Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The (...) primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6–2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. (shrink)

Volume 20, Issue 2, February 2020, Page 49-50.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Studies in Plato's Two-Level ModelIan MuellerHolger Thesleff. Studies in Plato's Two-Level Model. Helsinki: Societas Scientarum Fennica, 1999. Pp. vi + 143. N. P.After some 30 years of incisive intervention in Platonic scholarship, Holger Thesleff here offers us "an attempt to elaborate and ground more firmly some basic theses which I have propounded in various contexts before," (1) a rather modest description of what he also describes as an (...) attempt to contribute toward "a more general agreement on how to read and interpret Plato" (5). The richness of this book makes it impossible to describe in any detail, and I shall content myself with indicating some of what I take to be its principal points of view.Thesleff"s concern for agreement arises from his perception of the vastly discrepant schools of Plato interpretation, of which the most important for him might be labeled esotericist, analytic, and "literary." The last, which can hardly be called a school at all, includes a variety of scholars who downplay "literal" interpretation and emphasize such things as "dramatic artistry, the structure of the dialogues, the characterization of settings and persons, shifts of style, allusions, play, and irony" (3). Thesleff's sympathies clearly lie with these people, perhaps to an extent which, as I shall suggest, will limit the effectiveness of his attempt to move toward a consensus.As the title indicates Thesleff builds his reading around what he calls Plato's two-level model. This two-level model is not, as one might suppose, what has been called Plato's two worlds view, the belief in a world of pure being beyond the perceived world we inhabit. Indeed, it is not a doctrine or set of doctrines at all. Rather "it is an intuitive 'vision' which offers only crude basic patterns and frames for the structures of Plato's thinking, feelings, intuitions, and intentions, from his youth to his old age, and for our understanding of them" (123). Clearly one cannot expect a full and precise articulation of this vision. Thesleff proceeds by discussing in terms of their role in the earlier dialogues ten hierarchic pairs which form part of Plato's vision: divine/human, soul/body, leading/being led (particularly important in the conduct of a Socratic discussion), truth/appearance, knowledge/opinion, intellect/senses, defined/undefined, stability/change, one/many, same/different. These hierarchic or asymmetric pairs are contrasted by Thesleff with what he calls polar opposites like large/small and light/dark. He also stresses that the hierarchic pairs of Plato's two-level model involve no separation (chorismos), but rather a communion (koinônia).As the words "from his youth to his old age" in the quotation of the previous paragraph indicate, Thesleff is a "unitarian" in his approach to Plato. His Plato is not a philosopher whose positions changed through time as a result of reasoned argument. What many scholars take to be doctrines later given up, e.g., the view that learning is being reminded (anamnêsis), are "thought experiments," which are not followed up, thought experiments made within the context of the unchanging two-level vision.Although Thesleff is a unitarian in the sense I have indicated, he does believe that a kind of order of composition can be constructed for the dialogues. I say "kind of" because Thesleff's chronology involves assumptions of revisions over time, multiple authorship, and even dialogues "written down" by people other than Plato. The resulting chronology is complex, and I here only indicate it in rough form in a way which [End Page 272] brings out what I take to be its major points. Leaving out of account those Socratic" dialogues which Thesleff takes to be latish and the posthumously completed Laws, we can say that a series of late dialogues starts with the Parmenides and includes the Timaeus, Critias, Sophist, Politicus, and Philebus. All other dialogues, including the Theaetetus, were written prior to the Parmenides with the exception of the Republic, which Thesleff proposes is in its ultimate shape a late work, representing "only and purely Plato's 'own' and personal philosophy" (115). As for the other late dialogues, which have played an important... (shrink)

BackgroundAn analysis of the position statements of secular US medical and surgical professional societies on physician-assisted suicide (PAS) and euthanasia have not been published recently. Available statements were evaluated for position, content, and sentiment.MethodsIn order to create a comprehensive list of secular medical and surgical societies, the results of a systematic search using Google were cross-referenced with a list of societies that have a seat on the American Medical Association House of Delegates. Societies with position statements were identified. These statements (...) were divided into 5 categories: opposed to PAS and/or euthanasia, studied neutrality, supportive, acknowledgement without statement, and no statement. Linguistic analysis was performed using RapidMinder in order to determine word frequency and sentiment respective to individual statements. To ensure accuracy, only statements with word counts > 100 were analyzed. A 2-tailed independentttest was used to test for variance among sentiment scores of opposing and studied neutrality statements.ResultsOf 150 societies, only 12 (8%) have position statements on PAS and euthanasia: 11 for PAS (5 opposing and 4 studied neutrality) and 9 for euthanasia (6 opposing and 2 studied neutrality). Although the most popular words used in opposing and studied neutrality statements are similar, notable exceptions exist (suicide,medicine, andtreatmentappear frequently in opposing statements, but not in studied neutrality statements, whereaspsychologists,law, andindividualsappear frequently in studied neutrality statements, but not in opposing statements). Sentiment scores for opposing and studied neutrality statements do not differ (mean, 0.094 vs. 0.104;P = 0.90).ConclusionsFew US medical and surgical societies have position statements on PAS and euthanasia. Among them, opposing and studied neutrality statements share similar linguistic sentiment. Opposing and studied neutrality statements have clear differences, but share recommendations. Both opposing and studied neutrality statements cite potential risks of PAS legalization and suggest that good palliative care might diminish a patient’s desire for PAS. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Nursing Ethics:A Selected Bibliography, 1987 to PresentDoris Mueller Goldstein (bio)The ethics of nursing is emerging as a discipline distinct from bioethics or medical ethics. Although these areas have many concerns in common, nurses are demonstrating that their perspective can make a unique contribution to ethical debate.An especially dynamic area of discussion within nursing ethics is the philosophy of caring. The work on moral development by Harvard educator Carol (...) Gilligan in her book, In a Different Voice, is pivotal in this discussion (IV B, Cooper 1989). Jean Watson, a nurse at the University of Colorado Center for Human Caring, also has written extensively on the philosophy of caring. She states that "an ethic of caring has a distinct moral position: caring is attending and relating to a person in such a way that the person is protected from being reduced to the moral status of objects...." (I, Watson 1988).Even as the philosophy of caring becomes more predominant, however, nurses today are often drawn away from the caring role by forces prevalent in the modern hospital. First, modern technology can divert the nurse's attention away from the patient and toward the operation of complex equipment, and second, large hospitals are often managed as bureaucracies (I, Fitzpatrick 1988).A recent study examined the frequency and seriousness of ethical issues encountered in nursing practice (IV A, Berger 1991). A survey instrument that included 32 potential ethical issues was developed by the authors. Respondents were asked to identify what kinds of issues concerned them and with what frequency, and to indicate what resources were used to cope with these dilemmas. The study found that nurses were frequently faced with inadequate staffing, heroic measures for prolonging life, inappropriate resource allocation, situations where patients are being discussed inappropriately, and coping with irresponsible activity of colleagues.The variety of ethical dilemmas encountered on a daily basis by nurses and their expressed interest in developing a moral grounding for the profession of [End Page 177] nursing, along with increased attention to ethical issues in nursing education have led to an explosion in the literature on these topics. In the preparation of this bibliography over 1,000 citations were retrieved in computer searches of various databases: BIOETHICSLINE, MEDLINE and CATLINE (National Library of Medicine), CINAHL (Current Index to Nursing and Allied Health Literature), BOOKS IN PRINT PLUS, and ETHX (the online public access catalog for articles at the National Reference Center for Bioethics Literature). What is offered here is a small sampling of that literature. Books and special issues of periodicals are briefly annotated, but citations to articles are simply arranged by broad subject, and within that, alphabetically by author. The subcategories reflect the topics receiving the most discussion in current literature.This bibliography updates "The Ethics of Nursing: A Selected Bibliography," by Doris Mueller Goldstein, which covered the earlier literature and was published as an appendix to Ethical Decision Making in Nursing Administration (I, Silva 1990).I. BooksAustralian Nursing Federation. Ethics: Nursing Perspectives, vol. 2. North Fitzroy, Victoria: The Federation, 1989. 102 p. (Publisher's address: 373-375 St. Georges Road, postal code 3068.) The National Professional Development Committee of Australia fostered the publication of a second volume of papers on nursing ethics. Articles cover patients' rights, ethical theory in decisionmaking behaviors, the nurse and the DNR order, and whistleblowing. Several appendices represent difficult-to-obtain documents, such as the RANF (Royal Australian Nursing Federation) position statements on terminal care, AIDS and occupational health, professional practice problems, and conscientious objection.Bandman, Elsie L., and Bandman, Bertram. Nursing Ethics Through the Life Span. 2nd ed. Norwalk, CT: Appleton & Lange, 1990. 288 p. Following an extensive review of the moral foundations of decision making in nursing, the authors take the reader through a chronology of nursing ethics issues as they occur in the human life span, beginning with the procreative family period and concluding with the end of life. Each chapter contains discussion questions—an aid to educators using this as a textbook.Benjamin, Martin, and Curtis, Joy. Ethics in Nursing. 2nd ed. New York: Oxford University Press, 1986. 206 p. An overview of the nature of ethical inquiry and theory is followed by... (shrink)

The MS. hie tunc of V. 6 has no friends. L. Mueller's hoc tunc is weak and flat, and L. Rank, Mnemosyne 40. 51, is justly dissatisfied with the hietans of M. Havet's larger and smaller editions, to which the hians of Verg. Aen. 12. 754 lends no sufficient support, as there the dog is opening its mouth before it bites. Add to this that it is by no means certain that Phaedrus would either have used the word or (...) used it in the simple sense of opening the mouth. Rank's own proposal, ‘heu’ tunc, fails also to carry conviction. There is however a word which belongs to our author's vocabulary and is as near to the manuscripts as either of the above, and which hits the sense at which hietans aims. This is rictus. The word is often used of the opened mouths of dogs, Lucr. 5. 1064, Ovid Met. 13. 568. Juvenal 10. 271 sq. ‘canino latrauit rictu,’ and of other animals. That it is appropriate with dimisit ‘let go’ may be seen from the counterpart expression of Martial 1. 48. 1 ‘rictibus his tauros non eripuere magistri.’. (shrink)

The MS. hie tunc of V. 6 has no friends. L. Mueller's hoc tunc is weak and flat, and L. Rank, Mnemosyne 40. 51, is justly dissatisfied with the hietans of M. Havet's larger and smaller editions, to which the hians of Verg. Aen. 12. 754 lends no sufficient support, as there the dog is opening its mouth before it bites. Add to this that it is by no means certain that Phaedrus would either have used the word or (...) used it in the simple sense of opening the mouth. Rank's own proposal, ‘heu’ tunc, fails also to carry conviction. There is however a word which belongs to our author's vocabulary and is as near to the manuscripts as either of the above, and which hits the sense at which hietans aims. This is rictus. The word is often used of the opened mouths of dogs, Lucr. 5. 1064, Ovid Met. 13. 568. Juvenal 10. 271 sq. ‘canino latrauit rictu,’ and of other animals. That it is appropriate with dimisit ‘let go’ may be seen from the counterpart expression of Martial 1. 48. 1 ‘rictibus his tauros non eripuere magistri.’. (shrink)

This major new study by one of the most penetrating and persistent critics of philosophical and scientific orthodoxy, returns to Aristotle in order to examine the salient categories in terms of which we think about ourselves and our nature, and the distinctive forms of explanation we invoke to render ourselves intelligible to ourselves. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author (...) of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)

This major study examines the most fundamental categories in terms of which we conceive of ourselves, critically surveying the concepts of substance, causation, agency, teleology, rationality, mind, body and person, and elaborating the conceptual fields in which they are embedded. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad (...) categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)

This major new study by one of the most penetrating and persistent critics of philosophical and scientific orthodoxy, returns to Aristotle in order to examine the salient categories in terms of which we think about ourselves and our nature, and the distinctive forms of explanation we invoke to render ourselves intelligible to ourselves. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author (...) of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)

In recent years philosophers have given much attention to the ‘ontological problem’ of events. Donald Davidson puts the matter thus: ‘the assumption, ontological and metaphysical, that there are events is one without which we cannot make sense of much of our common talk; or so, at any rate, I have been arguing. I do not know of any better, or further, way of showing what there is’. It might be thought bizarre to assign to philosophers the task of ‘showing what (...) there is’. They have not distinguished themselves by the discovery of new elements, new species or new continents, nor even of new categories, although there has often been more dreamt of in their philosophies than can be found in heaven or earth. It might appear even stranger to think that one can show what there actually is by arguing that the existence of something needs to be assumed in order for certain sentences to make sense. More than anything, the sober reader will doubtlessly be amazed that we need to assume, after lengthy argument, ‘that there are events’. (shrink)

Following promulgation of the Nuremberg code in 1947, the ethics of research on human subjects has been a challenging and often contentious topic of debate. Escalation in the use of research participants in low-income countries over recent decades , has intensified the debate on the ethics of international research and led to increasing attention both to exploitation of vulnerable subjects and to considerations of how the 10:90 gap in health and medical research could be narrowed. In 2000, prompted by the (...) discussions over several years that led to the US NIH launching a capacity building programme on research ethics for members of research ethics committees in developing countries, we advanced a ‘new look’ for the ethics of international research.1 Since then progress has been made on several fronts.First, our ideas—considered somewhat radical and impractical at the time—have been provocatively addressed by scholars who have either contested them or advanced similar conceptions of what obligations international researchers have to research participants and communities in low income countries before, during and after clinical trials. Second, those researchers who have been sympathetic to our ideas have either endeavoured to put these into practice or have investigated the feasibility of doing so. Third, the intractability of the 10/90 gap and the escalation of interest in global health have sensitised many to the need to amplify the uptake of these ideas in practice.Here, we briefly review the conceptual and practical developments in international research ethics. While much conceptual progress has been made (and the concepts are now appearing …. (shrink)

As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)

P S Wilson; Perspectives on Punishment—Reply to Pamela Moore, Journal of Philosophy of Education, Volume 8, Issue 1, 30 May 2006, Pages 103–134, https://doi.org.

P S Wilson; Child-Centred Education, Journal of Philosophy of Education, Volume 3, Issue 1, 30 May 2006, Pages 105–126, https://doi.org/10.1111/j.1467-9752.1969.

P S Wilson; Interests and Educational Values, Journal of Philosophy of Education, Volume 8, Issue 2, 30 May 2006, Pages 181–199, https://doi.org/10.1111/j.1467-.

Journal of the Philosophy of Sport, Volume 41, Issue 2, Page 177-191, July 2014.

Even for persons who hold to the ethical acceptance of abortion practices in general, questions of detail often arise. If you assume the distinction between the physical human organism alone and the person that is associated with that organism, then you must face the question of whether it is permissible to abort a fetus if the corresponding person has come into being. We take the position that the abortion of a fetus that has achieved this level of development should be (...) declared unethical except in special circumstances. Our purpose here is to identify the point in the development of the fetus that serves as the marker for this level. (shrink)

United States of America demographic profiles illustrate a nation rich in cultural and racial diversity. Approximately 29% of the population are minorities and demographic projections indicate an increase to 50% by the year 2050. This creates a highly mobile and constantly changing environment, revealing the need for new levels of cultural awareness and sensitivity. These issues are particularly critical in the medical community where medical professionals must understand the impact cultural differences and barriers can have on evaluation, treatment, and rehabilitation. (...) During times of stress, such as when injury strikes, problems associated with lack of cultural sensitivity are intensified. Cultural diversity is of particular concern when standard measures for diagnosis and prognosis are derived from established norms for responding, because culture defines norms. This paper details a ten point checklist designed to facilitate cultural awareness and sensitivity in medical settings to ensure maximum successful recovery and outcomes for all patients. (shrink)

In worlds that lack life, there is no value. For all that, there is no mystery about 'the existence of values in a world of facts'. The world does not consist of facts, rather true descriptions of the world consist of statements of fact. It is as much a fact concerning the world that there are things that are of value to living things, that human beings value things and possess valuable characteristics, perform valuable deeds, stand in valuable relationships to (...) others, as it is a fact that there is life on earth. (shrink)

Throughout its long history metaphysics has been variously conceived. At its most sublime, it has been taken to be the study of the super‐sensible, in particular of the existence of a god, the nature of the soul, and the possibility of an afterlife. When the young Ludwig Wittgenstein entered the lists, it was entirely reasonable to conceive of metaphysics in this manner. Its subject matter was held to be the language‐independent and thought‐independent de re necessities of the world. The Tractatus (...) is dominated by three problems: first, the nature of logic and logical necessity; secondly, the essence of the proposition and hence the characterization of the general propositional form; and thirdly, the intentionality of the proposition. Logical propositions are combinations of elementary propositions by means of truth‐functional logical connectives. The metaphysics adumbrated in the Tractatus, Wittgenstein thought, was required for the possibility of representation and for the possibility of logic. (shrink)