Philosophical discussions on causal inference in medicine are stuck in dyadic camps, each defending one kind of evidence or method rather than another as best support for causal hypotheses. Whereas Evidence Based Medicine advocates the use of Randomised Controlled Trials and systematic reviews of RCTs as gold standard, philosophers of science emphasise the importance of mechanisms and their distinctive informational contribution to causal inference and assessment. Some have suggested the adoption of a pluralistic approach to causal inference, and an inductive (...) rather than hypothetico-deductive inferential paradigm. However, these proposals deliver no clear guidelines about how such plurality of evidence sources should jointly justify hypotheses of causal associations. We here develop such guidelines by first giving a philosophical analysis of the underpinnings of Hill’s viewpoints on causality. We then put forward an evidence-amalgamation framework adopting a Bayesian net approach to model causal inference in pharmacology for the assessment of harms. Our framework accommodates a number of intuitions already expressed in the literature concerning the EBM vs. pluralist debate on causal inference, evidence hierarchies, causal holism, relevance, and reliability. (shrink)

Edmund D. Pellegrino has played a central role in shaping the fields of bioethics and the philosophy of medicine. His writings encompass original explorations of the healing relationship, the need to place humanism in the medical curriculum, the nature of the patient’s good, and the importance of a virtue-based normative ethics for health care. In this anthology, H. Tristram Engelhardt, Jr., and Fabrice Jotterand have created a rich presentation of Pellegrino’s thought and its development. Pellegrino’s work has been dedicated (...) to showing that bioethics must be understood in the context of medical humanities, and that medical humanities, in turn, must be understood in the context of the philosophy of medicine. Arguing that bioethics should not be restricted to topics such as abortion, third-party-assisted reproduction, physician-assisted suicide, or cloning, Pellegrino has instead stressed that such issues are shaped by foundational views regarding the nature of the physician-patient relationship and the goals of medicine, which are the proper focus of the philosophy of medicine. This volume includes a preface by Dr. Pellegrino and a comprehensive Introduction by the editors. Of interest to medical ethicists as well as students, scholars, and physicians, _The Philosophy of Medicine Reborn_ offers fascinating insights into the emergence of a field and the work of one of its pioneers. “After a long period of dormancy, philosophy of medicine has blossomed with new life. The single most important physician-philosopher in that rebirth has been Edmund Pellegrino. His contributions to virtue theory, the concept of beneficence, the dispute over the internal and external sources of a morality for medicine, and the role of the Hippocratic tradition are all critical. The essays collected in this volume have changed the history of the philosophy of medicine. He shows that philosophy of medicine can be done with both passion and compassion.” —_Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University_ “Edmund Pellegrino's words have helped medical students, faculty, scholars and patients address the challenges they encounter in medicine and medical practice. His personal support has also been critical for many of us in developing programs in medical ethics and philosophy of medicine in our universities. Dr. Pellegrino combines the wisdom of a great physician with those of a great philosopher to produce a body of writing that will continue to inspire us all. This volume contains some of his best and most influential work.” —_Loretta Kopelman, The Brody School of Medicine, East Carolina University_ _ _ “Edmund Pellegrino has been a leading light in the philosophy of medicine for a generation. He was instrumental in the birth of bioethics, founded one of the leading journals, and provided able leadership in organizing early activities of the profession. He has served as department chairman, dean, and university president. Most recently, he chairs the President’s Council on Bioethics. In all this, first and foremost, he has been a physician. Those who are ill and suffering make a claim upon him. To respond to this claim, Pellegrino creatively brings together the worlds of science and of the humanities. For him, that is what medicine is about, making it the most scientific of the humanities and the most humane of the sciences. Fortunately for us, Pellegrino brings these worlds together in thought, as well as in practice. In this selection from his writings, Engelhardt and Jotterand have captured the heart of Pellegrino’s project, both in depth and breadth, so we can also hear that claim of the ill and so we can see what worlds must come together if we are to respond in the appropriate way.” —_George Khushf, University of South Carolina_ “Pellegrino’s work is both a treasure and important for understanding bioethics. His work in philosophy of medicine addresses the crucial questions that are so important to understanding the practice of medicine and the ethics of health care.” —_Kevin Wildes, President, Loyola University_ _ _. (shrink)

H. Tristram Engelhardt, Jr.; Can Philosophy Save Christianity? Are the Roots of the Foundations of Christian Bioethics Ecumenical? Reflections on the Nature of.

Engelhardt invites readers to understand what it means to live in a world after God, where questions of sin and virtue have been replaced with life-and-death-style choices. After God provides a dark prophetic vision. But there is still hope. As Engelhardt argues, In this culture, children now grow up apart from and defended against a recognition of the God Who lives. They are nurtured in a social fabric that is structured so as to avoid a recognition of, much (...) less an encounter with, God. Nevertheless... a traditional Christianity has endured, even though its morality and bioethics have become ever more strongly counter-cultural. The source of this traditional Christian otherness over against the surrounding post-theistic culture lies in the origins of Christianity itself, in the Christianity of the Apostles and the Fathers, namely, in Orthodox Christianity. Against the tenor of the times, disregarding the animus to set traditional Christianity aside, and despite heretics prominent within its fold, Orthodox Christianity remains a light in a world after God. --! From back cover. (shrink)

This article sketches an idealized strategy for the identification of neural correlates of consciousness. The proposed strategy is based on a state space approach originating from the analysis of dynamical systems. The article then focuses on one constituent of consciousness, phenomenal awareness. Several rudimentary requirements for the identification of neural correlates of phenomenal awareness are suggested. These requirements are related to empirical data on selective attention, on completely intrinsic selection and on globally unconscious states. As an example, neuroscientific findings on (...) synchronized γ activity are categorized according to these requirements. (shrink)

The philosophy of medicine cum bioethics has become the socially recognized source for moral and epistemic direction in health-care decision-making. Over the last three decades, this field has been accepted politically as an authorized source of guidance for policy and law. The field's political actors have included the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, the Department of Health, Education, and Welfare, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical (...) and Behavioral Research , the National Bioethics Advisory Commission, and the new Council on Bioethics; these groups and agencies have set forth rules on issues ranging from the role of humans in biomedical research to the production of human embryos for research, the definition of death, and the permissibility of human cloning. The members of the field are not just scholars and teachers in an academic realm directed to both theoretical and applied issues. They are, in addition, practitioners of a conceptual and moral trade that possesses a legal and political standing. This essay critically addresses the sudden emergence of bioethics as a societally recognized source of moral guidance, a source replete with authorized moral experts. Attention is directed to moral and conceptual assumptions that have led the philosophy of medicine, and especially bioethics, to acquire a quasi-juridical/political role in guiding clinical choices, framing health-care policy, and directing court holdings. (shrink)

"A book from the Park Ridge Center for the Study of Health, Faith, and Ethics." Includes bibliographical references (p. [141]-195) and index.

According to the objective Bayesian approach to inductive logic, premisses inductively entail a conclusion just when every probability function with maximal entropy, from all those that satisfy the premisses, satisfies the conclusion. When premisses and conclusion are constraints on probabilities of sentences of a first-order predicate language, however, it is by no means obvious how to determine these maximal entropy functions. This paper makes progress on the problem in the following ways. Firstly, we introduce the concept of a limit in (...) entropy and show that, if the set of probability functions satisfying the premisses contains a limit in entropy, then this limit point is unique and is the maximal entropy probability function. Next, we turn to the special case in which the premisses are categorical sentences of the logical language. We show that if the uniform probability function gives the premisses positive probability, then the maximal entropy function can be found by simply conditionalising this uniform prior on the premisses. We generalise our results to demonstrate agreement between the maximal entropy approach and Jeffrey conditionalisation in the case in which there is a single premiss that specifies the probability of a sentence of the language. We show that, after learning such a premiss, certain inferences are preserved, namely inferences to inductive tautologies. Finally, we consider potential pathologies of the approach: we explore the extent to which the maximal entropy approach is invariant under permutations of the constants of the language, and we discuss some cases in which there is no maximal entropy probability function. (shrink)

We study questionnaire responses to situations in which sacrificing one life may save many other lives. We demonstrate gender differences in moral judgments: males are more supportive of the sacrifice than females. We investigate a source of the endorsement of the sacrifice: antisocial preferences. First, we measure individual proneness to spiteful behavior, using an experimental game with monetary stakes. We demonstrate that spitefulness can be sizable—a fifth of our participants behave spitefully—but it is not associated with gender. Second, we find (...) that gender is consistently associated with responses even when we account for individual differences in the propensity to spitefulness. (shrink)

Augmented Reality (AR) is commonly defined as a digital layer of information viewed on top of the physical world through a smartphone, tablet or eyewear. Increasingly, this understanding of AR is shifting to a dynamic framework of ‘smart things’, including wearable technology, sensors and artificial intelligence (AI), with the ability to intercede in key moments and to deliver contextual and meaningful experiences. The things that come into context are the logical next steps in an evolutionary development towards computers that are (...) better able to show empathy in relation to people: even more human-oriented, anticipative and ubiquitous. Thus, this outsourcing of meaning to empathic technologies points to one of the fundamental questions concerning the relation of human and technology – the nature of the trust that users place in technology. (shrink)

H. Tristram Engelhardt, Jr.; Generic Chaplaincy: Providing Spiritual Care in a Post-Christian Age, Christian bioethics: Non-Ecumenical Studies in Medical Morali.

This paper proposes that, in many cases, conversational norms permit gaslighting when socially subordinate speakers report systemic injustice. Section 1 introduces gaslighting and the kinds of cases on which I focus—namely, cases in which multiple people gaslight. I give examples and statistics to suggest that these cases are common in response to reports of race- or gender-based injustice; and I appeal to scholarship on epistemologies of ignorance to suggest that this kind of gaslighting is common because it is systematically produced (...) by dominant epistemic systems. Section 2 draws on Lynne Tirrell’s account of language games that’ve been influenced by oppression to make the case that conversational norms make gaslighting “appropriate” when socially subordinate speakers report systemic injustice. Together, these points make the case that the kind of gaslighting discussed in this paper (i) occurs systematically and (ii) is mutually reinforcing with systems of ignorance. The discussion is meant to help us understand and address the conditions that make gaslighting commonplace. If it’s true that gaslighting occurs systematically in part thanks to our warped conversational norms, then we may be able to mitigate the prevalence of gaslighting by attending to these norms. (shrink)

Much of contemporary philosophy, political theory, and social thought has been shaped directly or indirectly by Georg Wilhelm Friedrich Hegel, though there is considerable disagreement about how his work should be understood. He has been described both as a metaphysician and characterized as an ironic narrator who anticipated the character of philosophy after metaphysics. His position is equally ambiguous with regard to his political thought. He has been construed both as an enemy of the liberal state and as a friend (...) of freedom. This volume's revisionist reassessment, building on the scholarship of Klaus Hartmann, explores these ambiguities in favor of a non-metaphysical reading of Hegel's arguments. It also shows how the foundations of his political thought support a liberal democratic state. This reappraisal of Hegel's arguments resituates him as a philosopher who anticipates the difficulties of post-modernity and offers a basis for reassessing ontology, aesthetics, and revolution. Philosophers and those doing work in political theory will find this volume of great interest. (shrink)

This collection of essays examines the ways in which disputes and controversies about the application of scientific knowledge are resolved. Four concrete examples of public controversy are considered in detail: the efficacy of Laetrile, the classification of homosexuality as a disease, the setting of safety standards in the workplace, and the utility of nuclear energy as a source of power. The essays in this volume show that debates about these cases are not confined to matters of empirical fact. Rather, as (...) is seen with most scientific and technical controversies, they focus on and are structured by complex ethical, economic, and political interests. Drs. Engelhardt and Caplan have brought together a distinguished group of scholars from the sciences and humanities, who sketch a theory of scientific controversy and attempt to provide recommendations about the ways in which both scientists and the public ought to seek more informed resolutions of highly contentious issues in science and technology. Scientific Controversies is offered as a contribution to the better understanding of the roles of both science and nonscientific interests in disputes and controversies pertaining to science and technology. (shrink)

This collection of essays, Global Bioethics: The Collapse of Consensus, deals with the issue of the repeated failure of attempts to derive a universal set of ...

: Its promises to the contrary notwithstanding, bioethics is plural. There is a diversity of content-full moral understandings of the good and the right. Moreover, there is no secular means in principle to set this diversity aside without begging the question. This moral diversity exists both as a sociological condition and as a moral epistemological constraint. Without succumbing to a metaphysical scepticism or moral relativism, the bioethics of the future, if it is to be honest, should learn how to live (...) with robust moral diversity. (shrink)

This essay is meant as a form of philosophical exorcism. The goal is to dispel the view that there are general secular grounds for holding human germline genetic engineering to be intrinsically wrong, a malum in se, or a morally culpable violation of human nature. The essay endorses the view that major obligations of prudence and care attend the development of this technology. However, these justifiable moral concerns can be seen more clearly when one has dispelled what must, from a (...) secular perspective, be regarded as pseudo-issues. (shrink)

The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social–historical construction (ASBH Core Competencies for Health Care Ethics Consultation , 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011 ). Core Competencies fails to recognize that the ethics of health care ethics consultants is not ethics in (...) the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered. (shrink)

H. Tristram Engelhardt, Jr.; The DeChristianization of Christian Health Care Institutions, or, How the Pursuit of Social Justice and Excellence can Obscure the.

This paper presents four different understandings of the family and their concomitant views of the authority of the family in pediatric medical decision making. These different views are grounded in robustly developed, and conflicting, worldviews supported by disparate basic premises about the nature of morality. The traditional worldviews are often found within religious communities that embrace foundational metaphysical premises at odds with the commitments of the liberal account of the family dominant in the secular culture of the West. These disputes (...) are substantial and ultimately irresolvable by sound rational argument because of the failure to share common foundational premises and rules of evidence. It is in light of these fundamental disagreements that there is a need to evaluate critically the claims and agenda advanced by the Convention on the Rights of the Child. (shrink)

This chapter contains sections titled: The Conceptual Geography Some Teleological Approaches to Distributing Health Care Hypothetical Contractor Theory Libertarian Approaches: Autonomy by Default Conclusion.

Physician-assisted suicide offers a moral and theological Rorschach test. Foundational commitments regarding morality and theology are disclosed by how the issue is perceived and by what moral problems it is seen to present. One of the cardinal differences disclosed is that between Western and Orthodox Christian approaches to theology in general, and the theology of dying and suicide in particular. Confrontation with the issue of suicide is likely to bring further doctrinal development in many of the Western Christian religions, so (...) as to be able to accept physician-assisted suicide and euthanasia. (shrink)

The first single-author text on the philosophical issues in bioethics, this book offers a systematic and comprehensive introduction to the philosophical principles underlying this discipline. It examines the ways in which facts, theories, and values are intertwined in concepts of disease and health, and covers a wide range of issues, including abortion, in vitrofertilization, sexual deviance, and organ transplantation. The discussion of these issues is critical and often controversial, and the distinguished author includes his own provocative views on topics of (...) current debate. Highly readable and challenging, this is an excellent text for advanced bioethics courses, as well as a thought-provoking study of considerable interest for physicians and philosophers. (shrink)

The chemist Max von Pettenkofer studied with Justus von Liebig, and after leaving Giessen in 1844 did not immediately find an academic position. During the period 1844/1845 he wrote a cycle of 16 Chemical Sonnets, but published them only in 1886. The Sonnets have with few exceptions a historiographical character. We present a translation of the Sonette into Portuguese as well as commentaries about their content and their philosophical significance. We also comment rather briefly on Pettenkofer’s career as an empirical (...) chemist and later as a somewhat heterodox hygienist. (shrink)