This is a brief response to David Wright’s commentary on my paper, “Critical Thinking Instruction: A Realistic Evaluation: The Dream vs. Reality.” Wright claims that if one looks more closely at the literature on critical thinking assessment that the reported effect sizes for CT instruction are quite respectable and my standards are too high. My comments will focus is on whether effect size is both problematic and an adequate measure for assessment.

The editors of the JRE solicited short essays on the COVID‐19 pandemic from a group of scholars of religious ethics that reflected on how the field might help them make sense of the complex religious, cultural, ethical, and political implications of the pandemic, and on how the pandemic might shape the future of religious ethics.

This paper proposes a framework for an ethical impact assessment which can be performed in regard to any policy, service, project or programme involving information technology. The framework is structured on the four principles posited by Beauchamp and Childress together with a separate section on privacy and data protection. The framework identifies key social values and ethical issues, provides some brief explanatory contextual information which is then followed by a set of questions aimed at the technology developer or policy-maker (...) to facilitate consideration of ethical issues, in consultation with stakeholders, which may arise in their undertaking. In addition, the framework includes a set of ethical tools and procedural practices which can be employed as part of the ethical impact assessment. Although the framework has been developed within a European context, it could be applied equally well beyond European borders. (shrink)

: The fifth edition of Beauchamp and Childress's Principles of Biomedical Ethics is distinguished by its emphatic embrace of common morality as the ultimate source of moral norms. This essay critically evaluates the fifth edition's discussion of common morality and, to a lesser extent, its treatment of coherence (both the model of ethical justification and the associated concept). It is argued that the book is overly accommodating of existing moral beliefs. The paper concludes with three suggestions for improving this (...) leading text. (shrink)

Let us look at autonomy in a new way. Autonomy has a richly deserved place of honor in bioethlcs. It has led the set of principles that formed the basis of the discipline since the beginning. It is the leading principle In what is now regularly called “the Georgetown Mantra,” a phrase suggested by one of the first philosophers ever to be hired In a medical school, K. Danner Clouser. The phrase applies to the principled approach of autonomy, beneficence, nonmaleficence, (...) and justice. This kind of bioethics was developed by scholars like Beauchamp and Childress, Veatch, and Engelhardt, during their association with Georgetown University. (shrink)

This is a response essay to Donald Hatcher’s, “Critical Thinking Instruction: A Realistic Evaluation: The Dream vs. Reality.” Hatcher argues that critical thinking instruction seriously falls short of the ideal of honestly evaluating alternative evidence and arguments. This failure is apparent, he argues, when one surveys student performance on a variety of CT assessment tests. Hatcher reviews the current CT assessment data, which includes an extensive pool of results collected from Baker University where Hatcher oversaw a (...) sophisticated and well-funded CT program for about two decades. Hatcher also argues that evidence from the philosophical and psychological literatures on disagreement and judgment suggests even CT experts fail to model the ideal and that CT has suffered from an unrealistic conception of rationality and human decision-making. I reply by arguing that, by putting the CT assessment data in a different context and asking an alternative set of questions, one can justifiably derive a more positive evaluation of the future of CT instruction in light of the CT ideal. Instead of focusing on whether students are achieving the CT ideal by the time of the post-test, instructors should ask whether they are making the kind of progress that there is good reason to expect. I close by challenging the soundness of the proposed implications of Hatcher’s arguments. (shrink)

Settling the debate over conscientious refusal (CR) in liberal democracies requires us to develop a conception of the healthcare provider’s moral role. Because CR claims and resulting policy changes take place in specific sociopolitical contexts with unique histories and diverse polities, the _method_ we use for deriving the healthcare norms should itself be a democratic, context-dependent inquiry. To this end, I begin by describing some prerequisites—which I call _publicity conditions_—for any democratic account of healthcare norms that conflict or jibe with (...) CR. Next, drawing on Ronald Dworkin’s jurisprudence and Tom Beauchamp & James Childress’s approach to bioethical reasoning, I briefly introduce one method for generating healthcare norms that is faithful to the publicity conditions and has potential to constructively, and democratically, derive important boundaries for CR. Finally, I argue that many critics of CR fail to similarly ground their accounts of healthcare norms in healthcare professionals’ sociopolitical contexts, often relying instead on their own interpretation of a generally stateable healthcare norm. This leads to their misconstruing both the value judgments on which their own approaches rest and the public, political values that are often invoked in favor of CR. (shrink)

General practice (community) pharmacy as a healthcare profession is largely devoted to therapeutic treatment of individual patients whether in dispensing medically authorised prescriptions or by providing members of the public with over-the-counter advice and service for a variety of common ailments. Recently, community pharmacy has been identified as an untapped resource available to undertake important aspects of public health and in particular health promotion. In contrast to therapeutic treatment, public health primarily concerns the health of the entire population, rather than (...) the health of individuals (Childress et al. in J Law Med Ethics 30:170–178, 2002). Thus, an important question for the profession is whether those moral and professional values that are appropriate to the therapeutic care of individual patients are relevant and adequate to support the additional public health role. (shrink)

Allen Buchanan and Daniel Brock, in a widely influential account, Deciding for Others (1990), advocate a sliding scale approach to the determination of whether a patient is competent to make a decision regarding his/her health care. An analysis of two critiques of their position (Beauchamp and Childress (1994), Wicclair (1991 a,b)) reveals a tacit presumption by all of these authors that the greater cognitive challenge often posed by high risk therapies constitutes grounds for an elevated standard of competence. This (...) presumption cannot be consistently maintained in cases where the patient's decision involves experimental therapies. It implies either that informed consent can never take place in such situations, or, perhaps even more counter-intuitively, that a lower standard of competency should be used than when the patient is asked to choose only among standard therapies. (shrink)

This essay challenges a "meta-theory" in just war analysis that purports to bridge the divide between just war and pacifism. According to the meta-theory, just war and pacifism share a common presumption against killing that can be overridden only under conditions stipulated by the just war criteria. Proponents of this meta-theory purport that their interpretation leads to ecumenical consensus between "just warriors" and pacifists, and makes the just war theory more effective in reducing recourse to war. Engagement with the new (...) meta-theory reveals, however, that these purported advantages are illusory, made possible only by ignoring fundamental questions about the nature and function of political authority that are crucial to all moral reflection on the problem of war. (shrink)

Beauchamp and Childress’ definition of autonomous decision‐making includes the conditions of intentionality, understanding, and non‐control. In genetics, however, a relational conception of autonomy has been increasingly recognized. This article aims to empirically assess aspects of social influence in genetic testing decision‐making and to connect these with principlist and relational theories of autonomy. We interviewed 18 adult genetic counsellees without capacity issues considering predictive genetic testing for cancer predisposition for themselves and two counselling physicians in Switzerland. We conducted a qualitative (...) analysis, building on a grounded theory study about predictive genetic testing decision‐making. We found that some participants agreed to predictive genetic testing predominantly because relatives wanted them to do it, with some even acting contrary to their own convictions. Others, in contrast, based their decision on purely individualistic reasons but expressed difficulties in explaining their decision to their social environment. Healthcare professionals had a critical influence on decision‐making in many cases without being manipulative, as perceived by counsellees. Still, cases of coercion and social pressure occurred within social relationships. In conclusion, predictive genetic testing decision‐making includes relational and individualistic aspects, and both are compatible with autonomous decision‐making. While the principlist and relational notions of autonomy compete on a theoretical level, they are two sides of the same coin when used as analytical lenses for genetic testing decision‐making. Social acceptance of refusal of testing should be improved to mitigate social pressure. Individuals should be encouraged to decide for themselves how much their social environment influences their decision regarding predictive genetic testing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:A Theory of Bioethics by David DeGrazia and Joseph MillumColin Hoy (bio) and Winston Chiong (bio)Review of David DeGrazia and Joseph Millum, A Theory of Bioethics (Cambridge University Press, 2021)David DeGrazia and Joseph Millum’s A Theory of Bioethics 2021 arrives at a curious time for an ambitious effort at systematic theory construction, seemingly out of step with bioethical fashion. At the same time, a prominent (...) group of philosophical bioethicists authored an article, possibly with a touch of defensiveness, to “make the case that philosophy and philosophers still have a very important and meaningful role to play in contemporary bioethics” (Blumenthal-Barby et al. 2021). Meanwhile, the annual meeting of the American Society for Bioethics and Humanities included several expressions of impatience with the historical privileging of philosophy over more empirical, situated, and community-oriented approaches to moral problems in health.DeGrazia and Millum’s work itself reflects the current state of bioethics and how it has changed since the heyday of grand bioethical theory construction in the late twentieth century. To apply Parfit’s philosophical taxonomy (1984), the general frameworks promulgated by theorists like Veatch, Engelhardt, and Gert, as well as Beauchamp and Childress, were by necessity revisionary. These bioethical theories were whole-cloth alternatives to a conventional and paternalistic medical ethos that was already widely acknowledged as unsatisfactory. Today, however, bioethics is a mature and institutionalized field, with well-established practices and a corpus of accepted tenets (alongside matters of ongoing but generally demarcated controversy). A plausible and fruitful contemporary theory of bioethics must be largely descriptive, in Parfit’s sense, providing an intellectual framework that gives coherence and sense to existing practice, while at the same time clarifying matters of confusion.In contemporary bioethics, a central component of this practice is the application of the four principles of biomedical ethics—non-maleficence, beneficence, justice and autonomy—not merely as originally proposed by Beauchamp and Childress (2019), but in their refined form, following decades of exchange, critique, and revision. DeGrazia and Millum’s theory begins with two core values: well-being and respect for rights holders. [End Page 321] The bulk of the book then applies the method of reflective equilibrium to specify these two values in terms of the canonical four principles, here treated as “mid-level” constructs with readier application to specific cases than the two core values. Experienced bioethicists may have an uncanny sense of setting off from a new trailhead, and yet, eventually finding themselves still walking a familiar path. However, this way of introducing and explicating the four principles will likely be more accessible to a wider audience, including high-level undergraduates and graduate students not already versed in the revisions, refinements, and compromises embedded in Beauchamp and Childress’s discussions.Two other features recommend this book as a resource for trainees and interested non-experts seeking to deepen their understanding of bioethics. First, the clarity of its style and organizational approach provides a welcome orientation for non-specialists. The chapters are structured so that major contending perspectives are outlined before the authors develop arguments for their own positions in that context. Each chapter proceeds by considering applications of the broader theory, showing how it can illuminate potential candidate approaches or policies, as well as demonstrating how to use the tools of ethical analysis to evaluate these proposals in both ideal and non-ideal cases. This didactic approach to the relationship between conceptual argument and practice will be accessible to many who are initially unfamiliar with or intimidated by theory. Second the commendable decision to make the book electronically available and accessible also has the potential to broaden the reach of the work, and in particular, to engage parties in under-resourced settings, which have so often been overlooked in bioethical discourse.As noted above, while the authors’ approach is descriptive in Parfit’s sense, it is not necessarily conservative. In many places, the authors highlight how their theory includes elements or renders conclusions that are not broadly accepted, and following the method of reflective equilibrium, they advocate for these positions both in terms of broad principles and particular judgments about cases. This begins with their dual-value... (shrink)

Clouser and Gert’s 'A Critique of Principlism’ (1990) has ignited debate over the adequacy of substituting principlism for moral theory as a means for dealing with biomedical dilemmas. Clouser and Gert argue that this sort of substitution is not adequate to the task. I examine their argument in light of recent defences of principlism on this score, those of B. Andrew Lustig (1992), David Degrazia (1992), and Beauchamp and Childress (1994). I argue that both sides in the debate (...) have assumed differing conceptions of a moral theory that virtually guarantee their respective conclusions. These differing conceptions are motivated by antecedent epistemological commitments. The present debate over principlism is therefore inconclusive. Future discussion should focus on the underlying epistemological issues. (shrink)

The bioethics of four principles, named as principlism, began in 1979 with the work of Principles of Biomedical Ethics by Tom Beauchamp and James F. Childress and has been widely criticized since the 80s. In recent years four rival approaches towards principlism have been specified in this critique. These include: a) impartial rule theory, developed by K. Danner Clouser; b) casuistry, represented by Albert Jensen, and c) virtue ethics, developed by Edmund D. Pellegrino. The critique of principlism presented by (...) K. Danner Clouser, Bernard Gert was not only defended by T. Beauchamp and J.F. Childress themselves, but also by others, including B. Andrew Lustig, David DeGrazia, and Henry Richardson. The discussion has not weakened but continued till the present time. It was presented extensively in the June issue of The Journal of Medicine and Philosophy. We want to join the discussion from the position of personalistic bioethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Basic Resources in Bioethics*Mary Carrington Coutts (bio)OrganizationsKennedy Institute of Ethics Georgetown University Washington, DC 20057 National Reference Center for Bioethics Literature 800-MED-ETHX or 202-687-3885The Hastings Center 255 Elm Road Briarcliff Manor, NY 10510 914-762-8500Society for Health and Human Values 6728 Old McLean Village Drive McLean, VA 22101 703-556-9222NOTE: There are numerous organizations in the United States and abroad that deal with bioethical issues. For a more comprehensive listing of (...) those organizations, see:American Hospital Association. Directory of Biomedical Ethics Organizations. Chicago: American Hospital Association, 1989.National Reference Center for Bioethics Literature. International Directory of Bioethics Organizations edited by Robert Iosco. Washington, DC: Georgetown University, 1986.Encyclopedia and DictionaryDictionary of Medical Ethics. Edited by A.S. Duncan, G.R. Dunstan, and R.B. Welborn. New rev. ed. New York: Crossroad, 1981. [End Page 75]Encyclopedia of Bioethics. Edited by Warren T. Reich. 4 vols. New York: Macmillan-Free Press, 1978; or 1982 reprint in 2 volumes available to members of the Kennedy Institute of Ethics through the membership office, 202-687-8099.Online DatabaseBioethicsline. Produced by the Kennedy Institute of Ethics for the National Library of Medicine. Searchable through the MEDLARS system. Focuses on questions of ethics and public policy in the fields of health care and biomedical research. Searches available upon request to the National Reference Center for Bioethics Literature. For information on securing a personal access code from the National Library of Medicine, call 800-638-8480.BibliographiesBibliography of Bioethics. Edited by LeRoy Walters and Tamar Joy Kahn. Washington, DC: Kennedy Institute of Ethics, Georgetown University. Issued annually since 1975. Corresponds to the BIOETHICSLINE database. Provides references to resources on ethical and public policy issues in medicine and biomedical research. Includes abstracts; arranged by broad subject categories.Ethics in Nursing. Edited by Terry Pence. 2nd ed. New York: National League for Nursing, 1986. An annotated bibliography of nursing ethics. Includes author and subject indexes.Goldstein, Doris M. Bioethics: A Guide to Information Sources. Detroit: Gale Research, 1982. A selected, annotated bibliography to the literature of bioethics.The Hastings Center's Bibliography of Ethics, Biomedicine and Professional Responsibility. Compiled by the staff of the Hastings Center. Frederick, MD: University Publications of America, 1984.Medical Ethics: An Annotated Bibliography. Edited by Mark Siegler, Peter A. Singer and David L. Schiedermayer. Philadelphia: American College of Physicians, 1988.Current Awareness ServicesNOTE: Several journals have sections where they highlight new publications. See, for example, the "In The Literature" section of the Hastings Center Report, or the "Medicolegal Reference Shelf" section of Law, Medicine and Health Care. Other services include:BioLaw. Edited by James F. Childress and Ruth D. Gaare. Frederick, MD: [End Page 76] University Publications of America, 1983 to present. Annual with bimonthly updates. (Previous title: Bioethics Reporter.) A compendium of articles and legal documents on ethical and legal issues in medicine, health care administration and human experimentation. Includes the text of important legal decisions in the Resources section.New Titles in Bioethics. Edited by Luanda Fitch Huttlinger. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. Published monthly 1975-1989; quarterly 1990—present. List of acquisitions by the National Reference Center for Bioethics Literature. Organized by subject categories. Includes ordering information for difficult-to-find items. Annual cumulation available.Scope Notes Series. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. A series of issue briefs including annotated bibliographies on the following popular bioethical topics:No 1. Dangerousness, September 1982, 5 p.No 2. Living Wills and Durable Powers of Attorney: Advance Directive Legislation and Issues, Revised February 1990, 15 p.No 3. Ethics Committees in Hospitals, Revised June 1989, 12 p.No 4. Diagnosis Related Groups and the Prospective Payment System, June 1984, 11 p.No 5. Baby Fae, January 1985, 19 p.No 6. Surrogate Mothers, Revised January 1988, 12 p.No 7. Withholding or Withdrawing Nutrition or Hydration, Revised September 1988, 12 p.No 8. AIDS: Law, Ethics and Public Policy, April 1988, 12 p.No 9. Bioethics Audiovisuals 1982 to Present, September 1988, 12 p.No 10. Ethical Issues in... (shrink)

Photo by Karl Raymund Catabas on Unsplash “After Buddha was dead, they still showed his shadow in a cave for centuries – a tremendous, gruesome shadow. God is dead; but given the way people are, there may still for millennia be caves in which they show his shadow. – And we – we must still defeat his shadow as well!” – Friedrich Nietzsche[1] INTRODUCTION Friedrich Nietzsche famously declared that “God is dead!”[2] but lamented that his contemporaries remained living in the (...) shadow of God. For Nietzsche, the morality of his time was still based in the Christian tradition, even though faith in God was waning. Bioethics lives under a similar shadow: the shadow of Enlightenment Era-rationalism. Bioethics curricula focus on principles derived from Kantian deontology and utilitarianism. The allure of maintaining a moral framework that provides a rational method that can be handily applied to any situation remains strong. The principlist approach advanced by Tom Beauchamp and James Childress is taught to nearly all medical students in the United States,[3] and is essentially the canonical ethical framework of bioethics. In this model, the principle of autonomy is Kantian in nature, and the principles of beneficence and non-maleficence are utilitarian in nature.[4] Moreover, the presented framework is an approach that, when applied rationally to any healthcare scenario, will yield an outcome “considered moral.”[5] This reflects a faulty conception of philosophy that plagues much of bioethics, wherein the only contribution of philosophy pertinent to bioethics is moral philosophy elucidated by European thinkers in the Enlightenment Era. The landscape of moral philosophy has evolved significantly from the 18th century. However, the bioethical world has not kept up with the philosophical world, remaining instead in the shadow of antiquated moral thinking. Also lacking in bioethics are other disciplines of philosophy, such as philosophy of language, existentialism, and aesthetics, which are often given no consideration at all. The inclusion of both modern moral philosophy and other philosophical fields is necessary if bioethics is to survive its transition into modernity. l. The Shadow of Enlightenment Enlightenment Era philosophers such as Immanuel Kant argued that one need only employ reason to obtain knowledge; emotion bore no relevance when determining ethical behavior. Kant’s moral theories thus privileged a duty to act according to moral imperatives over feelings. Other Enlightenment Era philosophers such as John Locke developed systems that attempted to quantify human goods and human ills. This quantification potentially reduces human welfare and suffering to utility. Today, in the world of philosophy, such a “neutral analysis,” as Cora Diamond noted, is “dead or moribund.”[6] Bernard Williams remarked that such moral philosophy is “empty and boring,”[7] and G. E. M. Anscombe stated that it “no longer generally survives.”[8] And yet, just as the atheists in Nietzsche’s world dwelt in the moral code of a dead God, bioethicists still pursue a unified moral system that takes an input, applies some moral rules, and generates a moral outcome, like the four principles approach that Beauchamp and Childress laid out.[9] Some detractors of principlism take issue with their approach for not being unified enough and want to replace it with a procedural framework that is even more systematic and complicated. They argue that the resulting moral framework would be a “comprehensive decision procedure for arriving at answers”[10] that retains the “impartiality that is an essential part of morality.”[11] The shadow of rationalist morality has caused bioethical decision making to become detached and rigid when bioethics should concern itself with the humans whose lives it affects. A rational, divorced-from-emotion way of thinking ultimately fails to yield satisfactory results when decisions are made by and for emotional beings. Dr. Paul Farmer, among others, championed the idea that bioethics should be de-philosophized, as philosophy, cold and calculated, fails to adequately respond to the realities of those worst off.[12] Instead, Dr. Farmer emphasized the inclusion of the social sciences, like sociology and anthropology, in bioethics. Undoubtedly, Dr. Farmer was on the right track; bioethics should certainly engage directly with the people whom its decisions involve. If the narrow band of moral philosophy currently found in bioethics – that of stringent rationalism – were all that philosophy had to offer, I, too, would advocate for a de-philosophization. Ludwig Wittgenstein notes that to attempt to capture the complexity of moral thinking in a manner that employs reason alone and casts aside emotion is a “hopeless task,” like reconstructing a sharp image “from a blurred one.”[13] Unfortunately, bioethics is mired in the remnants of this hopeless task. To Dr. Farmer, the dominant moral framework was too restrictive and was unresponsive to the social and humanitarian needs of those whom bioethics is meant to help. As such, he wished to free bioethics from the shadow of a morality derived from rationalist thinkers. ll. Beyond Rationalism Like Nietzsche, who tried to resolve Europe’s post-religion vacuum by providing his society with a new way to live, Dr. Farmer wanted to replace the rationalist philosophy upon which bioethics was built with a “resocialization” of the field.[14] I agree with Dr. Farmer’s call for resocialization, as well as his denouncement of philosophy as it exists in bioethics. Evaluating risks and benefits along a predetermined array of moral principles is far too rigid and impersonal to guide what are often the most important decisions one will make. For Dr. Farmer, the most needed change was restoring the social element of bioethics. However, in advocating for this resocialization, Dr. Farmer casts philosophy as the antithesis of social science, noting that “few would regard philosophy … as a socializing discipline.”[15] I disagree. Rationalist moral philosophy may be lacking in socializing force, but there are other fields of philosophy that are responsive to our social reality. Rather than de-philosophizing bioethics, it makes more sense to replace the antisocial philosophies predominant in bioethics with prosocial philosophies better suited to it. Of course, the contribution of philosophy to bioethics is more than moral theories from the Enlightenment Era. There are more recent philosophical contributions from outside the field of moral philosophy that have roused bioethical interest. Jennifer Blumenthal-Barby, et al., argue for philosophy’s continued place in bioethics, citing Derek Parfit’s “non-identity problem,” which altered the landscape of reproductive ethics, and David Chalmers’ contributions to philosophy of consciousness, which have implications for the moral status of brain organoids.[16] Still, these are narrow applications of philosophy to highly specialized areas of bioethics, which not all bioethicists are inclined to delve into. Philosophy in bioethics should not be confined to niche applications in specialist fields but should influence all bioethical thought. Fortunately, there remains untapped a wealth of philosophical disciplines that pertains to exactly this. Philosophy of language investigates the nature of meaning and understanding in communication, which is a necessary social action. Successfully deciphering and conveying moral values in discourse is a bioethicist’s bread and butter, as is resolving disagreements and reaching agreements. Indeed, it is often the case that miscommunication lies at the root of an impasse between a doctor and a patient. An understanding of the nature of the disagreement would help resolve the conflict, as different types of disagreements require different interventions for resolution. For instance, a “substantive disagreement,”[17] in which two parties use the same terms in the same ways and have a fundamental disagreement on which outcome is more desirable, can be resolved only if one party yields to the other. On the other hand, a “merely verbal dispute,”[18] in which two parties use the same terms to represent entirely different concepts and values, requires standardization of terminological usage for its resolution. As such, no one can overstate the moral importance of successful communication in bioethics, and an exploration of language itself would prove invaluable to a bioethicist’s training. Existentialism is another subset of philosophy that acknowledges the social nature of human existence, noting that one’s being in the universe is concomitant with the existence of others sharing the same universe.[19] Thus, there is the recognition that whatever existence is, it is not complete without the existence of others. With this as a starting point, existentialists examined how to live meaningfully with others in this world. Since ethics crucially involves others, it is no surprise that existentialists pondered how to live moral lives. Existentialist conceptions of morality did not revolve around acting in accordance with a set of rules, but rather, recognized individual freedom in choosing how to act and emphasized acting authentically. In this vein, bioethicists should commit to doing what is right rather than committing to applying a set of principles. Existentialism, while part of the broader bioethics literature, is less common throughout bioethics curricula and deserves more prominence. Martin Heidegger, for instance, emphasized the difference between two types of thinking: “calculative thinking” and “meditative thinking.” Heidegger characterizes calculative thinking as a computation, wherein from some given starting conditions “definite results”[20] are determined, and contrasts this with meditative thinking, which he describes as “thinking which contemplates the meaning which reigns in everything that is.”[21] Heidegger was critical of the pervasiveness of calculative thinking, seeing it as the “ground of thoughtlessness,”[22] in which we only relate to the world in a meaningless, mechanical way. This is the emphasized type of thinking in rationalist conceptions of morality popular in bioethics; from a set of starting conditions, a series of rules are applied, and a moral outcome is calculated. Such a technique, however, discounts the personal meaning individuals place on the aspects of their lives relevant to their decision making, as well as the meaning in committing to doing what is right. Under calculative thinking, such a commitment is reduced to rote rule-following. A turn to meditative thinking would ensure that bioethical decisions comport with living meaningful lives. Even aesthetics, a discipline devoted to examining beauty and taste,[23] has a place in bioethics. Just as the viewing of a painting, the listening of a song, or the reading of a book elicits an effective response, hearing a patient’s story leaves an emotional imprint. The recounting of a traumatic moment imparts sadness, and a joyous occasion begets joy in the listener as well. As acknowledged in the field of everyday aesthetics, these aesthetic experiences often spur us to act:[24] The unsightly appearance of a polluted riverbank drives us to remove the trash; the presence of sorrow in one’s life drives us to ameliorate it. To be mindful of aesthetic experiences and allow them to affect us emotionally is paramount to the motivation of a bioethicist to serve the patient, not out of an obligation to a job description, but out of a desire to truly avail the patient of their anguish. For example, the new field of narrative medicine utilizes critical reading and literary techniques to train clinicians and bioethicists in emotional understanding and listening skills that stress the social aspects of medicine beyond rational analysis and decision making. CONCLUSION Dr. Farmer is absolutely correct; bioethics is in dire need of resocialization. It should not be the case that the justification for a moral action is essentially that “the rules say so,” or that simply by teaching such rules to medical students, the very act of making bioethical decisions that diverge from those determined by principles can be seen as an act of “bad faith … hubris or, worse, malpractice.”[25] As bioethicists are coming to realize, the rationalist philosophical traditions that bioethics was founded upon are past their expiry, and the time for change is now. Indeed, as Dr. Farmer urges, “socializing disciplines” like anthropology, history, political economy, and sociology are necessary to humanize the field of bioethics.[26] So too, however, can philosophy be a socializing discipline, if we know where to look. Bioethics should evolve. Its new goal should be to focus on meaningful human relationships, and to phase out rigid, impersonal modes of moral thinking. The limited sampling of unsatisfying moral theories from hundreds of years ago leaves many bioethics students cold, and it is easy to see why bioethicists are ready to part ways with philosophy. I believe this is a move in the wrong direction; there is a place for philosophy in the future of bioethics. Just as bioethics needs a resocialization, it is also needs of a re-philosophization. These enrichments complement one another. There is more to bioethics than mechanically determining the right course of action in a healthcare setting. Bioethics engages with the most ancient of philosophical questions: questions of what makes human existence meaningful, what makes us who we are, how we want to relate to others, how and why we feel, what our place in the world is, how we can communicate what we think, and why our moral intuitions are so compelling. We would be remiss if we did not begin to investigate additional contributions to morality from a wider range of philosophies that try to provide answers to such questions, as they offer a richness to moral thinking that cannot be gleaned from traditional bioethical approaches alone. - [1] Friedrich Wilhelm Nietzsche, The Gay Science: With a Prelude in German Rhymes and an Appendix of Songs, ed. Bernard Williams, Josefine Nauckhoff, and Adrian Del Caro, Cambridge Texts in the History of Philosophy, 109. [2] Nietzsche, 120. [3] Daniel C O’Brien, “Medical Ethics as Taught and as Practiced: Principlism, Narrative Ethics, and the Case of Living Donor Liver Transplantation,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 47, no. 1 : 97, https://doi.org/10.1093/jmp/jhab039. [4] K. D. Clouser and B. Gert, “A Critique of Principlism,” Journal of Medicine and Philosophy 15, no. 2 : 219–36, https://doi.org/10.1093/jmp/15.2.219. [5] O’Brien, “Medical Ethics as Taught and as Practiced,” 97. [6] Cora Diamond, “Having a Rough Story about What Moral Philosophy Is,” New Literary History 15, no. 1 : 168, https://doi.org/10.2307/468998. [7] Bernard Williams, Morality: An Introduction to Ethics, Canto ed, xvii. [8] G. E. M. Anscombe, “Modern Moral Philosophy,” Philosophy 33, no. 124 : 1, https://doi.org/10.1017/S0031819100037943. [9] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 7th ed, 13. [10] Clouser and Gert, 233. [11] Clouser and Gert, “A Critique of Principlism,” 235. [12] Paul Farmer and Nicole Gastineau Campos, “Rethinking Medical Ethics: A View from Below,” Developing World Bioethics 4, no. 1 : 17–41, https://doi.org/10.1111/j.1471-8731.2004.00065.x. [13] Ludwig Wittgenstein, Philosophical Investigations, ed. Joachim Schulte, trans. P. M. S. Hacker, 4th edition, 40. [14] Farmer and Campos, “Rethinking Medical Ethics,” 20. [15] Farmer and Campos, 20. [16] Jennifer Blumenthal-Barby et al., “The Place of Philosophy in Bioethics Today,” The American Journal of Bioethics: AJOB, June 30, 2021, 3–5, https://doi.org/10.1080/15265161.2021.1940355. [17] Brendan Balcerak Jackson, “Verbal Disputes and Substantiveness,” Erkenntnis 79, no. S1 : 31–54, https://doi.org/10.1007/s10670-013-9444-5. [18] C. S. I. Jenkins, “Merely Verbal Disputes,” Erkenntnis 79, no. 1 : 11–30, https://doi.org/10.1007/s10670-013-9443-6. [19] Steven Crowell, “Existentialism,” in The Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta, Summer 2020, https://plato.stanford.edu/archives/sum2020/entries/existentialism/; Anita Avramides, “Other Minds,” in The Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta, Winter 2020, https://plato.stanford.edu/archives/win2020/entries/other-minds/. [20] Martin Heidegger, Discourse on Thinking, Harper Torchbooks, 46. [21] Heidegger, 46. [22] Heidegger, 45. [23] Nick Zangwill, “Aesthetic Judgment,” in The Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta, Winter 2021, https://plato.stanford.edu/archives/win2021/entries/aesthetic-judgment/. [24] Yuriko Saito, “Aesthetics of the Everyday,” in The Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta, Spring 2021, https://plato.stanford.edu/archives/spr2021/entries/aesthetics-of-everyday/. [25] O’Brien, “Medical Ethics as Taught and as Practiced,” 112. [26] Farmer and Campos, “Rethinking Medical Ethics,” 20. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Principles and Theory in BioethicsPat Milmoe McCarrick (bio)The following citations were selected from BIOETHICSLINE, the online database prepared at the Kennedy Institute of Ethics for the National Library of Medicine's MEDLARS system. Searching the keywords autonomy, beneficence, casuistry, justice, and virtues, as well as the text word principlism produced more than 400 citations. Only the citations concerned with theory and principle in the practice of bioethics are included here—e.g., (...) works about justice in resource allocation have been deleted.Arkes, Hadley V. When Bungling Practice Is Joined to Absurd Theory: Doctors, Philosophers, and the Right to Die. In Set No Limits: A Rebuttal to Daniel Callahan's Proposal to Limit Health Care for the Elderly, ed. Robert L. Barry and Gerard V. Bradley, pp. 31-44. Urbana: University of Illinois Press, 1991.Arnason, Vilhjalmur. Towards Authentic Conversations: Authenticity in the Patient-Professional Relationship. Theoretical Medicine 15 (3): 227-42, September 1994.Arras, John D. Getting Down to Cases: The Revival of Casuistry in Bioethics. Journal of Medicine and Philosophy 16 (1): 29-51, February 1991.Arras, John D. Principles and Particularity: The Role of Cases in Bioethics. Indiana Law Journal 69 (4): 983-1014, Fall 1994.Beauchamp, Tom L. Principles and Other Emerging Paradigms in Bioethics. Indiana Law Journal 69 (4): 955-71, Fall 1994.Beauchamp, Tom L. The Principles Approach. Hastings Center Report 23 (6): S9, November-December 1993.Beauchamp, Tom L., and Childress, [End Page 279] James F. Principles of Biomedical Ethics. 4th ed. New York: Oxford University Press, 1994. 752 p.Beauchamp, Tom L., and Walters, LeRoy. Ethical Theory and Bioethics. In their Contemporary Issues in Bioethics. 4th ed., pp. 1-38. Belmont, CA: Wadsworth, 1994.Beldecos, Athena, and Arnold, Robert M. Gathering Information and Casuistic Analysis. [Commentary]. Journal of Clinical Ethics 4 (3): 241-45, Fall 1993.Bole, Thomas J. The Rhetoric of Rights and Justice in Health Care. In Rights to Health Care, ed. Thomas J. Bole and William B. Bondeson, pp. 1-19. Boston: Kluwer Academic, 1991.Broome, John. Fairness Versus Doing the Most Good. [Commentary]. Hastings Center Report 24 (4): 36-39, July-August 1994.Campbell, Courtney S. Gifts and Caring Duties in Medicine. In Duties to Others, ed. Courtney S. Campbell and B. Andrew Lustig, pp. 181-97. Boston: Kluwer Academic, 1994.Carson, Ronald A.; Callahan, Sidney; Ross, Judith Wilson; and May, William F. Spirit, Emotion, and Meaning: The Many Voices of Bioethics. Hastings Center Report 24 (3): 26-27, May-June 1994.Charlesworth, Max. Bioethics in a Liberal Society. New York: Cambridge University Press, 1993. 172 p.Cherbas, Peter. Paradigms and Our Shrinking Bioethics. Indiana Law Journal 69 (4): 1105-13, Fall 1994.Childress, James F. Ethical Theories, Principles, and Casuistry in Bioethics: An Interpretation and Defense of Principlism. In Religious Methods and Resources in Bioethics, ed. Paul F. Camenisch, pp. 181-201. Boston: Kluwer Academic, 1994.Childress, James F., and Fletcher, John C. Individualism and Community: The Contested Terrain of Respect for Autonomy. Hastings Center Report 24 (3): 34-35, May-June 1994.Clouser, K. Danner, and Gert, Bernard. A Critique of Principlism. Journal of Medicine and Philosophy 15 (2): 219-36, April 1990.Devettere, Raymond J. Clinical Ethics and Happiness. Journal of Medicine and Philosophy 18 (1): 71-89, February 1993.DeGrazia, David. Moving Forward in Bioethical Theory: Theories, Cases, and Specified Principlism. Journal of Medicine and Philosophy 17 (5): 511-39, October 1992.Donnelly, William J. From Principles to Principals: The New Direction in Medical Ethics. [Commentary]. Theoretical Medicine 15 (2): 141-48, June 1994.Downie, Robin. Health Care Ethics and Casuistry. [Editorial]. Journal of Medical Ethics 18 (2): 61-62, 66, June 1992. [End Page 280]DuBose, Edwin R.; Hamel, Ronald P.; and O'Connell, Laurence J., eds. A Matter of Principles? Ferment in U.S. Bioethics. Valley Forge, PA: Trinity Press International, 1994. 381 p.Fox, Renée C. The Entry of U.S. Bioethics into the 1990s: A Sociological Analysis, pp. 21-71.Gudorf, Christine E. A Feminist Critique of Biomedical Principlism, pp.164-81.Campbell, Courtney S. Principlism and Religion: The Law and the Prophets, pp. 182-208.Charon, Rita. Narrative Contributions to Medical Ethics: Recognition, Formulation, Interpretation, and Validation... (shrink)

First-order logic. The origin of modern foundational studies. Frege's system and the paradoxes. The teory of types. Zermelo-Fraenkel set theory. Hilbert's program and Godel's incompleteness theorems. The foundational systems of W.V. Quine. Categorical algebra.

This book presents and survey of the foundations of mathematics. The emphasis is on a mathematical comparison of systems rather than on any exhaustive development of analysis within a single system. Nevertheless, for most systems considered, enough details are given for the development of arithmetic, and the method of constructing the other notions of analysis is indicated. The elements of the general theory of cardinal and ordinal numbers are also furnished in the course of this work.

Volume 19, Issue 11, November 2019, Page 9-12.

Accessibilism is a version of epistemic internalism on which justification is determined by what is accessible to the subject. I argue that misunderstandings of accessibilism have hinged on a failure to appreciate an ambiguity in the phrase ‘what is accessible to the subject’. I first show that this phrase may either refer to the very things accessible to the subject, or instead to the facts about which things are accessible to her. I then discuss Ralph Wedgwood’s (2002: 350-352) argument that (...) accessibilism absurdly implies that an infinite regress of facts, each more complex than the last, must be accessible to the subject. I show that this regress objection only threatens the ‘very things’ disambiguation of accessibilism, not the ‘facts about’ disambiguation. After this, I discuss the relationships between the motivations for accessibilism and these two disambiguations. We will see that these motivations appear to support each disambiguation. But I will argue this appearance depends on a mistake. Just as only the ‘facts about’ disambiguation escapes the regress objection, it is also the only disambiguation which enjoys genuine support from the motivations for accessibilism. For these reasons, I recommend that future discussions of accessibilism focus on the ‘facts about’ disambiguation. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics, 3rd ed. By Tom Beauchamp and James Childress Moral Theory and Moral Judgments in Medical Ethics, Baruch Brody. Theory and Practice in Medical Ethics. By Glenn C. Graber and David C. Thomasma.

This autobiographical piece is in response to Frank Fair’s kind invitation to write a reflective piece on my involvement over the last 30 years in the critical thinking movement, with special attention given to 18 years of assessment data as I assessed students’ critical thinking outcomes at Baker University. The first section of the paper deals with my intellectual history and how I came to a specific understanding of CT. The second deals with the Baker Experiment in combining instruction in (...) CT with written composition, with a special focus on Deductive Reconstruction. The third section goes over our attempts at assessment and what we discovered by using three separate tests. The final section of the paper presents my conclusions about the challenges of teaching CT based on the Baker Experiment. (shrink)

After critiquing the arguments against using formal logic to teach critical thinking, this paper argues that for theoretical, practical, and empirical reasons, instruction in the fundamentals of formal logic is essential for critical thinking, and so should be included in every class that purports to teach critical thinking.

Critical thinking is considered an essential educational goal. As a result, many philosophers dreamed their departments would offer multiple sections of CT, hence justifying hiring additional staff. Unfortunately, this dream did not materialize. So, similar to a current theory about teaching writing, “critical thinking across the curriculum” has become a popular idea. While the idea has appeal and unquestionable merit, I will argue that the likelihood the skills necessary for effective CT will actually be taught is minimal.

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with (...) the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions. (shrink)

The late Dr. William Hatcher was renowned both as an accomplished mathematician, logician and philosopher, and as one of the world?s foremost Bahá?í scholars. To those who knew him, he was also refreshingly approachable, supportive, honest and engaging. In this small but richly insightful volume, modern mathematics and logic meet religion and philosophy in a new and stimulating way. The five essays are entitled: "Platonism and Pragmatism", "Myths, Models and Mysticism", "From Metaphysics to Logic", "A Logical Solution to the (...) Problem of Evil", and "Science and the Bahá?í Faith" With characteristic originality, Dr. Hatcher explores the interface between these disciplines now approaching each other after centuries of mutual mistrust. These valuable intellectual contributions assist the reader to bring into closer harmony the two ultimate realms expressive of essential human nature - namely that of science and of religion. (shrink)

Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention—a bridge to recovery or transplant—not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of (...) withdrawal, including distributive justice, quality of life, patients’ rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned. (shrink)

Since the 80s, educators have supported instruction in critical thinking as “an Educational Ideal.” This should not be a surprise given some of the more common conceptions, e.g., Ennis’s “reasonable reflective thinking on what to believe or do,” or Siegel’s “being appropriately moved by reasons,” as opposed to bias, emotion or wishful thinking. Who would want a doctor, lawyer, or mechanic who could not skillfully evaluate arguments, causes, and cures? So, educators endorsed the dream that, through proper CT instruction, students’ (...) critical skills and “rational passions” could be greatly improved. In spite of the dream’s appeal, the reality is, after 30+ years, there is little reason to think the dream resembles reality. After describing what I take to be an adequate definition of CT, such a depressing conclusion will be supported by CT assessment scores from across academe, the continued widespread disagreement among experts in nearly all fields, including CT, and the abundant psychological research on rationality and decision making. And finally, while the ideal extols the value of objectivity, I shall argue that bias may be unavoidable because personal values play a vital role in the evaluation of many arguments. (shrink)

What is consciousness? How does the subjective character of consciousness fit into an objective world? How can there be a science of consciousness? In this sequel to his groundbreaking and controversial The Conscious Mind, David Chalmers develops a unified framework that addresses these questions and many others. Starting with a statement of the "hard problem" of consciousness, Chalmers builds a positive framework for the science of consciousness and a nonreductive vision of the metaphysics of consciousness. He replies to many (...) critics of The Conscious Mind, and then develops a positive theory in new directions. The book includes original accounts of how we think and know about consciousness, of the unity of consciousness, and of how consciousness relates to the external world. Along the way, Chalmers develops many provocative ideas: the " consciousness meter", the Garden of Eden as a model of perceptual experience, and The Matrix as a guide to the deepest philosophical problems about consciousness and the external world. This book will be required reading for anyone interested in the problems of mind, brain, consciousness, and reality. (shrink)

1 Th. 5:17 tells us to pray without ceasing. Many have worried that praying without ceasing seems impossible. Most address the problem by giving an account of the true nature of prayer. Unexplored are strategies for dealing with the problem that are neutral on the nature of prayer, strategies consistent, for example, with the view that only petition is prayer. In this article, after clarifying the nature of the problem for praying without ceasing, I identify and explore the prospects of (...) five different strategies that are neutral in this sense. I also raise problems for each strategy. (shrink)

I first clarify the idea that blameworthiness requires consciousness as the view that one can be blameworthy only for what is a response to a reason of which one is conscious. Next I develop the following argument: blameworthiness requires exercising control in a way distinctive of persons and doing this, in view of what it is to be a person, requires responding to a reason of which one is conscious. Then I defend this argument from an objection inspired by Arpaly (...) and Schroeder according to which responding to moral reasons suffices for exercising control distinctive of persons. (shrink)

"A very good book indeed: there is scarcely an issue anyone has thought to raise about the topic which Childress fails to treat with sensitivity and good judgement....Future discussions of paternalism in health care will have to come to terms with the contentions of this book, which must be reckoned the best existing treatment of its subject."--Ethics. "A clear, scholarly and balanced analysis....This is a book I can recommend to physicians, ethicists, students of both fields, and to those most (...) affected--the patients themselves."--Edmund D. Pellegrino, John Carroll Professor of Medicine and Medical Humanities, Georgetown University Medical Center. (shrink)

Some researchers have claimed that there is no significant correlation between students’ majors and their performance on standardized critical thinking tests. This paper provides both evidence and arguments that that claim may well be false. Besides arguments based on the correlation between students’ majors and other standardized tests, data from Baker University’s Critical Thinking and Writing Program show large differences in effect size gains relative to students’ majors.

This paper provides evidence and arguments that, given the choice of teaching critical thinking and written composition as separate, stand-alone courses or combining them, the two should be combined into an integrated sequence.

In this paper, after showing how the postmodern critiques of Enlightenment rationality apply to critical thinking, I argue that a critical discussion on any subject must assume specific principles of rationality. I then show how these principles can be used to critique and reject postmodern claims about the contextual nature of rationality.

In "The Problem with Percy: Epistemology, Understanding and Critical Thinking," Sharon Bailin argues that critical thinking skills do not generalize because students do not understand the larger epistemological picture in which to situate the importance of arguments and reasons. More plausible explanations are: (I) instructors across the disciplines do not give assignments requiring critical thinking (CT) skills, (2) single courses in CT have little effect, (3) pragmatic arguments showing the effectiveness of CT are more effective than epistemological arguments with the (...) average student. So to achieve the generalization of the logical skills and intellectual dispositions inherent in CT courses, CT thinking cannot be departmentalized. (shrink)