This volume of papers, arising from the Royal Institute of Philosophy Conference on Philosophy and Medical Welfare, includes contributions from doctors, nurses, and administrators in the field of health care as well as academics in the disciplines of philosophy, economics, and politics.

Si le débat catholique sur la limitation des naissances éclate au grand jour au xxe siècle, l’éminent dix-neuviémiste Claude Langlois nous démontre, dans cet ouvrage, que la question fut ouverte parmi les moralistes catholiques dès les années 1820 ; la limitation des naissances était alors devenue en France une réalité démographique. L’auteur s’appuie sur les questions posées, entre 1816 et 1901, aux congrégations romaines de la Sacrée Pénitencerie ou du Saint-Office par des clercs français....

Posthuman affirmative ethics relies upon a fluid, nomadic conception of the ethical subject who develops affective, material and immaterial connections to multiple others. Our purpose in this paper is to consider what posthuman affirmative business ethics would look like, and to reflect on the shift in thinking and practice this would involve. The need for a revised understanding of human–animal relations in business ethics is amplified by crises such as climate change and pandemics that are related to ecologically destructive business (...) practices such as factory farming. In this analysis, we use feminist speculative fiction as a resource for reimagination and posthuman ethical thinking. By focusing on three ethical movements experienced by a central character named Toby in Margaret Atwood’s MaddAddam trilogy, we show how she is continually becoming through affective, embodied encounters with human and nonhuman others. In the discussion, we consider the vulnerability that arises from openness to affect which engenders heightened response-ability to and with, rather than for, multiple others. This expanded concept of subjectivity enables a more relational understanding of equality that is urgently needed in order to respond affirmatively to posthuman futures. (shrink)

Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations (...) by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants’ perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a “helpful” or “very helpful” tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors’ knowledge this is the first investigatation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments. (shrink)

While consensus exists among many practitioners of ethics consultation about the need for and identification of core competencies and standards, there has been virtually no attempt to determine how these competencies and standards are best taught and assessed. We believe that clinical ethics consultation has reached a state of sufficient maturity that expert practitioners can evaluate those who are new to the field. We will outline several steps that can facilitate the creation of a certification process for clinical ethics consultants, (...) assuring the competency and quality of consultation for the patients, families, and healthcare professionals who utilize ECSs. (shrink)

There has been much interest in group judgment and the so-called 'wisdom of crowds'. In many real world contexts, members of groups not only share a dependence on external sources of information, but they also communicate with one another, thus introducing correlations among their responses that can diminish collective accuracy. This has long been known, but it has-to date-not been examined to what extent different kinds of communication networks may give rise to systematically different effects on accuracy. We argue that (...) equations that relate group accuracy, individual accuracy, and group diversity are useful theoretical tools for understanding group performance in the context of research on group structure. In particular, these equations may serve to identify the kind of group structures that improve individual accuracy without thereby excessively diminishing diversity so that the net positive effect is an improvement even on the level of collective accuracy. Two experiments are reported where two structures are investigated from this perspective. It is demonstrated that the more constrained network outperforms the network with a free flow of information. (shrink)

Since antiquity, opposed concepts such as the One and the Many, the Finite and the Infinite, and the Absolute and the Relative, have been a driving force in philosophical, scientific, and mathematical thought. Yet they have also given rise to perplexing problems and conceptual paradoxes which continue to haunt scientists and philosophers. In _Oppositions and Paradoxes_, John L. Bell explains and investigates the paradoxes and puzzles that arise out of conceptual oppositions in physics and mathematics. In the process, (...) class='Hi'>Bell not only motivates abstract conceptual thinking about the paradoxes at issue, but he also offers a compelling introduction to central ideas in such otherwise-difficult topics as non-Euclidean geometry, relativity, and quantum physics. These paradoxes are often as fun as they are flabbergasting. Consider, for example, the famous Tristram Shandy paradox: an immortal man composing an autobiography so slowly as to require a year of writing to describe each day of his life — he would, if he had infinite time, presumably never complete the work, although no individual part of it would remain unwritten. Or think of an office mailbox labelled “mail for those with no mailbox”—if this is a person’s mailbox, how can they possibly have “no mailbox”? These and many other paradoxes straddle the boundary between physics and metaphysics, and demonstrate the hidden difficulty in many of our most basic concepts. (shrink)

Explores the moral dimensions of the current global role of the U.S. military.

This monograph is a follow up to the author's classic text Boolean-Valued Models and Independence Proofs in Set Theory, providing an exposition of some of the most important results in set theory obtained in the 20th century--the independence of the continuum hypothesis and the axiom of choice. Aimed at research students and academics in mathematics, mathematical logic, philosophy, and computer science, the text has been extensively updated with expanded introductory material, new chapters, and a new appendix on category theory, and (...) includes recent developments in the field. Numerous exercises, along with the enlarged and entirely updated background material, make this an ideal text for students in logic and set theory. (shrink)

Holistic theories of meaning have, at least since Dummett’s Frege: The Philosophy of language, been assumed to be problematic from the perspective of the incremental nature of natural language learning. In this essay I argue that the general relationship between holism and language learning is in fact the opposite of that claimed by Dummett. It is only given a particular form of language learning, and a particular form of holism, that there is a problem at all; in general, for all (...) forms of holism, and irrespective of how language learning is understood, semantic holism is conducive to language learning. The paper has three main parts. In the first, I demonstrate with the use of a simple formal system, that the form of holism that generates the problem that Dummett draws attention to is really decomposable into three distinct components, each of which is necessary for the problem to arise. In the second part, I demonstrate that even Dummett’s strong form of holism is compatible with one natural way in which to understand the incremental nature of language learning. In the third part, I outline the reasons why all forms of holism are conducive to language learning and offer two ways in which this general fact can be spelled out precisely. I end the paper by addressing some possible objections, and in doing so I draw attention to some affinities between semantic holism and the principle of compositionality, a semantic principle which has long been assumed to be conducive to language learning. (shrink)

Explores the moral dimensions of the current global role of the U.S. military.

Conflicts of interest. None to report. Despite widespread acceptance in the United States of neurological criteria to determine death, clinicians encounter families who object, often on religious grounds, to the categorization of their loved ones as “brain dead.” The concept of “reasonable accommodation” of objections to brain death, promulgated in both state statutes and the bioethics literature, suggests the possibility of compromise between the family’s deeply held beliefs and the legal, professional and moral values otherwise directing clinicians to withdraw medical (...) interventions. Relying on narrative to convey the experience of a family and clinical caregivers embroiled in this complex dilemma, the case analyzed here explores the practical challenges and moral ambiguities presented by the concept of reasonable accommodation. Clarifying the term’s meaning and boundaries, and identifying guidelines for its clinical implementation, could help to reduce uncertainty for both health care professionals and families and, thereby, the incremental moral distress such uncertainty creates. (shrink)

Two predictions concerning the perceived severity of crimes can be derived from evolutionary theory. The first, arising from the theory of inclusive fitness, is that crimes in general should be viewed as more serious to the degree that the victim is genetically related to the perpetrator. The second, arising from the deleterious effects of inbreeding depression, is that heterosexual sexual coercion should be perceived as more serious the closer the genetic relationship of victim and perpetrator, particularly when the victim is (...) a female of fertile age. Two hundred and thirty university students estimated the magnitude of the severity of brief crime descriptions in three separate studies. In the first two, the biological kinship of victim and perpetrator was varied, and in the third, the hypothetical genetic relatedness of the subject and the fictitious victim was varied. All three studies found the linear relationships between biological kinship and perceived crime severity predicted by theory. (shrink)

Recent evidence that psychopathy is a nonarbitrary population, such that the trait may be categorical rather than continuous, is consistent with Mealey's distinction between primary and secondary psychopaths. Thus, there are likely to be at least two routes to criminality, and psychopathic and nonpsychopathic criminals are likely to respond differently to interventions.

In their invocations of the Muses the early epic poets use indifferently verbs meaning ‘tell’, ‘speak of’ and the verb which we normally translate as ‘sing’ When they refer directly to their own performance they may use the non-committalμνήσομαι, or ἐρέω, ἐνισπεῖνbut more often it isάείδω, ἄρχομ ἀείδεινor something of the sort; and they will pray for goodἀοιδήor hope for reward from it. We cannot make a distinction between two styles of performance, one characterized asἀείδειν the other as ἐνέπεινthe Iliad (...) beginsμῆνιν ἄειδε θεάbut later hasἔσπετε νῦν μοι Μοῦσαι;Hesiod moves straight fromχαίρετε τέκνα Διός, δότε δ᾿ ἱμερόεσσαν ἀοιδήνtoεἴπατε δ᾿ ὡς... ταῦτά μοι ἔσπετε Μοῦσαι... καὶ εἴπατε; the author of the Hymn to Pan beginsἔννεπε Μοῦσαand endsἴλαμαι δέ σ᾿ ἀοιδῇ... καὶ σεῖο καὶ ἄλλης μνήσομ᾿ ἀοιδῆς. (shrink)

Si on analyse le concept de vie dans la seconde version de L'amour et dans L'esprit du christianisme, on voit s'amorcer une métaphysique de l'amour comme synthèse et suprême manifestation de la vie ; mais l'amour y représente une élévation sur les niveaux de la loi et une réflexion d'ordre éthique et religieux. On y trouve également une réflexion sur les rapports de l'amour avec la « belle religion » par rapport à l'unité de la vie. Dans L'esprit du christianisme, (...) la vie apparaît comme un principe plus élevé que l'amour. If one analyzes the concept of life in Hegel's second version of Love and in The Spirit of Christianity one witnesses the surge of a metaphysics of love as synthesis and supreme manifestation of life ; but love also represents in this text a higher level above law and a new pondering of an ethical and religous order. One can also find a new approach on the relationships between love and the « beautiful religion » as linked with the unity of life. In The Spirit of Christianity, life appears as a higher principle than love. (shrink)

We congratulate Fox and her colleagues (2007) for contributing to the published empirical literature on ethics consultation in United States hospitals. Their study demonstrates the continued wide v...

In recruitment, promotion, admission, and other forms of wealth and power apportion, an evaluator typically ranks a set of candidates in terms of their perceived competence. If the evaluator is prejudiced, the resulting ranking will misrepresent the candidates’ actual ranking. This constitutes not only a moral and a practical problem, but also an epistemological one, which begs the question of what we should do – epistemologically – to mitigate it. The article is an attempt to begin to answer this question. (...) I first explore the presuppositions that must obtain for individual interventions to likely yield positive epistemological effects in ranking situations. I then compare these with the corresponding presuppositions of a novel, ‘post hoc’ approach to deprejudicing due to Jönsson and Sjödahl (Episteme 14(4):499–517, 2017), which does not attempt to change evaluators but attempts to increase the veracity of the rankings they produce after the fact (but before the rankings give rise to discriminatory effects) using statistical methods. With these two sets of presuppositions in place, I describe the limitations imposed by each presupposition on its intervention, compare presuppositions across the two kinds of interventions, and conclude that the two kinds of interventions importantly complement each other by having fairly disjoint, but non–conflicting, presuppositions. The post hoc intervention can thus complement an individual intervention (and vice versa) in situations where both are applicable (by adding further increases in veracity), but also by applying to situations where that intervention is not applicable (and thereby increase veracity in situations beyond the reach of that intervention). (shrink)

In recruitment, promotion, admission, and other forms of wealth and power apportion, an evaluator typically ranks a set of candidates in terms of their competence. If the evaluator is prejudiced, the resulting ranking will misrepresent the candidates’ actual rankings. This constitutes not only a moral and a practical problem, but also an epistemological one, which begs the question of what we should do—epistemologically—to mitigate it. In a recent paper, Jönsson and Sjödahl in [Episteme 14:499–517, 2017], argue that the epistemic problem (...) can be fruitfully addressed by way of a novel statistical method that changes the products of biased behaviour, i.e. the rankings themselves, rather than the biased persons. Jönsson and Sjödahl’s pioneering proposal is a both a welcome addition to the literature on implicit bias, due the problems with existing implicit bias interventions [see e.g. Lai et al. in J Exp Psychol Gen 143:1765–1785; J Exp Psychol Gen 145:1001–1016, 2014; 2016; Forscher et al. in J Person Soc Psychol 117:522–559, 2019] but also to the literature on prejudice more generally, where many proposed prejudice-reduction strategies enjoy less than adequate empirical support [Paluck and Green in Ann Rev Psychol 60:339–367, 2009]. Their proposal, however, needs supplementation in two ways: the circumstances that must hold in order for it to work needs to be refined, and their claim that it works as intended in these circumstances needs to be validated. We argue that four of Jönsson and Sjödahl’s method’s presumed presuppositions can be weakened, but needs to be supplemented by two additional assumptions, overlooked by Jönsson and Sjödahl. Moreover, we demonstrate that the method does work as intended by way of a statistical simulation. (shrink)

Reflections on, and analysis of, ethical issues facing military service in the United States.

Although military personnel are required to follow all legal orders, morally the traditional contract between soldier and state rests on shared assumptions about the purposes for which national militaries will and will not be used.

Inferential Role Semantics is often criticized for being incompatible with the platitude that words of different speakers can mean the same thing. While many assume that this platitude can be accommodated by understanding sameness of meaning in terms of similarity of meaning, no worked out proposal has ever been produced for Inferential Role Semantics. I rectify this important omission by giving a detailed structural account of meaning similarity in terms of graph theory. I go on to argue that this account (...) has a number of attractive features, prominent among them that it makes sameness of meaning probabilistically determine co-reference. (shrink)

The claim that empathy is both automatic and representational is criticized as follows: (a) five empathy-arousing processes ranging from conditioning and mimicry to prospective-taking show that empathy can be either automatic or representational, and only under certain circumstances, both; (b) although automaticity decreases, empathy increases with age and cognitive development; (c) observers' causal attributions can shift rapidly and produce more complex empathic responses than the theory allows.

Our hospital’s policy and procedures for “Patients Without Surrogates” provides for gradated safeguards for managing patients’ treatment and care when they lack decision–making capacity, have no advance directives, and no surrogate decision makers are available. The safeguards increase as clinical decisions become more significant and have greater consequences for the patient. The policy also directs social workers to engage in “rigorous efforts” to search for surrogates who can potentially provide substituted judgments for such patients. We describe and illustrate the policy, (...) procedures, and kinds of expected rigorous efforts through our narration of an actual but disguised case for which we provided clinical ethics guidance and social work expertise. Our experience with and reflection on this case resulted in four recommendations we make for health care facilities and organizations that aim to provide quality care for their own patients without surrogates. (shrink)