Breaching confidentiality to protect the public: evolving standards of medical confidentiality for military detainees

Confidentiality is a core value in medicine and public health yet, like other core values, it is not absolute. Medical ethics has typically allowed for breaches of confidentiality when there is a credible threat of significant harm to an identifiable third party. Medical ethics has been less explicit in spelling out criteria for allowing breaches of confidentiality to protect populations, instead tending to defer these decisions to the law. But recently, issues in military detention settings have raised the profile of decisions to breach medical confidentiality in efforts to protect the broader population. National and international ethics documents say little about the confidentiality of detainee medical records. But initial decisions to use detainee medical records to help craft coercive interrogations led to widespread condemnation, and might have contributed to detainee health problems, such as a large number of suicide attempts several of which have been successful. More recent military guidance seems to reflect lessons learned from these problems and does more to protect detainee records. For the public health system, this experience is a reminder of the importance of confidentiality in creating trustworthy, and effective, means to protect the public's health.     

A defense of intuitions

Radical experimentalists argue that we should give up using intuitions as evidence in philosophy. In this paper, I first argue that the studies presented by the radical experimentalists in fact suggest that some intuitions are reliable. I next consider and reject a different way of handling the radical experimentalists’ challenge, what I call the Argument from Robust Intuitions. I then propose a way of understanding why some intuitions can be unreliable and how intuitions can conflict, and I argue that on this understanding, both moderate experimentalism and the standard philosophical practice of using intuitions as evidence can help resolve these conflicts.

AIDS and confidentiality

ABSTRACT AIDS raises the moral problem of confidentiality because those in sexual contact with the patient may contract a life-threatening and incurable disease. Medicine has a tradition in which a patient's condition is regarded as confidential information held by the doctor alone. In this case there is a clear moral inclination to inform those at risk from the disease. In most cases no problem will arise but when it does the moral justification for a violation of confidentiality comes into question. Confidentiality is important because of our respect for certain human values and their importance to our patient. Where that patient acts so as to disregard the welfare of others with whom they are in close relationship, those values are lacking. This lack warrants a departure from our normal canons and provokes a suspension of normal moral privileges. The contention that any transgression, however slight, could be held to justify such a response posits a slope down which we, in fact, have no tendency to slide.     

A defense of indeterminate distinctness

On the one hand, philosophers have presented numerous apparent examples of indeterminate individuation, i.e., examples in which two things are neither determinately identical nor determinately distinct. On the other hand, some have argued against even the coherence of the very idea of indeterminate individuation. This paper defends the possibility of indeterminate individuation against Evans’s argument and some other arguments. The Determinacy of Identity—the thesis that identical things are determinately identical—is distinguished from the Determinacy of Distinctness—the thesis that distinct things are determinately distinct. It is argued that while the first thesis holds universally and there is no case of indeterminate identity, there are reasons to think that the second thesis does not hold universally, and that there are cases of indeterminate distinctness.     

A defense of Empirical Justification

Conclusion Overall, then, I conclude that Possin and Timmons have not shown the need for an alternative to the foundationalism of Empirical Justification.     

A defense of physical becoming

This paper defends physical becoming against Grünbaum's attack, by constructing three arguments in favor of physical becoming. Of the three, I rely primarily on an argument from the philosophy of language, and especially on the principle that tensed discourse involves presuppositions and commitments that Grünbaum's account of becoming cannot handle. I show that Grünbaum's analysis of becoming can provide only a very implausible reconstruction of the temporal coordination of speakers engaged in discourse.I am grateful to many for comments and criticism, but particularly to an anonymous reviewer for this journal, who found several infelicities and an outright blunder in an earlier draft.     

A defense of middle knowledge

Conclusion Adams has not demonstrated that conditionals of freedom are necessarily false, just as I have not demonstrated that they are possibly true. According to Adams, we have good reason to think that they are not possibly true because we do not know what it is for them to be true. This is basically the claim that we cannot explain conditionals of freedom without reference to what would happen in certain situations. I argued that similar considerations apply to propositions about future free choices. We cannot explain propositions about future free choices without reference to what will happen. Neither conditionals of freedom nor propositions about future free choices are true in virtue of corresponding to actual states of affairs or any states of affairs that are necessitated by certain other states of affairs. In both instances we must appeal to states of affairs that are not determined to be actual by either the present states of affairs or the antecedent of the counterfactual. I do not consider this difficulty with propositions about future free choices to be a sufficient reason to reject the possibility of them being true. They are true because they correspond to what will happen. But then I also do not believe that Adams' reasons are sufficient to reject the possibility of true conditionals of freedom. They are true because they correspond with what would happen in certain counterfactual situations. Hence it is no more difficult to understand what it is for conditionals of freedom to be true than it is to understand what it is for propositions about future free choices to be true. I conclude that, contrary to Adams, it is possible for God to have middle knowledge.     

A pragmatic defense of Millianism

A new kind of defense of the Millian theory of names is given, which explains intuitive counter-examples as depending on pragmatic effects of the relevant sentences, by direct application of Grice’s and Sperber and Wilson’s Relevance Theory and uncontroversial assumptions. I begin by arguing that synonyms are always intersubstitutable, despite Mates’ considerations, and then apply the method to names. Then, a fairly large sample of cases concerning names are dealt with in related ways. It is argued that the method, as applied to the various cases, satisfies the criterion of success: that for every sentence in context, it is a counter-example to Millianism to the extent that it has pragmatic effects (matching speakers’ intuitions).     

A defense of branching quantification

Adding branching quantification to a first-order language increases the expressive power of the language,without adding to its ontology. The present paper is a defense of this claim against Quine (1970) and Patton (1991).     

A hesitant defense of introspection

Consider the following argument: when a phenomenon P is observable, any legitimate understanding of P must take account of observations of P; some mental phenomena—certain conscious experiences—are introspectively observable; so, any legitimate understanding of the mind must take account of introspective observations of conscious experiences. This paper offers a (preliminary and partial) defense of this line of thought. Much of the paper focuses on a specific challenge to it, which I call Schwitzgebel’s Challenge: the claim that introspection is so untrustworthy that its indispensability for a genuine understanding of the mind only shows that no genuine understanding of the mind is possible.