Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if (...) the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)

My question in the chapter is this: could (and should) the role of the physician be construed as that of a friend to the patient? I begin by briefly discussing the “friendship model” of the physician-patient relationship—according to which physicians and patients could, and perhaps should, be friends—as well as its history and limitations. Given these limitations, I focus on the more one-sided idea that the physician could, and perhaps should, be a friend to the patient (a “physician-qua-friend model” of (...) the physician-patient relationship). I show that given recent developments in our understanding of the physician-patient relationship, this idea is far from asinine. I then make the case that the most plausible conception of the physician-qua-friend model incorporates the following components: (a) a common goal, that is, one that physician and patient share; (b) certain forms of equality between physician and patient; (c) an ideal of a caring physician. Finally, I show how the model can be instantiated in a certain type of physician-patient interaction, namely, in physician-assisted dying. (shrink)

A critical assessment of the second chapter of Samuel Fleischacker’s Being Me Being You, where Fleischacker makes use of Smith’s account of empathy to develop a distinctive Smithian conception of ‘humanity’.

Two problems seem to plague Adam Smith’s account of sympathy and approbation in The Theory of Moral Sentiments (TMS). First, Smith’s account of sympathy at the beginning of TMS appears to be inconsistent with the account of sympathy at the end of TMS. In particular, it seems that Smith did not appreciate the distinction between ‘self-oriented sympathy’ and ‘other-oriented sympathy’, that is, between imagining being oneself in the actor’s situation and imagining being the actor in the actor’s situation. Second, Smith’s (...) account of approbation, according to which a sentiment of approval arises when there is recognition of concordance between the spectator’s sympathetic passion and the actor’s original passion, seems to face the following problem: since the spectator attains both his own sympathetic passion and the actor’s original passion by sympathizing with the actor, the sympathetic passion of the spectator and the original passion of the actor will necessarily be identical. Therefore, Smith’s account of approbation requires that the spectator utilize both self-oriented and other-oriented sympathy (‘the double-sympathy model of approbation’). I offer a novel developmental account of sympathy in TMS that renders Smith’s account of sympathy consistent and allows for the utilization of the double-sympathy model of approbation. (shrink)

Physicians frequently ask whether they should give patients what they want, usually when there are considerations pointing against doing so, such as medicine’s values and physicians’ obligations. It has been argued that the source of medicine’s values and physicians’ obligations lies in what has been dubbed “the internal morality of medicine”: medicine is a practice with an end and norms that are definitive of this practice and that determine what physicians ought to do qua physicians. In this paper, I defend (...) the claim that medicine requires a morality that is internal to its practice, while rejecting the prevalent characterization of this morality and offering an alternative one. My approach to the internal morality of medicine is constructivist in nature: the norms of medicine are constructed by medical professionals, other professionals, and patients, given medicine’s end of “benefitting patients in need of prima facie medical treatment and care.” I make the case that patients should be involved in the construction of medicine’s morality not only because they have knowledge that is relevant to the internal morality of medicine—namely, their own values and preferences—but also because medicine is an inherently relational enterprise: in medicine the relationship between physician and patient is a constitutive component of the craft itself. The framework I propose provides an authoritative morality for medicine, while allowing for the incorporation, into that very morality, of qualified deference to patient values. (shrink)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, by bringing (...) medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

In The Sources of Normativity, Korsgaard argues for what can be called “The Universality of Humanity Claim” (UHC), according to which valuing humanity in one’s own person entails valuing it in that of others. However, Korsgaard’s reliance on the claim that reasons are essentially public in her attempt to demonstrate the truth of UHC has been repeatedly criticized. I offer a sentimentalist defense, based on Adam Smith’s moral philosophy, of a qualified, albeit adequate, version of UHC. In particular, valuing my (...) humanity, understood as (my awareness of) my perspective and the reasons determined from within it, entails valuing your humanity, understood as (your awareness of) your perspective and the reasons determined from within it. Given Korsgaard’s emphasis on the publicity of reasons in her argument for UHC, I also discuss the role of reasons in my account. I argue that the relative weights of (at least some of) an agent’s reasons are determined from within a shared evaluative point of view, namely, the standpoint of what Smith calls “the impartial spectator.” These reasons have normative authority over and constrain the agent’s private reasons, that is, those that are determined from within her own particular evaluative point of view. (shrink)

I demonstrate that analogies, both explicit and implicit, between Wittgenstein’s discussion of rituals, aesthetics, and psychoanalysis (and, indeed, his own philosophical methodology) suggest that he entertained the idea that Freud’s psychoanalytic project, when understood correctly—that is, as a descriptive project rather than an explanatory-hypothetical one—provides a “surveyable representation” (übersichtliche Darstellung) of certain psychological facts (as opposed to psychological concepts). The consequences of this account are that it offers an explanation of Wittgenstein’s admiration for and self-perceived affinity to Freud, as well (...) as of his apparent “know-nothing approach” to empirical psychology. (shrink)

I offer a novel two-stage reconstruction of Hume’s general-point-of-view account, modeled in part on his qualified-judges account in ‘Of the Standard of Taste.’ In particular, I argue that the general point of view needs to be jointly constructed by spectators who have sympathized with (at least some of) the agents in (at least some of) the actor’s circles of influence. The upshot of the account is two-fold. First, Hume’s later thought developed in such a way that it can rectify the (...) problems inherent in his Treatise account of the general point of view. Second, the proposed account provides the grounds for an adequate and well-motivated modest ideal observer theory of the standard of virtue. (shrink)

In this paper, we illustrate some serious difficulties involved in conveying information about uncertain risks and securing informed consent for risky interventions in a clinical setting. We argue that in order to secure informed consent for a medical intervention, physicians often need to do more than report a bare, numerical probability value. When probabilities are given, securing informed consent generally requires communicating how probability expressions are to be interpreted and communicating something about the quality and quantity of the evidence for (...) the probabilities reported. Patients may also require guidance on how probability claims may or may not be relevant to their decisions, and physicians should be ready to help patients understand these issues. (shrink)

John Rawls raises three challenges – to which one can add a fourth challenge – to an impartial spectator account: (a) the impartial spectator is a utility-maximizing device that does not take seriously the distinction between persons; (b) the account does not guarantee that the principles of justice will be derived from it; (c) the notion of impartiality in the account is the wrong one, since it does not define impartiality from the standpoint of the litigants themselves; (d) the account (...) would offer a comprehensive, rather than a political, form of liberalism. The narrow aim of the article is to demonstrate that Adam Smith's impartial spectator account can rise to Rawls's challenges. The broader aim is to demonstrate that the impartial spectator account offers the basis for a novel and alternative framework for developing principles of justice, and does so in the context of a political form of liberalism. (shrink)

I defend the feasibility of a medical conscience in the following sense: a medical professional can object to the prevailing medical norms because they are incorrect as medical norms. In other words, I provide an account of conscientious objection that makes use of the idea that the conscience can issue true normative claims, but the claims in question are claims about medical norms rather than about general moral norms. I further argue that in order for this line of reasoning to (...) succeed, there needs to be an internal morality of medicine that determines what medical professionals ought to do qua medical professionals. I utilize a constructivist approach to the internal morality of medicine and argue that medical professionals can conscientiously object to providing treatment X, if providing treatment X is not in accordance with norms that would have been constructed, in light of the end of medicine, by the appropriate agents under the appropriate conditions. (shrink)

The Humean Theory of Reasons, according to which all of our reasons for action are explained by our desires, has been criticized for not being able to account for “moral reasons,” namely, overriding reasons to act on moral demands regardless of one's desires. My aim in this paper is to utilize ideas from Adam Smith's moral philosophy in order to offer a novel and alternative account of moral reasons that is both desire-based and accommodating of an adequate version of the (...) requirement that moral demands have overriding reason-giving force. In particular, I argue that the standpoint of what Smith calls “the impartial spectator” can both determine what is morally appropriate and inappropriate and provide the basis for normative reasons for action—including reasons to act on moral demands—to nearly all reason-responsive agents and, furthermore, that these reasons have the correct weight. The upshot of the proposed account is that it offers an interesting middle road out of a dilemma pertaining to the explanatory and normative dimensions of reasons for informed-desire Humean theorists. (shrink)

I build on Adam Smith’s account of the impartial spectator in The Theory of Moral Sentiments in order to offer a modest ideal observer theory of moral judgment that is adequate in the following sense: the account specifies the hypothetical conditions that guarantee the authoritativeness of an agent’s (or agents’) responses in constituting the standard in question, and, if an actual agent or an actual community of agents are not under those conditions, their responses are not authoritative in setting this (...) standard. However, in the account that I provide, the hypothetical conditions can themselves be constructed from the psychology and interactions of actual human beings. In other words, facts about the morally appropriate and inappropriate are determined from hypothetical conditions that––while agents in a given society might have yet to attain them––can be constructed from those agents’ shared experiences. Thus, the account offers both an attainable standard of moral judgment and a standard that can transcend the biases of the society which gave rise to it. I also defend the account against three challenges: (a) ideal observer theories do not offer the right kind of motivation to act on the verdicts of the ideal observer; (b) ideal observer theories cannot explain why the idealization in question is well-motivated and not objectionably ad hoc; (c) the standard used in ideal observer theories cannot be defended upon further reflection, because we would need a non-arbitrary, second-order standard to govern our reflection on the first-order standard of moral judgment. (shrink)

I demonstrate that analogies, both explicit and implicit, between Wittgenstein’s discussions of rituals, aesthetics, and aspect-perception, have important payoffs in terms of understanding his notion of a “surveyable representation” (übersichtliche Darstellung) as it applies to phenomena that are not exclusively grammatical in nature. In particular, I argue that a surveyable representation of certain anthropological and aesthetic facts allows us to see, qua form of aspect-perception, internal relations and formal connections, so that the inner nature of a ritual or the solution (...) of an aesthetic puzzle is exhibited. This particular form of seeing both explains why Wittgenstein thought that hypothetical explanations about the origins of a ritual are irrelevant to appreciating its meaning and elucidates his understanding of rituals, which involves seeing “internal relations” and “formal connections.” The upshots of the account for work in anthropology are discussed. (shrink)

I introduce a new distinction between two types of paternalism, which I call ‘internal’ and ‘external’ paternalism. The distinction pertains to the question of whether the paternalized subject’s current evaluative judgments are mistaken relative to a standard of correctness that is internal to her evaluative point of view—which includes her ‘true’ or ‘ideal’ self—as opposed to one that is wholly external. I argue that this distinction has important implications for (a) the distinction between weak and strong paternalism; (b) the distinction (...) between soft and hard paternalism; and (c) medical practice, where internal paternalism can, and probably often does, occur. (shrink)

Steve Clarke, Nathan Emmerich, Francesca Minerva and Toni Saad have offered nuanced and insightful commentaries on my paper ‘The truth behind conscientious objection in medicine’.1 I cannot, in this brief response, do justice to all of the objections and suggestions that they have raised. I have tried to focus my response on what I take to be my interlocutors’ main concerns with my Smithian account, with the hope that we can continue the conversation elsewhere. Clarke argues that both Smith and (...) I ‘underestimate the difficulties involved in overcoming the distorting influence of “self-love” on moral judgement’ and ‘fail to recognise how easy it is for us to mistake a self-interested view for an impartial one’.2 His thought is that cognitive bias and ideological commitments will prevent many of us from identifying the standpoint of the impartial spectator and from realising that we are not impartial.1 I agree that successfully adopting the standpoint of the impartial spectator is not an easy task. However, moral reasoning more generally is difficult and susceptible to bias. This does not mean that we should cease such reasoning; rather, we ought to do our best, and we are, at times, successful. Clarke discusses the entrenched attitudes of Antebellum white racists. However, attitudes about slavery have changed, and cognitive biases can change too. In other words, moral progress is possible. Moreover, as I argue in the paper, one of the advantages of the impartial-spectator approach is that it ‘provides a standpoint from which shared deliberation is possible and public reasons are available’.1 Thus, we can appreciate, with relative ease, whether an objector is reasoning from this standpoint. Clarke further argues that we should entertain the idea of employing ‘experts who are trained to overcome cognitive bias and to set aside ideological commitments’ and …. (shrink)

Samuel Fleischacker’s Being Me Being You: Adam Smith & Empathy offers a new interpretation of Adam Smith’s conception of empathy—or ‘sympathy’, as Smith referred to the phenomenon in The Theory of...

Models are being used extensively for practicing and understanding scientific, engineering and mathematical subjects, but are rarely used as art analyzing tools, particularly, in learning environments. Contrarily, using art to explain mathematical ideas is not unprecedented. Strogatz (1988), for example, built a model based on Romeo and Juliet’s love story and used it to explain the idea of differential mathematics, and system dynamics. Artwork, specially written and plastic classics, is a fixed form of art. We frame them and put them (...) in a gallery, or a book (digital or physical). We don’t try to “fix” them or optimize their functioning, we analyze them to find meaning, intention, and patterns. In this article, we aim to show how, by building models combined with simple mathematical representations and analogies, it is possible to understand literary texts, from the prism of system and complexity theories, which emphasize the dynamic, non-linear, and non-reductionist aspects of the observed. We’ll demonstrate how modeling processes of three cultural assets, allow active correspondence with the original textual art, by treating them as systemic objects with interactions and dynamics. They will be analyzed while raising questions about the significance of modeling as a cognitive learning process. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life care, bioethics, and (...) health policy discuss if age should guide rationing decisions. (shrink)

This review-essay considers the book by Moshe Halbertal, The Birth of Doubt: Confronting Uncertainty in Early Rabbinic Literature (Brown, 2020), and highlights certain pragmatist trajectories in the book and in its scholarly object - early rabbinic law. Inter alia, the middle rabbinic path between realism and nominalism is discussed.

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that (...) draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

A Fortiori Logic: Innovations, History and Assessments is a wide-ranging and in-depth study of a fortiori reasoning, comprising a great many new theoretical insights into such argument, a history of its use and discussion from antiquity to the present day, and critical analyses of the main attempts at its elucidation. Its purpose is nothing less than to lay the foundations for a new branch of logic and greatly develop it; and thus to once and for all dispel the many fallacious (...) ideas circulating regarding the nature of a fortiori reasoning. -/- The work is divided into three parts. The first part, Formalities, presents the author’s largely original theory of a fortiori argument, in all its forms and varieties. Its four (or eight) principal moods are analyzed in great detail and formally validated, and secondary moods are derived from them. A crescendo argument is distinguished from purely a fortiori argument, and similarly analyzed and validated. These argument forms are clearly distinguished from the pro rata and analogical forms of argument. Moreover, we examine the wide range of a fortiori argument; the possibilities of quantifying it; the formal interrelationships of its various moods; and their relationships to syllogistic and analogical reasoning. Although a fortiori argument is shown to be deductive, inductive forms of it are acknowledged and explained. Although a fortiori argument is essentially ontical in character, more specifically logical-epistemic and ethical-legal variants of it are acknowledged. -/- The second part of the work, Ancient and Medieval History, looks into use and discussion of a fortiori argument in Greece and Rome, in the Talmud, among post-Talmudic rabbis, and in Christian, Moslem, Chinese and Indian sources. Aristotle’s approach to a fortiori argument is described and evaluated. There is a thorough analysis of the Mishnaic qal vachomer argument, and a reassessment of the dayo principle relating to it, as well as of the Gemara’s later take on these topics. The valuable contribution, much later, by Moshe Chaim Luzzatto is duly acknowledged. Lists are drawn up of the use of a fortiori argument in the Jewish Bible, the Mishna, the works of Plato and Aristotle, the Christian Bible and the Koran; and the specific moods used are identified. Moreover, there is a pilot study of the use of a fortiori argument in the Gemara, with reference to Rodkinson’s partial edition of the Babylonian Talmud, setting detailed methodological guidelines for a fuller study. There is also a novel, detailed study of logic in general in the Torah. -/- The third part of the present work, Modern and Contemporary Authors, describes and evaluates the work of numerous (some thirty) recent contributors to a fortiori logic, as well as the articles on the subject in certain lexicons. Here, we discover that whereas a few authors in the last century or so made some significant contributions to the field, most of them shot woefully off-target in various ways. The work of each author, whether famous or unknown, is examined in detail in a dedicated chapter, or at least in a section; and his ideas on the subject are carefully weighed. The variety of theories that have been proposed is impressive, and stands witness to the complexity and elusiveness of the subject, and to the crying need for the present critical and integrative study. But whatever the intrinsic value of each work, it must be realized that even errors and lacunae are interesting because they teach us how not to proceed. -/- This book also contains, in a final appendix, some valuable contributions to general logic, including new analyses of symbolization and axiomatization, existential import, the tetralemma, the Liar paradox and the Russell paradox. (shrink)

Hope and Memory: Lessons from the Twentieth Century by Tzvetan Todorov; David Bellos The Dictators: Hitler's Germany and Stalin's Russia by Richard Overy Stalinism and Nazism: History and Memory Compared by Henry Rousso; Lucy B. Golsan Stalinism and Nazism: Dictatorships in Comparison by Ian Kershaw; Moshe Lewin Did Somebody Say Totalitarianism? Five Interventions in the use of a Notion by Slavoj Zizek.