Recombinant values

An attractive admirer of George Bernard Shaw once wrote to himwith a not-so modest proposal: ``You have the greatest brain in theworld, and I have the most beautiful body; so we ought to producethe most perfect child.'' Shaw replied: ``What if the child inherits mybody and your brains?'' What if, indeed? Shaw's retort is interesting not because it revealsa grasp of elementary genetics, but rather because it suggests his graspof an interesting and important principle of axiology. Since the brainybut ugly Shaw and his beautiful but apparently dim admirer both fallshort of the ideal, she suggests that the best thing would be togenetically recombine his intelligence with her beauty. But what thenwould be the value of another genetic possibility: that of recombininghis ugliness with her stupidity? Underlining the prompted inference is afundamental principle of the theory of value which, perhapssurprisingly, has so far gone largely unnoticed in the ethicalliterature. I will call it the principle of recombinantvalues. It is the purpose of this paper to formulate the principle in a waywhich makes its content obvious and accessible; to motivate theprinciple philosophically; to both disentangle it from, and exhibitits relations to, principles of evaluative reasoning; to show howthis purely qualitative principle meshes with the infamous thesis ofadditivity of value; and finally, to use it to ground a rathersimple but quite general theory of the intrinsic value ofstates.     

Engagement and suffering in responsible caregiving: On overcoming maleficience in health care

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as ‘clinical phronesis,’ i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of ‘virtue ethics,’ yet one that is informed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their “disengaged” form (reflecting the malaise of “modern medicine”). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the ‘silent world of doctor and patient’ — provides may deny or refuse any ‘given’ connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of ‘calculative reasoning’ only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can ‘save the life of medical ethics’ — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can ‘prevent the death of medical ethics.’     

Begin with a Text: Teaching the Poetics of Medicine

This paper suggests that the purpose of humanities teaching within medical education should be primarily to teach and promote the informed, attentive, critical, and precise reading of the multiple texts that constitute medicine as a discursive field—in short, a poetics of medicine. This claim is illustrated by reconsidering Margaret Edson’s play Wit, not as it is often used in medical education, as a cautionary tale about unprofessional behavior or as a way to inculcate “humanistic skills,” but as an analysis of the relationships between texts and feelings—or cognition and emotion, or science and art. This reading is illustrated by comparing the poetics of Wit with those of two other texts representing ovarian cancer: a scientific paper in Oncology and a clinical case conference in JAMA.     

The Kant and Race Debate: A Frederick Douglass Intervention

Samuel Fleischacker is interested in two questions that are—what he refers to as—a rephrasing of three implications Charles Mills takes away from his encounter with Kant: (1) Is Kant's moral philosophy racist at its core? and (2) Whether it is or not, how should we respond to the fact that Kant displays open racism in some of his writings when we study, teach, or try to make use of his purportedly egalitarian teachings? Frederick Douglass was an abolitionist who wrestled with similar questions regarding the liberatory and inclusive nature of emancipatory documents like the Constitution. In this essay, I want to consider Douglass's changing views on this issue and reasons behind them to think about how he might offer insights into this current debate concerning Kant and race. In doing so, I will consider to what extent Fleischacker adheres to Douglass's guidelines on this matter as he makes his case. I then offer suggestions on how to move forward.     

Statements of Method and Teaching: The Case of Socrates

In this paper, I ponder the question of whether Socrates follows a method of investigation — the method of hypothesis — which he advocates in Plato's Phaedo. The evidence in the dialogue suggests that he does not follow the method, which raises additional questions: If he fails to do so, why does he articulate the method? Does his statement of method affect his actions or is it mainly forgotten? Although Socrates is a fictional character, his actions in the Phaedo suggests questions about the function of espoused methods in actual situations.     

The Head,the Heart,and Hysteria in Jeanne Flore's <Emphasis Type="Italic">Tales and Trials of Love</Emphasis> (c. 1542)

This essay examines a challenge to common literary representations of female mental illness in the Early Modern period—the hysterical woman—in a collection of French short stories contemporary to Vesalius's De Fabrica: Jeanne Flore's Tales and Trials of Love (1542). Jeanne Flore's tales depict several mentally disturbed female protagonists, young women prone to paroxysms of madness and self-mutilation. This study maintains that while Tales and Trials of Love superficially participates in the literary tradition that grew out of those accepted social and medical beliefs, it also questions the long-accepted paradigm of female hysteria and points to a shift in the socio-medical climate. Jeanne Flore's fictional narratives suggest that mental illness no longer consists in the realignment of a uterine imbalance, but rather in the telling of personal stories, a precursor to psychoanalysis and narrative medicine.     

Memory and self-consciousness: immunity to error through misidentification

In The Blue Book, Wittgenstein defined a category of uses of “I” which he termed “I”-as-subject, contrasting them with “I”-as-object uses. The hallmark of this category is immunity to error through misidentification (IEM). This article extends Wittgenstein’s characterisation to the case of memory-judgments, discusses the significance of IEM for self-consciousness—developing the idea that having a first-person thought involves thinking about oneself in a distinctive way in which one cannot think of anyone or anything else—and refutes a common objection to the claim that memory-judgments exhibit IEM.     

The role of attitudes and beliefs in differential health care utilisation among Chinese in Singapore

Abstract

One hundred and twenty-eight Chinese patients at two Western medical practices and two Chinese medical practices in Singapore completed a questionnaire regarding perceptions of illnesses. Health beliefs and attitudes towards different medical practitioners. Results indicate significant differences between those who consult only allopathic physicians (Western doctors) and those who consult both practitioners of traditional Chinese medicine (sinsehs) and Western doctors. Individuals consulting both Western doctors and sinsehs perceived a smaller proportion of “general” illness attributes (those found in both Western and Chinese medicine) to be relevant to specific diseases and showed greater endorsement of Chinese health beliefs than did individuals seeking help only from Western doctors. Also individuals consulting both types of practitioners expressed less satisfaction with the doctor's treatment than did those consulting only Western doctors and also rated sinsehs as more concerned with patient well-being and as listening more to their patients.     

The physician in the technological age

Translator's summary and notes: Karl Jaspers (1883–1969) argues that modern advances in the natural sciences and in technology have exerted transforming influence on the art of clinical medicine and on its ancient Hippocratic ideal, even though Plato's classical argument about slave physicians and free physicians retains essential relevance for the physician of today. Medicine should be rooted not only in science and technology, but in the humanity of the physician as well. Jaspers thus shows how, within the mind of every medical person, the researcher contests with the physician and the technician with the humanist. Jaspers therefore opposes all modern tendencies that regard men as abstractions. As a creative existentialist influenced by Kierkegaard, Nietzsche, and Husserl, he reasons that clinical medicine should always treat patients as irreducable individuals, and his thinking on psychotherapy argues for a realm of interiority, freedom, intelligibility, and existential communication that transcends the reach of the causal thinking of natural science. This essay, written in 1959, reflects Jaspers' lifelong preoccupation with the philosophical meaning of medicine (he received his MD degree in 1909) and the totality of the human person. It should significantly enhance our own comprehension of medical power, dangers, reasoning, and accomplishments. Key words have been added by the translator.     

Inhomogénéité des évaluations de durée d’incapacité totale de travail. Comparaison d’évaluations des durées d’incapacité totale de travail entre les médecins légistes,les médecins généralistes et les urgentistes

Setting a total length for time off work is a forensic act that all physicians must be able to perform. Given the importance of the legal consequences of this evaluation, it seems desirable that this practice is mastered by all practitioners. However, in practice there is often a disparity between forensic assessments and evaluations provided by other practitioners. To assess this difference in evaluation, we conducted a retrospective study, looking at 4 years of archives, of victims of Marseille's forensic service (CHU Timone), and highlighted a disparity between medical examiners, GPs and emergency physician's assessments. In both comparisons between medical examiners versus GPs (n = 367) or medical examiners versus emergency physicians (n = 511), were found in one third of cases of forensic requalification. The majority of checks on where GP's (80%) determined on over 8 days leave were reassessed under this limit by a medical examiner. This trend is reversed for the majority of (61%) requalification cases of emergency assessments (assessment over eight days by medical examiners. This study, proving a fact long suspected, raises many questions about these disparities evaluation we have discussed.     

Death by non-feeding: Not in the baby's best interests

It has recently been suggested that doctors have a duty to act in their patient's best interest and that this duty demands that life-sustaining treatment—including food and fluids—should sometimes be withheld or withdrawn and the patient allowed to die. In this article, the author explores the scope of the ‘best interests principle’ in the context of treatment decisions for seriously handicapped newborn infants. She argues that those who hold that it is permissible to starve or dehydrate an infant to death are mistaken to think that this course of action is in the infant's best interests. While it may be true that there are times whendeath is, everything considered, in an infant's best interests, a slow and distressingmethod of bringing death about is not. Since death by dehydration and starvation is not benign, the withholding of food and fluids is generally not in an infant's best interests. The author concludes by suggesting thatwhenever the withdrawal or non-employment of life-sustaining means imposes a heavy burden on the infant, the ‘best interests principle’ would demand that the infant be killed rather than allowed to die.     

Buying on the Internet: Gender Differences in On-line and Conventional Buying Motivations

Two studies are reported that examine gender differences in attitudes toward conventional buying and on-line buying. Thematic analysis of open-ended accounts (n=113) in Study 1 provides a rich, qualitative map of buying attitude dimensions that are important to young women and men. Study 2 is a quantitative survey (n=240) of functional, emotional–social, and identity-related buying motivations in the 2 environments. The on-line environment has an effect on buying attitudes, but more strongly so for women than for men. Whereas men's functional concerns are amplified—rather than changed—in the shift from conventional to on-line buying, women's motivational priorities show a reversal, and less involvement in shopping. In contrast to men, women's on-line buying is associated with barriers (social–experiential factors) and facilitators (efficiency, identity-related concerns) grounded in their attitudes toward conventional buying. This has implications for the ease with which women and men can and want to adapt to the accelerating shift toward computer-mediated shopping.     

Nerve/Nurses of the Cosmic Doctor: Wang Yang-ming on Self-Awareness as World-Awareness

In Philip J. Ivanhoe’s introduction to his Readings from the Lu-Wang School of Neo-Confucianism, he argues convincingly that the Ming-era Neo-Confucian philosopher Wang Yang-ming (1472–1529) was much more influenced by Buddhism (especially Zen’s Platform Sutra) than has generally been recognized. In light of this influence, and the centrality of questions of selfhood in Buddhism, in this article I will explore the theme of selfhood in Wang’s Neo-Confucianism. Put as a mantra, for Wang “self-awareness is world-awareness.” My central image for this mantra is the entire cosmos anthropomorphized as a doctor engaged in constant self-diagnosis, in which effort s/he is assisted by an entire staff of the nerves/nurses—individual humans enlightened as Wangian sages. In short, I will argue that the world for Wang could be meaningfully understood as a mindful, self-healing body within which humans are the sensitive nerves, using our mindful awareness to direct attention to the affected areas when injury or disease occurs. We are, and must thus recognize that we are, the bold but sensitive nervous system of the cosmos, sharing (like neurons) our loving excitement, carrying out (like a medical nurse) the doctor’s orders for the self-care of our cosmic body/medical corps.     

Kant's Opus Postumum and McDowell's Critique of Kant

In this article, I have a modest goal: (1) to sketch how Kant can avoid the charge of “subjective idealism” advanced against him by John McDowell and (2) to do so with reference to Kant's last work, the so‐called Opus Postumum. I am interested in defending Kant on this point because doing so not only (a) shows how we need not—at least not because of this point about idealism—jump ship from Kant to Hegel (as McDowell and others think), but also (b) suggests that the Opus Postumum is a text that ought to be explored more by Kantians and those interested in Kant. A subsidiary, implicit point is that (c) we need not shy away from McDowell's reading of Kant in order to oppose McDowell's criticism of Kant. In order to defend against McDowell's charge, I focus on the argument of the Refutation of Idealism, showing how this argument evolves in Kant's later works, especially the Opus Postumum.     

Spinoza and mental health

With the proviso that Spinoza's concerns were philosophical, not medical, we examine the Ethics with a view to bringing out those aspects of it which are of import for mental health. We find that the Ethics surrounds the idea that man can be egoless in the Buddhist sense of that term. This concept provides a criterion of mental health. Further, according to Spinoza's theory of the Affections, those which are passive include some which are based on pain. These he ‘enumerates among the diseases’. And for them he provides, in Part V, specific ‘remedies’. This in turn leads him to equate ‘Mental Freedom or beatitude’ with a ‘healthy Mind’. We thus have in Part V additional possible criteria of mental health. Finally, there is the suggestion that philosophy for Spinoza was a kind of therapy.’

There is not a philosophical method, though there are indeed methods, like different therapies. — The philosopher's treatment of a question is like the treatment of an illness. — A main cause of philosophical disease — a onesided diet . . .

Wittgenstein

This doctrine of knowledge first and action later is not a minor disease . . . My present advocacy of the unity of knowledge and action is precisely the medicine for that disease.

Wang Yang‐ming

When asked by two disciples which of the views of each was correct, Wang replied: both are. Which is used depends on the kind of person you are trying to help. Some persons need this one, others that.     

Externalist justification and the role of seemings

It’s not implausible to think that whenever I have a justified noninferential belief that p, it is caused by a seeming that p. It’s also tempting to think that something contributes to the justification of my belief only if I hold my belief because of that thing. Thus, given that many of our noninferential beliefs are justified and that we hold them because of seemings, one might be inclined to hold a view like Phenomenal Conservatism, according to which seemings play a crucial role—perhaps the only crucial role—in the justification of our noninferential beliefs. But Phenomenal Conservatism seems to conflict, in a number of ways, with externalist accounts of justification. As a result, the attractiveness of the intuitions appealed to in support of views like Phenomenal Conservatism present something of a challenge to externalism. The purpose of this paper is to deal with that challenge by developing and defending an externalist-friendly account of the role of seemings in the formation and justification of our noninferential beliefs—an account that incorporates what is attractive in views like Phenomenal Conservatism. Because this externalist-friendly account is compatible with both externalist accounts of justification and the plausible elements of views like Phenomenal Conservatism, the challenge to externalism inspired by such views is thereby undermined.     

Power and perceived influence: I caused your behavior,but I'm not responsible for it

There are numerous examples of powerful people denying responsibility for others' (mis)conduct in which they played—and acknowledge playing—a causal role. The current article seeks to explain this conundrum by examining the difference between, and powerful people's beliefs about, causality and responsibility. Research has shown power to have numerous psychological consequences. Some of these consequences, such as overconfidence, are likely to increase an individual's belief that he or she caused another person's behavior. However, others, such as decreased perspective‐taking, are likely to decrease an individual's belief that he or she was responsible for another person's behavior. In combination, these psychological consequences of power may lead powerful people to believe that they instigated another's behavior while simultaneously believing that the other person could have chosen to do otherwise. The dissociation between these two attributions may help to explain why people in positions of power often deny responsibility for others' behavior—unethical or otherwise—that they undeniably caused.     

The Early Years of Robert Shaw's Craniofacial Growth Project

The early years of Robert Shaw's long series of studies of the perception of growth are summarized. This body of work, when compared to an ideal set of ecological studies of event perception, misses some components. However, it is among the most successful bodies of ecological research, one involving an unusually wide variety of disciplines in addition to psychology. The scope and success of the project reflect the breadth and depth of Shaw's intellectual interests.