Clinical trials for acute conditions such as myocardial infarction and stroke pose challenges related to informed consent due to time limitations, stress, and severe illness. Consent processes shou...

Volume 20, Issue 8, August 2020, Page W12-W13.

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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The idea that there could be spatially extended mereological simples has recently been defended by a number of metaphysicians (Markosian 1998, 2004; Simons 2004; Parsons (2000) also takes the idea seriously). Peter Simons (2004) goes further, arguing not only that spatially extended mereological simples (henceforth just extended simples) are possible, but that it is more plausible that our world is composed of such simples, than that it is composed of either point-sized simples, or of atomless gunk. The difficulty for these (...) views lies in explaining why it is that the various sub-volumes of space occupied by such simples, are not occupied by proper parts of those simples. Intuitively at least, many of us find compelling the idea that spatially extended objects have proper parts at every sub-volume of the region they occupy. It seems that the defender of extended simples must reject a seemingly plausible claim, what Simons calls the geometric correspondence principle (GCP): that any (spatially) extended object has parts that correspond to the parts of the region that it occupies (Simons 2004: 371). We disagree. We think that GCP is a plausible principle. We also think it is plausible that our world is composed of extended simples. We reconcile these two notions by two means. On the one hand we pay closer attention to the physics of our world. On the other hand, we consider what happens when our concept of something—in this case space—contains elements not all of which are realized in anything, but instead key components are realized in different features of the world. (shrink)

The aim of this investigation is to explore the role of argumentation schemes in enthymeme reconstruction. This aim is pursued by studying selected cases of incomplete arguments in natural language discourse to see what the requirements are for filling in the unstated premises and conclusions in some systematic and useful way. Some of these cases are best handled using deductive tools, while others respond best to an analysis based on defeasible argumentations schemes. The approach is also shown to work reasonably (...) well for weak arguments, a class of arguments that has always been difficult to analyze without the principle of charity producing a straw man. (shrink)

Psychopaths continue to be demonised by the media and estimates suggest that a disturbing percentage of the population has psychopathic tendencies. This timely and controversial new book summarises what we already know about psychopathy and antisocial behavior and puts forward a new case for its cause - with far-reaching implications. Presents the scientific facts of psychopathy and antisocial behavior. Addresses key questions, such as: What is psychopathy? Are there psychopaths amongst us? What is wrong with psychopaths? Is psychopathy due to (...) nature or nurture? And can we treat psychopaths? Reveals the authors' ground-breaking research into whether an underlying abnormality in brain development leaves psychopaths with an inability to feel emotion or fear. The resulting theory could lead to early diagnosis and revolutionize the way society, the media and the state both views and contends with the psychopaths in our midst. (shrink)

This study investigates the ability of individuals with psychopathy to perform passive avoidance learning and whether this ability is modulated by level of reinforcement/punishment. Nineteen psychopathic and 21 comparison individuals, as defined by the Hare Psychopathy Checklist Revised (Hare, 1991), were given a passive avoidance task with a graded reinforcement schedule. Response to each rewarding number gained a point reward specific to that number (i.e., 1, 700, 1400 or 2000 points). Response to each punishing number lost a point punishment specific (...) to that number (i.e., the loss of 1, 700, 1400 or 2000 points). In line with predictions, individuals with psychopathy made more passive avoidance errors than the comparison individuals. In addition, while the performance of both groups was modulated by level of reward, only the performance of the comparison population was modulated by level of punishment. The results are interpreted with reference to a computational account of the emotional learning impairment in individuals with psychopathy. (shrink)

This work emerged from funded research examining collaboration among stake-holder organizations present at three U.S. nuclear weapons complex sites. The authors examine issues such as how and why stakeholder groups form collaborative alliances when dealing with the target organization, what leaders of stakeholder organizations actually think about when collaborating to deal with the target organization, and what outcomes result from the collaboration process. Drawing on stakeholder theory and research in interorganizational collaboration, the authors used an inductive, interview-based methodology to build (...) a model of collaboration among nonprofit stakeholder groups. The model contributes to the descriptive stream of stakeholder theory and, in turn, has implications for the instrumental stream. The model also offers implications for future researchers, leaders of stakeholder alliances, and leaders of target organizations. (shrink)

This study investigates the performance of psychopathic individuals on tasks believed to be sensitive to dorsolateral prefrontal and orbitofrontal cortex (OFC) functioning. Psychopathic and non-psychopathic individuals, as defined by the Hare psychopathy checklist revised (PCL-R) [Hare, The Hare psychopathy checklist revised, Toronto, Ontario: Multi-Health Systems, 1991] completed a gambling task [Cognition 50 (1994) 7] and the intradimensional/extradimensional (ID/ED) shift task [Nature 380 (1996) 69]. On the gambling task, psychopathic participants showed a global tendency to choose disadvantageously. Specifically, they showed an (...) impaired ability to show learning over the course of the task. On the ID/ED task, the performance of psychopathic individuals was not significantly different from incarcerated controls on attentional set-shifting, but significant impairments were found on response reversal. These results are interpreted with reference to an OFC and amygdala dysfunction explanation of psychopathy. (shrink)

Cet article présente les vues rabbiniques sur la composition du Psautier , les Psaumes dans le culte du temple , et les Psaumes comme prophétie eschatologique. Les vues des rabbins sont mises en parallèle avec celles des Pères de l'Église sur les mêmes sujets.

This intervention queries whether subjecting feminist jurisprudence to a methodological transfiguration toward pragrammatology (Derrida, in Smith and Kerrigan 1984) holds liberating potential for f (be it ‘woman’, ‘female’ or ‘feminine’) as both a signifier and a subject to be read with lucidity and nuance in feminist justice claims. I examine feminist jurisprudence’s methodological challenges in the settler colonial context of Alaska with respect to the murders of Della Brown (in 2000) and Mindy Schloss (in 2007). I advance my case for (...) pragrammatology as a critical methodology for feminist jurisprudence by subjecting the case(s) of Brown and Schloss to a more lucid (re)reading in two related and intersecting moves. First, I trace and deconstruct the citations of Brown and Schloss’ legal narratives to expose violence in the systemisation of f as a power and legal relation (Ahmed in Soc Legal Stud 4:55–73, 1995). I then examine the paradoxical nature of f justice claims which necessitate a pragrammatological approach. I conclude by advancing counsel on how we might move within paradox. (shrink)

This study investigated the performance of boys with psychopathic tendencies and comparison boys, aged 9 to 17 years, on two tasks believed to be sensitive to amygdala and orbitofrontal cortex func- tioning. Fifty-one boys were divided into two groups according to the Psychopathy Screening Device (PSD, P. J. Frick & R. D. Hare, in press) and presented with two tasks. The tasks were the gambling task (A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994) and the Intradimensional/ (...) Extradimensional (ID/ED) shift task (R. Dias, T. W. Robbins, & A. C. Roberts, 1996). The boys with psychopathic tendencies showed impaired performance on the gambling task. However, there were no group differences on the ID/ED task either for response reversal or extradimensional set shifting. The implications of these results for models of psychopathy are discussed. (shrink)

Background: Editorial peer review is universally used but little studied. We examined the relationship between external reviewers' recommendations and the editorial outcome of manuscripts undergoing external peer-review at the Journal of General Internal Medicine. Methodology/Principal Findings: We examined reviewer recommendations and editors' decisions at JGIM between 2004 and 2008. For manuscripts undergoing peer review, we calculated chance-corrected agreement among reviewers on recommendations to reject versus accept or revise. Using mixed effects logistic regression models, we estimated intra-class correlation coefficients at the (...) reviewer and manuscript level. Finally, we examined the probability of rejection in relation to reviewer agreement and disagreement. The 2264 manuscripts sent for external review during the study period received 5881 reviews provided by 2916 reviewers; 28% of reviews recommended rejection. Chance corrected agreement on rejection among reviewers was 0.11. In mixed effects models adjusting for study year and manuscript type, the reviewer-level ICC was 0.23 and the manuscript-level ICC was 0.17. The editors' overall rejection rate was 48%: 88% when all reviewers for a manuscript agreed on rejection and 20% when all reviewers agreed that the manuscript should not be rejected. Conclusions/Significance: Reviewers at JGIM agreed on recommendations to reject vs. accept/revise at levels barely beyond chance, yet editors placed considerable weight on reviewers' recommendations. Efforts are needed to improve the reliability of the peer-review process while helping editors understand the limitations of reviewers' recommendations. © 2010 Kravitz et al. (shrink)

Arthur Danto is the Johnsonian Professor Emeritus of Philosophy at Columbia University and the most influential philosopher of art in the last half century. As an art critic for The Nation for 25 years and frequent contributor to other widely read outlets such as the New York Review of Books, Danto also has become one of the most respected public intellectuals of his generation. He is the author of some two dozen important books, along with hundreds of articles and reviews (...) which have been the center of both controversy and discussion. In this volume Danto offers his intellectual autobiography and responds to essays by 27 of the keenest critics of his thought from the worlds of philosophy and the arts. The book includes 16 pages of color art reproductions. Danto is the author dozens of books on art, philosophy, the philosophy of art, and art criticism. He is a rare philosopher who is also a public intellectual. (shrink)

We study the filter ℒ*(A) of computably enumerable supersets (modulo finite sets) of an r-maximal set A and show that, for some such set A, the property of being cofinite in ℒ*(A) is still Σ0 3-complete. This implies that for this A, there is no uniformly computably enumerable “tower” of sets exhausting exactly the coinfinite sets in ℒ*(A).

General Electric has a rich history of being in the center of public discourse regarding the intersection of corporate strategy and environmental concerns. During Jeffrey Immelt’s tenure as Chief Executive Officer, G.E. has taken a proactive approach to coupling corporate social responsibility with organizational profitability in its Ecomagination initiatives. Critics abound with some investor groups questioning the utility of Immelt’s approach for shareholder returns while other stakeholder groups question G.E.’s motives and methods. This case study reviews G.E.’s past CSR efforts (...) and the more recent Ecomagination program and its efficacy and sustainability. The case was developed from public sources. (shrink)

General Electric (G.E.) has a rich history of being in the center of public discourse regarding the intersection of corporate strategy and environmental concerns. During Jeffrey Immelt’s tenure as Chief Executive Officer, G.E. has taken a proactive approach to coupling corporate social responsibility with organizational profitability in its Ecomagination initiatives. Critics abound with some investor groups questioning the utility of Immelt’s approach for shareholder returns while other stakeholder groups question G.E.’s motives and methods. This case study reviews G.E.’s past CSR (...) efforts and the more recent Ecomagination program and its efficacy and sustainability. The case was developed from public sources. (shrink)

This case recounts the founding of HealthSouth Rehabilitation, its rapid growth, financial mishandlings and the struggle former CFO Aaron Beam had in dealing with a conscience that kept him awake at night. Beam had met HealthSouth founder Richard Scrushy when applying for a job with Lifemark Hospital Corporation in Texas in 1980. After Lifemark was bought by AMI in 1983, Scrushy invited Beam to join him in the launching of his new company in Birmingham, Alabama. The uniqueness of the hospital (...) was that it would provide inpatient surgery for those who had suffered an injury, but it would also provide outpatient services such as rehabilitation, nutrition guidance and psychological counseling. This type of structure was appealing to insurance companies because it would move the patient out of the hospital much quicker and save the cost of extended hospitalization. The company experienced rapid growth and went public within three years of launch. By 1996, the top executives of the company realized that they would not be able to meet Wall Street analysts’ forecasts which would affect the price of their stock and reduce their holdings. They decided to “cook the books” temporarily to meet quarterly expectations. However, once the financial mishandling had begun, the executives found it difficult to reverse their actions and report accurate numbers to the public. Beam decided to retire from the company in 1996; and after this action, he continued to find it difficult to sleep at night because of his involvement in the fraud. The issue in the case is whether Beam should consider coming forward and revealing to the Securities and Exchange Commission how the books had been doctored so that he could salvage his damaged conscience. (shrink)

The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the prospect of having to ration medical goods and services on this scale.

The world is complex, but acknowledging its complexity requires an appreciation for the many roles context plays in shaping natural phenomena. In _Unsimple Truths, _Sandra Mitchell argues that the long-standing scientific and philosophical deference to reductive explanations founded on simple universal laws, linear causal models, and predict-and-act strategies fails to accommodate the kinds of knowledge that many contemporary sciences are providing about the world. She advocates, instead, for a new understanding that represents the rich, variegated, interdependent fabric of many (...) levels and kinds of explanation that are integrated with one another to ground effective prediction and action. Mitchell draws from diverse fields including psychiatry, social insect biology, and studies of climate change to defend “integrative pluralism”—a theory of scientific practices that makes sense of how many natural and social sciences represent the multi-level, multi-component, dynamic structures they study. She explains how we must, in light of the now-acknowledged complexity and contingency of biological and social systems, revise how we conceptualize the world, how we investigate the world, and how we act in the world. Ultimately _Unsimple Truths _argues that the very idea of what should count as legitimate science itself should change. (shrink)

This fine collection of essays by a leading philosopher of science presents a defence of integrative pluralism as the best description for the complexity of scientific inquiry today. The tendency of some scientists to unify science by reducing all theories to a few fundamental laws of the most basic particles that populate our universe is ill-suited to the biological sciences, which study multi-component, multi-level, evolved complex systems. This integrative pluralism is the most efficient way to understand the different and complex (...) processes - historical and interactive - that generate biological phenomena. This book will be of interest to students and professionals in the philosophy of science. (shrink)

This volume offers a collection of in-depth explorations of pragmatism as a framework for discussions in philosophy of science and metaphysics. Each chapter involves explicit reflection on what it means to be pragmatist, and how to use pragmatism as a guiding framework in addressing topics such as realism, unification, fundamentality, truth, laws, reduction, and more. -/- .

Biological knowledge does not fit the image of science that philosophers have developed. Many argue that biology has no laws. Here I criticize standard normative accounts of law and defend an alternative, pragmatic approach. I argue that a multidimensional conceptual framework should replace the standard dichotomous law/ accident distinction in order to display important differences in the kinds of causal structure found in nature and the corresponding scientific representations of those structures. To this end I explore the dimensions of stability, (...) strength, and degree of abstraction that characterize the variety of scientific knowledge claims found in biology and other sciences. (shrink)

This paper explains how to use a new software tool for argument diagramming available free on the Internet, showing especially how it can be used in the classroom to enhance critical thinking in philosophy. The user loads a text file containing an argument into a box on the computer interface, and then creates an argument diagram by dragging lines from one node to another. A key feature is the support for argumentation schemes, common patterns of defeasible reasoning historically know as (...) topics . Several examples are presented, as well as the results of an experiment in using the system with students in a university classroom. (shrink)

Human beings, even very young infants, and members of several other species, exhibit remarkable capacities for attending to and engaging with others. These basic capacities have been the subject of intense research in developmental psychology, cognitive psychology, comparative psychology, neuroscience, and philosophy of mind over the last several decades. Appropriately characterizing the exact level and nature of these abilities and what lies at their basis continues to prove a tricky business. The contributions to this special issue investigate whether and to (...) what extent the exercise of such capacities count as, or are best explained by, a genuine understanding of minds, where such understanding depends on the creatures in question possessing capacities for attributing a range of mental states and their contents in systematic ways. The question that takes center stage is: Do the capacities for attending to and engaging with others in question involve mindreading or is this achieved by other means? In this editorial we will review the state of the debate between mindreading and alternative accounts of social cognition. The issue is organized as follows: the first two papers review the experimental literature on mindreading in primates (Bermúdez) and children (Low & Wang), and the kinds of arguments made for mindreading and alternative accounts of social cognition. The next set of papers (Hedger & Fabricius, Lurz & Krachun, Zawidzki, and de Bruin et al.) further critique the existing experimental data and defend various mindreading and non-mindreading accounts. The final set of papers address further issues raised by phenomenological (Jacob, Zahavi), enactive (Michael), and embodied (Spaulding) accounts of social cognition. (shrink)