This paper argues that we have wrongly and not for the patient’s benefit made a form of stark autonomy our highest value which allows physicians to slip out from under their basic duty which has always been to pursue a particular patient’s good. In general – I shall argue – it is the patient’s right to select his or her own goals and the physician’s duty to inform the patient of the feasibility of that goal and of the means needed (...) to attain it. If the goal is not one that is possible, the patient, with the physician and family, must select a feasible goal and then discuss the costs/benefits of various approaches. The physician should take a leading role in helping the patient select the goal. I argue that to simply present a laundry list of means and insist that patients choose for themselves is not only abandoning patients to their autonomy but is, in fact, a crass form of violating the patient’s autonomy. Freely choosing not to choose is a choice a patient with decisional capacity is entitled to make and one that needs to be respected. (shrink)

In video games, identification with avatars—virtual entities or characters driven by human behavior—has been shown to serve many interpersonal and intraindividual functions but our understanding of the psychological variables that influence players' avatar choices remains incomplete. The study presented in this paper tested whether players' preferred style of avatar creation is linked to the magnitude of self-perceived discrepancies between who they are, who they aspire to be, and who they think they should be. One-hundred-and-twenty-five undergraduate gamers indicated their preferred avatar (...) creation style and completed a values measure from three different perspectives: their actual, ideal, and ought selves. The average actual/ideal values discrepancy was greater among those who preferred idealized avatars vs. those who preferred realistic avatars. The average actual/ought values discrepancy was greater among those who preferred completely different avatars vs. those who preferred realistic avatars. These results, therefore, offer additional evidence that self-discrepancy theory is a useful framework for understanding avatar preferences. (shrink)

Reasons and reasoning were central to the work of Paul Grice, one of the most influential and admired philosophers of the late twentieth century. In the John Locke Lectures that Grice delivered in Oxford at the end of the 1970s, he set out his fundamental thoughts about these topics; Aspects of Reason is the long-awaited publication of those lectures. They focus on an investigation of practical necessity, as Grice contends that practical necessities are established by derivation; they are necessary because (...) they are derivable. This work sets this claim in the context of an account of reasons and reasoning, allowing Grice to defend his treatment of necessity against obvious objections and revealing how the construction of explicit derivations can play a central role in explaining and justifying thought and action. Grice was still working on Aspects of Reason during the last years of his life, and although unpolished, the book provides an intimate glimpse into the workings of his mind and will refresh and illuminate many areas of contemporary philosophy. (shrink)

In this paper I: (1) Describe something of the present situation in the United States and briefly contrast this with the state of affairs in other nations of the industrialised world. I emphasise health care but also allude to other social conditions: health care is merely one institution of a society and, just as do its other institutions, the system of health care reflects the basic world-view of that society. (2) Sketch the world-view and the philosophy which underwrites the use (...) of a market system in distributing what are acknowledged to be critically important social goods like health care and higher education. I show that a well-functioning market can indeed be useful when it comes to distributing some, but not when distributing other goods. (3) Suggest that when competition and the market are used to ‘regulate’ health care, technology—instead of being used to benefit patients—is apt to be used primarily to maximise individual profit: it becomes a weapon between what is often painted as ‘warfare’ among health care providers and institutions. I argue that this state of affairs is based on an undue emphasis upon the demands of individual freedom to the detriment of the community. Finally (4) I suggest an alternative approach to balancing individual with communal interests, an approach which is neither based on a predominance of one with neglect of the other, nor on a dialectic balance between them, but rather upon an approach which sees both individual and communal interests as modifying forces in a complex homeostatic balance. Individual success, in any civilised sense of the term, is possible only in a viable and well-functioning community, and a well-functioning community is not possible without individual success: the two are inevitably interdependent and linked. (shrink)

Erhics committees and ethics consultants are becoming more involved in helping individuals make decisions and in advising institutions and legislatures about drafting policy. The role of these committees and consultants has been acknowledged in law, and their function is generally considered salutory and helpful. Ethics consultants and committees, furthermore, play a critical role in educating students and members of the hospital community and the public at large. More over, many ethicists engage in scholarky activities to expand the boundaries of our (...) understanding and, in turn, facilitate our capacity for helping. The role of the ethicist and of the ethics committee is thus manifold. Ethics committees and ethics consultants somehow “in competition” is a mistaken notion: when ethics committees, ethics consultants, and the community work smoothly together, much good can be accomplished. (shrink)

State of nature theories have a long history and play a lively role in contemporary work. Theories of this kind share certain nontrivial commitments. Among these are commitments to inclusion of a Lockean proviso among the principles of justice and to an assumption of invariance of political principles across changes of circumstances. In this article I want to look at those two commitments and bring to light what I believe are some important difficulties they engender. For nonpattern state of nature (...) theories, the justness of a society is marked by the conformance of the society to procedural principles. Distributions of resources and the like have no particular import for questions of justice. Whatever may later result, so long as it came about in accordance with the rules determined by the principles of justice, is itself just. The Lockean proviso is one of the principles of justice governing property and other rights of nonpattern theories of justice. The proviso hangs as a "shadow" over the results of the operation of the other (usual) principles of justice. It is intended to remedy a complaint which arises when the positions of those no longer at liberty to use some resource are worsened (1) by no longer being able to use freely what they previously were free to use and (2) in such a way that they fall below a "baseline." Following Locke, a traditional formulation of the proviso is to allow acquisition just so long as there is "enough and as good" left over for others. Section I concerns the relation of the Lockean proviso to pattern and nonpattern principles of justice, demonstrating that a Lockean proviso turns a nonpattern into a pattern theory of justice. Section II is about the relation of the Lockean proviso to the ideas revealed by an examination of a state of nature, suggesting reasons to reject ideal theories of justice. (shrink)

An ‘ideal’ health care system would be unencumbered by economic considerations and provide an ample supply of well-paid health care professionals who would supply culturally appropriate optimal health care to the level desired by patients. An ‘ideal’ health care system presupposes an ‘ideal’ society in which resources for all social goods are unlimited. Changes within health care systems occur both because of changes within the system and because of changes or demands in and by the ‘exterior environment’. Social systems must (...) be in a homeostatic balance. If one component fails to accommodate itself to other forces, needs and interests within the system, the system is imperiled. It is difficult to create a just health care system in an unjust society, just as it is difficult to practise truly ethical medicine in an ethically corrupt system. (shrink)

This paper examines the role of the physician in a pluralistic community. A personal and communal sense of identity must resolve a vast array of often conflicting backgrounds and contexts in order to function smoothly. Physicians are neither entitled to impose their own moral views on their patients nor expected to surrender their own moral agency. Several illustrative cases are given. The solution of inevitable conflicts is embodied within the context of the situation, but since irreconcilable differences remain, a resolution (...) is not always possible. Tolerance for such differences and ways of dealing with them allows the integrity of both parties to remain intact. (shrink)

A recent paper in this journal (1) suggests that involving terminally ill patients in choices concerned with Cardio-Pulmonary Resuscitation (CPR) produces 'psychological pain' and therefore is ill-advised. Such a claim rests on anecdotal observations made by the authors. In this paper I suggest that drawing conclusions in ethics, no less than in science, requires a rigorous framework and cannot be relegated to personal observation of a few cases. The paper concludes by suggesting that patients, if we acknowledge their valid interest (...) in making their own choices, must themselves be allowed to make a prior choice about choosing. Those who may not wish to choose may properly be relieved of this burden and may allow another to choose for them. Routinely allowing others to make choices for competent adults, however, is likely to decrease communication with the dying patient and to introduce an atmosphere of suspicion and fear and to exclude the competent patient from his/her rightful place in the community. (shrink)

An ‘ideal’ health care system would be unencumbered by economic considerations and provide an ample supply of well-paid health care professionals who would supply culturally appropriate optimal health care to the level desired by patients. An ‘ideal’ health care system presupposes an ‘ideal’ society in which resources for all social goods are unlimited. Changes within health care systems occur both because of changes within the system and because of changes or demands in and by the ‘exterior environment’. Social systems must (...) be in a homeostatic balance. If one component fails to accommodate itself to other forces, needs and interests within the system, the system is imperiled. It is difficult to create a just health care system in an unjust society, just as it is difficult to practise truly ethical medicine in an ethically corrupt system. (shrink)

Long-term care is controversial because it involves foundational disputes. Some are moral-economic, bearing on whether the individual, the family, or the state is primarily responsible for long-term care, as well as on how one can establish a morally and financially sustainable long-term-care policy, given the moral hazard of people over-using entitlements once established, the political hazard of media democracies promising unfundable entitlements, the demographic hazard of relatively fewer workers to support those in need of long-term care, the moral hazard to (...) responsibility of shifting accountability to third parties, and the bureaucratic hazard of moving from individual and family choice to bureaucratic oversight. These disputes are compounded by controversies regarding the nature of the family (Is it to be regarded primarily as a socio-biological category, a fundamental ontological category of social reality, or a construct resulting from the consent of the participants?), as well as its legal and moral autonomy and authority over its members. As the disputes show, there is no common understanding of respect and human dignity that will easily lead out of these disputes. The reflections on long-term care in this issue underscore the plurality of moralities defining bioethics. (shrink)

The works of Paul Grice collected in this volume present his metaphysical defense of value, and represent a modern attempt to provide a metaphysical foundation for value. Value judgments are viewed as objective; value is part of the world we live in, but nonetheless is constructed by us. We inherit, or seem to inherit, the Aristotelian world in which objects and creatures are characterized in terms of what they are supposed to do. We are thereby enabled to evaluate by reference (...) to function and finality. The most striking part of Grice's position, however, is his contention that the legitimacy of such evaluations rests ultimately on an argument for absolute value. (shrink)

Working-memory retention as activated long-term memory fails to capture orchestrated processing and storage, the hallmark of the concept of working memory. The event-related potential (ERP) data are compatible with working memory as a mental workspace that holds and manipulates information on line, which is distinct from long-term memory, and deals with the products of activated traces from stored knowledge.

This paper discusses the possibility of finding an ethic of at least partial and perhaps ever-growing content in a world not that of moral strangers (where we have nothing except our desire to live freely to unite us) and one of moral friends (in which values, goals and ways of doing things are held in common). I argue that both the world of moral strangers which Engelhardt's world view would support, as the world of moral friends which is the one (...) Pellegrino seeks both are untenable and that furthermore both can lead to a similar state of affairs. I suggest a dynamic world of moral acquaintances in which different belief systems and ways of doing things can come to some broad agreements about some essential thing. This is made possible because although we do not share the intimate framework Pellegrino might suggest, yet we are united by a much broader framework than the one moral strangers share. (shrink)

This paper argues for the necessity of universal health care (as well as universal free education) using a different argument than most that have been made heretofore. It is not meant to conflict with but to strengthen the arguments previously made by others. Using the second paragraph of the Declaration of Independence and the Preamble to the Constitution we argue that universal health care in this day and age has become a necessary condition if the ideals of life, liberty and (...) the pursuit of happiness are to be more than an empty promise and if the discussion of “promoting of general welfare” in the preamble is to have any meaning. (shrink)

This paper examines the reactions of physicians and other health-professionals when they become involved in decisions about the death of their patients. The way people understand the condition of death has a profound influence on attitudes towards death and dying issues. Four traditional views of death are explored. The problem that physicians have in helping patients die is analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the (...) community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary. (shrink)

Glenberg focuses on conceptualizations that change from moment to moment, yet he dismisses the concept of working memory (sect. 4.3), which offers an account of temporary storage and on-line cognition. This commentary questions whether Glenberg's account adequately caters for observations of consistent data patterns in temporary storage of verbal and visuospatial information in healthy adults and in brain-damaged patients with deficits in temporary retention.

Context: Although the theory of autopoietic systems was originally formulated to explain the phenomenon of life from an operational and temporal perspective, sociologist Niklas Luhmann incorporated it later within his theory of social systems. Due to this adoption, there have been several discussions regarding the applicability of this concept beyond its biological origins. Problem: This article addresses the conception of Luhman’s autopoietic social systems, and confronts this vision with criticism both of the original authors of the concept of autopoiesis and (...) of other social theorists in order to elucidate the main problems of this debate and its possible solutions. Method: The objectives of the article are reached by means of a theoretical reconstruction of the main issues of the debate on the concept of autopoiesis. The main method used for the research is the use of documentary sources to discuss the arguments. Results: We claim that it is justified to extend the concept of autopoiesis from its biological origin to other disciplines, and to develop its interdisciplinary character, following the spirit of systems theory and constructivism. Implications: Our results are useful for promoting the development of new interdisciplinary research in the field of systems theory and constructivism. Important changes to practice should be made, namely, the development of new research methods, new concepts and perspectives. Constructivist content: The concept of autopoiesis is one of the fundamental concepts of the constructivist epistemology. The discussion proposes a radical understanding of this concept in order to realize all its explanatory potential. (shrink)

Nocebo effects occur when an individual experiences undesirable physiological reactions caused by doxastic states that are not a treatment’s core or characteristic features.1 As Scott Gelfand2 points out, there are numerous studies that have shown that the disclosure of a treatment’s side effects to a patient increases the risk of the side effects. From an ethical point of view, nocebo effects caused by the disclosures of side effects present a challenging problem. On the one hand, clinicians’ duty to inform patients (...) of the consequences (including possible side effects) of their treatments is critical in ensuring that patients’ autonomy is respected. Patients cannot act autonomously if relevant information is withheld from them (without their consent, perhaps). On the other hand, clinicians also ought to minimize harm to patients. (shrink)

Originally published in 1970 this title commemorates the men and ideas that started, inspired and established a pioneer institution in British psychiatry. Based on the impetus of Freudian and related innovations after the First World War, the Tavistock Clinic offered treatment, training and research facilities in the field of neurosis, child guidance and later on group relations. Dr Dicks, who had been associated for nearly forty years with the work and personalities that helped to develop the Tavistock venture, describes the (...) struggles and capacity for survival of the clinic. He shows how, belonging neither to the older classical psychiatry nor to orthodox psychoanalysis, and suspect to both, the Clinic nevertheless became increasingly used by the rest of the profession as a psychotherapeutic resource. Dr Dicks describes the influence of the Tavistock on the medical, psychological and social work scene both before and after the Second World War, and assesses its achievements as a centre of psycho- and socio-dynamic thinking. The Tavistock is shown as a pioneer _sui generis_, launching psychosomatic research and initiating the exciting ventures in social psychiatry associated with the Army in the Second World War. As the Tavistock was the outcome of work with shell-shock victims in the first war, so its offspring, the Institute of Human Relations, was the natural continuation of the military effort in man-management, morale and group dynamic studies. The book includes an account of the inter-relationship between the Clinic, now part of the National Health Service, and the Institute, a private corporation. Still going strong as part of the Tavistock and Portman NHS Foundation Trust today this is an opportunity to revisit its early history. (shrink)