Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it tenable for clinicians to follow guidelines? Whose or what interests are served by applying performance (...) assessments? Does such application improve medical care quality? What happens when the best interests of vested parties conflict? Mindful of the constellation of socially and clinically relevant variables influencing health outcomes, is it fair to apply evidence-based performance assessment tools to judge the merits of clinical decision-making? Finally, is it fair and just to incentivize clinicians in ways that might sway clinical judgment? To address these questions, we consider various clinical applications of performance assessment strategies, examining what performance measures purport to measure, how they are measured and whether such applications demonstrably improve quality. With attention to the merits and frailties associated with such applications, we devise and defend criteria that distinguish between justice-sustaining and justice-threatening performance-based clinical protocols. (shrink)

Henri Bergson (1859-1941) was once the most famous philosopher in the world, but his reputation waned in the latter half of the 20th century. Barry Allen here makes the case for Bergson as a great philosopher, one whose thought has much to contribute to contemporary philosophical questions. Living in Time presents chapters on each of Bergson's four major works, explaining his theories of time, perception, memory, and panpsychic consciousness, his innovative concept of virtual existence, his objection to Darwin, his (...) controversy with Einstein, his philosophy of creative evolution, and his social philosophy of closed and open society. In particular Allen focusses on Bergson's powerful ideas on time. Classical arguments for determinism fallaciously apply spatial concepts to consciousness; once we take time seriously, which means acknowledging its reality as duration and its difference from space, Bergson showed that the arguments for determinism become insupportable. Bergson's ideas on time and evolution offer a comparison with Nietzsche, which Allen develops, exposing both philosophical concurrence and systematic difference. The book's conclusion discusses the question of Bergson and naturalism and summarizes the ontology of the virtual that emerges as a core part of Bergson's thought. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:NATURAL LAW, IMPARTIALISM, AND OTHERS' GOOD* MARK C. MURPHY Georgetown University Washington, D.C. The title of a recent article by Henry Veatch and Joseph Rautenberg asks "Does the Grisez-Finnis-Boyle Moral Philosophy Rest on a Mistake?'"; the answer that the text of that article produces is, unsurprisingly, "Yes." Veatch and Rautenberg argue that despite superficial similarities between the moral theory defended by Germain Grisez, John Finnis, and Joseph Boyle (...) and the eudaimonist moral theories defended by Aristotle and Aquinas, the Grisez-Finnis-Boyle (hereafter "GFB") view is more akin to utilitarian impartialism than to Aristotelian or Thomistic eudaimonism. I shall argue that although Veatch and Rautenberg are correct to label the GFB view a type of impartialism, they misunderstand both the character of its impartialism and the mistake on which it rests. A clearer understanding of what is at issue between impartialist and eudaimonist natural law theories will bring into focus the severity of the problem faced in trying to decide between these accounts. I Call the thesis that all correct practical reasoning proceeds from one's own good as a principle "eudaimonism"; call the thesis that all correct practical reasoning proceeds from the good * I owe a debt of gratitude to Melissa Barry, Lenn Goodman, Trenton Merricks, and (especially) Thomas Williams for their comments on early drafts of this article. 1 Henry Veatch and Joseph Rautenberg, "Does the Grisez-Finnis-Boyle Moral Philosophy Rest on a Mistake?" Review of Metaphysics 44 (1991): 807-830. 53 54 MARK C. MURPHY impartially considered "impartialism." As Veatch and Rautenberg point out, the GFB view endorses impartialism: from the point of view of practical reason, whether a good is instantiated in you or in me makes no difference.2 This impartialism places the GFB view on the side of the utilitarians against the eudaimonism of Aristotle and Aquinas. That Grisez, Finnis, and Boyle part ways with Aristotle and Aquinas on this issue is, of course, no argument against the GFB view. Veatch and Rautenberg attempt to call the GFB impartialism into question, though, by arguing both that the GFB impartialism has absurd consequences and that the argument by which Grisez, Finnis, and Boyle reach the impartialist thesis contains plain errors. Veatch and Rautenberg hold that the impartialism advocated by the GFB view is a result of modern moral philosophy's disconnecting the concept of a good from that of human needs, desires, and interests: The notion of 'good' [on the 'modern' view] needs to be denatured and completely dissociated from all reference to our liking, desiring, or finding pleasing those things which we take to be good. Instead, all 'goods' are to be converted into so many 'oughts', and as 'oughts' they are to be furthered and pursued.3 On the modern view, to assert that pleasure is a good is to assert only that pleasure ought to be promoted; to say that knowledge is a good is to say only that knowledge ought to be pursued. From this sundering of the relationship between the idea of a good and that of human needs and interests it is a small step 2 Although both utilitarianism and the GFB view endorse impartialism, they differ importantly in that utilitarianism is consequentialist whereas the GFB view is not. To move from the impartialist thesis that the good impartially considered is the starting point for practical reason to the utilitarian thesis that one ought to act so as to maximize overall goodness requires, among other presuppositions, the assumption that another's good and my own are commensurable. This premise the GFB view denies; no two instantiations of basic values between which choice is possible are commensurable. See Germain Grisez, Joseph Boyle, and John Finnis, "Practical Principles, Moral Truth, and Ultimate Ends," American Journal ofJurisprudence 32 (1987): 99-151, esp. 110.· 1 Veatch and Rautenberg, "Grisez-Finnis-Boyle Moral Philosophy," 816. NATURAL LAW, IMPARTIALISM, AND OTHERS' GOOD 55 indeed to impartialism: once goods are no longer such in virtue of anyone's needing or desiring them, there is no reason to promote one's own good over that of anyone else: "Instead, all goods having now been converted into so many 'oughts', it would seem to... (shrink)

Vulnerability does not mean much for our contemporary morality. It is antithetical to our emphasis on individualism and rationality; it requires that we attend to the body and to our feelings. Yet only by recognizing the depth and breadth of our vulnerability can we affirm our humanity.

Bringing together evolutionary biology, psychology, and philosophy, Henry Plotkin presents a new science of knowledge, one that traces an unbreakable link between instinct and our ability to know.

This book is a sustained criticism of John Rawls’ comprehensive work on the theory of justice. While recognizing the significant contribution of Rawls to both ethics and social theory in articulating clearly a distinct and coherent version of liberalism, Barry believes that "Rawls’ theory does not work and that many of his individual arguments are unsound." In the introductory chapter, the author gives an illuminating comparison of Rawls’ work with Henry Sedgwick’s Methods of Ethics. Throughout the book, critical (...) references have been made to Rawls’ views expressed in the earlier papers. Critical attention is given to the notions of the original position, primary goods, and the thin theory of the good and their relation to Rawls’ contractarian principles of justice. (shrink)

There is the world of ideas and the world of practice; the French are often for sup pressing the one and the English the other; but neither is to be suppressed. -Matthew Arnold The Function of Criticism at the Present Time From its inception, bioethics has confronted the need to reconcile theory and practice. At first the confrontation was purely intellectual, as writers on ethical theory (within phi losophy, theology, or other humanistic disciplines) turned their attention to topics from the (...) world of medical practice. Recently the confrontation has grown more intense. The ap pointment of clinical ethicists in hospitals and other health care settings is an accelerating trend in North America. Concomitantly, those institutions involved in training peo ple in clinical ethics have added organized exposure to the world of practice, in the form of placement requirements, to the normal academic course load. In common with other dis ciplines, bioethics has begun to see clinical training as a con dition of didactic theory and apprenticeship. (shrink)

The internal language of a monoidal category yields simple proofs of results about a natural numbers object therein.

How developing a more expansive, non-formal conception of reason produces richer ethical understandings of human situations, explored and illustrated with many real examples. In Re-Reasoning Ethics, Barry Hoffmaster and Cliff Hooker enhance and empower ethics by adopting a non-formal paradigm of rational deliberation as intelligent problem-solving and a complementary non-formal paradigm of ethical deliberation as problem-solving design to promote human flourishing. The non-formal conception of reason produces broader and richer ethical understandings of human situations, not the simple, constrained depictions (...) provided by moral theories and their logical applications in medical ethics and bioethics. Instead, it delivers and vindicates the moral judgment that complex, contextual, and dynamic situations require. Hoffmaster and Hooker demonstrate how this more expansive rationality operates with examples, first in science and then in ethics. Non-formal reason brings rationality not just to the empirical world of science but also to the empirical realities of human lives. Among the many real cases they present is that of how women at risk of having children with genetic conditions decide whether to try to become pregnant. These women do not apply the formal principle of maximizing expected utility (as advised by genetic counselors) and instead imagine scenarios of what their lives could be like with an affected child and assess whether they could accept the worst of these scenarios. Hoffmaster and Hooker explain how moral compromise and a liberated, extended, and enriched reflective equilibrium expand and augment rational ethical deliberation and how that deliberation can rationally design ethical practices, institutions, and policies. (shrink)

Yet these forces are largely ignored by a professional bioethics that concentrates on the theoretical justification of decisions.The original essays in this ...

This paper defends a realist interpretation of theories and a modest realism concerning the existence of quantities as providing the best account both of the logic of quantity concepts and of scientific measurement practices. Various operationist analyses of measurement are shown to be inadequate accounts of measurement practices used by scientists. We argue, furthermore, that appeals to implicit definitions to provide meaning for theoretical terms over and above operational definitions fail because implicit definitions cannot generate the requisite descriptive content. The (...) special case of establishing a temperature scale is examined to show that nonrealist accounts fail to provide insight into the theoretical connections that scientific laws postulate to hold among quantities. (shrink)

This volume provides an integrated and wide-ranging set of primary-source readings on the relationship between moral values and economic activity, as articulated by some of the leading figures in Western civilization.

Abstract: The optimum definition of the term "genocide" has been hotly contested almost since the term was coined. Definitional boundaries determine which acts are covered and excluded and thus to a great extent which cases will benefit from international attention, intervention, prosecution, and reparation. The extensive legal, political, and scholarly discussions prior to this article have typically (1) assumed "genocide" to be a fixed social object and attempted to define it as precisely as possible or (2) assumed the need for (...) a fixed convention and sought to stipulate the range of events that should be denoted by the term. Even if its meaning is a matter of convention, however, "genocide" is not a fixed object but varies by context and evolves in methods and forms over time. In fact, as relevant laws, legal interpretations, and political commitments develop, so do would-be perpetrators modify what genocide is in order to avoid political and legal consequences. This article advances an approach to a definition of "genocide" that allows even legal definitions to keep pace with this evolutionary process. (shrink)

achieved by the actions of a single animal. The concerted activity is coordinated by a multiplicity of cues and signals diffused between groups of ...

1. Introduction. Professor Nagel's account of the “cognitive status” of scientific theories has been attacked by P. K. Feyerabend [5] and M. B. Hesse [8] in terms of his alledgedly misguided distinction between experimental laws and theories. The difficulty lies, these critics agree, in Nagel's attempt to find a stable basis for scientific theories in an observational basis of experimental laws. Both Feyerabend and Hesse note the vacillation in Nagel's account of the stability of the meaning of experimental terms and (...) in his discussion of the status of observational as opposed to theoretical terms. They find Nagel too “positivistic” and see as a first step toward a more adequate account of scientific theories the abandonment of the theoretical-observational dichotomy as having more than a pragmatic significance. Nagel's discussion of the theoretical-observational dichotomy is, I agree, inadequate in certain respects. I shall, however, suggest a quite different remedy from those of Feyerabend and Hesse, one that depends neither on a phenomenalistic reduction of theoretical entities nor on a blurring of the theoretical-observational dichotomy. (shrink)

: Once cast aside as of no value, Charles S. Peirce manuscript 1570 "The First of Six Lessons . . ." and its context, provides uniquely valuable access to Peirce's religious practice (as distinct from his theology). Chronically unemployed, Peirce seized an opportunity to put in a bid for a vacant post in elocution at the Episcopal Church's major (and only "official") theological seminary, The General Theological Seminary in New York City. Peirce had on occasion appealed to nearby members of (...) the Episcopalian hierarchy seeking patronage for his scholarly work—to no avail. In this case, however, he was encouraged and aided by the current scholarly vicar of his own parish. The incumbent had pursued advanced education abroad and was also active in the seminary's affairs. And, of course, Peirce was confident about his expertise in elocution, which "General's" Dean claimed as well. Both the contextual narrative and the substantive theological content of his "lesson" are a rich resource for insights into the much vexed (if too often muddled) question of his lifelong commitment to a faith stemming from his earlier conversion to trinitarianism. (shrink)

Beginning from the standpoint that technologically mediated education is widely prescribed for developing countries, the author first probes the nature, meaning, and impact of this agenda through its economic and political context. He argues that this context produces and shapes the rush to technology. He then examines the notion of education and the nature of the claimed technological mediation of this process, concluding that the constraints of technological mediation, and its destructive impact on teaching, show its inability to provide for (...) adequate educational development (which is necessarily grounded in a concrete human relationship in a real—not virtual—dynamic social and cultural context). He closes with recommendations for a critical rather than a wholesale adoption of technology and encourages resistance to the present press for mindless adoption. (shrink)

Benjamin Constant (1767–1830) is the most important French liberal that most casual liberals have never heard of. Everyone knows something about Montesquieu because checks and balances and the separation of powers are household terms. Tocqueville’s Democracy in America and The Old Regime and the Revolution are both established classics. But Constant is largely terra incognita even for those with a university degree—to their loss.