Marshall et al. (2024) persuasively argue that some patients with opiate use disorder (OUD), who refuse observation after naloxone resuscitation in the emergency department (ED), “may be making non...

Current national and international guidelines for the ethical design and development of artificial intelligence (AI) and robotics emphasize ethical theory. Various governing and advisory bodies have generated sets of broad ethical principles, which institutional decisionmakers are encouraged to apply to particular practical decisions. Although much of this literature examines the ethics of designing and developing AI and robotics, medical institutions typically must make purchase and deployment decisions about technologies that have already been designed and developed. The primary problem facing medical (...) institutions is not one of ethical design but of ethical deployment. The purpose of this paper is to develop a practical model by which medical institutions may make ethical deployment decisions about ready-made advanced technologies. Our slogan is “more process, less principles.” Ethically sound decisionmaking requires that the process by which medical institutions make such decisions include participatory, deliberative, and conservative elements. We argue that our model preserves the strengths of existing frameworks, avoids their shortcomings, and delivers its own moral, practical, and epistemic advantages. (shrink)

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts about (...) who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

Decision-making Capacity matters to whether a patient’s decision should determine her treatment. But why it matters in this way isn’t clear. The standard story is that dmc matters because autonomy matters. And this is thought to justify dmc as a gatekeeper for autonomy – whereby autonomy concerns arise if but only if a patient has dmc. But appeals to autonomy invoke two distinct concerns: concern for authenticity – concern that a choice is consistent with an individual’s commitments; and concern for (...) sovereignty – concern that an individual exercises control over that which is hers to control. Here, I argue, neither concern can alone explain why dmc matters. Instead, dmc matters because it indicates a harmony between the two concerns – the demands of each concern are more likely to agree if a patient has dmc. This vindicates the standard story, but also makes clear that dmc is an inappropriate gatekeeper for autonomy. (shrink)

It is natural to think that there is a tight connection between whether someone is responsible for some outcome and whether it is appropriate to hold her accountable for that outcome. And this natural thought naturally extends to health: if someone is responsible for her health, then, all else being equal, she is accountable for it. Given this, some have thought that responsibility for health has an important role to play in distributing the benefits and burdens of healthcare. But there (...) is a reason for caution. That health is influenced by social, economic, and environmental factors is a matter of consensus. And some have argued that in light of these social determinants of health, individuals are not typically responsible for their health, rendering inappropriate policies that employ a responsibility‐for‐health criterion. This debate implicates a number of overlapping concepts and questions that are often difficult to pull apart. And I worry that those who maintain that social determinants undermine responsibility for health have latched on to the wrong target. The social determinants of health are relevant to such policies, but, I argue, not by globally undermining responsibility. Rather, social determinants are sometimes responsibility‐undermining, sometimes responsibility‐preserving, and often relevant to whether we should hold individuals accountable for their health regardless of their responsibility. This calls for a more nuanced appraisal of the ways in which the social determinants of health are relevant to such policies. And here I attempt to provide one. (shrink)

In this paper, we raise and discuss a puzzle about the relationships among goods, reasons, and deontic status. Suppose you have it within your power to give someone something they would enjoy. The following claims seem platitudinous: you can use this power to reward whatever kind of option you want, thereby making that option better and generating a reason for that person to perform it; this reason is then weighed alongside and against the other reasons at play; and altogether, the (...) reasons determine the deontic statuses of that person’s options. We show, however, that in a certain class of cases at least one of these apparent platitudes must be false. In particular, we show that in a certain kind of case wrongfulness cannot be rewarded. In some cases, if one tries to reward wrongfulness, something surprising must go awry: either what you attempt to give as a reward would not, in fact, be good, or it would not generate a reason, or it would have a surprising effect on the deontic status of the relevant options. The upshot is that the relationships among goods, reasons, and deontic status are complicated in ways that have not previously been remarked. (shrink)

As costs decline and technology inevitably improves, current trends suggest that artificial intelligence (AI) and a variety of "carebots" will increasingly be adopted in medical care. Medical ethicists have long expressed concerns that such technologies remove the human element from medicine, resulting in dehumanization and depersonalized care. However, we argue that where shame presents a barrier to medical care, it is sometimes ethically permissible and even desirable to deploy AI/carebots because (i) dehumanization in medicine is not always morally wrong, and (...) (ii) dehumanization can sometimes better promote and protect important medical values. Shame is often a consequence of the human-to-human element of medical care and can prevent patients from seeking treatment and from disclosing important information to their healthcare provider. Conditions and treatments that are shame-inducing offer opportunities for introducing AI/carebots in a manner that removes the human element of medicine but does so ethically. We outline numerous examples of shame-inducing interactions and how they are overcome by implementing existing and expected developments of AI/carebot technology that remove the human element from care. (shrink)

There are cases of ineffable learning — i. e., cases where an agent learns something, but becomes certain of nothing that she can express — where it is rational to update by Jeffrey conditionalization. But there are likewise cases of ineffable learning where updating by Jeffrey conditionalization is irrational. In this paper, we first characterize a novel class of cases where it is irrational to update by Jeffrey conditionalization. Then we use the d-separation criterion to develop a causal understanding of (...) when and when not to Jeffrey conditionalize that bars updating by Jeffrey conditionalization in these cases. Finally, we reflect on how the possibility of so-called “unfaithful” causal systems bears on the normative force of the causal updating norm that we advocate. (shrink)

The failure of many patients with chronic conditions to correctly follow medical advice that they hope or intend to follow is a major concern, especially as effective long‐term therapies for chronic conditions materialize. Some US healthcare providers have responded with strategies that involve implementing contracts with their patients, including provisions that may deny future treatments after continued nonadherence. This is among the first articles to explicitly discuss the ethics of patient contracts.

Navin, Brummett, and Wasserman (2022) argue—successfully, we think—that the standard “comparative” account of decision-making capacity (DMC) fails to capture an important range of cases in which a...

The question of how to treat an incapacitated patient is vexed, both normatively and practically—normatively, because it is not obvious what the relevant objectives are; practically, because even once the relevant objectives are set, it is often difficult to determine which treatment option is best given those objectives. But despite these complications, here is one consideration that is clearly relevant: what a patient prefers. And so any device that could reliably identify a patient’s preferences would be a promising tool for (...) guiding the treatment of incapacitated patients. The patient preference predictor is just such a tool—an algorithm that takes as inputs a patient’s sociodemographic characteristics, and outputs a reliable prediction about that patient’s treatment preferences.1 But some have worried that the use of such a tool would violate or fail to appropriately respect patients’ autonomy. There are, I think, two ways to understand this kind of criticism. First, globally—as a worry that any systematic implementation of the PPP would be problematic on the grounds that it would result in significant or pervasive autonomy violations. Second, locally—as a worry that in some important range of cases, certain uses of the PPP would be problematic on autonomy grounds. Jardas et al, as I read them, address global autonomy-based criticisms, arguing—convincingly, in my view—that there’s no reason to suspect the autonomy concerns raised by the PPP would be so significant and pervasive as to render any implementation of it generally problematic.1 But even with the global criticisms rebuffed, there remains work to be done. Any ethically acceptable implementation of the PPP must be sensitive to the more local autonomy-based criticisms, with restrictions and safeguards in place to ensure respect for autonomy in the kinds of cases in which the use of the PPP might otherwise threaten …. (shrink)

The role and importance of empathy in clinical practice has been widely discussed. This paper focuses on the ideal of clinical empathy, as involving both cognitive understanding and affective resonance. I argue that this account is subject to a number of objections. Affective resonance may serve more as a liability than as a benefit in clinical settings, and utilizing this capacity is not clearly supported by the relevant empirical literature. Instead, I argue that the ideal account of empathy in medicine (...) remains cognitive, though there is a central role for expressing empathic concern toward patients. (shrink)

One natural way to argue for the existence of some subjective constraint on agents’ obligations is to maintain that without that particular constraint, agents will sometimes be obligated to do that which they lack the ability to do. In this paper, I maintain that while such a strategy appears promising, it is fraught with pitfalls. Specifically, I argue that because the truth of an ability ascription depends on an (almost always implicit) characterization of the relevant possibility space, different metaethical accounts (...) take obligation to be constrained by different senses of ability. As a result, what initially looks to be a point of consensus—that ability constrains obligation—turns out to be a point of contention, and arguments with this at the foundation are much more likely to obscure, rather than resolve, metaethical disputes. Despite this, appeals to ability in metaethics aren’t doomed to be fruitless. On the contrary, if we can independently establish a particular sense of ability as the normatively relevant one, then we have good grounds for ruling out metaethical accounts that are inconsistent with it. In the final section, I make just such an argument. What seems right about the thought that ability constrains obligation is that an agent cannot be obligated to do that which her circumstances prevent her from doing. I argue that only a sense of ability that is both epistemically and motivationally restricted adequately respects the limits of agential control. (shrink)

Visiting historical places can give important impulses regarding education of history, society, and politics. While there does exist extensive research on visitors' experiences at memorial sites, little is known about the impact of everyday places holding dark history. Two experimental studies took place in a research institute, a former women's clinic, where in the time of National Socialist dictatorship in Germany hundreds of forced sterilizations took place. Historical awareness was manipulated via systematic variation of prior information. We found partial evidence (...) that historical awareness had a negative effect on personal mood. Awareness of the site's NS history had a negative effect on the perceived valence of related photos but did not influence their qualitative description. Also, there was partial evidence that the site itself was perceived less positively and evoked more arousal when participants were aware of its NS history. Possible reasons are discussed. (shrink)

Reinholds Briefe uber die Kantische Philosophie gehoren zu den wirkungsmachtigsten Produkten seines umfangreichen Schaffens. Von den Zeitgenossen teils mit grosser Begeisterung aufgenommen, tragen sie wesentlich zur Etablierung der ersten Kant-Bewegung bei. Durch ihr Bestreben, die Vernunftkritik als Theorie der moralisch-religiosen Erneuerung zu prasentieren, gelten sie als die brisanteste unter den damaligen philosophischen Neuerscheinungen. Sie sind wegweisend fur einen Kantianismus, der sich im Laufe der 1790er Jahre als eine die politischen Umwalzungen in Frankreich flankierende Geistesrevolution begreift. Der neu herausgegebene Band enthalt (...) zwolf Briefe, welche die auffallendsten Resultate von Kants Vernunftkritik ausgehend von den dringendsten wissenschaftlichen und moralischen Bedurfnissen unserer Zeit darstellen. Der Adressat erfahrt, dass mit Kants Erkenntniskritik und moralischer Neubegrundung der speziellen Metaphysik ein taugliches Mittel zur Bewaltigung gegenwartiger Grundlagenkrisen im Gebiete von Moral, Naturrecht, Theologie und Asthetik bereitsteht. Mit Nachdruck wird das problemlosende Potential von Kants moraltheologischen Resultaten hervorgehoben. In Kants Vernunftglauben und Statuierung eines moralischen Erkenntnisgrundes fur das Dasein Gottes und die Unsterblichkeit der Seele sieht Reinhold die besten Voraussetzungen fur die Beendigung einer Reihe aufklarungshemmender Debatten. Im Visier steht allem voran der als Pantheismusstreit beruhmt gewordene Disput zwischen Mendelssohn und Jacobi, in dessen Einflussbereich ein wenig ergiebiger Kampf zwischen Naturalisten und Supernaturalisten dominant werden sollte. Die Darstellung geschichtlicher Kontexte zur Idee der Unsterblichkeit der Seele und die eingehende Auseinandersetzung mit den antiken Seelenlehren kulminieren in der These, durch Kants Kritik und Neufundierung der rationalen Psychologie konne auch der bisherige, Antike und Neuzeit durchziehende Gegensatz zwischen Spiritualisten und Materialisten als aufgelost gelten. Wiederholt wird zu Reflexionen uber die Geschichte der Menschheit angesetzt, die deutlich machen, dass Reinhold das Geschichtsbild der Illuminaten mehr und mehr in Anlehnung an Lessings Idee einer kommenden Menschheitsepoche des dritten Evangeliums sowie an Kants Vision eines weltburgerlichen Endzustandes vortragt. Die Neuedition ist mit einer ausfuhrlichen Einleitung und einem Kommentar versehen. In diesen Teilen wird unter anderem auf die Entstehungsgeschichte der Briefe, auf Reinholds Kant-Rezeption sowie auf sein Kant-Verstandnis, das mit der damals gangigen Ansicht uber den Alleszermalmer kontrastiert, eingegangen. Vermerkt werden zudem inhaltlich relevante Abweichungen von fruheren Fassungen der in den Band von 1790 eingeflossenen Textteile. (shrink)

Affective empathy has been variously characterized. First, I argue that we have reasons to prefer a narrower account of affective empathy, which requires the cognitive mechanisms of perspective-taking. Second, I mount a challenge to the standard account of affective matching thought to be required for affective empathy. On one widely held view, affective empathy requires an actual affective match between the subject and the target of empathy. I reject this view. While empathy often involves an actual match, we also count (...) as empathizing with the target if we share the fitting state in their situation. This wider account better captures a number of plausible cases of empathy, and it also better explains why we care about affective empathy. (shrink)

Prediction-based decisions, which are often made by utilizing the tools of machine learning, influence nearly all facets of modern life. Ethical concerns about this widespread practice have given rise to the field of fair machine learning and a number of fairness measures, mathematically precise definitions of fairness that purport to determine whether a given prediction-based decision system is fair. Following Reuben Binns (2017), we take ‘fairness’ in this context to be a placeholder for a variety of normative egalitarian considerations. We (...) explore a few fairness measures to suss out their egalitarian roots and evaluate them, both as formalizations of egalitarian ideas and as assertions of what fairness demands of predictive systems. We pay special attention to a recent and popular fairness measure, counterfactual fairness, which holds that a prediction about an individual is fair if it is the same in the actual world and any counterfactual world where the individual belongs to a different demographic group (cf. Kusner et al. (2018)). (shrink)

This paper addresses the issue of narrative influence on knowledge acquisition in science education. Special characteristics of narratives and of narrative processing are compared to characteristics and processing of traditional expository educational materials. This paper goes beyond the existing literature on processing of media presentations that combine narrative and educational contents. Effects of four distinctive narrative features – dramatization, emotionalization, personalization, and fictionalization – are discussed with regard to their influence on single steps in knowledge acquisition to explain the superiority (...) of narratives over expository material found in some studies. The need for a model describing the complex relationships between the effects of the single narrative characteristics on knowledge acquisition is proposed. (shrink)

Zum I. Kapitel 1 Diesen hier nur skizzierten Strukturzusammenhang von Fragehinsichten und Sachbezügen, innerhalb dessen die Politische Philosophie ihren Ort gewinnt, hat der Verf des näheren darzulegen versucht in einem Aufsatz Die Staatsphilosophie im Verhältnis zur Politik als Wissenschaft, in: Dieter Oberndörfer (Hrsg.), Wissenschaftliche Politik. Eine Einführung in Grundfragen ihrer Tradition und Theorie. Freiburg i. Br. 1962, S. 153-195. Vgl. dazu insbesondere auch Arnold Bergslraesser, Politik in Wissenschaft und Bildung. Schriften und Reden. Freiburg i. Br. 1961, S. 17-29 (Die Stellung (...) der Politik unter den Wissen schaften); Dieter Oberndärfer, Politik als praktische Wissenschaft, in dem oben angeführten Band, S. 9-58, bes. S. 37ff. ; Olto Heinrich von der GablenlZ, Politische Wissenschaft und Philosophie, in: Politische Vierteljahresschrift 1, 1960/61, S. 4-11; H.R.G. Greaves, Grundlagen der Politischen Theorie. Neuwied-Berlin 1960 sowie die Arbeiten von Hans Barlh, Helmut Kuhn, Max Müller (vgl. Anm. 6, Nr. 7), Joachim Ritter (zu Aristoteles) und Leo Slrauss, die zu den wenigen gehören, die heute noch von der Philosophie selbst aus den Problembereich der Praktischen und Politischen Philosophie in einem unserem Ver ständnis verwandten Sinne zu erörtern und grundzulegen suchen (s. Lit.-Verz.). Es sei auch auf die unter diesem Betracht in Frage kommenden Publikationen Hannah Arendts hingewiesen. Siehe außerdem unsere Angaben unter Anm. 4 und 5.-In ein analoges Ver hältnis setzt Helmut Schelsky (Ortsbestimmung der deutschen Soziologie. Düsseldorf Köln 1959) Soziologie, philosophische Theorie der Gesellschaft und allgemeine Philosophie zueinander. (shrink)

Pickering, Newton-Howes, and Young argue for externalism about competence—the view that “welfare judgments are part of judgments about competence” and posit an “explanatory connection” betwe...

This article discusses John Stuart Mill's voluntary slavery argument in On Liberty. The author shows that standard interpretations of the argument rely on the assumption that part of Mill's objection to voluntary slavery is the permanent nature of the decision. However, in correspondence, Mill also objects to voluntary ‘coolie’ labour contracts, which he regards as a form of slavery. This produces difficulties for standard interpretations of the voluntary slavery argument. Finally, the author provides a revised interpretation of Mill's argument to (...) solve this problem. (shrink)

This article addresses ethical concerns with the use of electronic health records (EHRs) by physicians in clinical practice. It presents arguments for two claims. First, requiring physicians to maintain patient EHRs for medically unnecessary tasks is likely contributing to increased burnout, decreased quality of care, and potential risks to patient safety. Second, medical institutions have ethical reasons to employ medical scribes to maintain patient EHRs. Finally, this article reviews central objections to employing medical scribes and provides responses to each.