We aim to establish the following claim: other factors held constant, the relative weights of the epistemic burdens of competing treatment options serve to determine the options that patient surrogates pursue. Simply put, surrogates confront an incentive, ceteris paribus, to pursue treatment options with respect to which their knowledge is most adequate to the requirements of the case. Regardless of what the patient would choose, options that require more knowledge than the surrogate possesses (or is likely to learn) will (...) either be neglected altogether or deeply discounted in the surrogate’s incentive structure. We establish this claim by arguing that the relation between epistemic burdens and incentives in decision-making is a general feature of surrogate decision-making. After establishing the claim, we draw out some of the implications for surrogate decision-making in medicine and offer philosophical and psychological explanations of the phenomenon. (shrink)

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effectDesign, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on “Decisions near the End of Life”.Results–Practitioners accept the relevance (...) of concepts widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment.Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

The conditions of transport and slaughter at the end of their lives are a major challenge to the welfare of agricultural animals. • End-of-life experiences should be of a greater ethical concern than others of similar intensity and duration, due to their position in the animal’s life. • End-of-life welfare can have both internal importance to the animals and external ethical importance to human decision-makers. • We should pay extra care to ensure that the conditions during (...) transport and slaughter are as positive as possible. (shrink)

In this bioethical poem, the narrator reflects on the experience of their father's degenerative illness, and decisions that must be made about whether to continue life support technologies such as ventilation and nutrition/hydration. What is it that is owed to family and patient at the end of life? What must no one who loves anyone ever do to the one they love?

Thesis --University of Stellenbosch, 2004 Acceptance of the concept of medical futility facilitates a paradigm shift from curative to palliative medicine, accommodating a more humane approach and avoiding unnecessary suffering in the course of the dying process. This should not be looked upon as abandoning the patient but rather as providing the patient and family with an opportunity to come to terms with the dying process. It also does not entail withdrawal or passivity on the part of the health (...) care professional. In addition to medical skills, the treating physician is responsible for guiding this process by demonstrating sensitivity and compassion, respecting the values of patients, their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored. S Afr Med J 2008; 98: 284-286. (shrink)

Disorders of consciousness include coma, the vegetative state and the minimally conscious state. Such patients are often regarded as unconscious. This has consequences for end of life decisions for these patients: it is much easier to justify withdrawing life support for unconscious than conscious patients. Recent brain imaging research has however suggested that some patients may in fact be conscious.

This dissertation explores the influence of time constraints on different research practices. The first two parts present case studies, which serve as a basis for discussing the epistemological and ethical implications of temporal limitations in scientific research. Part I is a case study on gravitational wave research, conducted by the LIGO Scientific Collaboration. This exemplifies fundamental research – without immediate societal applications, open-ended in terms of timeline and in terms of research goals. It is based, in part, on qualitative interviews (...) conducted with gravitational wave physicists. I show that considerations about time and speed play a role in every stage of research: goal setting, method design, and the evaluation and communication of results. Part II provides a case study on translational medicine, an approach explicitly dedicated to accelerating research in order to develop and implement new therapies. This epitomizes applied research with high social stakes, motivated by non-epistemic goals. Here, epistemic trade-offs between speed and reliability intersect with ethical trade-offs between different types of harms. In Part III, the insights from both of these case studies are used as the basis for a more general discussion concerning the pragmatic aspects of epistemic practices, especially in relation to current debates centered on the role of values in science. A particular focus is on the value of speed and the ability to generate reliable results, either via choice of methods, or via decisions about which goals to set, as well as decisions about when to stop further testing. The primary thesis of the dissertation is that pragmatic considerations stemming from limitations of resources are a necessary feature of the pursuit of epistemic aims, and that the epistemic is thus inherently pragmatic. (shrink)

This article examines the subtle interconnection between the sanctity of life and individual autonomy within the context of assisted dying, as seen through the lens of Orthodox Christianity. It seeks to unravel the complex theological, ethical, and pastoral considerations that inform the Orthodox stance on end-of-life issues, particularly the nuanced understanding of suffering, death, and the redemptive potential encapsulated within them. Orthodox theology, with its profound veneration for life as a divine gift, offers a counter-narrative to contemporary (...) discourses that often prioritize personal autonomy and the alleviation of suffering above all. This tradition emphasizes the transformative power of suffering when united with Christ’s own redemptive suffering, proposing a vision of end-of-life care that is rooted in compassion, dignity, and hope for resurrection. The exploration begins with a historical and theological examination of the Orthodox perspective on life’s sanctity, engaging with the teachings of Church Fathers and contemporary theological and bioethical discussions. It highlights the foundational concepts of Orthodox anthropology, which perceives human beings as an indivisible unity of body and soul, reflecting the imago Dei. This anthropological understanding challenges reductionist views of human existence and informs the Orthodox approach to medical ethics, palliative care, and the spiritual accompaniment of the dying. By critically evaluating arguments for and against assisted dying, the article presents a balanced discourse that respects the depth of individual suffering while upholding the intrinsic value of life. It argues that Orthodox Christianity, through its rich theological heritage and pastoral practice, provides a compassionate and ethically nuanced framework for navigating the moral complexities of assisted dying. This framework advocates for an end-of-life care that honors the fullness of the human person, supports the spiritual journey toward eternal life, and fosters a communal embrace of life’s sacred threshold, offering a dignified passage that aligns with the faith’s deepest convictions about human destiny and divine grace. (shrink)

Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal should (...) be respected. (shrink)

Everywhere in the world, and in every period of human history, it has been common for energy decisions to be made in an ethically haphazard manner. With growing population pressure and increasing demand for energy, this approach is no longer viable. We believe that decision makers must include ethical considerations in energy decisions more routinely and systematically. To this end, we propose an applied ethics framework that accommodates principles from three classical ethical theories—virtue ethics, deontology, consequentialism, and two Native (...) American ethics (Lakota and Navajo)—all considered from the perspectives of the impacted communities. We illustrate this framework by evaluating five recent energy decisions: the Dakota Access Pipeline, the Navajo Nation’s possible transition from coal to solar, hydraulic fracturing in Pennsylvania, uranium mining in Virginia, and the construction of the Xiaolangdi Dam in China. An applied ethics framework is preferable to existing ethical analyses because it can serve to sharpen arguments for (un)ethical decisions and action. Rather than treat ethical reasoning as a matter of opinion, we argue that applying ethical principles in a universal and standardized way adds rigor to energy sector decisions by presenting a position available for objective scrutiny. Because our framework identifies which aspects of a targeted action (if any) must adjust to improve ethical merit, it can serve as a practical tool for improving decision-making as we enter a new era of energy transitions. (shrink)

Feminist bioethicists of a variety of persuasions discuss the 2013 case of Marlise Munoz, a pregnant woman whose medical care was in dispute after she became brain dead.

Berger (forthcoming) states that moral intimacy is important in applying the best interests standard. But what he calls moral intimacy requires that someone has overcome epistemic burdens needed to represent the patient. We argue elsewhere that good surrogate decision-making is first and foremost a matter of overcoming epistemic burdens, or those obstacles that stand in the way of a surrogate decision-maker knowing what a patient wants and how to satisfy those preferences. Berger’s notion of moral intimacy (...) depends on epistemic intimacy: the fact that a surrogate's epistemic burdens with respect to the best interests of the incapacitated patient have been adequately surmounted, plus some other feature. Thus, where a particular patient-surrogate relationship fails to be morally intimate, what is lacking is either epistemic intimacy or this second feature. Furthermore, Berger uses the notion of moral intimacy as an explanans for the application of the best interests standard. We argue that the notions of epistemic intimacy and epistemic burdens not only help to explain the notion of moral intimacy, but also better explain the application of the best interests standard. Given the role of epistemic burdens and the epistemic intimacy that overcoming them enables, bioethicists and physicians should consider a surrogate’s epistemic standing relative to the patient’s best interests before pronouncing on the former’s ethical probity. (shrink)

Central elements of Roman Catholic treatment ethics include: 1) that rejection of treatment with the intent of hastening death (even for a good end) is ethically equivalent to active euthanasia with the same intent; 2) a distinction between morally obligatory “ordinary” treatment and morally optional “extraordinary treatment”; 3) that the quality of the patient’s life is not be a legitimate basis for rejecting treatment; and 4) that extraordinary treatment is not forbidden, but optional, and that it is the patient (...) or the patient’s legal surrogate–not the doctor– who has the right to choose or reject it. Despite these principles, even in a cultural climate fully sympathetic to Catholic treatment ethics, it is appropriate as a legal matter to maintain the doctrine of informed consent under which it is possible for patients or their surrogates to reject life-preserving treatment, including for unethical reasons. It is normally impossible to enforce in practice in the external forum a differentiation between rejection of treatment for ethically acceptable and ethically unacceptable reasons. By contrast, in cases of direct killing, such as assisting suicide, the intent to cause death is unmistakable (as opposed to accepting an increased risk of death as a foreseeable but unintended consequence of pursuing a good end). In a pluralistic society Catholic ethics cannot be legislatively enforced on the ground that they are compelled by Catholic teaching. However, the basic principles of Catholic treatment ethics may be justified based on logic and widely accepted norms of human equality independently of revelation or ecclesiastical authority. Particularly in protecting the right of individuals to choose and obtain life-saving medical treatment regardless of their “quality of life,” and in suicide prevention, secular law can and should be congruent with key aspects of Catholic health care ethics. (shrink)

The Netherlands was the first country to legalize euthanasia and physician-assisted suicide. This paper offers a first legal perspective on the prospects of using AI in the Dutch practice of euthanasia and physician-assisted suicide. It responds to the Regional Euthanasia Review Committees’ interest in exploring technological solutions to improve current procedures. The specific characteristics of AI – the capability to process enormous amounts of data in a short amount of time and generate new insights in individual cases – may for (...) example alleviate the increased workload of review committees due to the continuous increase of euthanasia cases. The paper considers three broad categories for the use of AI in the Dutch euthanasia practice: (1) the physician’s assessment of euthanasia requests, (2) the actual execution of euthanasia, and (3) the retrospective reviews of cases by the Regional Euthanasia Review Committees. Exploring the legal considerations around each avenue, both in the EU AI Act and the Dutch legal framework, this paper aims to facilitate the societal discussion on the role of technology in such deeply human decisions. This debate is equally relevant to other countries that legalized euthanasia (e.g. Belgium and Canada) or physician-assisted suicide (e.g. Switzerland and numerous states in the US). (shrink)

The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices— though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human beings (...) generally. While hypocrisy is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. (shrink)

Presupposing that our consideration of ethical issues can be enriched by examining literary works, this paper focuses on Marsha Norman's play ‘night, Mother. The play describes the last hour and a half in the life of Jessie, a young woman who decides to die by suicide. Before ending her life, Jessie explains to her mother her reasons for her suicide. In the context of the play, these are presented as quite weighty and as, perhaps, justifying her decision. (...) Scholarly research on the play has also treated Jessie's suicide favorably. In this paper I argue that Jessie, and people in similar conditions, are wrong to die by suicide. Among other points, I criticize Jessie's arguments from the impossibility to improve life; the assured termination of suffering; the badness of the world; and the right for suicide. I also criticize arguments in the scholarly literature that view Jessie's suicide favorably, such as the arguments from independence, heroism, authenticity, and emotional closeness. (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments (...) and biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

Given the wide the range of legally available options for end-of-life care in recent decades: from aggressive, even experimental, treatment to active euthanasia, our ethical analysis struggles to keep pace with technology and law. In this essay I show that the principle of double effect (PDE) remains, and will continue to be, a useful tool for ethical analysis of end-of-life care. According to PDE, an agent may ethically perform an act that s/he foresees will have a significant bad (...) effect (e.g., death) in addition to a good effect (e.g., pain relief) only if s/he does not intend the bad effect, the act is not bad for reasons other than its causing the bad effect, and there is a proportionately serious reason to act. Following a brief explanation of PDE and preliminary considerations in favor of counting death as a bad effect, I analyze several end-of-life options in terms of the principle. I begin with those that enjoy significant consensus among proponents of PDE: active euthanasia, “passive euthanasia,” and palliative care. Then I consider the less-straightforward cases of drug provision, refusing food and water, and terminal sedation, arguing that participation in such actions is justifiable via PDE only under very limited conditions. (shrink)

Mackenzie Graham has made an important contribution to the literature on decisionmaking for patients with disorders of consciousness. He argues, and I agree, that decisions for unresponsive patients who are known to retain some degree of covert awareness ought to focus on current interests, since such patients likely retain the kinds of mental capacities that in ordinary life command our current respect and attention. If he is right, then it is not appropriate to make decisions for such patients by (...) appealing to the values they had in the past, either the values expressed in an advance directive or the values recalled by a surrogate. There are two things I wish to add to the discussion. My first point is somewhat critical, for although I agree with his general conclusion about how, ideally, such decisions should be approached, I remain skeptical about whether his conclusion offers decisionmakers real practical help. The problem with these cases is that the evidence we have about the nature of the patient’s current interests is minimal or nonexistent. However—and this is important—Graham’s conclusion will be extremely relevant if in the future, our ability to communicate with such patients improves, as I hope it will. This leads to my second point. Graham’s conclusion illustrates a more general problem with our standard framework for decisionmaking for previously competent patients, a problem that has not been adequately recognized. So, in what follows, I explain the problem I see and offer some brief thoughts about solutions. (shrink)

Forms of Artificial Intelligence (AI) are already being deployed into clinical settings and research into its future healthcare uses is accelerating. Despite this trajectory, more research is needed regarding the impacts on patients of increasing AI decision making. In particular, the impersonal nature of AI means that its deployment in highly sensitive contexts-of-use, such as in healthcare, raises issues associated with patients’ perceptions of (un) dignified treatment. We explore this issue through an experimental vignette study comparing individuals’ perceptions of (...) being treated in a dignified and respectful way in various healthcare decision contexts. Participants were subject to a 2 (human or AI decision maker) x 2 (positive or negative decision outcome) x 2 (diagnostic or resource allocation healthcare scenario) factorial design. We found evidence of a “human bias” (i.e., a preference for human over AI decision makers) and an “outcome bias” (i.e., a preference for positive over negative outcomes). However, we found that for perceptions of respectful and dignified interpersonal treatment, it matters more who makes the decisions in diagnostic cases and it matters more what the outcomes are for resource allocation cases. We also found that humans were consistently viewed as appropriate decision makers and AI was viewed as dehumanizing, and that participants perceived they were treated better when subject to diagnostic as opposed to resource allocation decisions. Thematic coding of open-ended text responses supported these results. We also outline the theoretical and practical implications of these findings. (shrink)

TWENTIETH-CENTURY ETHICS. AFTER NIETZSCHE -/- Preface This book tells the story of twentieth-century ethics or, in more detail, it reconstructs the history of a discussion on the foundations of ethics which had a start with Nietzsche and Sidgwick, the leading proponents of late-nineteenth-century moral scepticism. During the first half of the century, the prevailing trends tended to exclude the possibility of normative ethics. On the Continent, the trend was to transform ethics into a philosophy of existence whose self-appointed task was (...) that of describing the human condition as consisting of choices, as unavoidable as arbitrary, without any attempt at providing criteria for making such choices. In the Anglo-Saxon countries, the heir of ethics was a philosophy of morality, that is, an analysis of the language of morality that intended to clarify valuations without trying to justify them. 1958 was the year of the normative turn that led to the Rehabilitation of practical philosophy, a turn followed by decades of controversies between distinct kinds of normative ethics: utilitarian, Kantian, virtue ethics. While the controversy was raging, a quiet revolution took place, that of applied ethics which surprisingly dissolved the controversy's very subject matter by providing methods for making convergence possible on intermediate principles even when no agreement was available about first principles. The normative turn and the revolution of applied ethics have led us, at the turn of the century, to a goal that was quite far from the starting point. Instead of scepticism and relativism that was the fashion at the beginning of the century, at the beginning of the third millennium impartial and universal moral arguments seem to hold the spot being supported, if not by a final rational foundation, at least by reasonableness, the most precious legacy of the Enlightenment. -/- ● TABLE OF CONTENTS -/- ● I Anglo-Saxon philosophy: naturalism 1. Dewey beyond evolutionism and utilitarianism 2. Dewey and anti-essentialist moral epistemology 3. Dewey and naturalist moral ontology 4. Dewey and normative ethics of conduct and function 5. Perry and semantic naturalism -/- ● II Anglo-Saxon philosophy: ideal utilitarianism and neo-intuitionism 1. Moore's critique of utilitarian empiricism 2. Moore on the naturalistic fallacy 3. Moore on the nature of intrinsic value 4. Moore on ideal utilitarianism 5. Prichard on the priority of the right over the good 6. Ross's coherentist moral epistemology 7. Ross's moral ontology: realism, pluralism, and non-naturalism 8. Ross's normative ethics of prima facie duties -/- The chapter reconstructs the background of ideas, concerns and intentions out of which Moore's early essays, the preliminary version, and then the final version of Principia Ethica originated. It stresses the role of religious concerns, as well as that of the Idealist legacy. It argues that PE is more a patchwork of somewhat diverging contributions than a unitary work, not to say the paradigm of a new school in Ethics. -/- ●III Anglo-Saxon philosophy: non-cognitivism 1. The Scandinavian School, the Vienna circle and proto-emotivism 2. Wittgenstein and the ineffability of ethics 3. Russell's and Ayer's radical emotivism 4. Stevenson and moderate emotivism 5. Stevenson and the pragmatics of moral language 6. Stevenson and the methods for solving ethical disagreement 7. Hare and prescriptivism The chapter reconstructs first the discussion after Moore. The naturalistic-fallacy argument was widely accepted but twisted to prove instead that the intuitive character of the definition of 'good', its non-cognitive meaning, in a first phase identified with 'emotive' meaning. Alfred Julius Ayer is indicated as a typical proponent of such non-cognitivist meta-ethics. More detailed discussion is dedicated to Bertrand Russell's ethics, a more nuanced and sophisticated doctrine, arguing that non-cognitivism does not condemn morality to arbitrariness and that the project of rational normative ethics is still possible, heading finally to the justification of a kind of non-hedonist utilitarianism. Stevenson's theory, another moderate version of emotivism is discussed at some length, showing how the author comes close to the discovery of the role of a pragmatic dimension of language as a basis for ethical argument. A section reconstructs the discussion from the Forties about Hume's law, mentioning Karl Popper's argument and Richard Hare's early non-cognitivist but non-emotivist doctrine named prescriptivism. -/- ●IV Anglo-Saxon philosophy: critics of non-cognitivism 1. Neo-naturalism and its objections to the naturalistic fallacy argument 2. Objections to Hume's law 3. Clarence Lewis and the pragmatic contradiction 4. Toulmin and the good reasons approach 5. Baier and moral reasons 5. Baier, social moralities and the absolute morality 6. Baier and the moral point of view 7. Baier and the contents of absolute ethics -/- ● V Continental philosophy: the philosophy of values 1. Max Weber and the polytheism of values 2. Phenomenology against psychologism and rationalism 3. Reinach and the theory of social acts 4. Scheler and the material ethics of values 5. Hartmann and the ontology of values 6. Plessner, Gehlen and the Philosophische Anthropologie -/- The chapter illustrates first the idea of phenomenology and the Husserl's project of a phenomenological ethic as illustrated in his 1908-1914 lectures. The key idea is dismissing psychology and trying to ground a new science of the apriori of action, within which a more restricted field of inquiry will be the science of right actions. Then the chapter illustrates the criticism of modern moral philosophy conducted in the 1920 lectures, where the main target is naturalism, understood in the Kantian meaning of primacy of common sense. The third point illustrate is Adolph Reinach's theory of social acts as a key the grounding of norms, a view that sketches the ideas 'discovered' later by Clarence I. Lewis, John Searle, Karl-Otto Apel and Jürgen Habermas. A final section discusses Nicolai Hartman, who always refused to define himself a phenomenologist and yet developed a more articulated and detailed theory of 'values' – with surprising affinities with George E. Moore - than philosophers such as Max Scheler, who claimed to be Husserl's legitimate heirs. -/- ● VI Continental philosophy: the critics of the philosophy of values 1. Freud, the Superego and Civilization 2. Heidegger on original ethos against ethics 3. Sartre and de Beauvoir on authenticity and ambiguity 4. Adorno and Horkheimer on emancipation and immoralism -/- ●VII Post-liberal theologians and religious thinkers 1. Barth on the autonomy of faith from ethics 2. Developments of Reformed moral theology after Barth 3. Bonhoeffer on the concrete divine command and ethics of penultimate realities 4. Developments of Reformed and Catholic moral theology after world war II 5. Baeck and the transformation of liberal Judaism 6. Rosenzweig against liberal Judaism 7. Buber and religion as the vital lymph of morality 8. Heschel and Judaism as a science of actions -/- The chapter examines the main protagonists of Christian theology and Jewish religious thinking in the twentieth century. It stresses how the main dilemmas of contemporary philosophical ethics lie at the root of the various path of inquiry taken by these thinkers. -/- ● VIII Normative ethics: neo-Utilitarianism 1. The discussion on act and rule utilitarianism 2. Hare on two-tiered preference utilitarianism 3. Harsanyi, Gauthier and rational choice ethics 4. Parfit, utilitarianism and the idea of a person 5. Brandt and indirect conscience utilitarianism -/- The chapter addresses the issue of the complex process of self-transformation Utilitarianism underwent after Sidgwick's and Moore's fatal criticism and the unexpected Phoenix-like process of rebirth of a doctrine refuted. Two examples give the reader a glimpse at this uproarious process. The first is Roy Harrod Wittgensteinian transformation of utilitarianism in pure normative ethics depurated from hedonism as well as from whatsoever theory of the good. This transformation results in preference utilitarianism combined with a 'Kantian' version of rule utilitarianism. The second is Richard Hare's two-level preference utilitarianism, where act utilitarianism plays the function of the eventual rational justification of moral judgments and rule-utilitarianism that of an action-guiding practical device. -/- ● IX Normative ethics: neo-Aristotelianism and virtue ethics 1. Hannah Arendt, action and judgement 2. Hans-Georg Gadamer and phronesis 3. Alasdair MacIntyre on practices, virtues, and traditions 5. Stuart Hampshire on deliberation 6. Bernard Williams and moral complexity 7. Feminist ethics -/- Sect 1 reconstructs the post-war rediscovery of ethics by many German thinkers and its culmination in the Sixties in the movement named 'Rehabilitation of practical philosophy' is described. Heidegger's most brilliant disciples were the promoters of this Rehabilitation. Hans-Georg Gadamer is a paradigmatic example. His reading of Aristotle's lesson I reconstructed, starting with Heidegger's lesson but then subtly subverting its outcome thanks to the recovery of the significant role of the notion of phronesis. Sect 3 discusses the three theses defended by Anscombe in 'Modern Moral Philosophy'. It argues that: a) her answer to the question "why should I be moral?" requires a solution of the problem of theodicy, and ignores any attempts to save the moral point of view without recourse to divine retribution; b) her notion of divine law is an odd one more neo-Augustinian than Biblical or Scholastic; c) her image of Kantian ethics and intuitionism is the impoverished image manufactured by consequentialist opponents for polemical purposes and that she seems strangely accept it; d) the difficulty of identifying the "relevant descriptions" of acts is not an argument in favour of an ethics of virtue and against consequentialism or Kantian ethics, and indeed the role of judgment in the latter is a response to the difficulties raised by the case of judgment concerning future action. The chapter gives a short look at further developments in the neo-naturalist current trough a reconstruction of Philippa Foot's and Peter Geach's critiques to the naturalist-fallacy argument and Alasdair MacIntyre's grand reconstruction of the origins and allegedly inevitable failure of the Enlightenment project of an autonomous ethic. -/- ● X Normative ethics: Kantian and rights-based ethics 1. Dialogical constructivism 2. Apel, Habermas and discourse ethics 3. Gewirth and rights-based ethics 4. Nagel on agent-relative reasons 5. Donagan and persons as ends in themselves Parallel to the neo-Aristotelian trend, there was in the Rehabilitation of practical philosophy a Kantian current. This current started with the discovery of the pragmatic dimension of language carried out by Charles Peirce and the Oxford linguistic philosophy. On this basis, Karl-Otto Apel singled out as the decisive proponent of the linguistic and Kantian turn in German-speaking ethics, worked out the performative-contradiction argument while claiming that this was able to provide a new rational and universal basis for normative ethics. The chapter offers an examination of his argument in some detail, followed by a more cursory reconstruction of Jürgen Habermas's elaboration on Apel's theory. -/- ● XI The applied ethics renaissance 1. Elisabeth Anscombe on the atom bomb 2. From medical ethics to bioethics 3. Rawls and public ethics 3. Nozick, Dworkin and further developments of public ethics 5. Sen and the revival of economic ethics -/- The chapter presents the revolution of applied ethics while stressing its methodological novelty, exemplified primarily by Beauchamp and Childress principles approach and then by Jonsen and Toulmin's new casuistry. The chapter argues that Rawls's distinction between a "political" and a "metaphysical" approach to the theory of justice, one central part of ethical theory, is a formulation of the same basic idea at the root of both the principles approach and the new casuistry, both discussed in the following chapter. The idea is that it is possible to reach an agreement concerning positive moral judgments even though the discussion is still open – and in Rawls' view never will be close – on the essential criteria for judgment. -/- ● XII Fin-de-siècle metaethics 1. Deontic logics 2. Anti-realism 3. External realism 4. Internal realism 5. Kantian constructivism -/- The chapter illustrates the fresh start of meta-ethical discussion in the Eighties and Nineties and the resulting new alignments: metaphysical naturalism, internal realism, anti-realism, and constructivism. (shrink)

Regarding the relation of Plato’s early and middle period dialogues, scholars have been divided to two opposing groups: unitarists and developmentalists. While developmentalists try to prove that there are some noticeable and even fundamental differences between Plato’s early and middle period dialogues, the unitarists assert that there is no essential difference in there. The main goal of this article is to suggest that some of Plato’s ontological as well as epistemological principles change, both radically and fundamentally, between the early and (...) middle period dialogues. Though this is a kind of strengthening the developmentalistic approach corresponding the relation of the early and middle period dialogues, based on the fact that what is to be proved here is a essential development in Plato’ ontology and his epistemology, by expanding the grounds of development to the ontological and epistemological principles, it hints to a more profound development. The fact that the bipolar and split knowledge and being of the early period dialogues give way to the tripartite and bound knowledge and benig of the middle period dialogues indicates the development of the notions of being and knowledge in Plato’s philosophy before the dialogues of the middle period. -/- Keywords Plato; early dialogues; middle dialogues; being; knowledge; development -/- Introduction The differences between two groups of the early and middle period dialogues have always been a matter of dispute. Whereas the developmentalists like Vlastos, Silverman (2002), Teloh (1981), Dancy (2004) and Rickless (2007) think that from the early to the middle dialogues Plato’s philosophy changes, at least in some essential points, the unitarists like Kahn, Cherniss and Shorey believe that there happens no development and the differences must be taken as natural, ignorable and even pedagogic. In his well-known article, Socrates contra Socrates in PLATO, Vlastos lists ten theses of difference between two groups of dialogues. The first group which includes Plato’s early dialogues he divides to 'elenctic' (Apology, Charmides, Crito, Euthyphro, Gorgias, Hippias Minor, Ion, Laches, Protagoras and Republic I) and 'transitional' (Euthydemus, Hippias Major, Lysis, Menexenus and Meno) dialogues. These transitional come after all the elenctic dialogues and before all the dialogues of the second group which compose Plato’s middle period dialogues, including (with Vlastos' chronological order) Cratylus, Phaedo, Symposium, Republic II-X, Phaedrus, Parmenides and Theaetetus (1991, 46-49). Vlastos asserts strictly that his list of differences are 'so diverse in content and method that they contrast as sharply with one another as with any third philosophy you care to mention, beginning with Aristotole’s' (ibid, 46). Vlastos’ list of differences between two Socrateses is considered a view breaking sharply between the early and the middle dialogues. Besides all ten differences between the two Socrateses in Vlastos’ list that can be supportive for our doctrine here, we intend to focus on some ontological as well as epistemological distinctions that have not completely been discussed hitherto. Contrary to the developmentalist theory of Vlastos, unitarian theory of Charles Kahn wishes to eliminate any substantial difference between the early and the middle dialogues. He distinguishes seven 'pre-middle' or 'threshold' dialogues including Laches, Charmides, Euthyphro, Protagoras, Meno, Lysis and Euthydemus from the other Socratic dialogues which he calls 'earliest group' (1996, 41). The threshold dialogues, Kahn thinks, 'embarke upon a sustained project' that is to reach to its climax in the middle period dialogues, namely Phaedo, Symposium and Republic. Believing in that there is no 'fundamental shift'between the early and middle dialogues (ibid, 40), Kahn thinks the Socratic dialogues are just the 'first stage' with a 'deliberate silence' towards the theories of later periods (ibid, 339). One of the reasons of the surprising fact that Plato gives no hint of the metaphysics and epistemology of the Forms in the early dialogues, he thinks, is the pedagogical advantages of aporia. He thinks that Plato 'obscurely', and mostly because of education, hinted to some doctrines and conceptions in his early dialogues and with the aim of clarifying them only in the later ones (ibid, 66). The seven threshold dialogues, Kahn asserts, 'had been designed from the first' to prepare the pupils and readers for the views expounded in the middle period dialogues (ibid, 59-60). To show that the differences of the two Socrateses of the early and middle period dialogue are in their onto-epistemological grounds and thence cannot be explained by a unitaristic view, we try to draw the ontological and epistemological principles of the early dialogues in the first part below in order to show, in the second part, that those principles have been developed in the middle period dialogues. -/- A. The Onto-Epistemologic Principles of the Early Dialogues Socratic dialogues are paradoxical about knowledge because while being knowledge-oriented always searching for knowledge, they deny it and even never discuss it directly. Three elements of Socrates’ way of searching Knowledge throughout the early dialogues, i.e. Socratic 'what is X?' question, his disavowal of knowledge and his elenctic method combined together produce something like a circle which works, more or less, in the same way in these dialogues. Though this circle is an embaressing inquiry always resulting in ignorance instead of knowledge, its motivation is surprisingly Socrates’ passionate enthusiasm for knowledge, an intensive love of wisdom. The starting point of this circle is Socrates’ confession of having no knowledge which might be explicitly asserted or presupposed, maybe because it was one of the famous characteristics of Socrates; a confession always paradoxically accompanied with his intense longing for knowledge (e.g., Gorgias 505e4-5). Every time Socrates encounters with someone who thinks he knows something (οἴεταί τι εἰδέναι) (Apology 21d5) and tries to examine him. This examination seems to be the simplest one asking just what it is that he knows. Socrates’ elenchus, therefore, is always connected with 'what is X?' (τίς ποτέ ἐστιν) question, a question that most of the early dialogues of Plato are concerned with; 'what is courage?' in the Laches, 'what is piety?' in Euthydemus, 'what is temperance?' in Charmides and 'what is beauty?' in Hippias Major. This question we call here 'Socratic question' and probably is the very question the historical Socrates used to employ, is tightly interrelated with both his disavowal and his elenchus. He disclaims knowledge because he cannot find the answer to the question himself and he rejects others’ since they cannot offer the correct answer too. Every interlocutor can claim he knows X, if and only if he can answer the Socratic question. Otherwise, he is more of an ignorant than of a knower of τί ποτέ ἐστι X. Knowing the answer to this question is, thus, knowledge’s criterion for Socrates. Having found out that he cannot answer what it is which he would claim to know, the interlocutor comes to the point Socrates was there at the beginning. The least advantage of this circle is that he becomes as wise as Socrates does about the subject, becoming aware that he does not know it. At the end of the circle they are both still at the beginning, not knowing what X is. So let us first take a glance at these three elements. Socratic disavowal of knowledge is strictly asserted in some passages. At Apology 21b4-5, Socrates says: -/- I do not know of myself being wise at all (οὔτε μέγα οὔτε σμικρὸν σύνοιδα ἐμαυτῷ σοφὸς ὤν) -/- Moreover, at 21d4-6: -/- None of us knows anything worthwhile (καλὸν κἀγαθὸν εἰδέναι) …. I do not know (οἶδα) neither do I think I know. -/- In Charmides Socrates speaks about a fear about his probable mistake of thinking that he knows (εἰδέναι) something when he does not (166d1-2). The somehow generalization of this disavowal can be seen in Gorgias. After calling his disavowal 'an account that is always the same' (509a4-5), Socrates continues (a5-7): -/- I say that I do not know (οἶδα) how these things are, but no one I have ever met, like now, who can say anything else without being absurd. -/- At the end of Hippias Major (304d7-8), Socrates affirms his disavowal of knowledge of 'what is X?' this time about the fine: -/- I do not know (οἶδα) what that is itself (αὐτὸ τοῦτο ὅτι ποτέ ἐστιν). Some other passages, however, made a number of scholars dubious about Socrates’ disavowal. Vlastos mentions Apology 29b6-7 as an evidence : 'that to do wrong and to disobey one’s master, both god and men, I know (οἶδα) to be evil and shameful'. He thinks that if we give this single text 'its full weight' it can suffice to show that Socrates does claim knowledge of a moral truth (1985, 7). Vlastos’ claim is not admittable since it would be too strange, I think, for a man like Socrates to violate his disavowal claim just after emphasizing it. We can see his claim just before the already mentioned passage: -/- And surely it is the most blameworthy ignorance to believe that one knows what one does not know. It is perhaps on this point and in this respect, gentlemen, that I differ from the majority of men and if I were to claim that I am wiser than anyone in anything it world be in this, that, as I have no adequate knowledge (οὐκ εἰδὼς ἱκανῶς) of things in the underworld, so I do not think I have (οὐκ εἰδέναι) (Apology 29b1-6) Vlastos tries to solve what he calls the 'paradox' of Socrates’ disavowal of knowledge distinguishing the 'certain' knowledge from 'elenctic' knowledge (1985, 11) and thinking that when Socrates avows knowledge, we must perceive it as an elenctic knowledge, a knowledge its content 'must be propositions he thinks elenctically justifiable' (ibid, 18). Irwin’s solution is the distinction of knowledge and belief. He approves that Socrates does not 'explicitly' make such a distinction, but still thinks that Socrates’ 'test for knowledge would make it reasonable for him to recognize true belief without knowledge, and his own claims are easily understood if they are claims to true belief alone' (1977, 40). While I agree with Vlastos up to a point, I strongly disagree with Irwin about the early dialogues. As I will try to show below, we are not permitted to consider any kind of distinction within knowledge in Socratic dialogues because only one category of knowledge is alluded to there and the distinction of knowledge and belief thoroughly belongs to the second Sorcates. Although no kind of distinction can be admittable here, I think Vlastos’ distinction can be accepted only if we regard it as a distinction between knowledge, which is unique and without any, even incomparable, rival, and a semi-idiomatic and ordinary one that is a necessary requirement for any argument, and thus, unavoidable even for someone who does not claim any kind of knowledge. An apparent evidence of this is Gorgias 505e6-506a4: -/- I go through the discussion as I think it is (ὡς ἄν μοι δοκῇ ἔχειν), if any of you do not agree with admissions I am making to myself, you must object and refute me. For I do not say what I say as I know (οὐδὲ γάρ τοι ἔγωγε εἰδὼς λέγω ἃ λέγω) but as searching jointly with you (ζητῶ κοινῇ μεθ᾽ ὑμῶν). -/- The minimal degree of knowledge everyone must have to take part in an argument, conduct it and use the phrase "I know" when it is necessary is what Socrates cannot deny. We can call it elenctic knowledge only if we agree that it is not the kind of knowledge that Socrates has always been searching, the one that can be accepted as the answer of Socratic 'what is X?' question. His disavowal of knowledge is applied only to the knowledge which can truly be the answer of Socratic question and pass the elenctic exam; a knowledge that, I believe, is never claimed by first Socrates. Socrates conducts his method of examining his interlocutors’ knowledge, our second element here, by almost the same method repeated in Socratic dialogues. That whether we are allowed to regard all the examinations of Socrates in the early dialogues as based on the same or not has been a matter of dispute. Vlastos himself (1994, 31) distinguished Euthydemas, Lysis, Menexenns and Hippias Major from the other Socratic dialogues because he thinks Socrates has lost his faith to elenchus in there. Irwin (1977, 38) distinguishes Apology and Crito where Socrates’ own convictions is present. Contrary to some scholars like Benson (2002, 107) who take elenchus in all the Socratic dialogues as a unique method, Michelle Carpenter and Ronald M. Polansky (2002, 89-100) argue pro the variety of methods of elenchus. Thomas C. Brickhouse and Nicholas D. Smith (2002, 145-160) even reject such a thing as Socratic elenchus which can gather all of the Socrates’ various arguments under such a heading. There can be no solution for the problem of elenchus, they think, is due to 'the simple reason that there is no such thing as 'the Socratic elenchos"'(p.147). Though we consider elenchus a somehow determined process and a part of Socratic circle in the early dialogues, all we assume is that whatever differences it might have in different dialogues, it has the same onto-epistemological principles and, thus, we are not going to take it necessarily as a unique method. This method sets out to prove that the interlocutors are as ignorant as Socrates himself is. That whether elenchus is constructive, capable of establishing doctrines as Vlastos (1994) or Brickhouse and Smith (1994, 20-21) believe or not is another issue to which this paper is not to claim anything. What is crucial for our discussion here is that elenchus does not reach to the very knowledge Socrates is looking for. This is strictly against Irwin who thinks that not only elenchus leads to positive results, 'it should even yield knowledge to match Socrates’ conditions'(1977, 68, cf. 48). He does not explain where and how they really yield to that kind of knowledge. He explains his elenctic method in his apology in the court (Apology 21-22), that how he used to examine wise men, politicians, poets and all those who had the highest reputation for their knowledge and every time found that they have no knowledge. If we accept, as I strongly do, that Socrates’ disavowal of his knowledge is not irony, it might seem more reasonable to agree that the process that has that disavowal as its first step cannot be irony as well. The key of the circle which can explain why Socrates disclaims knowledge and how he can reject others’ claim of having any kind of knowledge lies in the third element, Socratic question. In Hippias Major (287c1-2), Socrates asks: 'Is it not by Justice that just people are Just? (ἆρ᾽ οὐ δικαιοσύνῃ δίκαιοί εἰσιν οἱ δίκαιοι). He insists at 294b1 that they were searching for that by which (ᾧ) all beautiful things are beautiful (cf. b4-5, 8). At Euthyphro 6d10-11 it is said that the Socratic question is waiting for 'the form itself (αὐτὸ τὸ εἶδος) by which (ᾧ) all the pious actions are pious; and at 6d11-e1: -/- Through one form (που μιᾷ ἰδέᾳ) impious actions are impious and pious actions pious. -/- Since the X itself is that by which X is X, knowing 'X itself' is the only way of knowing X. It is probably because of this that Socrates makes the distinction between the ousia as a right answer to the question and effect as a wrong one: -/- I am afraid, Euthyphro, that when you were asked what piety is (τὸ ὅσιον ὅτι ποτ᾽ ἐστίν) you did not wish to make clear its nature itself (οὐσίαν … αὐτοῦ) to me, but you said some effect (πάθος) about it. (Euthp. 11a6-9) -/- 1. Knowledge of what X is Now it is time to look for the onto-epistemological principles of Socratic circle and its three elements. It cannot reasonably be expected from the first Socrates to present us explicitly and clearly formulated principles of his onto-epistemology when such explications cannot be found even in the second Socrates who has some obviously positive theoris. Since there must be some principles underlying this first systematic inqury of knowledge, we must seek to them and be satisfied with elicitation of the first Socratas’ principle. What will be drawn out as his principles cannot and must not, thus, be taken as very fix and dogmatic principles. Some very slightest principles and grounds suffice for our purposes here. The first principle that is the prima facie significance of the Socratic question and his implementation of all those elenctic arguments I call the principle of 'Knowledge of What X is' (KWX): -/- KWX To know X, it is required to know what X is. -/- Aristotle (Metaphysics 1078b23-25, 27-29, 987b4-8) takes Plato’s τί ἐστι question as seeking the definition of a thing that is the same as historical Socrates’ search but applying to a different field. That Plato’s 'what is X?' question was a search for definition became the prevailed understanding of this question up to now. I am going neither to discuss the answer of Socratic question nor to challenge taking it as definition. What I am to insist is that knowledge is attached firmly to the answer of the question: Knowledge of X is not anything but the knowledge of what X is. It entails, certainly, the priority of this knowledge to any other kind of knowledge about X but it also has something more fundamental about the relation of knowledge and Socratic question. Socrates’ exclusive focus on the answer of his question can authorize the consideration of such an essential role for KWX in his epistemolgoy. The total rejection of his interlocutors’ knowledge when they are unable to answer the question can be regarded as a strong evidence for it. Socrates’ elenctic method and his rejection of others’ knowledge in the early dialogues, which all end aporetically with no one accepted as knower and nothing as knowledge, prevent us from finding any positive evidence for this. We have to be content, therefore, of negative evidences which, I think, can be found wherever Socrates rejects his interlocutors’ knowledge when they are not able to give an acceptable answer to his 'what is X?' question. 2. Bipolar Epistemology Socrates’ rejection of his interlocutors’ knowledge has another epistemological principle as its basis. Let me call this principle Bipolar Epistemology' (BE): BE There is no third way besides knowledge and Ignorance. -/- BE says that about every object of knowledge there are only two subjective statuses: knowledge and Ignorance. Socrates’ disavowal, however, says nothing but that he is ignorant of knowledge of X because he does not know what X is. This means that BE is presupposed here. Socrates’ elenchus and his rejection of interlocutors’ having any kind of knowledge are the necessary results of the fact that he does not let any third way besides knowledge and ignorance. The first Socrates never let anyone partly know X or have a true opinion about it, as he would not let anyone know anything about X when he did not know what X is. -/- 3. Bipolar Ontology The principle of BE in first Socrates’ epistemology is parallel to another principle in his ontology. Plato’s bipolar distinction between being and not being is as strict and perfect as his distinction between knowledge and ignorance. This principle I shall call the principle of 'Bipolar Ontology' (BO): BO Being is and not being is not. BO is apparently the same with the well-known Parmenidean Principle of being and not being (cf. Diels-Kranz (DK) Fr. 2.2-5). Euthydemus’ statement against the possibility of false knowledge can be good evidence for this principle: -/- The things which are not surely do not exist (τὰ δὲ μὴ ὄντα … ἄλλο τι ἢ οὐκ ἔστιν). (Euthydemus 284b3-4) -/- He continues (b4-5): -/- There is nowhere for not being to be there (οὖν οὐδαμοῦ τά γε μὴ ὄντα ὄντα ἐστίν). -/- That BE does not let true opinion as a third option besides knowledge and ignorance seems to be related to BO’s rejecting a third option besides being and not being, which is itself the basis of the impossibility of false belief. Socrates’ elaborate discussion of the problem of false belief in Theatetus that leads to a more decisive discussion and finally to some solutions in Sophist can make our consideration of BO for the first group of dialogues authentive. -/- 4. &5. Split Knowledge and Split Being The fourth principle I shall call the principle of 'Split Knowledge' (SK): -/- SK Knowledge of X is separated from any other knowledge (of anything else) as if the whole knowledge is split to various parts. -/- This Principle is hinted and criticized as Socrates’ way of treating with knowledge in Hippias Major: -/- But Socrates, you do not contemplate the entireties of things, nor do people you have used to talk with (τὰ μὲν ὅλα τῶν πραγμάτων οὐ σκοπεῖς, οὐδ᾽ ἐκεῖνοι οἷς σὺ εἴωθας διαλέγεσθαι). (301b2-4) -/- Contrary to Rankin who regards the passage as 'antilogical, almost eristic in tone rather than presenting a serious philosophy of being' (1983, 54), I think it can be taken as serious. Hippias criticizes Sorcates that he does not contemplate (σκοπεῖς) the entireties of things (ὅλα τῶν πραγμάτων), a critique which Socrates is not its only subject but all those whom Socrates accustomed to talk with (ἐκεῖνοι οἷς σὺ εἴωθας διαλέγεσθαι). This last phrase, I think, extends this critic beyond this dialogue to other Socratic dialogues. Hippias’ use of the perfect tense of the verb ἔθω (to be accustomed) is a good evidence of this extension. We can get, thus, these ἐκεῖνοι as Socrates’ interlocutors in his other dialogues that hints that this criticism has the epistemological groundings of the previous dialogues as its subject. What ἐκεῖνοι οἷς σὺ εἴωθας διαλέγεσθαι points to is that Hippias does not have in mind Socrates’ way of treating things only in this dialogue, but he is also criticizing Socrates’ way throughout his dialogues. At 301b4-5, Socrates and his interlocutors’ way of beholding things is described as such: -/- You people knock (κρούετε) at the fine and each of the beings (ἕκαστον τῶν ὄντων) by taking each being cut up in pieces (κατατέμνοντες) in words (ἐν τοῖς λόγοις). This leads us to our next principle that is parallel to, and the ontological side of, SK, the principle of 'Split Being'(SB): -/- SB Everything (being) is separated from any other thing as if the whole being is split to many beings. -/- Socrates and his interlocutors and thus, as we saw, the Socratic dialogues are accused to regard everything as it is separated from all other things. This separation is en tois logois that, I think, can reasonably be taken as saying that Socratic dialogues (it refers of course to the dialogues before Hippias Major) cut up all things which have the same name/definition from all other things and try to understand them separately, without considering other things that are not in their logos. They, for example in Hippias Major, are cutting up to kalon and try to understand what it and all others inside this logos are by separating it from all other things. This is directed straightly against Socratic question and the way Socratic dialogues follow to find its answer, every time separating one logos. As Meyer (1995, 85) points out, every question 'presupposes that the X in question in a logos is something' and 'every answer to every question aims at unity' (84). The critique of Hippias Major is, therefore, at the same time a critique of SK and SB. It is also a critique of KWX because it is only based on KWX that Socratic dialogues could search for the answer of 'what is X' question supposing that knowing what X is is enough for the knowledge of X. SK and KWX are absolutely interdependent. What Socrates and all his previous interlocutors have neglected in Socratic dialogues, Hippias says, was 'continuous bodies of being' (διανεκῆ σώματα τῆς οὐσίας) (301b6). Either this theory actually belongs to the historical Hippias as it is being said or not, it is strictly criticizing SB. We have the same phrase with changing sūma to logos some lines later at 301e3-4: διανεκεῖ λόγῳ τῆς οὐσίας. Although this theory that can be observed as both an ontological and an epistemological theory is rejected by Socrates (301cff.), it is still against first Socrates’ onto-epistemological principles and might let us look at what is rejected as Socratic prineple. -/- 6. Knowledge is of Being The sixth principle that I think is presupposed by the first Socrates, is the 'Knowledge of Being' Principle (KB): -/- KB Knowledge is of Being. -/- This principle is obviously the source of the problem of false knowledge, a very important problem throughout Plato’s philosophy. We face this problem maybe for the first time in Euthydemus. In less than 20 Stephanus’ pages, 276-295, we are encountered with different interwoven problems about knowledge , all grounded in the problem of false opinion. Having challenged the obvious possibility of telling lies at 283e, at 284 Euthydemus discusses it saying that the man who speaks is speaking about 'one of those things that are (ἓν μὴν κἀκεῖνό γ᾽ ἐστὶν τῶν ὄντων)' (284a3) and thus speaks what is (λέγων τὸ ὄν) (a5). He must necessarily be saying truth when he is speaking what is because he who speaks what is (τὸ ὄν) and the things that are (τὰ ὄντα) speaks truth (τἀληθῆ λέγει) (a5-6). This is based on Parmenidean principle of the impossibility of being of not being which Euthydemus restates (284b3-4) and we mentioned discussing BO principle above. The things that are not are nowhere (οὐδαμοῦ) and there is no possibility for anyone to do (πράξειεν) anything with them because they must be made as being before anything else can be done, which is impossible (b5-7). The words, then, are of things that exist (εἰσὶν ἑκάστῳ τῶν ὄντων λόγοι) (285e9) and as they are (ὡς ἔστιν) (e10). The result is that no one can speak of things as they are not. It is this impossibility of false speach that is extended to thinking (δοξάζειν) at 286d1 and leads to the impossibility of false opinion (ψευδής … δόξα) (286d4). The general conclusion is asserted at 287a extending this impossibility to actions and making any kind of mistake. Not only knowledge is of being but speech, thought and action are of being simply because of the fact that nothing can be of not being. -/- B. First Socrates’ Principles in the Middle Period Dialogues Out of what were presupposed or criticized mostly in five dialogues, Euthyphro, Euthydemus, Hippias Major, Laches and Charmides, we tried to draw the first Socrates’ principles. Our inquiry here is directed to find out the fate of these principles in the three dialogues of the middle period, Meno, Phaedo and Republic. To do this, first we ought to check the situation of Socratic circle in these dialogues. The Socratic circle that was predominant in the early dialogues, does not look like a circle here anymore though they certainly have some features in common. Meno, Phaedo and Republic II-X are not committed to the principles of the circle and the whole circle in disrupted in them. The difference of the two Socrateses towards acquiring knowledge is obvious. The Socrates of Meno, Phaedo and Republic is evidently more self-confident that he can get to some truths during his arguments as he does. They are in their first appearance, as almost all other dialogues, committed to Socrates’ disavowal. All of them try to keep the shape of the Socratikoi Logoi genre, which is committed to the historical Socrates’ way of discussion; a dramatic personage who is to challenge his interlocutors, ask them and refuse the answers. Nevertheless, the fact is that what we have in common between two groups of dialogues is mostly a dramatic structure. Whereas the first group’s arguments are based on Socrates’ disavowal and lead to no positive results, the second group is decisively going to achieve some positive results. The aim of the first Socrates was to show others that they are ignorant of what they thought they knew. The new Socrates of Meno, on the opposite, makes so much efforts to show that the slave boy has within himself true opinions (ἀληθεῖς δόξαι) about the things that he does not know (οἶδε) (85c6-7). Despite his lack of knowledge, he has true opinions nevertheless. The way from these true opinions to knowledge, as Socrates states, is not so long. These true opinions are now like a dream but 'can become knowledge of the same things not less accurate than anyone’s' (οὐδενὸς ἧττον ἀκριβῶς ἐπιστήσεται περὶ τούτων) (c11-d1), if they be repeated by asking the same questions. The most outstanding text regarding Socrates’ disavowal is Meno 98b where he explicitly claims knowledge: -/- And indeed I also speak as (ὡς) one who does not know (εἰδὼς) but is guessing (εἰκάζων). However, [about the fact] that true opinion and knowledge are different, I do not altogether expect (δοκῶ) myself to be guessing (εἰκάζειν), but if I say about anything that I know (εἰδέναι) -which about few things I say- this is one of the things that I know (οἶδα). (98b1-5) This passage is very significant about Plato’s disavowal of knowledge. There can hardly be found, I think, anywhere else in Plato’s corpus where Socrates speaks about his knowledge of something as such. He says first that he speaks as someone who does not know. This ὡς οὐκ εἰδὼς λέγω comparing with what he used to say in the first group, οὐκ οἶδα, has this added ὡς. Socrates does not claim strongly anymore that he does not know anything but speaks only as someone who does not know. He needs this ὡς not only because he is going to accept that he does know some, though few, things immediately after this sentence, but also because he needs his previous disavowal to be loosened from Meno on. He does not merely say here that he knows something. It is then different from the examples mentioned before which could be taken as idiomatic or at least not emphatic. Socrates’ remarkable emphasis on distinguishing εἰδέναι from εἰκάζειν departs it from all other passages where he says only he knows something. Moreover, he claims definitely that he has knowledge about few (ὀλίγα) things. From the early to the middle dialogues, Socrates’ attitude to knowledge has totally renewed its face. He brings forth a new concept, true opinion, and he does not speak of knowledge as he used to before; the rough, perfect and unachievable knowledge of the first group has turned to something more smooth, realistic and achievable. Comparing with the early dialogues that did not set out from the first to reach positive results, the middle ones are extraordinarily and surprisingly positive and hence destroy the basis of the Socratic circle. The questions and answers are purposely directed to some specific new theories; most of them are not directly related to the topics or the main questions of the dialogues. They are suggested when Socrates draws the attention of the interlocutor away from the main question because of the necessity of another discussion. Even if the main question remains unanswered, we have still many positive theories, prominently of metaphysical type. These theories are so abundant and dominant in these dialogues, especially Phaedo and Republic, that one might think that they may appear to be arbitrarily sandwiched in there. This helps dialogues to keep their original Socratic structure while they are suggesting new theories. Hence, the Socratic question of 'what is X?', though is still used to launch the discussion, is loosened and is forgotten for most part of the dialogues. Meno that has first a differently formulated question, 'can virtue be taught?', leads finally to the Socratic question of 'What is virtue?'. Phaedo is dedicated to the demonstration of the immortality of soul and the life after death without having a central Socratic question. The case of Republic is more complicated. The first book, on the one hand, has all the criteria of a Socratic circle: its 'what is justice?' question, Socrates’ strong disavowal (e.g. 337d-e), his rejection of all answers and coming back to the first point without finding out any answer. This Book, considered alone, is a perfect Socratic dialogue, as many scholars regard it as early and separated from other books. The books II-X are, on the other hand, far from implementing a Socratic circle. They have still the 'what is justice?' question as their incentive leading question, but they are, in most of the positive doctrines and methods that encompass the main parts, ignoring the question. Even these books that, I believe, are the farthest discussions from the Socratic circle are so cautious not to break the Socratic structure of the dialogue as long as it is possible. What is changed is not the structure of the dialogue but the ontological and epistemological grounds based on which new theories are suggested. -/- 1. Knowledge of the Good We can clearly see in the second group of dialogues that the KWX principle loses the place it had before in our first group. It is not, of course, rejected, but still we cannot say that it has the same situation. KWX that was based on Socratic question, as we discussed before, was the leading principle of the first Socrates’ epistemology and of the highest position. Other epistemological principles, SK directly and BE indirectly, were relying on Socratic question and therefore on KWX. Such a position does not belong to KWX from Meno on. What makes it different in the second Socrates is another principle that is needed it not only as its complementary principle but also as what is more fundamental. Plato, then, does not reject KWX in this period, but, it seems, he transcends to another more basic principle; a principle we shall call the principle of 'Knowledge of the Good' (KG): -/- KG Knowledge of X requires knowledge of the Good. -/- Whereas all the dialogues of our first group are free from any discuscon about KG, it bears a very important role in the second group so as becomes the superior principle of knowledge in Republic. Trying to solve the problem of teachability of virtue, Socrates says that it can be teachable only if it is a kind of knowledge because nothing can be taught to human beings but knowledge (ἐπιστήμην) (Meno 87c2). The dilemma will be, then, whether virtue is knowledge or not (c11-12) and since virtue is good, we can change the question to: whether is there anything good separate from knowledge (εἰ μέν τί ἐστιν ἀγαθὸν καὶ ἄλλο χωριζόμενον ἐπιστήμης) (d4-5). Therefore, the conclusion will be that if there is nothing good which knowledge does not encompass, virtue can be nothing but knowledge (d6-8). What let us discuss KG as an epistemological principle for the second Secrates is the relation he tries to establish between knowledge and the Good which, though is alongside with the mentioned thesis and the idea of virtue as knowledge, goes much deeper inside epistemology asking to regard the Good as the basis of knowledge. The effort of Phaedo cannot succeed in establishing the Good as the criterion of explanation and knowledge since, I think, it needs a far more complicated ontology of Republic where Socrates can finally announce KG. What is said in Republic is totally compatible with Phaedo 99d–e and the metaphor of watching an eclipse of the sun. In spite of the fact that we do not have adequate knowledge of the Idea of the Good, it is necessary for every kind of knowledge: 'If we do not know it, even if we know all other things, it is of no benefit to us without it' (505a6-7). The problem of our not having sufficient knowledge of the Idea of Good is tried to be solved by the same method of Phaedo 99d-e, that is to say, by looking at what is like instead of looking at thing itself (506d8-e4). It is this solution that leads to the comparison of the Good with sun in the allegory of Sun (508b12-13). What the Good is in the intelligible realm corresponds to what the sun is in the visible realm; as sun is not sight, but is its cause and is seen by it (b9-10), the Good is so regarding knowledge. It has, then, the same role for knowledge that the sun has for sight. Socrates draws our attention to the function of sun in our seeing. The eyes can see everything only in the light of the day being unable to see the same things in the gloom of night (508c4-6). Without the sun, our eyes are dimmed and blind as if they do not have clear vision any longer (c6-7). That the Good must have the same role about knowledge based on the analogy means that it must be considered as a required condition of any kind of knowledge: -/- The soul, then, thinks (νόει) in the same way: whenever it focuses on what is shined upon by truth and being, understands (ἐνόησέν), knows (ἔγνω) and apparently possesses understanding (νοῦν ἔχειν). (508d4-6) -/- Socrates does not use agathon in this paragraph and substitutes it with both aletheia and to on. He links them with the Idea of the Good when he is to assert the conclusion of the analogy: -/- That which gives truth to the objects of knowledge and the power of knowing to the knower, you must say, is the Idea of the Good: being the cause of knowledge and truth (αἰτίαν δ᾽ ἐπιστήμης οὖσαν καὶ ἀληθείας) so far as it is known (ὡς γιγνωσκομένης μὲν διανοοῦ). (508e1-4) Knowledge and truth are called goodlike (ἀγαθοειδῆ) since they are not the same as the Good but more honoured (508e6-509a5). KG, which had been implicitly contemplated and searched in Phaedo, is now explicitly being asserted in Republic. As what was quoted clearly proves, this principle is the very one which we can observe as the most fundamental principle of the second Socrates in Republic, corresponding to the role KWX had in the first Socrates. The Form of the Good in Republic, of which Santas speaks as 'the centerpiece of the canonical Platonism of the middle dialogues, the centerpiece of Plato’s metaphysics, epistemology, ethics and …' (1983, 256) much more can be said. Plato’s Cave allegory in Book VIII dedicates a similar role to the Idea of the Good. The Idea of the Good is there as the last thing to be seen in the knowable realm, something so important that its seeing equals to understanding the fact that it is the cause of all that is correct and beautiful (517b). Producing both light and its source in visible realm, it controls and provides truth and understanding in the intelligible realm (517c). -/- 2. Tripartite Epistemology BE is thoroughy rejected in the second Socrates and substituted by its opposite, the principle of 'Tripartite Epistemolgy' (TE): -/- TE Opinion is an epistemological status between knowledge and ignorance. BE of the first Socrates was denying any third way besides knowledge and ignorance which was the foundation of Socratic circle without which Socrates could not reject his interlocutors’ possessing any kind of knowledge. We cannot say, however, that the first Socrates had a third epistemological status in mind but rejected it. Such a status was unacceptable for him so that one can say that he would reject any kind of such status if suggested. There were only two possibilities about knowledge: either one knows something or he does not know it. TE, thus, was not the first Socrates’ discovery and, I think it is not the second Socrates’discovery. All we can see in our second group of dialouges is that he uses this principle as an already demonstrated one. Having examined the slave boy in Meno for the prupose of showing the working of recollection, it truns out that he has some opinions in him while he still does not know. Without trying to prove it, Socrates takes this as the distinction between knowledge and opinion: -/- So, he who does not know (οὐκ εἰδότι) about what he does not know (περὶ ὧν ἂν μὴ εἰδῇ) has within himself true opinions (ἀληθεῖς δόξαι) about the same things he did not know (περὶ τούτων ὧν οὐκ οἶδε) (85c6-7). -/- The same distinction is set between ὀρθὴν δόξαν and ἐπιστήμην at 97b5-6 ff. (also cf. 97b1-2: ὀρθῶς μὲν δοξάζων … ἐπιστάμενος). He connects then their difference to the myth of Daedalus, the statue that would run away and escape. So are true opinions, not willing to remain long in mind and thus not worthy until one ties them down by αἰτίας λογισμῷ (98a3-4). Socrates says that this tying down is anamnesis. We face, in Phaedo, the same relation is settled between knowledge as the process of being tied down and getting the capability to give an account, on the one hand, and anamnesis, on the other hand. When a man knows, he must be able to give an account of what he knows (Phaedo 76b5-6) and since not all people are able to give such an account, those who recollect, recollect what once they learned (76c4). Although the distinction between knowledge and opinion is not explicitly used in Phaedo, referring to the parallel link between knowledge plus account and anamnesis in Phaedo and Meno, one can say that those who cannot recollect are not able to give account and, thus, are in a state of opinion. What is said at Phaedo 84a, though not yet a definite distinction between knowledge and opinion, makes a distinction between their objects so as we can agree that it is presupposed. The soul of the philosopher, Socrates says, follows reason, stays with it forever and contemplates the divine, which is not the object of opinoin (ἀδόξαστον) (84a8, cf. Meno 98b2-5). The distinction of knowledge and belief in Republic has a significant difference with what we discussed in Meno and Phaedo since the distinction of Meno was based on anamnesis and thus more an epistemological distinction. Even in Phaedo that we do not have any elaborate discussion about the distinction, the only hint to the matter at 76 is bound to the theory of anamnesis. In addition to the relation of the distinction with this theory, there is another evidence that does not permit us to consider the distinction as an ontological distinction. Let’s see Meno 85c6-7: -/- So, he who does not know about what he does not know has within himself true opinions about the same things he did not know (τῷ οὐκ εἰδότι ἄρα περὶ ὧν ἂν μὴ εἰδῇ ἔνεισιν ἀληθεῖς δόξαι περὶ τούτων ὧν οὐκ οἶδε). (85c6-7) -/- This last sentence persists that the objects of knowledge and true opinion are the same. What Socrates is to say here is that whereas he does not know X he has true opinion about the same X. I think Socrates’ sentence that the slave boy οὐκ εἰδότι ἄρα περὶ ὧν ἂν μὴ εἰδῇ and his restatement of it by saying περὶ τούτων ὧν οὐκ οἶδε is because he wants to emphasize that the slave boy who does not know, has true opinion about the same thing. Socrates could say this just with using τούτων and there would be no necessity to bring περὶ ὧν ἂν μὴ εἰδῇ for οὐκ εἰδότι if he did not want to emphasize. -/- 3. Tripartite Ontology The distinction between knowledge and true opinion in Republic, on other side, has nothing to do with recollection, but is based on an ontological principle, 'Tripartite Ontology' (TO): -/- TO There are things that both are and are not. -/- This principle I confine, among our three dialogues of the second group, to Republic not extended to Meno and Phaedo, is obviously the opposite of BO. Speaking about the lovers of sights and sounds in the fifth book, Socrates distinguishes them from philosophers because their thought is unable to understand the nature of beautiful itself besides beautiful things (476a6-8) and hence they can only have opinions. The philosopher who, on the contrary, believes in beautiful itself and can distinguish it from beautiful things (476c9-d3), has knowledge because he knows, contrasting others who have opinion because they only opine (d5-6). Since those whose knowledge were degraded as opinion will complain about Socrates’ such calling their thought, he provides them the following argument (476e7-477b1): -/- - Does the person who knows, knows (γιγνώσκει) something (τὶ) or nothing (οὐδέν)? - He knows something (τί). - Something that is (ὂν) or is not (οὐκ ὄν)? - Something that is (ὂν) for how could something that is not be known (πῶς γὰρ ἂν μὴ ὄν γέ τι γνωσθείη)? - Then we have an adequate grasp of this: No matter how many ways we examine it, what completely is (παντελῶς ὂν) is completely knowable (παντελῶς γνωστόν) and what is in no way (μὴ ὂν δὲ μηδαμῇ) is in every way unknowable (πάντῃ ἄγνωστον). - A most adequate one. - Good. Now, if anything is such as to be and also not to be (ὡς εἶναί τε καὶ μὴ εἶναι), won’t it be intermediate (μεταξὺ) between what purely is (εἰλικρινῶς ὄντος) and what in no way is (μηδαμῇ ὄντος)? - Yes, it’s intermediate. - Then as knowledge (γνῶσις) is set over what is (τῷ ὄντι), while ignorance (ἀγνωσία) is of necessity set over what is not (μὴ ὄντι) mustn’t we find an intermediate between ignorance (ἀγνοίας) and knowledge (ἐπιστήμης) to be set over the intermediate, if there is such a thing? -/- From the third status of being we must reach to the third status of knowledge. The simple reading of this text can be an existential reading, taking the "is" of the mentioned sentences as existence. The problem is that when it is said that there is something that both is and is not reading "is" existentially, it sounds too bizarre to be acceptable. It cannot easily be understandable to have something as both existent and non-existent at the same time. This problem arose so many debates and led many scholars to reject the existential reading of "is" and suggest some other readings like predicative or veridical readings. I think though Plato’s complicated ontology of Republic cannot be correctly understood by a simple existential reading, this "is" cannot be free from existential sense of being and, thus, cannot be reduced to just a predicative or veridical sense of being. -/- 4. Bound Knowledges In addition to KG, the Good is also the basis of another principle in the second Socrates, namely the principle of 'Bound Knowledge' (BK): -/- BK Knowledge of everything is bound to the knowledge of the Good. -/- We distinguished BK from KG because we want to insist, in BK, on what had not been insisted upon in KG, that is, the binding role that the Good plays in the second Socrates, contrasting the absence of such a role in the first Socrates. Socrates remembers, in Phaedo, his wonderful keen on natural philosophers' wisdom when he was young. The origin of this enthusiasm was Socrates’ hope to know the cause of everything as they used to claim. When he was searching the matters of his interest on their basis, Socrates says, he became convinced he can get no acceptable answer from them and found himself blind even to the things he thought he knew before. One day he hears Anaxagoras’ theory that 'it is Mind that arranges and is the cause of everything (ὡς ἄρα νοῦς ἐστιν ὁ διακοσμῶν τε καὶ πάντων αἴτιος)' (Phd. 97c1-2 cf. DK, Fr.15.8-9, 11-12, 12-14) and thinks that he can finally find what he has always expected, i.e. something which can explain all things. What I intend to show here is that what makes Socrates hopeful is that Anaxagoras’ theory tries 1) to explain all things by one thing and 2) this explanation is understood by Socrates as if it is based on the concept of the Good. That Socrates was searching for one explanation for all things can be proved even from what he has been expecting from natural philosophers. The case is, nonetheless, more clearly asserted when he speaks about Anaxagoras’ theory. In addition to διακοσμῶν τε καὶ πάντων αἴτιος of 97c2 mentioned above, we have τὸ τὸν νοῦν εἶναι πάντων αἴτιον (c3-4) and τόν γε νοῦν κοσμοῦντα πάντα κοσμεῖν (c4-5) all emphasizing on the cause of all things (πάντα) which can clearly prove that one of the reasons which caused Socrates to embrace it delightfully was its claim to provide the cause of all things by one thing. Another reason was that Anaxagoras’ Mind, at least in Socrates’ view, was attempting to explain everything by the concept of the Good. This connection between Mind and Good belongs more to the essential relation they have in Socrates’ thinking than Anaxagoras’ theory because there are almost nothing about such a relation in Anaxagoras. The reason for Socrates’ reading can be that Mind is substantially compatible with Socrates’ idea of the relation between good and knowledge. Both the thesis 'no one does wrong willingly' and the theory of virtue as knowledge we pointed to above are evidences of this essential relation. Nobody who knows that something is bad can choose or do it as bad. The reason, when it is reason, that means when it is as it should be, when it is wise or when it knows, works only based on good-choosing. In this context, when Socrates hears that Mind is considered as the cause of everything, it sounds to him like this: good should be regarded as the basis of the explanation of all things. We see him, thus, passing from the former to the latter without any proof. This is done in the second sentence after introducing Mind: -/- I thought that if this were so, the arranging Mind would arrange all things and put each thing in the way that was Best (ὅπῃ ἂν βέλτιστα ἔχῃ). If one then wished to find the cause of each thing by which it either perishes or exists, one needs to find what is the best way (βέλτιστον αὐτῷ ἐστιν) for it to be, or to be acted upon, or to act. On these premises then it befitted a man to investigate only, about this and other things, what is the most excellent (ἄριστον) and best (βέλτιστον). The same man must inevitably also know what is worse (χεῖρον), for that is part of the same knowledge. (97c4-d5) This passage is a good evidence of Socrates’ leap from Anaxagoras’ Mind to his own concept of the Good that can explain why Socrates found Anaxagoras theory after his own heart (97d7). Mind is welcomed because of its capability for explanation on the basis of good to 'explain why it is so of necessity, saying which is better (ἄμεινον), and that it was better (ἄμεινον) to be so' (97e1-3). What Socrates thought he had found in Anaxagoras can indicate what he had been expecting from natural scientists before. Socrates could not be satisfied with their explanations because they were unable to explain how it is the best for everything to be as it is. It can probably be said, then, that it was the lack of the unifying Good in their explanation that had disappointed him. We must insist that we are discussing what Socrates thought that Anaxagoras’ theory of Mind should have been, not about Anaxagoras’ actual way of using Mind. Phaedo 97c-98b, is not about what Socrates found in Anaxagoras but what he thought he could find in it. On the contrary, it should also be noted that it was not this that was dashed at 98b, but Anaxagoras’ actual way of using Mind. It was Anaxagoras’ fault not to find out how to use such an excellent thesis (98b8-c2, cf. 98e-99b). Socrates gives an example to show how not believing in 'good' as the basis of explanation makes people be wanderers between different unreal explanations of a thing. His words δέον συνδεῖν (binding that binds together) as a description for the Good we chose as the name of BK principle: They do not believe that the truly good and binding binds and holds them together (ὡς ἀληθῶς τὸ ἀγαθὸν καὶ δέον συνδεῖν καὶ συνέχειν οὐδὲν οἴονται). (99c5-6) -/- Having in mind Plato’s well-known analogy of the sun and the Good at Republic 508-509, we can dare to say that his warning of the danger of seeing the truth directly like one watching an eclipse of the sun in Phaedo (99d-e) is more about the difficulty of so-called good-based explanation than its insufficiency, a difficulty which is precisely confirmed in Republic (504e-505a, 506d-e). Moreover, BK is asserted in a more explicit way in the Republic, where the Good is considered not only as a condition for the knowledge of X, as was noted above discussing KG, but also as what binds all the objects of knowledge and also the soul in its knowing them. At Republic VI, 508e1-3, when Socrates says that the Form of the Good 'gives truth to the things known and the power to know to the knower (τοῦτο τοίνυν τὸ τὴν ἀλήθειαν παρέχον τοῖς γιγνωσκομένοις καὶ τῷ γιγνώσκοντι τὴν δύναμιν ἀποδιδὸν)', he wants to set the Good at the highest point of his epistemological structure by which all the elements of this structure are bound. This binding aspect of the Good is by no means a simple binding of all knowledges or all the objects of knowledge, but the most complicated kind of binding as it is expected from the author of the Republic. The kind of unity the Good gives to the different knowledges of different things is comparable with the unity which each Form gives to its participants in Republic: as all the participants of a Form are united by referring to the ideas, all different kinds of knowledge are united by referring to the Good. If we observe Aristotle's assertion that for Plato and the believers of Forms, the causative relation of the One with the Forms is the same as that of the Forms with particulars (e.g. Metaphysics 988a10-11, 988b4), that is to say the One is the essence (e.g., ibid, 988a10-11: τοῦ τί ἐστὶν, 988b4-6: τὸ τί ἢν εἶναί) of the Forms besides his statement that for them One is the Good (e.g., ibid, 988b11-13) the relation between the Good and unity may become more understandable. Since the quiddity of the Good (τί ποτ᾽ ἐστὶ τἀγαθὸν) is more than discussion (506d8-e2), we cannot await Socrates to tell us how this binding role is played. All we can expect is to hear from him an analogy by which this unifying role is envisaged, the sun. The kind of unity that the Good gives to the knowledge and its objects in the intelligible realm is comparable to the unity that the sun gives to the sight and its objects in the visible realm (508b-c). The allegory of Line (Republic VI, 509d-511), like that of the Sun, tries to bind all various kinds of knowledges. The hierarchical model of the Line which encompasses all kinds of knowledge from imagination to understanding can clearly be considered as Plato’s effort to bind all kinds of knowledges by a certain unhypothetical principle. The method of hypothesis starts, in the first subsection of the intelligible realm, with a hypothesis that is not directed firstly to a principle but a conclusion (510b4-6). It proceeds, in the other subsection, to a 'principle which is not a hypothesis' (b7) and is called the 'unhypothetical principle of all things' (ἀνυποθέτου ἐπὶ τὴν τοῦ παντὸς ἀρχὴν) (511b6-7). This παντὸς must refer not only to the objects of the intelligible realm but to the sensible objects as well. Plato does posit, therefore, an epistemological principle for all things, a principle that all things are, epistemologically, bound and, thus, unified by. -/- 5. Bound Beings The ontological aspect of BK we shall call the principle of 'Bound Beings' (BB): -/- BB Being of all things are bound by the Good. -/- We saw in our principle of Split Being (SB) how the first Socrates was criticized because of his approach to split being and separate each thing from other things. The principle of Bound Beings intends to make the things more related, a duty which is done again by the Good. In the allegory of Sun, there are two paragraphs that evidently and deliberately extend the binding role of the Good to the ontological scene: -/- You will say that the sun not only makes the visible things have the ability of being seen but also coming to be, growth and nourishment. (509b2-4) -/- This clearly intends to remind the ontological role the sun plays in bringing to being all the sensible things in order to display how its counterpart has the same role in the intelligible realm (b6-10): -/- Not only the objects of knowledge (γιγνωσκομένοις) owe their being known (γιγνώσκεσθαι) to the Good, but also their existence (τὸ εἶναί) and their being (οὐσίαν) are due to it, though the Good is not being but superior to it in rank and power. That the Good is here represented as responsible for being of things in addition to their being known means, in my opinion, that Plato wants to posit BB in addition to BK. The allegory of Cave at the very beginning of the seventh Book (514aff.) can be taken as another evidence. The role of the Good, one might say, is confined to the intelligible realm because it is asserted that the role the Good plays in this realm is corresponding to that of the sun in the visible realm. The fact that Plato wants to observe the Good also as the ontological cause of the sensible things is obvious from his saying, in the allegory of Cave, that the Form of the Good 'produces light and its source (τὸν τούτου κύριον) [i.e. the sun] in the visible realm' (517c3). We can conclude, then, that the ontological function of the Good is not confined to the intelligible realm in which it is the lord and provides truth and understanding (c3-4) because it is also responsible to produce τὸν κύριον of light. 6. Proportionality of Being and Knowledge Insofaras BE and BO principles of the first Socrates gave way to TE and TO principles of the second Socrates, we cannot expect him to preserve KB in the same way as it was in the first Socrates. The new tripartite ontology and epistemology necessitates some modifications in KB which results in the principle of 'Proportionality of Being and Knowledge' (PBK): -/- PBK To every class of being there is a proportionate category of knowledge. -/- This principle, of course, does not entail the refutation of KB and thus is not kind of rejecting PBK but only a more complicated version of it. Based on PBK, we can still agree that knowledge is of being (KB) but the issue is that since none of the concepts of knowledge and being in the second Socrates are as simple as they were for the first Socrates, we need a more complicated principle for their relation here. Although from Meno 97a where the distinction of knowledge and true opinion is drawn out in the second group of the dialogues, we can expect a new relation, it is articulated in its most complete way in Republic and specifically in the allegory of Line. All the beings are divided there hierarchically to four classes, to each of them belongs a class of knowledge: imagination to images, belief to the sensible things (more correctly: the things of which they[in previous class] were images (ᾧ τοῦτο ἔοικεν)), thought to mathematical objects (?) and understanding to the Forms and the first principle. The degree of clarity that each of the classes of knowledge shares in (σαφηνείας ἡγησάμενος μετέχειν) is proportionate to the degree that its object shares in truth (ἀληθείας μετέχει). (511e2-4) -/- Conclusion From the six onto-epistemilogical principles of the first Socrates, four principles turn to their opposite in the middle period dialogues. While bipolar epistemology and ontology of the early dialogues give place to tripartite epistemology in the middle period dialogues and tripartite ontology in Republic, the split knowledge and being of the first Socrates are inclined to be substituted by bound knowledges and bound beings in the second Socrates and specifically in Republic. Not all our system of principles in this article is necessarily determinative. Either they are rightly formulated or not, our result would not be vulnerable if we accept that 1) making the distinction of knowledge and belief, 2) accepting the being of not being and 3) trying to bind both being and knowledge by the concept of the Good happens only in middle period dialogues, having been absent in the early ones. These are the favourite results all those somehow arbitrary and even oversimplified principles were to illustrate; that there is kind of a development in the epistemological as well as the ontological grounds of Plato’s philosophy. -/- Notes . (shrink)

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans (...) feel reluctant to the end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust. (shrink)

Patient autonomy has a critical role in making decisions in medical practice and it is accepted by international conventions on health care and various national medical codes. However, pertaining to terminally ill patients, this right becomes very problematic in regards to end of life decisions. Utilitarian ethicists motivated by materialistic worldview and individualism have made patient autonomy based arguments for the permissibility of active euthanasia. An appraisal of pro-euthanasia arguments that include the best interest, golden rule, and (...) autonomy is made in this paper. The best interest and golden rule arguments are based on subjective moral judgment thus failing the universalization test. The argument from autonomy is unconvincing because of the confounded autonomy of the terminally ill patients. (shrink)

In this peer commentary on L. Syd M. Johnson’s “Inference and Inductive Risk in Disorders of Consciousness,” I argue for the necessity of disability education as an integral component of decision-making processes concerning patients with DOC and, mutatis mutandis, all patients with disabilities. The sole qualification Johnson places on such decision-making is that stakeholders are educated about and “understand the uncertainties of diagnosis and prognosis.” Drawing upon research in philosophy of disability, social epistemology, and health psychology, I argue (...) that this educational qualification is insufficient to address systemic ableism and other forms of epistemic bias in quality of life judgments. (shrink)

Suppose that we think it important that people have the chance to enjoy autonomous lives. An obvious corollary of this thought is that people should, if they want it, have control over the time and manner of their deaths, either ending their own lives, or by securing the help of others in doing so. So, generally, and even if we overall think that the practice should not be legalized on other grounds, it looks like common sense to think that considerations (...) of autonomy tell at least somewhat in favour of legalizing at least some acts of suicide and voluntary euthanasia. In this paper, I argue that, in fact, when we scrutinize the reasons for most end of life decisions, it turns out that they are seriously problematic from the point of view of autonomy. Full autonomy requires that we are responsible for the consequences of our decisions, and responsibility is precluded by non-voluntariness, which is to say decisions made because there are no acceptable alternatives. Since most end of life decisions are made for precisely this reason, it looks as though most such decisions are non-voluntary, and therefore undermine our autonomy: a discomforting and paradoxical claim. I argue that we should respond by taking the paradox to illuminate the context required by an autonomy-respecting framework for legalizing assisted suicide and euthanasia. People should have a legal right to a reasonable choice about when and how to die. However, this must go hand in hand with institutions that ensure, as far as possible, that such choices are made against a background which ensures, as far as possible, that people choose death clear-sightedly and not because nothing else is acceptable. (shrink)

As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent. In this lucid and vigorous book, Craig Paterson discusses assisted suicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of (...) just why we are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life. Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; person/non-person. Paterson defends the central normative proposition that ‘it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive’. (shrink)

Evidence-based medicine is a clinical decision-making framework which makes claims about what physicians ought to do. Though heralded as the cutting edge of medical science, evidence-based medicine is a value-laden normative theory which implicitly depends on substantive views regarding what is morally good or right. In this paper, I provide an ethical analysis of evidence-based medicine. I consider its normative underpinnings in three ethical theories: utilitarianism, Kantian deontology, and virtue ethics. In the face of uncertainty, evidence-based medicine endorses (...) expected utility theory using the best available evidence in order to avoid doing more harm than good. In accordance with the Kantian respect for individuals as ends in themselves, evidence-based medicine calls for integrating the values and preferences of the patient. De-emphasizing intuition, clinical expertise, and pathophysiologic rationale emphasizes the need for the intellectual virtues of curiosity, critical thinking, and courage. Evidence-based medicine is a successful clinical practice that can be morally justified by all three major ethical theories. Although its focus on maximizing good health outcomes and integrating respect for individual patients has been emphasized, the role of the intellectual virtues in evidence-based medicine remains highly under-explored. (shrink)

Evidence-based medicine is a clinical decision making framework which makes claims about what physicians ought to do. Though heralded as the cutting edge of medical science evidence-based medicine is a value laden normative theory which implicitly depends on substantive views regarding what is morally good or right. In this paper, I provide an ethical analysis of evidence-based medicine. I consider its normative underpinnings in three ethical theories: utilitarianism, Kantian deontology, and virtue ethics. In the face of uncertainty, evidence-based (...) medicine endorses expected utility theory using the best available evidence in order to avoid doing more harm than good. In accordance with the Kantian respect for individuals as ends in themselves, evidence-based medicine calls for integrating the values and preferences of the patient. De-emphasizing intuition, clinical expertise, and pathophysiologic rationale emphasizes the need for the intellectual virtues of curiosity, critical thinking, and courage. Evidence-based medicine is a successful clinical practice that can be morally justified by all three major ethical theories. Although its focus on maximizing good health outcomes and integrating respect for individual patients has been emphasized, the role of the intellectual virtues in evidence- based medicine remains highly under-explored. (shrink)

The paper reports results of the very first survey-based study on the prevalence, frequency and nature of ethical or other non-medical difficulties faced by Polish physicians in their everyday clinical practice. The study involved 521 physicians of various medical specialties, practicing mainly in inpatient healthcare. The study showed that the majority of Polish physicians encounter ethical and other non-medical difficulties in making clinical decisions. However, they confront such difficulties less frequently than their foreign peers. Moreover, Polish doctors (...) indicate different circumstances as a source of the experienced problems. The difficulties most often reported relate to (i) patients (or their proxies) requests for medically non-indicated interventions; (ii) problems with communication with patients (or their proxies) due to the patients’ negative attitude, unwillingness to cooperate, or aggression; and (iii) various difficulties with obtaining informed consent. Polish physicians report difficulties associated with disagreements among care givers or scarcity of resources less frequently than doctors from other countries. The study’s findings provide support for the thesis that a significant portion of Polish physicians still follow a traditional, paternalistic, and hierarchical model of healthcare practice. Instead of promoting patient’s empowerment, engagement, and rights, they often consider these ideas as a threat to physicians’ professional authority and autonomy. The study leads to the conclusion that due to insufficient training in medical ethics, communication skills, and medical law, many Polish physicians lack the knowledge and competence necessary to adequately respond to challenges posed by modern healthcare practice. (shrink)

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles help (...) to understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (shrink)

Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the ethical (...) imperative of respecting patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy. (shrink)

Looking to Scripture through the eyes of contemporary medical experience, I analyze the meaning of the criteria used for determining death, specifically in the light of Jesus’ final moments and the resurrection of the Shunammite’s son in 2 Kings, chapter 4. I argue that four theses are consistent with, and informed by, these passages that can help guide Christian belief and decision-making about how death is determined in the clinical context: (1) death is neither permanent nor irreversible; (2) (...) something like the “brain dead” state is, at best, a confounding state that requires one to “pace and pray” or let go; (3) that the case for determining death by neurologic criteria depends on the “working togetherness” of the body's parts for the sake of impacting its environment; and (4) that the practice of neurologically-based death determination is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible. I end with advice about how Christians might approach the debates over the law and practice even if they cannot come to a consensus. (shrink)

Artificial intelligence and robotics is pervasive in daily life and set to expand to new levels potentially replacing human decision-making and action. Self-driving cars, home and healthcare robots, and autonomous weapons are some examples. A distinction appears to be emerging between potentially benevolent civilian uses of the technology (eg unmanned aerial vehicles delivering medicines), and potentially malevolent military uses (eg lethal autonomous weapons killing human com- batants). Machine-mediated human interaction challenges the philosophical basis of human existence and ethical (...) conduct. Aside from technical challenges of ensuring ethical conduct in artificial intelligence and robotics, there are moral questions about the desirability of replacing human functions and the human mind with such technology. How will artificial intelligence and robotics engage in moral reasoning in order to act ethically? Is there a need for a new set of moral rules? What happens to human interaction when it is mediated by technology? Should such technology be used to end human life? Who bears responsibility for wrongdoing or harmful conduct by artificial intelligence and robotics? -/- Whilst Kant may be familiar to international lawyers for setting restraints on the use of force and rules for perpetual peace, his foundational work on ethics provides an inclusive moral philosophy for assessing ethical conduct of individuals and states and, thus, is relevant to discussions on the use and development of artificial intelligence and robotics. His philosophy is inclusive because it incorporates justifications for morals and legitimate responses to immoral conduct, and applies to all human agents irrespective of whether they are wrongdoers, unlawful combatants, or unjust enemies. Humans are at the centre of rational thinking, action, and norm-creation so that the rationale for restraints on methods and means of warfare, for example, is based on preserving human dignity as well as ensuring conditions for perpetual peace among states. Unlike utilitarian arguments which favour use of autonomous weapons on the basis of cost-benefit reasoning or the potential to save lives, Kantian ethics establish non-consequentialist and deontological rules which are good in themselves to follow and not dependent on expediency or achieving a greater public good. -/- Kantian ethics make two distinct contributions to the debate. First, they provide a human-centric ethical framework whereby human exist- ence and capacity are at the centre of a norm-creating moral philosophy guiding our understanding of moral conduct. Second, the ultimate aim of Kantian ethics is practical philosophy that is relevant and applicable to achieving moral conduct. -/- I will seek to address the moral questions outlined above by exploring how core elements of Kantian ethics relate to use of artificial intelli- gence and robotics in the civilian and military spheres. Section 2 sets out and examines core elements of Kantian ethics: the categorical imperative; autonomy of the will; rational beings and rational thinking capacity; and human dignity and humanity as an end in itself. Sections 3-7 consider how these core elements apply to artificial intelligence and robotics with discussion of fully autonomous and human-machine rule-generating approaches; types of moral reasoning; the difference be- tween ‘human will’ and ‘machine will’; and respecting human dignity. (shrink)

Using artificial intelligence (AI) to make decisions in human resource management (HRM) raises questions of how fair employees perceive these decisions to be and whether they experience respectful treatment (i.e., interactional justice). In this experimental survey study with open-ended qualitative questions, we examine decision making in six HRM functions and manipulate the decision maker (AI or human) and decision valence (positive or negative) to determine their impact on individuals’ experiences of interactional justice, trust, dehumanization, and perceptions of (...) decision-maker role appropriate- ness. In terms of decision makers, the use of human decision makers over AIs generally resulted in better perceptions of respectful treatment. In terms of decision valence, people experiencing positive over negative decisions generally resulted in better perceptions of respectful treatment. In instances where these cases conflict, on some indicators people preferred positive AI decisions over negative human decisions. Qualitative responses show how people identify justice concerns with both AI and human decision making. We outline implications for theory, practice, and future research. (shrink)

This article explores the Nuffield Council on Bioethics’ recent report about non-invasive prenatal testing. Given that such testing is likely to become the norm, it is important to question whether there should be some ethical parameters regarding its use. The article engages with the viewpoints of Jeff McMahan, Julian Savulescu, Stephen Wilkinson and other commentators on prenatal ethics. The authors argue that there are a variety of moral considerations that legitimately play a significant role with regard to (prospective) parental (...) class='Hi'>decision-making in the context of NIPT, for example, views on the morality of abortion and understandings of the impact of disability on quality of life. The variable nature of such considerations, both singularly and combined, suggests that any approach to NIPT should be sensitive to and understanding of similarly variable parental assessments and decisions. The implications of the approach developed for current and future policies in this area are explored, along with the impact of such arguments on ideas about procreative beneficence. (shrink)

This paper expands on another which focussed on Socrates’s question: ‘How should one live?’. The present paper also focusses on the ‘meaning of life’ and ‘meaning in life’ issues, and more on rights. To fully rationally answer Socrates’s question, we need to answer the epistemic question: ‘How can one know how one should live?’. This paper attempts to answer both. And knowing how one should live fundamentally involves knowing what values one should live by. This includes which rights (...) one should have and which rights others should have. So one’s values include how one should treat all persons (and (other) animals, the environment and so on.) All this relates to what one finds meaningful in life and the meaning or point of one’s life. In sum, all the notions in this paper’s title are interrelated. The issue of rationality is crucial here. Just one example here (qualified later) is that our rationality gives us cognitively meaningful notions. ‘Rationality’ here only concerns knowledge, e.g., ways to acquire scientific knowledge, and meta-knowledge concerning values. No values or rights as such are rational or knowledge. However:- Many factors are required for human rationality to exist and develop, e.g., life, mental health and evidence-based education. Human rationality’s need for those factors, hence their value to rationality, is rationally-unquestionable – and that applies to the practised values prescribing the prescribable factors. With this, there are rationally-unquestionable rights to those factors. Those prescribable factors require certain interrelated epistemic, moral, social, political, legal, educational and other values/rights to be practised. This implies a pro-rationality values-theory with one obligatory, general end – a uniquely rationally-unquestionable end. This end provides the basis for answering Socrates’s question as rationally (correctly) as is possible for values/rights. That end is fundamentally epistemic, namely ‘Be pro-rationality’, yet the theory has deeply-humanly-meaningful, universal applications. It has implications for current and all possible moral, social, political, legal, educational, environmental etc issues. E.g., the theory shows that human rationality crucially requires love and certain other emotions, health-care, education and upbringing. These require certain right to be respected and practised. With this, the paper discusses affection, free speech, journalism, psychotherapy, political and sexual consent, responsibilities, freedom and government. The theory’s general sub-values prescribe much prescribed by some other theories, e.g., broad and deep knowledge-acquisition (in certain areas), rationally-critical thinking, non-sexism, non-racism, general types of liberalism, holistic flourishing, happiness, unselfishness and fairness. However, all other values-theories lack pro-rationality theory’s maximum possible rational-unquestionability, internal coherence and coherence with rationality. The theory encourages (the right to) total freedom in a-rationality areas, areas irrelevant to its obligatory end. The theory inherently requires its advocates to be (self )critical, rationally viewing the theory’s necessarily human-suggested specifics as often fallible or unavoidably approximate. So the theory is a work-in-progress. (shrink)

Goal: To assess public knowledge and attitudes towards the family’s role in deceased organ donation in Europe. -/- Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data (...) collection were performed by two or more independent reviewers for each record. -/- Results: Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. -/- Conclusions: Public views on the authority of the family in organ donation decision-making require further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation. (shrink)

When medical assistance in dying (MAiD) was legalized in Canada in June 2016, the question of allowing decisionally capable persons to make advance requests in anticipation of later incapacity was reserved for further consideration during the mandatory parliamentary review originally scheduled to begin in June 2020 (but since delayed by COVID-19). In its current form the legislation does not permit such requests, since it stipulates that at the time at which the procedure is to be administered the patient must (...) give “express consent” to receiving it. Since express consent presupposes decisional capacity, this requirement rules out administering MAiD to a patient who has lost capacity. Amendments to the legislation passed by Parliament in March 2021 open the door slightly by allowing advance requests by patients after they have been approved for MAiD, if they fear losing capacity before the procedure can be administered. But this provision would apply only to patients whose natural death was deemed to be “reasonably foreseeable”, and would continue to exclude (a) requests made after diagnosis of a “grievous and irremediable medical condition” but in advance of approval for MAiD, and (b) requests made before such a diagnosis. My aim in this paper is twofold: to explore the ethical and legal issues concerning advance requests for MAiD, and to argue for expanding provision for such requests to include both of these further scenarios. (shrink)

Background: Use of patients’ medical data for secondary purposes such as health research, audit, and service planning is well established in the UK. However, the governance environment, as well as public understanding about this work, have lagged behind. We aimed to systematically review the literature on UK and Irish public views of patient data used in research, critically analysing such views though an established biomedical ethics framework, to draw out potential strategies for future good practice guidance and inform ethical (...) and privacy debates. Methods: We searched three databases using terms such as patient, public, opinion, and electronic health records. Empirical studies were eligible for inclusion if they surveyed healthcare users, patients or the public in UK and Ireland and examined attitudes, opinions or beliefs about the use of patient data for medical research. Results were synthesised into broad themes using a framework analysis. Results: Out of 13,492 papers and reports screened, 20 papers or reports were eligible. While there was a widespread willingness to share patient data for research for the common good, this very rarely led to unqualified support. The public expressed two generalised concerns about the potential risks to their privacy. The first of these concerns related to a party’s competence in keeping data secure, while the second was associated with the motivation a party might have to use the data. Conclusions: The public evaluates trustworthiness of research organisations by assessing their competence in data-handling and motivation for accessing the data. Public attitudes around data-sharing exemplified several principles which are also widely accepted in biomedical ethics. This provides a framework for understanding public attitudes, which should be considered in the development in any guidance for regulators and data custodians. We propose four salient questions which decision makers should address when evaluating proposals for the secondary use of data. (shrink)

The protection of rare species abounds with scientific and ethical considerations. An ethical dilemma can emerge when the life of one species is valued higher than that of another, and so we discuss the basis of ranking, protection, and valuation of plants and animals. A duty to protect rare species exists in this age of great losses to plant and animal life, but the scientific and public communities are not always in agreement regarding what species deserve protection. Using (...) a case study, we illustrate how the decision to kill beavers to protect a rare plant and rare animals found in a tidewater creek demanded an ecological ethic approach. We present the concept of a" conservation mediator" and how its use may help find a common ground between stakeholders and decision-makers in similar situations. (shrink)

In Humanity’s End: Why We Should Reject Radical Enhancement, Nicholas Agar presents a novel argument against the prospect of radical life-extension. Agar’s argument hinges on the claim that extended lifespans will result in people’s lives being dominated by the fear of death. Here we examine this claim and the surrounding issues in Agar’s discussion. We argue, firstly, that Agar’s view rests on empirically dubious assumptions about human rationality and attitudes to risk, and secondly, that even if those assumptions are (...) granted, the fears that Agar adverts to are unlikely to dominate people’s lives if and when radical life-extension is made possible. Further, we claim that the structure of the decision-making process around life-extension is unlikely to be the way that it would have to be in order for Agar’s claims about fear of death to make sense. Finally, we argue that Agar is implicitly committed to a narrow conception of human value. In response, we suggest that the pursuit of life-extension can itself be seen as an expression of certain important aspects of our distinctively human nature. (shrink)

Patients in Quebec can legally obtain medical assistance in dying (MAID) if they are able to give informed consent, have a serious and incurable illness, are at the end of their lives and are in a situation of unbearable suffering. Since the Supreme Court of Canada’s 2015 Carter decision, access to MAID, under certain conditions, has become a constitutional right. Quebec physicians are now likely to receive requests for MAID from their patients. The Quebec and Canadian laws recognize (...) a physician’s right to conscientious objection, but this right is contested both in the medical ethics literature and in the public sphere. This paper presents the results of a qualitative study conducted with twenty Quebec physicians who did not integrate MAID into their medical practice, either because they were opposed to or deeply ambivalent about MAID. The interviews aimed to explore the reasons – religious and secular – for opposition to or ambivalence towards MAID. The secular reasons given by participants were grouped into four main categories: 1) the ends of medicine and professional identity, 2) the philosophy of palliative medicine and resource allocation in palliative care, 3) benevolent paternalism, the “good death”, and the interests of future selves, 4) the risk of a slippery slope and the protection of vulnerable people. (shrink)

How do we prepare engineering students to make ethical and responsible decisions in their professional work? This paper presents an approach that enhances engineering students’ engagement with ethical reasoning by simulating decision-making in a complex scenario. The approach has two principal inspirations. The first is Anthony Weston’s scenario-based teaching. Weston’s concept of a scenario is a situation that changes in response to choices made by participants, according to an inner logic. Scenarios can dynamically explore open-ended complex problems without imposing (...) predetermined results, allowing students to apply their ethical reasoning in a more realistic fashion. The second inspiration is Thi Nguyen’s theory of games. According to Nguyen, games are the “art of agency,” meaning that they provide a structure under which some result is agreed to be valuable, along with prescribed ways of achieving that result, in a relatively low-stakes and temporary social arrangement. By playing many games, Nguyen argues, we can develop a “library of agency,” that is to say, a set of values and means to achieving them that can inform how we make high-stakes decisions in real life. Engaging with carefully designed game scenarios, then, can enable students to practice making ethical decisions within a structured framework, which unfolds in response to their choices, while their decisions are driven by some defined goal. This roleplaying game–based approach thus allows students to build their own ethical libraries of agency, in preparation for professional decision-making. The approach is illustrated using a specific example recently deployed in a seminar on engineered living materials (building materials that incorporate living tissues). The scenario uses techniques from tabletop roleplaying games (e.g. Dungeons & Dragons) for outcome resolution, adventure design, and character creation. Through the game, students practice making difficult decisions in a humanitarian context. (shrink)

Decisional capacity evaluations (DCEs) occur in clinical settings where it is unclear whether a consumer of medical services has the capacity to make an informed decision about the relevant medical options. DCEs are localized interventions, not the global loss of competence, that assign a surrogate decision maker to make the decision on behalf of the medical consumer. We maintain that one important necessary condition for a DCE to be morally justified, in cases of (...) medical necessity, is that the health care consumer under evaluation is incapable of expressing a preference for a certain outcome. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an (...) important higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

What process ought to guide decision making for pediatric patients? The prevailing view is that decision making should be informed and guided by the best interest of the child. A widely discussed structural model proposed by Buchanan and Brock focuses on parents as surrogate decision makers and examines best interests as guiding and/or intervention principles. Working from two recent articles by Ross on “constrained parental autonomy” in pediatric decision making (which is grounded in the Buchanan (...) and Brock model), I discuss (supportively) features of Ross’s effort visa-vis the best interest standard. I argue that any pediatric decision-making model that brackets or formally limits an engagement with the child patient assumes too much. Further, any model that under appreciates the place of parents and their autonomy, and the dynamic parent-child relationship, misses an opportunity to broaden the clinical encounter by considering questions of justice for the child (Rawls) and within a family (Ross). In this context, I focus on the child’s emerging and ongoing emotional and intellectual development and autonomy—their capabilities and identifying primary goods. (shrink)

Patient preference predictors aim to solve the moral problem of making treatment decisions on behalf of incapacitated patients. This commentary on a case of an unrepresented patient at the end of life considers 3 related problems of such predictors: the problem of restricting the scope of inputs to the models (the “scope” problem), the problem of weighing inputs against one another (the “weight” problem), and the problem of multiple reasonable solutions to the scope and weight problems (the “multiple reasonable (...) models” problem). Each of these problems poses challenges to reliably implementing patient preference predictors in important, high-stakes health care decision making. This commentary also suggests a way forward. (shrink)

Medical ethics would be better if people were taught to think more clearly about well-being or the concept of what is good for a person. Yet for a variety of reasons, bioethicists have generally paid little attention to this concept. Here, I argue, first, that focusing on general theories of welfare is not useful for practical medical ethics. I argue, second, for what I call the “theory-without-theories approach” to welfare in practical contexts. The first element of this approach (...) is a focus on examining important and relatively uncontroversial constituents of welfare as opposed to general theories. The second key element is a framework for thinking about choice in relation to welfare, a framework I refer to as “the mild objectivity framework.” I conclude with illustrations of the way in which the “theory without theories approach” can improve thinking in medicine. (shrink)