Eukaryotic mRNAs are monocistronic, and therefore mechanisms exist that coordinate the synthesis of multiprotein complexes in order to obtain proper stoichiometry at the appropriate intracellular locations. RNA‐binding proteins containing low‐complexity sequences are prone to generate liquid droplets via liquid‐liquid phase separation, and in this way create cytoplasmic assemblages of functionally related mRNAs. In a recent iCLIP study, we showed that the Drosophila RNA‐binding protein Imp, which exhibits a C‐terminal low‐complexity sequence, increases the formation of F‐actin by binding to 3′ untranslated (...) regions of mRNAs encoding components participating in F‐actin biogenesis. We hypothesize that phase transition is a mechanism the cell employs to increase the local mRNA concentration considerably, and in this way synchronize protein production in cytoplasmic territories, as discussed in the present review. (shrink)

Therapieentscheidungen lösen in klinischen Teams häufig Unsicherheiten und Konflikte aus, insbesondere wenn es um schwerkranke Patienten geht. Fallen Entscheidungen vornehmlich situationsgeleitet, sind bestimmte Patientengruppen einem Risiko der Unter-, Über- oder Ungleichversorgung ausgesetzt. Der Metap-Leitfaden unterstützt Ärzte, Pfleger und Therapeuten daher in ihrer ethisch reflektierten Entscheidungskompetenz mit verschiedenen Orientierungs- und Entscheidungsinstrumentarien. Diese berücksichtigen eine gerechte Zuteilung der Ressourcen.

Ethische Leitlinien für die klinische Praxis erfreuen sich zunehmender Beliebtheit. Damit klinisch-ethische Leitlinien aber überhaupt erfolgreich wirksam werden können, ist noch Pionierarbeit zu leisten. Solche Leitlinien müssen wissenschaftlich stärker fundiert und ihre praktische Anwendbarkeit muss verbessert werden. In dieser Arbeit werden die ersten Schritte des Projekts METAP zur methodischen Entwicklung und praktischen Implementierung einer Leitlinie für eine patientengerechte Versorgung am Krankenbett beschrieben und zur Diskussion gestellt. Das Projekt orientiert sich methodisch an der Entwicklung medizinischer Leitlinien und generiert damit eine forschungs- (...) und konsensgestützte Leitlinie, die systematischer Evaluation und Modifikation unterliegt und Rechenschaft über ihre wissenschaftliche Fundierung gibt. Zusätzlich zur Leitlinie bietet das Projekt in der Form eines Handbuchs ein Entscheidungsfindungsverfahren an, welches unter anderem deliberative Aspekte unterstützt. Das Handbuch konzentriert sich auf ethische Fragen der Mikroallokation und liefert darüber hinaus Informationen über empirische, ethische und rechtliche Grundlagen für Therapieentscheidungen. Anhand eines Eskalationsmodells können unterschiedliche Instrumente nach Bedarf als ethische Lösungsstrategien eingesetzt werden, von der Kurzfassung im Kitteltaschenformat („Leporello“) mit den wichtigsten Fakten, weiterführenden Texten und Empfehlungen mit normativen und prozeduralen Hinweisen, über stationsinterne Lösungsversuche bis hin zum Ethikkonsil. Klinische Partner sind von Beginn an aktiv in den Entwicklungsprozess eingebunden und verbessern so die Praxistauglichkeit und Akzeptanz sowie die Ausrichtung des Instrumentariums an den tatsächlichen Bedürfnissen. Dieses partnerschaftliche, partizipative Vorgehen scheint eine wichtige Voraussetzung dafür zu sein, dass METAP in der Klinik Fuß fassen konnte. (shrink)

Recently, ethical guidelines for clinical practice have gained increased popularity, but in order to become useful they require more pioneer’s work. Clinical-ethical guidelines need to be based on a scientific foundation and their practicability must be improved. We present and put to discussion the initial steps of the METAP Project about the development and practical implementation of a clinical-ethical guideline dedicated to a fair resource-allocation at the bedside. -/- With its methodological orientation, the project represents a guideline which is based (...) on both research and consensus-building, undergoing systematic evaluation and modification. In addition to the guideline, the project comes with a manual (a tool kit) including a procedural instrument for making decisions supporting deliberative aspects. It focuses on issues of micro-allocation; furthermore, it provides empirical, ethical and legal basics for making fair treatment decisions that should help to prevent overtreatment, undertreatment or discrimination in patient care. We propose an Escalation Model with various instruments serving as problem solving strategies that correspond to the respective needs; these instruments include a pocket-summary (“Leporello”) with the most important facts; further reading material; normative and procedural recommendations; ward-specific strategies, and also the option of clinical ethics consultation. -/- Clinical partners have been actively involved in the developmental process from the beginning and contributed to the practical applicability, acceptance and a valid need-orientation of the whole tool kit. This partnership and the participatory approach seem to have helped METAP to gain a foothold in the clinic. (shrink)

Die qualitative Interviewstudie analysiert informelle Wissensstrukturen von Pflegenden und Ärzten hinsichtlich der beiden Einflussfaktoren „Alter“ und „Kosten“ auf Therapieentscheide am Lebensende als Grundlage ethischer Meinungsbildung. Als Auswertungsmaterial dienen spontane Aussagen zu „Alter“ und „Kosten“, die nicht im Kontext von Fragestellungen zu Ageism oder Rationierung erhoben wurden. Diese Aussagen wurden einer Inhaltsanalyse unterzogen, und zwar anhand von qualitativen und quantitativen Analyseschritten.Die Studie zeigt, dass der Faktor „Alter“ wesentlich häufiger als Einflussfaktor auf Therapieentscheide am Lebensende genannt wird als der Faktor „Kosten“. Zudem (...) gibt es Hinweise auf mögliche Ungleichbehandlung sowie auf Überversorgung von Patienten am Lebensende. Die Befunde stützen die Annahme, dass Therapieentscheidungen eher auf informellen, nicht-institutionalisierten Prozessen beruhen. Eine stärker explizite Strukturierung des Prozesses zur Therapieentscheidung könnte die Risiken von Ungleichbehandlung und Überversorgung reduzieren und dadurch zu ethisch besser vertretbaren Ergebnisse führen. (shrink)

ZusammenfassungDie qualitative Interviewstudie analysiert informelle Wissensstrukturen von Pflegenden und Ärzten hinsichtlich der beiden Einflussfaktoren „Alter“ und „Kosten“ auf Therapieentscheide am Lebensende als Grundlage ethischer Meinungsbildung. Als Auswertungsmaterial dienen spontane Aussagen zu „Alter“ und „Kosten“, die nicht im Kontext von Fragestellungen zu Ageism oder Rationierung erhoben wurden. Diese Aussagen wurden einer Inhaltsanalyse unterzogen, und zwar anhand von qualitativen und quantitativen Analyseschritten.Die Studie zeigt, dass der Faktor „Alter“ wesentlich häufiger als Einflussfaktor auf Therapieentscheide am Lebensende genannt wird als der Faktor „Kosten“. Zudem (...) gibt es Hinweise auf mögliche Ungleichbehandlung sowie auf Überversorgung von Patienten am Lebensende. Die Befunde stützen die Annahme, dass Therapieentscheidungen eher auf informellen, nicht-institutionalisierten Prozessen beruhen. Eine stärker explizite Strukturierung des Prozesses zur Therapieentscheidung könnte die Risiken von Ungleichbehandlung und Überversorgung reduzieren und dadurch zu ethisch besser vertretbaren Ergebnisse führen. (shrink)

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two (...) geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and staff can be overcome when people are convinced that the benefits justify the effort. (shrink)

When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. (...) In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making. (shrink)

Medizinethische Entscheidungsfindungsmodelle müssen nachweisen können, weshalb die mit ihnen getroffenen Entscheidungen richtig oder zumindest „belastbar“ sind. Hierfür sind theoretische Rechtfertigungsansätze aus der Ethik unverzichtbar. Der Klinischen Ethik wird aber mitunter ein Mangel an theoretischer Fundierung vorgeworfen. Um diesem Vorwurf entgegenzutreten, soll unter Bezugnahme auf ein Projekt der Klinischen Ethik („METAP“) die ethische Unterstützung in Form der ethischen Fallbesprechung und der Ethikkonsultation mittels Prinzipienethik und Diskursethik gerechtfertigt werden. Prinzipienethik und Diskursethik können einander über das Medium der ethischen Fallbesprechung oder Ethikkonsultation fruchtbar (...) ergänzen. So können einige theoretische und praktische Schwächen der beiden Ansätze durch den jeweils anderen abgefedert werden. Die Diskursethik übernimmt bspw. die Sicherung der ethischen Gültigkeit von moralischen Entscheidungen bzw. Handlungsnormen und vermindert dadurch ein Rechtfertigungsdefizit, welches bei einem rein prinzipienorientierten Verfahren auftritt. Umgekehrt antwortet die Prinzipienethik u. a. auf Fragen der ethischen Angemessenheit und dient v. a. der adäquaten Einzelfallentscheidung. Durch die Integration des einen Ansatzes in den anderen ist eine umfassendere Rechtfertigungsleistung erzielbar als bei einem alleinigen Einsatz von Prinzipienethik oder Diskursethik. Selbst wenn einige Herausforderungen bestehen bleiben und auch das integrierte Modell moralische Dissense nicht immer verhindern kann, vermag es durch seine „doppelte“ Absicherung (Prinzipien und Diskurs) ein praktisches Vertrauen in die getroffene ethische Entscheidung zu stärken und so der Klinischen Ethik mehr „Robustheit“ zu geben, als sie bisher besitzt. (shrink)

ZusammenfassungMedizinethische Entscheidungsfindungsmodelle müssen nachweisen können, weshalb die mit ihnen getroffenen Entscheidungen richtig oder zumindest „belastbar“ sind. Hierfür sind theoretische Rechtfertigungsansätze aus der Ethik unverzichtbar. Der Klinischen Ethik wird aber mitunter ein Mangel an theoretischer Fundierung vorgeworfen. Um diesem Vorwurf entgegenzutreten, soll unter Bezugnahme auf ein Projekt der Klinischen Ethik („METAP“) die ethische Unterstützung in Form der ethischen Fallbesprechung und der Ethikkonsultation mittels Prinzipienethik und Diskursethik gerechtfertigt werden. Prinzipienethik und Diskursethik können einander über das Medium der ethischen Fallbesprechung oder Ethikkonsultation fruchtbar (...) ergänzen. So können einige theoretische und praktische Schwächen der beiden Ansätze durch den jeweils anderen abgefedert werden. Die Diskursethik übernimmt bspw. die Sicherung der ethischen Gültigkeit von moralischen Entscheidungen bzw. Handlungsnormen und vermindert dadurch ein Rechtfertigungsdefizit, welches bei einem rein prinzipienorientierten Verfahren auftritt. Umgekehrt antwortet die Prinzipienethik u. a. auf Fragen der ethischen Angemessenheit und dient v. a. der adäquaten Einzelfallentscheidung. Durch die Integration des einen Ansatzes in den anderen ist eine umfassendere Rechtfertigungsleistung erzielbar als bei einem alleinigen Einsatz von Prinzipienethik oder Diskursethik. Selbst wenn einige Herausforderungen bestehen bleiben und auch das integrierte Modell moralische Dissense nicht immer verhindern kann, vermag es durch seine „doppelte“ Absicherung (Prinzipien und Diskurs) ein praktisches Vertrauen in die getroffene ethische Entscheidung zu stärken und so der Klinischen Ethik mehr „Robustheit“ zu geben, als sie bisher besitzt. (shrink)

This edited volume addresses lacunae given the momentum translanguaging has already gained internationally in publications on school contexts for pupils aged 4 to 18. In this book, the epistemologi...

Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another “committee”. One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The (...) most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study. (shrink)

Shame is a painful emotion concerned with failure to live up to certain standards, norms, or ideals. The subject feels that she falls in the regard of others; she feels watched and exposed. As a result, she feels bad about the person that she is. The most popular view of shame is that someone only feels ashamed if she fails to live up to standards, norms, or ideals that she, herself, accepts. In this paper, I provide support for a different (...) view, according to which shame is about failure to live up to public expectations. Such a view of shame has difficulties explaining why an audience is central to shame, why shame concerns the self as a whole, and why the social rank of someone affects their ability to shame others. These features, I argue, are best explained by reference to the descent of shame in the emotion connected with submission in nonhuman animals. The function of submission—to appease relevant social others—also throws light on the sort of emotion that shame is. From the point of view of other people, a subject who experiences shame at her own failing is someone who is committed to living together with others in a socially sanctioned way. The argument is not that we must understand the nature of shame in terms of what it evolved for, but that its heritage is important to understanding the emotion that shame has become. (shrink)

The debate and implementation of Clinical Ethics Consultation is still in its beginnings in Europe and the issue of the patient's perspective has been neglected so far, especially at the theoretical and methodological level. At the practical level, recommendations about the involvement of the patient or his/her relatives are missing, reflecting the general lack of quality and practice standards in CEC. Balance of perspectives is a challenge in any interpersonal consultation, which has led to great efforts to develop “technical”approaches, e.g., (...) in psychological counseling or psychotherapeutic treatment. In ethics, unbalance or partiality is a matter of justice and has provoked significant theoretical work, also relevant for practical medical ethics. A lack of balance seems to be particularly serious in those situations, where ethical conflict is triggering a consultation and where the “parties” involved may try to persuade the consultant that their particular opinion is the most convincing; but to our knowledge the connection between patient/relatives involvement and balance has not yet been discussed in the context of CEC. Central questions of access and involvement of the patient and his/her relatives will be analysed and discussed regarding the challenge of balance and the adequate role or attitude of a Clinical Ethics Consultant. It is argued that the Clinical Ethics Consultant should have a methodological awareness regarding the concepts of “neutrality” versus “advocacy” in his/her role and try to achieve a balanced procedure that allows for an optimum of change of perspectives. The argumentation is developed along the narrative of a real case study. Recommendations concerning the involvement of the patient or the relatives are formulated for the practice of CEC. (shrink)

The paper describes how ethics consultation can be valuable to health professionals, patients and their families in understanding and evaluating ethical values and their consequences in a particular situation. Ethics consultation as it is practised at the university hospital of Freiburg is a special professional service offered by members of an academic institution.The practical approach and the goals are illustrated by a case study showing the difficulties of deciding about the limitation of intensive care medicine after heart surgery in the (...) setting of maximum treatment. Here, the ethics consultation was initiated by the relatives of the patient who wanted a decision to withhold further life-sustaining treatment.Following the experiences in Freiburg, it is concluded that clinical ethicists have to cover a variety of relevant fields of knowledge, need special analytical skills, and should have professional competence in counselling, including conflict mediation or crisis intervention. (shrink)

Having enjoyed more than twenty years of development, feminist epistemology and philosophy of science are now thriving fields of inquiry, offering current scholars a rich tradition from which to draw. In addition to a recognition of the power of knowledge itself and its effects on women’s lives, a central feature of feminist epistemology and philosophy of science has been the attention they draw to the role of power dynamics within knowledge-seeking practices and the implications of these dynamics for our understandings (...) of knowledge, science, and epistemology. Feminist Epistemology and Philosophy of Science: Power in Knowledge collects new works that address today’s key challenges for a power-sensitive feminist approach to questions of knowledge and scientific practice. The essays build upon established work in feminist epistemology and philosophy of science, offering new developments in the fields, and representing the broad array of the feminist work now being done and the many ways in which feminists incorporate power dynamics into their analyses. (shrink)

Fictional names present unique challenges for semantic theories of proper names, challenges strong enough to warrant an account of names different from the standard treatment. The theory developed in this paper is motivated by a puzzle that depends on four assumptions: our intuitive assessment of the truth values of certain sentences, the most straightforward treatment of their syntactic structure, semantic compositionality, and metaphysical scruples strong enough to rule out fictional entities, at least. It is shown that these four assumptions, taken (...) together, are inconsistent with referentialism, the common view that names are uniformly associated with ordinary individuals as their semantic value. Instead, the view presented here interprets names as context-sensitive expressions, associated in a context of utterance with a particular act of introduction, or dubbing, which is then used to determine their semantic value. Some dubbings are referential, which associate names with ordinary individuals as their semantic values; others are fictional, which associate names, instead, with sets of properties. Since the semantic values of names can be of different sorts, the semantic rule interpreting predication must be complex as well. In the body of the paper, I show how this new treatment of names allows us to solve our original puzzle. I defend the complexity of the semantic predication rule, and address additional worries about ontological commitment. (shrink)

We regularly wield powers that, upon close scrutiny, appear remarkably magical. By sheer exercise of will, we bring into existence things that have never existed before. With but a nod, we effect the disappearance of things that have long served as barriers to the actions of others. And, by mere resolve, we generate things that pose significant obstacles to others' exercise of liberty. What is the nature of these things that we create and destroy by our mere decision to do (...) so? The answer: the rights and obligations of others. And by what seemingly magical means do we alter these rights and obligations? By making promises and issuing or revoking consent When we make promises, we generate obligations for ourselves, and when we give consent, we create rights for others. Since the rights and obligations that are affected by means of promising and consenting largely define the boundaries of permissible action, our exercise of these seemingly magical powers can significantly affect the lives and liberties of others. (shrink)

Clinical ethics consultation not only interprets moral issues at the bedside and is not restricted to giving support for the “technical” handling of these moral issues, but it has to substantively address moral values, norms, and conflicts in the process of discussing cases and problems. We call this the normative dimension and use normative in the sense of embracing moral values and convictions of persons and groups, norms, and relevant professional and ethical guidelines as well as legal frameworks. The roles (...) and activities of the consultant as a person and the quality of CEC as a process are discussed in the American Society of Bioethics and Humanities’ Core Competences for Healthcare Ethics Consultation. (shrink)

Initiating clinical ethics support in psychiatry and maintaining its continuity appear to be easy. This is contradicted by the observed delay or lack of CESiP, e.g. ethics consultation. On the basis of a published literature search and the discussion of practical experiences over 2.5 years 10 tasks and relating challenges of initiating and maintaining CESiP are formulated and illustrated by examples. Referral to experiences is grounded on the systematic documentation of ca. 100 CESiP activities. The tasks and challenges illustrate how (...) CESiP was initiated and maintained in child and adolescent, adult and forensic psychiatry. Each example is followed by a “rule of thumb” that was found useful in our centre. Discussion: Suggestions I–III are of organisational nature, IV–X have explicit ethical content concerning the ethos or professionalism of the ethics consultant and CES practice. Their realisation requires a minimum of stability of CESiP and considerable consultancy experience. (shrink)

What is the status of empirical contributions to bioethics, especially to clinical bioethics? Where is the empirical approach discussed in bioethics related to the ongoing debate about principlism versus casuistry? Can we consider an integrative model of research in medical ethics and which empirical methodology could then be valuable, the quantitative or the qualitative? These issues will be addressed in the first, theoretical part of the paper. The concept of the “embedded researcher” presented in this article was stimulated by the (...) two questions, (1) how can we safeguard that our research will yield valid and meaningful results to practice? and (2), how can we convince clinical colleagues that medical ethics offers relevant contributions to the analysis and solution of problems? One tentative answer has been our effort to elaborate a coherent methodological research approach in the field of end-of-life issues integrating qualitative and quantitative as well as casuistic methodologies. This development is characterized in the second part describing the ECOPE Study (short title)“Ethical Conditions Of Passive Euthanasia.” The achievements and limitations of the suggested approach of the “embedded researcher” are discussed referring to 3 examples of our joint studies about ethical issues concerning(1) critical decision-making in neonatology(2) limitation of treatment in intensive care(3) problems with doctor-patient conversation at the end of life in oncologyConclusions from our studies are put to discussion in the final part of the paper about how to further develop research in the field of end-of-life care and, maybe,clinical bioethics as a whole. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how-to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North‐America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how‐to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end‐of‐life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi‐centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

This symposium includes twelve personal narratives from parents about making the decision whether to circumcise their infant male children. The authors of the narratives include five fathers and seven mothers. Nine of the 12 parent authors opted to circumcise their infant sons, though the reasons they stated for doing so varied. Most of the parent authors relied on cultural or social beliefs, religious guidance, or a desire for sameness with the infant's father. Parents who didn't circumcise their male infants discuss (...) their convictions about autonomy, bodily rights, and the medical benefits of circumcision versus the harm or pain caused by the procedure. The symposium includes four expert commentaries on the narratives that are informed and enriched by the commentators' expertise in pediatric bioethics, healthcare ethics, gender studies, Jewish law and tradition, and the medical and surgical techniques of circumcision. (shrink)

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances of intentional wrongdoing, by males in nonacademic medical settings, with oversight problems and a selfish motive such as financial gain or sex. More than half of cases involved a wrongdoer with a suspected (...) personality disorder or substance use disorder. Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions. (shrink)

This chapter contains sections titled: The Problem of Definition Problems of Interpretation Nature and Convention Transcendence Death and the Afterlife Problems of Evil Fatalism and Free Will? Divine Command Theory Piety and Divine Simplicity Works cited.

Converging findings from English, Mandarin, and other languages suggest that observed “universals” may be algorithmic. First, computational principles behind recently developed algorithms that acquire productive constructions from raw texts or transcribed child-directed speech impose family resemblance on learnable languages. Second, child-directed speech is particularly rich in statistical (and social) cues that facilitate learning of certain types of structures.

Previous studies of auditory expectation have focused on the expectedness perceived by listeners retrospectively in response to events. In contrast, this research examines predictive uncertainty —a property of listeners' prospective state of expectation prior to the onset of an event. We examine the information-theoretic concept of Shannon entropy as a model of predictive uncertainty in music cognition. This is motivated by the Statistical Learning Hypothesis, which proposes that schematic expectations reflect probabilistic relationships between sensory events learned implicitly through exposure. Using (...) probability estimates from an unsupervised, variable-order Markov model, 12 melodic contexts high in entropy and 12 melodic contexts low in entropy were selected from two musical repertoires differing in structural complexity (simple and complex). Musicians and non-musicians listened to the stimuli and provided explicit judgments of perceived uncertainty (explicit uncertainty). We also examined an indirect measure of uncertainty computed as the entropy of expectedness distributions obtained using a classical probe-tone paradigm where listeners rated the perceived expectedness of the final note in a melodic sequence (inferred uncertainty). Finally, we simulate listeners' perception of expectedness and uncertainty using computational models of auditory expectation. A detailed model comparison indicates which model parameters maximize fit to the data and how they compare to existing models in the literature. The results show that listeners experience greater uncertainty in high-entropy musical contexts than low-entropy contexts. This effect is particularly apparent for inferred uncertainty and is stronger in musicians than non-musicians. Consistent with the Statistical Learning Hypothesis, the results suggest that increased domain-relevant training is associated with an increasingly accurate cognitive model of probabilistic structure in music. (shrink)

Psychopaths are renowned for their immoral behavior. They are ideal candidates for testing the empirical plausibility of moral theories. Many think the source of their immorality is their emotional deficits. Psychopaths experience no guilt or remorse, feel no empathy, and appear to be perfectly rational. If this is true, sentimentalism is supported over rationalism. Here, I examine the nature of psychopathic practical reason and argue that it is impaired. The relevance to morality is discussed. I conclude that rationalists can explain (...) the moral deficits of psychopaths as well as sentimentalists. In the process, I identify psychological structures that underpin practical rationality. (shrink)

Much of the literature concerning epistemic injustice has focused on the variety of harms done to socially marginalized persons in their capacities as potentialcontributorsto knowledge projects. However, in order to understand the full implications of the social nature of knowing, we must confront the circulation of knowledge and the capacity of epistemic agents to take up knowledge produced by others and make use of it. I argue that members of socially marginalized lay communities can sufferepistemic trust injusticeswhen potentially powerful forms (...) of knowing such as scientific understandings are generated in isolation from them, and when the social conditions required for aresponsibly-placed trustto be formed relative to the relevant epistemic institutions fail to transpire. (shrink)

Psychopaths are renowned for their immoral behavior. They are ideal candidates for testing the empirical plausibility of moral theories. Many think the source of their immorality is their emotional deficits. Psychopaths experience no guilt or remorse, feel no empathy, and appear to be perfectly rational. If this is true, sentimentalism is supported over rationalism. Here, I examine the nature of psychopathic practical reason and argue that it is impaired. The relevance to morality is discussed. I conclude that rationalists can explain (...) the moral deficits of psychopaths as well as sentimentalists. In the process, I identify psychological structures that underpin practical rationality. (shrink)

In this article we refine the design ofcontext shifting experiments, which play a central role in contextualist debates, and we subject a large number of scenarios involving different types of expressions of interest to contextualists, including ‘know’ and color adjectives like ‘green’, to experimental investigation. Our experiment (i) reveals an effect of changing contexts on the evaluation of uses of the sentences that we examine, thereby overturning the absence of results reported in previous experimental studies (so‐callednull results), (ii) uncovers evidence (...) for a ‘truth bias' in favor of positive over negative sentences, and (iii) reveals previously unnoticed distinctions between the strength of the contextual effects displayed by scenarios involving knowledge ascriptions and scenarios concerning color and other miscellaneous scenarios. (shrink)

Feminist philosophers of science have been prominent amongst social epistemologists who draw attention to communal aspects of knowing. As part of this work, I focus on the need to examine the relations between scientific communities and lay communities, particularly marginalized communities, for understanding the epistemic merit of scientific practices. I draw on Naomi Scheman's argument (2001) that science earns epistemic merit by rationally grounding trust across social locations. Following this view, more turns out to be relevant to epistemic assessment than (...) simply following the standards of "normal science". On such an account, philosophers of science need to attend to the relations between scientific communities and various lay communities, especially marginalized communities, to understand how scientific practices can rationally ground trust and thus earn their status as "good ways of knowing". Trust turns out to involve a wide set of expectations on behalf of lay communities. In this paper I focus on expectations of knowledge sharing, using examples of "knowledge-sharing whistleblowers" to illustrate how failures in knowledge sharing with lay communities can erode epistemic trust in scientific communities, particularly in the case of marginalized communities. (shrink)

During the past decades, research collaboration between researchers from different disciplines has become more frequent. However, there is a need to look into the generic modalities and challenges. The article explores a series of potential obstructions to cross-disciplinary collaboration of methodological and epistemological nature. Furthermore, a number of contextual, inhibiting factors are outlined. As means of overcoming the obstacles, the importance of mutual knowledge, allocation of adequate time and conducive research management is emphasised. New teams may benefit from tutoring by (...) facilitators, who can help to make problem areas explicit and negotiate solutions. Owing to the training background of the author, most of the examples are drawn from the interface between biomedicine/natural science and applied medical anthropology. However, the issues raised basically apply to all sorts of cross-disciplinary research collaboration in various combinations. (shrink)

Empathy is one of the most talked about and widely studied concepts of recent years. Some argue it can help create a more just society, improve medical care and even avert global catastrophe. Others object that it is morally problematic. Who is right? And what is empathy anyway? Is it a way of feeling with others, or is it simply feeling sorry for them? Is it a form of knowledge? What is its evolutionary origin? In this thorough and clearly-written introduction (...) to the philosophy of empathy Heidi Maibom explores these questions and more, examining the following topics: The nature of empathy and key themes in the literature Empathy as a way of understanding others, particularly 'simulation theory' and 'perspective-taking' Empathy, emotional contagion, and sympathy Empathy's role in moral understanding or motivation Empathy and art appreciation, with examples from film, music and fiction Empathy and mental disorder, such as psychopathy and autism. Including chapter summaries, annotated further reading and a glossary, Empathy is an excellent resource for students of philosophy of mind and psychology, psychology, and cognitive science, as well as for those in related subjects such as art, literature and politics. (shrink)

Existing research on the formation of employee ethical climate perceptions focuses mainly on organization characteristics as antecedents, and although other constructs have been considered, these constructs have typically been studied in isolation. Thus, our understanding of the context in which ethical climate perceptions develop is incomplete. To address this limitation, we build upon the work of Rupp to develop and test a multi-experience model of ethical climate which links aspects of the corporate social responsibility, ethics, justice, and trust literatures and (...) helps to explain how employees’ ethical climate perceptions form. We argue that in forming ethical climate perceptions, employees consider the actions or characteristics of a complex web of actors. Specifically, we propose that employees look outward at how communities are impacted by their organization’s actions, upward to make inferences about the ethicality of leaders in their organizations, and inward at their own propensity to trust others as they form their perceptions. Using a multiple-wave field study conducted at a privately held US corporation, we find substantial evidence in support of our model. (shrink)

Food media have become a formidable part of adolescents’ food environments. This study sought to explore how and why adolescents use food media by focusing on selectivity and motives for consumption. We conducted in-depth, semi-structured interviews with 31 Flemish adolescents aged 12 to 16. Food media were both incidentally consumed and selectively sought for education, social utility, and entertainment. The levels of selectivity and motives for consumption varied among the different food media platforms. Incidental consumption was more prevalent with TV (...) cooking shows compared to online food media. The dominant motives for TV cooking show consumption were companionship and entertainment, while online food media were used for a more diverse range of motives dominated by information/inspiration and social interaction. Some participants consumed food media to get motivation and inspiration to improve health and fitness while others consumed food media to watch appetizing and aesthetically pleasing food content. The social environment in the form of friends and family as well as existing food preferences were dominant psychosocial factors for both traditional and online food media use. Future research is warranted to explore how incidental exposure and the identified motives for use relate to food media effects. (shrink)

Clinical ethics consultation has developed from local pioneer projects into a field of growing interest among both clinicians and ethicists. What is needed are more systematic studies on the ethical challenges faced in clinical practice and problem solving through ethics consultation from interdisciplinary perspectives. The Thematic Issue covers a range of topics and includes five recent studies from various European countries and the USA, focusing on issues such as the ethical difficulties of end of life decisions, experiences with newly developed (...) or well established ethics consultation services, and the expectations of physicians in various clinical fields who are still unfamiliar with clinical ethics consultation. The papers included illustrate the interface between different socio-cultural contexts and their ways of dealing with clinical ethics consultation. They deepen the dialogue on clinical ethics consultation that has emerged at the European and International level. (shrink)

Although medical and public health practitioners aim for high rates of vaccination, parent vaccination concerns confound doctors and complicate doctor-patient interactions. Medical and public health researchers have studied and attempted to counter antivaccination sentiments, but recommended approaches to dispel vaccination concerns have failed to produce long-lasting effects. We use observations made during a small study in a rural area in a southeastern state to demonstrate how a shift away from analyzing vaccination skepticism as a national issue with a global remedy (...) reveals the nuances in vaccination sentiments based on locality. Instead of seeing antivaccinationists as a distinct public based on statistical commonalities, we argue that examining vaccination beliefs and practices at the local level offers a fuller picture of the contextualized nature of vaccination decisions within the psychosocial spaces of families. A view of vaccination that emphasizes the local public, rather than a globally conceived antivaccination public, enables medical humanists and rhetoricians to offer important considerations for improving communications about vaccinations in clinical settings. (shrink)

Among theory theorists, it is commonly thought that folk psychological theory is tacitly known. However, folk psychological knowledge has none of the central features of tacit knowledge. But if it is ordinary knowledge, why is it that we have difficulties expressing anything but a handful of folk psychological generalisations? The reason is that our knowledge is of theoretical models and hypotheses, not of universal generalisations. Adopting this alternative view of (scientific) theories, we come to see that, given time and reflection, (...) we can say what we know. (shrink)

Many spectacular claims about psychopaths are circulated. This contribution aims at providing the reader with the more complex reality of the phenomenon (or phenomena), and to point to issues of particular interest to philosophers working in moral psychology and moral theory. I first discuss the current evidence regarding psychopaths’ deficient empathy and decision-making skills. I then explore what difference it makes to our thinking whether we regard their deficit dimensionally (as involving abilities that are on or off) and whether we (...) focus on primary or secondary psychopathy. My conclusion is that most grand claims about psychopathy settling long-standing debates in moral philosophy and psychology are overblown, but there is much to be learnt from this disorder when it comes to formulating modern theories of moral psychology. (shrink)

Many previous treatments of voluntary behavior have viewed intentions as causes of behavior. This has resulted in several dilemmas, including a dilemma concerning the origin of intentions. The present article circumvents traditional dilemmas by treating intentions as constraints that restrict degrees of freedom for behavior. Constraints self-organize as temporary dynamic structures that span the mind-body divide. This treatment of intentions and voluntary behavior yields a theory of intentionality that is consistent with existing findings and supported by current research.