In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

The main aim of this political philosophy study is to analyze the two fundamental ideas developed by Jean Monnet, namely, the idea of a federally united Europe and its sovereignty. This analysis is combined with an attempt to capture at least some of the essential assumptions of his philosophical ideas and their evolution. The source materials on which the article is based are primarily Monnet’s Memories, his notes and official memoranda, the correspondence from the war and postwar period and the (...) speeches he gave as the President of the High Authority of the European Coal and Steel Community in 1952-1955. They were supplemented with Memorandum of Aristide Briand, the speech of Winston Churchill in Zurich, Convention for European Economic Cooperation and Erinnerungen 1945-1953 by Konrad Adenauer. When it comes to literature, the author referred to the extensive bibliography on the subject contained in Suwerenność by Jacek Czaputowicz. The study uses the method of multidisciplinary analysis of sources and their historical, political and philosophical interpretation. The research conducted allows us to speak of certain philosophical assumptions in Monnet’s thinking about a united Europe and its future. Among the main components of his understanding we can enumerate: necessity, change, specific strength, development in stages and incompleteness which is essentially characteristic to nature. The carried out analysis also allows us to formulate the hypothesis about Monnet’s philosophy of life and action, which can be understood as a certain phenomenology of the community in its becoming, and to situate it, at least partially, within the framework of the phenomenology of Europe as formulated by Erich Przywara in this treatise Idee Europe. (shrink)

Steven Vogel’s Thinking like a Mall, which continues themes developed in his previous work Against Nature: The Concept of Nature in Critical Theory, is clearly intended to provok...

As the gap between the need for and supply of human organs continues to widen, the aim of securing additional sources of these “gifts of the body” has become a seemingly overriding moral imperative, one that could—and some argue, should—override the widespread ban on organ markets. As a medical practice, organ transplantation entails the inherent risk that one human being, a donor, will become little more than a means to the end of healing for another human being and that he (...) or she will come to have a purely instrumental value. With the establishment of organ markets, not only will the harms of instrumentalization be a reality—the ends of medicine will be further compromised and confused. (shrink)

We provide an empirical investigation of leadership characteristics and social justice issues in the context of financial literacy service-learning. Using a unique dataset of student self-ratings, we find that students experience statistically significant increases in 8 of the 10 leadership dimensions and 7 of the 7 social justice issues examined in this study. Leadership dimensions include: persuasion, building community, “commitment to the growth of people,” stewardship, empathy, awareness, foresight, and listening. Interest in social justice issues include: dignity of the human (...) person, community and the common good, rights and responsibilities, option for the poor, dignity of work, solidarity, and care for God’s creation. The statistically significant increases in these dimensions following the completion of the service-learning suggest positive effects on students’ self-perception of leadership qualities and interests in social justice issues: business school students sense improvement in nurturing growth of employees and colleagues, commitment to serving the need of others, understanding and empathizing with others, ethics, ability to foresee the likely outcome of a situation, and listening intently to others. As a consequence of the financial literacy service-learning, we believe that business students become more prepared toward becoming ethical leaders and citizens with compassion to serve the world for the well-being of all people, rich and poor alike. (shrink)

This article focuses mainly on (1) the policy of Delft University of Technology since 1992 as regards the university-wide introduction of a compulsory course on ethics and engineering, and (2) the ideal structure of such a course, including the educational goals of the course.

One group of commentators takes book 10 as determinative and thus tortures the text in book 1 to say the same thing. This position is described as intellectualist or exclusivist and produces certain puzzles in reading Aristotle’s ethical theory. These puzzles are not benign since the privileged position given wisdom in book 10 seems at odds with the discussion of virtue in book 1 and its development in the Nicomachean Ethics as a whole. Indeed, Aristotle appears inconsistent or even contradictory, (...) recommending in these two brief chapters of book 10 a life devoted to contemplation that only grudgingly allows for the necessity of the practical life discussed in such detail in the rest of his ethical works. If this is the case, under what conditions are we expected to forgo contemplation to engage in the various activities of the moral virtues? Since no conditions are spelled out in the text, the range of speculation is confused and ways around the apparent inconsistencies complex. (shrink)

Dr. Toynbee is the author of A Study of History in ten volumes, on which he spent twenty-five years, and which has received very high praise from competent critics as well as much criticism. Of the present two books the first is based on the Gifford Lectures delivered in the University of Edinburgh in 1952–3, the second on the Hewett Lectures given in the United States in the Fall of 1955. As the two treat almost identical topics, the first more (...) fully than the second, it is intended here to give a summary of the doctrine contained in the two—mostly in the author’s own words—and then to add a few criticisms. (shrink)

This appraisal of two of the most fundamental terms in the moral language of Thomas Aquinas draws on the contemporary moral distinction between the goodness of a person and the rightness of a person's living. Keenan thus finds that Aquinas's earlier writings do not permit the possibility of such a distinction. But in his mature works, specifically the Summa Theologiae, Thomas describes the human act of moral intentionality, and even the virtues in a way analogous to our use of the (...) term moral rightness. To Thomas, only the virtue of charity expresses moral goodness. And, although Thomas describes vices and sin as wrong conduct, he never really develops a description for moral badness.Keenan compels us to carefully examine Thomas's central moral concepts and to measure them against contemporary standards for meaning and correctness. As a result, any student of Thomas will find here a forceful argument that his notion of the good is considerably different from ours. Similarly, ethicists and moral theologians will find in the Thomas presented here a consistent-virtue ethicist concerned with descriptions for right living. Any student of theology will also find here a Thomas whose critical and concrete thinking enabled him to develop and even abandon earlier positions as his comprehension of the Good evolved. This analysis prompts a re-examination of our own concepts. Measuring Thomas's standards against our own, Keenan obliges us to ask whether we sufficiently understand rightness and moral intentionality. He also asks whether we correctly describe what it means to will or to desire something. He further questions whether we have surrendered our understanding of the virtues to the voluntarism and subjectivism which Thomas relentlessly critiqued. This historically sophisticated reading of the Summa Thologiae both allows Thomas to speak again as he once did, and affords us the chance to evaluate the way we describe ourselves and one another as being good and living rightly. (shrink)

Ce travail pose la question des critères de la „progression biologique“ , d'après les documents fossiles, dans le monde des organismes, c'est-à-dire de ce perfectionnement qui ne s'arrête pas à l'intérieur du cadre d'un phylum donné, comme le „perfectionnement de l'adaptation“, mais qui conduit, au-de-là de phylums de rang différent, à des types supérieurs, par exemple, des Poissons pas les Amphibies et les Reptiles jusqu'aux Mammifères ou aux Oiseaux. Deux groupes de critères y sont recensés en détail, leur contenu est (...) exposé, et on les examine pour voir s'ils caractérisent sans ambiguïté la „progression biologique“. Le premier groupe comprend les critères de „différenciation croissante“ et „d'intégration harmonique”. Ils sont fondés sur la différenciation morphophysiologique ou plus exactement sur la „totalité” des organismes, c'est-à-dire leur multiplicité dans l'unité. Le second groupe de critères, à savoir „indépendance croissante du milieu” et „autonomie individuelle croissante”, part des relations de l'organisme au milieu et aux autres formes vivantes et souligne la „subsistence” des individus, c'est-à-dire leur plus ou moins grande indépendence ou leur stabilité interne. Comme „totalité” et „subsistence” sont les éléments décisifs d'une définition biologique de l'individu, on peut dire que la „progression biologique“ d'un organisme est d'autant plus élevée que sa totalité et subsistence et par là son être individuel sont plus accusés.Tous les critères mentionnés ne sont pas uniformes. Les motifs de leur imprécision sont divers. Tout d'abord, il n'y a pas encore de définition unique et complète de l'individu biologique, de sorte qu'on ne peut circonscrire d'une manière univoque ce qui confère à un organisme une individualité plus forte ou moins forte. Ensuite les lignées au-delà desquelles s'accomplissent des perfectionnements, et dont l'une reste intérieur au phylum , tandis que l'autre le transcende , sont entrelacées si intimement et d'une façon si particulière qu'elles ne se laissent pas séparer franchement et décrire rigoureusement selon leurs signes distinctifs. Tout représentant d'un phylum, peu importe son palier, est en effet nécessairement inséré dans un milieu et en quelque façon spécialisé. Il n'existe pas des types à caractères phylétiques purs, qui ne montrent dans aucune direction un „perfectionnement de l'adaptation”, mais seulement des marques caractéristiques de la „progression biologique”. Enfin nous ne connaissons pas les restes fossiles que le développement ou la formation des grands phylums du règne animal, à savoir du rameau des Vertébrés et des divers groupes des Invertébrés, mais non pas le plus intéressant et le plus important, leur „progression biologique” jusqu'au degré d'organisation qu'ils présentent déjà à l'époque du Silurien ou plutôt du Cambrien. C'est cela seulement qui permettrait une vue plus profonde sur la nature de la „progression biologique”.Die Arbeit stellt die Frage nach den Kriterien des fossil belegten Biologischen Aufstiegs” der Organismenwelt, d.h. derjenigen Vervollkommnung, die sich nicht innerhalb des Rahmens eines gegebenen Bauplans hält, wie die „Anpassungsvervollkommnung”, sondern über verschiedenrangige Baupläne hinweg zu höheren Typen führt, z.B. von den Fischen über die Amphibien und Reptilien zu den Säugern bzw. Vögeln. Ausführlich werden zwei Gruppen von Kriterien besprochen, ihr Inhalt dargelegt und ihre Eindeutigkeit zur Charakterisierung des „Biologischen Aufstiegs” untersucht. Die erste Gruppe umfasst die Kriterien der „zunehmenden Differenzierung” und „harmonischeren Integration”. Diese legen die morphologisch-physiologische Differenzierung oder genauer die „Ganzheit” der Organismen zugrunde, d.h. ihre Vielheit in der Einheit. Die zweite Kriteriengruppe, nämlich „zunehmende Umweltunabhängigkeit” und „zunehmende individuelle Autonomie”, geht von den Beziehungen des Organismus zur Umwelt und zu andern Lebensformen aus und betont die „Subsistenz” der Individuen, d.h. ihr grösseres oder geringeres Losgelöstsein oder ihre Selbständigkeit. Da nun „Ganzheit” und „Subsistenz” die entscheidenden Elemente einer biologischen Definition des Individuums sind, lässt sich sagen, dass der „Biologische Aufstieg” eines Organismus um so höher ist, je stärker seine Ganzheit und Subsistenz und damit sein Individuumsein ist.Eindeutigkeit kommt allen genannten Kriterien nicht zu. Die Gründe für ihre Unschärfe sind verschiedener Art. Zunächst gibt es noch keine eindeutige und vollständige Definition des biologischen Individuums, so dass sich nicht eindeutig umreissen lässt, was einem Organismus eine stärkere oder weniger starke Individualität verleiht. Dann sind die Linien, über die sich Vervollkommnungen vollziehen und von denen die eine innerhalb des Bauplans bleibt , die andere aber über ihn hinausführt so innig und in so eigenartiger Weise miteinander verflochten, dass sie sich nicht sauber scheiden und in ihren charakteristischen Merkmalen genau beschreiben lassen. Jeder Vertreter eines Bauplans, ganz gleich von welcher Ranghöhe, ist nämlich notwendig in eine Umwelt eingepasst und irgendwie spezialisiert. Es gibt keine Typen mit reinen Bauplanmerkmalen, die nach keiner Richtung hin eine „Anpassungsvervollkommnung”, sondern nur Merkmale des „Biologischen Aufstiegs” aufweisen. Schliesslich kennen wir fossil nur die Entfaltung oder Ausgestaltung der Grossbaupläne des Tierreichs, nämlich des Wirbeltierstammes und der verschiedenen Gruppen der Wirbellosen, nicht aber das Interessanteste und Wichtigste, nämlich ihren „Biologischen Aufstieg” zu der organisatorischen Höhe, mit der sie sich im Silur bzw. im Kabrium bereits vorstellen. Das erst würde einen tieferen Einblick in das Wesen des „Biologischen Aufstiegs” vermitteln.This article deals with the question of the criteria for the “biological ascent” of the organic world, resting on fossil evidence. That is, of that improvement which is not only restricted to the framework of a given “general structure” as is the “improvement of adaptation”, but which also leads beyond general structures of differentiated levels to a higher type,e.g. from the fishes through the amphibians and reptiles to the mammals or birds. Two groups of criteria are discussed at length, their content exposed and their univocity for the characterisation of this “biological ascent” is examined. The first group includes the criteria of “increasing differentiation” and “more harmonious integration”. The basis for these is the morphological-physiological differentiation, or more exactly, the “totality” of the organisms,i.e., their variety-in-unity. The second group of criteria, “increasing independence of environment” and “increasing individual autonomy”, is derived from the relationships of the organism to its environment and to other living forms, and stresses the “subsistence” of individuals,i.e., their greater or lesser degree of independence or self-sufficiency. Now since “totality” and “subsistence” are the decisive elements in a biological definition of the individual, it may be said that the “biological ascent” of an organism is higher, the more perfect its totality and subsistence and therefore its individuality is.The criteria mentioned are not univocal. The reasons for this lack of clarity are varied. First of all, there is no univocal and complete definition of the biological individual, so that it cannot be exactly stated just what gives an organism a more or less perfect individuality. Then the lines, along which improvements are made, and according to which the one remains within the general structure and the other goes beyond the general structure , are so intimately and singularly bound together, that they cannot be cleanly distinguished, and their characteristic notes exactly described. For each representative of a general structure, regardless of its level, is necessarily fitted into an environment and somehow or other specialised. There are no types with only notes of the general structure which show in no direction an “improvment of adaption”, but only the signs of “biological ascent”. Finally, we only have fossil evidence for the development or deployment of the “great general structures” of the animal world, namely that of the vertebrates and of the different groups of invertebrates, not for the most interesting and most important, that is, their “biological ascent” to the level of organisation with which they are found in the Silurian or Cambrian periods. Only that would give us a deeper insight into the essence of “biological ascent”. (shrink)

Al cumplirse los 50 años de la publicación de la Populorum Progressio este artículo presenta los orígenes y la evolución del concepto del desarrollo y de la reflexión en torno a las políticas de desarrollo. A continuación, se hace un breve recorrido del Magisterio pontificio sobre la cuestión, desde la Populorum Progressio a la Laudato Si’. Sintetizando lo aprendido en ambos recorridos, el artículo concluye presentando las exigencias y los desafíos con los que se enfrenta el discípulo misionero a propósito (...) del desarrollo. (shrink)

Charles S. Peirce has a great deal to contribute both to understanding and to solving many of the philosophical problems which puzzle contemporary thinkers. In fact it is probably true that in some ways philosophers of our time are in a better position to understand Peirce's thought than those of his own day. In this paper I would like to consider two puzzling notions: 1) the substantiality of things, and 2) the foundations of human knowledge.

Metaphysicians go on busily doing metaphysical thinking all over the world, and apparently with a modicum of self-assurance that they are not talking nonsense or pursuing an illusory will-of-the-wisp. Yet other philosophers of empirical, analytical, phenomenological, or other turns of mind seem to have more and more difficulty in understanding just how metaphysicians give meaning and positive content to the vast abstract concepts by which they seek to describe and explain the entire spectrum of reality extending far beyond present or (...) perhaps even possible human experience. Since there is no way of gaining direct insight into dimensions of reality beyond human experience, and since in order to be applied to the whole range of reality these concepts must abstract from purely human experience, it is hard for them to see—and it is a serious problem in itself—how these all-embracing terms can be anything more than empty, formal, verbal symbols or conceptual constructions, with no positive existential content describing reality itself across its whole spectrum. Even the metaphysician himself, though when left alone he may have a sure sense of how to do metaphysical thinking fruitfully, when questioned to explain and justify what he is doing, and is convinced is worth doing, can feel embarrassed and struck dumb as to how to articulate and justify the principles behind the procedures he is following. (shrink)