This paper is a response to Christopher Boorse's recent defense of hisBiostatistical Theory (BST) of health and disease. Boorse maintains that hisconcept of theoretical health and disease reflects the ``consideredusage of pathologists.'' I argue that pathologists do not use ``disease'' inthe purely theoretical way that is required by the BST. Pathology does notdraw a sharp distinction between theoretical and practical aspects ofmedicine. Pathology does not even need a theoretical concept of disease. Itsfocus is not theoretical, but practical; pathology's goal is (...) to contribute tothe healing of patients. Pathology, even experimental pathology, is notvalue-free. Not only ``disease'' but also such terms as ``nerve'' and ``organ''are laden with conceptual values. (shrink)

Using ideas gleaned from the philosophy of technology of Martin Heidegger and Hans Jonas and the philosophy of health of Georges Canguilhem, I argue that one of the characteristics of emerging medical technologies is that these technologies lead to new conceptions of health. When technologies enable the body to respond to more and more challenges of disease, we thus establish new norms of health. Given the continued development of successful technologies, we come to expect more and more that our bodies (...) should be able to respond to ever-new challenges of environment and disease by establishing ever-new norms of health. Technologies may aim at the prevention and treatment of disease, but they also bring about modifications of what we consider normal for the human being. Thus, new norms of health arise from technological innovation. (shrink)

“Geneticization” is a term used to describe the ways in which the science of genetics is influencing society at large and medicine in particular; it has important implications for the process of diagnostics. Because genetic diagnostics produces knowledge about genetic disease and predisposition to disease, it is essentially influenced by these innovations in the disease concept. In this paper, I argue that genetic diagnostics presents new ethical challenges not because the diagnostic process or method in genetic diagnostics is ethically different (...) in kind from traditional medical diagnostics, but because it relies on a neo-ontological concept of disease in a context of genetic reductionism. Geneticization has not produced a radically new concept of disease, however, but has introduced innovations into the classical ontological concept of disease. When this new concept of disease is held in tandem with genetic reductionism, we are led to the absurd conclusion that disease is the very essence of the human being. I argue that neither the neo-ontological concept of disease nor genetic reductionism is necessary for a proper understanding of genetic diagnostics. (shrink)

William E. Stempsey, S.J.; Institutional Identity and Roman Catholic Hospitals, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 7, Issue.

Virtually all activities of health care are motivated at some level by hope. Patients hope for a cure; for relief from pain; for a return home. Physicians hope to prevent illness in their patients; to make the correct diagnosis when illness presents itself; that their prescribed treatments will be effective. Researchers hope to learn more about the causes of illness; to discover new and more effective treatments; to understand how treatments work. Ultimately, all who work in health care hope to (...) offer their patients hope. In this paper, I offer a brief analysis of hope, considering the definitions of Hobbes, Locke, Hume and Thomas Aquinas. I then differentiate shallow and deep hope and show how hope in health care can remain shallow. Next, I explore what a philosophy of deep hope in health care might look like, drawing important points from Ernst Bloch and Gabriel Marcel. Finally, I suggest some implications of this philosophy of hope for patients, physicians, and researchers. (shrink)

Although many of the pioneers of present-day bioethics came from religious and theological backgrounds, the recent controversy about the role of religion in bioethics has elicited much attention. Timothy Murphy would ban religion from bioethics altogether. Much of the ado hinges on conflicting understandings of just what bioethics is and just what religion is. This paper attempts to make more explicit how the fields of bioethics and religion have been understood in this context, and how they should not be understood. (...) We begin by looking at bioethics as a field: its origins, purpose, scope, and its methods. We then examine the notion of religion, looking especially at its importance for bioethics. Humanity is not just Homo sapiens but also Homo religiosus. Religion is more than a code of ethics; it gives insight into many of the foundational matters of bioethics. (shrink)

This article is an introduction to a special issue of Theoretical Medicine and Bioethics on clinical reasoning. Clinical reasoning encompasses the gamut of thinking about clinical medical practice—the evaluation and management of patients’ medical problems. Theories of clinical reasoning may be normative or descriptive; that is, they may offer recommendations on how clinicians ought to think or they may simply attempt to describe how clinicians actually do think. This article briefly surveys these approaches in order to show the complexity of (...) clinical reasoning and the inadequacy of any one theory for capturing the full richness of clinical reasoning. The authors of this issue offer both normative and descriptive elements in their accounts. Topics discussed include the importance for clinical reasoning of tacit knowing, risk assessment, narrative and hermeneutics, wisdom, and virtue epistemology. (shrink)

The nature of health is one of the central topics in the philosophy of medicine. The concept of health is complex because it comprises multiple features and there is no consensus on which feature is most basic or even whether some particular feature has any importance at all. This paper focuses on how several basic elements play a role in the formation of the concept of health. My central claim is that the theory of emergence offers a way to construct (...) a theory of health that is sympathetic to both analytic and holistic perspectives. In one way, this emergent theory of health looks very much like a holistic theory in that it considers not only biological factors as fundamental to understanding health, but also psychological, and social factors. In another way, this theory looks very much like an analytic theory because it sees health as a phenomenon that emerges from more basic elements: biology, psychology, and sociology. This may seem ambiguous, but this kind of ambiguity might just be the biggest virtue of the theory. (shrink)

Patients increasingly see physicians not as humane caregivers but as unfeeling technicians. The study of philosophy in medical school has been proposed to foster critical thinking about one's assumptions, perspectives and biases, encourage greater tolerance toward the ideas of others, and cultivate empathy. I suggest that the study of ethics and philosophy by medical students has failed to produce the humane physicians we seek because of the way the subject matter is quarantined in American medical education. First, the liberal arts (...) are seen as the province of undergraduate education, and not medical school. Second, philosophy, when taught in medical school, is seen by students as just one subject to be mastered along with many other more important ones, and not as a way to foster critical thinking and empathy. What is needed is a new pedagogy that combines both cognitive and affective elements to implant and nourish the liberal arts in students. Removing the quarantine of philosophy from other facets of medical education is an important first step. (shrink)

It is common to talk of wise physicians, but not so common to talk of wise patients. "Patient" is a word derived from the Latin patior - "to suffer," but also "to let be." Suffering has been the universal lot of humanity, and medicine rightly tries to relieve suffering. Medical progress, like all technological progress, leads us more and more to hope that we can control our fate. However, we do well to ask whether our attempts to control our fate (...) are wise. Wisdom played a major role in the philosophy of the ancient Stoics, and so I propose putting these questions into the context of a new stoicism. For the Stoic, happiness consists in living in accord with nature. Stoics are sometimes portrayed as apathetic fatalists, silently accepting whatever misfortune might come their way, but this is a misunderstanding. The Stoic sage, like the common person, wants to preserve life and health. The difference is that the sage's wisdom brings knowledge about what actions are appropriate in the face of suffering. The sage sees suffering not as something that demands immediate control, but as something that might reasonably direct actions. Suffering brings turmoil to the common patient, who will take any possible steps to end the suffering. The wise patient possesses the knowledge that enables a correct assessment of the options in the face of the reality that we ultimately do not control our own fate. (shrink)

The distinction between killing and letting die has been a controversial element in arguments about the morality of euthanasia and physician-assisted suicide. The killing/letting die distinction is based on causation of death. However, a number of causal factors come into play in any death; it is impossible to state a complete cause of death. I argue that John Mackie’s analysis of causation in terms of ‘inus factors,’ insufficient but nonredundant parts of unnecessary but sufficient conditions, helps us to see that (...) moral responsibility for death cannot rest on causation alone. In specifying the cause of death, some factors can be considered alternatively as either causal factors or merely parts of the presupposed background conditions. If a factor is moved from the background field into the causal field, the result is a changed background field. Comparisons of cases of killing and letting die often do just this; hence, the cases depend on different presuppositions and the causation cannot be directly compared. Moral judgments determine how to apportion factors to the causal and background fields. (shrink)

This paper explores the role of religious belief in public debate about physician-assisted dying and argues that the role is essential because any discussion about the way we die raises the deepest questions about the meaning of human life and death. For religious people, such questions are essentially religious ones, even when the religious elements are framed in secular political or philosophical language. The paper begins by reviewing some of the empirical data about religious belief and practice in the United (...) States and Europe. It then explores the question of the proper role of religion in public policy debate and concludes with a discussion of the importance of religion and religious practices in considerations of how we die. (shrink)

In considering whether medical miracles occur, the limits of epistemology bring us to confront our metaphysical worldview of medicine and nature in general. This raises epistemological questions of a higher order. David Hume’s understanding of miracles as violations of the laws of nature assumes that nature is completely regular, whereas doctrines such as C. S. Peirce’s "tychism" hold that there is an element of absolute chance in the workings of the universe. Process philosophy gives yet another view of the working (...) of nature. Physicians have no epistemological grounds for declaring any cure to be miraculous. Miracles are theological (or philosophical) entities, and not medical entities. All physicians can do is to determine whether or not a cure is scientifically inexplicable according to the current epistemological standards of medical science. (edited). (shrink)

Popular visions of holistic health and holistic medicine are not so much reactions to perceived excesses of technological medicine as they are visions of the good life itself and how to attain it. This paper attempts to clarify some of the concepts associated with holistic health and medicine. The particular vision of holistic health presented here is well exemplified in the writings of Plato. First, I examine the scientific concept of holism and argue that, while medicine is inadequately characterized by (...) scientific reductionism, any plausible holistic medicine must make room for a limited scientific reductionism. Next, I analyze the complexity of Plato's usage of health and demonstrate some of the parallels between Plato's thought and popular and scientific visions of holistic health. Finally, I look at what Plato has to say about medical practice and the relation of medicine and philosophy as therapies for the whole person. (shrink)

Religious voices were important in the early days of the contemporary field of bioethics but have now become decidedly less prominent. This is unfortunate because religious elements are essential parts of the most foundational aspects of bioethics. The problem is that there is an incommensurability between religious language and languages of public discourse such as the “public reason” of John Rawls. To eliminate what is unique in religious language is to lose something essential. This paper examines the reasons for the (...) marginalization of religion in bioethics, shows the limitations of Rawls’s notion of public reason, and argues for a more robust role for theology in articulating a new language for public discourse in bioethics. (shrink)

Hans Jonas argued that death is both a blessing and a burden, basing his argument on an evolutionary viewpoint. He highlighted the paradox that life carries the burden of death within itself. Daniel Callahan responded that Jonas’s failure to fully appreciate the value of life shows the deficiency of using evolution to explain how death could be a blessing for individuals. Jazmine Gabriel now convincingly defends Jonas against Callahan’s charges, showing that Jonas’s commitment to fight against the Nazis, his attack (...) against nihilism, and his rejection of the metaphysical dualism that opposes valuing, purpose-seeking humans against a value-free, purposeless world all demonstrate Jonas’s commitment to honoring individual lives. This paper affirms Gabriel’s response and advances the dialectic by considering a further paradox. As life carries within itself death, so does the blessing of death carry within itself the burden of death and the burden of death carry within itself the blessing of death. (shrink)

The Twentieth European Conference on Philosophy of Medicine and Health Care was held in Helsinki, Finland, in August 2006 and highlighted the theme “Medicine, Philosophy and the Humanities.” The four papers in this thematic section are developed from presentations made at that conference.They are the work of physicians and philosophers and present fundamentally philosophical reflections on the medical humanities. The authors show that philosophy offers both a substantial way of humanizing the theory and practice of medicine and a way to (...) orchestrate the contributions of all the medical humanities. (shrink)

The question of whether the universe is expanding or contracting serves as a model for current questions facing the medical humanities. The medical humanities might aptly be described as a metamedical multiverse encompassing many separate universes of discourse, the most prominent of which is probably bioethics. Bioethics, however, is increasingly developing into a new interdisciplinary discipline, and threatens to engulf the other medical humanities, robbing them of their own distinctive contributions to metamedicine. The philosophy of medicine considered as a distinct (...) field of study has suffered as a result. Indeed, consensus on whether the philosophy of medicine even constitutes a legitimate field of study is lacking. This paper presents an argument for the importance of a broad conception of the philosophy of medicine and the central role it should play in organizing and interpreting the various fields of study that make up the metamedical multiverse. (shrink)

This paper is a criticalexamination of the development of thephilosophy of medicine as a discipline. Ithighlights two major themes in the contemporarydebate about the philosophy of medicine: thescope of the discipline and the relation of thediscipline to its cognate disciplines. A broadview of the philosophy of medicine is defendedand the philosophy of medicine is seen as aphilosophical sub-discipline. These viewsdepend in important ways on three factors: ageneral metaphysical world view, particularunderstandings of the cognate disciplines, andthe perspective from which one asks (...) thequestions about the nature of the discipline. It is proposed that the future of thephilosophy of medicine may follow thephilosophy of science in that philosophical,sociological and historical studies may combinein a mutually enriching way to form ‘‘medicinestudies.’‘. (shrink)

In _Facing the Planetary_ William E. Connolly expands his influential work on the politics of pluralization, capitalism, fragility, and secularism to address the complexities of climate change and to complicate notions of the Anthropocene. Focusing on planetary processes—including the ocean conveyor, glacier flows, tectonic plates, and species evolution—he combines a critical understanding of capitalism with an appreciation of how such nonhuman systems periodically change on their own. Drawing upon scientists and intellectuals such as Lynn Margulis, Michael Benton, Alfred North (...) Whitehead, Anna Tsing, Mahatma Gandhi, Wangari Maathai, Pope Francis, Bruno Latour, and Naomi Klein, Connolly focuses on the gap between those regions creating the most climate change and those suffering most from it. He addresses the creative potential of a "politics of swarming" by which people in different regions and social positions coalesce to reshape dominant priorities. He also explores how those displaying spiritual affinities across differences in creed can energize a militant assemblage that is already underway. (shrink)

One of the most vivid aspects of consciousness is the experience of emotion, yet this topic is given relatively little attention within consciousness studies. Emotions are crucial, for they provide quick and motivating assessments of value, without which action would be misdirected or absent. Emotions also involve linkages between phenomenal and intentional consciousness. This paper examines emotional consciousness from the standpoint of the representational theory of consciousness . Two interesting developments spring from this. The first is the need for the (...) representation of value, which is distinctive of emotional experience. The second is an extension of RTC’s theory of introspection to emotional states, revealing why emotional consciousness is so often introspective even though introspective abilities are not needed to experience emotions, and also explaining why introspection of emotional states is so much less reliable than that of other states of consciousness. (shrink)

In _The Fragility of Things_, eminent theorist William E. Connolly focuses on several self-organizing ecologies that help to constitute our world. These interacting geological, biological, and climate systems, some of which harbor creative capacities, are depreciated by that brand of neoliberalism that confines self-organization to economic markets and equates the latter with impersonal rationality. Neoliberal practice thus fails to address the fragilities it exacerbates. Engaging a diverse range of thinkers, from Friedrich Hayek, Michel Foucault, Hesiod, and Immanuel Kant to (...) Voltaire, Terrence Deacon, Friedrich Nietzsche, and Alfred North Whitehead, Connolly brings the sense of fragility alive as he rethinks the idea of freedom. Urging the Left not to abandon the state but to reclaim it, he also explores scales of politics below and beyond the state. The contemporary response to fragility requires a militant pluralist assemblage composed of those sharing affinities of spirituality across differences of creed, class, gender, sexual orientation, and ethnicity. (shrink)

William Whewell is considered one of the most important nineteenth-century British philosophers of science and a contributor to modern philosophical thought, particularly regarding the problem of induction and the logic of discovery. In this volume, Robert E. Butts offers selections from Whewell's most important writings, and analysis of counter-claims to his philosophy.

How does the experience of busyness impact democratic political life? My hunch is that those reading this essay might very well offer the following answer: busyness means that we relegate political activities to the bottom of a long and sometimes tedious laundry list of “things to get done.” In fact, many of us no longer even bother to include the basic activities of citizenship –getting informed about the issues, deliberating with our peers about matters of common concern, attending a political (...) meeting, or even voting —on the list in the first place. Like this author, many of you probably feel somewhat guilty about this as well, and thus try to compensate in some way or another… At worst, busyness generates political disinterest and apathy: many of our fellow citizens openly describe the most fundamental form of democratic participation, the vote, as “a waste of time.” At best, it seems to privilege an acceleration of political activity: we seek speedy and rapidly consummated types of involvement that do not unduly add to the enormous time pressures we already feel. Unfortunately, it remains unclear whether even such high-speed forms of citizen involvement are normatively satisfactory. Can liberal democracy flourish when a growing number of us avoid the responsibilities of citizenship altogether, while even those of us who try to remain politically involved insist that they be dealt with quickly and painlessly? In this essay, I hope at the very least to deepen our understanding of this quagmire. If I am not mistaken, it provides a useful starting point for examining one of the core challenges of contemporary political life: how can we make sure that busyness and citizenship coexist in a potentially fruitful, though by no means necessarily harmonious, relationship? (shrink)

This essay examines lines of connection between disgust, the effect of disciplines upon such intensive appraisals, political action, and the shape of ethical responsiveness. Philosophies that espouse purity in moral ity or politics mask these lines of connection; they thereby disparage the sig nificance of techniques of the self to ethical and political life. Immanuel Kant and Hannah Arendt provide the two main figures through whom these themes are explored. Arendt and Kant are brought into relation with each other through (...) the way each comes to terms with disgust and common sense. Kant's attempt to purify morality draws upon the spontaneity of common sense even more than it does upon a set of transcendental arguments. The Kantian metaphysic of the supersensible and the sensible then authorizes a concept of morality that almost removes the will beyond the reach of disci plines. But aporias he confronts within the will may bring these tactics back in. Arendt, while rising above the command conception of morality pro jected by Kant through her invocation of gratitude for being and appre ciation of new beginnings, reinstates purity in the concept of 'the political'. Arendt's drive to bracket the body - often treated as an assemblage of com pulsive moods and interests - from the realm of ethical and political life also disparages tactics by the self on the self. To challenge the metaphysic of the supersensible and the sensible with a metaphysic of the infrasensible and the sensible is to confirm the nobility of such tactics. The presentation of this alternative perspective calls into question the pretension of many contemporaries to be 'post-metaphysical'; it also helps to show why meta physical pluralism sets a condition for a politics of plurality attuned to the velocity and scope of late-modern life. Key Words: amygdala • Arendt • body • common sense • Deleuze • ethics • Kant • metaphysics • plurality • Spinoza. (shrink)

Complexity, agency, and time -- The vicissitudes of experience -- Belief, spirituality, and time -- The human predicament -- Capital flows, sovereign decisions, and world resonance machines -- The theorist and the seer.

Donald Davidson espouses two fundamental theses about the individuation of mental events. The thesis of causal individuation asserts that sameness of cause and effect is sufficient and necessary for event identity. The thesis of content individuation gives only a sufficient condition for difference of mental events: if e and f have different contents then they are different mental events. I argue that given these theses, psychological externalism--the view that mental content is determined by factors external to the subject of the (...) relevant mental events--entails that the token identity theory is false. (shrink)

In The City of God, XI, 10, St Augustine claims that the divine nature is simple because ‘it is what it has’ (quod habet hoc est). We may take this as a slogan for the Doctrine of Divine Simplicity (DDS), a doctrine which finds its way into orthodox medieval Christian theological speculation. Like the doctrine of God's timeless eternality, the DDS has seemed obvious and pious to many, and incoherent, misguided, and repugnant to others. Unlike the doctrine of God's timeless (...) eternality, the DDS has received very little critical attention. The DDS did not originate with Augustine, but I am not primarily concerned with its pedigree. Nor am I concerned to ask how the doctrine interacts with trinitarian speculation. I will have my hands full as it is. In Section I of this paper I shall provide a rough characterization of the DDS, indicate its complexity, and focus on a particular aspect of the doctrine which will exercise us in the remainder of the paper, namely, the thesis that the divine attributes are all identical with each other and with God. In section n I shall discuss Alvin Plantinga's recent objections to Aquinas' version of the DDS. I shall then offer a more detailed presentation of what I take to be Aquinas' version (section III), and recast it in terms of a theory of attributes which is significantly different from Plantinga's (section IV). Although the recasting of the doctrine will enable me to rebut Plantinga's objections (section v), it by no means solves all the problems of the DDS. In section vi I shall discuss the chief lingering problem facing a defender of the DDS. (shrink)

Recent estimates suggest that the number of people seeking mental health treatment has increased significantly in the past 20 years (Kessler et al., 2005; Lipson et al., 2019; Mojtabai, 2005). Many...

This study examines the effects of nationality (U.S. vs. China) and personal values on managers’ responses to the Perceived Role of Ethics and Social Responsibility (PRESOR) scale. Evidence that China’s transition to a socialist market economy has led to widespread business corruption, led us to hypothesize that People’s Republic of China (PRC) managers would believe less strongly in the importance of ethical and socially responsible business conduct. We also hypothesized that after controlling for national differences, managers’ personal values (more specifically, (...) self-transcendence values) would have a significant impact on PRESOR responses. The hypotheses were tested using a sample of practicing managers enrolled in part-time MBA programs in the two countries. The results indicate that nationality did not have a consistent impact on PRESOR responses. After controlling for national differences, self-transcendence values had a significant positive impact on two of the three PRESOR dimensions. Conservation values such as conformity and tradition also had a significant association with certain dimensions of the PRESOR scale. (shrink)

This paper examines fraudulent financial reporting within the context of Jones' (1991) ethical decision making model. It was hypothesized that quantitative materiality would influence judgments of the ethical acceptability of fraud, and that both materiality and financial risk would affect the likelihood of committing fraud. The results, based on a study of CPAs employed as senior executives, provide partial support for the hypotheses. Contrary to expectations, quantitative materiality did not influence ethical judgments. ANCOVA results based on participants' estimates of the (...) likelihood that a "typical CPA" would manipulate reported results indicated that both materiality and risk significantly influenced the likelihood of fraud, but that the perceived morality of the action did not. In contrast, results based on participants' self-reported behavior indicated that materiality and the perceived morality of the action would influence the likelihood of fraud, but that financial risk would not. Regardless of the measure used for the likelihood of fraud, the results indicate that financial executives continue to be influenced by quantitative materiality when misstatements are clearly material on qualitative grounds. (shrink)

In the pathbreaking essays collected here, Neumann and Kirchheimer demonstrate that the death of democracy and the rise of fascism during the first half of the twentieth century suggest crucial lessons for contemporary political and legal scholars. The volume includes writings on constitutionalism, political freedom, Nazism, sovereignty, and both Nazi and liberal law. Most important, the Frankfurt authors point to the continuing efficacy of the rule of law as an instrument for regulating and restraining state authority, as well as ominous (...) evidence of the rule of law's fragility in modern liberal democracy. (shrink)

The Perceptual Hypothesis is that we sometimes see, and thereby have non-inferential knowledge of, others' mental features. The Perceptual Hypothesis opposes Inferentialism, which is the view that our knowledge of others' mental features is always inferential. The claim that some mental features are embodied is the claim that some mental features are realised by states or processes that extend beyond the brain. The view I discuss here is that the Perceptual Hypothesis is plausible if, but only if, the mental features (...) it claims we see are suitably embodied. Call this Embodied Perception Theory. I argue that Embodied Perception Theory is false. It doesn't follow that the Perceptual Hypothesis is implausible. The considerations which serve to undermine Embodied Perception Theory serve equally to undermine the motivations for assuming that others' mental lives are always imperceptible. (shrink)

This study proposes and tests a model of the relations among corporate accountants’ perceptions of the ethical climate in their organization, the perceived importance of corporate ethics and social responsibility, and earnings management decisions. Based on a field survey of professional accountants employed by private industry in Hong Kong, we found that perceptions of the organizational ethical climate were significantly associated with belief in the importance of corporate ethics and responsibility. Belief in the importance of ethics and social responsibility was (...) also significantly associated with accountants’ ethical judgments and behavioral intentions regarding accounting and operating earnings manipulation. These findings suggest that perceptions of ethical climate, usually presumed to reflect the “tone at the top” in the organization, lead accounting professionals to rationalize earnings management decisions by adjusting their attitudes toward the importance of corporate ethics and social responsibility. This is the first study to document a relationship between organizational ethical climate and professional accountants’ support for corporate ethics and social responsibility, and also the first study to document that industry accountants’ views toward corporate ethics and social responsibility are associated with their willingness to manipulate earnings. The findings have important implications, suggesting that organizational efforts to enhance the ethical climate and emphasize the importance of corporate ethics and social responsibility could reduce the prevalence of earnings manipulation. (shrink)