The vignette described in the introduction of this symposium raises a number of ethical and legal problems for physicians who work for correctional institutions and death row inmates. They are not confined to correctional physicians, however, as states have requested aid from practicing physicians in the community, and even from other states, when conflicts have arisen in the treatment of death row inmates as they near the date of execution. As outlined, the case involves a 48-year-old man with a long (...) history of schizophrenia, initially diagnosed at age 19. Compliant with medication, he remained generally free from positive symptoms-delusions and hallucinations. Nonetheless, he committed two murders during a robbery and was sentenced to death. Since his incarceration, the defendant has consistently refused psychotropic medications and has been forcibly medicated on several occasions when he exhibited violent outbursts and was overtly psychotic. (shrink)

I defend the widely-held view that morally worthy action need not be motivated by a desire to promote rightness as such. Some have recently come to reject this view, arguing that desires for rightness as such are necessary for avoiding a certain kind of luck thought incompatible with morally worthy action. I show that those who defend desires for rightness as such on the basis of this argument misunderstand the relationship between moral worth and the kind of luck that their (...) argument employs. Consequently, the argument provides no reason to doubt the popular view that a desire for rightness as such is no part of virtue. I conclude by suggesting that a family of worries about merely accidentally right action presuppose one side of the recent debate about objectivism and perspectivism about moral rightness. (shrink)

Cost containment by means of prospective payment and other mechanisms is widely seen as a challenge to modern medicine; but the challenge is seldom articulated clearly in terms of core professional values and the moral content of a claim to professionalism. Medical ethics, as it has evolved as a field of study in the past twenty years, has contributed little to the concept of professionalism in medicine. For an investigation of professionalism in the face of cost containment to evolve fruitfully, (...) several things must occur. The true nature of today's challenge to medicine must be appreciated. The balance between tradition and response to social change in defining a professional value system must be appreciated. Physician income must be explicitly addressed as a moral issue. And practical strategies for investigating and affirming core professional values must be developed for health delivery systems and medical education settings. (shrink)

Employing the National Institute of Mental Health-funded Prevention of Suicide in Primary Care Elderly Collaborative Trial as a case study, we discuss 2 sets of ethical issues: obtaining informed consent for a clinic-based intervention study and using treatment as usual (TAU) as the control condition. We then address these ethical issues in the context of the debate about the quality improvement efforts of health care organizations. Our analysis reveals the tension between ethics and scientific integrity involved with using TAU as (...) a control condition and the difficulty in designing high-quality research in a community-based setting. (shrink)

In some circles, faith is said to be one of three theological virtues, along with hope and agape. But not everyone thinks faith is a virtue, theological or otherwise. Indeed, depending on how we understand it, faith may well conflict with the virtues. In this chapter we will focus on the virtue of humility. Does faith conflict with humility, or are they in concord? In what follows, we will do five things. First, we will sketch a theory of the virtue (...) of humility. Second, we will summarize a common view of faith, arguably held by Thomas Aquinas among others, and we will argue that Thomistic faith is not an intellectual virtue and that it conflicts with humility in the domain of inquiry. Third, we will plump for an older view of faith, one that predates Aquinas by at least 1500 years, Markan faith. Fourth, we will argue that Markan faith is an intellectual virtue and it is in concord with humility in the domain of inquiry. Fifth, we will argue that Markan faith, unlike Thomistic faith, is a personal virtue and that it is in concord with humility in the domain of personal relationships, both human-human and human-divine. (shrink)

Published in 1981, “The Maximin Strategy in Modern Obstetrics” offered two claims—first, that obstetrical interventions ought to be assessed not singly, but rather as packages of interconnected measures that could cumulatively increase risks of harm; and second, that many of these interventions, considered either singly or as a package, lacked a sound evidence base. The first claim has been well supported by later literature, although the term “cascade effect” has proven a more felicitous descriptor for the phenomenon of interventions that (...) trigger the use of other interventions to monitor, prevent, or treat possible side-effects. The second claim was initially supported in a very inadequate way, since the “Maximin” article appeared before an understanding of the methods of systematic reviews of medical evidence had been widely promulgated. Despite these defects, subsequent, rigorously conducted systematic reviews have tended to confirm the impression first offered in 1981, that practices that support physiologic childbearing and the innate, hormonally driven capacities of childbearing women and their fetuses/newborns are much more in keeping with the available evidence than practices involving common or routine high-technology interference with physiologic processes. Harm may occur either directly, through high-technology interventions, or when such procedures distract attention and resources from safe, effective biological processes and lower-technology measures. Surveys indicate a lack of knowledge of this evidence among childbearing women, signaling a serious ethical deficiency in shared decision-making processes and perhaps the skills and knowledge of maternity care clinicians. (shrink)

Froom and Froom all attention to referral bias as a frequent cause for misinterpreting the medical literature. This is particularly a source of false certainty, and therefore false science, in U.S. practice, where referral centers are often seen as the only legitimate source of medical knowledge and where primary care is discounted as a source of scientific observations. Appreciation of the primary care setting is therefore a critical element in theoretical understanding of medical epistemology.

A review of the philosophical debate on theoretical models for the physician-patient relationship over the past fifteen years may point to some of the more productive questions for future research. Contractual models have been criticized for promoting a legalistic and minimalistic image of the relationship, such that another form of model (such as convenant) is required. Shifting from a contractual to a contractarian model (in keeping with Rawls' notion of an original position) provides an adequate response to many criticisms of (...) this type. A deeper criticism, however, is one that advocates a shift to a virtue-based approach. A creative amalgam between a contractarian model and elements of the virtue-based approach, combined with appropriate empirical investigation, may yield richer models in the future. (shrink)

Responding to the rash of books supporting a "new atheism" in recent years, some excellent rebuttals and refutations by Berlinski, Novak, Hart, Day, and others have also been published. The present book, however, is not a continuation of these critical salvos against the likes of Dawkins, Hitchens, Dennett, and Harris, but engages in a fresh reexamination of several important aspects of the "God-question," along with an exploration of the theory of the "faith-instinct"---a theory that emerges from a respectably long tradition, (...) but in recent years has been largely relegated to the sidelines in theology and philosophy. In the first chapter, scientific, metaphysical, and theological approaches are utilized and integrated in relationship to the question of God's existence. The second chapter is devoted to the "problem of evil," differentiated into the special categories often lumped into that all-too-generic term---moral evils, natural evils, suffering as an evil. Chapter 3 concerns the obvious follow-up question concerning what sort of characteristics, personal or otherwise, we can attribute to God---going beyond the question of God's mere "existence," even if and when we are intellectually convinced of this existence. In the second half of the book, the various meanings of "faith" are considered; and the apparent discrepancy of many New Testament descriptions of faith with the conventional Catholic and Protestant concepts of faith is investigated. Some "family resemblances" of supernatural faith seem to emerge. Then a monograph by Tubingen theologian Max Seckler, Instinkt und Glaubenswille ("Instinct and the Will to Believe"), which comments on thought-provoking texts concerning a "faith-instinct" in the works of Thomas Aquinas, is considered; Seckler brings out the philosophical and theological basis for this concept, as well as its reverberations for modern theology. The theory of a faith-instinct, however, leads to the question of the proper and improper, real or substitute, "objects," of the proposed instinct. Finally, if this instinct is, as hypothesized, implanted in human nature itself, for all places and all times, what is the function of the various religions in "activating" or placing obstacles to, the activation of this instinct? How are "false prophets," who may be instrumental in redirecting or misdirecting this instinct, to be recognized? Is faith bolstered or hindered by miracles---do miracles have any important relationship to faith? The book ends with a final consideration of the probable mental outlook of the atheist confronted with claims by theists of varying persuasions. (shrink)

This is a survey of theories of scientific method which opens the book "After Popper, Kuhn and Feyerabend: Recent Issues in Theories of Scientific Method".

The chapter examines the political arcanum historically and conceptually and reflects on the implications of digital technology for the state and civil society relation.

Parallel to Koriat & Goldsmith's accounting of human memory, there are two distinct approaches in animal learning. Behaviorist approaches focus on quantitative aspects of conditioned response probability, whereas cognitive and ethological approaches focus on qualitative aspects of how memory is used in real life. Moreover, in animal research these distinguishable measures of memory are dissociated in experimental amnesia.

Knight has shown how the moral growth of medical students involves a spiritual journey. He may, however, present too sanguine a portrayal of the extent to which the medical education environment promotes this moral and spiritual growth. Medical school may indeed be more abusive than supportive. Admitting more women to medical school and teaching more humanities courses, while worthwhile, will not necessarily promote the goals that Knight appropriately advocates.

Chapter traces the theme of hyperaesthesia and its correlates throughout Bergson’s work, arguing for a reading of his contributions to psychic research in the context of his theory of perception. It also shows that the experience of expanded perception was central to Bergson’s expansive understanding of inherent human powers and their development.

A class of states obtained by extremizing the energy of a system under certain conditions is introduced and their properties are compared with those of the coherent states. Conditions under which these states move without change of shape and follow the classical path are investigated.