We will argue here that after more than 30 years of talk, theory, and clinical practice, we bioethicists still know far too little about what patients, subjects, and healthcare professionals are up to, morally. Bioethics is still near the beginning in grasping what it means to understand, much less to honor fully, the moral power and perspicacity of those bioethics is designed to serve. This is, of course, a serious charge, but one we will endeavor to show has merit. However, (...) we want to be clear from the start that we do not gainsay the important work that has been done in and through the influence of bioethics, both as a field of practical engagement and as a cultural movement, in improving how healthcare is delivered and how human subjects are treated. Thirty or 40 years—depending on how one marks the beginning point—is a very short time, and it is hard to imagine that wholesale changes, all of them in the right direction, could be the outcome for a field this young. Hence, we do not intend the title, “One Cheer for Bioethics,” as a wholesale indictment, but as an indication that there is a great deal of work yet to be done, and that following the currently dominant direction of the field is not likely to get us there. Our aim is to indicate just where future work should be focused, and to do so we will need to be critical of some of the preoccupations of the last three decades. a. (shrink)

The multiple emergencies of global heating require bioethicists to embrace the dormant, comprehensive bioethics legacy of Van Rensselaer Potter, moving beyond the current narrower focus of the field on medicine and health care. We recommend readings that expand the core literature of bioethics to address key environmental issues. These are Jessica Pierce and Andrew Jameton's The Ethics of Environmentally Responsible Health Care; Dale Jamieson's Reason in a Dark Time; and David Wallace‐Well's The Uninhabitable Earth. Because efforts to mitigate climate (...) disasters are likely to be only partially successful, we also recommend the teachings of late Roman Stoicism and core texts of Buddhism, which provide ethical wisdom likely to be needed in the multiple crises of the Anthropocene. (shrink)

In a recent article in The Journal of Clinical Ethics, David Wendler argues that worries about the therapeutic misconception (TM) are not only misconceived, but detract from the larger agenda of a proper informed consent for subjects involved in clinical research. By contrast, we argue that Wendler mischaracterizes those who support TM research, and that his arguments are fragmentary, often illogical, and neglect a critical difference between clinical care and clinical research. A clear explanation about the chief aim of (...) research is, in fact, what gives the other elements in a consent process their meaning. We argue that informed consent must be both trial-specific and context-sensitive, and that concern about the TM is needed now more than ever. (shrink)

This volume considers the confluence of world history and historical materialism, with the following guiding question in mind: given developments in the field of historical materialism concerned with the intersection of race, gender, labour, and class, why is it that within the field of World History, historical materialism has been marginalized, precisely as World History orients toward transnational socio-cultural phenomenon, micro-studies, or global histories of networks? Answering this question requires thinking, in an inter-related manner, about both the development of World (...) History as a discipline, and the place of economic determinism in historical materialism. This book takes the position that historical materialism (as applied to the field of World History) needs to be more open to the methodological diversity of the materialist tradition and to refuse narrowly deterministic frameworks that have led to marginalization of materialist cultural analysis in studies of global capitalism. At the same time, World History needs to be more self-critical of the methodological diversity it has welcomed through a largely inclusionary framework that allows the material to be considered separately from cultural, social, and intellectual dimensions of global processes. (shrink)

Perched on the ramparts of Volterra last July, I gaze over i dolci colli toscani, the sweet hills of Tuscany, drenched in summer sun. Warm, content and at peace, I am bemused at how much at home I feel in this strange land. I have felt this way since 1991 when I returned for the first time to la bell' Italia thirty-seven years after having lived in Rome as a young child in a Foreign Service family. In its sensuous beauty (...) and riotous disorder, Rome was stunning. My wife Eileen and I explored old childhood haunts, including the Embassy apartment residences on viale villa Graziole where my family had lived for four years in Rome—two consecutive two-year posts—in the 1950s. Memory cells exploding, I was assailed by vivid images from childhood. Once when I was five or six, my brother David and I accompanied our housemaid Marcella to her simple country home and joined villagers in the fields as they all turned out—men, women, and children—to harvest the bean crop. As dusk set in, fires were lit, simple musical instruments appeared with the wine, and the feasting and dancing began. Bonfires were soon aglow for miles up and down the sweet rolling hills. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors' Introduction to the Special Issue on the Translational Work of BioethicsElizabeth Lanphier and Larry R. ChurchillRecent essays in Perspectives and Biology and Medicine, including "Can Clinical Ethics Survive Climate Change" by Andrew Jameton and Jessica Pierce and "Ethical Maxims for a Marginally Inhabitable Planet" by David Schenck and Larry R. Churchill, both appearing in the Autumn 2021 issue, inspired conversations between us, among our colleagues, and (...) with various contributors to this symposium. We asked of ourselves and each other: where can, should, or must bioethics as a field go to make what bioethicists know and publish about in the academic literature relevant to public policy decisions, health and technological innovation, and a general public? In other words, where do we, practically speaking, go with our bioethical insights and discoveries to make a tangible impact on issues like climate change—though that is only one of the various topics that the authors in this symposium tackle.This translational work of connecting scholarly innovation back to overt practical innovation is often peripheral to academic bioethics. It is not the work the academy typically recognizes in its credit system. Yet this translational work is becoming a critical, central duty of bioethics for the 21st century, while the kinds of work the academy most valorizes may be the least important at this time. In particular, the need for translational initiatives is increasingly evident as pandemics linger into a new normal, the long history and ongoing impacts of racism become even more evident at institutional levels, and the devastating health implications of global warming emerge. [End Page 515]Bioethicists function in privileged proximity to the deleterious effects of failed health and social policy, as well the interplay between seemingly personal health choices, such as those related to diet or lifestyle, and inequitable conditions that impact the options available to individuals and groups. We are increasingly distressed by what we see from this privileged window into health. The COVID-19 pandemic has made preexisting social and policy inequities impacting health impossible to ignore. At the same time, the patterns of carbon pollution portend health crises of unprecedent severity and magnitude in the near future—and will likely deepen inequities and disparities already occurring between those most contributing to, and those most harmed by, climate change.As a field, bioethics has, since its start, been at the intersection of theory and practice. But it is not sufficient for the field to reside passively at this crossroads. The field must be constantly innovating new byways and highways, new offshoots from existing pathways and connector roads between them, that build out both the theory and practice of bioethics in a mutually innovative relationship to each other. Bioethics does not make sense without attention to the real-world practices and the lived realities of health and care. The practical engagement is what deepens and enriches theory, in ways that are more responsive to the real world in which bioethicists toil. But it also is not enough to merely contribute to the body of bioethics scholarship. The translational bioethics we envision is also about using novel theories and concepts to actively shape practices and realities; it is a bioethics in which theory and practices mutually influence each other, each reaching out to generate and change the other.This collection of essays, drawn from a diverse number of scholars, offers several promising paths forward. The essays were written in the spring of 2022, two years into the COVID-19 pandemic, two years after the murder of George Floyd and international attention to the movement for Black lives, and for the most part in the weeks just prior to a set of US Supreme Court decisions with enormous impacts on health, including the June 24 Dobbs v. Jackson Women's Health Organization and the June 30 West Virginia v. EPA decisions.The authors are diverse in age, spheres of work, discipline, sex, race, and ethnicity. They expand our vision for what bioethics can and should be. While we have grouped the essays by subject matter, most of the pieces speak to the field as a whole and invite cross-fertilization. We hope readers will find new ideas, old ideas... (shrink)

The “life phenomenology” theme of the 35th International Human Science Research Conference challenged participants to consider pressing questions of life and of living with others of our own and other-than-human kinds. The theme was addressed by keynote speakers Maxine Sheets-Johnstone, Ralph Acampora and David Abram who invoked a motile, affective and linguistic awareness of how we might dwell actively and ethically amongst human communities and with the many life forms we encounter in the wider, wilder world we have in (...) common. Conference participants were provoked to consider the following questions: “How might phenomenology have us recognize a primacy of movement and bring us in touch with the motions and gestures of the multiple lifeworlds of daily living? What worlds from ecology to technology privilege certain animations? What are the affects and effects of an enhanced phenomenological sensitivity? What senses, feelings, emotions and moods of self-affirmation and responsiveness to others sustain us in our daily lives? And to what extent might the descriptive, invocative, provocative language of phenomenology infuse the human sciences and engender a language for speaking directly of life?”. (shrink)

This article analyzes the shift from emotion to affect in Caryl Churchill’s writing for the theatre, a process which becomes prominent in the later seventies and culminates in the production of A Mouthful of Birds, a project designed jointly with the choreographer David Lan. The effects of the transformation remain traceable in The Skriker, a complex play taking several years to complete. It is argued that there is a tangible and logical correlation between Churchill’s dismantling of the (...) representational apparatus associated with the tradition of institutional theatre—a process which involves, primarily, a dissolution of its artificially constructed, docile bodies into orificial ones—and her withdrawal from the use of emotional expression in favour of the affective. In the following examination, emotions are conceived as interpretative acts modelled on cognition and mediated through representations while the intensity of affect remains unstructured. Often revealed through violence, pain and suffering, affect enables the theatre to venture into the pre-cognitive and thus beyond the tradition of liberal subject formation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 341 if you started asking them questions about possible worlds. But Bradley's contribution is to have given us a painstaking and thorough reading of some extremely tightly wound and important aspects of the Tractatus, to have brought that text into direct contaot with con· temporary issues, and to have made progress toward showing that how· ever remarkable we thought the Tractatus was, it is still more remarkable (...) than that. JOHN CHURCHILL Hendrix College Conway, Arkansas The Human Person: Animal and Spirit. By DAVID BRAINE. Notre Dame, Indiana: University of Notre Dame Press, 1992. Pp. xxv + 555. $32.95 (cloth). Any study in philosophical anthropology that rejects both mate· rialism and dualism, and seeks to set forth a " holistic " alternative, may be met in many quarters with some skepticism today-especially if that alternative seeks to accommodate itself to religious teaching regarding the soul's continued existence after death. For, it will be asked, on the one hand, how can it deny that the esse of the human being ceases at death (538) without affirming some sort of dualism? On the other hand, unless it is some sort of soft-headed New Age philosophy (which this most certainly is not), how can it sustain its claim to "holism" while rejecting the monolithic materialism of those whom Walker Percy once described as our "brain engineers, neuropharmacologists, and chemists of the synapses "? The challenge is " how to produce an account which allows the human person to continue exist· ing after death, and even to have body restored to it, while remaining completely faithful to the insight that it belongs to human nature to be bodily," and, at the same time, to " avoid reerecting the soul into a complete substance" (xix). The peculiar obstacle faced by such a project is the pervasive proclivity towards reductionism in modern accounts of human nature stemming from the impress of both materialism and dualism. Both analyze the human person into an aggregate of parts in certain relations, the behavior of the whole being ·the result of the interactions of these parts. " In all this the materialist has exactly the same picture as the dualist. Indeed, unless the mental can first be represented as inner, logically independent of anything in the ' outer man ' and the ' world,' there is no way in which it can be identified with a brain-process or 342 BOOK REVIEWS state" (3). So whether one thinks of the mind as an independent en· tity (as in dualism), or not (as in materialism), the body is left to be accounted for by the brain engineers and their aggregates of physi· ological, anatomical, neurological, and chemical causes. And since materialism involves no complicating questions about causal interaction between the physical and the mental (as in dualism), it is usually preferred on grounds of its simplicity-all causation being subsumed under the physical. In this ambitious tome, David Braine, a philosopher at the University of Aberdeen, offers a thoroughgoing analysis and critique of such views, whereby he undertakes to overturn these ways of viewing human nature and to offer a holistic alternative. He sets forth a framework for understanding things like perceiving, doing, and speaking as irreducibly the acts of the psychosomatically integrated beings to which we normally attribute them-an understanding that conforms to the ordinary experience of such acts in ourselves and in others. He seeks to expose how materialist arguments repeat the mistakes of the dualists by reducing human beings (and other animals) to their aggregate parts, segmented sequences, and their interrelations. He takes issue with the arguments of recent analytical philosophers (such as Davidson and Dummett) in detail, and sets forth a holistic alternative-both with re· spect to the human person as " animal" and as " spirit." As to the human as "animal," Braine notes, accordingly, that "it is the bodily animal being as such, not just its mind, which is an ' I ', a ' he or she ', a focalized subject in relation to the world. The primary reason why human behaviour cannot be simulated by a computer does not lie in things special to human beings, but in the fact that this fo. calized psychophysical structure which they share with the... (shrink)

Book reviewed in this article: Gays/Justice by Richard Mohr. Death:Beyond Whole‐Brain Criteria, edited by Richard M. Zaner. The Contraceptive Ethos:Reproductive Rights and Responsibilities Edited by S.F. Spicker, W.B. Bondeson, H.T. Englehardt, Jr., Dordrecht, Holland:D. Reidel. Made to Order:The Myth of Reproductive and Genetic Progress Edited by Patricial Spallone and Deborah Lynn Steinberg. Reproductive Technologies:Gender, Motherhood and Medicine Edited by Michele Stanworth. For the Patient's Good:The Restoration of Beneficence in Health Care by Edmund D. Pellegrino and David C. Thomasma. ‘The (...) Physician as Captain of the Ship:A Critical Reappraisal’, Philosophy and Medicine, vol. 29. Edited by Nancy M.P. King, Larry R. Churchill, and Alan W. Cross. (shrink)

Healers: Extraordinary Clinicians at Work, by David Schenck and Larry R. Churchill, and What Patients Teach: The Everyday Ethics of Health Care, by Churchill, Joseph B. Fanning, and Schenck are both important and thought‐inspiring books. For the first, Schenck and Churchill recruited fifty practitioners, mostly physicians but some clinicians who practice alternative therapies, “identified by their peers as excellent healers,” and interviewed them to find out what they did to establish a good relationship with their patients. (...) The results of their interviews and how they wrote their book makes this the best and most concrete understanding of a necessary step to healing that I have read. What Patients Teach examines the patients’ perspective about forming relationships with their clinicians. The patients’ clinicians were asked to nominate patients to be interviewed to help answer the question. This volume, while important, is less extraordinary than the first because we hear less what the patients want to say and more what the authors want to tell us. That aside, taken together, these two books are a major advance in the literature of healing. (shrink)

_Slow Cures and Bad Philosophers_ uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is not to (...) examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine. _Contributors._ Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy. (shrink)

In a 2015 Hastings Center Report essay, Robert Truog and his coauthors argued that the clinical ethics portion of medical education should cast both a wider and a finer net than is sometimes realized. Many of the morally important moments in patient care are missed if we teach only general moral principles, they held; we also need to give attention to an indefinite stream of “microethical” decisions in everyday clinical practice. In the current issue, Truog plays out a similar theme (...) as he discusses the moral significance of touching a patient and asks how artificial intelligence and other emerging technologies may change this ancient part of the physician‐patient relationship. And one of the articles in this issue examines the significance of clinicians’ relationships with other clinicians. Donna Chen and colleagues propose, in effect, that “teamwork” has become part of the ethics of everyday clinical practice—a new addition to what Larry Churchill and David Schenck called the “healing skills.”. (shrink)

Much has been written about the importance of narrative in teaching ethics and humanities to medical students and residents, as well as the value of narratives in clinical care. Relatively little has been said about the essential role of narrative in bioethics consultations. For most consults, the interpretation of narratives is the central moral feature, and the ethics consultant is inevitably one of the narrators. In a recent consult in which I participated, at least three narratives were in play. The (...) medical record itself was a narrative, or really, a variety of narratives. A second distinct narrative was the story of why this case had come to be categorized as an ethical concern for the medical team. A third narrative was the tentative sketch running through my mind as a consultant‐partly factual, partly anticipatory and conjectural, inevitably personal‐about what was going on here. (shrink)

The Covid‐19 pandemic has concentrated bioethics attention on the “lifeboat ethics” of rationing and fair allocation of scarce medical resources, such as testing, intensive care unit beds, and ventilators. This focus drives ethics resources away from persistent and systemic problems—in particular, the structural injustices that give rise to health disparities affecting disadvantaged communities of color. Bioethics, long allied with academic medicine and highly attentive to individual decision‐making, has largely neglected its responsibility to address these difficult “upstream” issues. It is time (...) to broaden our teaching, research, and practice to match the breadth of the field in order to help address these significant societal inequities and unmet health needs. (shrink)

Book reviewed in this article: The Needs of Strangers. By Michael Ignatieff. The Health Economy. By Victor Fuchs. Just Health Care. By Norman Daniels.

The ultimate challenge for psychology as a human science inheres in accessing the experience of the other. In general, the field of psychology has perpetuated the epistemological dualism of distinguishing between the realm accessible by external perception and the realm accessible by inner perception, and hence between the subjective and the objective , regarding the "first person" perspective as a legitimate means of access only to one's own private experience, while insisting that all others' experience must be observed from a (...) neutral "third person" perspective. By reflecting on his participant-observational encounters with the animal other of the Bonobo, the author attempts to demonstrate in this paper the possibility of a third approach between the antinomy of methodological subjectivism and methodological objectivism as a way out of the dilemmas posed by epistemological dualism. The alternative proposed is the "second person" framework of observation, which, by invoking empathic seeing as its means of accessing the private space of the other and creating the space of the "in between", allows for intersubjective engagement in an experiential gestalt consisting of "myself and the other", and offers the possibility of testing one's ‘own' experience of an intersubjective moment in dialogue with the other. In so far as it infers the focusing of consciousness on embodied experience and expression, and the synthesis of receptive and proprioceptive consciousness in "experiaction" , the "second person" perspective restores inner reality to the realm of the observable, and thus reclaims observation as the method of psychology, and behaviour as its subject matter. The notion of empathy and intuition as a reliable and valid mode of access to the psychological life of others is substantiated theoretically with reference to inter alia Husserl's concepts of "coupling" and "co-constitution", Merleau-Ponty's notions of "inter-corporeality" or "carnal intersubjectivity" and of "the intertwining and the chiasm" of the "Ineinander" as constitutive of the "flesh of the world", Laing's postulation of the possibility of "interexperience", and the sense of union with the object of perception implied by Scheler's term "Einsfühlung" as the essence of intersubjective encounter. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:336 BOOK REVIEWS The Nature of All Being: A Study of Wittgenstein's Modal Atomism. By RAYMOND BRADLEY. New York and Oxford: The Oxford University Press, 1992. Pp. xxi + 244. $39.95. Bradley offers as his point of departure this epigraph from Wittgenstein 's Notebooks 1914-1916, written 22 January, 1915: My whole task consists in giving the nature of the proposition. In giving the nature of all being. (And here (...) being does not stand for existence.) His aim in this contribution to the corpus of Wittgenstein scholarship is to " bring into sharp focus the crucial role which modal notions-the notions of necessity, contingency, possibility, impossibility, and so onplay in Wittgenstein's early thinking" (xiii). At this task the book is a clear success. I know of no other work on the Tractatus which is so thoroughly dedicated to the role of modal notions, nor of any which does so much to bring the early Wittgenstein into conversation with contemporary philosophers who work on modal logic and who talk about possible worlds. Bradley convincingly argues that Wittgenstein is not only the largely unrecognized Urvater of modal logic in the twentieth century, with a stature that ought to be equivalent to that of Leibniz, he also presented arguments that even now have an important role to play in contemporary debates among possible world theorists and practitioners of modal logic. Philosophers who are interested in modal logic, especially its history, or in the logical structures of the Tractatus, will find very much of interest in this book. Those who, on the other hand, are chiefly interested in Wittgenstein's views on ethics, the aesthetic, God, or the mystical, or who are interested in the relation between the Tractatus and his later work, will find little here to their taste. The book's structure perspicuously tracks Bradley's argument. Chapter One sets the reader straight on what modal atomism is, giving the history of Wittgenstein's association with Russell, and establishing that the atomism of the Tractatus is in fact modal in nature. Chapter Two argues that Wittgenstein is a possibilist, that is, that he asserts the reality of merely possible entities and that his work is consistent with the modern modal logic called SS. Chapter Three turns to the ontological side, showing how Wittgenstein's commitments to atomic objects as the " substance of the world " entails certain modal relations among objects and the complex facts which they may form. In Chapter Four logic and ontology are brought together in an account of the mirroring relation through which language depicts the world, with attention to a set of intricately argued principles that makes this relation possible. The final chapter brings Wittgenstein's thought to bear on the BOOK REVIEWS 337 whole range of contemporary problems and issues in modal logic, demonstrating by example the author's contention that the Tractatus, rightly attended to, contains important contributions, still unappre· ciated, to the field. Bradley's overall intentions could not be more clear. His strategy for each chapter is clear. Each chapter is divided into between ten and twenty short sections each of which has a specific and well-defined topic. The argumentation within each such section, with a pardonable lapse or two, is well-structured and easy to follow, even for one whose expertise in modal logic is not honed by regular practice. And yet the hook has, on reading, the feel of a very dense landscape of trees, with· out much overview of the forest. This impression is given, I believe, by the style of argumentation. While the topics are sequentially related and build to a general picture, the arguments that must be articulated and answered in each section have little relation, one to the next: a problem in this view, a contradiction or a paradox in that, a resolution, and then on to the next section, where an apparent inconsistency of some sort must be addressed, and so on. There is the feeling of dealing serially with connected topics, but not the feeling of cumulative argumentation building toward a conclusion. A conclusion, however, there is: that Wittgenstein was the modal logician par excellence of the early 20th century, who has much... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 529 any agent qualitatively identical with S would do A in a situation qualitatively identical with S's" (257). (14) The " would " in the above statement is the " would " of Molina, and the author acknowledges that his theory resembles that of Molina (262). For a reader who cannot swallow Molina's "futurihles," a good deal of Leftow's argument falls apart. In the end, then, we (...) have here a hook that verges on the monumental hut that will he diversely judged-as is normally the caseaccording to the philosophic stance of the reader. Surely it is a hook that cannot he ignored. JAMES w. FELT, S.J. Santa Clara University Santa Clara, California Wittgenstein on Ethics and Religious Belief. By CYRIL BARRETT. Oxford : Basil Blackwell, 1991. Pp. xiv + 285. $44.95 (cloth). Since his editorship in 1974 of the volume Lectures and Conversa· tions: Aesthetics, Psychology, and Religious Belief, Cyril Barrett's name has been associated with the interpretation of Wittgenstein's views on ethics and religious belief. At last we have in hook form his comprehensive exposition of this important dimension of the philosopher's thought. Barrett ranges from the Notebooks 1914-1916 all the way to remarks in On Certainty that stem from only a few days before Wittgenstein 's death. In addition to placing pertinent remarks of early and late periods in the context of the relevant major works and their chief themes, Barrett also expounds and analyses such shorter, more explicit treatments of ethics and religious belief as the " Lecture on Ethics," the "Remarks on Frazer's Golden Bough," and the remarks collected in Vermischte Bemerkungen (Remarks on Culture and Value). The hook is sympathetic in tone-perhaps too much so. The reader quite often feels-as I will make plain in what follows-that Barrett interprets Wittgenstein in a way that obscures the strangeness of his thought, tending to assimilate it too readily to the mainstream of Western theological reflection. Barrett has a three-fold program: "to show that (a) what Wittgen· stein has to say on ethics and religious belief was for him of the ut· most importance, if not sole importance; (h) his views on these subjects did not radically alter throughout his life, appearances to the contrary notwithstanding; and (c) what Wittgenstein said about ethics was intimately interwoven with what he said about religious belief " (xiv). The elements of this program call for different sorts of evalua· 530 BOOK REVIEWS tion. Clearly Wittgenstein thought ethics and religious belief were im· portant. So the question is whether Barrett's claim, that for Wittgen· stein they are the most important elements of his work or even the only important elements of his work, is an exaggeration. Barrett takes as determinative such remarks as Wittgenstein's statement to Ludwig Ficker that the point of the Tractatus is ethical, and he must explain or discount the fact that the vast hulk of his work has little obvious hearing on ethics or religion. Or if the hulk of that work is ethical and religious, then these terms come to mean, in a Wittgensteinian context, something quite different from their senses in Barrett's somewhat domesticated reading. As for the third element in the program-the interweaving of ethics and religion-this, too, is a question of degree. And the question is whether Barrett's analysis, keeping as it does to relatively standard notions of what constitutes religious belief, really does justice to Wittgenstein's insistence that religion must he a way of life rather than a body of doctrine. But it is Barrett's second thesis which is most interesting, most difficult to understand, and most promising, if it is true, for helping us to understand Wittgenstein's thought on ethics and religion. Barrett writes: " Wittgenstein did not abandon his earlier views on ethics and religious belief with their attendant notions of the mystical, transcendental, inexpressible, viewing sub specie aetemitate.... (T) here is no compelling reason to assume such a radical change of view and... all the features of the earlier views can he fitted into the new conceptions of language-games and forms of life" (xiii). Can it he that what Wittgenstein has to... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A RESPONSE TO PROFESSOR McDONOUGH Professor McDonough's response to my review of his book on the Tractatus consists of six main points. I will respond to them in sequence. First, Professor McDonough believes that I have ignored the central point of his hook: namely, the contention that the Tractatus embodies a philosophical argument built around certain " fundamental ideas." I have not done so, though an ambiguity in his (...) idea of what that argument is explains why he thinks that I have. By " the argument of the Tractatus " Professor McDonough may mean the pattern of remarks in the text concerning the non-representational status of logical con· stants, the idea that the sole logical constant is the general propositional form, and the idea that the tautological propositions of logic exhibit the framework of possibility for language and the world. In his interpretation of the links among these ideas Professor McDonough neither advances nor strays from the sorts of interpretations other commentators have offered. So in my review I dealt principally with the other side of the ambiguity, in which "the argument of the Tractatus " means an attempt, which Professor McDonough attributes to Wittgenstein, to establish a philosophical discourse about logic, the world, and mind, a discourse not covered by the injunction to silence. It is here that Professor McDonough's reading-as I think we both agree-is eccentric, and it was to this most interesting, though mis· taken, aspect of hi,s argument that I have directed my attention. Second, P1ofessor McDonough seems to suppose that I believe that the import of proposition 7 is that no one can consistently offer interpretative discourse about the Tractatus, and that I, in my remarks, seize special, unfair advantage by offering interpretation and then invoking silence. He charges that I " [make my] own interpretative claims " and that I ·then insist " (conveniently) that one must there· after he silent." By no means. It is only Wittgenstein (or one who endorses the Tractarian doctrines) who is open to a circumstantial ad hominem charge of inconsistency if he offers interpretations. For those of us who try to understand the Tractarian perspective without precisely sharing it, the question of consistency with proposition 7 is not an issue. What is an issue is construing Wittgenstein's doctrines in 327 328 JOHN CHURCHILL such a way that they are consistent with proposition 7. It is here that McDonough's reading is, as I have said, both most interesting and least convincing. Further, in suggesting that I have paid attention to the " conclusions " of his argument but not its substance, Professor McDonough does not do justice to the coherence of his own work. Those aspects of his interpretation to which much of my review is directed-for example, his interpretation of the thought as a " meaning locus "-are essential to the structure of his argument. By focusing my attention there I have shown, I believe, how these elements of his interpretation contribute to his central claim that the Tractatus is built around an argument. Third, he attributes to me the implausible idea that there is a " stand· ard interpretation of ' the plain sense of what Wittgenstein wrote ' " throughout the Tractatus. But I allude to a " plain sense " only in commenting on the injunction to silence about philosophy in proposi· tion 7. Of course there are many interpretative difficulties in the text. Professor McDonough supposes me to be denying that by ignoring the fact that, in the line he quotes from my review, I refer only to proposition 7 and to his attempt to interpret it. Fourth, Professor McDonough takes exception to my use of allusions to some of Wittgenstein's later works to illustrate shortcomings in his interpretation of the Tractatus.. He is quite right in detecting my own underlying assumptions of continuity throughout Wittgenstein's philosophical work. If space to articulate those assumptions was lacking in my review, it is scarcer here. I will simply say that one of the strongest continuities, the concern to see how philosophical inquiry comes to an end, is precisely the thing that Professor McDonough's " argument of the Tractatus " misconstrues. Fifth, Professor McDonough provides a list of seven points at which, he... (shrink)

Our culture is well on its way to reducing medical ethics to legal requirements, general citizen ethics, or personal values. A distinctive ethic for medicine provides critical distance and moral meaning for the profession and an enriched societal ethic.

Being a patient and living a life -- Clinical space and traits of healing -- False starts and frequent failures -- Three journeys : A.'Ibuprofen and love', B. 'Staying tuned up', C. 'We all want the same things' -- Being a patient : the moral field -- Rethinking healthcare ethics : the patient's moral authority.

This paper examines the contents and institutional context of August Weismann's long essay on Amphimixis (1891). Therein he presented detailed discussions of his on-going studies of reduction division and parthenogenesis, but more to the point, he included an elaborate examination of Émile Maupas's two major publications in protozoology. To understand the relevance of this part to the other two, the author briefly reviews highpoints in earlier nineteenth century protozoology and concludes that only in the mid-1870s and 1880s did protozoa add (...) an important dimension to heredity theory. Otto Bütschli and then Maupas provided Weismann with a deeper understanding of how conjugation and fertilization were related but not identical processes. This allowed him to integrate the two into a fuller understanding of evolution by natural selection. (shrink)

"This book maps the moral terrain in the grounded reality of human experience without relying on theories or systems of ethics as the primary orienting strategy. Moral awareness needs first to be appreciated for what it is before it is made to conform to theories or systems. And moral consciousness is not a steady or stable set of perceptions; as we change so do the moral challenges that most concern us"--.

This essay strives to bring together the institutional history of phenomenological psychology within the American academy from the middle of the 20th century to the current moment. Although phenomenological psychology has always been a dynamically international and interdisciplinary movement, the scope of this essay is limited to the different ways in which this new field expressed itself in certain psychology departments and educational institutions across the United States. After presenting this institutional history, and some individual contributors, a brief commentary is (...) offered. (shrink)

The age-rationing debate of fifteen years ago will inevitably reemerge as health care costs escalate. All age-rationing proposals should be judged in light of the current system of rationing health care by price in the U.S., and the resulting pattern of excess and deprivation. Age-rationing should be rejected as public policy, but recognized as a personal virtue of stewardship among the elderly.

Edmund Pellegrino claims that medical ethics must be derived from a perception of the patient's damaged humanity, rather than from the self-imposed duties of professionals. This essay explores the meaning and examines the challenges to this patient-centered ethic. Social scientific and bioethical interpretations of medicine constitute one kind of challenge. A more pervasive challenge is the ascendancy of managed care, and especially investor-owned, for-profit managed care. A list of questions addressed to patients, physicians and organizations is offered as one means (...) of assessing this threat and moving toward morally trustworthy relationships. (shrink)

This article provides a brief review of Saybrook Review, Vol 6, No. 1, Spring 1986. Special issue: Extensions in Human Science Methodology guest edited by Donald E. Polkinghorne. This issue contains articles written by four of the faculty of the Saybrook Institute, all of which examine "the consequences of extending the criteria of science beyond the traditional objectivism-relativism dichotomy." Polkinghorne's lead article is a compelling and clear historical characterization of the place of human science in today's academic world. The second (...) is an article by Anthony Stigliano that proposes "an ontology for the human sciences" where research would be grounded in a language of description that is "incomplete, discontinuous, dialogal, and interlaced with different 'levels' of discourse". Jurgen Kremer's article reviews prevailing views of reason and truth, and makes a proposal "for the development of narratives of truths...that consciously include moral and aesthetic dimensions." The final article is by Marcia Salner and is a piece that explores the question of validity in human science research, paying particular attention to "the central role of linguistic communication as a major data source, and to the role of communal negotiation and juridical rules for dealing with conflicting interpretations." Together these articles make a positive advance toward the understanding of the context as well as consequences of an epistemological position that stresses contextual relativism and embraces methodological pluralism. 2012 APA, all rights reserved). (shrink)

In March 1996, the General Accounting Office (GAO) issued the reportScientific Research: Continued Vigilance Critical to Protecting Human Subjects.It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always cleartoclinicians. Controversy (...) exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health (NIH) Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

There are three well-developed sorts of answer to the question ‘What kind of meaning is possessed by religious beliefs?’ The first sort regards religious beliefs as truth claims of the kind encountered in the natural and social sciences and in everyday life. Religious beliefs are claims about how things stand in some part of the world. They are to be counted as true or false depending on whether those claims correspond with how things in fact stand. On this reading, religious (...) beliefs are at least in principle verifiable or falsifiable through experiences of appropriate types. There are of course different notions of ‘experiences of the appropriate type’. A Russian cosmonaut returned from space saying that there was no God. He regarded religious beliefs as falsified by the observations he made when he went into the sky and looked around. Others think of religious beliefs as testable, not through ordinary sense experience, but through rather similar kinds of experiences after death. In either of these versions, the sort of meaning possessed by religious beliefs and the sort of truth or falsehood of which they are susceptible are not radically different from the sorts of meaning and truth typical of claims about empirical facts. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 533 Mind in Action: Essays in the Philosophy of Mind. By AMELIE OKSEN· BERG RORTY. Boston: Beacon Press, 1988. Pp. x & 378. This volume assembles essays written over a period of fifteen years (1973-1988), dealing with topics grouped into the following four areas: (1) persons and identity, (2) the nature of psychological activities, (3) problems in philosophy of mind such as fear, self-deception and akrasia, and (...) (4) issues of virtue and character in social context. Rorty's approach to these topics is governed by a " commitment to the primacy of the particular" (ix). Her style, consequently, is rich in detail, in the exhibition of differences between related issues (e.g., between personal identity and identity of human being), and in the dis· play of the importance of context for setting the philosophical problems concerning mind. Indeed, she writes: " If there were a great ontological table of contents, neither mind nor individ"Ual minds would be likely to appear on the list of independent substances " (5). Thus the collec· tion does not set out a substantial theory of mind; rather, it exhibits a set of commitments and preoccupations-in the author's words, " a point of view." The value of the collection lies in its wealth of discriminating exposition of intricately related issues, and in the display of a philosophical intellect whose consistency survives the strategic pre· disposition to analyze by distinguishing contexts. The first grouping of essays is "Persons and Personae." The title essay "Persons and Personae" (1987) argues that there is no over· arching synthesis that will reconcile the several concepts of a person. Rorty argues from the premise that any concept of person is rooted in and reflects the characteristic central activities of a society: "primary, privileged activities, the activities that are thought to express human excellence and tasks " (25). This unpacks into three parts: (1) that there is no such thing as the concept of a person; (2) that concepts of persons are always reflective of some particular society; and (3) that the element of a society that defines its concept of self will be its list of central human activities, be they religious, political, economic, or moral in nature. Rorty analyzes seven such concepts, and concludes by eschewing what she calls a "vulgar Wittgensteinian" approach; namely, simply advising philosophers to be cured of the yearning for one metaphysical concept of person. Instead, briefly, she acknowledges that yearning and recommends inquiry into its roots and recommends scrutiny of the various overlapping but uncoordinatable concepts of person in the various areas of life that give rise to them. In "The Transformation of Persons" (1973) she argues that the question " Is this the same person? " may have multiple admissible 534 BOOK REVIEWS answers. The question of personal identity through change has, she argues, typically given rise to either psychological, memory-based criteria, or to criteria based on reidentification of the same physical agent. Her claim is that either of these, pressed hard enough, presupposes the other. She dismisses the potentially dismal construal of this conclusion, holding that a recognition of the interdependence of psychological and physical criteria of identity is in fact beneficial, as both kinds of criteria tend to emphasize our notion of persons as (at least) the "irreducible units of responsible agency " (57). The argumentation supporting this contention of criterial interdependence is, however, thin. In "Persons, Policies, and Bodies" (1973) Rorty moves her concerns further toward the issues of responsibility. She examines the theory that a person is a locus of rational agency, that is, one who operates according to deliberately adopted policies that guide particular choices. She notes that if this theory holds, the concept of a person is conceptually distinct from the concept of an individual human being and from an individuated self as a subject of experience. But it does not hold, according to her, at least in any robust sense. She discloses difficulties in fleshing out the notions of choice and rational agency required by the theory, arguing that attempts to salvage it by resorting to rationality as a matter of degree or as a potential tend to vitiate the theory instead of saving it. Rather, her view is that... (shrink)