While uncertainty can never be totally eliminated from clinical practice, physicians can at least come to terms with it. In interviews with Canadian physicians in a variety of clinical settings, three sources of uncertainty affecting the allocation of medical resources were identified. Technical uncertainty arises from inadequate scientific data. Personal uncertainty arises from not knowing patients' wishes. Conceptual uncertainty arises from the problem of applying abstract criteria to concrete situations.

This is an important book precisely because there is none other quite like it.

(This insularity was further promoted by the guileless duplicity of scholars in other fields, who were all too prepared to bequeath "the problem of ...

David Hume's Enquiry concerning Human Understanding is the definitive statement of the greatest philosopher in the English language. His arguments in support of reasoning from experience, and against the "sophistry and illusion"of religiously inspired philosophical fantasies, caused controversy in the eighteenth century and are strikingly relevant today, when faith and science continue to clash. The Enquiry considers the origin and processes of human thought, reaching the stark conclusion that we can have no ultimate understanding of the physical world, or indeed (...) our own minds. In either sphere we must depend on instinctive learning from experience, recognizing our animal nature and the limits of reason. Hume's calm and open-minded skepticism thus aims to provide a new basis for science, liberating us from the "superstition" of false metaphysics and religion. His Enquiry remains one of the best introductions to the study of philosophy, and his edition places it in its historical and philosophical context. (shrink)

During the last three decades, reflections on the growth of scientific knowledge have inspired historians, sociologists, and some philosophers to contend that scientific objectivity is a myth. In this book, Kitcher attempts to resurrect the notions of objectivity and progress in science by identifying both the limitations of idealized treatments of growth of knowledge and the overreactions to philosophical idealizations. Recognizing that science is done not by logically omniscient subjects working in isolation, but by people with a variety of personal (...) and social interests, who cooperate and compete with one another, he argues that, nonetheless, we may conceive the growth of science as a process in which both our vision of nature and our ways of learning more about nature improve. Offering a detailed picture of the advancement of science, he sets a new agenda for the philosophy of science and for other "science studies" disciplines. (shrink)

“Supposing that truth is a women-what then?” This is the very first sentence in Nietzsche’s Beyond Good and Evil . Not very often are philosophers so disarmingly explicit in their intention to discomfort the reader. In fact, one might say that the natural state of Nietzsche’s reader is one of perplexity. Yet it is in the process of overcoming the perplexity that one realizes how rewarding to have one’s ideas challenged. In Beyond Good and Evil, Nietzsche critiques the mediocre in (...) modernity and challenges the reader to accept their state of becoming and accept improvisation and creativity of the process. Nietzsche’s book is carefully designed to disorient the reader, to systematically provoke and tease her to the point of stealing away her certainties. It is challenging yet rewarding to overcome the perplexities of Nietzsche’s teachings. (shrink)

In this 1989 book Rorty argues that thinkers such as Nietzsche, Freud, and Wittgenstein have enabled societies to see themselves as historical contingencies, rather than as expressions of underlying, ahistorical human nature or as realizations of suprahistorical goals. This ironic perspective on the human condition is valuable on a private level, although it cannot advance the social or political goals of liberalism. In fact Rorty believes that it is literature not philosophy that can do this, by promoting a genuine sense (...) of human solidarity. A truly liberal culture, acutely aware of its own historical contingency, would fuse the private, individual freedom of the ironic, philosophical perspective with the public project of human solidarity as it is engendered through the insights and sensibilities of great writers. The book has a characteristically wide range of reference from philosophy through social theory to literary criticism. It confirms Rorty's status as a uniquely subtle theorist, whose writing will prove absorbing to academic and nonacademic readers alike. (shrink)

What is morally permissible, and what is morally obligatory? These questions form the core of a vast amount of philosophical reasoning. In his Fundamental Principles of the Metaphysics of Morals, Immanuel Kant developed a basis for the answers. In this landmark work, the German philosopher asks what sort of maxim might function as a guide to appropriate action under a given set of circumstances. By universalizing such a maxim, would morally permissible behavior not become clear? Suppose that everyone were to (...) behave in accordance with this maxim. If everyone followed the maxim in the same way without harm to civilized culture, then the behavior would be morally permissible. But what if no one followed the maxim? Would civilization thereby be at risk? In such a case, the behavior would be morally obligatory. Kant's test, known as the Categorical Imperative, is a logical proof of the Golden Rule and the centerpiece of this work. It constitutes his best-known contribution to ethical discussion, and a familiarity with his reasoning in this book is essential to students of philosophy, religion, and history. (shrink)

Oxford Philosophical Texts Series Editor: John Cottingham The Oxford Philosophical Texts series consists of authoritative teaching editions of canonical texts in the history of philosophy from the ancient world down to modern times. Each volume provides a clear, well laid out text together with a comprehensive introduction by a leading specialist, giving the student detailed critical guidance on the intellectual context of the work and the structure and philosophical importance of the main arguments. Endnotes are supplied which provide further commentary (...) on the arguments and explain unfamiliar references and terminology, and a full bibliography and index are also included. The series aims to build up a definitive corpus of key texts in the Western philosophical tradition, which will form a reliable and enduring resource for students and teachers alike. David Hume's aim in writing An Enquiry concerning Human Understanding was to introduce his philosophy to a European culture in which many educated people read original works of philosophy. He gives an elegant and accessible presentation of strikingly original and challenging views about the limited powers of human understanding, the attractions of scepticism, the compatibility of free will and determinism, and weaknesses in the foundations of religion. Hume's philosophy was highly controversial in the eighteenth century and remains so today. The text printed in this edition is that of the Clarendon critical edition of Hume's works. A substantial introduction by the editor explains the intellectual background to the work and surveys its main themes. The volume also includes detailed explanatory notes on the text, a glossary of terms, a full list of references, and a section of supplementary readings. (shrink)

In a certain sense, uncertainty andignorance have been recognized in science andphilosophy from the time of the Greeks.However, the mathematical sciences have beendominated by the pursuit of certainty.Therefore, experiments under simplified andidealized conditions have been regarded as themost reliable source of knowledge. Normally,uncertainty could be ignored or controlled byapplying probability theory and statistics.Today, however, the situation is different.Uncertainty and ignorance have moved intofocus. In particular, the global character ofsome environmental problems has shown that theproblems cannot be disregarded. Therefore,scientists and technologists (...) have in many wayscome into a new situation. The Chernobylaccident is a dramatic example, however,problems such as a possible greenhouse effect,a possible reduction of the ozone layer, and soon are all of the same type. These encompasstotally different problems than scientists andtechnologists are traditionally trained to dealwith. In these cases, the standard use ofstatistics has to change, the burden of proofshould be reversed, one should draw ondifferent kinds of expertise, and, in general,science should be ``democratized.''. (shrink)

In its restless metamorphosis, the environmental movement captures ideas and transforms them into principles, guidelines and points of leverage. Sustainability is one such idea, now being reinterpreted in the aftermath of the 1992 Rio Conference. So too is the precautionary principle. Like sustainability, the precautionary principle is neither a well defined principle nor a stable concept. It has become the repository for a jumble of adventurous beliefs that challenge the status quo of political power, ideology and civil rights. Neither concept (...) has much coherence other than it is captured by the spirit that is challenging the authority of science, the hegemony of cost-benefit analysis, the powerlessness of victims of environmental abuse, and the unimplemented ethics of intrinsic natural rights and inter-generational equity. It is because the mood of the times needs an organising idea that the precautionary principle is getting a fair wind. However, unless its advocates sharpen up their understanding of the term, the precautionary principle may not establish the influence it deserves. Its future looks promising but it is not assured. (shrink)

This paper introduces taxonomy of clinical uncertaintes and argues that the choice of scientific method should match the underlying level of uncertainty. Clinical trial is one of these methods aiming to resolve clinical uncertainties. Whenever possible these uncertainties should be quantified. The paper further shows that the still ongoing debate about the usage of "equipoise" vs. "uncertainty principle" vs. "indifference" as an entry criterion to clinical trials actually refers to the question "whose uncertainty counts". This question is intimately linked to (...) the control of research agenda, which is not quantifiable and hence is not solvable to equal acceptability to all interested parties. The author finally shows that there is a predictable relation between [acknowledgement of] uncertainty (the moral principle) on which trials are based and the ultimate outcomes of clinical trials. That is, [acknowledgement of] uncertainty determines a pattern of success in medicine and drives clinical discoveries. (shrink)