English, French, German, and Italian, with summaries in the same languages.

Consensus is growing among ethicists and lawyers that medical decision making for incompetent patients who were previously competent should be made in accordance with that person's prior wishes and desires. Moreover, this legal and ethical preference for the substituted judgment standard has found its way into the daily practice of medicine. However, what appears on the surface to be an agreement between jurists, bioethicists, and clinicians obscures the very real differences between disciplines regarding the actual implementation of the sub stituted (...) judgment standard. Ethicists and judges have carefully outlined how substituted judgments ought to be made and evaluated. Although differences arise, especially at the state court level, regarding the scope of the substituted judgment standard and its relation to other standards of surrogate decision making, agreement is fairly widespread on the priority of substituted judgment and on the necessity of sufficient evidence being available in order to support a particular substituted judgment. (shrink)

This paper is a personal account of the events associated with the author’s work at the University of Toronto’s Hospital for Sick Children on a drug, deferiprone, for the treatment of thalassaemia. Trials of the drug were sponsored by the Canadian Medical Research Council and a drug company which would have been able, had the trials been successful, to seek regulatory approval to market the drug. When evidence emerged that deferiprone might be inadequately effective in a substantial proportion of patients, (...) the drug company issued legal threats when the author proposed informing her patients and the scientific community. Until protests were made by international authorities in her field of research, the hospital and university did not adequately support the author’s academic freedom and responsibilities as a medical practitioner. It is argued that underlying cause of this, and of other similar cases, is the political philosophy which is driving the commercialisation of universities and bringing about the deregulation of drug approval procedures. Together these changes constitute a serious threat to the public good. (shrink)

Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five (...) distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient. (shrink)

Acting for the good of the patient is the most fundamental and universally acknowledged principle of medical ethics. However, given the complexity of modern medicine as well as the moral fragmentation of contemporary society, determining the good is far from simple. In his philosophy of medicine, Edmund Pellegrino develops a conception of the good that is derived from the internal morality of medicine via the physician-patient relationship. It is through this healing relationship that rights, duties, and privileges are defined for (...) both physicians and patients. Moreover, this relationship determines the characteristics or virtues that are necessary to engage in the medical telos. This paper addresses the role of the moral virtues in clinical medicine and the physician-patient relationship. First, it provides a brief background of the Aristotelian foundations of virtue-ethics. Second, it delves into Pellegrino’s philosophy of medicine understood as a practice oriented towards a teleological goal. Third, it relates the telos of medicine to the notion of the medical community as a fundamentally moral community. Finally, it concludes with a section that creates a dialogue between virtue ethics and principlism. (shrink)

1. Une polémique historique En matière de syntaxe, la notion de corpus fut très controversée et reste encore problématique. Avant Chomsky, les structuralistes utilisaient des corpus, mais le terme désignait alors un échantillon représentatif et homogène d’un aspect syntaxique particulier ou d’une langue donnée et était utilisé dans une perspective behaviouriste exlusivement empiriste et taxinomique. C’est contre ce type de « corpus » que Chomsky s’est prononcé lorsqu’il a commencé à développe...

The Description for this book, Machiavelli in Hell, will be forthcoming.

In lieu of an abstract, here is a brief excerpt of the content:Leibniz on Innate Ideas and the Early Reactions to the Publication of the Nouveaux Essais (1765)* GIORGIO TONELLI LIzmNIz' Nouve~ Essais,written in 1703-1705 (citedhereafter as NE), were posthumously published by Raspe x in 1765, at the beginning of a Leibniz revivalwhich was alsomarked by thelargeDutens editionof 1768. As the greatupheaval in Kant's thought took place in 1769, and as thisupheaval had as one of itsmain characteristicsthe rejection of (...) sensibility as the sole source of knowledge,2 it is easy to infer that Kant's reading of the NE may have been one of the elements prompting him to adopt his new solution. It is not the ambition of this paper to answer that difficult question: rather it is an attempt towards clearing the ground for an answer to it, by inquiring into the early reactions of philosophical circles, especially German, to the appearance of the NE. To what extent was the significance of the particular doctrines expounded in the NE noticed? To what extent did contemporary philosophers realize that these were to profoundly modify the picture of Leibniz' psychological tenets? And, therefore, to what extent could Kant have been stimulated by a widespread reaction to pay special attention to the peeu!ia~lies of that work7 In conformity with this purpose, I shall focus my research on the question o/the origin of knowledge. As it is my task to reconstruct a general philosophical atmosphere, I will not confine my research to philosophic reactions prior to 1769, but will also take into consideration some attitudes of the following decade. As frequently happens in the history of ideas, the impact of a certain event may be noticed almost immediately after its occurrence, but the documentation of its effects may be available only after a certain delay. But they are nevertheless indicative of that prior impact. Before starting this enquiry, I shall: (1) point out the difference between the doctrine in question as it is expounded in the NE and as it appeared in the previously published works of Leibniz; (2) examine the interpretations of Leibniz' psychology prior to 1765, especially as represented in the version which was accepted by Wolff and incorporated into his system. * I want to expressmy gratitude to my friend Dr. Heinrieh Schepers,Director of the LeibnizStelle of Miinster University, for severalreferences and suggestions,and for his sympathy with the subjectof this paper. 1 Oeuvres philosophique$ latines et franfaises du feu Mr. de Leibniz tir~es de ses Manuscrits qui #e conservent dans la Biblioth~que royale ~ Hanovre et publi~es par M. Rud. Eric Raspe. Avec une preface de Mr. Kaestner, Professeur en math$matique d GOttingue (Amsterdam et Leipzig, 1765). Cf. (3. Tondli, "Die Umwiilzung yon 1769 bed Kant," Kant-Studien,LIV (1963), 369 ft. [437] 438 HISTORY OF PHILOSOPHY I. It is an obvious principle in Leibniz' metaphysics that all knowledge stems from the interior of the soul, or monad: from this point of view, it may correctly be stated that for Leibniz all knowledge is innate. It is equally obvious in our day that Leibniz held that there is a basic distinction between the way we know necesstwy and universal truths, emerging from the soul's intellect, and the way we know contingent and particular truths, emerging from the soul's sensibility. Therefore, from a psychological and exoteric point of view (as in the NE) the first kind of truths may be called innate (par excellence), while the second may be called acquired. As it happened, the works of Leibniz published prior to 1765 almost exclusively represented the general metaphysical point of view, and this led to a fatal distortion of his thought by his followers. The interpretations of Leibniz were from the very beginningm and still are in our day---profoundly influenced by the fact that many of Leibniz' works were not published in his lifetime, but appeared (and still shall appear) posthumously during more than two centuries. Consequently the distinction between the origin of necessary and the origin of contingent truths was generally overlooked. This is clearly explained by an examination of Leibniz' worksa which were published before his death (1716) and shortly thereafter. One of the most influential... (shrink)

The reality of resource limitation during the Coronavirus Disease 2019 pandemic has deeply challenged established approaches to healthcare system emergency response. Early preparation du...

The present study was aimed at investigating whether and how the explicit representation of the decision outcome, framed in terms of lives saved or lost, could affect decision choices, emotional experience, and decision times in the course of a moral dilemma task. Decision outcomes were framed in a between-group design by means of smiling (POS group) or injured faces (NEG group) depicting, respectively, the lives saved or lost with each choice. A control condition with no frame and no outcome (NOF (...) group) was included. Results showed that behavioral choices were highly resistant to the framing manipulation in both dilemma types. However, an overall reduction in the number of utilitarian choices and in the decision times, associated with an increase in unpleasantness during decision-making, was found, suggesting a progressive increase in aversive emotional activation favoring the rejection of utilitarian resolutions. Interestingly, at the beginning of the task, the POS group showed a delay in decision times as compared with the NOF group, specifically for footbridge-type dilemmas. This result might be interpreted as an interference effect temporarily slowing decision-making during the resolution of dilemmas in which the internal representation is spontaneously focused on the personal cost of causing intentional harm to others. (shrink)

Persuasive technologies are interactive systems designed to change and shape users’ behaviours towards specific goals. By discussing the case of screen-time management applications, this paper explores how persuasive systems transform self-awareness and the self’s cognitive architecture. Drawing on the notion of tectonoetic awareness, I will illustrate how artefacts enable the transition from the temporal bounded experience characterizing first-person perspective (noetic awareness) to the ability of reflecting on oneself from a third person and temporally extended perspective (autonoetic awareness). I will argue (...) that persuasive systems make possible new modalities of self-recognition and self-projection while they simultaneously affect the sense of agency by interfering with users’ actions and intentions. (shrink)

Within the evidence-based medicine construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians’ primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the “best” evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here (...) we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients. (shrink)

While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the context of the treatment of a particular individual, and argue that evidence of mechanisms is indeed key to various aspects of clinical practice, including assessing population-level research reports, diagnostic as well as therapeutic decision making, and the assessment of treatment effects. (...) We use the pulmonary condition bronchiectasis as a source of examples of the importance of mechanistic reasoning to clinical practice. (shrink)

En este trabajo, aludiremos sintéticamente a los argumentos que se suceden en el primer libro de la _República _de Platón alrededor de la definición de justicia. No atenderemos a cada uno de ellos con detalle, sino que examinaremos el modo peculiar en que Platón presenta a los tres interlocutores de Sócrates en ocasión de establecer acuerdos dialógicos que permitan la progresión, o no, de su investigación. Intentaremos mostrar que el primer intercambio entre Sócrates y Céfalo parece más bien un diálogo (...) sordo pero que sirve de disparador para el segundo. Con Polemarco, Sócrates tiene la oportunidad de construir un diálogo cooperativo que se orienta a la persuasión, aunque tropieza, en el último tramo, con la imposibilidad del diálogo, que se muestra en el intercambio con Trasímaco. De este modo, creemos que, en el libro I de la _República_, Platón ofrece un panorama general de los fines, alcances y límites de la actividad filosófica y ello sienta las bases generales de las discusiones que se sucederán en el resto del diálogo. _ _. (shrink)

Go to John Cantwell’s response to the original paper from here › Go to Grazia Ietto-Gillies’ original paper from here ›.