The implications
for abortion are clear: the violinist is meant to be
analogous to a fetus, and you and your kidneys are analogous
to a pregnant woman providing life support to a fetus. If,
Thomson argues, it is implausible that you are morally
obligated to sustain the violinist’s life at such a cost to your
personal freedom, then it ought to be equally implausible
that a fetus’s right to life guarantees it the right to continued
use of a woman’s body (Thomson). Thus, the fetus’s right to
life doesn’t make abortion morally impermissible, for “having
a right to life does not guarantee having either a right to
be given the use of or a right to be allowed continued use of
another person’s body—even if one needs it for life itself�
(Thomson, p. 336).
If Thomson’s analogy is accepted, there are serious
grounds for questioning the assumption that abortion is
morally impermissible if a fetus has a right to life. However,
both opponents and proponents of the right to abortion
have argued against the soundness of Thomson’s analogy.
Abortion critics claim that there is a deep, even grotesque
disanalogy between a fetus and the violinist, and that
Thomson fails to attend to the moral distinction between
intentionally killing and letting die. Abortion, it is argued,
intentionally kills a fetus, but detaching oneself from the
violinist only allows the violinist to die from his kidney
ailment, an act with a very different moral status than
murder. Abortion proponents and opponents alike raise a
responsibility objection to Thomson’s argument, claiming
that her conclusion only holds in cases where pregnancy
results from an involuntary act. Warren criticizes Thomson’s
analogy on those grounds, arguing that it is too weak to
provide a thorough defense of a right to abortion, allowing it
only in cases of rape (Warren, 1973). Since the majority of
unwanted pregnancies are not the result of rape, Thomson’s
argument would permit abortion in only a small fraction of
unwanted pregnancies. Thomson acknowledges that her
argument leaves open the possibility that there may be some
cases in which the unborn person acquires, tacitly or by
consent, a right to the use of the mother’s body, and in
which abortion would be an unjust killing. But this possibility
does not force the conclusion that all abortions are unjust
killings.
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Ambitious and diverse goals have been proposed for medical ethics education, including increased awareness of ethical issues; a cultivation of basic ethical commitments; more humane medical practice ; tolerance of conflicting views; development of analytic skill in moral reasoning; enhanced intellectual development in ethics and the humanities; positive attitudes toward patients; less paternalism in clinical practice; higher professional conduct; and improved clinical decision making (Callahan; Miles et al.). Despite this dauntingly heterogeneous list, a consensus has developed regarding some core objectives. First, the primary goal of clinical ethics education is to prepare to deal effectively with ethical issues in clinical practice. Accomplishing this requires that students learn to: (1) recognize ethical issues as they arise in clinical care and identify hidden values and unacknowledged conflicts; (2) think clearly and critically about ethical issues in ways that lead to an ethically justifiable course of action; and (3) apply the practical skills needed to implement an ethically justifiable course of action. Each of these objectives in turn requires that the students possess specific knowledge, attitudes, and skills. To recognize ethical issues as they appear in clinical care usually requires a positive attitude concerning the importance of the humanistic and value-laden aspects of medical care. For example, a physician's decision regarding chemotherapy for a woman with breast cancer involves the physician's awareness of the biomedical issues and of the morbidity and mortality of the disease, as well as of the patient's own views regarding continued life, her body image, and the morbidity of treatment. Recognizing the presence of an hoodia diet ethical issue also requires knowledge of the nature of commonethical issues and how they arise in clinical practice.

There was a long tradition of teaching medical deontology (study of moral obligation) in both Europe and Latin America, particularly in Catholic medical schools. But the 1980s saw in these countries, as in North America, a steady expansion of the number and scope of medical ethics programs. In Great Britain, the General Medical Council created a committee in 1984 to study the teaching of medical ethics in British medical schools and make recommendations. The resulting 1987 “Pond Report” recommended that the teaching of medical ethics be encouraged in medical school, but no specific guidelines were advocated (Institute of Medical Ethics). While initially little progress was made, a later study found that most medical schools included ethics education (Goldie). A 1991 study in Canada found that fifteen of the sixteen Canadian medical schools provided medical ethics education and some sort of examination, with the number of required hours ranging from 10.5 to 45 (Baylis and Downie). Almost all of the schools used physicians as instructors and focused on specific ethical issues (e.g., euthanasia), as opposed to ethical theory or professional codes of ethics. The College of Family Physicians of Canada and the Royal College of Physician and Surgeons of Canada require ethics training, and there is increasing interest in continuing education in bioethics (McKneally and Singer). In numerous other countries, medical schools have developed curricula in medical ethics. At Lagos University in Nigeria, two-day workshops were initiated in 1982 for fourth-year students, at which lawyers, doctors, and patients all participated in lectures and discussions of issues in medical ethics (Olukoya). In Australia, medical graduates are required to understand basic medical ethics principles, and in the early 2000s educators promulgated a core curriculum (Working Group).

In contrast to cognitively oriented behavior therapists, radical behaviorists reject outright the concept of “self.” They view cognition as simply a form of behavior that occurs in correlation to a person’s responses to environmental contingencies, but not as a cause of those responses. All behavior is presumed to be “caused” by a relationship between external events (contingencies) and behavior. According to radical behavior therapists (e.g., Hayes, 1987, 1989; Kohlenberg and Tsai), people learn sets of “rules” that guide their behavior through the experience of being rewarded or punished for particular behaviors in specific situations. Rules, considered to be verbal representations of environmental contingencies (the relationship between behavior and reward or punishment), are largely determined by an individual’s cultural and linguistic milieu and prior learning history. According to radical behaviorists, rules and the linguistic milieu constitute a context that forms the causal matrix within which behavior is produced. Emotional disorders result from rigid adherence to “rules” of behavior that do not apply in a particular context, or to misattributing the causes of one’s behavior to emotions rather than environmental contingencies. Thus, rules themselves are potential causes of emotional or behavioral problems. A similar situation can arise from responding to inappropriately formed environmental contingencies, usually those derived from the structure of the individual’s language. These inappropriately formed contingencies reinforce aspects of a person’s subjective experience (e.g., the association of emotions with events) in a way that leads the person concerned to misattribute behavior to emotions rather than to the external contingencies that, in the radical behaviorist view, actually cause behavior. Radical behaviorist approaches to treatment place strong emphasis on the role of an individual’s linguistic community and language structure in guiding behavior. Cognition per se is irrelevant, except to the degree that thought is a part of the client’s use of language. Behavior change is brought about by teaching new linguistic structures that lead to less affective upset. This is accomplished by attempting to alter the way in which clients use language to form attributions about the causes and meanings of their emotional experience. Most often, this involves teaching clients that emotions are not experiences that can or should be avoided. Rather, they are to be viewed as natural accompaniments to the process of living. Clients are taught to accept and utilize in a positive fashion affective and other inner experiences that their linguistic community has taught them should be avoided or eliminated (e.g., anxiety). Clients are also shown how to alter the contexts (contingencies) that control their behavior. Curiously, radical behaviorist approaches to behavior therapy are in some ways philosophically more similar to psychoanalysis than they are to traditional behavior or cognitive-behavior therapy, in that clients are taught that negative emotions are a natural part of life and cannot be eliminated. Eschewing mechanistic, linear views, radical behavior therapists prefer to view behavior as the product of an interaction between person and context.

The technical language that behaviorism aspired to generate was certainly not ordinary everyday language , for it never lost sight of consciousness, its complexity, and its manifold contents, purposes, and values. Since the middle of the twentieth century, more and more philosophers, psychologists, neuroscientists, and psychotherapists have acknowledged the centrality of consciousness for their own activities. Consciousness is now seen as being complex, ranging from minimal awareness devoid of conceptual representation, through symbolic awareness, to self-awareness, while a great deal of nonconscious data-processing occurs (Gazzaniga et al.). Consciousness and immediate self-awareness are indispensable for people to understand their uniqueness and their personal, ethical, professional, and therapeutic relations with each another. Initially, behaviorists aspired to explain what people do on a simple Pavlovian stimulus–response model; but the terms stimulus, response, and behavior have been used quite loosely. Muscles, glands, and organs (and who knows what else) react to external (and, they confessed later, to internal) stimuli; and no conscious processing or activities intervene. This view, however, proved to be too simple, too ambiguous, and too devoid of comprehensiveness, to be true—which does not deny that valuable lessons can be learned from the study of behavior. Gestalt psychologists recognized that empirical stimuli or data are processed internally and holistically, and that no simple stimulus–response theory could explain how humans perceive continuous motion from discontinuous and still motion-picture frames. Noam Chomsky argued effectively that psychological conditioning and associationist learning theory, according to which learning occurs solely through repeated exposures that form connecting links, are too weak to account for the genetically prestructured dispositions of human infants to learn human languages—and for the creative and rule-governed ways in which languages are employed. Abraham Maslow (1971) reported that having a child of his own made behavioristic views of conditioned associationist learning look so foolish that he could not stomach them anymore. To Maslow, the presence of conscious, creative processing of information in his own children was too obvious to be denied. Cognitive psychologists emphasized the indispensability of conscious cognitive or conceptual maps in understanding how people understand, anticipate the future, plan ahead, and act accordingly. According to evolutionary psychology, the evolutionary process has prepared and predisposed people to act, feel, think, and choose in certain ways; and conscious comprehension, insight, information processing, and problem solving have immense significance for purposive and voluntary activity, adaptation, and survival.

Many philosophers are attracted to behaviorism’s original emphasis on observable external behavior, either for metaphysical or methodological reasons. Some want to escape from Cartesian mind–body dualism—from “the ghost in the machine,” as Gilbert Ryle (1900–1976) put it—though this may be done without resorting to behaviorism. Members of the positivistic Vienna Circle, an influential group of scientifically oriented philosophers who flourished in Vienna from the early 1920s to the mid-1930s, wanted to avoid introspective methodology, and so do those influenced by them. They are attracted to the behavioristic methodology of theoretically redefining mentalistic language in terms of external, overt, publicly observable behavior because of its compatibility with the empiricist, or verification criterion, of meaning: that meaning consists exclusively in sensory reference. Logical, or linguistic, positivism attempts to analyze or redefine the meanings of concepts and beliefs in terms of sensory reference and verifiability. Many recent and contemporary philosophers with a bent toward this form of positivism have tried to formulate in observable behavioral terms the meanings of psychological concepts such as thought, understanding, intelligence, doubt, imagination, and memory, as well as the classes and manifold subclasses of feelings, sensations, pleasures, pains, emotions, desires, and purposes. Gilbert Ryle, a prominent British linguistic philosopher, was convinced that ordinary language is a behavioristic language, and that ordinary meanings of psychological terms are behavioral meanings. Without denying the existence of inner mental events, he believed that the ordinary meanings of mental concepts can be captured by reference to observable behaviors (or the dispositions to manifest them), without appeal to private or privileged access. Most philosophers and psychologists since Ryle, however, have believed that psychological concepts in ordinary language and “folk psychology” cannot be analyzed purely behaviorally without an important loss of significance. Many see this as a reason for abandoning familiar psychological terminology for a technically or theoretically constructed psychological vocabulary. Others have found self-awareness to be too evident and significant to be abandoned, believing that a purely behavioral outlook only fosters trivialities and ignores the obvious.

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