Chalmers Clark

In this essay it is shown that the imaginative art of scientific theorizing – at its technical best – animates Quine's philosophy as importantly as the more Spartan norms honored in his present pantheon of virtues. By drawing a contrast between the standing of theories in philosophy and theories in science, it will be shown that the speculative reaches of philosophy, along with developments in semantic theory, now oblige an internal revision of Quine's stance against meaning as it was announced in “Two Dogmas of Empiricism.” So, corollary to this proposed revision, I argue that in natural philosophy, the muse of the “art of science” deserves an address along with the more Spartan norms in Quine's present philosophical pantheon. As semantic theory and analyticity thus gain a measure of philosophical tenability, Quine's holism emerges as the more central doctrine of his mature vision.

In this essay I offer an assessment of W. V. Quine's immanent natural position for the above three areas of philosophical interest. With the case of meaning, I argue that in light of a proposal by Jerrold J. Katz, there appear to be major internal considerations to indicate that Quine's skeptical views on meaning currently should be "softened." I will argue that this point, while pro tem, is consistent with a broad interpretation of Quine's naturalistic outlook. I further urge that such a broad interpretation is required to account for the progressive natural philosophy that Quine is committed to. The issue of epistemic skepticism is then addressed directly. Barry Stroud's influential work on the importance of philosophical skepticism contains an explicit challenge to Quine's naturalism and Stroud argues that naturalized epistemology either fails as epistemology, or it fails to be epistemology. On this debate I argue that Quine can enlist grounds to hold that the immanent naturalized position currently enjoys an ascending viability against Stroud's skeptical challenge. Quine's position is then shown to be strengthened by an immanent construal of scientific truth that provides a straightforward way of rejecting Stroud's claim that naturalized epistemology fails. However, I conclude the essay with a critical treatment of whether Quine's move to immanence does full justice to the concept of scientific truth. While Quine asserts that the only conception of truth that he recognizes is an immanent one, I try to show that pending further argument to the contrary, the concept of truth cannot be immanently construed without sacrificing much of the progressive scientific outlook that Quine otherwise endorses. If I am right on this score, until such arguments are forthcoming, not only do Stroud's criticisms regain vigor, but issue is raised regarding Quine's emphasis on immanent standards of clarification and whether this requirement can ultimately improve our understanding of natural science.

Rid and Wendler propose the development of a Patient Preference Predictor (PPP), an actuarial model for predicting incapacitated patient’s life-sustaining treatment preferences across a wide range of end-of-life scenarios. An actuarial approach to end-of-life decision making has enormous potential, but transferring the logic of actuarial prediction to end-of-life decision making raises several conceptual complexities and logistical problems that need further consideration. Actuarial models have proven effective in targeted prediction tasks, but no evidence supports their effectiveness in the kind of broad spectrum prediction task that is the proposed goal of the PPP. We argue that a more focused approach, targeting specific medical conditions and generating treatment predictions based on the preferences of individuals with actual disease experience, is both more firmly grounded in past research and is a more prudent initial strategy for exploring the efficacy of actuarial prediction in end-of-life decision making.

Trust relations in medicine are argued to be a requisite response to the special vulnerability of persons as patients. Even so, the problem of motivating trust remains a vital concern. On this score, it is argued that a strong motivation can be found in recognizing that professional self-interest actually entails cultivation of patient trust as a means to maintain professional self-governance. And while the initial move to restore trust must be provoked from such narrow concerns, the process of sustaining trust will require educational initiatives aimed at restoring attitudes and skills suggestive of Percival's concept of empathic care. By including such initiatives, future waves of medical professionals are apt to sustain trust with deepened commitments to character, care, and trust as constitutive properties of their professional mission.

In June 2001, the American Medical Association (AMA) issued a revised and expanded version of the Principles of Medical Ethics (last published in 1980). In light of the new and more comprehensive document, the present essay is geared to consideration of a longstanding tension between physician's autonomy rights and societal obligations in the AMA Code. In particular, it will be argued that a duty to treat overrides AMA autonomy rights in social emergencies, even in cases that involve personal risk to physicians (e.g., bioterrorist attack, HIV infection, SARS). The argument will be made by way of the logic and language of the AMA Code through its history, commentaries, and precedents. It also will be shown that there are substantial reasons to believe that the logic of the Code is sound in morally relevant ways. The essay will conclude with some philosophical proposals suggesting a framework for the duty to render aid and the extension of those duties to physicians facing personal risks.

As the issue of assisted dying continues toward more expanded legal standing, we shift our primary focus from questions of patients' rights to the largely overlooked challenges that face physicians who elect to assist patients in ending their lives. Dr. Howard Grossman, a Manhattan internist and plaintiff in the unsuccessful New York lawsuit to the Supreme Court, came forward to say, “Anybody who has done it knows that it is a tremendous decision that you carry with you forever.”1 We focus our attention on the psychological experience and philosophical conflicts faced by physicians engaged in physician-assisted dying. Based on those potential conflicts, we argue for a new model of the physician and patient relationship in assisted dying: a medical friendship. a.

In this paper I will argue that in emergency cases, physician autonomy is soci-etally constrained under Principle VI of the American Medical Association's “Principles of Medical Ethics”1 The issue will be seen to turn on whether the contextual use of “emergency” should be construed narrowly or broadly; I argue for a broadened rendering. Although a societal emergency is not defined here, I recommend that the condition of inner city healthcare presents a paradigm “patient” for such emergency care. I further urge that because societal constraints on physician autonomy are ambiguous and only derived indirectly in the AMA document, further AMA comment on physician autonomy and societal responsibility would advance clarity on the profession's commitment to the public trust.