A definition of ?alienation? is proposed which is a rational reconstruction of the term as it is used in primarily moral contexts. Special attention is given to the Marxist tradition. It is argued that the earliest, moral form of Marx's economic determinism can be expressed in terms of the principle of the sufficiency of unalienated labor. In this connection four main kinds of alienation are distinguished. In the final section, it is argued that while ?alienation? has and should have an (...) important theoretical role in the context of moral discourse, social scientists, and in particular sociologists, would be better off if they eliminated ?alienation? from their scientific vocabulary. (shrink)

The arguments contained in books criticizing American social scientists by C. Wright Mills ( The Sociological Imagination) and Bernard Crick (The Science of American Politics) are discussed, compared and criticized. It is argued that Mills' criteria of evaluation and constructive alternatives to the tendencies he criticizes are immeasurably sounder than those found in Crick's book. An effort to supplement Mills' argument by providing a more explicit statement of its moral underpinnings is made. Finally, it is argued that though both critiques (...) have serious empirical flaws, the authors have undeniably demonstrated that important tendencies for irresponsible thought and action do exist within the American social sciences. (shrink)

The idea of human rights gained prominence at a time when the rising bourgeoisie viewed the state as the main obstacle to commercial expansion, private property as the major protection against dependency, and material scarcity as an indelible condition of society. As moral concepts are largely shaped by the social forces that call them into being, it is not surprising that the very language of rights was early tailored to suit the needs of an expanding, acquisitive, increasingly powerful segment of (...) society. (shrink)

Examination of human activities and their outcomes is a basic function of philosophy. Historically such examination has tended to conform to one of two patterns.

Authors, reviewers, and editors have critical responsibilities to ensure the validity and utility of published biomedical research.

Commercialism first became a major problem for medicine in the decade of the 1970s, when huge quantities of new money began to flow into the healthcare system, as a result of Medicaid and Medicare, and the rapid expansion of private, employer-based insurance. Of course, physicians benefited, but most of this new money went to insurance plans and medical care delivery institutions, like hospitals, nursing homes, diagnostic services, and ambulatory care facilities of many kinds. Many of these were newly established for-profit (...) businesses. A vast number of satellite enterprises sprang up to serve the growing needs of the new businesses by providing services like marketing and advertising, brokering, consulting, information technology, financial services, case and disease management, billing and collecting, and so forth. (shrink)

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that i...

Volume 20, Issue 10, October 2020, Page W4-W7.

Professor Toynbee observes in his Study of History that as he walked down Whitehall one day in the spring of 1918, and passed the Board of Education offices which had been commandeered for a new department of the War Office, “improvised in order to make an intensive study of trench warfare,” he found himself repeating the passage from St. Matthew's Gospel.

Over the course of three decades, in works spanning questions of theory, technique, and clinical practice, Charles Brenner has emerged as one of the preeminent analysts of his generation, a thinker whose probing estimation of mental conflict has promoted the evolutionary growth of analysis as theory even as it has clarified the clinical import of analysis as therapy. In _Psychoanalysis: The Science of Mental Conflict_, distinguished theorists and clinicians pay homage to Brenner by presenting original essays that converge in their (...) estimation of analysis as "the science of mental conflict." In sections that encompass "The Theory of Psychoanalysis," "The Concepts of Psychoanalysis," "The Technique of Psychoanalysis," "The Clinical Practice of Psychoanalysis," "The Teaching of Psychoanalysis," and "The Application of Psychanalysis," the contributors show how the perspective of conflict - broadened and refined by the clinical findings of recent decades - offers a vehicle for creative theory-building and, as such, a conceptual handle for apprising the indications for, and action of, psychoanalytic therapy. Arnold Richards' comprehensive overview of Brenner's ranging contributions to theory and practice, along with Martin Willick's critical introductions to the various sections of the book, round out a collections whose scope is complimented by its unusual coherence and thematic unity. Taken together, the essays comprising this book present readers with a cogent summary of current psychoanalytic thinking, along with an exciting preview of where it is heading in the future. As such, this volume will be welcomed not only by analysts, but by all mental health professionals who draw on, and learn from, the psychoanalytic assessment of conflict in mental life. It is a work that follows Brenner's own example in promoting the critical understanding of a generation of theorists, clinicians, and educators. (shrink)

Professor Toynbee observes in his Study of History that as he walked down Whitehall one day in the spring of 1918, and passed the Board of Education offices which had been commandeered for a new department of the War Office, “improvised in order to make an intensive study of trench warfare,” he found himself repeating the passage from St. Matthew's Gospel.

In Ethics and the A Priori Michael Smith discusses two types of claims that invoke the term ‘should.’ The first type invokes the ‘should’ of instrumental reason and the second type invokes the should of full practical reason . I argue that these are not mutually exhaustive categories. There is a third type of should-claim that does not fall into either category, such as when we say to someone who is going to smoke, ‘You should smoke low tar cigarettes.’ This (...) third type of should-claim aims, in a sense, at damage control. By comparing it to shouldFPR-claims, I show that shouldFPR-claims cannot be, contrary to what Smith suggests, even partly based on defects of character such as an agent’s irrational anger. Smith also claims that what I shouldFPR do is determined by the strongest desire my fully rational self would have, where a necessary condition of being fully rational is having no false beliefs and all relevant true beliefs. I point out that on such a view the connection between shouldFPR-claims and criticizability is lost and the connection between shouldFPR-claims and the agent’s abilities is lost. I sketch out an alternative view of shouldFPR-claims that retains these connections and on which the shouldFPR is constrained by the beliefs it is reasonable to require that agent to have. (shrink)

Few residency training programmes explicitly require substantive exposure to issues in medical ethics and fewer still have a formal curriculum in this area. Traditional undergraduate medical ethics courses teach preclinical students to identify ethical issues and analyse them at a theoretical level. Residency training, however, is the ideal time to establish the critical behavioural link which makes ethics truly useful in clinical medicine. The General Internal Medicine Residency Training Program at Rhode Island Hospital has developed an integrated, three-year curriculum with (...) the goals of helping residents to perceive ethical issues in clinical practice, to utilise basic philosophical principles in resolving ethical dilemmas and to communicate these issues clearly and sensitively to patients. The curriculum has been well received by residents and has had a hospital-wide impact. We believe that training residents in medical ethics and communication skills is an effective approach to developing physicians' humane qualities. (shrink)

Why does a baby who is otherwise cognitively similar to an animal such as a dog nevertheless have a higher moral status? We explain the difference in moral status as follows: the baby can, while a dog cannot, participate as a rearee in what we call “person-rearing relationships,” which can transform metaphysically and evaluatively the baby’s activities. The capacity to engage in these transformed activities has the same type of value as the very capacities (i.e., intellectual or emotional sophistication) that (...) explain unimpaired adult humans’ high moral status. We attempt to extend this account to individuals with severe cognitive impairments. (shrink)

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues. Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix. Setting: University medical center. Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center. Interventions: Presented with four hypothetical cases involving urgent decision making near the end of (...) life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases. Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r 2 < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study. Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies. (shrink)

In “Moral Luck” Bernard Williams describes a lorry driver who, through no fault of his own, runs over a child, and feels “agent-regret.” I believe that the driver’s feeling is moral since the thought associated with this feeling is a negative moral evaluation of his action. I demonstrate that his action is not morally inadequate with respect his moral obligations. However, I show that his negative evaluation is nevertheless justified since he acted in way that does not live up to (...) his moral values. I then use this distinctive negative moral evaluation to distinguish agent-regret from guilt and mere regret. (shrink)

In most discussions of moral responsibility, an agent’s moral responsibility for harming or failing to aid is equated with the agent’s being blameworthy for having done wrong. In this paper, I will argue that one can be morally responsible for one’s action even if the action was not wrong, not blameworthy, and not the result of blameworthy deliberation or bad motivation. This makes a difference to how we should relate to each other and ourselves in the aftermath. Some people have (...) blown off their responsibility when they shouldn't have, and others have held themselves responsible – or second and third parties have held them responsible – as if they were wrongdoers and blameworthy when neither is the case. (shrink)

When, in spite of our good intentions, we fail to meet our obligations to others, it is important that we have the correct theoretical description of what has happened so that mutual understanding and the right sort of social repair can occur. Consider an agent who promises to help pick a friend up from the airport. She takes the freeway, forgetting that it is under construction. After a long wait, the friend takes an expensive taxi ride home. Most theorists and (...) non-theorists react to such cases by either judging the agent's action as a violation of her obligation to help or as having satisfied the only obligation she really had, namely to try to help. However, as I show, there are serious difficulties that arise from categorizing this agent's action as satisfying or violating her obligation – difficulties that are avoided if we instead add “mere moral failures” to the basic categories for moral evaluation. An agent merely fails when she neither satisfies nor violates her obligation. She is responsible fo.. (shrink)

Historically the terms “final,” “unconditional,” and “intrinsic” have played a foundational role in ethical theory. I argue that final/instrumental distinction is best understood in terms of the for-sake-of relation and involves a tri-part division of goods. I show that this first way of categorizing goods is more closely aligned with a second way of categorizing goods in terms of intrinsic/extrinsic goods than has thus far been acknowledged. Lastly, I distinguish yet a third way of categorizing goods: unconditional/conditional goods. While the (...) final/instrumental and intrinsic/extrinsic distinctions have received the lion’s share of philosophical attention, the unconditional/conditional distinction is no less important. (shrink)

A most sensible exposition of Nietzsche's philosophy.