What the philosophy of medicine is -- Philosophy of medicine: should it be teleologically or socially construed? -- The internal morality of clinical medicine: a paradigm for the ethics of the helping and healing professions -- Humanistic basis of professional ethics -- The commodification of medical and health care: the moral consequences of a paradigm shift from a professional to a market ethic -- Medicine today: its identity, its role, and the role of physicians -- From medical ethics to a (...) moral philosophy of the professions -- Moral choice, the good of the patient, and the patient's good -- The four principles and the doctor-patient relationship: the need for a better linkage -- Patient and physician autonomy: conflicting rights and obligations in the physician-patient relationship -- Character, virtue, and self-interest in the ethics of the professions -- Toward a virtue-based normative ethics for the health professions -- The physician's conscience, conscience clauses, and religious belief: a Catholic perspective -- The most humane of the sciences, the most scientific of the humanities -- The humanities in medical education: entering the post-evangelical era -- Agape and ethics: some reflections on medical morals from a catholic christian perspective -- Bioethics at century's turn: can normative ethics be retrieved? -- Hippocratic tradition -- Toward an expanded medical ethics: the Hippocratic ethic revisited -- Medical ethics: entering the post-Hippocratic era. (shrink)

In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life (...) determinations, the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient 's values. In order to act in the patient 's best interests, or the patient 's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient 's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient 's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician- patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today. (shrink)

It is usually maintained that a subject with manifestly contradictory beliefs is irrational. How can we account, then, for the intuitive rationality of dialetheists, who believe that some manifest contradictions are true? My paper aims to answer this question. Its ultimate goal is to determine a characterization of (or rather a constraint for) rational belief approvable by both the theorists of Dialetheism and its opponents. In order to achieve this goal, a two-step strategy will be adopted. First, a characterization of (...) rational belief applicable to non-dialetheist believers will be determined; this characterization will involve the semantic apparatus of Nathan Salmon’s Millian Russellianism but will get rid of the problematic and obscure notion of mode of presentation (guise in his own terminology), replacing it with a couple of novel devices, belief subsystems and cognitive coordination. Second, using ideas from Graham Priest, the leading proponent of Dialetheism, such a characterization will be modified, so as to devise a new one able to account for the intuitive rationality of both dialetheist and non-dialetheist believers. (shrink)

In recent years, virtue theories have enjoyed a renaissance of interest among general and medical ethicists. This book offers a virtue-based ethic for medicine, the health professions, and health care. Beginning with a historical account of the concept of virtue, the authors construct a theory of the place of the virtues in medical practice. Their theory is grounded in the nature and ends of medicine as a special kind of human activity. The concepts of virtue, the virtues, and the virtuous (...) physician are examined along with the place of the virtues of trust, compassion, prudence, justice, courage, temperance, and effacement of self-interest in medicine. The authors discuss the relationship between and among principles, rules, virtues, and the philosophy of medicine. They also address the difference virtue-based ethics makes in confronting such practical problems as care of the poor, research with human subjects, and the conduct of the healing relationship. This book woith the author's previous volumes, A Philosophical Basis of Medical Practice and For the Patient's Good, are part of their continuing project of developing a coherent moral philosophy of medicine. (shrink)

This manuscript focuses on a problem for Millian Russellianism raised by Fine : “[Assuming] that we are in possession of the information that a Fs and the information that a Gs, it appears that we are sometimes justified in putting this information ‘together’ and inferring that a both Fs and Gs. But how?” It will be my goal to determine a Millian-Russellian solution to this problem. I will first examine Nathan Salmon’s Millian-Russellian solution, which appeals to a non-semantic and subjective (...) notion of coordination defined in terms of guises. I will object that in order to convincingly solve a specific version of Fine’s problem, identity conditions for guises must be provided. On the other hand, the most plausible way to individuate guises is by means of the equivalence classes of coordination itself. But, if so, the guise-based strategy to solve Fine’s problem risks being circular; in addition, there are serious doubts that coordination is transitive. An alternative Millian-Russellian solution to Fine’s problem will then be explored, which gives up guises and employs, instead, a non-semantic and subjective relation of coordination not defined in terms of guises, along with occurrences of Russellian propositions of a special sort, for which identity conditions will be provided and via which token attitude states intuitively more fine-grained than guises will be individuated. (shrink)

This Handbook offers a broad yet unified treatment of all the philosophical issues connected with climate change, ranging from foundational puzzles to detailed applications. It addresses the philosophical foundations of the discussion on the ethical, social, political and legal impacts of climate change. It covers all branches of philosophy that are relevant to the understanding of the premises and implications of the impacts on human, animal and natural life on Earth. More specifically, the Handbook examines the scientific accounts of climate (...) change as well as its causes. It explores the tools offered by social sciences and humanities to study the societal impact of climate change. It studies the ethical and political issues connected with and resulting from climate change, and puts it all in an environmental and historical context. In addition, the book offers solutions to the main philosophical puzzles and problems, and provides paths of interaction between philosophy and other disciplines. The discussion about climate change and the mitigation/adaptation policies spans many areas and levels – from abstract science and philosophy to current on-the-ground politics. However, climate change is also a great a philosophical puzzle. Indeed, its existential and practical relevance can be thought to largely derive from the philosophical complications it engenders. Climate change is applied philosophy par excellence. Preventing dangerous anthropogenic climate change needs very good philosophy applied to concrete and specific practical issues. Climate change is an area where scholars from very different provenances should cooperate on equal terms, having in view a common, and really important, purpose – contribute to preventing great burdens and even the extinction of humankind and the destruction of hospitable and valuable non-human nature. (shrink)

Reframing reveals possibilities. This article highlights how conceptual shifts regarding ‘sustainability’ occurring inside China’s municipalities and major corporations are opening the way for new collaborations with technology companies and technology artists. These shifts – from predetermined accounting to systems thinking – reveal new opportunities to intervene in the biophysical and economic challenges facing China today. In companies, this shift implies placing financially relevant environmental, social and governance (ESG) factors at the core of business strategy. In municipalities, this shift necessitates designing (...) and implementing systems that track ecosystem services rather than simply stocks of natural resources and recognizing interdependencies between these services and economic development. This article suggests that this sustainability reframing can draw heavily on systems thinking from environmental science, technology companies’ drive to develop products that meet these emerging demands, corporations’ need to compete in an uncertain developing market and the reframing skills of artists, particularly digital artists. This article concludes with opportunities for digital artists to intervene and collaborate with sustainability practitioners to open new directions for cities and companies in China. (shrink)

This Handbook offers a broad yet unified treatment of many philosophical issues connected with climate change, ranging from foundational puzzles to detailed applications. It extends to many branches of philosophy that are relevant to the understanding of the premises and implications of the impacts of climate change on human and nonhuman life on Earth. More specifically, the handbook examines the scientific accounts of climate change as well as its causes. It explores the tools offered by social sciences and humanities to (...) study the societal premises and impacts of climate change as well as delving deeper into the ethical and political issues connected with and resulting from climate change. By doing so, it puts it all in an ecological and historical context. In addition, the book offers solutions to some important philosophical puzzles and problems, and indicates paths of interaction between philosophy and other disciplines. The discussion about climate change and the mitigation/adaptation policies spans many areas and levels – from abstract science and philosophy to current on-the-ground politics. However, climate change is also a great a philosophical puzzle. Indeed, its existential and practical relevance can be thought to largely derive from the philosophical complications it engenders. Climate change is applied philosophy par excellence. Preventing dangerous anthropogenic climate change needs very good philosophy applied to concrete and specific practical issues. Climate change is an area where scholars from very different provenances should cooperate on equal terms, having in view a common, and really important, purpose – contribute to preventing great burdens and even the extinction of humankind and the destruction of hospitable and valuable non-human nature. (shrink)

Millianism is the doctrine according to which the semantic content of a proper name is exhausted by its referent. This article raises and attempts to solve a dilemma for Millians: either a proper name of a truth bearer is in turn a truth bearer ; or having a truth bearer as semantic content is not sufficient for a linguistic expression to be a truth bearer. As it will be shown in the manuscript, the dilemma does not arise with “that”-clauses in (...) the place of proper names, if “that”-clauses are taken to be non-Millian designators whose semantic content is not a truth bearer. An account of “that”-clauses having such features and originating with Salmon, Frege's Puzzle, will be defended. (shrink)

Book reviewed in this article: For the Patient's Good: The Restoration of Beneficence in Health Care. By Edmund D. Pellegrino and David C. Thomasma.

This collection of essays, commissioned by the President’s Council on Bioethics, explores a fundamental concept crucial to today’s discourse in law and ethics in general and in bioethics in particular. Since its formation in 2001, the council has frequently used the term “human dignity” in its discussions and reports. In this volume scholars from the fields of philosophy, medicine and medical ethics, law, political science, and public policy address the issue of what the concept of “human dignity” entails and its (...) proper role in bioethical controversies. __Human Dignity and Bioethics_ _is an attempt to clarify a controversial concept, one that is a critical component in the decisions of policymakers. (shrink)

In his monograph Semantic Relationism, Kit Fine proposes two characterizations of coordination between proper names: an intuitive test; and a technical definition. The intuitive characterization is grounded in a notion of understanding distinct from the familiar notion of linguistic competence. Three prima facie appealing proposals to characterize this notion of understanding will be examined in the present paper and then dismissed as intrinsically implausible or as incompatible with Fine’s semantics. Not even his technical characterization of coordination, involving the notion of (...) semantic requirement, will enable us to escape the impasse. Ultimately, the question of what exactly coordination between names is will remain open. (shrink)

Es bien conocido el aprecio que desde hace tiempo tiene la Iglesia por el método ver-juzgar-actuar, sin embargo, las reflexiones de la filosofía y la sociología hacen considerar hoy la necesidad de enriquecer el momento del ver, con unos elementos fenomenológicos y hermenéuticos que lo hagan más histórico y menos objetivista y de lograr además una mayor interacción entre los tres momentos. En este sentido, la investigación propone la inserción de las historias de vida de las personas y las comunidades (...) como un camino nuevo de conocimiento de la realidad. En efecto, la realidad no sólo consiste en el hecho desnudo, sino también en el hecho tal y como lo percibe el sujeto; no sólo es suceso, sino también narración. Así, las historias de vida, y el consecuente método autobiográfico constituyen, según la investigación, un recurso vital en la planificación pastoral; no simplemente un apéndice secundario o un recurso simplemente aplicativo, sino, un momento intrínseco de la reflexión y de la experiencia teológica y pastoral. It is well-known the log lasting appreciation of the church for the method see-judge-act, however the current philosophical and sociological considerations are considering the need for an enrichment of the moment of seeing with some phenomenological and hermeneutical elements which could make it more historical and less objective and to achieve, moreover, a major interaction among the three moments. In this sense, the research proposes also the introduction of the stories of people’s lives and of the communities as a new way of awareness of reality. Indeed, reality is not only in the naked event, but also in the event as it is seen by the subject; not only the happened event, but also its narration. For this reason, the life stories and the autobiographical method are, according to the research a vital resource in the pastoral planning; not simply a secondary appendix or a applicative type, but as an intrinsic moment of the theological and pastoral reflection and experience. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:President’s Council on BioethicsEdmund D. Pellegrino (bio) and F. Daniel Davis (bio)Approximately two weeks before what was to have been its final meeting, the White House dissolved the President’s Council on Bioethics by terminating the appointments of its 18 members. The letters of dismissal, dated 10 June 2009, informed the members that their service on the Council would end with the close of business the next day.The Council’s (...) term was set to expire on 30 September 2009. After President Obama’s election in November and during the transition, we were advised to proceed on the assumption that the Council would be permitted to cease on that date. Reasons for the abrupt move to disband the Council are unknown. We have accepted the fact that we Council members served at the pleasure of the President and that he simply exercised his rightful prerogative. No explanation is therefore required.Some observers have speculated that the action was retaliatory. They related to the fact that several members of the Council disagreed with the President’s stem cell policy in a signed statement published in the Hastings Center’s Bioethics Forum. Others have speculated that the move was pre-emptive. At its final meeting, scheduled for 25–26 June, the Council was set to sign-off on two of its final publications. One was a comprehensive report on the ethics of organ transplantation, and the other a white paper entitled Health Care and the Common Good. The aim was immediately to release the latter as a contribution to the intensifying debate about health care reform. Health Care and the Common Good could well have aided rather than impeded the President’s drive to better control health care costs and achieve universal coverage. The Council report attempted to ground both goals in the ethical framework of, as the title indicates, the common good of all Americans.In his letter terminating the members’ appointments, Assistant to the President for Presidential Personnel Don Gips said that the President “recognizes the values of having a commission of experts in bioethical issues to provide objective and non-ideological bioethics advice to his administration.” Gips went on to say that the President is “currently rethinking the purposes and goals of such a bioethics commission, and is carefully considering a revitalized mission and mandate.” And, [End Page 309] responding to media enquiries, White House press officer Reid Cherlin explained that the President’s Council was terminated because it was a “philosophically leaning advisory group” and, according to a New York Times account by Nicholas Wade, “because it favored discussion over developing a shared consensus.” As for the ultimate outcome of the President’s “rethinking,” Cherlin indicated that President Obama will appoint a new commission with the mandate of offering “practical policy options” in bioethics.In the light of our experiences with the Council, we leave it with hopes that certain questions of national importance will be addressed. In light of the nature of federal advisory commissions, what is or are the proper roles of a national bioethics commission? If the aim is to provide advice and counsel to the President or, perhaps to the U. S. Congress, is that advice best rendered as a group consensus or as an in-depth exploration of the inevitably conflicting ethical perspectives on a given issue? How should such a commission be constituted—with what sorts of individuals? And what is the nature of the expertise that they individually and collectively bring to the commission’s functions? If the commission is to promote public debate and discussion, how exactly should it go about that task? And how is the efficacy of a commission to be assessed? Such questions inevitably lead us deep into contested territory, as the experience of this Council has shown: into the intersections of politics, religion, and science and into the relations between practice and theory—between policy and what some seem to deride as “philosophy.” Indeed, policy without an underlying philosophy is an edifice without a foundation; philosophy without policy is a foundation without an edifice.At the last meeting of the Council in March 2009, we launched a discussion of these questions with the... (shrink)

A large body of literature looks at how firms develop and maintain their reputation. Little is known, however, about factors leading to a damaged corporate reputation. In this article, the authors compare two sets of predictors of reputational damage following a reported breach of norms: the characteristics of the breach and the characteristics of the actor reporting the breach. Theoretically, the authors argue that the latter is likely to prevail over the former. The authors test this proposition in the highly (...) normative context of corporate social responsibility (CSR). Building on a global data set of over 8,600 CSR-related norm breaches, directed against 451 firms on the Fortune ranking reputation over the 2006-2009 period, the authors find empirical support for the idea that reputation damage is not really driven by the severity and novelty of the allegation, but by the type of source reporting the issue as well as the credibility of this source. Hence, these results lend some support to a socially constructed view of reputational damage, in which being portrayed by prominent actors as deviating from the norm is more important than the actual deviation from the goal of the norm itself. (shrink)

: Managed care per se is a morally neutral concept; however, as practiced today, it raises serious ethical issues at the clinical, managerial, and social levels. This essay focuses on the ethical issues that arise at the bedside, looking first at the ethical conflicts faced by the physician who is charged with responsibility for care of the patient and then turning to the way in which managed care exacts costs that are measured not in dollars but in compromises in the (...) caring dimensions of the patient-physician relationship. (shrink)

This paper aims to solve the following twofold problem. Suppose that a rational speaker, Ralph, mistakenly takes (for some reason) the Roman orator Cicero and the World War II German spy Cicero to be the same individual. By sincerely uttering the sentence “Cicero is an orator and a spy”, (a) does Ralph use the name “Cicero” of the Roman orator or the name “Cicero” of the German spy or another name of the genus “Cicero”? And (b) which Cicero does Ralph (...) refer to: the Roman orator, the German spy, both of them or neither of them? After drawing a distinction between the notion of mistaking one individual for another (exemplified by Kripke's “Jones”/“Smith” case and Putnam's “water”/“water” case) and the notion of wrongly taking two individuals to be one and the same individual (exemplified by the “Cicero”/“Cicero” case under discussion), I will defend the following solution to the last puzzling case: Ralph inadvertently creates an abstract individual playing the role of “fusion” or “amalgam” of the two Ciceros and also inadvertently creates a new name “Cicero” referring to such an individual. (shrink)

This response to Kevin WildesÕs article in the previous issue of the Kennedy Institute of Ethics Journal addresses several major points of disagreement between Pellegrino and Wildes regarding the nature and scope of a philosophy of medicine, in particular how it is derived and by what method of philosophical enquiry it is best pursued.

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. (...) The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary. (shrink)

Climate change generates new topics for philosophy. Philosophy, for its part, can contribute important conceptual tools to climate change discussions, as well as shed light on various dimensions of climate change studies – especially the underlying assumptions of the natural and social sciences of climate change. This Handbook provides a wide-ranging overview of the outcomes of this encounter between climate change and philosophical reflection. It consists of five parts, for a total of 63 chapters covering topics in and for the (...) natural and social sciences, the humanities, and the ethics and political philosophy of climate change. (shrink)

This paper develops a view of the wrongness of personal political corruption. The latter is wrong even when it has no impact or relations with political institutions. The thought is that instances of personal moral corruption of politicians are wrong to voters because they amount to forcing the latter to be authors, namely responsible, of their representatives’ misdeeds. Political corruption is wrong because it violates citizens’ moral integrity, i.e., their entitlement to abstain from immoral deeds, and to be free of (...) responsibility for them. (shrink)

In his book Semantic Relationism, Kit Fine propounds an original and sophisticated semantic theory called ‘semantic relationism’ or ‘relational semantics’, whose peculiarity is the enrichment of Kaplan’s, Salmon’s and Soames’ Russellian semantics (more specifically, the semantic content of simple sentences and the truth-conditions of belief reports) with coordination, “the very strongest relation of synonymy or being semantically the same”. In this paper, my goal is to shed light on an undesirable result of semantic relationism: a report like “Tom believes that (...) Cicero is bald and Tom does not believe that Tully is bald” is correct according to Fine’s provided truth-conditions of belief reports, but its semantic content is (very likely) a contradiction. As I will argue in the paper, even the resort to the notion of token proposition, introduced in Fine’s recent article “Comments on Scott Soames’ ‘Coordination Problems’”, does not suffice to convincingly eliminate the contradiction; moreover, it raises new difficulties. (shrink)

What it means to be a medical professional has been defined by medical ethicists throughout history and remains a contemporary concern addressed by this paper. A medical professional is generally considered to be one who makes a public promise to fulfill the ethical obligations expressed in the Hippocratic Code. This presentation summarizes the history of medical professionalism and refocuses attention on the interpersonal relationship of doctor and patient. This keynote address was delivered at the Founders of Bioethics International Congress (June, (...) 2010). (shrink)

CATHOLIC PERSPECTIVES AND CONTEMPORARY MEDICAL MORALS A Catholic perspective on medical morals antedates the current world wide interest in medical and biomedical ethics by many centuries[5]. Discussions about the moral status of the fetus, abortion, contraception, and sterilization can be found in the writings of the Fathers and Doctors of the Church. Teachings on various aspects of medical morals were scattered throughout the penitential books of the early medieval church and later in more formal treatises when moral theology became recog (...) nized as a distinct discipline. Still later, medical morality was incorpor ated into the many pastoral works on medicine. Finally, in the contemporary period, works that strictly focus on medical ethics are produced by Catholic moral theologians who have special interests in matters medical. Moreover, this long tradition of teaching has been put into practice in the medical moral directives governing the operation of hospitals under Catholic sponsorship. Catholic hospitals were monitored by Ethics Committees long before such committees were recommended by the New Jersey Court in the Karen Ann Quinlan case or by the President's Commission in 1983 ([8, 9]). Underlying the Catholic moral tradition was the use of the casuistic method, which since the 17th and 18th centuries was employed by Catholic moralists to study and resolve concrete clinical ethical dilem mas. The history of casuistry is of renewed interest today when the case method has become so widely used in the current revival of interest in medical ethics[ll]. (shrink)

This paper will critically examine two solutions to Frege’s puzzle: the Millian-Russellian solution proposed by Salmon and Braun, which invokes non-semantic modes of presentation (guises, ways of believing or the like); and Fine’s relationalist solution, which appeals to semantic coordination. Special attention will be devoted to discussing the conception of modes of presentation as mental files and to elucidating the nature of coordination. A third solution to Frege’s puzzle will be explored which, like Salmon’s and Braun’s, adopts the Millian-Russellian semantics (...) but, like Fine’s, involves coordination instead of modes of presentation; however, coordination will not be conceived as a semantic relation but as a cognitive and subjective relation, which provides no contribution to semantic content. This novel Millian-Russellian account involving cognitive coordination will be labelled cognitive relationism. (shrink)