Objective: Ethical guidelines are designed to ensure benefits, protection and respect of participants in clinical research. Clinical trials must now be registered on open-access databases and provide details on ethical considerations. This systematic survey aimed to determine the extent to which recently registered clinical trials report the use of standard of care and post-trial obligations in trial registries, and whether trial characteristics vary according to setting. Methods: We selected global randomized trials registered on http://www.clinicaltrials.gov and http://www.controlled-trials.com. We searched for intervention (...) trials of HIV/AIDS, malaria, and tuberculosis from 9 October 2004, the date of the most recent version of the Helsinki Declaration, to 10 April 2007. Results: We collected data from 312 trials. Fifty-eight percent (58%, 95% CI = 53 to 64) of trial protocols report informed consent. Fifty-eight percent (58%, 95% CI = 53 to 64) of trials report active controls. Almost no trials (1%, 95% CI = 0.5 to 3) mention post-trial provisions. Most trials measure surrogate outcomes. Twenty percent (20%, 95% CI = 16 to 25) of trials measure patient-important outcomes, such as death; and the odds that these outcomes are in a low income country are five times greater than for a developed country (odds ratio (OR) 5.03, 95% CI = 2.70 to 9.35, p = < 0.001). Pharmaceutical companies are involved in 28% (CI = 23 to 33) of trials and measure surrogate outcomes more often than nonpharmaceutical companies (OR 2.45, 95% CI = 1.18 to 5.09, p = 0.31). Conclusion: We found a large discrepancy in the quality of reporting and approaches used in trials in developing settings compared to wealthier settings. (shrink)

Focal brain metabolic effects detected by proton magnetic resonance spectroscopy (MRS) in obsessive-compulsive disorder (OCD) represent prospective indices of clinical status and guides to treatment design. Sampling bilateral pregenual anterior cingulate cortex (pACC), anterior middle cingulate cortex (aMCC), and thalamus in 40 adult patients and 16 healthy controls, we examined relationships of the neurometabolites glutamate+glutamine (Glx), creatine+phosphocreatine (Cr), and choline-compounds (Cho) with OCD diagnosis and multiple symptom types. The latter included OC core symptoms (Yale-Brown Obsessive-Compulsive Scale - YBOCS), depressive symptoms (...) (Montgomery-Åsberg Depression Rating Scale - MADRS), and general functioning (Global Assessment Scale - GAS). pACC Glx was 9.7% higher in patients than controls. Within patients, Cr and Cho correlated negatively with YBOCS and MADRS, while Cr correlated positively with the GAS. In aMCC, Cr and Cho correlated negatively with MADRS, while Cr in thalamus correlated positively with GAS. These findings present moderate support for glutamatergic and cingulocentric perspectives on OCD. Based on our prior metabolic model of OCD, we offer one possible interpretation of these group and correlational effects as consequences of a corticothalamic state of elevated glutamatergic receptor activity alongside below-normal glutamatergic transporter activity. (shrink)

Essays on Philosophy and Economic Methodology By Daniel M. Hausman Cambridge University Press, 1992. Pp. 259. ISBN 0?521?41740?6. £35.00. Le Fondement de la morale: Essai d'éthiquephilosophique By André Léonard Cerf, 1991. Pp. 381. ISBN not available. FF240. The Philosophy of Time Edited By Robin Le Poidevin and Murray MacBeath Oxford University Press, 1993. Pp. 230. ISBN 0?19?823998?X. £27.50. The Ethics and Politics of Human Experimentation By Paul M. McNeill Cambridge University Press, 1993. Pp. 315. ISBN 0?521?41627?2. £35.00. Modern Conditions, Postmodern (...) Controversies By Barry Smart Routledge, 1991. Pp. 241. ISBN 0?415?06952. £10.99. Religion in Relation. Method, Application and Moral Location By Ivan Strenski Macmillan, 1993. Pp. ix + 257. ISBN 0?333?53469?7. £45.00. Robert Nozick: Property, Justice and the Minimal State By Jonathan Wolff Polity Press, 1991. Pp. ix + 168. ISBN 0?7456?0603?2. £8.95 pbk. (shrink)

Ramon Lemos provides an enhancement of a traditional realistic metaphysics. This work is not a general metaphysics text, and, although the positions taken are consistent with much of Aristotelianism and medieval realism, the work is not a historically oriented treatise. This can be seen as defining the book's contribution to metaphysics: the development of certain metaphysical principles in light of modern, and especially twentieth-century, disputes about logical and linguistic issues. Berkeley, Chisholm, Descartes, Green, Hampshire, Hegel, Hume, Husserl, Kant, Leibniz, Lewis, (...) Locke, Peirce, and Strawson are discussed in the text and others, such as Sellars, occur unnamed, while evaluations are made of various views. (shrink)

In this paper, I discuss the role of Anselm’s ontological argument in the philosophy of R.G. Collingwood. Anselm’s argument appears prominently in Collingwood’s Essay on Philosophical Method (1933) and Essay on Metaphysics (1940), as well as in his early work Speculum Mentis (1924). In the proof, Collingwood finds the central expression of the priority of “faith” in the first principles of thought to reason’s activities. For Collingwood, it is Anselm’s proof that clearly expresses this relationship between faith and reason. The (...) two elements of this analysis that must be understood if one is to understand Collingwood’s use of the proof are what he means by “the idea of an object that shall completely satisfy the demands of reason” and the “special case of metaphysical thinking.” I analyze both of these elements and conclude by showing how Anselm’s proof is essential to Collingwood’s historical science of mind. (shrink)

Men often make riskier decisions than women across a wide range of real-life behaviors. Whether this sex difference is accentuated, diminished, or stable under stressful conditions is, however, contested in the scientific literature. A critical blind spot lies amid this contestation: Most studies use standardized, laboratory-based, cognitive measures of decision making rather than complex real-life social simulation tasks to assess risk-related behavior. To address this blind spot, we investigated the effects of acute psychosocial stress on risk decision making in men (...) and women using a standardized cognitive measure and a novel task that simulated a real-life social situation. Participants were exposed to either an acute psychosocial stressor or an equivalent control condition. Stressor-exposed participants were further characterized as high- or low-cortisol responders. Results confirmed that the experimental manipulation was effective. On the IGT, participants characterized as low-cortisol responders made significantly riskier decisions than those characterized as high-cortisol responders. Similarly, in the online chatroom, participants characterized as low-cortisol responders were, relative to those in the Non-Stress group, significantly more likely to make risky decisions. Together, these results suggest that at lower levels of cortisol both men and women tend to make riskier decisions in both economic and social spheres. (shrink)

The power of technology to transform religions, science, and political institutions has often been presented as nothing short of revolutionary. Does technology have a similarly transformative influence on societies’ morality? Scholars have not rigorously investigated the role of technology in moral revolutions, even though existing research on technomoral change suggests that this role may be considerable. In this paper, we explore what the role of technology in moral revolutions, understood as processes of radical group-level moral change, amounts to. We do (...) so by investigating four historical episodes of radical moral change in which technology plays a noteworthy role. Our case-studies illustrate the plurality of mechanisms involved in technomoral revolutions, but also suggest general patterns of technomoral change, such as technology’s capacity to stabilize and destabilize moral systems, and to make morally salient phenomena visible or invisible. We find several leads to expand and refine conceptual tools for analysing moral change, specifically by crystallizing the notions of ‘technomoral niche construction’ and ‘moral payoff mechanisms’. Coming to terms with the role of technology in radical moral change, we argue, enriches our understanding of moral revolutions, and alerts us to the depths of which technology can change our societies in wanted and unwanted ways. (shrink)

In Democracy and the Claims of Nature, the leading thinkers in the fields of environmental, political, and social theory come together to discuss the tensions and sympathies of democratic ideals and environmental values. The prominent contributors reflect upon where we stand in our understanding of the relationship between democracy and the claims of nature. Democracy and the Claims of Nature bridges the gap between the often competing ideals of the two fields, leading to a greater understanding of each for the (...) other. (shrink)

One of the topics that often comes up in ethical discussions of deep brain stimulation (DBS) is the question of what impact DBS has, or might have, on the patient’s self. This is often understood as a question of whether DBS poses a “threat” to personal identity, which is typically understood as having to do with psychological and/or narrative continuity over time. In this article, we argue that the discussion of whether DBS is a “threat” to continuity over time is (...) too narrow. There are other questions concerning DBS and the self that are overlooked in discussions exclusively focusing on psychological and/or narrative continuity. For example, it is also important to investigate whether DBS might sometimes have a positive (e.g. a rehabilitating) effect on the patient’s self. To widen the discussion of DBS, so as to make it encompass a broader range of considerations that bear on DBS’s impact on the self, we identify six features of the commonly used concept of a person’s “true self”. We apply these six features to the relation between DBS and the self. And we end with a brief discussion of the role DBS might play in treating otherwise treatment-refractory anorexia nervosa. This further highlights the importance of discussing both continuity over time and the notion of the true self. (shrink)

In the past decade Mary Wollstonecraft has become an increasingly important figure in the history of political thought. However, relatively few interpretations of her work exist. This piece focuses on Wollstonecraft's least-read text, An Historical and Moral View of the Origin and Progress of the French Revolution; and the Effect It Has Produced in Europe . It provides a new interpretation of this work, one that stresses its relation to the Scottish Enlightenment. The argument is that Wollstonecraft's text can be (...) read as a novel move initiated from within the discourse of ‘manners’ that J.G.A. Pocock, especially, has shown to be key to understanding the period in general and the Scots in particular. Wollstonecraft challenged the central claim of the Scottish four-stage historical thesis that extant European manners marked the development of a higher level of moral and civic virtue. At the same time, however, she appropriated the Scots’ underlying notion of a civilizing process. By rewriting the history of manners from a perspective that denied their necessary connection to morals, Wollstonecraft sought to explain the French Revolution's violence as a predictable consequence of moral underdevelopment, while simultaneously defending the Revolution itself as a positive moment in the evolution of civilization based on intellectual progress. This attempt to shift the Scottish Enlightenment discursive paradigm of manners in the course of articulating a ‘moral view’ of the French Revolution, I argue, constitutes the view of history held by the most important early-modern feminist. (shrink)

Margaret Cavendish was an English natural philosopher. Influenced by Hobbes and by ancient Stoicism, she held that the created, natural world is purely material; there are no incorporeal substances that causally affect the world in the course of nature. However, she parts company with Hobbes and sides with the Stoics in rejecting a participate theory of matter. Instead, she holds that matter is a continuum. She rejects the mechanical philosophy's account of the essence of matter as simply extension. For Cavendish, (...) matter is also essentially living, sensing, and rational. She also rejects the mechanical philosophy's explanation of change solely in terms of transference of motion. Her own explanation of change relies upon a notion of "occasional cause." This paper argues that Cavendish's occasional causes are not to be confused with those of Malebranche; hers have some efficient causal powers. It traces the concept of an occasional cause from the ancient Stoics, through Galen, to Renaissance natural philosophers such as J. B. van Helmont, and ultimately to Cavendish and to Descartes. Thus, the aim of the paper is to explicate Cavendish's non-mechanical model of natural change and to show how the key concept in this model, that of "occasional cause," has a long philosophical pedigree. L'anglaise Margaret Cavendish pratique la philosophic naturelle. Sous l'influence de Hobbes et du stoïcisme ancien, elle a soutenu que le monde naturel créé est purement matériel ; dans le cours de la nature, il n'y a pas de substances incorporelles qui affectent causalement le monde. Elle se sépare néanmoins de Hobbes et rejoint les Stoïciens dans son rejet d'une théorie de la matière particulaire. Elle considère au contraire que la matière est un continuum. Elle rejette l'explication de l'essence de la matière comme simple extension, fournie par la philosophic mécaniste. Pour Cavendish, la matière est de plus essentiellement vivante, sentante et rationnelle. Elle rejette aussi l'explication mécaniste du changement en simples termes de transmission de mouvement. Sa propre explication du changement s'appuie sur la notion de cause occasionnelle. Cet article defend l'idée que les causes occasionnelles de Cavendish ne doivent pas être confondues avec celles de Malebranche ; les siennes ont des pouvoirs causaux efficients. Il permet done de suivre l'histoire du concept de cause occasionnelle des anciens Stoïciens, en passant ensuite par Galien jusqu'aux Philosophes de la nature de la Renaissance, comme J. B. van Helmont, et finalement jusqu'à Cavendish et Descartes. Le but de cet article est ainsi de rendre explicite le modèle que Cavendish donne du changement naturel et de montrer comment le concept clé de ce modèle, celui de cause occasionnelle, est le produit d'une longue filiation philosophique. (shrink)

The primary aim of this dissertation is an exegesis of Collingwood's historical science of mind. I take seriously Collingwood's claim that history is for "self-understanding" and treat his philosophy of history as a form of reflective philosophy. In particular, I examine the epistemological basis for Collingwood's claim that mind is an object that changes as it understands itself. ;In Chapter One, I consider the distinction between natural process and historical process as central to an understanding of Collingwood's historical science of (...) mind. I defend Collingwood's attempt to preserve the distinction between historical process and natural process in order to reserve for history its appropriate subject matter---mind. ;In Chapter Two, I consider the epistemological basis for Collingwood's claim that mind changes fundamentally in the historical process. I argue that Collingwood's reading of Anselm's proof of the existence of God is the key to understanding his theory of the priority of "faith" to reason and so to the historical nature of first principles. ;Chapter Three has two parts. In part one, I examine Collingwood's logic of philosophical concepts: the scale of forms. In part two, I argue Collingwood's moral philosophy, found in The New Leviathan and in his lectures on "Goodness, Rightness, Utility" , exemplifies this logic. I conclude that Collingwood's historical study of mind is an attempt to overcome the disjunction between theory and practice caused by the abstract thinking of modern scientific consciousness. ;Chapter Four provides a survey of the scholarship surrounding Collingwood's corpus as a whole. I argue that there have been three waves of Collingwood scholarship. The first is influenced by T. M. Knox's editing of Collingwood's manuscripts and his "radical conversion hypothesis." The second wave of Collingwood scholarship argues for the systematic or thematic unity of Collingwood's philosophy. The third and most recent wave builds on the second. As an example, I discuss Guiseppina D'Oro's suggestion that Collingwood's thought is unified by its overarching concern with critical philosophy. I conclude with the suggestion that Collingwood's thought is unified by an attempt to provide a viable reflective philosophy based on historical consciousness. (shrink)

Background Ensuring individual free and informed decision‐making for research participation is challenging. It is thought that preliminarily informing communities through ‘community sensitization’ procedures may improve individual decision‐making. This study set out to assess the relevance of community sensitization for individual decision‐making in research participation in rural Gambia. Methods This anthropological mixed‐methods study triangulated qualitative methods and quantitative survey methods in the context of an observational study and a clinical trial on malaria carried out by the Medical Research Council Unit Gambia. (...) Results/discussion Although 38.7% of the respondents were present during sensitization sessions, 91.1% of the respondents were inclined to participate in the trial when surveyed after the sensitization and prior to the informed consent process. This difference can be explained by the informal transmission of information within the community after the community sensitization, expectations such as the benefits of participation based on previous research experiences, and the positive reputation of the research institute. Commonly mentioned barriers to participation were blood sampling and the potential disapproval of the household head. Conclusion Community sensitization is effective in providing first‐hand, reliable information to communities as the information is cascaded to those who could not attend the sessions. However, further research is needed to assess how the informal spread of information further shapes people's expectations, how the process engages with existing social relations and hierarchies (e.g. local political power structures; permissions of heads of households) and how this influences or changes individual consent. (shrink)

Augustin est bien connu comme défenseur d’une « théorie privative » du mal. On peut lire, par exemple, dans les Confessions que « le mal n’est que la privation du bien, à la limite du pur néant ». Le problème, cependant, avec les théories privatives du mal est qu’elles ne nous offrent pas, généralement, une explication robuste ni de l’activité du mal, ni de son pouvoir à causer des effets bien réels ; effets desquels l’expérience demande, malgré tout, une explication (...) rationnelle. Or, selon Augustin, la privation seule ne permet pas de rendre compte de toutes les manifestations du mal. L’explication privative du mal est, certes, la plus étudiée par la littérature ; mais elle ne constitue qu’une partie du tableau. Cet article veut souligner quatre moments de l’explication du mal qu’Augustin propose : le mal comme privation ; le mal comme parasite par rapport à l’être ; le mal comme perversion de la volonté ; et finalement, le mal comme conflit d’intérêts. Chacun de ces moments éclaire un type de mal, mais aucun ne permet à lui seul de rendre compte du problème. Pris ensemble, cependant, et gardant leurs différences respectives à l’esprit, la réponse d’Augustin à la question du mal se révèle beaucoup plus sophistiquée et exhaustive qu’on ne voudrait souvent l’admettre lorsqu’on se limite uniquement à la théorie de la privation. | : Augustine is well-known for advocating a ‘privation theory’ of evil. In Confessions, he writes that “evil has no existence except as a privation of good, down to that level which is altogether without being.” The problem with privation theories of evil generally is that they do not provide a robust enough account of the activity and power of evil to cause the very real effects for which experience demands a rational explanation. For Augustine, however, privation alone does not fully account for evil in all of its manifestations. The privation account of evil receives much scholarly treatment, but it is only part of the complete Augustinian picture. This paper outlines four accounts of evil in Augustine : evil as privation, as parasitic on being, as perversion of the will, and as conflict of interest. Each deals with a kind of evil, but none alone provides a complete account. Taken together, however, with their differences in mind, Augustine’s explanation of evil is shown to be much more sophisticated and comprehensive than is often recognised when one limits one’s understanding of Augustine’s conception of evil to the privation theory alone. (shrink)

Dans ce texte où il adopte la posture de l’observateur-participant, l’auteur propose d’abord quelques remarques sur la naissance, mi-octobre 2011, dans la ville de Québec, du mouvement Occupy. Il analyse ensuite certaines des caractéristiques de la période ou Occupons Québec s’est matérialisé dans un campement, entre le 22 octobre et le 22 novem­bre. Finalement, il propose sa vision de l’avenir du mouvement, à Québec et ailleurs, depuis le démantèlement de ce campement.

Subjects and Simulations presents essays focused on suffering and sublimity, representation and subjectivity, and the relation of truth and appearance through engagement with the legacies of Jean Baudrillard and Philippe Lacoue-Labarthe.

Twenty psychologists were interviewed about an ethical dilemma that they had found to be particularly difficult to resolve. In just under half of the cases the dilemma involved a perceived conflict of ethical principles (e.g., the welfare of the consumer vs. the right to privacy). In the other cases, the psychologists were prevented from following an ethically prescribed course of action by some nonethical consideration such as contractural obligation, legal requirement, or the demands of an employer. We discuss the implications (...) of these two sorts of dilemmas for psychological practice and make some suggestions for proactive approaches to ethical problem solving. (shrink)

This article reports on a conversation convened by Quentin Skinner at the invitation of the Editors of The Journal of Political Philosophy and held in Cambridge on 13 February 2001.

Political Freedom By George G. Brenkert Routledge, 1991. Pp. 278. ISBN 0–415–03372–1. £35 hbk.Wittgenstein: A Bibliographical Guide By Guido Frongia and Brian McGuinness Basil Blackwell, 1990. Pp. x + 438. ISBN 00631–13765–3. £60.00.Metaphysics By Peter van Inwagen Oxford University Press, 1993. Pp. xiii + 222. ISBN 0–19–8751400. £11.95 pbk.The Nature of Moral Thinking By Francis Snare Routledge, 1992. Pp. 187. ISBN 0–415–04709–9. £9.99 pbk.Filosofía analitica hoy: Encuentro de tradiciones Edited by Mercedes Torrevejano Servicio de Publications Universidade de Santiago de Compostela, (...) 1991. Pp. 284. ISBN 84–7191–722‐X. $15.5 pbk.The Puzzle of Experience By J.J. Valberg Clarendon Press, 1992. Pp. 227. ISBN 0–19–824291–3. £25.Religion and Philosophy Edited by Martin Warner Royal Institute of Philosophy Supplement: 31 Cambridge University Press, 1992. Pp. vi + 155. ISBN 0–521–42951‐X. £10.95 pbk.The Uses of Philosophy By Mary Warnock Blackwell, 1992. Pp. 256. ISBN 0–631–18038–9. £35.00 hbk. £11.95 pbk.The Disappearance of Time: Kurt Godel and the Idealistic Tradition in Philosophy By Palle Yourgrau Cambridge University Press, 1991. Pp. x + 182. ISBN 0–521–41012–6. £27.50. (shrink)

Proponents of the dominant contemporary model of corporate governance maintain that the shareholder is the primary constituent of the firm. The responsibility for managerial decision makers in this governance system is to maximize shareholder wealth. Neoclassical economists ethically justify this objective with their interpretation of Adam Smith's notion of the Invisible Hand. Using a famous quotation from The Wealth of Nations, they interpret the Invisible Hand as Smith's (An Inquiry into the Nature and Causes of the Wealth of Nations, Methuen (...) & Co., London) assertion that market participants, in pursuing their own self-interests without regard to the interests of others, will collectively provide the optimal economic benefit to society. We argue that the traditional interpretation of Smith is too narrow and potentially harmful to society. In order to fully understand Smith's notion of the influence of the Invisible Hand on human behavior, one must also consider The Theory of Moral Sentiments. In that work, Smith (The Theory of Moral Sentiments, A. Millar, London) portrays the pursuit of self-interest as only one of several potential motivations for human action. He also acknowledged the existence of a “sympathy principle,” which refers to the ability and propensity of human beings to consider the interests of others. Heilbroner (The Essential Adam Smith, W.W. Norton, New York, p. 59) suggests that Smith's sympathy principle allows one to “determine the appropriate degree of self-interest, the proper display of benevolence, the desirable strictness of justice.” In fact, Smith indicates that (1) a society whose members pursue self-interest without a sense of justice will eventually collapse; (2) a society whose members pursue self-interest checked by their sense of justice alone will survive; (3) a society whose members pursue self-interest, justice, and the interests of others will flourish. Since a more complete reading of Smith indicates that human beings, in considering their own interests, also reflexively consider the interests of others when making decisions, then the traditional corporate governance model appears to be lacking. A broader, multiple stakeholder approach to corporate governance that considers the interests of other constituencies may be more consistent with Smith's views. In particular, Smith's sympathy principle provides a theoretical foundation for a shift away from the narrow, yet dominant, shareholder-based corporate governance model and toward multiple stakeholder models of corporate governance [e.g., Business and Society: A Strategic Approach to Corporate Citizenship, Houghton Mifflin, Boston, MA] and internal decision-making [e.g., Sloan Management Review 38, (1997) 25–37]. (shrink)

Next SectionFollowing the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O’Neill in recommending a principled (...) version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring “patient autonomy” when it is, in fact, abrogation of their duty as doctors. (shrink)

Introducing Applied Ethics Edited by Brenda Almond, Blackwell, 1995. Pp. 375. ISBN 0-631-19389-8. 45.00 (hbk), 14.99 (pbk). Environmental Ethics Edited by Robert Elliot, Oxford University Press, 1995. Pp. 255. ISBN 9-19-875144-3. 9.95 (pbk) Medicine and Moral Reasoning Edited by K.W.M. Fulford, Grant Gillett and Janet Martin Soskice Cambridge University Press, 1994. Pp. 207. ISBN 0-521-45325-9 37.50 (hbk), 12.95 (pbk). Enlightenment and Religion. Rational Dissent in Eighteenth-century Britain Edited by Knud Haakonssen, Cambridge University Press, 1996. Pp. xii + 348. ISBN 0-521-56060-8. (...) 40.00. Dialettica, Arte e Societ : Saggio su Theodor W. Adorno By Giacomo Rinaldi, Quattroventi, Urbino, 1994. Pp. 205. L. 30,000. Relevance: Communication and Cognition, new revised edition, By Dan Sperber and Deirdre Wilson, Blackwell, 1995. Pp. 326. ISBN 0-631-19878-4. 15.99. Autobiographical Reflections By Eric Voegelin (Edited, with Introduction, by Ellis Sandoz), Louisiana State University Press, 1996. Pp. 131. ISBN 0807120766 $10.95. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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Önsöz 6 Yenilenmiş 2. baskıya önsöz 7 İçindekiler 8 Kısaltmalar 11 Giriş 13 BİRİNCİ BÖLÜM 1. AHLAK VE BASIN AHLAKI ALANINDA OLUŞTURULAN KURUMLAR BAĞLAMINDA GAZETECİNİN ETİK KİMLİĞİ 19 1.1. Ahlak Kavramı 20 1.1.1. Bireyci Ahlak 24 1.1.2. Toplumcu Ahlak 27 1.1.3. Sofist Ahlak Anlayışı 31 1.1.4. Ödev Ahlakı 32 1.1.5. Yararcı Ahlak (Utilitarianism) 35 1.2. Etik Kavramı 38 1.2.1. Etik Değer 40 1.3. Mesleki Etik 43 1.3.1. Basında Etik 46 1.3.2. Din ve Hukuk Yasaları Bağlamında Basında Etik İlkeler 51 1.3.3. (...) Basında Etik Değerlerin Saptanması 54 1.4. Basın Ahlak Kuralları ve Basında Özdenetim 59 1.4.1. Basın Ahlak Kurallarının Kaynakları 65 1.4.2. Basında Özdenetimin Yararlan 67 1.5. Basın Ahlak Kurallarının Uygulanması 68 1.5.1. Gönüllü (ya da İsteğe Bağlı) Kuruluşlar 71 1.5.1.1. Gönüllü Kuruluşların Basın Özgürlüğünün Korunması Açısından Yararları 73 1.5.1.2. Gönüllü Kuruluşların Yaptırım Uygulama Açısından Yetersizlikleri 74 1.5.2. Yasaya Dayanan Zorunlu Kuruluşlar 76 1.5.2.1. Yasaya Dayanan Zorunlu Kuruluşların Yaptırım Uygulama Açısından Üstün Yanlan 77 1.5.2.2. Yasaya Dayanan Zorunlu Kuruluşların Basın Özgürlüğü Açısından Sakıncaları 78 İKİNCİ BÖLÜM 2. BASIN KURAMLARI BAĞLAMINDA GAZETECİNİN ETİK KİMLİĞİ.. 82 2.1. Basında Liberal Kuramın Ortaya Çıkışını Hazırlayan Nedenler.... 83 2.1.1. Basında Liberal Kuramın Dayandığı Düşünsel Kaynaklar 88 2.1.2. Basında Liberal Kurama 20. Yüzyılda Getirilen Eleştiriler 99 2.2. Otoriter ve Totaliter Rejimlerin Basına Yaklaşımları Bağlamında Basında Etik Anlayışın Tartışılması 100 2.3. Toplumsal Sorumluluk Kuramının Ortaya Çıkışı 111 2.3.1. Toplumsal Sorumluluk Kuramının Basına Yönelttiği Eleştirel Yaklaşım 117 2.3.2. Toplumsal Sorumluluk Kuramına Göre Basının Yerine Getirmesi Gereken Görevler 119 2.4. Basında Liberal Kuram İle Toplumsal Sorumluluk Kuramının Karşılaştırılması 122 2.4.1. Liberal ve Toplumsal Sorumluluk Kuramları Temelinde Farklılaşan Özgürlük Anlayışı 127 ÜÇÜNCÜ BÖLÜM 3. TÜRKİYE’DE BASIN AHLAKI OLUŞTURULMASI ÇALIŞMALARININ TARİHÇESİ BAĞLAMINDA GAZETECİNİN ETİK KİMLİĞI 131 3.1. Cumhuriyet Öncesi Dönemde Türk Basınında Basın Ahlakı İle İlgili Yasal Girişimler 136 3.1.1. Basım Etkinliği İle İlgili İlk Düzenlemeler ve Matbaalar Nizamnamesi 136 3.1.2. 1864 Tarihli Matbuat Nizamnamesi 137 3.1.3. Ali Kararname 140 3.1.4. Birinci Meşrutiyet ve Kanunu Esasi’nin Basın Etkinliği Açısından Önemi 141 3.1.5. İkinci Meşrutiyet ve 1909 Basın Kanunu 143 3.1.6. Osmanlı İmparatorluğunda Gazetecilerin İlk Örgütlenme Çabalan 147 3.2. Cumhuriyet Sonrası Dönemde Türk Basınını Etkileyen Yasal Düzenlemelerle Basın Ahlakı İle İgili Girişim ve Gelişmeler 148 3.2.1. Birinci Türk Basın Kongresi (25 Mayıs 1935) 152 3.2.2. Basın Birliği 155 3.2.2.1. Basın Birliği’nin Eleştirisi 158 3.2.3. Gazeteciler Cemiyeti’nin Kuruluşu ve Amaçları 161 3.2.4. İkinci Dünya Savaşı Sonrası Türkiye’nin Siyasal Durumu ve DP’nin Kuruluşu 165 3.2.5. 1950-1960 Arasında DP-Basın İlişkileri ve Basın Şeref Divanı’nın Ortaya Çıkış Nedenlerini Hazırlayan Koşullar 170 3.2.5.1. Basın Şeref Divanı’nın Kuruluşu 175 3.2.5.2. Basın Şeref Divanı’nda Yer Alan Kurumların Temsilcileri ve Görevleri 177 3.2.5.3. Basın Şeref Divanı’nın Başarısızlık Nedenleri 178 3.2.6. Basın Şeref Divanı Sonrasında Basın Ahlakı İle İlgili Girişimler 183 3.2.6.1. Basın Konseyi’nin Kuruluşu 196 3.2.6.1.1. Basın Konseyi’ nin Örgütlenme ve Çalışma Biçimi 199 3.2.6.2. Ombudsman (Okur Temsilcisi) 204 Sonuç 212 Ekler 221 Kaynakça 254. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:THE HOLINESS OF THE CHURCH IN LUMEN GENTIUM HE NOTION OF the Church as a smner, not often spoken of in Catholic theology of other times, has become quite common in recent years.1 Among the questions of a pastoral and theological nature that have given rise to it, the following may be noted: a) The ecumenical question. Many would wish the Church as such to accuse herself of sin, (...) as a means towards reconciliation. b) The idea borrowed from traditional Protestant theology of a certain compatibility between sin and holiness,2 the simul sanctus et pecca.tor of Luther. c) The notion of evil as a mere deficiency properly belonging to a given stage of development of the Cosmos; such is t:he understanding of Teilhard de Chardin.3 1 The mark of holiness has been applied to the Church more than any of the other three, from the very beginning of Christian times; Baptismal creeds are a clear witness to this. 2 Cf. n. 66 on Kiing. 3 "What is the inevitable complement of anything which results from such a process (an evolutive one) but having to pay the price of some losses? Lack of harmony and physical decomposition in the Pre-Vivant, suffering in the Vivant, sin in the dominion of Freedom..." (Comment je crois) ; "We must say that God, in spite of his power, cannot unite any creature to himself without necessarily entering into battle with Evil, because Evil appears inevitably with the first atom of being which creation 'releases' into existence. Creation and sinlessness are terms as much at loggerheads with divine Power and Wisdom as creature with unicity" (Notes sur les modes de l'ac-tion divine dans l'Universe-yr. 1920). Undoubtedly, sin in its effects is a lack of what man (and creation dependent on him) should have, but the point that Teilhard misses is that the 'deficiency' due to sin (unlike other imperfections found in creation) is due to the responsible action of human beings, and has no inevitability about it. 673 674 PAUL o'cALLAGHAN d) An increased awareness of the social dimension of sm. Undoubtedly sin has numerous (though divisive) social efects.4 But it would be incorrect to affirm that sin is an entirely social phenomenon.5 An application of such a notion to the Church would be an easy next stage. e) A certain undoing of the constrast between the ' Kingdom of God' and the 'world ',6 to the detriment, let it be said, both of the eternity and definitiveness of the former, and the progressive sanctification of the latter. The Church then, not belonging so intimately to the All-Holy, may be more easily looked upon as a sinner. f) Another factor has been the positive humanizing em4 In the Apostolic Exhortation Reeonciliatio et Paenitentia (English translation ; London: CTS, 1984) where Pope John Paul II ga.thers together the findings of the 1983 Synod of Bishops, many acceptable ways of understanding ' social sin' are explained: as mystically ' dragging down ' the whole world; in the sense that it goes in the detriment of our neighbour; in the relationships between various human communities (n.16: p. 51-54). 5 For example, the following words of G. Gutierrez: "No se trata, en la perspectiva liberadora, de! pecado como realidad individual, privada e intimista, afirmada justo lo necesario para necesitar una redenci6n 'espiritual ', que no cuestiona el orclen en que vivimos. Se trata del pecado como un hecho social, hist6rico... El pecatlo se da en estructures opresoras en la explotaci6n del hombre por el hombre, en la dominaci6n y esclavitud de los pueblos, razas y clases sociales. El pecado surge, entonces, como la alienaci6n fundamental, como la rniz de una situaci6n de injusticia y explotaci6n" Teofogia de la liberaci6n (Salamana: Sigueme, 1972), p. 236-237. And in a more recent work of his: " pecar es optar por la opresi6n y contra la liberaci6n " La fuerza hist6rioa de los pobres, (Lima, 1979) p. 19. As J. M. IbaiiezLanglois points out, this statement would be fine if it were to say 'to opt for oppression and against liberation is sinful', that is one more among many possible sins: Teologia de la liberacion... (shrink)

Towards Justice and Virtue challenges the rivalry between those who advocate only abstract, universal principles of justice and those who commend only the particularities of virtuous lives. Onora O'Neill traces this impasse to defects in underlying conceptions of reasoning about action. She proposes and vindicates a modest account of ethical reasoning and a reasoned way of answering the question 'who counts?', then uses these to construct linked accounts of principles by which we can move towards just institutions and virtuous (...) lives. (shrink)

Knowledge aims to fit the world, and action to change it. In this collection of essays, Onora O'Neill explores the relationship between these concepts and shows that principles are not enough for ethical thought or action: we also need to understand how practical judgement identifies ways of enacting them and of changing the way things are. Both ethical and technical judgement are supported, she contends, by bringing to bear multiple considerations, ranging from ethical principles to real-world constraints, and while (...) we will never find practical algorithms - let alone ethical algorithms - that resolve moral and political issues, good practical judgement can bring abstract principles to bear in situations that call for action. Her essays thus challenge claims that all inquiry must use either the empirical methods of scientific inquiry or the interpretive methods of the humanities. They will appeal to a range of readers in moral and political philosophy. (shrink)

Kant's ethics, like others, has unavoidable anthropocentric starting points: only humans, or other 'rational natures', can hold obligations. Seemingly this should not make speciesist conclusions unavoidable: might not rational natures have obligations to the non-rational? However, Kant's argument for the unconditional value of rational natures cannot readily be extended to show that all non-human animals have unconditional value, or rights. Nevertheless Kant's speciesism is not thoroughgoing. He does not view non-rational animals as mere items for use. He allows for indirect (...) duties 'with regard to' them which afford welfare but not rights, and can allow for indirect duties 'with regard to' abstract and dispersed aspects of nature, such as biodiversity, species and habitats. (shrink)

Review of John O'Neill, Alan Holland and Andrew Light, Environmental Values (London: Routledge, 2007 ).

In lieu of an abstract, here is a brief excerpt of the content:AQUINAS AS POSTLIBERAL THEOWGIAN BRUCE D. MARSHALL St. Olaf Oollege Northfield, Minnesota, 1JHE PURPOSE of this essay is to discuss the relation between Thomas Aquinas' account of religious and heological truth and a " posrtliberal " one sruch rus that sketched in George Lindbeck's The Nature of Doctrine. Most reviewers assume that Lindbeck's.app:voach is on this point incompatible with the mainstream of the tmdition, and Colman O'Neill, writing (...) :in The Thomist symposium on Lindbeck's book, thinks it oontradicts Aquinas in particular. This paper presents the case to the contr:ary. Afte'I." outlining O'Neill's problem, it argues thart he mis11eads Lindbeck 'and,.at greater length, that Aquinas''S views on t:ruth :are, as Lindbeck affirms, compatible with postliberal emphases. I O'Neill's basic problem with Lindbeck's: "cultural linguistic " understanding of truth is thwt Lindbeck " would clearly have us puTify [Christi.an] language by ridding it of extra-linguistic accretions-in particular the intrusion of reference to objective reality. In the end the only thing that matters is scriptural discourse verified by action." 1 Lindbeck may not intend this " purification," 2 but whatever the intention, his 1 Colman E. O'Neill, "The Rule Theory of Doctrine and Propositional Truth," The Thomist 49 (1985), p. 422. 2 So Lindbeck writes: "The great strength of a cognitive-propositional theory of religion is that •.. it admits the possibility of [ontological] truth claims, and a crucial theological challenge to a cultural-linguistic approach is whether it also can do so." The Nature of Doctrine: Religion a,nd Theology in a, Postlibera,l Age (hereafter ND), (Philadelphia, 1984), pp. 63-4. 353 854 BRUCE D. MARSHALL view of •religious truth entails a raidical rejection of 1any claim that Christian beliefs!are onto1ogioally true, in other words, tha;t they rre£er or correspond •to reality. The reruson rllor this putative entailment lies in Lindbeck's manifest oontention (to be explained below) that truth claims in any l'eligion, including Christianity, are subject to 1a twofold criterion of coherence: they must fit wirth the wider linguistic (especially scriptural) paradigms of the 11eligion, and also with a range of practices appropriate to the belief the truth of which is being claimed. But, says O'Neill, Christian beliefs are not true because they cohere with anything, they are true (like all true propositions) "because of their reference to the real." a By introducing ;an irreducible element of coherence into his interpl'etation of Christian truth claims, Lindbeck inevitably " attaches to the ·term ' propositional truth '.a purely pra.gmatic signification," so that " a quite precise philosophical option has: been ma.de in faV'or of the moral or pragmatic definition of truth." 4 O'NeiiH'is point is that " ontological " or " propositional " truth has here been equa,ted with nothing more than the con£ormity of one's life to the patterns narrated in the!biblical story (O'Nei1l's "·scriptural dis-·oourse verified by 1action "), •such tha;t " no claims to objective truth" need be made for the story or any a.ssociated beliefs.5 Tihis, O'Neill alleges, is ·a " novel definition of ontological truth." 6 We ought to!'eject this novelty in favor of the under- •standing of Christian beliefs and their truth articulated by 'Ihomas Aquinas, whel"e it is firmly maintained against " the moral or pmgmatic definition of truth " that " propositions are true because of their I"eference ·to.the real." In order to undevstand the issues ·raised by O'Neill's criticism, it is important to bear in mind the distinction-often made but often overlooked ais well-between truth :and justis O'Neill, "Propositional Truth," p. 430. 4 O'Neill, "Propositional Truth," p. 429. 5 O'Neill," Propositional Truth," p. 420. 6 O'Neill, "Propositional Truth," p. 431. AQUINAS AS POSTLIBERAL THEOLOGIAN 355 fica.tion. The very isisue of what it means to say that propositions 1 are true can be distinguished from the issue of ho,w one justifies, warrants, or tests the truth of propositions. So, for example, one might maintain that in regard to propositions, "true" should be defined as "oorresponds to reality," or perhaps "fitly expresses experience," or perhaps "is... (shrink)