This article examines the implicit promises of fairness in evidence based medicine , namely to avoid discrimination through objective processes, and to distribute effective treatments fairly. The relationship between EBM and vulnerable groups is examined. Several aspects of EBM are explored: the way evidence is created , and the way evidence is applied in clinical care and health policy. This analysis suggests that EBM turns our attention away from social and cultural factors that influence health and focuses on a narrow (...) biomedical and individualistic model of health. Those with the greatest burden of ill health are left disenfranchised, as there is little research that is relevant to them, there is poor access to treatments, and attention is diverted away from activities that might have a much greater impact on their health. (shrink)

This volume brings together eleven essays that address a range of issues extending from broader questions of social justice to the sexual intimacy that bears the mark of our fleshly existence. Collectively, these essays extend the reach of Paul Ricoeur’s early to late works by taking up some of the major social, political and religious challenges facing us in a postmodern, ultrapluralistic world.

Conceptual foundations for the changeover from behaviorism to mentalism are reviewed in an effort to better clarify frequently contested and misinterpreted features. The new mentalist tenets which I continue to support have been differently conceived to be a form of dualism, mind-brain identity theory, functionalism, nonreductive physical monism, dualist interactionism, emergent interactionism, and various other things. This diversity and contradiction are attributed to the fact that the new mentalist paradigm is a distinctly new position that fails to fit traditional philosophic (...) dichotomies. Formerly opposed features from previous polar alternatives become merged into a novel unifying synthesis, an unambiguous description of which demands redefinition of old terms or/and the invention of new terminology. The present analysis and interpretation are backed by statements from the early papers. (shrink)

If within the borders of human life the truth is, as Vico has said, what is made, then the task of a student of human life can be and should be to find out from what human beings have made what manner of makers they are and what sorts of production their circumstance allows.

In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust (...) at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors. (shrink)

The exemplary value of individual moral and political acts provides a unique vantage point for inquiring into the role of the creative imagination in social life. Drawing on Kant’s concept of productive imagination, I argue that an act’s exemplification of a fitting response to a moral or political problem or crisis is comparable to the way that a work of art expresses the ‘thought’ or ‘idea’ to which it gives voice. The exercise of practical reason, or phronesis, is akin to (...) the way that a work augments the practical field of our experiences in this respect. For, like a work of art, the act produces the rule to be followed by means of the example that it sets. Accordingly, I explain how the injunction issuing from the act can be credited to the way that the singular case summons its rule. The singular character of the injunction issuing from the act thus brings to the fore the relation between reflective judgment and this injunction’s normative value. The conjunction of reason, action, and the creative power of imagination offers a critical point of access for interrogating the normative force of claims rooted in individual acts. By setting reason, action, and imagination in the same conceptual framework, I therefore highlight the creative imagination’s subversive role in countering hegemonic systems and habits of thought through promoting the causes of social and political struggles. (shrink)

Israel Kirzner is to be credited for clarifying and developing the theory of capital and interest set out by Ludwig von Mises and for articulating and defending the pure time preference theory of interest. A revisiting of Mises and his critics suggests that the pure time preference theory is best formulated in terms of economic actions and then applied to the anticipated consequences of those actions. Differences between the Misesian and Knightian reckonings of time preference are to be understood in (...) terms of the contrasting conceptions of a zero time preference. Parallels between the time preference theory of interest and a leisure preference theory of wages are explored. Austrian economics is deemed healthy despite lingering puzzles about its theories of interest and wages.On doit au Professeur Kirzner la clarification et le développement de la théorie du capital et de l’intérêt dans la lignée de Ludwig von Mises et l’articulation et la défense de la théorie de l’intérêt comme étant la préférence pure pour le temps. Une relecture des travaux de Mises et de ses critiques suggère qu la théorie de la préférence pure pour le temps est mieux formulée en termes d’actions économiques et ensuite appliquée aux conséquences anticipées de ces mêmes actions. Les différences entre les acceptions Misessiennes et Knigtienne de la préférence pour le temps doivent être comprises en termes de conceptions différentes d’une préférence nulle pour le temps. Les rapprochements entre la théorie de l’intérêt comme préférence pour le temps et la théorie des salaires comme préférence pour les loisirs sont explorés. L’économie autrichienne est jugée saine en dépit des énigmes persistantes qui entourent ses théories de l’intérêt et des salaires. (shrink)

Context Professionalism remains a challenging part of the medical curriculum to define, teach and evaluate. We suggest that one way to meet these challenges is to clarify the definition of professionalism and distinguish this from medical ethics. Methods Our analysis is two staged. First, we reviewed influential definitions of professionalism and separated elements relating to (a) ethico-legal competencies, (b) clinical competence and (c) professionalism. In reference to professionalism, we then distinguished between aspirational virtues/values and specific behaviours. From these, we develop (...) a working definition of medical professional behaviour consisting of six domains of behaviour: responsibility; relationships with and respect for patients; probity and honesty; self awareness and capacity for reflection; collaboration and team work; and care of colleagues. Second, we tested this working definition against empirical data concerning disciplinary action against practising doctors using (a) sources in the literature and (b) an original analysis of complaints received by the Medical Board of South Australia. Conclusion Our empirical analysis supports the relevance of four of the six potential domains: responsibility; relationships with and respect for patients; probity and honesty; self awareness and capacity for reflection. There are additional reasons for retaining ‘collaboration and team work’ in the medical professional behaviour curriculum but ‘care of colleagues’ may be better addressed in the ethico-legal curriculum. Our definition of professional behaviour is consistent with the theoretical literature, captures behaviours that predict future complaints against practitioners and is consistent with current complaints about professionalism in South Australian practitioners. This definition can further the teaching and assessing of professional behaviour in medical schools. (shrink)

Hannah Arendt’s claim that thinking is the last defense against the moral outrages of criminal political regimes sets the problematic of good and evil in relief. Human freedom, Paul Ricœur reminds us, is responsible for evil. The avowal of the evil of violence is thus the condition of our consciousness of the freedom to act anew. Aesthetic experience’s lateral transposition onto the planes of ethics and politics highlights our capacity to respond to exigencies in apposite ways. Exemplary representations of the (...) good, the right, and the justexpress a desire for being. Eros is accordingly the law of every work, word, deed, or act that answers to a difficulty, challenge, or crisis. Bound to living experiences, thought attains its true height through interrogating, demystifying, and vacating frozen norms, standards, and mores. Judgment actualizes thought’s liberating effects in answer to the demands of the situations in which we find ourselves. (shrink)

This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable (...) of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Father’s Will: Christ’s Crucifixion and the Goodness of God by Nicholas E. Lombardo, O.P.Roger W. NuttThe Father’s Will: Christ’s Crucifixion and the Goodness of God. By Nicholas E. Lombardo, O.P. Oxford: Oxford University Press, 2013. Pp. ix + 270. $99.00 (cloth). ISBN: 978-0-19-968858-6.The centrality that Christ’s death by crucifixion has in Christian life, doctrine, and culture is scarcely in need of elaboration. Nevertheless, the relation between (...) the will of the Father and the violent and humiliating manner of Christ’s death raises substantive questions concerning the internal coherence of Christian claims about the love, goodness, and justice of God. In The Father’s Will: Christ’s Crucifixion and the Goodness of God, Nicholas E. Lombardo, O.P., confronts these questions, openly acknowledging their difficulty and seriousness, and provides a philosophically precise and theologically fresh response to the challenges they pose to the credibility of the Christian message.The ten chapters of The Father’s Will are divided into tripartite units that progress in logical sequence from “philosophical prolegomena” (part 1) to “New Testament evidence” (part 2), culminating with a “theological [End Page 317] evaluation” (part 3). The question at the heart of the book is how to reconcile the Christian doctrine that God and evil are incompatible with the theology of the Cross, which seems to require that God’s will is implicated in the evil actions that bring about Christ’s death.The first five chapters (part 1) provide a philosophical analysis of intention (chap. 1), value and obligation (chap. 2), double-effect reasoning (chap. 3), the ethical problems associated with self-sacrifice (chap. 4), and God’s will in relation to the crucifixion (chap. 5). Drawing on his analysis of intention and employing the principle of double effect, Lombardo establishes that it is not necessary to conclude that God wills the evils that are attendant on Christ’s death. “Actions performed by rational intentions,” Lombardo explains, “are not only intended; they are also willed. Rational intending implies rational choice, and rational choice is an act of the will” (32). This understanding of intention and willing, as distinguishable from intentional action, provides a foundation upon which the moral goodness of actions can be determined. “For an action to be good,” Lombardo argues, “it must do more than simply advance our natural inclinations: it must also avoid frustrating them. Only actions that both advance our natural inclinations and avoid frustrating them are morally good” (49). When moral actions have good effects and nonintended bad effects that do not outweigh the good effects—as in cases of self-defense or the use of medicine and medical procedures—these complex actions retain their moral goodness, notwithstanding the bad effects. The reason for this is that the bad effects are not included in the agent’s intention. Lombardo presents the crucifixion of Christ as one of these complex cases in which the bad effects can be separated from the agent’s intention. Chapter 3 explores the reasoning associated with the principle of double effect to clarify how actions implicated in bad or evil effects can be judged to be morally good. Lombardo is hesitant to identify double effect as an isolated principle that is applicable within unique circumstantial cases. Rather, he presents double effect as “merely an algorithm for applying basic concepts to morally ambiguous actions” (72). For example, in addition to affirming that the intended effects of the action are consistent with our natural inclinations, in cases of double-effect reasoning “the action’s positive, intended effects [must] outweigh the action’s negative, nonintended effects” (73). This material, in turn, connects logically with the conclusion of chapter 4 on the ethics of self-sacrifice: “double effect reasoning shows that it can be acceptable, and even heroic, to cause our own death non-intentionally for the sake of some greater good” (79). The last chapter in part 1 applies these distinctions to the problem of God’s will and the moral evil involved in Christ’s crucifixion. Here, the basic dilemma that the book addresses is succinctly restated: “Being all good, God never wants... (shrink)