I SHALL develop, in this article, certain distinctions suggested by recent contributions to the philosophical discussion of punishment, which help to clarify the issues involved. Having separated out what I consider the four central philosophical questions, I shall suggest an approach to them, which, while mainly utilitarian, takes due account, I believe, of the retributivist case where it is strongest, and meets the main retributivist objections.
“Evidence based medicine” is often seen as a scientific tool for quality improvement, even though its application requires the combination of scientific facts with value judgments and the costing of different treatments. How this is done depends on whether we approach the problem from the perspective of individual patients, doctors, or public health administrators. Evidence based medicine exerts a fundamental influence on certain key aspects of medical professionalism. Since, when clinical practice guidelines are created, costs affect the content of EBM, (...) EBM inevitably becomes a form of rationing and adopts a public health point of view. This challenges traditional professionalism in much the same way as managed care has done in the US. Here we chart some of these major philosophical issues and show why simple solutions cannot be found. The profession needs to pay more attention to different uses of EBM in order to preserve the good aspects of professionalism. (shrink)
Background: Ethical dilemmas are an integral part of medicine. Whether physicians actually feel that they have made ethically problematic treatment decisions or choices in their work is largely unknown. Identifying physicians with ethical problems, and the types of problems and underlying factors, might benefit organisational and educational efforts to help physicians solve ethical dilemmas in a constructive way. We investigated how the frequency and types of ethically difficult treatment decisions vary by specialty.Method: A mail survey of all non-retired Finnish physicians (...) was conducted in 2004. Of those who had made any ethically problematic treatment decisions, the types of decisions and reasons given for these decisions were asked for. Factor analysis was used to investigate clustering of ethically problematic treatment decisions, and logistic regression to investigate the effect of specialty, adjusted for age and gender.Results: Psychiatrists experienced ethically problematic treatment decisions most frequently, followed by pulmonologists, internists and neurologists. Problems were reported least often by pathologists, laboratory physicians and ophthalmologists. Overtreatment was more common than undertreatment in most specialties, with the exception of psychiatrists who emphasised undertreatment and patient rights issues.Conclusion: Physicians of different specialties differ significantly regarding frequency and types of ethically problematic treatment decisions they have made. Psychiatrists differ from all other specialists in reporting more undertreatment and patient rights issues. Experiencing ethically problematic decisions might affect the quality of care and physician well-being in many ways. The findings could be useful for both under- and postgraduate ethics education. (shrink)
In Australia and Oregon, USA, legislation to permit statutory sanctioned physician-assisted dying was enacted. However, opponents, many of whom held strong religious views, were successful with repeal in Australia. Similar opposition in Oregon was formidable, but ultimately lost in a 60-40% vote reaffirming physician-assisted dying. This paper examines the human dilemma which arises when technological advances in end-of-life medicine conflict with traditional and religious sanctity-of-life values. Society places high value on personal autonomy, particularly in the United States. We compare the (...) potential for inherent contradictions and arbitrary decisions where patient autonomy is either permitted or forbidden. The broader implications for human experience resulting from new legislation in both Australia and Oregon are discussed. We conclude that allowing autonomy for the terminally ill, within circumscribed options, results in fewer ethical contradictions and greater preservation of dignity. (shrink)
The aim of this paper is to distinguish between, and examine, three issues surrounding Humphreys's paradox and interpretation of conditional propensities. The first issue involves the controversy over the interpretation of inverse conditional propensities — conditional propensities in which the conditioned event occurs before the conditioning event. The second issue is the consistency of the dispositional nature of the propensity interpretation and the inversion theorems of the probability calculus, where an inversion theorem is any theorem of probability that makes explicit (...) (or implicit) appeal to a conditional probability and its corresponding inverse conditional probability. The third issue concerns the relationship between the notion of stochastic independence which is supported by the propensity interpretation, and various notions of causal independence. In examining each of these issues, it is argued that the dispositional character of the propensity interpretation provides a consistent and useful interpretation of the probability calculus. (shrink)
There are striking structural similarities between Freud's ego and Kant's transcendental unity of apperception, which for Kant grounds our use of ‘I’ in ‘I think’. There are also striking similarities between Freud's superego and Kant's account of the mental structure that grounds our use of ‘I’ in the moral ‘I ought to’. The paper explores these similarities on three main points: the conflict of motivations internal to the mind, the relation between discursive and pre-discursive representation of moral motivation, and the (...) unconscious character of moral motivation. The suggestion is that Freud offers resources for a naturalized account (an account in terms of the causal development of empirical human beings) of just those features of our moral motivation that, according to Kant, seem to make it least amenable to a naturalistic explanation. How much of a revision of Kant's analysis of moral justification is thereby entailed is beyond the purview of the paper. (shrink)
Philosophers readily talk about merely verbal disputes, usually without much or any explicit reflection on what these are, and a good deal of methodological significance is attached to discovering whether a dispute is merely verbal or not. Currently, metaphilosophical advances are being made towards a clearer understanding of what exactly it takes for something to be a merely verbal dispute. This paper engages with this growing literature, pointing out some problems with existing approaches, and develops a new proposal which builds (...) on their strengths. (shrink)
A complimentary assessment of Blum's award-winning book about racism and its affects. Well written as it is, it needs to be supplemented with a definition of racial injustice, and also to analyze racism not only on the level of individual morality but from a human rights perspective that discredits political and economic motives for racism (e.g., by drawing on Hannah Arendt's Origins of Totalitarianism).
This chapter attempts to put structure on some of the different philosophical uses of ‘intuition’. It argues that ‘intuition’-hood is associated with four bundles of symptoms: a commonsensicality bundle; an a prioricity and immediacy bundle, and a metaphilosophical bundle. Tentatively suggesting that the word ‘intuition’ as used by philosophers is best regarded as ambiguous, the chapter offers a much simpler view concerning the meaning of ‘intuition’ in philosophy. With some of the attacks on ‘intuition’ as an epistemic source explored, the (...) chapter concludes that one significant kind of philosophical ‘intuition’, related to a prioricity and conceptual truth, can be defended against a range of typical epistemological challenges. (shrink)
Reading and re-reading the difficult and important small book I and Thou, by Professor Martin Buber, which Mr. Ronald Gregor Smith has translated with so much care and skill, and trying to make it clearer to myself in words of my own, I find myself at odds on the threshold with the translator's Introduction. He is explaining the title and the general theme of the book:— “There is, Buber shows, a radical difference between a man's attitude to other men and (...) his attitude to things. The attitude to other men is a relation between persons, to things it is a connexion with objects. In the personal relation one subject— I —confronts another subject— Thou ; in the connexion with things the subject contemplates and experiences an object. These two attitudes represent the basic twofold situation of human life, the former constituting the ‘world of Thou,’ and the latter the ‘world of It ’”. (shrink)
There are striking structural similarities between Freud's ego and Kant's transcendental unity of apperception, which for Kant grounds our use of ‘I’ in ‘I think’. There are also striking similarities between Freud's superego and Kant's account of the mental structure that grounds our use of ‘I’ in the moral ‘I ought to’. The paper explores these similarities on three main points: the conflict of motivations internal to the mind, the relation between discursive and pre‐discursive representation of moral motivation, and the (...) unconscious character of moral motivation. The suggestion is that Freud offers resources for a naturalized account of just those features of our moral motivation that, according to Kant, seem to make it least amenable to a naturalistic explanation. How much of a revision of Kant's analysis of moral justification is thereby entailed is beyond the purview of the paper. (shrink)
David Lewis is associated with the controversial thesis that some properties are more eligible than others to be the referents of our predicates solely in virtue of those properties’ being more natural; independently, that is, of anything to do with our patterns of usage of the relevant predicates. On such a view, the natural properties act as ‘reference magnets’. In this paper I explore (though I do not endorse) a related thesis in epistemology: that some propositions are ‘justification magnets’. According (...) to the doctrine of justification magnetism, we have better justification for some propositions than for others solely in virtue of certain features of those propositions; independently, that is, of anything to do with evidential support or cognitive accomplishment. In the course of discussing an objection to justification magnetism I describe (though I do not endorse) a novel approach to epistemology akin to interpretationism in the theory of reference. (shrink)
There is a New Idea in epistemology. It goes by the name of ‘knowledge first,’ and it is particularly associated with Timothy Williamson’s book Knowledge and Its Limits. In slogan form, to put knowledge first is to treat knowledge as basic or fundamental, and to explain other states—belief, justification, maybe even content itself—in terms of knowledge, instead of vice versa. The idea has proven enormously interesting, and equally controversial. But deep foundational questions about its actual content remain relatively unexplored. We (...) think that a wide variety of views travel under the banner of ‘knowledge first’ (and that the slogan doesn’t help much with differentiating them). Furthermore, we think it is far from straightforward to draw connections between certain of these views; they are more independent than they are often assumed to be. Our project here is exploratory and clarificatory. We mean to tease apart various ‘knowledge first’ claims, and explore what connections they do or do not have with one another. Our taxonomy is offered in §2, and connections are explored in §3. The result, we hope, will be a clearer understanding of just what the knowledge first theses are. We conclude, in §4, with some brief suggestions as to how we think the various theses might be evaluated. (shrink)
ABSTRACT:The paper begins by surveying a range of possible views on the metaphysics of romantic love, organizing them as responses to a single question. It then outlines a position, constructionist functionalism, according to which romantic love is characterized by a functional role that is at least partly constituted by social matters, although this role may be realized by states that are not socially constructed.
This paper builds on some important recent work by Amie Thomasson, wherein she argues that recent disputes about the existence of ordinary objects have arisen due to eliminiativist metaphysicians’ misunderstandings. Some, she argues, are mistaken about how the language of quantification works, while others neglect the existence and significance of certain analytic entailments. Thomasson claims that once these misunderstandings are cleared away, it is trivially easy to answer existence questions about ordinary objects using everyday empirical methods of investigation. She reveals (...) how two conflicting metaontologies can lead to different positions in the first-order debate. In this paper, I bring a third metaontological perspective to the table: one that enables us to maintain that ontological disputes about ordinary objects are not trivially easy to settle, even if we agree with Thomasson that they are merely verbal. These are serious verbal disputes. (shrink)
In this paper, we explore the traditional conception of a prioricity as epistemic independence of evidence from sense experience. We investigate the fortunes of the traditional conception in the light of recent challenges by Timothy Williamson. We contend that Williamson’s arguments can be resisted in various ways. En route, we argue that Williamson’s views are not as distant from tradition as they might seem at first glance.