Abraham D. Graber Graber

Post-Dobbs v. Jackson, abortion regulation is left entirely to the states. Laws that restrict access to abortion generally allow for exceptions when determined necessary for the life or safety of the pregnant patient. Some states, e.g., Ohio, use a “subjective” legal standard when determining whether an abortion is medically necessary. Other states, e.g., Texas, rely on an “objective” legal standard, whereby the necessity of an abortion is not determined by any particular physician’s judgments, but rather by the judgment of a hypothetical “reasonable physician.” Though objective legal standards are widespread in American jurisprudence, they are a poor fit for clinical judgments about the medical necessity of abortion. On the contemporary model of clinical decision-making, medical judgment is irremediably subjective. In addition to being responsive to patient values and medical evidence, medical judgment is, and should be, informed by physician values. Because Texas abortion regulations rely on an objective standard of judgment that fails to correspond to a medically meaningful category, they fail to provide adequate guidance to physicians regarding the circumstances under which abortion is legally protected.

It is commonplace for people with intellectual and developmental disabilities to have a guardian who is legally authorized to make decisions on their behalf. Such guardianships are often comprehensive, providing the guardian with legal authorization to make all decisions on behalf of a person with intellectual and developmental disabilities. This comprehensive legal authority clashes with the understanding of patient autonomy dominant in clinical ethics whereby nearly every patient has the right to make some of their own decisions. Drawing lessons from Britney Spears’s conservatorship as a case study of tension between moral obligations and legal authority, this manuscript explores an identical tension ubiquitous in the lives of those with intellectual and developmental disabilities.

The nature of full moral status remains one of the most hotly contested issues in normative ethics. At stake are fundamental issues about how we should treat non-human animals and individuals with severe or profound intellectual disability. Those accounts of full moral status that count out non-human animals also count out individuals with severe or profound intellectual disability. Relatedly, those accounts of full moral status that hold that those with severe or profound intellectual disability have full moral status generally also give full moral status to at least some non-human animals. Rather than attempting to provide an account of full moral status that navigates this dilemma, this manuscript aims to put substantive constraints on the desiderata for a theory of full moral status. In brief, there is a particular quality of love that is sufficient for its object to have full moral status. Individuals with severe or profound intellectual disability are loved in this way. It follows that individuals with severe or profound intellectual disability have full moral status and, concomitantly, that any theory that entails otherwise is false.

While cochlear implantation is now considered routine in many parts of the world, the debate over how to ethically implement this technology continues. One’s stance on implantation often hinges on one’s understanding of deafness. On one end of the spectrum are those who see cochlear implants as a much needed cure for an otherwise intractable disability. On the other end of the spectrum are those who view the Deaf as members of a thriving culture and see the cochlear implant as an attempt to eliminate this culture. Rather than take a stance in this debate, we will argue that the informed consent process for cochlear implantation must include access to Deaf perspectives. Deaf individuals know best what it is like to be a member of the Deaf community; the reasonable person would put significant weight on the testimony of Deaf individuals when considering whether to undergo cochlear implantation. The reasonable person standard determines what information careproviders must present as part of the informed consent process; thus, informed consent for cochlear implantation requires access to the testimony of Deaf individuals.

Accountable Care Organizations are a key mechanism of the Patient Protection and Affordable Care Act. ACOs will influence incentives for providers, who must understand these changes to make well-considered treatment decisions. Our paper defines an ethical framework for physician decisions and action within ACOs. Emerging ethical pressures providers will face as members of an ACO were classified under major headings representing three of the four principles of bioethics: autonomy, beneficence, and justice. Conflicts include a bias against transient populations, a motive to undertreat conditions lacking performance measures, and the mandate to improve population health incentivizing life intrusions. After introducing and explaining each conflict, recommendations are offered for how providers ought to precede in the face of novel ethical choices. Our description of novel ethical choices will help providers know what to expect and our recommendations can guide providers in choosing well.

Explanation is the name for both the process we use to answer questions raised by observed ambiguities and for the conclusion we offer others. This divergence hints at the many conflicting approaches used to create our contemporary understanding of explanation. Modes of Explanation is the first book in decades to attempt to bring these conflicting approaches together and to offer a compelling narrative to explore how those conflicts can converge. In May 2013, fifty philosophers of science, cognitive scientists, systems scientists, cyberneticists, semioticians, and humanities scholars gathered for three full days of debate. These scholars - including the contributors to this volume - compared insights into a variety of conceptions of explanation and their associated worldviews. Through examples such as the creationism/evolution debate, this volume illustrates the major issues regarding explanation through the dual lenses of scientific realism and pragmatic constructivism. Modes of Explanation is about how we make sense of, and create results in, our world.

Personal identity is critical to provider–patient interactions. Patients and doctors tend to self-select, ideally forming therapeutic units that maximise the patients' benefit. Recently, however, ‘reality’ has changed. The internet and virtual worlds such as Second Life allow models of identity and provider–patient interactions that go beyond the limits of mainstream personal identity. In this paper some of the ethical implications of virtual patient–provider interactions, especially those that have to do with personal identity, are explored

Abstract   Street has argued that the meta-ethical realist is faced with a dilemma. Either evolutionary forces have had a distorting influenced on our ability to track moral properties or evolutionary forces influenced our beliefs in the direction of tracking moral properties. Street argues that if the realist accepts the first horn of the dilemma, the realist must accept implausible skepticism regarding moral beliefs. If the realist accepts the second horn of the dilemma, the realist owes an explanation of the fitness producing nature of moral beliefs. As Street establishes the dialectic, the anti-realist’s explanation is better. I will argue that Street’s first horn is question begging then I will grasp the second horn of the dilemma and argue that only the realist can explain the role of moral beliefs in our evolutionary history. My argument will take the form of a dilemma. For our evaluative judgments to be fitness conducive, they must be responsive to the right sort of external world properties. The non-reductive realist can provide such a set of properties. On the first horn of the dilemma, the anti-realist cannot. The realist, unlike the anti-realist, can explain why our evaluative judgments are fitness conducive. The realist has won the explanatory battle. On the second horn of the dilemma, the anti-realist can provide a set of non-normative external world properties that our evaluative attitudes are responsive to. In doing so, the anti-realist has provided the heretofore-missing component of the reductive realist’s project. Again, the realist has won.

In this paper I will argue that there is a bi-directional relationship between philosophy and meaning such that doing philosophy can change the meaning of terms. A rhetorically powerful work of philosophy that garners widespread interest has the potential to change how people use a predicate. This gives rise to three concerns. First, one’s conclusion can become right in virtue of one doing a particularly good job arguing for it. Second, it may be implausible to take philosophy to be a primarily descriptive enterprise. Part of the job of the philosopher is to proselytize about the correct usage of a word. Lastly, and most worrisome of all, the age-old method of the dialectic, a centerpiece of the philosophical project for thousands of years, threatens to plunge a range of domains of philosophical discourse into incoherence

In a methodological milieu characterized by efforts to bring the methods of philosophy closer to the methods of the sciences, one can find, with increasing regularity, meta-ethical arguments relying on scientific theory or data. The received view appears to be that, not only is it implausible to think that a scientific vindication of a non-mentalist moral semantics will be forthcoming but that evidence from a variety of sciences threatens to undermine non-mentalist views. My aim is to push back against this apparent consensus. The well-established phenomenon whereby moral judgments influence our attributions of putatively purely descriptive properties has come to be known as the Knobe Effect. Joshua Knobe has attempted to explain this surprising phenomenon by arguing that our folk psychological judgments are partially constituted by moral judgments. Drawing on an argument originally offered by Moore, I argue that if some instantiation of Knobe’s explanatory strategy is accurate, we have good reason to believe that mentalist moral semantics are untenable