Two attitudes are possible: one, that the world is an absolute jungle and that the exercise of coercive power by rulers is only a manifestation of this; and the other, that it is both necessary and right that there should be this exercise of power, that through it the world is much less of a jungle than it could possibly be without it, so that one should in principle be glad of the existence of such power, and only take exception (...) to its unjust exercise. (shrink)

Editor James Fetzer presents an analytical and historical introduction and a comprehensive bibliography together with selections of many of Carl G. Hempel's most important studies to give students and scholars an ideal opportunity to appreciate the enduring contributions of one of the most influential philosophers of science of the 20th century.

Moral enhancement is an ostensibly laudable project. Who wouldn’t want people to become more moral? Still, the project’s approach is crucial. We can distinguish between two approaches for moral enhancement: direct and indirect. Direct moral enhancements aim at bringing about particular ideas, motives or behaviors. Indirect moral enhancements, by contrast, aim at making people more reliably produce the morally correct ideas, motives or behaviors without committing to the content of those ideas, motives and/or actions. I will argue, on Millian grounds, (...) that the value of disagreement puts serious pressure on proposals for relatively widespread direct moral enhancement. A more acceptable path would be to focus instead on indirect moral enhancements while staying neutral, for the most part, on a wide range of substantive moral claims. I will outline what such indirect moral enhancement might look like, and why we should expect it to lead to general moral improvement. (shrink)

The current prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support an important public good. Consequently, all have a duty to participate. The (...) current social norm is that individuals participate only if they have a good reason to do so. The public goods argument implies that individuals should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making society significantly healthier and longer lived. (shrink)

While philosophers are often concerned with the conditions for moral knowledge or justification, in practice something arguably less demanding is just as, if not more, important – reliably making correct moral judgments. Judges and juries should hand down fair sentences, government officials should decide on just laws, members of ethics committees should make sound recommendations, and so on. We want such agents, more often than not and as often as possible, to make the right decisions. The purpose of this paper (...) is to propose a method of enhancing the moral reliability of such agents. In particular, we advocate for a procedural approach; certain internal processes generally contribute to people’s moral reliability. Building on the early work of Rawls, we identify several particular factors related to moral reasoning that are specific enough to be the target of practical intervention: logical competence, conceptual understanding, empirical competence, openness, empathy and bias. Improving on these processes can in turn make people more morally reliable in a variety of contexts and has implications for recent debates over moral enhancement. (shrink)

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

Some philosophers argue that any attempt to model changing the past will either be contradictory or really model avoiding the past. Using Nicholas Smith's (1997) argument as a basis, I formulate a generic version of this Avoidance Argument. I argue that the Avoidance Argument fails because (i) it involves an equivocation of what is meant by ‘bifurcation of the time of an event’ and (ii) resolving the equivocation results in the falsity of at least one of the premises. Hence, the (...) Avoidance Argument will not support the claim that changing the past is logically impossible. (shrink)

The concept of facticity denotes conditions of experience whose necessity is not logical yet whose contingency is not empirical. Although often associated with Heidegger, Fichte coins ‘facticity’ in his Berlin period to refer to the conclusion of Kant’s metaphysical deduction of the categories, which he argues leaves it a contingent matter that we have the conditions of experience that we do. Such rhapsodic or factical conditions, he argues, must follow necessarily, independent of empirical givenness, from the I through a process (...) of ‘genesis.’ I reconstruct Fichte’s argument by tracing the origin of his neologism, presenting his Jena critique of Kant’s rhapsodic appeal to the forms of judgment, and illustrating the Jena period’s continuity with the Berlin period’s genetic method, while noting a methodological shift whereby Fichte directs his critique against his own doctrine of intellectual intuition in order to eliminate its ‘factical terms.’. (shrink)

It is now nearly axiomatic among Platonic scholars that the Timaeus and its unfinished sequel the Critias belong to the last stage of Plato's writings. The Laws is generally held to be wholly or partly a later production. So, by many, is the Philebus, but that is all. Perhaps the privileged status of the Timaeus in the Middle Ages helped to fix the conviction that it embodies Plato's maturest theories.

Some statements couched in the present tense have no reference to time. They are, if you like, grammatically tensed but logically tenseless. Mathematical statements such as ‘twice two is four’ or ‘there is a prime number between 125 and 128’ are of this sort. So is the statement I have just made. To ask in good faith whether there is still the prime number there used to be between 125 and 128 would be to show that one did not understand (...) the use of such statements, and so would any attempt to answer the question. It is tempting to take another step and talk of such timeless statements as statements about timeless entities. If the number 4 neither continues nor ceases to be twice two this is, surely, because the number 4 has no history of any kind, not even the being a day older today than yesterday. Other timeless statements might shake our confidence in this inference: ‘clocks are devices for measuring time’ is a timeless statement, but it is not about a class of timeless clocks. But, given a preoccupation with a favoured set of examples and a stage of thought at which men did not distinguish the properties of statements from the properties of the things they are about, we can expect timeless entities to appear as the natural proxies of timeless statements. (shrink)

Fichte argues that the conclusion of Kant’s transcendental deduction of the categories is correct yet lacks a crucial premise, given Kant’s admission that the metaphysical deduction locates an arbitrary origin for the categories. Fichte provides the missing premise by employing a new method: a genetic deduction of the categories from a first principle. Since Fichte claims to articulate the same view as Kant in a different, it is crucial to grasp genetic deduction in relation to the sorts of deduction that (...) Kant offers. I propose to interpret genetic deduction as the simultaneous fulfillment of two tasks: answering the question quid facti by deriving the categories from the I and answering the question quid juris by establishing our entitlement to the categories as conditions of experience. While the second task represents Fichte’s agreement with Kant’s transcendental deduction, the first reflects his correction of Kant’s metaphysical deduction. (shrink)

In recent years there has been a surge in corporate governance reform around the world. On the African continent this phenomenon is evident in the number of national corporate governance reports that have been produced. This article analyzes these national codes of corporate governance in Africa to determine how the relationship between corporate governance and business ethics is being perceived. The article commences by providing a background to the corporate governance reform process that still is in the making in Africa. (...) It then explores the relation between corporate governance and business ethics by looking at various aspects of corporate governance that might have an impact on how business ethics is being perceived and practiced. Finally new corporate governance developments that potentially might have an impact on the prominence and practice of business ethics are reviewed. (shrink)

Throughout his career, Schelling assigns knowledge of the absolute first principle of philosophy to intellectual intuition. Schelling's doctrine of intellectual intuition raises two important questions for interpreters. First, given that his doctrine undergoes several changes before and after his identity philosophy, to what extent can he be said to “hold onto” the same “sense” of it by the 1830s, as he claims? Second, given that his doctrine of intellectual intuition restricts absolute idealism to what he calls a “science of reason”, (...) which he says cannot prove the absolute’s existence, what other doctrine does he require in order to prove this? I will answer these questions by tracing the shifts in Schelling’s doctrine of intellectual intuition from the 1790s to the 1830s and drawing out its evolving methodological role within his science of intelligibility. (shrink)

This paper explores the concept of hope in Aristotle’s philosophy. First, I note that Aristotle contrasts hopefulness with the virtue of courage, although hopefulness can be a source of courage in some contexts, because hopefulness can create confidence. Next, I examine hope in relation to fear, defending Aristotle’s claim that without hope we cannot fear, and suggesting that hope, as a foundation for both fear and confidence, is a fundamental requirement for deliberation. Finally, I look at the hopefulness that underlies (...) Aristotle’s virtue of high-mindedness, concluding that hopefulness is a foundation for self-confidence and ethical self-improvement. (shrink)

We apply the distinction between parameter independence and outcome independence to the linear and nonlinear models of a recent nonrelativistic theory of continuous state vector reduction. We show that in the nonlinear model there is a set of realizations of the stochastic process that drives the state vector reduction for which parameter independence is violated for parallel spin components in the EPR-Bohm setup. Such a set has an appreciable probability of occurrence (≈ 1/2). On the other hand, the linear model (...) exhibits only extremely small parameter dependence effects. We investigate some specific features of the models and we recall that, as has been pointed out recently, if one wants to be able to speak of definite outcomes (or equivalently of possessed objective elements of reality) at finite times, one has to slightly change the criteria for their attribution to physical systems. The concluding section is devoted to a detailed discussion of the difficulties which one meets when one tries to take, as a starting point for the formulation of a relativistic theory, a nonrelativistic scheme which exhibits parameter dependence. Here we derive a theorem which identifies the precise sense in which the occurrence of parameter dependence forbids a genuinely relativistic generalization. Finally we show how the appreciable parameter dependence of the nonlinear model gives rise to problems with relativity, while the extremely weak parameter dependence of the linear model does not give rise to any difficulty, provided one takes into account the appropriate criteria for the attribution of definite outcomes. (shrink)

Graduate-level historical study is ideal for students intending to specialize in the topic, as well as those who only need a general treatment. Part I discusses traditional and symbolic logic. Part II explores the foundations of mathematics, emphasizing Hilbert’s metamathematics. Part III focuses on the philosophy of mathematics. Each chapter has extensive supplementary notes; a detailed appendix charts modern developments.

Our understanding of Schelling’s internal critique of German idealism, including his late attack on Hegel, is incomplete unless we trace it to the early “Philosophical Letters on Dogmatism and Criticism,” which initiate his engagement with the problem of systematicity—that judgment makes deriving a system of a priori conditions from a first principle necessary, while this capacity’s finitude makes this impossible. Schelling aims to demonstrate this problem’s intractability. My conceptual aim is to reconstruct this from the “Letters,” which reject Fichte’s claim (...) that the Wissenschaftslehre is an unrivalled system. I read Schelling as charging Fichte with misrepresenting a system’s livability or commensurability with our finitude. My historical aim is to provide a framework for understanding Schelling’s Freiheitsschrift, which argues that a system’s liveability depends on its incompleteness or limitation by our finitude. On my reading, Schelling is early and continually committed to systematicity within the bounds of human finitude. (shrink)

In the late 1810s and 1820s the Edinburgh phrenologists were largely concerned with trying to establish phrenology as the true science of mind. They challenged the accepted theories about the nature of mind and the brain; in turn, phrenology was attacked by the proponents of Scottish common-sense philosophy and by some medical men. The ensuing debate, which is discussed as an example of conflict between incommensurable world-views, involved a wide range of contentious theological, philosophical, scientific and methodological issues.

Aristotle argued that you need some wealth to live well. The Stoics argued that you could live well with or without wealth. But the Cynics argued that wealth is a hinderance. For the Cynics, a good life consists in self-sufficiency, or being able to rule and help yourself. You accomplish this by living simply and naturally, and by subjecting yourself to rigorous philosophical exercises. Cynics confronted people to get them to abandon extraneous possessions and positions of power to live better. (...) And while the Cynics were experts in living in this way, their ascetic lifestyles made their message curious to some audiences. This paper reflects on Cynic ascetic practices and the ways others perceived them. (shrink)

The term "non-monotonic logic" covers a family of formal frameworks devised to capture and represent defeasible inference , i.e., that kind of inference of everyday life in which reasoners draw conclusions tentatively, reserving the right to retract them in the light of further information. Such inferences are called "non-monotonic" because the set of conclusions warranted on the basis of a given knowledge base does not increase (in fact, it can shrink) with the size of the knowledge base itself. This is (...) in contrast to classical (first-order) logic, whose inferences, being deductively valid, can never be "undone" by new information. (shrink)

Research examining firm and industry effects on performance has primarily focused on the financial aspects of firm performance. Corporate social performance is a major aspect of firm performance that has been under-examined empirically in the literature to date. Adding to the fundamental debate regarding firm versus industry effects on performance, this study uses data drawn from the Kinder, Lydenberg and Domini Co. database to examine the degree to which CSP is related to firm, industry, and temporal factors. The results of (...) these analyses suggest that CSP tends to change in a linear manner over time; however, the slope of this line varies across firms and industries. These findings are supported by several robustness checks accounting for autocorrelation, alternative measures of industry, different samples commonly used when using KLD data to measure CSP, and alternative measures of CSP when using the KLD database. The authors also directly compare firm, industry, and temporal effects between CSP and financial performance. (shrink)

Originally published in 1965. This is a textbook of modern deductive logic, designed for beginners but leading further into the heart of the subject than most other books of the kind. The fields covered are the Propositional Calculus, the more elementary parts of the Predicate Calculus, and Syllogistic Logic treated from a modern point of view. In each of the systems discussed the main emphases are on Decision Procedures and Axiomatisation, and the material is presented with as much formal rigour (...) as is compatible with clarity of exposition. The techniques used are not only described but given a theoretical justification. Proofs of Consistency, Completeness and Independence are set out in detail. The fundamental characteristics of the various systems studies, and their relations to each other are established by meta-logical proofs, which are used freely in all sections of the book. Exercises are appended to most of the chapters, and answers are provided. (shrink)

In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or (...) physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998). (shrink)

Intentionality in Interaction revisits some of the classical questions to be found in the original programme for second-personal studies as established in Thompson's 2001 JCS issue and sheds new light on them, witnessing the evolving dynamics of such a programme over the last decade. The contributions in this issue approach the questions of how persons share intentions, emotions, and experiences, of how interaction is shaped by and transforms affection, emotion, and cognition, and of how such interactions develop over time and (...) provide important insights into the development of human capacities in general, both in normal and pathological cases. In this introduction, we situate the special issue in the context of social cognition in general and second-personal studies in particular. We propose an outline of a new framework to approach questions regarding interaction and its development and evolution, a framework based on a novel understanding of interaction in terms of engagement between persons. (shrink)

Research ethics committees are charged with providing an opinion on whether research proposals are ethical. These committees are overseen by a central office that acts for the Department of Health and hence the State. An advisory group has recently reported back to the Department of Health, recommending that it should deal with inconsistency in the decisions made by different RECs. This article questions the desirability and feasibility of questing for consistent ethical decisions.

After briefly reviewing the standard set-theoretic resolutions of the Burali-Forti paradox, we examine how the paradox arises in set theory formalized with plural quantifiers. A significant choice emerges between the desirable unrestricted availability of ordinals to represent well-orderings and the sensibility of attempting to refer to ‘absolutely all ordinals’ or ‘absolutely all well-orderings’. This choice is obscured by standard set theories, which rely on type distinctions which are obliterated in the setting with plurals. Zermelo's attempt ( 1930 ) to secure (...) ordinal representability of arbitrary well-orderings through relativization of quantification to set-theoretic models is reviewed and found wanting. The natural modal-structural recasting provides, it is claimed, a good repair. (shrink)

How should religion and ethics be studied if we want to understand what people believe and why they act the way they do? An energetic guide to the study of religion and ethics, rejecting theories from postmodernism and cognitive science in favour of a return to pragmatic enquiry.

The foregoing considerations support the conjecture that prototypes are semi-compositional in the sense that there exist unboundedly many combinations of nouns with non-exceptional adjectives, which satisfy the rule default-to-prototype and hence are compositional. Presumably there also exist unboundedly many combinations of nouns with exceptional adjectives, which violate DP and hence are non-compositional. An analysis of the connection between productivity and compositionality has been suggested by Robbins. He argues that, for the explanation of productivity, one need not assume that conceptual meanings (...) always compose—it is enough that they compose in infinitely many cases. Since semi-compositionality entails the existence of unboundedly many non-compositional cases, non-compositionality cannot be dealt away with a finite list of idiomatic exceptions, but is a genuine feature of prototype semantics in natural language. (shrink)

Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of “personality disorder” is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and may become, (...) in itself, a therapeutic intervention. (shrink)

Dutch developments on euthanasia have drawn much attention over the years. Defenders and opponents have been telling very different stories about the practice of euthanasia and the frequency of cases, and the Dutch government has been struggling with the legal and moral problems involved. Concern about the procedures followed by physicians as well as questions on the “real” figures led the government to decide to organize an epidemiological study on the extent and the decision making. The results of the study (...) were published in November 1991. Interpretation of the data may lead to a final settlement of the debate on euthanasia and has inevitably led to a revival of the moral debate of the 1970s. For the moment it has been decided that euthanasia will remain officially illegal under the Penal Code. However, in cases where euthanasia does occur, Attorneys General will continue to check the procedures followed by physicians to ensure no abuses have occurred and to safeguard physicians against prosecution. In this contribution, we discuss the development and intertwinement of legal, medical, and moral aspects of euthanasia in The Netherlands and the effects of the empirical studies of 1991, both on definitions and procedures for medical decisions at the end of life. (shrink)

Currently, brain tissue transplantations are being developed as a clinical-therapeutic tool in neurodegenerative diseases such as Parkinson's or Alzheimer's disease. From an ethical point of view, distinguishing between the preservation and an alteration of personal identity seems to be central to determining the scope for further application of brain tissue transplantation therapy. The purpose of this article is to review "standard" arguments which are used on the one hand by proponents to prove preservation of personal identity and by opponents on (...) the other hand to prove that brain tissue transplantation results in an altered personal identity. Proponents and opponents are shown to use the same arguments, albeit with different presuppositions. These presuppositions concern the meaning of the term "identity", either numerical or qualitative, the definition of brain identity, either structurally or functionally, and the relationship between mental states, psychological functions and neurophysiological properties as criteria for personal identity. Furthermore the respective neurophysiological, clinical and philosophical evidence for the different presuppositions are discussed. It is concluded that evaluation of personal identity in brain tissue transplantation should not only rely on the "standard" arguments but, additionally, neurophysiological, clinical and philosophical implications should be discussed. (shrink)

The principle of “equivalence of care” in prison medicine is a principle by which prison health services are obliged to provide prisoners with care of a quality equivalent to that provided for the general public in the same country. It is cited in numerous national and international directives and recommendations.The principle of equivalence is extremely relevant from the point of view of normative ethics but requires adaptation from the point of view of applied ethics. From a clinical point of view, (...) the principle of equivalence is often insufficient to take account of the adaptations necessary for the organization of care in a correctional setting. The principle of equivalence is cost-effective in general, but has to be overstepped to ensure the humane management of certain special cases. (shrink)

Research has demonstrated that employee reactions to monitoring systems depend on both the characteristics of the monitoring system and how it is implemented. However, little is known about the role individual differences may play in this process. This study proposes that individuals have generalized attitudes toward organizational control and monitoring activities. We examined this argument by assessing the relationship between employees’ baseline attitudes toward a set of monitoring and control techniques that span the employment relationship. We further explore the effects (...) of employees’ generalized attitudes toward monitoring and their individual ethical orientations on their attitudinal reactions to an Internet monitoring system implemented in their workplace. Results of a longitudinal study indicate that as expected, prior beliefs and ethical orientation interact to affect employees’ reactions to monitoring systems. Implications for research and practice are discussed. (shrink)

The practice of paternalism has changed along with developments in medicine, philosophy, law, sociology and psychology. Physicians have learned that a patient's values are a factor in determining what is best for that patient. Modern paternalism continues to be guided by the principle that the physician decides what is best for the patient and pursues that course of action, taking into account the values and interests of the patient. In the autonomy model of the doctor-patient relationship, patient values are decisive. (...) In the paternalistic model, they are but one among several factors the physician must consider in making a medical decision. Although difficult to practise because of limitations in empathising with another person, modern paternalism remains a way to achieve maximum patient benefit. (shrink)

The volume also publishes for the first time a part of his Debrecen Ph.D. thesis and it is concluded by a bibliography of his Hungarian writings.

Anterior cingulate cortex {ACC} is a part of the brain's limbic system. Classically, this region has been related to affect, on the basis of lession studies in human and in animals. In the late 1980s, neuroimaging research indicated that ACC was active in many studies of cognition. The finding from EEG studies of a focal area of negativity in scalp electrodes following an error response led to the idea that ACC might be the brain's error detection and correction device.

This chapter contains sections titled: “Pedagogy” and “Science” The Educational Reform Movement of the Eighteenth Century Kant, Hegel, and the Reform Movement Kant Hegel Conclusion.

Among the most outstanding discoveries of the last century is one that is not quite as momentous as the theory of relativity or cybernetics. It may even still be enigmatic. It has no one single author, it is not expressed in a single formula, conception, or invention. Nonetheless it is worth all the others combined.

Anselm: I agreed that Pegasus is a flying horse according to the stories people tell, the paintings painters paint and so on . That is, Pegasus is a flying horse in the understanding of storytellers, their readers and the artists who depict Pegasus. You asked whether flying is not an unmediated causal power . Well, it could be an unmediated causal power if you or I had it, but not if a being with only mediated powers had it. And so (...) poor Pegasus, a being whose powers are only those given him by storytellers and artists, has only the mediated power of flying that they have given him. He flies in the thoughts and depictions of beings with unmediated powers. Still, Pegasus has not only the mediated power to fly but also the mediated power to entertain us, and perhaps even inspire us. Fool: But people could tell stories about you, too, about how you sprouted wings and flew onto the roof of Canterbury Cathedral. Anselm: Alas, if it were only in stories that I could do that, then flying would not be an unmediated causal power of mine. I would still have unmediated causal powers all right, and so would be greater than Pegasus. But flying is not one of my unmediated causal powers. However, something than which nothing greater can be conceived would, and does, as I have proved in my Proslogion, have unmediated causal powers – indeed, much greater unmediated causal powers than any poor mortals like you and me.1 •↵1 For …. (shrink)

The TRIPS agreement has been widely discussed. Critics have accused it to favour property rights at the cost of public health in AIDS-stricken development countries. In this article, the conflict between on the one hand Intellectual Property Rights and on the other a right to subsistence is analysed with the help of a method for specification. The rationalization of TRIPS and its amendments raises two questions for ethics, one normative and one meta-ethical. First, which right has priority: the right to (...) property or the right to subsistence? Second, how can conflicting rights be reconciled in a coherent ethical system. The aim of the article is to answer these two questions and in order to do that the method of specification developed by the philosopher Henry Richardson is applied. The result is a specified norm applicable for this kind of rights conflicts. (shrink)

Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where not for resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients. Having previously involved patients in CPR decision-making, we chose formally to explore the reasons behind the choices made. Although the patients were not upset, and readily decided at the time (...) of initial consultation, on later analysing the decision-making we found poor understanding of the procedure, poor recall of information given and in some cases evidence of harm. This may be attributed to impaired decision-making capacity of elderly hospitalised patients as previously shown, or to the discomfort precipitated by having to contemplate the apparent immediacy of cardiac arrest by these patients. We propose that subscribing to autonomy as a general principle needs to be balanced against particular cases where distress may be caused by, or result in, diminished competence and limited autonomy. (shrink)

Throughout his career Aquinas held to the Avicennian doctrine that the nature or essence of sensible substances is somehow indifferent. According to Aquinas's version of this well-known doctrine an essence as such posssesses only those characteristics which are specified in its definition. The essence of a human being, for instance, possesses as such animality and rationality and nothing else. On this view, all the other characteristics and in particular general properties like being one or many, universal or particular, do not (...) belong to essence as such, but are attributed to it only in so far as it enjoys a particular mode of existence. Essence, for instance, is in itself neither universal nor particular, but is universal in so far as it exists in the intellect and particular in its extra-mental existence in different individuals. Although Aquinas is entirely consistent all through his career in maintaining that essence as such is neither universal nor particular, there is a point of viw from which the essence of a sensible substance can be regarded as universal or common, namely the point of view of inviduation. (shrink)

Traditionally, surgical practice has been experiential and based on the contemporary understanding of basic mechanisms of disease. It was both a science and an art and depended to far too great an extent on the individualism and self belief of its main exponents. “Evidence based medicine” emerged in the 1980s and a new gospel of “Rules of Evidence” was introduced. There is no doubt that the net effect of EBM has been beneficial, but over reliance on randomised controlled trials and (...) the lack of generalisability of scientific evidence to individual patients has perhaps led to less enthusiasm for its tenets among surgeons. There are valid and spurious reasons for this that are discussed. The situation is improving but inevitable tensions remain between the surgeon committed to the individual patient here and now, and the clinical researcher whose focus is the benefit of future patients in the larger community. (shrink)