This paper argues that the provision of effective informed consent by surgical patients requires the disclosure of material information about the comparative clinical performance of available surgeons. We develop a new ethical argument for the conclusion that comparative information about surgeons' performance - surgeons' report cards - should be provided to patients, a conclusion that has already been supported by legal and economic arguments. We consider some recent institutional and legal developments in this area, and we respond to some common (...) objections to the use of report cards on the clinical performance of surgeons. (shrink)

An understanding of logic is essential to computer science. This book provides a highly accessible account of the logical basis required for reasoning about computer programs and applying logic in fields like artificial intelligence. The text contains extended examples, algorithms, and programs written in Standard ML and Prolog. No prior knowledge of either language is required. The book contains a clear account of classical first-order logic, one of the basic tools for program verification, as well as an introductory survey of (...) modal and temporal logics and possible world semantics. An introduction to intuitionistic logic as a basis for an important style of program specification is also featured in the book. (shrink)

For Socrates, the virtues are a kind of knowledge, and the virtues form a unity. Sometimes, Socrates suggests that the virtues are all ‘one and the same’ thing. Other times, he suggests they are ‘parts of a single whole.’ I argue that the ‘what is x?’ question is sophisticated, it gives rise to two distinct kinds of investigations into virtue, a conceptual investigation into the ousia and a psychological investigation into the dunamis, Plato recognized the difference between definitional accounts of (...) the ousia and a psychological accounts of the dunamis, and the distinction between these two investigations can effectively resolve various interpretive puzzles regarding the unity of the virtues. It is argued that the virtues are ‘one and the same’ psychologically, while they are ‘parts of a single whole’ conceptually. (shrink)

In raising the “What-is-F?” question, commentators disagree about whether Socrates is asking a conceptual question or a causal question. I argue that the contexts surrounding Socrates' two most prominent examples of adequate answers confirm that the “What-is-F?” question is a conceptual question in both the Meno and Euthyphro, but a causal question in the Laches and Protagoras. The “What-is-F?” question is multifunctional. Plato's Socrates consistently employs two separate vocabularies in connection with these two types of questions. By outlining their vocabularies, (...) and by examining other important contextual signals, I pave the way for readers to distinguish between conceptual and causal investigation in the “dialogues of definition.”. (shrink)

In the so-called ‘dialogues of definition,’ Socrates appears to endorse the ‘priority of definition.’ This principle states that an agent cannot know anything about F-ness (its instances, examples, properties, etc.) without knowing what F-ness is (the definition of F-ness). Not only is this principle implausible, it is also difficult to square with Socrates’ method. In employing his method, Socrates appeals to truths about the instances and properties of F-ness, even while pursuing definitional knowledge; meanwhile, he holds that one cannot know (...) those truths without already knowing the definition. Thus, there is a tension between Socrates’ principle and his method. Commentators have tried to resolve this problem in various ways, though typically without a careful examination of his ‘What is F-ness?’ question. I argue that Socrates employs the ‘What is F-ness?’ question as a way of introducing two distinct types of investigation into F-ness (conceptual and causal). With this established, the relationship between Socrates’ principle and his method comes to light, and the tension is resolved. (shrink)

I want to motivate an account of what it is for an object to have a property, which may as well be called a deflationary view about properties. Such a view follows from a conception of predication I ground in the work of Donald Davidson, some of which remains unpublished. I claim that if we take seriously Davidson’s account of predication, by maintaining that sentences are the primary linguistic unit, we can define properties in terms of predicates. The aim of (...) this paper is twofold. First, I argue that this account is present in Davidson’s systematic treatment of the problem of predication. Second, I claim that this account is serviceable and economical, as it can accommodate a wide scope of properties and abstract objects without appealing to entities such as truthmakers or joints in nature. (shrink)

In this dissertation I defend the claim, long held by Donald Davidson, that truth is a primitive concept that cannot be correctly or informatively defined in terms of more basic concepts. To this end I articulate the history of the primitive thesis in the 20th century, working through early Moore, Russell, and Frege, and provide improved interpretations of their reasons for advancing and eventually abandoning the primitive thesis. I show the importance of slingshot-style arguments in the work of Frege, Church, (...) Davidson, and Gödel for resisting certain versions of the correspondence theory of truth. I argue that most slingshots fail to convincingly establish a collapsing conclusion, but that a Gödelian version of the slingshot is terminal to certain varieties of the correspondence theory of truth. I then provide a Davidsonian theory of truth and interpretation that is consistent with and makes use of the primitive thesis. Finally, I provide an account of predication, properties, and universals that I argue is both serviceable and consistent with Davidson’s overall program. (shrink)

If certain versions of the correspondence theory of truth are correct, then truth can be informatively defined as correspondence to facts; facts would be truth-makers, and we could explain truth in terms of truth-bearers, correspondence, and truth-makers. I explain how slingshot arguments work generally, as collapsing arguments (regardless of their targets). Working through the slingshots of Davidson, and Gödel, I claim that Davidson’s slingshot involves dubitable premises, but that Gödel’s slingshot is terminal to certain versions of the correspondence theory, as (...) it poses a fatal dilemma between what I call fact fission and fact fusion. My claim is that it is impossible to informatively define truth in terms of correspondence to facts. (shrink)

Moral rationalism, the belief that acting contra a moral requirement is always irrational, is a strong claim; if true, seems to greatly reduce in scope the number of plausible moral theories due to what has been called the demandingness objection. One response to this consequence of moral rationalism has been to adopt moral anti-rationalism. Dale Dorsey thinks one can escape the demandingess objection with a weak form of anti-rationalism that still grants morality pride of place among normative systems. In this (...) paper I’ll argue that the demandingness objection is a formidable challenge to moral rationalism, and that Dorsey is correct in arguing that his weak anti-rationalism neatly offers a way to evade the objection. I’ll maintain, however, that weak anti-rationalism opens theories up to another powerful objection, the permissiveness objection, which ought to lead someone comfortable abandoning moral rationalism to abandon weak anti-rationalism as well, accepting moral anti-rationalism. (shrink)

Toward the end of the Charmides, Socrates declares the search for temperance a ‘complete failure’ (175b2‐3). Despite this, commentators have suspected that the dialogue might contain an implicit answer about temperance. I propose a new interpretation: the dialogue implies that temperance is the knowledge of good and bad, when this knowledge is applied specifically to certain operations of the soul. This amounts to a kind of self‐knowledge; it also involves a kind of reflexivity, for it involves knowing about the value (...) of one's knowledge. This positive reading, more than any other, makes sense of the dialogue's dramatic and dialectic features. (shrink)

In "Mathematical Truth", Paul Benacerraf articulated an epistemological problem for mathematical realism. His formulation of the problem relied on a causal theory of knowledge which is now widely rejected. But it is generally agreed that Benacerraf was onto a genuine problem for mathematical realism nevertheless. Hartry Field describes it as the problem of explaining the reliability of our mathematical beliefs, realistically construed. In this paper, I argue that the Benacerraf Problem cannot be made out. There simply is no intelligible problem (...) that satisfies all of the constraints which have been placed on the Benacerraf Problem. The point generalizes to all arguments with the structure of the Benacerraf Problem aimed at realism about a domain meeting certain conditions. Such arguments include so-called "Evolutionary Debunking Arguments" aimed at moral realism. I conclude with some suggestions about the relationship between the Benacerraf Problem and the Gettier Problem. (shrink)

BackgroundWe conducted a survey to identify what types of health/medical research could be exempt from research ethics reviews in Australia.MethodsWe surveyed Australian health/medical researchers and Human Research Ethics Committee members. The survey asked whether respondents had previously changed or abandoned a project anticipating difficulties obtaining ethics approval, and presented eight research scenarios, asking whether these scenarios should or should not be exempt from ethics review, and to provide comments. Qualitative data were analysed thematically; quantitative data in R.ResultsWe received 514 responses. (...) Forty-three per cent of respondents to whom the question applied, reported changing projects in anticipation of obstacles from the ethics review process; 25% reported abandoning projects for this reason. Research scenarios asking professional staff to provide views in their area of expertise were most commonly exempted from ethics review ; scenarios involving surplus samples and N-of-1 studies were most commonly required to undergo ethics review. HREC members were 26% more likely than researchers to require ethics review. Need for independent oversight, and low risk, were most frequently cited in support of decisions to require or exempt from ethics review, respectively.ConclusionsConsiderable differences exist between researchers and HREC members, about when to exempt from review the research that ultimately serves the interests of patients and the public. It is widely accepted that evaluative research should be used to reduce clinical uncertainties—the same principle should apply to ethics reviews. (shrink)

John Dupr argues that 'scientific imperialism' can result in 'misguided' science being considered acceptable. 'Misguided' is an explicitly normative term and the use of the pejorative 'imperialistic' is implicitly normative. However, Dupr has not justified the normative dimension of his critique. We identify two ways in which it might be justified. It might be justified if colonisation prevents a discipline from progressing in ways that it might otherwise progress. It might also be justified if colonisation prevents the expression of important (...) values in the colonised discipline. This second concern seems most pressing in the human sciences. (shrink)

The revival of virtue ethics over the last thirty‐five years has produced a bewildering diversity of theories, which on the face of it seem united only by their opposition to various features of more familiar Kantian and Utilitarian ethical theories. In this paper I present a systematic account of the main positive features of virtue ethics, by articulating the common ground shared by its different varieties. I do so not to offer a fresh defence of virtue ethics, but rather to (...) provide a conceptual map that locates its main claims and arguments in relation to those of rival theories, and identifies its distinctive contribution to contemporary ethics. I set out six specific claims which are made by all forms of virtue ethics, and I explain how these claims distinguish the theory from recent character‐based forms of Kantian ethics and Utilitarianism. I then use this framework to briefly survey two main strands of virtue ethics which have been developed in the literature.1. (shrink)

Professionals, it is said, have no use for simple lists of virtues and vices. The complexities and constraints of professional roles create peculiar moral demands on the people who occupy them, and traits that are vices in ordinary life are praised as virtues in the context of professional roles. Should this disturb us, or is it naive to presume that things should be otherwise? Taking medical and legal practice as key examples, Justin Oakley and Dean Cocking develop a (...) rigorous articulation and defence of virtue ethics, contrasting it with other types of character-based ethical theories and showing that it offers a promising new approach to the ethics of professional roles. They provide insights into the central notions of professional detachment, professional integrity, and moral character in professional life, and demonstrate how a virtue-based approach can help us better understand what ethical professional-client relationships would be like. (shrink)

It is widely agreed that the intelligibility of modal metaphysics has been vindicated. Quine's arguments to the contrary supposedly confused analyticity with metaphysical necessity, and rigid with non-rigid designators.2 But even if modal metaphysics is intelligible, it could be misconceived. It could be that metaphysical necessity is not absolute necessity – the strictest real notion of necessity – and that no proposition of traditional metaphysical interest is necessary in every real sense. If there were nothing otherwise “uniquely metaphysically significant” about (...) metaphysical necessity, then paradigmatic metaphysical necessities would be necessary in one sense of “necessary”, not necessary in another, and that would be it. The question of whether they were necessary simpliciter would be like the question of whether the Parallel Postulate is true simpliciter – understood as a pure mathematical conjecture, rather than as a hypothesis about physical spacetime. In a sense, the latter question has no objective answer. In this article, I argue that paradigmatic questions of modal metaphysics are like the Parallel Postulate question. I then discuss the deflationary ramifications of this argument. I conclude with an alternative conception of the space of possibility. According to this conception, there is no objective boundary between possibility and impossibility. Along the way, I sketch an analogy between modal metaphysics and set theory. (shrink)

Introduction In recent years there has been a welcome reawakening of philosophical interest in the emotions. A significant number of contemporary ...

In many recent discussions of the morality of actions where both good and bad consequences foreseeably ensue, the moral significance of the distinction between intended and foreseen consequences is rejected. This distinction is thought to bear on the moral status of actions by those who support the Doctrine of Double Effect. According to this doctrine, roughly speaking, to perform an action intending to bring about a particular bad effect as a means to some commensurate good end is impermissible, while performing (...) an action where one intends only this good end and merely foresees the bad as an unintended sideeffect may be permissible. Consequentialists argue that this is a distinction which makes no moral difference to the evaluation of the initial act in the two cases, given that the overall consequences are the same in each case. In this paper we aim to show that a standard consequentialist line of argument against the moral relevance of the intention/foresight distinction fails. Consequentialists commonly reject the moral relevance of this distinction on the grounds that there is no asymmetry in moral responsibility between intending and foreseeing evil. We argue that even if this claim about moral responsibility is correct, it does not entail, as many Consequentialists believe, that there is no moral asymmetry between acts of intended and foreseen evil. We go on to argue that those consequentialists who do concede the moral relevance of the intention/foresight distinction at the level of agent evaluations cannot consistently make such a concession, and that such a position is in any case untenable, because it entails a complete severance of important conceptual connections between act and agent evaluations. (shrink)

Scanlon’s Being Realistic about Reasons (BRR) is a beautiful book – sleek, sophisticated, and programmatic. One of its key aims is to demystify knowledge of normative and mathematical truths. In this article, I develop an epistemological problem that Scanlon fails to explicitly address. I argue that his “metaphysical pluralism” can be understood as a response to that problem. However, it resolves the problem only if it undercuts the objectivity of normative and mathematical inquiry.

Originally published in 1992 this book attacks many recent philosophical and psychological theories of the emotions and argues that our emotions themselves have intrinsic moral significance. He demonstrates that a proper understanding of the emotions reveals the fundamental role they play in our moral lives and the practical consequences that arise from being morally responsible for our emotions.

Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one or (...) more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap. (shrink)

To what extent are the subjects of our thoughts and talk real? This is the question of realism. In this book, Justin Clarke-Doane explores arguments for and against moral realism and mathematical realism, how they interact, and what they can tell us about areas of philosophical interest more generally. He argues that, contrary to widespread belief, our mathematical beliefs have no better claim to being self-evident or provable than our moral beliefs. Nor do our mathematical beliefs have better (...) claim to being empirically justified than our moral beliefs. It is also incorrect that reflection on the "genealogy" of our moral beliefs establishes a lack of parity between the cases. In general, if one is a moral antirealist on the basis of epistemological considerations, then one ought to be a mathematical antirealist as well. And, yet, Clarke-Doane shows that moral realism and mathematical realism do not stand or fall together -- and for a surprising reason. Moral questions, insofar as they are practical, are objective in a sense that mathematical questions are not. Moreover, the sense in which they are objective can be explained only by assuming practical anti-realism. One upshot of the discussion is that the concepts of realism and objectivity, which are widely identified, are actually in tension. Another is that the objective questions in the neighborhood of questions of logic, modality, grounding, and nature are practical questions too. Practical philosophy should, therefore, take center stage. (shrink)

This chapter contains sections titled: The Rise of Virtue Ethics Essential Features of Virtue Ethics Virtue Ethics Approaches to Bioethics Criticisms of Virtue Ethics Conclusion References Further reading.

We are grateful to the commentators on our article1 for their thoughtful engagement with the ethical and clinical complexity of expanded terminal sedation (ETS) in end-of-life care. We will start by noting some points of common ground, before moving on to the more challenging ways in which TS might be permissibly expanded. First, several commentators pointed out, and we completely concur, that it is important to provide patients with full information about their end-of-life options, including the ‘outcomes, uncertainties and costs (...) of ETS’.2 Where possible, they should be given time to ‘process their feelings and to reflect on how they wish to live in their last few days, weeks or months’.3 Furthermore, where patients receive sedation, it will be critical that they receive appropriate medical and nursing care to prevent physical complications such as pressure ulcers.2 This would be no different from other patients who are in states of reduced consciousness from disease. We acknowledge that there are heightened risks with earlier and more rapid TS, including the potential loss of spiritual and social moments,4 as well as the meaning that can be derived from conscious existential distress.3 However, while these conscious experiences might be valuable to some, others might weigh them less highly against the foreseen …. (shrink)

In this article we argue that the worries about whether a consequentialist agent will be alienated from those who are special to her go deeper than has so far been appreciated. Rather than pointing to a problem with the consequentialist agent's motives or purposes, we argue that the problem facing a consequentialist agent in the case of friendship concerns the nature of the psychological disposition which such an agent would have and how this kind of disposition sits with those which (...) are commonly thought proper to relations of friendship. To the extent that we are right, then, the rejoinders which indirect consequentialists have offered to the problem of alienation are ill directed and so do not succeed in meeting the real problem. In articulating what we see as the source of the alienation problem which friendship poses for consequentialism, we also hope to clarify the general distinction between dispositions and motives and to show how certain kinds of guiding internalized normative dispositions help us to define and therefore distinguish between various types of relationships. Undertaking this task may also help to identify some of the crucial issues for an adequate moral psychology of friendship and its place in any plausible ethical theory. (shrink)

ObjectiveTo compare techniques for computing clustering and switching scores in terms of agreement, correlation, and empirical value as predictors of incident cognitive impairment.MethodsWe transcribed animal and letter F fluency recordings on 640 cases of ICI and matched controls from a national epidemiological study, amending each transcription with word timings. We then calculated clustering and switching scores, as well as scores indexing speed of responses, using techniques described in the literature. We evaluated agreement among the techniques with Cohen’s κ and calculated (...) correlations among the scores. After fitting a base model with raw scores, repetitions, and intrusions, we fit a series of Bayesian logistic regression models adding either clustering and switching scores or speed scores, comparing the models in terms of several metrics. We partitioned the ICI cases into acute and progressive cases and repeated the regression analysis for each group.ResultsFor animal fluency, we found that models with speed scores derived using the slope difference algorithm achieved the best values of the Watanabe–Akaike Information Criterion, but with good net reclassification improvement only for the progressive group. For letter fluency, different models excelled for prediction of acute and progressive cases. For acute cases, NRI was best for speed scores derived from a network model, while for progressive cases, the best model used clustering and switching scores derived from the same network model. Combining variables from the best animal and letter F models led to marginal improvements in model fit and NRI only for the all-cases and acute-cases analyses.ConclusionSpeed scores improve a base model for predicting progressive cognitive impairment from animal fluency. Letter fluency scores may provide complementary information. (shrink)

In this issue of the Hastings Center Report, Ann Hamric, John Arras, and Margaret Mohrmann highlight how contemporary accounts of the virtue of courage in health care often gloss over deeper problems in the underlying health care systems themselves. They express particular concerns about the appropriateness and personal costs of exhortations to health professionals to take courageous action in circumstances where this is “required only because of unethical institutional structures” (p. 39). They offer valuable points that are not adequately recognized (...) in discussions of courage as a professional virtue in health care practice. The call for more judicious appeals to health professionals to exercise courage in health care practice should clearly be heeded. A sole reliance on practitioner courage for exposing unethical workplace practices would be misguided. Nevertheless, there is still a legitimate place for encouraging health professionals to develop and act on courage. (shrink)

The standard problem with many slippery slope arguments is that they fail to provide us with the necessary evidence to warrant our believing that the significantly morally worse circumstances they predict will in fact come about. As such these arguments have widely been criticised as ‘scare-mongering’. Consequentialists have traditionally been at the forefront of such criticisms, demanding that we get serious about guiding our prescriptions for right action by a comprehensive appreciation of the empirical facts. This is not surprising, since (...) consequentialism has traditionally been committed to the idea that right action be driven by empirical realities, and this hard-headed approach has been an especially notable feature of Australian consequentialism. But this apparent empirical hard-headedness is very selective. While consequentialists have understood their moral outlook and commitments as guided by a partnership with empirical science – most explicitly in their replies to the arguments of their detractors – some consequentialists have been remarkably complacent about providing empirical support for their own prescriptions. Our key example here is the consequentialist claim that our current practises of partiality in fact maximise the good, impartially conceived. This claim has invariably been made without compelling support for the large empirical claims upon which it rests, and so, like the speculative empirical hand-waving of weak slippery slope arguments, it seems similarly to be undermined. While these arguments have presented us with ‘wishful thinking’ rather than ‘scare-mongering’, we argue in this paper that their complacency in meeting the relevant empirical justificatory burden remains much the same. (shrink)

To have free will is to have what it takes to act freely. When an agent acts freely—when she exercises her free will—what she does is up to her. A plurality of alternatives is open to her, and she determines which she pursues. When she does, she is an ultimate source or origin of her action. So runs a familiar conception of free will.

It is commonly suggested that evolutionary considerations generate an epistemological challenge for moral realism. At first approximation, the challenge for the moral realist is to explain our having many true moral beliefs, given that those beliefs are the products of evolutionary forces that would be indifferent to the moral truth. An important question surrounding this challenge is the extent to which it generalizes. In particular, it is of interest whether the Evolutionary Challenge for moral realism is equally a challenge for (...) mathematical realism. It is widely thought not to be. In this paper, I argue that the Evolutionary Challenge for moral realism is equally a challenge for mathematical realism. Along the way, I substantially clarify the Evolutionary Challenge, discuss its relation to more familiar epistemological challenges, and broach the problem of moral disagreement. The paper should be of interest to ethicists because it places pressure on anyone who rejects moral realism on the basis of the Evolutionary Challenge to reject mathematical realism as well. And the paper should be of interest to philosophers of mathematics because it presents a new epistemological challenge for mathematical realism that bears, I argue, no simple relation to Paul Benacerraf's familiar challenge. (shrink)