This classroom exercise uses the movie Jojo Rabbit to teach students Kohlberg’s three levels and six stages of moral development. This is a helpful way to teach the concept of moral development because it helps students to visualize the nature of each of the stages and how one might move through them. It is appropriate for both undergraduate and graduate classes in management principles, ethics, organizational behavior, and leadership. The exercise can be completed in a 60 or 90 minute class. (...) Student feedback is very positive. (shrink)

In the course of his interesting article on the practice of introspection and its justification, ‘Introspection as practice', Pierre Vermersch reveals a commitment to a particular framework or model of the nature of introspection. My comments in this discussion note will be directed towards that model. The following passage from Vermersch's article may serve as a clear account of the model to which I refer.

This essay investigates the influences that led J.B. Watson to change from being a student in an introspectionist laboratory at Chicago to being the founder of systematic (or radical) behaviourism. Our focus is the crucial period, 1913-1914, when Watson struggled to give a convincing behaviourist account of mental imaging, which he considered to be the greatest obstacle to his behaviourist programme. We discuss in detail the evidence for and against the view that, at least eventually, Watson rejected outright the very (...) existence of mental images. We also discuss in detail whether or not Knight Dunlap was the crucial influence on his eventual rejection of mental images. Finally we consider whether Watson's rejection of mental images was bolstered by some personal incapacity as regards imaging or whether his rejection was more like a form of 'ideological blindness'. (shrink)

Australia and New Zealand boast an active community of scholars working in the field of history, philosophy and social studies of science. Australasian Studies in History and Philosophy of Science aims to provide a distinctive publication outlet for their work. Each volume comprises a group of thematically-connected essays edited by scholars based in Australia or New Zealand with special expertise in that particular area. In each volume, a majority ofthe contributors are from Australia or New Zealand. Contributions from elsewhere are (...) by no means ruled out, however, and are actively encouraged wherever appropriate to the balance of the volume in question. Earlier volumes in the series have been welcomed for significantly advancing the discussion of the topics they have dealt with. I believe that the present volume will be greeted equally enthusiastically by readers in many parts of the world. R. W. Home General Editor Australasian Studies in History And Philosophy of Science viii ACKNOWLEDGEMENTS The majority of the papers in this collection had their origin in the 2001 Australasian Association for History, Philosophy, and Social Studies of Science annual conference, held at the University of Melbourne, where streams of papers on the themes of scientific realism and commonsense were organised. (shrink)

What determines whether an action is right or wrong? Morality, Rules, and Consequences: A Critical Reader explores for students and researchers the relationship between consequentialist theory and moral rules. Most of the chapters focus on rule consequentialism or on the distinction between act and rule versions of consequentialism. Contributors, among them the leading philosophers in the discipline, suggest ways of assessing whether rule consequentialism could be a satisfactory moral theory. These essays, all of which are previously unpublished, provide students in (...) moral philosophy with essential material and ask key questions on just what the criteria for an adequate moral theory might be. (shrink)

There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD).

The 2008 financial crisis has raised serious ethical questions about behaviors associated with the free market system and the effectiveness of undergraduate business ethics education. We offer opposing interpretations of the crisis, a “Markets Work” and a “Critical” perspective, in order to provide students with an opportunity to examine their ethical assumptions. We frame our discussion around legitimacy; therefore, we utilize an institutional theory lens to frame the processes by which financial organizations are rewarded with social legitimacy for using “proper” (...) structures and following “appropriate” procedures and punished when they do not. By presenting these two opposing narratives of the crisis, we provide a richer framework for discussing the crisis and relating it to the larger issue of corporate malfeasance. We draw upon a wealth of readily available, easily accessible material. We identify films, readings, and provide notes that may use to set the direction and tenor of classroom discussion. (shrink)

Introduction of O2 to Earth's early biosphere stimulated remarkable evolutionary adaptations, and a wide range of electron acceptors allowed diverse, energy-yielding metabolic pathways. Enzymatic reduction of O2 yielded a several-fold increase in energy production, enabling evolution of multi-cellular animal life. However, utilization of O2 also presented major challenges as O2 and many of its derived reactive oxygen species are highly toxic, possibly impeding multicellular evolution after the Great Oxidation Event. Remarkably, ROS, and especially hydrogen peroxide, seem to play a major (...) part in early diversification and further development of cellular respiration and other oxygenic pathways, thus becoming an intricate part of evolution of complex life. Hence, although harnessing of chemical and thermo-dynamic properties of O2 for aerobic metabolism is generally considered to be an evolutionary milestone, the ability to use ROS for cell signaling and regulation may have been the first true breakthrough in development of complex life. The importance of Earth's oxygen cycle and reactive oxygen species produced on the evolution of complex life. The ability to detoxify oxygen species is not a trait that emerged as a response to increased O2 levels but rather crucial adaptation to the early Earth's weakly oxic microenvironments. (shrink)

I give a brief precis of Lyons' book. I discuss the problem of delineating basic from non-basic beliefs. I argue that one of Lyons' possible solutions doesn't work - his definition of a perceptual module does not allow us to decide which beliefs are basic. And I argue that another possible solution undermines some of Lyons' motivation. The intuitive understanding of belief may not generate the Clairvoyancy troubles he fears.

The ethics of psychiatry The ethics of psychiatry is one of the areas of medical ethics where the overlap between medical ethics and philosophy of medicine is largest. This is illustrated by two papers in the current issue of the JME. Charlotte Blease discusses whether it is “… ever right to prescribe placebos to patients in clinical practice?” in the context of prescribing for patients with severe depression . Would such prescriptions for instance amount to morally problematic deception? In (...) an intricate analysis she points out that the answer to the question depends on a range of complex conceptual distinctions that will be familiar to scholars in philosophy of medicine. One very significant issue that is raised is that well-being is not synonymous with a realistic assessment of oneself or one's circumstances. Most of us who are not depressed have positive illusions about ourselves and this may even …. (shrink)

I am enormously grateful to everyone who has contributed to this double issue of Philosophical Topics, to Manuel Dries and Joseph Schear for conceiving the issue and initiating the process of inviting contributions, and to Ed Minar and Jack Lyons, former editor and current editor of the journal respectively, for their excellent work in bringing the issue into existence. Each contribution displays a level of engagement with my book1 that would have been gratifying even if the contribution had been confined (...) exclusively to the chapter that is its immediate focus. What I have found most gratifying, however, is the sensitivity that the contributors have shown to the broader project of the book and to the various connections and patterns that I try to trace across chapters. I thank them warmly for this.In the preface to my book I comment on the fact that I am a philosophical generalist, and I go on to apologize to “all those whose expertise I may have propagated without acknowledgement, or mangled, or worst of all ignored” (MST, xix). That certainly includes the present contributors. I take this opportunity to repeat the apology to them, an apology whose need I feel all the more keenly having read their contributions. (shrink)

The major portion of the book is devoted to careful and detailed historical analysis of two traditions of theodicy in Christian theology, the Augustinian and the Irenaean. The latter, though foreshadowed by the second century Bishop of Lyons, was first fully developed by Schleiermacher. Both traditions are traced right up to the contemporary scene in English theology and systematically compared. The last five chapters are devoted to the author's own constructive theodicy which grows out of the Irenaean tradition. He finds (...) the ultimate solution to the problem of evil in a doctrine of universal salvation.—M. W. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Falling From the Sky: Trauma in Perec’s W and Caruth’s Unclaimed ExperienceEleanor Kaufman (bio)1 Fear of FallingIt is not surprising to find a link between trauma and falling in an entire strain of postwar literature. It is arguably the case that, in the wake of the Spanish Civil War and World War II, a new and more aerial form of spatial perception came into prominence, one in which something (...) or someone might reasonably be expected to fall out of the sky. Such a form of perception, vertical rather than horizontal in its orientation, is often experienced as an uneasiness directed at falling in both its physical and its metaphysical senses. That is, there is both a literal fear of falling from a height and a spiritual angst about falling, generally through no agency of one’s own, from one station in life to another.Within the postwar French tradition, 1 the conjunction of these two forms of falling is nowhere better articulated than in Georges Perec’s semi-autobiographical novel W or the Memory of Childhood. W alternates chapter by chapter between two different forms of writing: one a fantastical narrative about the faraway island of W, in which a robust society of athletes devote their lives to an Olympic ideal of sport, and which is organized by a system that first appears like a rational utopia but by the novel’s end devolves into a terrifying concentrationary universe; the other a non-narrative, truncated, and elliptical set of references to Perec’s own Jewish wartime childhood (Perec’s father died fighting for France in 1940; his mother died after being deported to Auschwitz in early 1943; in 1942, his mother placed the young Perec, aged six, on a Red Cross convoy headed toward the French Free Zone). In the autobiographical section of W, Perec gives several versions of his departure from his mother. In what follows are two of these versions, followed by Perec’s subsequent analysis of this memory.Of particular interest is the way that images of falling or suspension, here in the form of the parachute, punctuate this memory and take on their meaning precisely at the later [End Page 44] moment when Perec finds himself parachuting from the sky.The only surviving memory of my mother is the day she took me to the Gare de Lyon, which is where I left for Villard-de-Lans in a Red Cross convoy: though I have no broken bones, I wear my arm in a sling. My mother buys me a comic entitled Charlie and the Parachute: on the illustrated cover, the parachute’s rigging lines are no other than Charlie’s trouser braces.[26]My mother took me to the Gare de Lyon. I was six. She entrusted me to a Red Cross convoy leaving for Grenoble, in the free zone. She bought me a magazine, an issue of Charlie, with a cover showing Charlie Chaplin, with his walking stick, his hat, his shoes and his little mustache, doing a parachute jump. The parachute is attached to Charlie by his trouser braces.[54]A triple trait runs through this memory: parachute, sling, truss: it involves suspension, support, prosthesis almost. In order to be, you had to be propped. Sixteen years later, in 1958, when the haphazard fate of military service made me into a short-lived parachutist, I was able to read, at the very instant of jumping, one of the decoded texts of that memory: I was thrown into the void; all the threads were broken; I was falling, alone and without support. The parachute opened. The canopy unfurled, a fragile and firm suspense before the controlled descent.[55, translation modified]These two memories of Perec’s departure from his mother, as well as the third decoded reading dating from 1958, might be viewed together as the story of a trauma that, with characteristic belatedness, is only readable after the fact. Moreover, the motif of falling, in this instance figured by the recurrence of the parachute, provides the key to deciphering the memory of the trauma. The last—and lasting—memory of the mother is that of her buying Perec... (shrink)

Adam Naruszewicz - the court poet of the last king of Poland was born on 20th October 1733 in Polesie. He studied at Villinus University and in Lyon. Thanks to Adam Kazimierz Czartoryski he established a very close friendship with Stanisław August Poniatowski. In the course of time he started to bring out his political opinions and put some of his plans into practice. He edited Zabawy Przyjemne i Pożyteczne - the first Polish literary magazine. Franciszek Bohomolec printed his (...) main works in Dzieła. However, the first publications has already been issued in Zabawy Przyjemne i Pożyteczne. As far as literary writing is concerned, Adam Naruszewicz gave his undivided attention to contemporary situation. It was difficulties in the country and on the King’s court that inspired Naruszewicz to express his opinions in public. The resources of contemporary political situation, particularly the times of Barski Confederation, the First Partition of Poland and the dissolution of Delegation Representatives were found between 1768—1775 in Poniatowski’s royal collection. The above events, in Adam Naruszewicz’s poems, are presented in the following order: The Barski and Radom Confederation, the abduction of the King and the Frist Partition of Poland. The plots are very important in poet’s life. The writer perceives and comments on the subject touching various areas. Above all, patriotism and love to the Country are the most important issues in Naruszewicz’s works. (shrink)

The doctor-patient relationship is built on an implicit covenant of trust, yet it was not until the post-World War Two era that respect for patient autonomy emerged as an article of mainstream medical ethics. Unlike their medical forebears, physicians today are expected to furnish patients with adequate information about diagnoses, prognoses and treatments. Against these dicta there has been ongoing debate over whether placebos pose a threat to patient autonomy. A key premise underlying medical ethics discussion is the notion that (...) the placebo effect necessitates patient deception. Indeed, the American Medical Association guidelines imply that placebo treatment necessary entails a form of deception. As a consequence of this assumption, the fulcrum of debate on the use of placebo treatment has hinged on whether that deception is ever justified. Recently performed experiments with open-label transparently prescribed placebos have begun to challenge the notion that deception is necessary in eliciting the placebo effect and such effects necessarily involve a binary distinction between autonomy and beneficence. In this article we focus on the content of disclosures in distinctive open-label, transparently disclosed placebo studies and inquire whether they might be said to invoke deception in clinical contexts, and if so, whether the deception is unethical. We find that open placebos may be said to involve equivocation over how placebos work. However, drawing on surveys of patient attitudes we suggest that this equivocation appears to be acceptable to patients. We conclude that open placebos fulfil current American Medical Association guidelines for placebo use, and propose future research directions for harnessing the placebo effect ethically. (shrink)

Is it ever right to prescribe placebos to patients in clinical practice? The General Medical Council is ambivalent about the issue; the American Medical Association asserts that placebos can be administered only if the patient is (somehow) ‘informed’. The potential problem with placebos is that they may involve deception: indeed, if this is the case, an ethical tension arises over the patient's autonomy and the physician's requirement to be open and honest, and the notion that medical care should be the (...) primary concern. This paper examines the case of depression as an entry point for understanding the complexities of the prescription of placebos. Recent important meta-analyses of antidepressants claim that they are not significantly more effective in a clinical setting than placebos. Given that antidepressants have numerous adverse side effects and are hugely expensive, this provocative research has serious potential ethical and practical implications for patients and medical providers. Should placebos be prescribed in place of antidepressants? The case of depression highlights another important issue which medical ethical codes have hitherto overlooked: well-being is not synonymous with being realistic about oneself, one's circumstances and the future. While severely depressed individuals are unduly pessimistic about themselves and the world around them, treatment of depressed individuals can be deemed successful when patients have successfully attained those positive illusions that are indicative of psychological health. This is exactly what successful psychological treatments of depression seem to achieve. It is therefore possible that there may be a limited unavoidable role for deception in medicine. (shrink)

A common observation in placebo studies is that definitional disagreement is rife. Philosopher and historian of science Robin Nunn recently argued that "Nobody who came and saw the placebo has conquered its definition". Nunn insists that "the placebo construct conceals more than it clarifies," and that we need to prepare for "a post-placebo paradigm". Pronouncements that disagreement is endemic are often the prologue for new definitions of placebo and "placebo effect": for example, in the opening of a recent philosophical paper (...) on the issue, Jeremy Howick observed that debates about placebos "rage," and that "there is currently no widely accepted definition of the 'placebo'".... (shrink)

It is now an ethical dictum that patients should be informed by physicians about their diagnosis, prognosis and treatment options. In this paper, I ask: ‘How informed are the ‘informers’ in clinical practice?’ Physicians have a duty to be ‘well-informed’: patient well-being depends not just in conveying adequate information to patients, it also depends on physicians keeping up-to-date about: popular misunderstandings of illnesses and treatments; and the importance of patient psychology in affecting prognosis. Taking the case of depression as an (...) entry point, this paper argues that medical researchers and physicians need to pay serious attention to the explanations given to patients regarding their diagnosis. Studies on lay understanding of depression show that there is a common belief that depression is wholly caused by a ‘chemical imbalance’ that can be restored by chemically restorative antidepresssants, a claim that has entered ‘folk wisdom’. However, these beliefs oversimplify and misrepresent the current scientific understanding of the causes of depression: first, there is consensus in the scientific community that the causes of depression include social as well as psychological triggers ; second, there is significant dissensus in the scientific community over exactly what lower level, biological or biochemical processes are involved in causing depression; third, there is no established consensus about how antidepressants work at a biochemical level; fourth, there is evidence that patients are negatively affected if they believe their depression is wholly explained by of ‘biochemical imbalance’. I argue that the medical community has a duty, to provide patients with adequate information and to be aware of the negative health impact of prevalent oversimplifications—whatever their origins. (shrink)

The use of ‘placebos’ in clinical practice is a source of continued controversy for physicians and medical ethicists. There is rarely any extensive discussion on what ‘placebos’ are and how they work. In this paper, drawing on Louhiala and Puustinen's work, the author proposes that the term ‘placebo effect’ be replaced in clinical contexts with the term ‘positive care effect’. Medical treatment always takes place in a ‘context of care’ that encompasses all the phenomena associated with medical intervention: it includes (...) the particular method of treatment, the interpersonal relationships between medical staff and the patient and other factors, including physicians' and patients' beliefs in the power of the treatment. Together, these phenomena can result in a full spectrum of therapeutic effects to the patient—from no effects, to small effects, to large effects. In cases where there are significant therapeutic benefits to the patient, ‘positive care effects’ may be spoken of. Since the ethical codes of the General Medical Council and the American Medical Association demand transparency with respect to patient treatment and insist on complete openness in ‘placebo’ usage, the author argues that, as a matter of conceptual rigour and consistency, if the term ‘placebo effect’ is replaced by ‘positive care effect’, these ethical codes appear to insist on transparency about all such beneficial components of treatment. Given that this appears to be a counterintuitive obligation, the author concludes the paper with some comments on the clinical consequences of this conceptual revision, including a brief discussion of how this important debate might develop. (shrink)

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. (...) Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (shrink)

This paper aims to show that the classification by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders of a distinct listing of disorders known as Culture-Bound Syndromes is misguided. I argue that the list of CBS comprises either genuine disorders that should be included within the main body of the DSM; or ersatz-disorders that serve a practical role for psychiatrists dealing with patients from certain cultures but will one day be eliminated or assimilated by bona (...) fide DSM classifications. In support of these views I draw on claims from two key themes in the philosophy of science: the claim that all folk explanations for phenomena are thoroughly theoretical and therefore fallible; and the occurrence of theoretical elimination in the history of science. I contend that any ersatz-disorders located in the DSM that are judged to be radically false do not differ in kind from eliminated theories in the history of pre-science. (shrink)

Patients in around 20 countries worldwide are now offered online access to at least some of their medical records. Access includes test results, medication lists, referral information, and/or the very words written by clinicians (so-called ‘open notes’). In this paper, I discuss the possibility of one unintended negative consequence of patient access to their clinical notes—the potential to increase ‘nocebo effects’. A growing body of research shows that nocebo effects arise by engaging perceptual and cognitive processes that influence negative expectancies, (...) and as a consequence, adverse health effects. Studies show that increased awareness about the side effects of medications, the framing of information and the socioemotional context of care can increase the risk of nocebo effects. Connecting research into the nocebo effect with open notes provides preliminary support for the hypothesis that patient access to clinical notes might be a forum for facilitating unwanted nocebo effects. Furthermore, current findings indicate that we might expect to see systematic differences in how nocebo effects are experienced among different patient populations. The ethical implications of the tension between transparency and the potential for harm are discussed, with an emphasis on what open notes might mean for justice and equity in clinical care for a range of already marginalised patient populations. I argue that to resolve these challenges does not thereby justify ‘closed notes’, and conclude with suggestions for how health systems and clinicians might adapt to this innovation to reduce the risk of potential nocebo effects arising via this novel route. (shrink)

In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (‘open notes’). However, even in countries that (...) have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety. (shrink)

Patient online record access (ORA) is spreading worldwide, and in some countries, including Sweden, and the USA, access is advanced with patients obtaining rapid access to their full records. In the UK context, from 31 October 2023 as part of the new NHS England general practitioner (GP) contract it will be mandatory for GPs to offer ORA to patients aged 16 and older. Patients report many benefits from reading their clinical records including feeling more empowered, better understanding and remembering their (...) treatment plan, and greater awareness about medications including possible adverse effects. However, a variety of indirect evidence suggests these benefits are unlikely to accrue without supplementation from internet-based resources. Using such routes to augment interpretation of the data and notes housed in electronic health records, however, comes with trade-offs in terms of exposing sensitive patient information to internet corporations. Furthermore, increased work burdens on clinicians, including the unique demands of ORA, combined with the easy availability and capability of a new generation of large language model (LLM)-powered chatbots, create a perfect collision course for exposing sensitive patient information to private tech companies. This paper surveys how ORA intersects with internet associated privacy risks and offers a variety of multilevel suggestions for how these risks might be better mitigated. (shrink)