The most recent commentators on Edmund Burke have renewed the charge that his political thought lacks the consistency and coherency necessary to even claim the status of a political philosophy and that he is indeed a "utilitarian." They mark him off as an "ideologist," a "rhetorician," and a "deliberate propagandist." Even Burke’s Reflections on the Revolution in France, his most profound statement of a political philosophy, is regarded by some as a work of mere "persuasion," not "philosophy." All this occurs (...) in spite of the seminal work of Stanlis, Canavan, and Wilkins, who in the 1950s and ‘60s, demonstrated the natural law foundations of Burke’s politics. Burke revisionists, forced to acknowledge his use of the "natural law," label such use as a rhetorical means for utilitarian ends. Directly opposed to this renewed "utilitarian" interpretation of Burke is Joseph Pappin’s work The Metaphysics of Edmund Burke. Not only does this work challenge the "utilitarian" view of Burke, it sets out, as not other work on Burke has attempted to do, "to make explicit the implicit metaphysical core of Burke’s political thought." Pappin does this by examining both Burke’s critics and Burke’s own attack on a rationalist, ideologically inspired metaphysics. Drawing from Burke’s vast writings, Pappin establishes as his goal "to demonstrate that Burke’s political philosophy is grounded in a realist metaphysic, one that is basically consonant with the Aristotelian-Thomistic tradition." Does the author succeed? According to Francis Canavan, in his Foreword to this work, the "explanatory key" of a realist metaphysics grounding Burke’s politics "is a key that fits the lock better than any other that scholars have offered." Canavan further holds that the author offers "us a more thorough analysis of Burke’s understanding of God, the creation, nature, man, and society than has previously appeared.". (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ill HUME ON THE MORALITY OF PRINCES "There is a maxim very current in the world," says Hume (Treatise III, ii, sec. 11) "that there is a system of morals calculated for princes, much more free than that which ought to govern private persons. " He interprets the maxim to mean that "the morality of princes... has not the same force as that of private persons, and may lawfully (...) be transgress 'd from a more trivial motive." And he gives as an example: "we must necessarily give a greater indulgence to a prince or minister, who deceives another; than to a private gentleman, who breaks his word of honour" (T 569). This passage, cryptic though it is, makes Hume sound bad. He seems to be a cynic, or a skeptic, or an immoralist, with respect to the morality of nations. Does he think that princes have a special right to act immorally? Even worse is the reason he gives: international relations just don't matter very much, he says. And the chapter in question is not just a self-contained essay more or less tacked on to the Treatise. Hume tries to connect it integrally with his theory of justice. The point of the chapter is not to put forward a view about the morality of international relations (a view Hume himself admits may be found shocking), but to demonstrate the power of the theory of justice by showing how the "maxim current in the world" can be defended upon the theory's principles. The passage has not won approval from recent commentators. One, Marshall Cohen, labels Hume a "moderate skeptic" with regard to international morality and argues vehemently that Hume's position 2 should be condemned as immoral. Cohen, who thinks that there is only one system of morality and that it 112 applies "with equal force to princes and private persons," evidently thinks any system weakening ordinary standards is immoral by definition. He traces Hume's allegedly morally flawed views to what he regards as a deep flaw in Hume's moral theory, namely, his conventionalism. J. L. Mackie and Jonathan Harrison are both considerably more sympathetic to Hume's general position, but nevertheless are critical of the chapter in question. They agree with Hume's observation that international morality is weaker than private. (Harrison points out that people tend to regard breaches of private morality as more serious than breaches of international morality: "A minister may be dismissed for sexual misconduct, although he breaks solemn treaties with other nations with impunity." But, contrary to Hume, they find this weakness deplorable, Harrison arguing that, given the relative amount of harm princes do, the indulgence allowed them is irrational. Harrison in fact at first agrees with Hume: "He is right, too, in suggesting that the obligations of nations to be just in their dealings with one another is [sic] of less force than the obligations of private persons." But after ten pages he has evidently changed his mind: "[with respect to] what Hume says about the comparative force of the morality of princes and the morality of private persons, though it is clear that there is nothing in principle wrong with Hume's view that the former has less force than the latter... it is doubtful whether he is right in saying that the former do in fact have less force than the latter." Like Cohen, who holds that "Injustice among nations should be regarded as being as reprehensible as injustice among individuals," Harrison concludes (more tentatively than Cohen) "my 113 own feeling... is that though Hume is right in thinking that the morality of princes is commonly regarded as being of less force than private morality, he is wrong... in thinking that... they [sic] are of less force." So none of our commentators agree with Hume that international morality not only is, but is properly, weaker than domestic. How did Hume go wrong? Hume argues that international morality is weaker because the interests at stake are less. Where the interests at stake do not matter very much, Hume thinks, it is not so important what people do, and thus the moral obligations involved are weaker. (Hume thinks this idea... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:248 HISTORY OF PHILOSOPHY be taken from a philosophical point of view. Since it is not certain whether the author of the Prolegomena was or was not a Christian (p. xlix), "god" should not be capitalized, and the translation of T&~ia 5~l~ttovo'f~l~taTa as "God's creation" at IV. 15. 6 is actually misleading. Moreover, for no apparent reason, 0~oX07tz6gis translated as "metaphysical" in the first four chapters, but as "theological" (...) thereafter. Inaccuracies are very few indeed. "Ungrateful" is peculiar for o~5~5t• at I. 2. 25, and so is "adapted state" for ~to~tTe[a~ ~no~ae0g at I. 5.35; X. 26. 38, 40, and 44; at II. 10. 11, there is no need to translate o~Te&0t~6)g bu~yovxctL as "they do not aim at accurate expression," and on p. 32, line 1, "as yet" is not in the Greek of the Prolegomena, although it should have been, if the Anonymous had quoted correctly from Plato, Phaedrus 229 E. But this is trifling criticism of a work which leaves nothing to be desired in any other respect, and which displays the same high qualities of scholarship which we have come to expect of the author on the basis of his earlier achievements. MARTIN OSTWALI) Swarthmore College The Fountain of Life (Fons Vitae). By Solomon ibn Gabirol (Avicebron). Specially abridged edition, translated from the Latin by Harry E. Wedeck, with an Introduction by Theodore E. James. (New York: Philosophical Library, 1962. Unpaged introduction, 133 pp. $4.75.) The romance of the nineteenth-century discovery, by Salomon Munk, that "Avicebron's" Fons Vitae, a major source of neoplatonic thought in the thirteenth and fourteenth centuries, was actually the work of the eleventhcentury Hispano-Jewish poet, Solomon ibn Gabirol, and has often been retold. It is, indeed, a remarkable story. Perhaps its most noteworthy feature is that it reveals how closely alike Muslim, Jewish, and Christian philosophers were; by implication, then, it indicates that theological considerations were of less importance in medieval philosophy than is suggested by most historical accounts. Although the story of The Fountain of Lqe has now become an oft-told tale, the work itself has never been available in English dress. The present edition remedies this situation in part. It presents Tract III of the original text, a section dealing with the existence of simple spiritual substances. Harry Wedeck's translation is lucid and readable. Theodore E. James's introduction is useful for the beginning student but too elementary to be of much use to a more advanced reader. It is good that there is now this much to recommend to our students; we may hope that the day will come when BOOK REVIEWS 249 larger sections of the work will be translated-preferably not from the Latin, but from the Arabic original. JOSEPHL. B~u Columbia University Commentary on the Metaphysics of Aristotle. By St. Thomas Aquinas. Trans. by John P. Rowan. (Chicago, Illinois: Henry Regnery Company, 1961. Pp. xxiii + 955.2 vols., boxed, $25.00.) Generally speaking, the two Summae of St. Thomas, long available in English translation, contain all that is most personal and most profound in his philosophical thought. Nonetheless, it is quite impossible to get a fully adequate conception of St. Thomas' place in the history of western thought from a consideration of his theological writings alone. Hence, by translating St. Thomas' Commentary on the Metaphysics of Aristotle into English, Professor J. P. Rowan has provided the non-Latin reading student of the history of philosophy an invaluable service. For it is in his r61e as Aristotelian commentator that we see St. Thomas creating for the Schoolmen a version of Aristotle which served to render the Stagirite's thought into terms which became fundamental to the philosophical defense of Christianity. Further, by keeping in mind the fully-developed notions of St. Thomas on the existence of God and the nature of being as these are given us to understand in the Summae, the reader becomes better enabled, by a critical reading of Thomas' Commentary, to grasp the sense in which the Saint's theological writings are said by his enthusiasts to represent a "completing" and "perfecting" of... (shrink)

This rich and varied collection of essays addresses some of the most fundamental human questions through the lenses of philosophy, literature, religion, politics, and theology. Peter Augustine Lawler and Dale McConkey have fashioned an interdisciplinary consideration of such perennial and enduring issues as the relationship between nature and history, nature and grace, reason and revelation, classical philosophy and Christianity, modernity and postmodernity, repentance and self-limitation, and philosophy and politics.

Hildegard of Bingen was one of the most remarkable women of her day. From early childhood she experienced religious visions, and at the age of eight she entered a cloistered religious life in the Benedictine monastery of Disibondenberg. Eventually she not only became abbess of the community, but presided over the establishment of an important new convent near Bingen. All but forgotten for hundreds of years, Hildegard was rediscovered in the 1980s and since then her visionary writings have been widely (...) read and studied. Even more surprisingly, music that she composed has been performed and recorded to great acclaim. She has come to be seen by some as a proto-feminist icon -- a woman of great accomplishments who made her own way in a man's world and exerted extraordinary influence over some of the most powerful figures of her time. Much of Hildegard's correspondence has been preserved. It reveals that for more than 30 years this cloistered nun was an unflinching adviser and correspondent to all levels of church and society, from popes and kings to ordinary lay persons, from Jerusalem to England. With the 2004 OUP publication of Volume III of Joseph Baird and Radd Ehrman's translation, the complete correspondence became available for the first time in English. For this new abridgement, Baird has selected 75 of the most interesting and revealing of the letters from Volumes I, II, and III. Freed from the organizational restraints of the Latin edition of the letters, he has arranged them in roughly chronological order and provided greatly expanded, accessibly written introductory notes that contextualize the letters and explain their significance. As a result, this fascinating collection serves as a kind of life in letters that makes an ideal introduction ot this exceptional woman, her world, and her work. This book is the first to give a thorough and definitive illlumination of the personal life of Hildegard of Bingen as viewed through the defining lens of her personal correspondence: her early, hesitant bid for recognition of her spiritual gifts; her courageous, and ultimately futile, fight to retain the companionship of her close personal friend and the poignant outcome of that struggle; her vehement defiance of the male hierarchy in her bid to establish her own communities under her personal governance; her impudent challenge to contemporary conservatives views by the dress and customs she established in her community; her paean of praise for the power of music; and her adamant refusal, even at the advanced age of eighty, to give in to the demands of the male authorities even in the face of excommunication. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Sur la base des travaux théologiques publiés par Ernst Troeltsch entre 1900 et 1913, rassemblés dans le volume 111 de ses Oeuvres , nous cherchons à montrer comment s'est précisée sa pensée sur la théologie durant cette période. Dans le but de l'intégrer à la culture scientifique, il lui assigne pour méthode et site l'histoire de la religion en général, et pour tâche propre l'exploration des connaissances normatives qui se dégagent de la finalité de cette histoire. La tâche spécifique de (...) la théolo­gie chrétienne est de situer la prédication de Jésus et celle de l'Église dans l'histoire universelle de la religion et de subvenir aux besoins spirituels de la communauté ; il lui trace, dans cette perspective, un programme de « dogmatique » inspiré de Schleiermacher.L'intérêt actuel de la pensée de Troeltsch est de souligner les condi­tionnements historiques du christianisme auxquels doit se soumettre la théologie. Cependant, ni son épistémologie ni sa conception téléologi­que de l'histoire ne peuvent fonder la méthode d'une théologie pour aujourd'hui. Trop préoccupé du déploiement de Hélée religieuse, il ne permet pas de penser la révélation de l'Absolu dans la contingence de l'événement et de la chair du Christ. Mais son souci du divorce entre la pensée chrétienne et la culture occidentale moderne nous encourage à frayer les voies du « libre christianisme » auquel il aspirait.On the basis of the theological works published by Ernst Troeltsch between 1900 and 1913, brought together in volume III of his Works , we would like to show how his thinking on theology during this period became more precise. In order to integrate it into scientific culture, he uses a method and background in the history of religion in general, and more particularly the exploration of normative knowl­edge that comes out of the finality of this history. The specific task of Christian theology is to situate the preaching of Jesus and that of the Church in the universal history of religion and to provide for the spiritual needs of the community. In this perspective he traces a program of “dogmatics" inspired by Schleiermacher.Today's interest in the thought of Troeltsch is to point out the historical conditions of a Christianity that ought to defer to theology. Nevertheless, neither his epistemol­ogy nor his theological conception of history are capable of laying the ground for a theological method today. Too preoccupied about the use of the religious Idea, he does not allow for reflection on revelation of the Absolute in the contingency of the event and theflesh of Christ. But his concern about the divorce between Christian thought and modern occidental culture encourages us to trace the paths of a 'free Chris­tianity " to which he aspires. (shrink)

La cuestión de si los lenguajes intensionalesson más expresivos que los lenguajes nointensionalessurge en el marco de unaperspect i va semánt i ca de l as t eorí as.Desde esta perspectiva, la cuestión esesta. ¿Hay clases modelo que se puedencaracterizar mediante teorías que usanconceptos intensionales que no se puedencaracterizar mediante teorías que no usanconceptos intensionales? Se sugiere unaformulación precisa de esta cuestión, perono se ofrece una respuesta.Para aproxi marse a est a cuest i ón, seresume la teoría de modelos de (...) primerorden [II] y se revisa el enfoque semánticode las teorías que emplea incrementost eóri cos, no i nt ensi onal es, de pri merorden [III].Los i nc r e me nt os t e ór i c os de pr i me rorden se bosquejan pero no se definenr i g u r o s a me n t e [ I V] . E s t e l e n g u a j ei n t e n s i o n a l pr o po r c i o n a e l a p a r a t op a r a a t r i b u i r u s o d e l l e n g u a j e yact i t udes i nt ens i onal es a i ndi vi duoscuyo comportami ento es el obj eto deinvestigación. También proporciona elaparato para habl ar sobre traducci óndel lenguaj e atribuido al lenguaj e delinvestigador.La cuestión inicial se convierte entoncesen si hay clases modelo que se puedanc a r a c t e r i z a r me d i a n t e i n c r e me n t o sintencionales de lógica de primer ordenq ue n o pue de n s e r c a pt ur a do s po rincrementos teóricos no-intensionales [V].The ques t i on of whet her i nt ens i onallanguages are more expressive than nonintensional languages is raised within the framework of a semantic view of theories. Fromthis perspective, the question isthis. Are there model classes that can becharacterized by theories using intensionalconcepts that cannot be characterizedby theories that do not use intensionalconcepts? A precise formulation of thisquestion is suggested, but no answer isgiven.To approach this question, model theory offirst order theories is summarized [II] andthe semantic approach to theories usingnon-intensional, theoretical augmentationsof first order theories is reviewed [III].I n t e n s i o n a l a u g me n t a t i o n s o f f i r s torder theories are sketched [IV] but notr i gor ous l y de f i ne d. Thi s i nt e ns i onall anguage provi des t he apparat us f orattributing language use and intensionalattitudes to individuals whose behavioris the object investigation. It also providesapparatus for talking about translationf r om t he at t r i but e d l anguage t o t heinvestigator’s language.T h e i n i t i a l q u e s t i o n t h e n b e c o me swhet her t here are model cl asses t hatc a n be c ha r a c t e r i z e d by i nt e ns i ona laugmentations of first order logic thatcannot be captured by non-intensionaltheoretical augmentations [V]. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The "Thinking of Thinking" in MetaphysicsA.9 JOSEPH G. DE FILIPPO a+~6v &Qa voE[, e~eQ ~o~t ~6 XQ&~O~OV, xetl. I~o~tv ~1VdOloLgvo1]o~t0g v6"qotg. (A.9, 1o74b33-34) Therefore it thinks itself, if indeed it is most powerful, and its thinking is the thinking of thinking. Thus culminates Aristotle's treatment of God's activity in the twelfth book of the Metaphysics. The conclusion seems transparent. God is an intellect (vo~Sg); since he is also (...) the best thing, and it is absurd that he should think anything worse than himself, he therefore thinks himself. And since he is nothing other than a thinking (v6"qotg), what he thinks of is thinking (vo~loEe0g). "Thinking of thinking," however, is a notion that is as ambiguous in ancient Greek as it is in English. It is just not clear what sort of thing such a reflexively self-thinking mind would be, though it might seem natural to construe the activity of Aristotle's God as somehow an act of pure self-awareness, self-consciousness or self-knowledge. On such an understanding God would be a separately existing consciousness, with himself or his activity as the only object of that consciousness. In 196 9 R. Norman published a paper which disputed this sort of interpretation.' He argued that when one considers Aristotle's theory of, R. Norman, "Aristotle's Philosopher-God," Phronesis 14 (1969): 63-74 (reprinted in Articles on Aristotle, vol. 4, ed. J. Barnes, M. Schofield and R. Sorabji [London, 1979], 93-1o2). While I a-m indebted to Norman's basic approach, my treatment of God's self-thought differs substantially from his in two respects. First, although it isessential to recognize that in Aristotle human thought too thinks itself, this does not justify the conclusion that God's thinking is "of the same kind as our own normal abstract thought" (73). As 1shall argue below in section 4, the characterization of the Prime Mover as v6"qoLgvo~o~t0g is meant specifically to differentiate its activity from the selfthinking of human volSg;human thought could never be characterized as v6"qotgvofioEt0g.Secondly, Norman does not isolate the real source of A.9's argument, which, as l shall argue, is the potential conflict between Aristotle's own physical and psychological theories. M. Wedin, Mind and Imagination in Aristotle (New Haven, 1988), 229-45, also argues against Norman's thesis that human and divine thought are the same in kind. [543] 544 JOURNAL OF THE HISTORY OF PHILOSOPHY 33:4 OCTOBER 1995 volSg from De Anima III.4-8, it is clear that the conception of God as a selfthinking mind does not entail that he engages in self-contemplation in the normal sense of the term. On Norman's interpretation, God thinks himself because he thinks a definite content with which he is numerically identical, according to the well-known Aristotelian doctrine of the unity of vo~g with its object of thought (vo~lx6v). To describe this act simply as self-contemplation belies the fact that its object must have an intelligible content, which in the case of God is not adequately described as his "self," for this self would indeed be nothing more than an act of self-contemplation. While many commentators have followed Norman in recognizing that the description of God as "thinking himself" is drawn from the De Anima's characterization of self-thinking, there has persisted a tendency to interpret Aristotle 's God as engaged in an act of pure self-awareness or under some similar description.' The reason for this persistence is due, I believe, to a crucial difference between chapters 7 and 9 of book A. Whereas both chapters characterize the Prime Mover (PM) as a self-thinker, in chapter 9 he is also said to be ~1 v61]otg vo~loec0g V6tlOtg (the thinking of thinking), which understandably appears to be a much more specific delineation of his thought content. A. 7 tells us that the PM is a vofJg that thinks itself (to72b18-3o); according to De Anima III. 4 that simply is what voa)g does at the highest level of actuality, since it... (shrink)

This English translation gathers together essays from Le sujet de la philosophie: Typographies I and L'imitation des modernes: Typographies II, along with a major essay entitled "Typographie." These essays are an inquiry into the delimitation of mimesis from Plato to Heidegger as representation or imitation "with a character of veri-similitude " [[sic]]. Concealed within the Platonic determination of Being as eidos is the filiation between "the representation of Being as figure and Darstellung, presentation... or 'literary representation'". In uncovering the derivation (...) of Gestalt and Darstellung from Ge-stell, or installation, Lacoue-Labarthe exposes the "ontological power of poiesis.... Philosophy, then, will have always been a matter of erection", that is, of fiction in the sense of installation, which is to say of mimesis as poiesis. The threat of mimesis lies in its displacement or "disinstallation of poiesis," or the productive capacity of representation so that "it proves difficult, if not impossible, to refer the thing thus installed to its truth or Being, to its idea". In the six essays that make up the book, Lacoue-Labarthe turns to Plato, Diderot, Hölderlin, Nietzsche, Reik, Heidegger, and Rene Girard, and to such topics as tragedy, music, autobiography, and the problematics of individual and national self-identification. In demonstrating how mimesis has determined philosophical thought, Lacoue-Labarthe provokes us into reconsidering our understanding of history and politics. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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In lieu of an abstract, here is a brief excerpt of the content:470 HISTORY OF PHILOSOPHY of fundamental notions (e.g.,"creator" and "demiurge") are omnipresent. Sometimes even a confusion happens of Anaxagoras with Democritus when the "atom" is ascribed to Anaxagoras (p. 48). And the author does not seem to feel the fatal inadequacy of merely second-hand knowledge. While he in longura et latum argues with Aristotelian presentations and misrepresentations of Anaxagorean tenets, there is good reason for the suspicion that he (...) might never have read even one authentic sentence written by Anaxagoras himself. For those interested in general cultural history, this book, the religious diatribe of a modem Zoroastrian believer, is very worthwhile reading. For the historian of philosophy, itis of rather modest value. P-~LIX M. CLEVE New School for Social Research New York City The Esthetics of the Middle Ages. By Edgar De Bruyne. Trans. Eileen B. Hennessy. (New York: Frederick Uugar, 1969. Pp. viii+232. $6.50) This book has a very complex character. It is the English translation of a French work, L'Esth~tique du moyen dge,I which, in turn, is a one-volume abridged version by Edgar De Bruyne of his own original three-volume work, I~tudes d'Esth~tique M~di~vale.2 Thus, one may evaluate this book either as a translation or, presupposing the faithfulness and correctness of the translation itself,as a relatively short work by E. De Bruyne, or else in its relation to or as compared with the original three-volume work. I will confine myself here to the lattertwo considerations.3 First, considering this book in comparison with the three-volume original work, one of the principal writings of De Bruyne and one of the most significant contemporary contributions to the history of medieval aesthetics, we can find both quantitative and qualitative differences between the original work and its abridged version. The quantitative difference is considerable. While the abridged work, at least in its English translation, is less than a quarter of a thousand pages in length, the original work includes altogether 1,224 pages 4 and is thus more than five times longer than thc translated abridged version of it. The qualitative or methodological difference is at least equally great. In the original work, each of the three volumes deals primarily with the various medieval authors of aesthetic works and doctrines in a chronological order.5 In contrast, the contents of the translated abridged version follow a topical arrangement with chronology playing only a subordinate role, if any at all, within Louvain. L'InstitutSupdrieur de Philosophic, 1947. Brugge: De Tempel, 1946. s I have had no access to the abridged French original. 9 Vol. I, xiv+370; II, x-{-420; III,x-F400. 9 VoL I: Boethius to Erigena; II. "L'l~poque Romane," from the Carolingian period to the schools of Chartres and St. Victor; and Ill:the thirteenthcentury, from St. Bernard to Duns Scotus. BOOK REVIEWS 471 each topic. The six chapters are entitled, "'The Sources," "The Fundamental Principles," "Various Esthetic Systems," "The Esthetic Experience," "Art," and "The Fine Arts." To this may be added a third difference that is the result of the first two differences. There is virtually neither any direct quotation from any author on any topic, nor a~y direct reference to texts in the works of medieval authors mentioned or discussed. While the quantitative difference in itself is understandable, since only a scholar specializing in this field would read over 1,200 pages on medieval aesthetics, and while the qualitative difference is perfectly justified in terms of an intelligent summary, the absence especially of direct references to discussed texts is, as will be shown below, deeply regxettable. So much for the relative consideration of this translated abridged work. Let us next consider the abridged work in itself in the form of a positive and a negative evaluation. Second, despite the relative brevity of the work, one finds this book extremely valuable both in terms of the quantity and the quality of the data it contains. As to quantity, De Bruyne manages to compress an enormous amount of information about medieval aesthetic thought into this book. The significance of this, to confine ourselves at this point only... (shrink)

In early 2017, Nevada amended its Uniform Determination of Death Act, in order to clarify the neurologic criteria for the determination of death. The amendments stipulate that a determination of death is a clinical decision that does not require familial consent and that the appropriate standard for determining neurologic death is the American Academy of Neurology’s guidelines. Once a physician makes such a determination of death, the Nevada amendments require the withdrawal of life-sustaining treatment within twenty-four hours with limited exceptions. (...) Neurologists have generally supported Nevada’s amendments for clarifying the diagnostic standard and limiting the ability of family members to challenge it. However, it is more appropriate to view the Nevada amendments with concern. Even though the primary purpose of the UDDA is to ensure that all functions of a person’s entire brain have ceased, the AAN guidelines do not accurately assess this. In addition, by characterizing the determination of death as solely a clinical decision, the Nevada legislature has improperly ignored the doctrine of informed consent, as well as the beliefs of particular faiths and cultures that reject brain death. Rather than resolving controversies regarding brain death determinations, the Nevada amendments may instead instigate numerous constitutional challenges. (shrink)

In 1968, the Harvard criteria equated irreversible coma and apnea with human death and later, the Uniform Determination of Death Act was enacted permitting organ procurement from heart-beating donors. Since then, clinical studies have defined a spectrum of states of impaired consciousness in human beings: coma, akinetic mutism, minimally conscious state, vegetative state and brain death. In this article, we argue against the validity of the Harvard criteria for equating brain death with human death. Brain death does not disrupt somatic (...) integrative unity and coordinated biological functioning of a living organism. Neurological criteria of human death fail to determine the precise moment of an organism’s death when death is established by circulatory criterion in other states of impaired consciousness for organ procurement with non-heart-beating donation protocols. The criterion of circulatory arrest 75 s to 5 min is too short for irreversible cessation of whole brain functions and respiration controlled by the brain stem. Brain -based criteria for determining death with a beating heart exclude relevant anthropologic, psychosocial, cultural, and religious aspects of death and dying in society. Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis on autopsy; therefore, they do not completely exclude reversible loss of integrated neurological functions in donors. The questionable reliability and varying compliance with these guidelines among institutions amplify the risk of determining reversible states of impaired consciousness as irreversible brain death. The scientific uncertainty of defining and determining states of impaired consciousness including brain death have been neither disclosed to the general public nor broadly debated by the medical community or by legal and religious scholars. Heart-beating or non-heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of physician-assisted death, and therefore, violates both criminal law and the central tenet of medicine not to do harm to patients. Society must decide if physician-assisted death is permissible and desirable to resolve the conflict about procuring organs from patients with impaired consciousness within the context of the perceived need to enhance the supply of transplantable organs. (shrink)

While denying that God has moral obligations, William Alston defends divine moral goodness based on God’s performance of supererogatory acts. The present article argues that an agent without obligations cannot perform supererogatory acts. Hence, divine moral goodness cannot be established on that basis. Defenses of divine moral obligation by Eleonore Stump and Nicholas Wolterstorff are also questioned. Against Stump, it is argued (among other things) that the temptations of Jesus do not establish the existence of a tendency to sin in (...) a divine being. Hence, Stump’s Christological objection to Alston’s denial of divine moral obligation fails. Some counterexamples to that denial offered by Wolterstorff also fail. It is concluded that claims of divine moral goodness remain problematic. (shrink)

Alvin Plantinga’s solution to J. L. Mackie’s logical problem of evil invokes possible-worlds metaphysics. There are reasons for thinking that the solution is, at least, problematic. Difficulties emerge in the attempts to answer four related questions. (1) Can God’s necessary existence, understood in terms of possible-world metaphysics, make God’s actual existence impossible to explain? (2) Can an omniscient being with knowledge of the contents of every possible world (a being endowed with “middle knowledge”) prove ignorant of the consequences of his (...) creative acts? (3) Can an immoral action performed by an agent suffering from “transworld depravity” also be free in the libertarian sense? (4) Does the possible-worlds interpretation of libertarian freedom generate a vicious infinite regress? Special focus is on the possibility, advanced by Plantinga, that there are possible worlds that even an omnipotent being cannot create. Plantinga’s views are contrasted with those of Thomas Aquinas. (shrink)

BackgroundBioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die."DiscussionAdvances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used for permanent support (...) of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death.SummaryDestination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

Everyone has mistaken one thing for another, such as a stranger for an acquaintance. A person who has mistaken two things, Joseph Camp argues, even on a massive scale, is still capable of logical thought. In order to make that idea precise, one needs a logic of confused thought that is blind to the distinction between the objects that have been confused. Confused thought and language cannot be characterized as true or false even though reasoning conducted in such language (...) can be classified as valid or invalid. To the extent that philosophers have addressed this issue at all, they take it for granted that confusion is a kind of ambiguity. Camp rejects this notion; his fundamental claim is that confusion is not a mental state. To attribute confusion to someone is to take up a paternalistic stance in evaluating his reasoning. Camp proposes a novel characterization of confusion, and then demonstrates its fruitfulness with several applications in the history of philosophy and the history of science. (shrink)

Since the introduction of the concept of brain death by the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death in 1968, the validity of this concept has been challenged by medical scientists, as well as by legal, philosophical, and religious scholars. In light of increased criticism of the concept of brain death, Stephen Napier, a staff ethicist at the National Catholic Bioethics Center, set out to prove that the whole-brain death criterion serves as (...) good evidence for death in the Catholic bioethical framework, on the grounds that when whole-brain death has occurred the soul has already departed from the body. Opponents have argued that (1) brain death does not disrupt the somatic integrative unity and coordinated biological functioning of a living organism and (2) clinical tests outlined in the practice guidelines for determining brain death lack sufficient power to exclude persisting function and fail to detect elements of the brain that, although currently functionless, may retain potential for recovery under conditions of optimal medical care. It is therefore possible that heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of active euthanasia and physician-assisted death, both of which, either concealed or overt, the Catholic Church opposes. (shrink)

Mealey's (1995a) psychological explanation of the sociopath's antisocial activity appeals to an incomplete or nonstandard theory of mind. This is not the only possible mechanism of mental state attribution. The simulation theory of mental state ascription offers a better hope of explaining the diverse elements of sociopathy reported by Mealey.

The tendency to test outcomes that are predicted by our current theory (the confirmation bias) is one of the best-known biases of human decision making. We prove that the confirmation bias is an optimal strategy for testing hypotheses when those hypotheses are deterministic, each making a single prediction about the next event in a sequence. Our proof applies for two normative standards commonly used for evaluating hypothesis testing: maximizing expected information gain and maximizing the probability of falsifying the current hypothesis. (...) This analysis rests on two assumptions: (a) that people predict the next event in a sequence in a way that is consistent with Bayesian inference; and (b) when testing hypotheses, people test the hypothesis to which they assign highest posterior probability. We present four behavioral experiments that support these assumptions, showing that a simple Bayesian model can capture people's predictions about numerical sequences (Experiments 1 and 2), and that we can alter the hypotheses that people choose to test by manipulating the prior probability of those hypotheses (Experiments 3 and 4). (shrink)

The debate between the theory-theory and simulation has largely ignored issues of cognitive architecture. In the philosophy of psychology, cognition as symbol manipulation is the orthodoxy. The challenge from connectionism, however, has attracted vigorous and renewed interest. In this paper I adopt connectionism as the antecedent of a conditional: If connectionism is the correct account of cognitive architecture, then the simulation theory should be preferred over the theory-theory. I use both developmental evidence and constraints on explanation in psychology to support (...) this claim. (shrink)

There is a trend of recruiting faith leaders at mosques to overcome religious barriers to organ donation, and to increase donor registration among Muslims. Commentators have suggested that Muslims are not given enough information about organ donation in religious sermons or lectures delivered at mosques. Corrective actions have been recommended, such as funding campaigns to promote organ donation, and increasing the availability of organ donation information at mosques. These actions are recommended despite published literature expressing safety concerns (i.e., do no (...) harm) in living and end-of-life organ donation. Living donors require life-long medical follow-up and treatment for complications that can appear years later. Scientific and medical controversies persist regarding the international guidelines for death determination in end-of-life donation. The medical criteria of death lack validation and can harm donors if surgical procurement is performed without general anesthesia and before biological death. In the moral code of Islam, the prevention of harm holds precedence over beneficence. Moral precepts described in the Quran encourage Muslims to be beneficent, but also to seek knowledge prior to making practical decisions. However, the Quran also contains passages that demand honesty and truthfulness when providing information to those who are seeking knowledge. Currently, information is limited to that which encourages donor registration. Campaigning for organ donation to congregations in mosques should adhere to the moral code of complete, rather than selective, disclosure of information. We recommend as a minimal standard the disclosure of risks, uncertainties, and controversies associated with the organ donation process. (shrink)

Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically (...) suitable for transplantation. Some states have enacted the Revised UAGA (2006) and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006) for legislation and remaining states are likely to follow soon. (shrink)