Linking the process of rational decision making to emotions, an award-winning scientist who has done extensive research with brain-damaged patients notes the dependence of thought processes on feelings and the body's survival-oriented regulators. 50,000 first printing.

The Embodied Mind provides a unique, sophisticated treatment of the spontaneous and reflective dimension of human experience.

This classic and controversial book examines the roots of the idea of virtue, diagnoses the reasons for its absence in modern life, and proposes a path for its recovery.

Suitable for students and scholars, this title challenges the assumption that skepticism, rather than established belief, lies at the heart of scientific discovery.

In this work the distinguished physical chemist and philosopher, Michael Polanyi, demonstrates that the scientist's personal participation in his knowledge, in both its discovery and its validation, is an indispensable part of science itself. Even in the exact sciences, "knowing" is an art, of which the skill of the knower, guided by his personal commitment and his passionate sense of increasing contact with reality, is a logically necessary part. In the biological and social sciences this becomes even more evident. The (...) tendency to make knowledge impersonal in our culture has split fact from value, science from humanity. Polanyi wishes to substitute for the objective, impersonal ideal of scientific detachment an alternative ideal which gives attention to the personal involvement of the knower in all acts of understanding. His book should help to restore science to its rightful place in an integrated culture, as part of the whole person's continuing endeavor to make sense of the totality of his experience. In honor of this work and his The Study of Man Polanyi was presented with the Lecomte de Noüy Award for 1959. (shrink)

The publication of this book is an event in the making. All over the world scientists, psychologists, and philosophers are waiting to read Antonio Damasio's new theory of the nature of consciousness and the construction of the self. A renowned and revered scientist and clinician, Damasio has spent decades following amnesiacs down hospital corridors, waiting for comatose patients to awaken, and devising ingenious research using PET scans to piece together the great puzzle of consciousness. In his bestselling Descartes' Error, Damasio (...) revealed the critical importance of emotion in the making of reason. Building on this foundation, he now shows how consciousness is created. Consciousness is the feeling of what happens-our mind noticing the body's reaction to the world and responding to that experience. Without our bodies there can be no consciousness, which is at heart a mechanism for survival that engages body, emotion, and mind in the glorious spiral of human life. A hymn to the possibilities of human existence, a magnificent work of ingenious science, a gorgeously written book, The Feeling of What Happens is already being hailed as a classic. (shrink)

Every year in this country, some 10,000 college and university courses are taught in applied ethics. And many professional organizations now have their own codes of ethics. Yet social science has had little impact upon applied ethics. This book promises to change that trend by illustrating how social science can make a contribution to applied ethics. The text reports psychological studies relevant to applied ethics for many professionals, including accountants, college students and teachers, counselors, dentists, doctors, journalists, nurses, school teachers, (...) athletes, and veterinarians. Each chapter begins with the research base of the cognitive-developmental approach--especially linked to Kohlberg and Rest's Defining Issues Test. Finally, the book summarizes recent research on the following issues: * moral judgment scores within and between professions, * pre- and post-test evaluations of ethics education programs, * moral judgment and moral behavior, * models of professional ethicseducation, and * models for developing new assessment tools. Researchers in different professional fields investigate different questions, develop different research strategies, and report different findings. Typically researchers of one professional field are not aware of research in other fields. An important aim of the present book is to bring this diverse research together so that cross-fertilization can occur and ideas from one field can transfer to another. (shrink)

Bioethics represents a dramatic revision of the centuries-old professional ethics that governed the behavior of physicians and their relationships with patients. This venerable ethics code was challenged in the years after World War II by the remarkable advances in the biomedical sciences and medicine that raised questions about the definition of death, the use of life-support systems, organ transplantation, and reproductive interventions. In response, philosophers and theologians, lawyers and social scientists joined together with physicians and scientists to rethink and revise (...) the old standards. Governments established commissions to recommend policies. Courts heard arguments and legislatures passed laws. This book is the first broad history of the growing field of bioethics. Covering the period 1947-1987, it examines the origin and evolution of the debates over human experimentation, genetic engineering, organ transplantation, termination of life-sustaining treatment, and new reproductive technologies. It assesses the contributions of philosophy, theology, law and the social sciences to the expanding discourse of bioethics. Written by one of the field's founders, The Birth of Bioethics is based on extensive archival research into sources that are difficult to obtain and on interviews with many of the leading figures in the moral debates in medicine. A very readable and comprehensive account of the evolution of bioethics, this book stresses the history of ideas but does not neglect the social and cultural context and the people involved. It will serve the information needs of philosophers, ethicists, social historians, and everyone interested in the origins of some of today's most hotly debated issues. (shrink)

Noted psychologist and philosopher develops his own brand of pragmatism, based on theories of C. S. Peirce. Emphasis on "radical empiricism," versus the transcendental and rationalist tradition. One of the most important books in American philosophy. Note.

In recent years, virtue theories have enjoyed a renaissance of interest among general and medical ethicists. This book offers a virtue-based ethic for medicine, the health professions, and health care. Beginning with a historical account of the concept of virtue, the authors construct a theory of the place of the virtues in medical practice. Their theory is grounded in the nature and ends of medicine as a special kind of human activity. The concepts of virtue, the virtues, and the virtuous (...) physician are examined along with the place of the virtues of trust, compassion, prudence, justice, courage, temperance, and effacement of self-interest in medicine. The authors discuss the relationship between and among principles, rules, virtues, and the philosophy of medicine. They also address the difference virtue-based ethics makes in confronting such practical problems as care of the poor, research with human subjects, and the conduct of the healing relationship. This book woith the author's previous volumes, A Philosophical Basis of Medical Practice and For the Patient's Good, are part of their continuing project of developing a coherent moral philosophy of medicine. (shrink)

In a Different Voice is the little book that started a revolution, making women's voices heard, in their own right and with their own integrity, for virtually the first time in social scientific theorizing about women. Its impact was immediate and continues to this day, in the academic world and beyond.

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.

In this new volume in the Oxford Psychology Series, the author presents a highly readable account of the cognitive unconscious, focusing in particular on the problem of implicit learning. Implicit learning is defined as the acquisition of knowledge that takes place independently of the conscious attempts to learn and largely in the absence of explicit knowledge about what was acquired. One of the core assumptions of this argument is that implicit learning is a fundamental, "root" process, one that lies at (...) the very heart of the adaptive behavioral repertoire of every complex organism. The author's goals are to outline the essential features of implicit learning that have emerged from the many studies that have been carried out in a variety of experimental laboratories over the past several decades; to present the various alternative perspectives on this issue that have been proposed by other researchers and to try to accommodate these views with his own; to structure the literature so that it can be seen in the context of standard heuristics of evolutionary biology; to present the material within a functionalist approach and to try to show why the experimental data should be seen as entailing particular epistemological perspectives; and to present implicit processing as encompassing a general and ubiquitous set of operations that have wide currency and several possible applications. Chapter 1 begins with the core problem under consideration in this book, a characterization of "implicit learning" as it has come to be used in the literature. Reber puts this seemingly specialized topic into a general framework and suggests a theoretical model based on standard heuristics of evolutionary biology. In his account, Reber weaves a capsule history of interest in and work on the cognitive unconscious. Chapter 2 turns to a detailed overview of the experimental work on the acquisition of implicit knowledge, which currently is of great interest. Chapter 3 develops the evolutionary model within which one can see learning and cognition as richly intertwining issues and not as two distinct fields with one dominating the other. Finally, Chapter 4 explores a variety of entailments and speculations concerning implicit cognitive processes and their general role in the larger scope of human performance. (shrink)

Early in this century, most empirically oriented psychologists believed that all motivation was based in the physiology of a set of non-nervous system tissue needs. The theories of that era reflected this belief and used it in an attempt to explain an increasing number of phenomena. It was not until the 1950s that it became irrefutably clear that much of human motivation is based not in these drives, but rather in a set of innate psychological needs. Their physiological basis is (...) less understood; and as concepts, these needs lend themselves more easily to psycho logical than to physiological theorizing. The convergence of evidence from a variety of scholarly efforts suggests that there are three such needs: self-determination, competence, and interpersonal relatedness. This book is primarily about self-determination and competence (with particular emphasis on the former), and about the processes and structures that relate to these needs. The need for interpersonal relat edness, while no less important, remains to be explored, and the findings from those explorations will need to be integrated with the present theory to develop a broad, organismic theory of human motivation. Thus far, we have articulated self-determination theory, which is offered as a working theory-a theory in the making. To stimulate the research that will allow it to evolve further, we have stated self-determination theory in the form of minitheories that relate to more circumscribed domains, and we have developed paradigms for testing predictions from the various minitheories. (shrink)

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

After a decade of educational reforms, The Challenge to Care in Schools is even more relevant now than when it was first published. In her new Introduction, Nel Noddings revisits her seminal book and places care as central to current debates on standardization, accountability, privatization, and the continuous struggle between traditional and progressive methods of education. Rather then forcing one side to yield to the other, this book advocates an alternative, "responsive system" that will allow the best ideas to flourish. (...) In the Second Edition, Noddings once again envisions a school system built on the idea that different people have different strengths, and that these strengths should be cultivated in an environment of caring, not of competition. She suggests that if we make the responsiveness characteristic of caring more basic than accountability, we can accommodate both traditional and progressive preferences in one school system to the benefit of all... especially the children. Chapters address the practical and theoretical questions involved in organizing traditional and nontraditional areas of study around themes of care. Introductory chapters focus on caring in general and on the problems of liberal education, while the final chapter offers sound advice for implementing a caring curriculum in our schools. (shrink)

The author introduces and explains the flow psychological theory. He demonstrates how it is possible to improve the quality of life by controlling the information that enters the consciousness.

The book uses Zen Buddhism as the opening wedge for an extraordinarily wide-ranging exploration of consciousness.

Assesses the ethical problems that doctors face every day and advocates a more universal code of medical ethics, one that draws on the traditions of religion and philosophy.

An updated and expanded successor to Culver and Gert's Philosophy in Medicine, this book integrates moral philosophy with clinical medicine to present a comprehensive summary of the theory, concepts, and lines of reasoning underlying the ...

Moral problems do not always come in the form of great social controversies. More often, the moral decisions we make are made quietly, constantly, and within the context of everyday activities and quotidian dilemmas. Indeed, these smaller decisions are based on a moral foundation that few of us ever stop to think about but which guides our every action. Here distinguished philosopher Bernard Gert presents a clear and concise introduction to what he calls "common morality" -- the moral system that (...) most thoughtful people implicitly use when making everyday, common sense moral decisions and judgments. Common Morality is useful in that -- while not resolving every disagreement on controversial issues -- it is able to distinguish between acceptable and unacceptable answers to moral problems. In the first part of the book Gert lays out the fundamental features of common morality: moral rules, moral ideals, and a two-step procedure for determining when a violation of a moral rule is justified. Written in a non-technical style, the ten general moral rules include rules on which everyone can agree, such as "do not kill," "do not deceive," and "keep your promises." The moral ideals include similarly uncontroversial precepts such as "Relieve pain" and "Aid the needy." In the second part of the book Gert examines the underlying concepts that justify common morality, such as the notions of rationality and impartiality. The distillation of over 40 years of scholarship, this book is the most accessible version of Gert's influential theory of morality as well as an eye-opening look at the moral foundations of our everyday actions. Throughout the discussion is clear enough for a reader with little or no philosophy background. (shrink)

From the author of Setting Limits comes a challenging exploration of the proper goals of medicine in our rapidly changing society--a work destined to spark debate and influence policy for years to come.

Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than (...) generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)

A physician says, "I have an ethical obligation never to cause the death of a patient," another responds, "My ethical obligation is to relieve pain even if the patient dies." The current argument over the role of physicians in assisting patients to die constantly refers to the ethical duties of the profession. References to the Hippocratic Oath are often heard. Many modern problems, from assisted suicide to accessible health care, raise questions about the traditional ethics of medicine and the medical (...) profession. However, few know what the traditional ethics are and how they came into being. This book provides a brief tour of the complex story of medical ethics evolved over centuries in both Western and Eastern culture. It sets this story in the social and cultural contexts in which the work of healing was practiced and suggests that, behind the many different perceptions about the ethical duties of physicians, certain themes appear constantly, and may be relevant to modern debates. The book begins with the Hippocratic medicine of ancient Greece, moves through the Middle Ages, Renaissance and Enlightenment in Europe, and the long history of Indian and Chinese medicine, ending as the problems raised modern medical science and technology challenge the settled ethics of the long tradition. (shrink)

The best things in my Ufe have come to me by accident and this book results from one such accident: my having the opportunity, out of the blue, to go to work as H. Tristram Engelhardt, Jr. 's, research assistant at the Institute for the Medical Humanities in the University of Texas Medi cal Branch at Galveston, Texas, in 1974, on the recommendation of our teacher at the University of Texas at Austin, Irwin C. Lieb. During that summer Tris "lent" (...) me to Chester Bums, who has done important schol arly work over the years on the history of medical ethics. I was just finding out what bioethics was and Chester sent me to the rare book room of the Medical Branch Library to do some work on something called "medical deontology. " I discovered that this new field of bioethics had a history. This string of accidents continued, in 1975, when Warren Reich (who in 1979 made the excellent decisions to hire me to the faculty in bioethics at the Georgetown University School of Medicine and to persuade Andre Hellegers to appoint me to the Kennedy Institute of Ethics) took Tris Engelhardt's word for it that I could write on the history of modem medical ethics for Warren's major new project, the Encyclopedia of Bioethics. Warren then asked me to write on eighteenth-century British medical ethics. (shrink)

A discussion of Christian ethics focuses on the physician's image as a parent, warrior against death, expert, and teacher, and the oath that guides his or her practice.

The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service medicine to a (...) system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)

The topic of developing professionalism dominated the content of many academic medicine publications and conference agendas during the past decade. Calls to address the development of professionalism among medical students and residents have come from professional societies, accrediting agencies, and a host of educators in the biomedical sciences. The language of the professionalism movement is now a given among those in academic medicine. We raise serious concerns about the professionalism discourse and how the specialized language of academic medicine disciplines has (...) defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label of "professionalism." In particular, we argue that the professionalism discourse needs to pay more attention to the academic environment in which students are educated, that it should articulate specific positive behaviors, that the theory of professionalism must be constructed from a dialogue with those we are educating, and that this theoretical and practical discourse must aim at a deeper understanding of social justice and the role of medicine within a just society. (shrink)

In Wrong Medicine, Lawrence J. Schneiderman, M.D., and Nancy S. Jecker, Ph.D., address issues that have occupied the media and the courts since the time of Karen Ann Quinlan. The authors examine the ethics of cases in which medical treatment is offered--or mandated--even if a patient lacks the capacity to appreciate its benefit or if the treatment will still leave a patient totally dependent on intensive medical care. In exploring these timely issues Schneiderman and Jecker reexamine the doctor-patient relationship and (...) call for a restoration of common sense and reality to what we expect from medicine. They discuss economic, historical, and demographic factors that affect medical care and offer clear definitions of what constitutes futile medical treatment. And they address such topics as the limits on unwanted treatment, the shift from the "Age of Physician Paternalism" to the "Age of Patient Autonomy," health care rationing, and the adoption of new ethical standards. (shrink)

After distinguishing two different meanings of the notion of a morality internal to medicine and considering a hypothetical case of a society that relied on its surgeons to eunuchize priest/cantors to permit them to play an important religious/cultural role, this paper examines three reasons why morality cannot be derived from reflection on the ends of the practice of medicine: (1) there exist many medical roles and these have different ends or purposes, (2) even within any given medical role, there exists (...) multiple, sometimes conflicting ends, and, most critically, (3) the ends of any practice such as medicine must come from outside the practice, that is, from the basic ends or purposes of human living. The paper concludes by considering whether these ends external to medicine are universally part of the moral reality or whether they are socially constructed. The paper argues that, even if various cultural accounts of the common, universal morality are socially constructed, they may, nevertheless, be reflections, however, imperfect, of a more universal common morality that should be thought of as real. Therefore, the morality of medicine must come from a more fundamental morality external to medicine. That external morality will be socially constructed, but may nevertheless reflect an underlying common morality. (shrink)

While twentieth-century medical ethics has focused on the duty of physicians to benefit their patients, the next century will see that duty challenged in three ways. First, we will increasingly recognize that it is unrealistic to expect physicians to be able to determine what will benefit their patients. Either they limit their attention to medical well-being when total well-being is the proper end of the patient or they strive for total well-being, which takes them beyond their expertise. Even within the (...) medical sphere, they have no basis for choosing among the proper medical goals for medicine. Also, there are many plausible strategies for relating predicted benefits to harms, and physicians cannot be expert in picking among these strategies. Second, increasingly plausible ethical systems recognize that in some cases, patient benefit must be sacrificed to protect patient rights including the right to the truth, to have promises kept, to have autonomy respected, and to not be killed. Third, ethics of the next century will increasingly recognize that some patient benefits must be sacrificed to fulfill duties to others - either the duty to serve the interests of others or other duties such as keeping promises, telling the truth, and, particularly, promoting justice. Physicians in the twenty-first century will be seen as having a new, more limited duty to assist the patient in pursuing the patient's understanding of the patient's interest within the constraints of deontological ethical principles and externally imposed duties to promote justice. The result will be a duty to be loyal to the consumer of health care with the recognition that often this will mean that the physician is not permitted to pursue the physician's understanding of the patient's well-being. (shrink)

Who should decide? In When Doctors Say No, philosopher and bioethicist Rubin examines this controversial issue.

American doctors in the 1990s are being asked to serve as "double agents," weighing competing allegiances to patients' medical needs against the monetary costs to society. This situation is a reaction to rapid cost increases for medical services, themselves the result of the haphazard development since the 1920s of an inherently inflationary, open-ended system for funding and delivering health care. The answer to an inefficient system, however, is not to stint on care, but rather to restructure the system to remove (...) the inflationary pressures. As long as we are spending enormous resources on an inherently inefficient and inflationary system we cannot justify asking doctors to withhold beneficial care to save money for third-party payers. Doing so serves a largely political agenda and endangers the patient-centered ethic that is central to medicine. (shrink)

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)