This paper reviews the concept of professional autonomy from anhistorical perspective. It became formalised in the United Kingdom onlyafter a long struggle throughout most of the nineteenth century. In itspure form professional autonomy implies unlimited powers to undertakemedical investigations and to prescribe treatment, irrespective of cost.Doctors alone should determine the quality of care and the levels ofremuneration to which they should be entitled. In the second half of thetwentieth century a steady erosion of professional autonomy occurred inthe United Kingdom. The (...) level of remuneration has been restricted formost doctors for nearly fifty years, whilst the costs of health carehave steadily reduced the doctor's ability to provide unrestricted carewithin the health care system. Reorganisation of the National HealthService in 1983 and 1991 has substantially eroded professional autonomy,to the point where research developments, clinical judgement and ethicalstandards are all now being placed at risk. (shrink)

The Great New Wilderness Debate is an expansive, wide-ranging collection that addresses the pivotal environmental issues of the modern era. This eclectic volume on the varied constructions of “wilderness” reveals the recent controversies that surround those conceptions, and the gulf between those who argue for wilderness "preservation" and those who argue for "wise use." J. Baird Callicott and Michael P. Nelson have selected thirty-nine essays that provide historical context, range broadly across the issues, and set forth the positions of (...) the debate. Beginning with such well-known authors as Ralph Waldo Emerson, Henry David Thoreau, John Muir, and Aldo Leopold, the collection moves forward to the contemporary debate and presents seminal works by a number of the most distinguished scholars in environmental history and environmental philosophy. The Great New Wilderness Debate also includes essays by conservation biologists, cultural geographers, environmental activists, and contemporary writers on the environment. (shrink)

This paper applies theory and research examining errors in complex organizational systems to the problem of individual and collective morality in organizations. It is proposed that because of the nature of complex organizations, unjust outcomes can (and will) result from organizational actions even when all organization members have acted responsibly. The argument that complex organizations are therefore immoral is considered and rejected. Instead, the paper argues that morality in complex organizations begins with "heedful interrelating" among individual organization members. The paper (...) concludes with a discussion of organizational processes and structures that promote heedful interrelating. (shrink)

"For courses in anthropology, cultural geography, environmental philosophy and ethics. Brief text focusing on environmental attitudes and practices of American Indians using the Ojibwa narrative, myths, legends, stories and rituals. Introductory essay offers theory of environmental ethics, an overview of the field of environmental ethics, and places the Ojibwa within this contemporary debate."--Publisher.

Originally published in 1957, this book collects together large sections of important tracts from a variety of political documents, particularly those concerned with democracy, communism, Protestantism or Catholicism. The extracts come from a wide range of authors including Bertrand Russell, Karl Marx, John Locke and Pope Pius XII. This book will be of value to anyone seeking an overview of the key political divisions in the late 20th century or who is interested in political theory generally.

The grammatical manipulation and production of language is a great deceiver. We have become habituated to accept the use of well-constructed language to indicate intelligence, understanding and, consequently, intention, whether conscious or unconscious. But we are not always right to do so, and certainly not in the case of large language models (LLMs) like ChapGPT, GPT-4, LLaMA, and Google Bard. This is a perennial problem, but when one understands why it occurs, it ceases to be surprising that it so stubbornly (...) persists. This paper will have three main sections. In the Introduction I will say a little about language, its aetiology, and useful sub-divisions into natural and cultural. In the second section I will explain the current situation with regard to large language models and fill in the background debates which set the problem up as one of increased complexity rather than one of a qualitatively different kind from narrow or specific AI. In the third section I will present the case for the missing phenomenological background and why it is necessary for the co-creation of shared meaning in both natural and cultural language, and I will conclude this section by presenting a rationale for why this situation arises and will continue to arise. Before we do any of this, I need to clarify one point: I do not wish to challenge the ascription of artificial general intelligence (AGI) to LLMs, indeed I think agnosticism is best in this respect, but I do challenge the more serious, and erroneous, ascription of understanding, intention, reason, and consciousness to them. And so, I am making two points: an epistemological one about why we fall into error in our ascription of a mental life to LLMs, and an ontological one about the impossibility of LLMs being or becoming conscious. (shrink)

We explore psychological contracts as mechanisms by which individuals gain influence in organizations. Using two distinct research settings and longitudinal analysis, we demonstrate that ideological contracts endow individuals with increased centrality in the organization’s influence network. More generally, we propose that an important outcome of different psychological contract types may be how they affect the nature of influence in organizations.

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. Some of them have themselves (...) practised euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practised and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice. (shrink)

Over the past decade, public discussion has focused on the ethics of issuing Do‐Not‐Resuscitate Orders, and the failure of many hospitals to acknowledge their actions openly. Recent efforts on the part of some hospitals to establish formal DNR guidelines that are prudent, fair, and humane, are a helpful beginning, though they cannot account for all the vagaries of illness and human communication. But concerns about DNR should not divert us from looking closely and rigorously at other, more common treatment/nontreatment decisions (...) in the critical care setting. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionStuart J. Youngner (bio), Laura A. Siminoff (bio), and Renie Schapiro (bio)This issue of the Kennedy Institute of Ethics Journal (KIEJ) centers on a piece of empirical research. The motivation behind the study of Laura Siminoff, Christopher Burant, and Stuart Youngner (2004) was to find out more about what the general public understands and believes about when a person is dead. More specifically, the study tried to determine (...) how members of the public define death, especially their acceptance and interpretation of the medical concept of "brain death," and their attitudes toward the so-called "dead donor rule," an informal but powerful social and legal norm insisting that the taking of organs for transplantation not cause the death of the source of those organs.As the demand for organs increases and the waiting list grows, the United States has explored multiple ways to expand the pool of potential donors. One approach has been to gerrymander (coherently or not) the line between life and death to shift patients who are extremely compromised but traditionally considered to be in the living category into the dead category. In this way, the dead donor rule remains technically intact. This reasoning is explicit in the report of the Harvard Medical School Ad Hoc Committee (1968) that "introduced" "brain death" to the American culture. Since then, other efforts to redraw the line have been proposed and rejected.One alternative to gerrymandering is to consider under what conditions, if any, it is morally acceptable to violate the dead donor rule. Some would argue that this alternative is the more "honest" approach. Rather than sidestepping moral problems by calling people dead, it brings the moral problems to the surface where the necessity of sticking to the rule can be considered on its own merits. However, when the Journal of the American Medical Association printed a position paper that proposed making anencepahlic newborns an exception to the dead donor rule, along with arguments about why this was acceptable, the outcry was so great that the proposal was retracted (AMA 1995).Clearly, our society has identified organ transplantation as a priority, although two papers in this volume (those by Courtney Campbell and by Megan Crowley-Matoka and Robert Arnold) take issue with that prioritization. The fact that the donor pool has remained relatively stable (and inadequate) despite massive efforts [End Page 211] to increase it speaks, at least in part, to the cultural and legal resistance to "new" ways to procure more organs. Voluntarism seems to have peaked. Financial incentives clash with the heavily endorsed notion of the "gift of life" and seem to many to violate the dignity of the human body. Presumed consent or eminent domain, in which the community has a greater claim to a person's organs than that person or his/her family, go against the grain of American individual freedom and the ethos of patient autonomy.Abandoning the dead donor rule generally is regarded as an even tougher sell to the American public and its legislators. The study by Siminoff and colleagues attempts, among other things, to gauge just how tough this sell would be. What the data actually demonstrate is a matter of interpretation, and this issue of the KIEJ is devoted to some of those interpretations. The authors, with the exception of Daniel Hausman, came together for a meeting in Cleveland, Ohio, during which the study's methods and data were presented with time for questions, clarifications, and general discussion. The authors then worked with the editors to generate the papers printed in this volume.The issue begins with a presentation of the study conducted by Siminoff and colleagues. The same paper also appears in the journal Social Science and Medicine, where it includes the conclusions of the authors (Siminoff, Burant, and Youngner 2004). In the current volume, we present only the methodology of and data from the study, allowing a number of distinguished commentators to offer their own conclusions and reflections.The first response comes from Tracy Schmidt, Executive Director of Intermountain Donor Services, one of our nation's organ procurement organizations (OPOs). For years, organ procurement professionals have reported anecdotal stories about families who wished to donate organs of... (shrink)

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

The transplantation and procurement of human organs has become almost routine in American society. Yet, organ transplantation raises difficult ethical and psychosocial issues in the context of “controlled” death, including the blurring of boundaries between life and death, self and other, healing and harming, and killing and letting die. These issues are explored in the context of the actual experiences of organ donors and recipients, brain death, the introduction of non‐heartbeating donor protocols, and the increasing reliance on living donors. The (...) author draws on a thematic analysis of the way that organ transplantation is presented in the media, films, and science fiction and on his clinical experience as a psychiatrist working with transplant patients, their families, and the nurses and physicians who care for them. (shrink)

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of (...) literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

In this paper it is argued that certain stimulus-response learning models which are adequate to represent finite automata (acceptors) are not adequate to represent noninitial state input-output automata (transducers). This circumstance suggests the question whether or not the behavior of animals if satisfactorily modelled by automata is predictive. It is argued in partial answer that there are automata which can be explained in the sense that their transition and output functions can be described (roughly, Hempel-type covering law explanation) while their (...) behaviors are in principle not predictable short of possession of their complete histories or of information concerning present internal states by indirect observation. (shrink)

Computational systems biologists create and manipulate computational models of biological systems, but they do not always have straightforward epistemic access to the content and behavioural profile of such models because of their length, coding idiosyncrasies, and formal complexity. This creates difficulties both for modellers in their research groups and for their bioscience collaborators who rely on these models. In this paper we introduce a new kind of visualization that was developed to address just this sort of epistemic opacity. The visualization (...) is unusual in that it depicts the dynamics and structure of a computer model instead of that model’s target system, and because it is generated algorithmically. Using considerations from epistemology and aesthetics, we explore how this new kind of visualization increases scientific understanding of the content and function of computer models in systems biology to reduce epistemic opacity. (shrink)

Introduction. During the past two decades philosophers of psychology have considered a large variety of computational models for philosophy of mind and more recently for cognitive science. Among the suggested models are computer programs, Turing machines, pushdown automata, linear bounded automata, finite state automata and sequential machines. Many philosophers have found finite state automata models to be the most appealing, for various reasons, although there has been no shortage of defenders of programs and Turing machines. A paper by Arthur Burks (...) convinced me long ago that “all natural human functions” are, or can be fruitfully modeled to be, finite state automata with output. Further work in the field has reinforced this conviction. There is room, however, for the use of any of the above models in philosophy of mind and in the ongoing development of cognitive science. (shrink)