Context Conflicts over treatment decisions have been linked to physicians' emotional states. Objective To measure the prevalence of emotional exhaustion and conflicts over treatment decisions among US obstetrician/gynaecologists (ob/gyns), and to examine the relationship between the two and the physician characteristics that predict each. Methods Mailed survey of a stratified random sample of 1800 US ob/gyn physicians. Criterion variables were levels of emotional exhaustion and frequency of conflict with colleagues and patients. Predictors included physicians' religious characteristics and self-perceived empathy. Results (...) Response rate among eligible physicians was 66% (1154/1760). 36% of ob/gyns reported high levels of emotional exhaustion, and majorities reported conflict with colleagues (59%) and patients (61%). Those reporting conflict were much more likely to report emotional exhaustion (58% vs 29% who never conflict, OR, 95% CI 2.8, 1.6 to 4.8 for conflict with colleagues; 55% versus 26%, OR, 95% CI 2.2, 1.4 to 3.5 for conflict with patients). Physicians with lower self-perceived empathy were more likely to report physician-patient conflicts (65% vs 58% with higher empathy, OR, 95% CI 1.4, 1.0 to 1.9), as were female ob/gyns (66% vs 57% of males, OR, 95% CI 1.5, 1.1 to 2.0). Foreign-born physicians were less likely to report such conflicts (47% vs 64% of US born, OR, 95% CI 0.5, 0.4 to 0.8). Physicians' religious characteristics were not significantly associated with reporting conflict. Conclusions Conflicts over treatment decisions are associated with physicians' empathy, gender, immigration history and level of emotional exhaustion. With respect to the latter, conflict in the clinical encounter may represent an overlooked source or sign of burnout among ob/gyns. (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)

In this essay, I consider three different conceptions of ‘the people’ and what it means to ‘respect’ their collective will and wisdom: (a) the democratic conception of the people as a sprawling demos, (b) the populist conception of the people as an authentic folk (c) and, finally, the vanguardist conception of the people as the semi-mute masses who stand in need of revolutionary transformation. Although my ultimate aim is to defend the democratic conception of the people over both the populist (...) conception and the vanguardist conception, much of this essay is taken up simply spelling out each of these conceptions of the people and outlining their consequences for the conduct of politics. I begin by contrasting the democratic conception with the populist conception. I then turn briefly to the vanguardist conception. I close with a brief, and admittedly incomplete defence of a particular form of democracy – what I call transformative or ameliorative democracy – which conceives of the people as a self-transformative totality. (shrink)

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)

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)

This paper examines and rejects some purported refutations of eliminative materialism in the philosophy of mind: a quasi-transcendental argument due to Jackson and Pettit (1990) to the effect that folk psychology is “peculiarly unlikely” to be radically revised or eliminated in light of the developments of cognitive science and neuroscience; and (b) certain straight-out transcendental arguments to the effect that eliminativism is somehow incoherent (Baker, 1987; Boghossian, 1990). It begins by clarifying the exact topology of the dialectical space in which (...) debates between eliminativist and anti-eliminativist ought to be framed. I claim that both proponents and opponents of eliminativism have been insufficiently attentive to the range of dialectical possibilities. Consequently, the debate has not, in fact, been framed within the correct dialectical setting. I then go onto to show how inattentiveness to the range of dialectical possibilities undermines both transcendental and quasi-transcendental arguments against eliminativism. In particular, I argue that the quasi-transcendentalist overestimates the degree to which folk psychology can be insulated from the advance of neuroscience and cognitive science just in virtue of being a functional theory. I argue further that transcendental arguments are fallacious and do not succeed against even the strongest possible form of eliminativism. Finally, I argue that that transcendental arguments are irrelevant. Even if such arguments do succeed against a certain'very strong form of eliminativism, they remain complete non-starters against certain weaker forms of eliminativism. And I argue that if any of these weaker forms is true, folk psychology is in trouble enough to vindicate Paul Ckurchland's claim that our common sense psychological framework is “a radically false and misleading conception of the causes of human behavior and the nature of cognitive activity”. (shrink)

This paper discusses the role of religious speech in the public square and the common school. It argues for more openness to political theology than many liberals are willing to grant and for an educational strategy of engagement over one of avoidance. The paper argues that the exclusion of religious debate from the public square has dysfunctional consequences. It discusses Rawls’s more recent views on public reason and claims that, while they are not altogether adequate, they are consistent with engagement. (...) The outcome of these arguments is applied to three ‘hot button’ issues in US education: creationism, an issue of gay rights, and teaching the Bible in schools. (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...

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)

This paper discusses the role of religious speech in the public square and the common school. It argues for more openness to political theology than many liberals are willing to grant and for an educational strategy of engagement over one of avoidance. The paper argues that the exclusion of religious debate from the public square has dysfunctional consequences. It discusses Rawls’s more recent views on public reason and claims that, while they are not altogether adequate, they are consistent with engagement. (...) The outcome of these arguments is applied to three ‘hot button’ issues in US education: creationism, an issue of gay rights, and teaching the Bible in schools. (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)

This chapter contains sections titled: Orientation Teacher Ethics and the Law The NEA Code of Ethics Teaching with Integrity Citizenship, Civic Norms, and Moral Education Conclusion.

We glide easily from thought and talk about worldly objects to thought and talk about the contents of our beliefs about such worldly objects all the time. Smith ask Jones about the whereabouts of their pet cat and on the basis of Jones’s assertion that the cat is on the mat, Smith comes to believe that the cat is on the mat. Black in turn may ascribe to Smith the belief that the cat is on the mat. Such transitions from (...) thought and talk about worldly objects to thought and talk about states of mind are so familiar to us as to seem second nature. But there is a long-standing philosophical tradition, originating with Frege, but endorsed by philosophers with otherwise varying philosophical outlooks, which makes the very possibility of such transitions puzzling. That tradition assumes that in making at least certain attitude ascriptions – so-called de dicto or “notionally sensitive” ascriptions -- speakers refer to, describe, quantify over, or somehow pragmatically implicate the notions, representations, or modes of presentations that plausibly figure as constituents of our mental contents -- either to the exclusion of the worldly objects themselves or in addition to those objects. Such attitude ascriptions are widely taken to be the primary or unmarked case of an attitude ascription. But it is seldom acknowledged that twin facts that on this approach worldly objects will relate to the representational items that supposedly serve as ingredients of thought content in a one-many fashion and there is no automatic way “back-up” from worldly objects to modes of presentation thereof together generate a mystery about how possibly we are able execute transitions from thought and talk about worldly objects to thought and talk about representational states of mind. It is argued in this essay that the way around this mystery is to see that de re, rather than de dicto ascriptions are the unmarked form of attitude ascription and that our representations of mental contents are parasitic on our representations of worldly objects. That is, we talk about the contents of our states of mind not by adverting, in the first instance, to talk about peculiarly mental or representational entities like notions or modes of presentations, but primarily by talking about worldly entities themselves. That is, to attribute to another the belief that the cat is on the mat, one need not refer to modes of presentations, or their ilk, of said cat or said mat, but only to the relevant cat and the relevant mat. (shrink)

Over the past two decades we have seen dramatic improvements in the efficacy, safety and availibity of antiretroviral therapy (ART). In the USA and Europe, life expectancy in people living with HIV disease approaches that of the HIV-uninfected.1 Even in regions hardest hit by the HIV epidemic, effective HIV therapy has reversed more than a decade of HIV-related decreased survival. Despite these advances in ART, motivations to pursue HIV cure remain strong due to the toxicity, adherence challenges, cost and access (...) to care issues associated with HIV therapy, as well as the persistant stigma associated with having HIV infection. Further and renewed motivation comes from a single case of HIV cure after stem cell transplantation for acute leukaemia. Given the tremendous improvements in ART, it is important to assess how effective and safe an HIV cure would need to be in order to be a viable option compared to ART. We argue that this should be done prior to the availability of a cure to provide realistic goals for researchers and policy makers. One methodology that has been increasingly popular over the past decade is the use of mathematical simulation modelling to assess the clinical impact, cost-effectiveness and clinical role of different treatment strategies in HIV disease, as well as in medicine broadly.2 Such models provide a framework and approach for using the best available data at any point in time, and assessing the potential impact of emerging innovations. Further, unlike individual trials focused on a single endpoint, these models can integrate multiple data sources to project beyond the timeline or outcomes of individual studies and project long-term outcomes in many domains, including virologic, immunologic, clinical and cost.3 Mathematical models have particular value in their ability to assess uncertainty in clinical care. Examples include parameters determined in …. (shrink)

A meta-analytic review of studies that experimentally elicited awe and compared the emotion to other conditions (84; 487 effects; 17,801 participants) examined the degree to which experimentally elicited awe (1) affects outcomes relative to other positive emotions (2) affects experience, judgment, behaviour, and physiology, and (3) differs in its effects if the awe state was elicited through positive or threatening contexts. The efficacy of methods that have been used to experimentally elicit awe and the possibility of assessing changes in the (...) state of the self with experimental awe elicitations were also examined. Meta-analyses with robust variance estimation revealed that awe affected outcomes compared to other positive emotions and control conditions; affected experience, judgment, and behaviour; and had similar effects if elicited through positive or threatening contexts. The ability to compare awe to negative emotion states and its effects on physiology was limited by a small number of available effects. Images, videos, autobiographical recall, and naturalistic exposure were effective in eliciting awe. Exploratory analyses suggested that some processes involved in changes in the self can be related to experimental awe elicitations. These findings suggest awe is a discrete emotion and identifies areas for future investigation. (shrink)

This chapter contains sections titled: Abstract What is Conceptual Relativism? The Kantian Roots of Conceptual Relativism Epistemology or Metaphysics? Conceptual Relativism and Truth The Scheme and Content Relativized? Davidson Against the Very Idea of a Conceptual Scheme Empirical Sources: Conceptual Relativism in Linguistics and Psychology References.

This paper examines two questions. The first is what it would mean for schools to be communities. This question is pursued by examining four metaphors for community: families, congregations, guilds, and democratic polities. Three models of school communities are then sketched. The second question is whether schools that are communities are inherently illiberal. The paper distinguishes between a liberal interpretation of schools as communities, where schools are viewed as limited-purpose free associations, and a communitarian interpretation where community and polity are (...) not adequately distinguished. I argue that, within a framework of liberal pluralism, schools can be communities without being illiberal. (shrink)

If reason is a real causal force,operative in some, but not all ofour cognition and conation, then itought to be possible to tell anaturalistic story that distinguishes themind which is moved byreason from the mind which is movedby forces other than reason.This essay proposes some steps towardthat end. I proceed by showingthat it is possible to reconcile certainemerging psychological ideasabout the causal powers of themind/brain with a venerablephilosophical vision of reason as the facultyof norms. My accountof reason is psychologistic, social, (...) and consistent with anevolutionary approach to mind. The account preserves thenormativity by deflating it. But I argue that onlysuch deflated normativity has any chance of beingmade naturalistically respectable. (shrink)

This essay examines the syntax of names. It argues that names are a syntactically and not just semantically distinctive class of expressions. Its central claim is that names are a distinguished type of anaphoric device—devices of explicit co-reference. Finally it argues that appreciating the true syntactic distinctiveness of names is the key to resolving certain long-standing philosophical puzzles that have long been thought to be of a semantic nature.

Kenneth Strike’s essay on pluralism, personal identity, and freedom of conscience, takes up the concept of identity, and contrasts cultural and religious pluralism. He argues that the issues of affiliational obligation and recognition are often different in these two types of pluralism, and that religious groups are often asking for something very different from cultural groups. Strike makes a case for a more fluid conception of the idea of identity and against its essentialist form; he holds, e.g. that some (...) of his affiliations are stronger than others and more tied to his sense of a larger self, but it is questionable, he argues, whether any of these affiliations could not be re-evaluated without loss of the larger idea of the self. Strike does allow that members of groups more oppressed than his might certainly rally around the attributes that they hold in common, and he is sympathetic to this strategic function of identity. Nevertheless, he wants to hold onto the individualized and phenomenological conception of identity: identity is whatever the agent feels it to be. (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 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)

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)

The argument in this paper is that the exclusion of empirical research has led to a deficiency in the Positivist model; the neglect of conflict in the form of the trouble-case. In the attempt to define law in a relatively narrow way Positivists have avoided important knowledge about social behavior. In addition the analytical method of Positivism has been connected with a value-position which tends to exaggerate the extent to which law functions within social structures as an orderly system. One (...) consequence of this perspective is that the role of conflict in the law process is hardly appreciated. Studies of law in some primitive societies suggest that although social behavior generally is not regulated in rule-terms, conflict often is institutionalized in a manner capable of providing norms appropriate to new situations. It is suggested that the focus upon the trouble-case is more likely to develop our understanding of conflict as a dynamic element in the law process. (shrink)

Schools in liberal societies are responsible for producing liberal citizens. However, if they have too robust a view of citizenship, they may find themselves undermining the view of good lives held by many pacific and law abiding groups. Here I argue against treating citizenship as an educational good that simply trumps private values when they conflict and in favor of a view that seeks a context sensitive balance between such conflicting goods. The paper explores Rawls's distinction between two moral powers (...) as a way of understanding the character of some of the private interests in schooling. (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 paper examines two questions. The first is what it would mean for schools to be communities. This question is pursued by examining four metaphors for community: families, congregations, guilds, and democratic polities. Three models of school communities are then sketched. The second question is whether schools that are communities are inherently illiberal. The paper distinguishes between a liberal interpretation of schools as communities, where schools are viewed as limited-purpose free associations, and a communitarian interpretation where community and polity are (...) not adequately distinguished. I argue that, within a framework of liberal pluralism, schools can be communities without being illiberal. (shrink)

A translation of Aristotle’s Nicomachean Ethics.