One day in 1938, John Dewey addressed a room of professional educators and urged them to take up the task of “finding out just what education is.” Reading this lecture in the late 1940s, Philip W. Jackson took Dewey’s charge to heart and spent the next sixty years contemplating his words. The stimulating result of a lifetime of thinking about educating,_ What Is Education?_ is a profound philosophical exploration of how we transmit knowledge in human society and how we (...) think about accomplishing that vital task. Most contemporary approaches to education follow a strictly empirical track, aiming to discover pragmatic solutions for teachers and school administrators. Jackson argues that we need to learn not just how to improve on current practices but also how to think about what education means—in short, we need to answer Dewey by constantly rethinking education from the ground up. Guiding us through the many facets of Dewey’s comments, Jackson also calls on Hegel, Kant, and Paul Tillich to shed light on how a society does, can, and should transmit truth and knowledge to successive generations. Teasing out the implications in these thinkers’ works ultimately leads Jackson to the conclusion that education is at root a moral enterprise. At a time when schools increasingly serve as a battleground for ideological contests, _What Is Education?_ is a stirring call to refocus our minds on what is for Jackson the fundamental goal of education: making students as well as teachers—and therefore everyone—better people. (shrink)

The author critically examines and rejects alvin plantinga's defense of the free will theodicy, As presented in chapter six of plantinga's "god and other minds". If the author's arguments are correct, Then any attempt on the part of the rational apologist to explain evil by reference to man's free will must be considered futile. Since the arguments presented will be seen as supporting natural atheology (which, For plantinga, Is "the attempt...To show that, Given what we know, It is impossible or (...) unlikely that God exists"), The article ends with the claim that both rational apologetics and natural atheology are conceptually confused, And that this confusion can be traced to their failure to understand the nature of religious belief. (shrink)

This study seeks to examine Umberto Eco's views of the key ideas in John Dewey's Art as Experience. Eco's proferred suggestion of transactional psychology as a corrective to Dewey's views is criticized as a misreading of Dewey's position.

This chapter contains sections titled: A Biographical Sketch Dewey's Early Works Dewey's Chicago Years of Transition Dewey's Middle Period Dewey's Later Period Dewey's Pragmatism.

Despite wittgenstein's commitment to philosophy as a practice designed to free us from the impulse to generate philosophical theories, it seems to the author that wittgenstein did have a theory of knowledge in "on certainty". the paper is devoted to displaying this theory; it is written in the hope that others will find a way of reading "on certainty" that frees it from this interpretation.

This edition brings Dewey's educational theory into sharp focus, framing his two classic works by frank assessments, past and present, of the practical applications of Dewey's ideas. In addition to a substantial introduction in which Philip W. Jackson explains why more of Dewey's ideas haven't been put into practice, this edition restores a "lost" chapter, dropped from the book by Dewey in 1915.

Scholars of early Chinese philosophy frequently point to the nontranscendent, organismic conception of the cosmos in early China as the source of China's unique perspective and distinctive values. One would expect recent works in Confucian ethics to capitalize on this idea. Reviewing recent works in Confucian ethics by P. J. Ivanhoe, David Nivison, R. P. Peerenboom, Henry Rosemont, and Tu Wei-Ming, the author analyzes these new studies in terms of the extent to which their representation of Confucian ethics reflects and (...) is consistent with the view that in early China the cosmos was conceived to be organismic, nontranscendent, and nondualistic. (shrink)

Institutional review boards are almost universally considered to be overworked and understaffed. They also require substantial commitments of time and resources from their members. Although some surveys report average IRB memberships of 15 people or more, federal regulations require only five. We present data on IRB meetings at eight of the top 25 academic medical centers in the United States funded by the National Institutes of Health. These data indicate substantial contributions from primary reviewers and chairs during protocol discussions but (...) little from other members, which implies that it may be possible for smaller IRBs to accomplish the same tasks with no reduction in the quality of review. (shrink)

Are humans free, or are we determined by our genes and the world around us? The question of freedom is not only one of philosophy’s greatest conundrums, but also one of the most fundamental questions of human existence. It’s particularly pressing in societies like ours, where our core institutions of law, ethics, and religion are built around the belief in individual freedom. Can one still affirm human freedom in an age of science? And if free will doesn’t exist, does it (...) make sense to act as though it does? These are the issues that are presented, probed, and debated in the following chapters. A dozen experts―specialists in medicine, psychology, ethics, theology, and philosophy—grapple with the multiple and often profound challenges presented by today’s brain science. After examining the arguments against traditional notions of free will, several of the authors champion the idea of a chastened but robust free will for today, one that allows us still to affirm the value of first-person experience. (shrink)

John Conington was a towering figure in Victorian scholarship, not least because of his remarkably sensitive and literate commentaries on Virgil’s _Aeneid. _The three-volume cloth edition of _The Works of Virgil_, begun by Conington in 1852, has been unavailable for over a century, except in rare second-hand sets. Now, for the first time, the whole of Conington’s work is being reissued in a set of six paperback volumes. Each volume includes a new introduction by an established scholar, setting Conington's commentary (...) in context, as well as a general introduction to Conington’s work by Philip Hardie, who offers a fresh appreciation of the work. (shrink)

What determines whether an action is right or wrong? Morality, Rules, and Consequences: A Critical Reader explores for students and researchers the relationship between consequentialist theory and moral rules. Most of the chapters focus on rule consequentialism or on the distinction between act and rule versions of consequentialism. Contributors, among them the leading philosophers in the discipline, suggest ways of assessing whether rule consequentialism could be a satisfactory moral theory. These essays, all of which are previously unpublished, provide students in (...) moral philosophy with essential material and ask key questions on just what the criteria for an adequate moral theory might be. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

School principals world-wide report high levels of strain and attrition resulting in a shortage of qualified principals. It is thus, crucial to identify psychosocial risk factors that reflect principals’ occupational wellbeing. For this purpose, we used the Copenhagen Psychosocial Questionnaire (COPSOQ-II), a widely used self-report measure covering multiple psychosocial factors identified by leading occupational stress theories. We evaluated the COPSOQ-II regarding factor structure and longitudinal, discriminant, and convergent validity using latent structural equation modeling in a large sample of Australian school (...) principals (N = 2,049). Results reveal that confirmatory factor analysis produced marginally acceptable model fit. A novel approach we call set exploratory structural equation modeling (ESEM-set), where cross-loadings were only allowed within a priori defined sets of factors, fit well, and was more parsimonious than a full ESEM. Further multitrait-multimethod models based on the set-ESEM confirm the importance of a principal’s psychosocial risk factors; Stressors and depression were related to demands and ill-being, while confidence and autonomy were related to wellbeing. We also show that working in the private sector was beneficial for showing a low psychosocial risk, while other demographics have little effects. Finally, we identify five latent risk profiles (high risk to no risk) of school principals based on all psychosocial factors. Overall the research presented here closes the theory application gap of a strong multi-dimensional measure of psychosocial risk-factors. (shrink)

My poetized culture is one which has given up the attempt to unite one’s private ways of dealing with finitude and one’s sense of obligation to other human beings.Richard Rorty repudiated W. B. Yeats’s aspiration “to hold justice and reality in a single vision,” and he did so with relish.2 Thrilling though it is, Rorty would say, there is no need to weave into a single, coherent narrative our commitment to the end of cruelty (justice) and our idiosyncratic aesthetic tastes (...) (reality). We can affirm both principles individually—justice and reality—without concocting a “philosophy of life” (or finding a “philosophical slop-shop”3) that will draw straight lines from aesthetic obsession to justice work. Allowing .. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

Thematically organized around the major concerns of Basil Bernstein's work as a sociologist, this book includes chapters from some of the leading sociologists and educational scholars. Each section attempts to provide a critical evaluation of Bernstein's work, framed within four interrelated contexts: his sociological theory, sociology of language and code theory, sociology of education and social reproduction, and the influence of his sociology on educational research. In a separate section, Bernstein himself responds to the earlier chapters. The book examines Bernstein's (...) sociology of schools in relation to his general sociological theory and in doing so demonstrates that sociology is an essential lens for understanding the structure and processes of schooling. It also provides a critical evaluation of the strengths and weaknesses of Bernstein's work, as well as a correction to current work in education, which eschews theory in favor of practicality. (shrink)

This commentary on Müller's target article is designed to help bridge the gap between method and theory in neurobiological approaches to language. We focus on pathonormal inference as reflective of broader conceptual issues concerning universality and modularity. Our commentary directs attention to how current methodological and analytic procedures are less than optimal and minimize possibilities for reaching theoretical consensus. We make suggestions about alternative analytic strategies that provide a direction for future scientific progress.

The central project of the Critique of Pure Reason is to answer two sets of questions: What can we know and how can we know it? and What can't we know and why can't we know it? The essays in this collection are intended to help students read the Critique of Pure Reason with a greater understanding of its central themes and arguments, and with some awareness of important lines of criticism of those themes and arguments.

Recent reports of the discovery of a “God module” in the human brain derive from the fact that epileptic seizures in the left temporal lobe are associated with ecstatic feelings sometimes described as an experience of the presence of God. The brain area involved has been described as either (a) the seat of an innate human faculty for experiencing the divine or (b) the seat of religious delusions.In fact, religious experience is extremely various and involves many parts of the brain, (...) including some that are prehuman in their evolutionary history and some that are characteristically human. In the continuing integration of such experiences, spiritual formation takes place. Thus the entire human brain might be described as a “God module.”Such a process is only possible because of the brain's complexity. The human brain is the most complex entity for its size that we know of. As used here, complexity is a specialized term denoting the presence of a web of interlinked and significant connections—the more intricate the web, the more complex the entity. Complex systems develop only in a milieu that provides both lawfulness and freedom, and they tend to be self‐organizing, becoming more complex and more effective as a result of both inward and outward experience. The evidence suggests that both personal growth and spiritual growth are processes of complexification of character, and of the brain itself. This thesis is tested in light of the work of William James and James W. Fowler. (shrink)

Trust is a kind of risky reliance on another person. Social scientists have offered two basic accounts of trust: predictive expectation accounts and staking (betting) accounts. Predictive expectation accounts identify trust with a judgment that performance is likely. Staking accounts identify trust with a judgment that reliance on the person’s performance is worthwhile. I argue (1) that these two views of trust are different, (2) that the staking account is preferable to the predictive expectation account on grounds of intuitive adequacy (...) and coherence with plausible explanations of action; and (3) that there are counterexamples to both accounts. I then set forward an additional necessary condition on trust, according to which trust implies a moral expectation. The content of the moral expectation is this: W hen A trusts B to do x, A ascribes an obligation to B to do x, and holds B to this obligation. This moral expectation account throws new light on some of the consequences of misplaced trust. I use the example of physicians’ defensive behavior to illustrate this final point. (shrink)

W.G. Sebald’s literary output has consistently addressed the theme of exile, which is most fully explored in his last novel, Austerlitz. This article places Sebald’s literary output in the context of contemporary debate in the social sciences about memory and identity. It is argued that Sebald used the form of a biographical memoir to illuminate powerfully the ‘condition of exile’. His focus is the impact of the Holocaust on European Jews. As a self-conscious German writer possessed of a sense of (...) historical responsibility, he chose to treat this subject obliquely. Sebald used the device of the unreliable narrator. At least some of the disconcerting effect of his literary work lies in its playful use of an ethnographic style and method. It is argued that Sebald has developed a hybrid style, method and form that may be called ‘literary ethnography’. For Sebald, himself in self-exile, the recovery of memory and the seeking of one’s past do not – and cannot – ultimately resolve the problems of being in exile. Knowing one’s past has no ultimately redemptive qualities. The condition of exile remains irredeemably liminal and there is no repairing the damage. (shrink)

W.V.O.Quine’s doctrine of referential inscrutability (RI) is the thesis that, first, linguistic reference must always be determined relative to an interpretation of the discourse and, second, that the empirical evidence always underdetermines our choice of interpretation--at least in principle. Although this thesis is a central result of Quine’s theory of language, it was long unclear just how much force RI actually carried. At best, Quine’s discussions provided localized examples of RI (e.g., ‘gavagai’), supplemented merely by arguments for the (in principle) (...) constructability of more general referentially divergent manuals. In defense of Quine, Gerald Massey provides a method for generating large-scale referentially divergent manuals for a complex language. I argue that, while Massey’s rival manuals do meet Quine’s translational criteria, they are demonstrably inferior to their commonsensical “homophonic” competitor. This result provides a clear indication of seminal deficiencies in Quine’s behaviorial approach to the theory of language. Next I argue that Quine’s acceptance of standard assumptions about the nature of perception strongly influences the shape of his semantical theory. Finally, I suggest how an alternative to the standard account of perception might provide grounds for a more adequate understanding of language. (shrink)

"The essays, both philosophical and historical, demonstrate the continuing significance of a neglected aspect of Kant’s thought."—Religious Studies Review Challenging the traditional view that Kant's account of religion was peripheral to his thinking, these essays demonstrate the centrality of religion to Kant's critical philosophy. Contributors are Sharon Anderson-Gold, Leslie A. Mulholland, Anthony N. Perovich, Jr., Philip J. Rossi, Joseph Runzo, Denis Savage, Walter Sparn, Burkhard Tuschling, Nicholas P. Wolterstorff, and Allen W. Wood.

This paper is concerned with organic conceptions of socio-political life and is concerned with the rehabilitation of organicism as a positive social ontology. It demonstrates that: organicism does not necessarily imply the negation of individuality by a monolithic society, and; that G. W. F. Hegel’s references to the state as organic do not imply social holism. With Hegel’s organicism, as with Idealist organicism generally, what is found is a relational rather than a holistic social ontology. This relational ontology is one (...) that addresses the tension between individualism and holism by theorizing the reciprocal or recursive nature of social relations; thus neither society nor the individuals within it can be seen as either purely determined or purely determining, each contributes to the constitution of the other. In making this case the paper provides both: a conceptual articulation of relational organicism which shows that it is an instructive and coherent positive social ontology, and; a historical account of its emergence into Idealist thought in the work of Immanuel Kant and G. W. F. Hegel. Through developing this account of the organic relation this paper seeks to offer a conception of socio-political life that provides resources for thinking through both the tension between holism and atomism in social theory and the tension between liberal individualism and communitarian collectivism in political theory. (shrink)

In 2001, the algebraico-tree-theoretic simplicity hierarchical structure of J. H. Conway’s ordered field ${\mathbf {No}}$ of surreal numbers was brought to the fore by the first author and employed to provide necessary and sufficient conditions for an ordered field to be isomorphic to an initial subfield of ${\mathbf {No}}$, i.e. a subfield of ${\mathbf {No}}$ that is an initial subtree of ${\mathbf {No}}$. In this sequel, analogous results are established for ordered exponential fields, making use of a slight generalization of (...) Schmeling’s conception of a transseries field. It is further shown that a wide range of ordered exponential fields are isomorphic to initial exponential subfields of $$. These include all models of $T$, where ${\mathbb R}_W$ is the reals expanded by a convergent Weierstrass system W. Of these, those we call trigonometric-exponential fields are given particular attention. It is shown that the exponential functions on the initial trigonometric-exponential subfields of ${\mathbf {No}}$, which includes ${\mathbf {No}}$ itself, extend to canonical exponential functions on their surcomplex counterparts. The image of the canonical map of the ordered exponential field ${\mathbb T}^{LE}$ of logarithmic-exponential transseries into ${\mathbf {No}}$ is shown to be initial, as are the ordered exponential fields ${\mathbb R})^{EL}$ and ${\mathbb R}\langle \langle \omega \rangle \rangle $. (shrink)

The concept of natural history has received a great deal of attention in contemporary practical philosophy, especially as a result of Michael Thompson's concept of natural-historical judgments which aims to explain the normativity of the human life-form. With this concept, the norms effective in a life-form are understood as something natural and constitutive for that life-form. Although Thompson does not present a historical-philosophical model, he claims to be able to determine the normativity of the historically developing human life-form. By contrast, (...) Theodor W. Adorno developed his own concept of natural history on the one hand as an interpretative conceptual model of historical reality, on the other hand, to indicate the normativity of the natural-historical course of human history itself. The normativity of natural history that Adorno focuses on is historically and socially determined, in contrast to the categorically conceived natural normativity that is at the heart of Thompson's approach. This article analyses the similarities and differences between the two approaches in such a way that it becomes clear to what extent ethical naturalism also provides possibilities for critique that can be made fruitful for a critical theory inspired by Adorno. (shrink)

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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This essay explores some of the similarities and differences between the views of several Western and Chinese thinkers on the metaphysical status of moral qualities and how we come to perceive and appreciate them. It then uses this comparative analysis to identify and address some remaining problems in regard to these two issues. The essay offers a brief sketch of and introduction to the history of the study of moral qualities and moral perception in modern Western philosophy and takes the (...) views of John McDowell, W ang Yangming, and Mencius as the primary focus of its comparative component. It seeks to understand the views of these thinkers by a careful examination of the metaphors as well as the arguments they employ. (shrink)