what we call the Way of Medicine, in which medicine is a moral practice oriented to the patient’s health. A steadfast refusal intentionally to harm or kill is a touchstone of the Way of Medicine, one (...) unambiguously affirmed by Christians through the centuries. Moreover, physician aid-in-dying contradicts one of the distinctive contributions that the Christian era brought to medicine, namely, a taken-for-granted solidarity between medical practitioners and those suffering illness and disability. Insofar as medical practitioners cooperate in aid-in-dying, they contradict this solidarity and undermine the trust that patients need to allow themselves to be cared for by physicians when they are sick and debilitated. (shrink)

Market metaphors have come to dominate discourse on medical practice. In this essay, we revisit Peter Berger and colleagues’ analysis of modernization in their book The Homeless Mind and place that analysis in conversation with Max Weber’s 1917 lecture “Science as a Vocation” to argue that the rise of market metaphors betokens the carry-over to medical practice of various features from the institutions of technological production and bureaucratic administration. We refer to this carry-over as the product presumption. The product presumption (...) foregrounds accidental features of medicine while hiding its essential features. It thereby confounds the public understanding of medicine and impedes the professional achievement of the excellences most central to medical practice. In demonstrating this pattern, we focus on a recent article, “Physicians, Not Conscripts—Conscientious Objection in Health Care,” in which Ronit Stahl and Ezekiel Emanuel decry conscientious refusals by medical practitioners. We demonstrate that Stahl and Emanuel’s argument depends on the product presumption, ignoring and undermining central features of good medicine. We conclude by encouraging conscientious resistance to the product presumption and the language it engenders. (shrink)

Cognitive science has recently made some startling discoveries about temporal experience, and these discoveries have been drafted into philosophical service. We survey recent appeals to cognitive science in the philosophical debate over whether time objectively passes. Since this research is currently in its infancy, we identify some directions for future research.

If man has no nature - if our intellect and understanding are products of our own activities - do we possess a key to self-modification? Are we free to re-make mankind? Sartre champions the romantic idea that we can - by sheer determination - begin afresh. Oakeshott is struck by the vandalism of such a project - he seeks to defend political culture from degradation by meddling academics. The Radical and Conservative understanding of social order and the human self are (...) compared in this in-depth analysis of two contrasting philosophies. (shrink)

For most of the past generation, clinicians have been taught to treat patients' pain until the patient says it is relieved. The opioid crisis has forced both clinicians and patients to reconsider that approach. This essay considers how Christians in particular might assume and seek to overcome their experiences of persistent pain. Wise and faithful responses to pain, especially chronic pain, can take their bearings from how early Christians made sense of the place of both medicine and suffering in a (...) faithful life. This results in not asking medicine to resolve persistent pain, especially not through the use of opioids. Resisting the impulse to medicalize chronic pain will require patience on the part of those who suffer, and both patience and fortitude on the part of the clinicians to whom they present. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life care, bioethics, and (...) health policy discuss if age should guide rationing decisions. (shrink)