Pour chaque volume de la collection Lectures de..., l'éditeur a fait appel aux universitaires les plus éminents dans le souci d'offrir au public francophone un ensemble d'études, hors de tout parti pris, sur les principaux philosophes de l'Antiquité à nos jours. Longtemps tenu pour un auteur ésotérique, Wittgenstein est aujourd'hui une référence centrale dans la vie intellectuelle, et il ne s'agit plus d'un simple effet de mode. Son oeuvre est présente dans le paysage international, non seulement en philosophie, mais (...) aussi en sciences humaines et sociales : la sociologie, l'anthropologie, la philosophie du droit et de l'économie s'en inspirent. Elle a largement débordé le monde anglophone, où elle façonne une partie de la réflexion depuis plus d'un demi-siècle. Pourtant, l'appréhension philosophique de cette oeuvre est loin d'être univoque, puisque l'on a assisté, depuis la mort de Wittgenstein en 1951, à une série de lectures divergentes de ses textes, dont les plus prégnantes méritent d'être ici expliquées. Les points de vue sur Wittgenstein se sont par ailleurs multipliés : d'abord lu dans les années 1950-1960 comme philosophe avant tout logicien, en fonction du Tractatus et dans le sillage de ses maîtres Frege et Russell, comme mystique ou comme philosophe du langage, au vu de sa "seconde" philosophie, il apparaît ensuite comme l'auteur d'une oeuvre complexe et multidimensionnelle touchant à des questions de philosophie générale (expérience, signification, réalité, etc.). Le présent ouvrage se donne pour tâche de cartographier ce réseau complexe qu'est la philosophie de Wittgenstein, d'abord en présentant les grands textes et les thèmes majeurs qui ont jalonné son parcours philosophique, puis en introduisant aux différentes lectures qui en ont été proposées dans la tradition interprétative. (shrink)

Neurocognitive enhancement, or cosmetic neurology, offers the prospect of improving the learning, memory and attention skills of healthy individuals well beyond the normal human range. Much has been written about the ethics of such enhancement, but policy-makers in the USA, the UK and Europe have been reluctant to legislate in this rapidly developing field. However, the possibility of discrimination by employers and insurers against individuals who choose not to engage in such enhancement is a serious threat worthy of legislative intervention. (...) While lawmakers should not prevent individuals from freely pursuing neurocognitive enhancement, they should act to ensure that such enhancement is not coerced. This paper offers one model for such legislation, based upon a proposed US law, the Genetic Information Nondiscrimination Act of 2008, to address precisely this particular pitfall of the impending neuroscience revolution. (shrink)

The public discourse surrounding sex and severe disability over the past 40 years has largely focused on protecting vulnerable populations from abuse. However, health professionals and activists are increasingly recognising the inherent sexuality of disabled persons and attempting to find ways to accommodate their intimacy needs. This essay explores several ethical issues arising from such efforts.

Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life as a result of their depressive symptoms when similarly situated (...) incapacitated patients without such depressive symptoms would have their previous wishes honoured via substituted judgment. This commentary argues for reconsidering this approach and for using a substituted judgment standard for a subset of EMP/LQL patients seeking death. (shrink)

Apolitical, amoral, an aesthete whose writings point toward some form of liberation: this is the figure who emerges from most recent scholarship on Friedrich ...

Artificial intelligence (AI) holds considerable promise for transforming clinical diagnostics. While much has been written both about public attitudes toward the use of AI tools in medicine and about uncertainty regarding legal liability that may be delaying its adoption, the interface of these two issues has so far drawn less attention. However, understanding this interface is essential to determining how jury behaviour is likely to influence adoption of AI by physicians. One distinctive concern identified in this paper is a ‘negative (...) outcome penalty paradox’ (NOPP) in which physicians risk being penalised by juries in cases with negative outcomes, whether they overrule AI determinations or accept them. The paper notes three reasons why AI in medicine is uniquely susceptible to the NOPP and urges serious further consideration of this complex dilemma. (shrink)

Although considerable attention has been devoted to the concepts of “visible” and “invisible” victims in general medical practice, especially in relation to resource allocation, far less consideration has been devoted to these concepts in behavioral health. Distinctive features of mental health care in the United States help explain this gap. This essay explores three specific ways in which the American mental health care system protects potentially “visible” individuals at the expense of “invisible victims” and otherwise fails to meet the needs (...) of great numbers of people with serious psychiatric conditions: prioritization of the wrong patients, incentivization of excessive caution among providers, and a narrow definition of psychiatry's purview. While each of these practices has been discussed elsewhere in the literature, they are rarely considered as part of an interrelated and systemic problem. Reconceptualizing these three issues as aspects of the larger conflict between the interests of “visible” and “invisible” victims may prove a path toward reform. (shrink)

The integrity of the patient–physician relationship depends on maintaining professional boundaries. While ethicists and professional organisations have devoted significant consideration to the subject of sexual boundary transgressions, the subject of non-sexual boundaries, especially outside the mental health setting, has been largely neglected. While professional organisations may offer guidance on specific subjects, such as accepting gifts or treating relatives, as well as general guidance on transparency and conflict of interest, what is missing is a principle-based method that providers can use to (...) assess non-sexual interactions with patients that transcend norms of practice. This paper attempts to offer an operational model for such assessment that considers not only the traditional emphasis on beneficence, but also incorporates concerns over entanglement and concordance. (shrink)

The “Goldwater rule,” a policy adopted by the American Psychiatry Association in 1973, prohibits organization members from diagnosing or offering professional opinions regarding the mental health of public figures without both first-hand evaluation and authorization. Initially developed in response to a controversial survey of APA members during the 1964 Presidential election campaign, the ethics rule faced few large scale challenges until the election of Donald Trump in 2016. Since that time, a significant number of psychiatrists have either violated or criticized (...) the rule openly. This paper argues that whatever the initial merits of the rule, the prohibition has since been rendered obsolete by the combined lack of professional consensus supporting the policy, absence of a meaningful enforcement mechanism, and the credible statements of non-APA members in the mental health professions regarding public figures. (shrink)

Priority for solid organ transplant generally does not consider the underlying cause of the need for transplantation. This paper argues that a distinctive set of factors justify assigning lower priority to willfully unvaccinated individuals who require transplant as a result of suffering from COVID‐19. These factors include the personal responsibility of the patients for their own condition and the public outrage likely to ensue if willfully unvaccinated patients receive organs at the expense of vaccinated ones. The paper then proposes a (...) three‐prong test for similar deviations from the current allocation standard that incorporates patient responsibility, foreseeability and avoidability, and the frequency of the occurrence. (shrink)

On February 24, 2022, Russia invaded its neighboring nation, Ukraine, in what is widely regarded in the West as a grave breach of international law. Since that time, the Russian military has been i...

Physicians expressing opinions on medical matters that run contrary to the consensus of experts pose a challenge to licensing bodies and regulatory authorities. While the right to express contrarian views feeds a robust marketplace of ideas that is essential for scientific progress, physicians advocating ineffective or dangerous cures, or actively opposing public health measures, pose a grave threat to societal welfare. Increasingly, a distinction has been made between professional speech that occurs during the physician-patient encounter and public speech that transpires (...) beyond the clinical setting, with physicians being afforded wide latitude to voice empirically false claims outside the context of patient care. This paper argues that such a bifurcated model does not sufficiently address the challenges of an age when mass communications and social media allow dissenting physicians to offer misleading medical advice to the general public on a mass scale. Instead, a three-tiered model that distinguishes between citizen speech, physician speech and clinical speech would best serve authorities when regulating physician expression. (shrink)

A Philosophy of Mitzvot by Rabbi Dr. Gersion Appel sets forth the Hinnukh's objectives and his approach to revealing the religious and ethical meaning of the mitzvot. In his wide-ranging study, the author presents a comprehensive view of Jewish philosophy as developed by the Hinnukh and the classical Jewish philosophers. The Hinnukh emerges in this study as a great educator and moral and religious guide, and his classic work as a treasure-trove of Jewish knowledge, religious inspiration, and brilliant insight (...) in the molding of human character. (shrink)

“An original, compelling, and provocative exploration of ethical issues in our society, with thoughtful and balanced commentary. I have not seen anything like it.” —Alan Lightman, author of Einstein’s Dreams Drawing upon the author’s two decades teaching medical ethics, as well as his work as a practicing psychiatrist, this profound and addictive little book offers up challenging ethical dilemmas and asks readers, What would you do? A daughter gets tested to see if she’s a match to donate a kidney to (...) her father. The test reveals that she is not the man’s biological daughter. Should the doctor tell the father? Or the daughter? A deaf couple prefers a deaf baby. Should they be allowed to use medical technology to ensure they have a child who can’t hear? Who should get custody of an embryo created through IVF when a couple divorces? Or, when you or a loved one is on life support, Who says you’re dead? In short, engaging scenarios, Dr. Appel takes on hot-button issues that many of us will confront: genetic screening, sexuality, privacy, doctor-patient confidentiality. He unpacks each hypothetical with a brief reflection drawing from science, philosophy, and history, explaining how others have approached these controversies in real-world cases. Who Says You’re Dead? is designed to defy easy answers and to stimulate thought and even debate among professionals and armchair ethicists alike. (shrink)

Between inventing the concept of a universal computer in 1936 and breaking the German Enigma code during World War II, Alan Turing, the British founder of computer science and artificial intelligence, came to Princeton University to study mathematical logic. Some of the greatest logicians in the world--including Alonzo Church, Kurt Gödel, John von Neumann, and Stephen Kleene--were at Princeton in the 1930s, and they were working on ideas that would lay the groundwork for what would become known as computer science. (...) Though less well known than his other work, Turing's 1938 Princeton PhD thesis, "Systems of Logic Based on Ordinals," which includes his notion of an oracle machine, has had a lasting influence on computer science and mathematics. This book presents a facsimile of the original typescript of the thesis along with essays by Andrew Appel and Solomon Feferman that explain its still-unfolding significance. A work of philosophy as well as mathematics, Turing's thesis envisions a practical goal--a logical system to formalize mathematical proofs so they can be checked mechanically. If every step of a theorem could be verified mechanically, the burden on intuition would be limited to the axioms. Turing's point, as Appel writes, is that "mathematical reasoning can be done, and should be done, in mechanizable formal logic." Turing's vision of "constructive systems of logic for practical use" has become reality: in the twenty-first century, automated "formal methods" are now routine. Presented here in its original form, this fascinating thesis is one of the key documents in the history of mathematics and computer science. (shrink)

Since several landmark legal decisions in the 1970s and 1980s, substituted judgment has become widely accepted as an approach to decision‐making for incapacitated patients that incorporates their autonomy and interests. Two notable exceptions have been cases involving minors and those involving cognitively or psychiatrically impaired individuals who never previously possessed the ability to contemplate the medical decisions involved in their care. While a best interest standard may have universal merit in pediatric cases, this paper argues that substituted judgement has been (...) rejected too broadly for “never‐capacitated” patients. It then lays out a three‐condition test for using substituted judgment in these cases. For a subset of “never‐capacitated” patients who belong to distinctive religious or cultural communities with clear medical values and have an appropriate surrogate, these values may prove helpful in vindicating the interests of the never‐capacitated and should not be blanketly dismissed. (shrink)

The American Journal of Bioethics, Volume 12, Issue 9, Page 9-11, September 2012.

Imperial ceremony was a vital form of self-expression for late antique society. Sabine MacCormack examines the ceremonies of imperial arrivals, funerals, and coronations from the late third to the late sixth centuries A.D., as manifest in the official literature and art of the time. Her study offers us new insights into the exercise of power and into the social, political, and cultural significance of religious change during the Christianization of the Roman world.

Over the past century, the “right to health” has been recognized by medical organizations and governments across the globe. This essay calls for recognition of a parallel “right to be sick” intended to reframe physician attitudes toward patient autonomy and the right to refuse care. Rather than seeking to discourage allopathic medicine or to question laws requiring involuntary treatment when indicated by the collective welfare, the goal is to have the medical and public health communities reconceptualize their attitudes toward individuals (...) who reject unsought guidance and care. (shrink)

Whether the law should permit individuals to opt out of accepted death standards is a question that must be faced and clarifiedWhile media coverage of the Terri Schiavo case in Florida has recently refocused public attention on end of life decision making, another end of life tragedy in Utah has raised equally challenging—and possibly more fundamental—questions about the roles of physicians and families in matters of death. The patient at the centre of this case was Jesse Koochin, a six year (...) old boy suffering from “inoperable and incurable” brain cancer. He had been undergoing care at Primary Children’s Medical Center in Salt Lake City since September 15, 2004 when “his tumor pushed his brain stem down through the skull”.1 Subsequently, two physicians independently determined that the child was “brain dead” and informed his parents that they would order life support removed within twenty four hours. Steve and Gayle Koochin overtly rejected the hospital’s definition of death. The couple, relying on traditional notions of cardiopulmonary death, obtained a restraining order to keep Jesse on a ventilator and ultimately removed the brain dead child from the hospital. The ongoing case raises the complex question of whether patients’ families should be permitted to opt out of widely accepted definitions of death in favour of their own standards.The definition of death has evolved rapidly in the United States over the past thirty five years. Until the middle of the twentieth century, the medical community, the legal system, and an overwhelming majority of the public understood death to …. (shrink)

Parental surrogacy remains a highly controversial issue in contemporary ethics with considerable variation in the legal approaches of different jurisdictions. Finding a societal consensus on the issue remains highly elusive. John Rawls’ theory of public reason, first developed in his A Theory of Justice (1971), offers a unifying model of political discourse and engagement that enables reasonable citizens to accept policies that they do not necessarily support at a personal level. The theory established a promising framework for private citizens with (...) distinct moral positions on the subject to find common ground and, in doing so, to negotiate a consensus regarding the degree and nature of regulation that is palatable to all rational citizens. (shrink)

I discuss two ways in which emotions explain actions: in the first, the explanation is expressive; in the second, the action is not only explained but also rationalized by the emotion's intentional content. The belief-desire model cannot satisfactorily account for either of these cases. My main purpose is to show that the emotions constitute an irreducible category in the explanation of action, to be understood by analogy with perception. Emotions are affective perceptions. Their affect gives them motivational force, and they (...) can rationalize actions because, like perception, they have a representational intentional content. Because of this, an emotion can non-inferentially justify a belief which in its turn justifies or rationalizes an action; so emotions may constitute a source of moral knowledge. (shrink)

As a result of workplace clean air regulations and strict guidelines imposed by the Joint Commission on Accreditation of Healthcare Organizations in 1993, most hospitals in the United States are now virtually smoke free. Although evidence suggests that these restrictions both cause smoking employees to consume fewer cigarettes per day and induce some employees to quit smoking entirely, the policies have also driven many healthcare providers—including physicians—onto the public sidewalks for their cigarette breaks. Patients entering many hospitals pass white-coated medical (...) students and residents puffing away at the curbside. (shrink)

Aims to show graduate students and researchers the vital benefits of integrating mathematics into their study and experience of the physical world. This book details numerous topics from the frontiers of modern physics and mathematics such as convergence, Green functions, complex analysis, Fourier series and Fourier transform, tensors, and others.

Platons Uberlegungen zur Okonomie verdienen mehr Aufmerksamkeit. Dies zeigt die systematische Untersuchung seiner zentralen Texte. Sie erhellt die allgemeinen Grundlagen von Platons Okonomie sowie die Ansatze seiner Regulierungsvorschlage und zeigt die Verbindung zu modernen wirtschaftstheoretischen Reflexionen uber den homo oeconomicus und die Bedeutung kultureller Faktoren fur das wirtschaftliche Handeln des Individuums. ".

Minor-attracted persons raise multiple ethical and legal challenges. Sexual contact between adults and children is justly prohibited on child welfare grounds. Advances in technology raise the prospect of interventions for minor-attracted persons that have the potential to reduce harm to children by diverting would-be offenders to other endeavors that nonetheless may generate moral disgust This essay examines three of these potential harm reduction technologies (sex robots, haptic devices and synthetic child pornography) and raises the possibility that their use can be (...) justified and their acceptance morally obligatory if doing so reduces harm to real children. (shrink)

One of the criteria used by many transplant centers in assessing psychosocial eligibility for solid organ transplantation is social support. Yet, social support is a highly controversial requirement that has generated ongoing debate between ethicists and clinicians who favor its consideration (i.e., utility maximizers) and those who object to its use on equity grounds (i.e., equity maximizers). The assumption underlying both of these approaches is that social support is not a commodity that can be purchased in the marketplace. This essay (...) argues for the reconceptualization of social support as a product that can—and should—be purchased for transplant candidates to render them eligible for transplant. (shrink)

The model for capacity assessment in the United States and much of the Western world relies upon the demonstration of four skills including the ability to communicate a clear, consistent choice. Yet such assessments often occur at only one moment in time, which may result in the patient expressing a choice to the evaluator that is highly inconsistent with the patient’s underlying values and goals, especially if a short-term factor (such as frustration with the hospital staff) distorts the patient’s preferences (...) momentarily. These challenges are particularly concerning in cases, which arise frequently in hospital settings, in which patients demand immediate self-discharge, often during off-hours, while faced with life-threatening risks. This paper examines the distinctive elements that shape such cases and explores their ethical implications, ultimately offering a model for such situations that can be operationalized. (shrink)

This essay has examined a women's subculture within a broader discipline. In the Victorian era physiology, understood in its then-dominant meaning as hygiene, en- tered the women's colleges and was likely also to have been found in modified form in other types of colleges. Toward the turn of the century physiology began to be redefined as a male-oriented experimental biomedical science. Physiology in the five women's colleges under discussion was transformed in light of that new meaning, but in such a (...) manner as to preserve a female network with an identity of its own. (shrink)

Limitations on reproductive decision making, including forced sterilization and involuntary birth control, raise significant ethical challenges. In the United States, these issues are further complicated by a disturbing history of the abuse and victimization of vulnerable populations. One particularly fraught challenge is the risk of teratogenicity posed by moodstabilizing psychiatric medications in patients who are incapable of appreciating such dangers. Long-acting reversible contraception (LARC) offers an intervention to prevent pregnancy among individuals who receive such treatments, but at a cost to (...) their reproductive autonomy. This article examines the ethical issues involved in the use of involuntary LARC for patients on teratogenic psychiatric medications (TPMs) and argues that such an approach can only be justified as a last resort after a careful consideration of the alternatives and an assessment of potential risks and benefits. (shrink)

The most widely accepted model of decisional capacity assessment requires that a patient communicate a clear and consistent choice to the evaluator. This approach works effectively when patients prove unable to express a choice owing to physical, psychological, or cognitive limitations. In contrast, the approach raises ethics concerns when applied to patients who volitionally refuse to communicate a choice. This article examines the ethical issues that arise in such cases and offers a rubric for addressing decisional capacity under such circumstances.

The laws of medical malpractice have historically differed in significant ways from general liability laws. Until the mid‐twentieth century, physician liability in the United States was limited to cases in which the doctor and patient had an established professional relationship. In the 1970s, courts and legislatures began carving out exceptions when patients posed an imminent threat to identifiable third parties. Recently, a series of cases involving circumstances such as curbside consultation, threats of violence, and automotive accidents have led some state (...) courts to abandon the requirement of a preexisting physician‐patient relationship. Instead, the courts now focus on whether foreseeable reliance is present. While these developments may significantly impact clinical practice, the connections between these cases have gone largely overlooked by both the medical and bioethics communities. This essay aims to highlight these parallel developments and to suggest that this evolution reflects a broader trend with implications far beyond the individual cases themselves. (shrink)

Liver transplantation offers a lifesaving treatment for patients suffering from end-stage liver failure, but not all candidates in the United States are eligible owing to center-specific criteria. When a patient is rejected at a transplantation center for medical, surgical, or psychosocial issues, they are often referred to other centers. We focus on this practice of reevaluation at a second center when the candidate was rejected for psychosocial reasons. We review the criteria used by health professionals to determine psychosocial eligibility and (...) present three case examples from a large teaching hospital that demonstrate this phenomenon in practice. The cases illustrate the conflicts among autonomy, beneficence, nonmaleficence, and justice. We present arguments for and against this practice and provide concrete solutions as a path forward. (shrink)

This essay advocates for the wholesale reevaluation of the process used by American medical schools for selecting physicians, examining fundamental questions such as the purpose of physicians and the nature of meritocracy. It raises questions about the size of medical school classes, the specific academic requirements, and the inadequacy of current efforts to increase diversity. Ultimately, the essay argues for consideration of a range of reforms that will focus on the community-empowering aspects of medical admissions decisions.

Clinicians are often called upon to assess the capacity of a patient to appoint a healthcare agent. Although a consensus has emerged that the standard for such assessment should differ from that for capacity to render specific healthcare decisions, exactly what standard should be employed remains unsettled and differs by jurisdiction. The current models in use draw heavily upon analogous methods used in clinical assessment, such as the “four skills” approach. This essay proposes an alternative model that relies upon categorization (...) and sliding scale risk assessment that can be used to determine to how much scrutiny the proxy appointment should be subjected and how much certainty of accuracy should be required in order to maximize the patient’s autonomy and ensure that her underlying wishes are met. (shrink)