Abraham Flexner delivered his eponymous report 100 years ago. The Report had an immediate and profound impact on medical education in North America that resonated for several decades afterwards. Its impact was less immediate in the United Kingdom, but over time the major principles have been assimilated (GMC 1993). However, which—if any—of these principles are still relevant today? No doubt there will be debate about this, but in my view, Flexner's principle of academic and scientific excellence as one of the (...) most fundamental underpinnings of medical education is even more relevant today than it was in 1910. To illustrate this, I shall highlight two aspects of current medical education in the United Kingdom: the .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Rhetorical Investigations: Studies in Ordinary Language Criticism, and: Ordinary Language Criticism: Literary Thinking after Cavell after WittgensteinRichard FlemingRhetorical Investigations: Studies in Ordinary Language Criticism, by Walter Jost; 368 pp. Charlottesville: University of Virginia Press, 2004, $55.00. Ordinary Language Criticism: Literary Thinking after Cavell after Wittgenstein, edited by Kenneth Dauber and Walter Jost; 353 pp. Evansville: Northwestern University Press, 2003, $29.95 paper.On the question of ordinary language criticism (...) and philosophy, "Who pleases whom?" Judging by many of the articles, essays, and books of the last decade the answer might be: almost nobody pleases anyone. Whether in appreciation or incomprehension of its importance and substance, renewed efforts at understanding, redirections of thinking, and disappointments and frustrations with the [End Page 209] subject-matter are prevalent when ordinary language is the topic of discussion. These two recent books tend to strengthen this assessment. Rhetorical Investigations is a sustained effort to "revisit" and "rethink" grammatical (conceptual) reflections on ordinary language and literature; and in so doing provide a "reinvention" of characteristics of literary theory through an extensive and detailed consideration of the work of Robert Frost. Although sometimes overreaching in its efforts (particularly when discussing logic), it imaginatively uses rhetoric and ordinary language concerns as a means of direction and focus for new, explanatory discussions in literary—philosophical analysis. Ordinary Language Criticism (part of the general series, "Rethinking Theory," edited by Gary Saul Morson) is a diverse and uneven collection of fifteen articles concerning and using ordinary language interests, several of which (R. M. Berry, Garry L. Hagberg, Richard Eldridge, Gerald L. Bruns) valuably repay the diligence needed to discover them in 350 plus pages. The text includes an editors' introduction that voices the wish to "return criticism to its grounds in the 'ordinary' or natural language we all speak" and (unsuccessfully but lustily) pronounces and explains "ordinary language criticism" as a new yet traditional area of study. ("New" in that it takes "as its point of departure" the ordinary language philosophy of Wittgenstein, and "traditional" in that "all criticism is really ordinary language criticism.") The editors further undertake in this introduction the endeavor to sketch something of a program for the book, meant to show connected promptings among the various writings, whereas the specific authors themselves settle down quickly and separately to a critical work at hand without particular references to each other. Both of these texts, like others in this field of study before, valuably raise questions and apprehensions of what use there is in talk about ordinary language. The best of such material provides provocations for thinking that are to be found nowhere else. The worst of such books and articles is that they prejudice sensible people against the study of the ordinary.Can one conceive of something to say about these two books that the authors and the current readers haven't already heard or of which they can be profitably reminded? It certainly would not be wise to presume such a grand stand. This is a large question to which only a small answer might be given here. Setting aside the perhaps undiscussable differences of what we each see of primary importance in the primary texts and how best to read them, one issue and difference of understanding, specific and plain enough to state briefly, perhaps usefully does arise. It is a lack of a clear sense of the "ordinary," its distinctiveness, its implications; and thereby a continuation of many of the confusions that have inhabited philosophical and literary writing before and after Wittgenstein turned his attention to the matter. Is this not partly why frustrations of understanding, disagreements in thinking, and displeasures in discussion remain pervasive and unrelenting?This difficulty and difference with such work can only prove worthwhile introducing, however, against a background of agreement over the centrality [End Page 210] of a cluster of issues, of which three might be specified: a first agreement concerns the sensitivity or fear that something is being missed or remains unintelligible in the culture about the ordinary; a respect for the ordinary is a needed, often unnoticed beginning of our reflections. Rhetorical Investigations importantly develops its analyses from such a perspective (Jost's... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Rhetorical Investigations: Studies in Ordinary Language Criticism, and: Ordinary Language Criticism: Literary Thinking after Cavell after WittgensteinRichard FlemingRhetorical Investigations: Studies in Ordinary Language Criticism, by Walter Jost; 368 pp. Charlottesville: University of Virginia Press, 2004, $55.00. Ordinary Language Criticism: Literary Thinking after Cavell after Wittgenstein, edited by Kenneth Dauber and Walter Jost; 353 pp. Evansville: Northwestern University Press, 2003, $29.95 paper.On the question of ordinary language criticism (...) and philosophy, "Who pleases whom?" Judging by many of the articles, essays, and books of the last decade the answer might be: almost nobody pleases anyone. Whether in appreciation or incomprehension of its importance and substance, renewed efforts at understanding, redirections of thinking, and disappointments and frustrations with the [End Page 209] subject-matter are prevalent when ordinary language is the topic of discussion. These two recent books tend to strengthen this assessment. Rhetorical Investigations is a sustained effort to "revisit" and "rethink" grammatical (conceptual) reflections on ordinary language and literature; and in so doing provide a "reinvention" of characteristics of literary theory through an extensive and detailed consideration of the work of Robert Frost. Although sometimes overreaching in its efforts (particularly when discussing logic), it imaginatively uses rhetoric and ordinary language concerns as a means of direction and focus for new, explanatory discussions in literary—philosophical analysis. Ordinary Language Criticism (part of the general series, "Rethinking Theory," edited by Gary Saul Morson) is a diverse and uneven collection of fifteen articles concerning and using ordinary language interests, several of which (R. M. Berry, Garry L. Hagberg, Richard Eldridge, Gerald L. Bruns) valuably repay the diligence needed to discover them in 350 plus pages. The text includes an editors' introduction that voices the wish to "return criticism to its grounds in the 'ordinary' or natural language we all speak" and (unsuccessfully but lustily) pronounces and explains "ordinary language criticism" as a new yet traditional area of study. ("New" in that it takes "as its point of departure" the ordinary language philosophy of Wittgenstein, and "traditional" in that "all criticism is really ordinary language criticism.") The editors further undertake in this introduction the endeavor to sketch something of a program for the book, meant to show connected promptings among the various writings, whereas the specific authors themselves settle down quickly and separately to a critical work at hand without particular references to each other. Both of these texts, like others in this field of study before, valuably raise questions and apprehensions of what use there is in talk about ordinary language. The best of such material provides provocations for thinking that are to be found nowhere else. The worst of such books and articles is that they prejudice sensible people against the study of the ordinary.Can one conceive of something to say about these two books that the authors and the current readers haven't already heard or of which they can be profitably reminded? It certainly would not be wise to presume such a grand stand. This is a large question to which only a small answer might be given here. Setting aside the perhaps undiscussable differences of what we each see of primary importance in the primary texts and how best to read them, one issue and difference of understanding, specific and plain enough to state briefly, perhaps usefully does arise. It is a lack of a clear sense of the "ordinary," its distinctiveness, its implications; and thereby a continuation of many of the confusions that have inhabited philosophical and literary writing before and after Wittgenstein turned his attention to the matter. Is this not partly why frustrations of understanding, disagreements in thinking, and displeasures in discussion remain pervasive and unrelenting?This difficulty and difference with such work can only prove worthwhile introducing, however, against a background of agreement over the centrality [End Page 210] of a cluster of issues, of which three might be specified: a first agreement concerns the sensitivity or fear that something is being missed or remains unintelligible in the culture about the ordinary; a respect for the ordinary is a needed, often unnoticed beginning of our reflections. Rhetorical Investigations importantly develops its analyses from such a perspective (Jost's... (shrink)

A sensible code of right and wrong for public officials everywhere, this book explores what ethics and the public trust mean. It includes sample codes of ethics and examines ways to improve the ethical climate of government. Excerpted and adapted from a longer work, Ethics, Conflicts, and Offices: A Guide for Local Officials, which also covers conflict of interest and office-holding laws in North Carolina.

Whether to treat autism as exculpatory in any given circumstance appears to be influenced both by models of autism and by theories of moral responsibility. This article looks at one particular combination of theories: autism as theory of mind challenges and moral responsibility as requiring appropriate experience of the reactive attitudes. In pursuing this particular combination of ideas, we do not intend to endorse them. Our goal is, instead, to explore the implications of this combination of especially prominent ideas about (...) autism and about moral responsibility. These implications can be quite serious and practical for autists and those who interact directly with autists, as well as for broader communities as they attend to the fair, compassionate, and respectful treatment of increasing numbers of autistic adults. We find that these theories point to a limited range of situations in which autists should not be blamed for transgressive actions for which neurotypical individuals should be blamed. We build on what others have written on these issues by bringing in a recent cognitive model of the role theory of mind plays in empathy, by discussing the social implications of the theoretical findings, and by raising questions about the compatibility of reactive attitude theories of moral responsibility with the neurodiversity approach to autism. (shrink)

Agricultural research raises fundamental ethical and value questions going beyond those in other fields both because of its public funding and because its results have significant impacts on habitats and other species. Questions about the sustainability of modern agriculture, which are shared with other sectors, require us to examine alternative visions and structures. These can be seen to range from status quo preserving ideologies to change-oriented utopias. It is argued that at the national level current ideologies—which include positivistic approaches and (...) belief in the neutrality of technology—mask real structural and policy choices as well as their ethical and value implications. At the international level, the export of fossil-fuel based modes of agriculture to the developing countries raises additional structural, policy, value, and ethical issues. (shrink)

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on (...) which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

As a neurodevelopmental condition that affects cognitive functioning, autism has been used as a test case for theories of moral responsibility. Most of the relevant literature focuses on autism’s impact on theory of mind and empathy. Here I examine aspects of autism related to executive function. I apply an account of how we might fail to be reasons responsive to argue that autism can increase the frequency of excuses for transgressive behavior, but will rarely make anyone completely exempt from moral (...) responsibility in general. On this account, although excuses may apply more often to autists than to others, the excuses that apply to autists are just the same excuses that can apply to anyone. (shrink)

In the article Privacy and Health Practices in the Digital Age, the authors describe current privacy challenges for digital health data and review the theoretical framework on privacy in the contex...

Drawing on broad definitions of technology and engineering as well as precedents in the philosophical literature, this paper makes the novel argument that the purposeful design of one’s unique good life using existing philosophical concepts is an engineering activity. Whether as a metaphor or as an engineering activity in its own right, a sampling of important benefits and perspectives provided for well-being by the presented “life engineering” framework are highlighted. A key strength of the framework is the conceptual simplicity, with (...) minimal sacrifices in completeness or consistency. This necessitates a tradeoff of limited precision for any one practical implementation. Consistent conceptual definitions for wisdom, virtue and the good life are presented within an informative ethics. Only a descriptive evaluation to aid in conceptual understanding is discussed, no prescriptive normative evaluations are made. The good life is defined to be one in which the minimum requirements are met and then performance is good, but no attempt is made to define what is good. A fundamental limitation of the framework stems from the inherent focus of technology on human utility. Although no novel fundamental conclusions are drawn in this paper, the presented framework is demonstrated to correspond with numerous ethical precepts of many existing philosophical traditions. (shrink)

McCoy, Liu, Lutz, and Sisti (2020) raise concerns about “partial representation,” in which nonelected advocates or advocacy organizations fail to engage and hold themselves accountable to the full range of people they purport to represent. They are right to point out that the autism community is vulnerable to partial representation. This open peer commentary notes some elements among those engaged with autism that may not fit under the type of “federated model” of representation McCoy, et al recommend. Advocates should tread (...) carefully to avoid some types of harm that do not arise when forming federations on other topics. The influence of antivaxxers and other questionable or harmful movements might even lead us to think, despite the value of open debate and engagement, that there is benefit to partial representation if it prevents potential harms that could arise from legitimizing dangerous practices. (shrink)

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology (...) and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness. (shrink)

This book casts the argument for personal immortality into new light as the outcome of systems processes rather than human nature. Personal immortality is the output of becoming human rather than of being human. If this is the case, then God must be seen to enter into personal relationships with us: a view that current science supports.

Michelle Garcia Winner’s Social Thinking Curriculum is widely used by schools across the USA and has garnered attention internationally. The curriculum addresses social language and behavior deficits among those on the autism spectrum. Although many embrace this curriculum without reservation, the emphasis on social conformity, including avoiding behaviors that make others uncomfortable, merits scrutiny. Individuals who have difficulty understanding social cues and conventions can derive tremendous benefit from learning to fit in, for example, or learning what is likely to make (...) others uncomfortable and why. However, too much emphasis on pleasing others can reinforce undesirable tendencies. For example, autism is already linked to avoidant personality disorder. An emphasis on avoiding making others uncomfortable may also inhibit the development of principled ethical thinking and action. Reframing social thinking to treat it not (or not only) as an end in itself, but as a way to achieve a variety of social and personal goals would go a long way toward addressing the weaknesses of the Social Thinking Curriculum. (shrink)

We suggest that there is confusion between why consciousness developed and what additional functions, through continued evolution, it has co-opted. Consider episodic memory. If we believe that episodic memory evolved solely to accurately represent past events, it seems like a terrible system—prone to forgetting and false memories. However, if we believe that episodic memory developed to flexibly and creatively combine and rearrange memories of prior events in order to plan for the future, then it is quite a good system. We (...) argue that consciousness originally developed as part of the episodic memory system—quite likely the part needed to accomplish that flexible recombining of information. We posit further that consciousness was subsequently co-opted to produce other functions that are not directly relevant to memory per se, such as problem-solving, abstract thinking, and language. We suggest that this theory is compatible with many phenomena, such as the slow speed and the after-the-fact order of consciousness, that cannot be explained well by other theories. We believe that our theory may have profound implications for understanding intentional action and consciousness in general. Moreover, we suggest that episodic memory and its associated memory systems of sensory, working, and semantic memory as a whole ought to be considered together as the conscious memory system in that they, together, give rise to the phenomenon of consciousness. Lastly, we suggest that the cerebral cortex is the part of the brain that makes consciousness possible, and that every cortical region contributes to this conscious memory system. (shrink)

Recent research on genetic and biological diversity suggests that they underlie, and are the source of renewable resources--which are themselves more fundamental than non-renewable resources. If this is the case, then our understandings of the "limits to growth" debate will need modification and current approaches to development--in both the industrial countries and in the Third World--will need reconceptualization. A major part of this will involve a reversal of roles and priorities for agricultural and industrial development. Also, more sustainable/regenerative types of (...) agriculture and food systems will need to be developed. Current explorations along these lines are briefly reviewed. Finally, the links between this and the wider need to develop more sustainable societies are examined. (shrink)

This essay some first steps toward the naturalization of what I call rational intentionality or alternatively type II intentionality. By rational or type II intentionality, I mean that full combination of rational powers and content-bearing states that is paradigmatically enjoyed by mature intact human beings. The problem I set myself is to determine the extent to which the only currently extant approach to the naturalization of the intentional that has the singular virtue of not being a non-starter can be aggregated (...) up into an account of rational intentionality. I have in mind a broadly defined family of accounts whose main members are the indicator/information-theoretic approach of Dretske (1988), the asymmetric dependence theory of Jerry Fodor (1987, 1990, 1994) and the teleo-semantics of Ruth Millikan (1984, 1993). Somewhat inaccurately, I will call this family of approaches the information-theoretic family. To be sure, there is only a rough family resemblance among the members of the information-theoretic family. Indeed, several intense quarrels divide the members of that family one from another, but the precise outcome of those internecine struggles is not directly relevant to the aims of this essay. ² Taken collectively, the information-theoretic family yields a compelling picture of the place of at least a crude form of intentionality -- what I call frog-like or type I intentionality -- in the natural order. Though frog-like or type I intentionality is, I think, a genuine species of intentionality, it may subsist in the absence of rational powers. It is that species of intentionality enjoyed by irritable creatures who, following Brandom (1994). (shrink)

This paper responds to Goodwin Liu's argument in Volume II of this Journal that a pedagogy must be supported by an appropriate theory of knowledge, and that the epistemology which best supports the service-learning pedagogy is anti-foundational pragmatism. The author shows that Liu's characterization of the pragmatist model of knowledge does not avoid the dualism which he sees as a fault of the traditional epistemology. After suggesting a remedy to this, the author then extends Liu's argument by indicating the limits (...) to what the appropriately modified epistemological support will sanction. These limits are shown to be more restrictive than Liu suggests. The result is an improved philosophical justification of the service-learning pedagogy and some suggestions for evaluating proposed curriculum. (shrink)

By appealing to Paul Ricoeur’s view of interpretation as the dialectical process of understanding through explanation, Kenneth A. Reynhout contributes to the growing field of religion and science by developing an alternative understanding of interdisciplinary theology that is fundamentally hermeneutical.

The Ethics Consultation Quality Assessment Tool (ECQAT) establishes standards by which the quality of ethics consultation records (ECRs) can be assessed. These standards relate to the ethics question, consultation-specific information, ethical analysis, and recommendations and/or conclusions, and result in a score associated with one of four levels of ethics consultation quality. For the ECQAT to be useful in assessing and improving the quality of healthcare ethics consultations, individuals who rate the quality of ECRs need to be able to reliably use (...) the tool.We developed a short course to train ethics consultants in using the ECQAT, and evaluated whether the participants (1) achieved an acceptable level of calibration in matching expert-established quality scores for a set of ethics consultations, and (2) were satisfied with the course. We recruited 28 ethics consultants to participate in a virtual, six-session course. At each session participants and faculty reviewed, rated, and discussed one to two ECRs. The participants’ calibration in matching expert-established quality scores improved with repeated exposure at all levels of ethics consultation quality. Participants were generally more accurate when assessing consultation quality at the dichotomous level of “acceptable” (scores of three or four) versus “unacceptable” (scores of one or two) than they were with a more specific score. Participants had higher rates of accuracy with the extreme ratings of “strong” (level four) or “poor” (level one). Although participants were highly satisfied with the course, only a minority of participants achieved the prespecified acceptable level of calibration (that is, 80 percent or greater accuracy between their score and expert-established scores). These results suggest that ECQAT training may require more sessions or need modification in the protocol to achieve higher reliability in scoring. Such trainings are an important next step in ensuring that the ECQAT is a tool that can be used to promote improvement in ethics consultation quality. (shrink)

By appealing to Paul Ricoeur’s view of interpretation as the dialectical process of understanding through explanation, Kenneth A. Reynhout contributes to the growing field of religion and science by developing an alternative understanding of interdisciplinary theology that is fundamentally hermeneutical.

The premise of this article is that technologies are not neutral in terms of their design objectives, their scale, and the fact that they reflect the physical and social environments in which they have developed. Specific agricultural technologies, the midwestern plow, the California tomato harvester, and various biotechnologies, are evaluated in these terms and shown to have generally predictable impacts upon rural regions and farmers. Finally, the article examines a series of major threats such as climate change that require the (...) rethinking and restructuring of agriculture along more sustainable lines, something the can be accomplished only with a conscious recognition of the non-neutrality of technologies. (shrink)