Early in the COVID-19 pandemic there was widespread concern that healthcare systems would be overwhelmed, and specifically, that there would be insufficient critical care capacity in terms of beds, ventilators or staff to care for patients. In the UK, this was avoided by a threefold approach involving widespread, rapid expansion of critical care capacity, reduction of healthcare demand from non-COVID-19 sources by temporarily pausing much of normal healthcare delivery, and by governmental and societal responses that reduced demand through national lockdown. (...) Despite high-level documents designed to help manage limited critical care capacity, none provided sufficient operational direction to enable use at the bedside in situations requiring triage. We present and describe the development of a structured process for fair allocation of critical care resources in the setting of insufficient capacity. The document combines a wide variety of factors known to impact on outcome from critical illness, integrated with broad-based clinical judgement to enable structured, explicit, transparent decision-making founded on robust ethical principles. It aims to improve communication and allocate resources fairly, while avoiding triage decisions based on a single disease, comorbidity, patient age or degree of frailty. It is designed to support and document decision-making. The document has not been needed to date, nor adopted as hospital policy. However, as the pandemic evolves, the resumption of necessary non-COVID-19 healthcare and economic activity mean capacity issues and the potential need for triage may yet return. The document is presented as a starting point for stakeholder feedback and discussion. (shrink)

This chapter argues that Kant’s aesthetic theory of the sublime has particular relevance for his ethics of virtue. Kant contends that our readiness to revel in natural sublimity depends upon a background commitment to moral ends. Further lessons about the emotional register of the sublime allow us to understand how Kant can plausibly contend that the temperament of virtue is both sublime and joyous at the same time.

It has been insufficiently remarked that Murdoch deems “Kant’s ethical theory” to be “one of the most beautiful and exciting things in the whole of philosophy” in her 1959 essay “The Sublime and the Good”. Murdoch specifically has in mind the connection between Kant’s ethics and his theory of the sublime, which runs via the moral feeling of respect (Achtung). The chapter examines Murdoch’s interest in Kant on this point as a way to tease out the range of issues that (...) complicate Kant’s significance for the development of Murdoch’s distinctive conception of ethics as it is articulated in _The Sovereignty of Good_ and earlier essays. It focuses on her particular concerns about the moral dangers of consolation, and why this led her to propose reworking the Kantian theory of the sublime as a theory of art, and specifically of tragedy. (shrink)

Conceptual engineering is to be explained by appeal to the externalist distinction between concepts and conceptions. If concepts are determined by non-conceptual relations to objective properties rather than by associated conceptions (whether individual or communal), then topic preservation through semantic change will be possible. The requisite level of objectivity is guaranteed by the possibility of collective error and does not depend on a stronger level of objectivity, such as mind-independence or independence from linguistic or social practice more generally. This means (...) that the requisite level of objectivity is exhibited not only by natural kinds, but also by a wide range of philosophical kinds, social kinds and artefactual kinds. The alternative externalist accounts of conceptual engineering offered by Herman Cappelen and Derek Ball fall back into a kind of descriptivism which is antithetical to externalism and fails to recognise this basic level of objectivity. (shrink)

This Element considers Kant's account of the sublime in the context of his predecessors both in the Anglophone and German rationalist traditions. Since Kant says with evident endorsement that 'we call sublime that which is absolutely great' and nothing in nature can in fact be absolutely great, Kant concludes that strictly speaking what is sublime can only be the human calling to perfect our rational capacity according to the standard of virtue that is thought through the moral law. The Element (...) takes account of the difference between respect and admiration as the two main varieties of sublime feeling, and concludes by considering the role of Stoicism in Kant's account of the sublime, particularly through the channel of Seneca. (shrink)

I discuss the relevance of the current predicament in cosmology to the debate over scientific realism. I argue that the existence of two, empirically successful but ontologically inconsistent cosmological theories presents difficulties for the realist position.

Abstract: My aim is to reconstruct Kant's argument for the principle of the synthetic unity of apperception. I reconstruct Kant's argument in stages, first showing why thinking should be conceived as an activity of synthesis (as opposed to attention), and then showing why the unity or coherence of a subject's representations should depend upon an a priori synthesis. The guiding thread of my account is Kant's conception of enlightenment: as I suggest, the philosophy of mind advanced in the Deduction belongs (...) to an enlightenment epistemology. Kant's conception of enlightenment turns on the requirement that a subject be able to recognize herself as the source of her cognitions. The argument for the apperception principle is reconstructed under the guidance of this conception of the ideal of enlightenment. (shrink)

This article responds to Professor Romano’s piece in this issue. It concerns our ongoing debate with regard to the desirability of permitting issuers to choose the securities regulation regime by which they are bound. Romano favors issuer choice, arguing that it would result in jurisdictional competition to offer issuers share value maximizing regulations. I, in contrast, believe that abandoning the current mandatory system of federal securities disclosure would likely lower, not increase, U.S. welfare. Each issuer, I argue, would select a (...) regime requiring a level of disclosure less than is socially optimal because its private costs of disclosure would be greater than the social costs of such disclosure. Professor Romano and I agree on most of the basic analytic building blocks for deciding whether issuer choice is a desirable reform: belief in analyzing the problem in terms of the broadly accepted principles of modern financial economics; recognition that disclosure has costs as well as benefits; and acknowledgment that incentives exist for issuers to provide at least some disclosure. We nevertheless reach the opposite conclusion on the desirability of issuer choice. To start, Romano believes that issuers’ private costs of disclosure will not generally be greater than the social costs of such disclosure, whereas I show they will be. Romano argues as well that this is a special case in which any divergence of private and social costs that does exist will not lead to a market failure, at least one possibly correctable by public regulation. I show her argument to be unpersuasive. Finally, Romano interprets the existing empirical evidence as proving mandatory disclosure’s lack of social value, while I show that the evidence in fact does not point in either direction. Where, as here, the theoretical case for the existence of a market failure is strong and the current program for dealing with it is widely admired, the advocate of change should have the burden of proof. Professor Romano has not met this burden. If she is serious about advancing her proposal for issuer choice, she needs to show that despite the market failure inherent in issuer choice, there is inevitably an even greater failure in the regulatory response. Absent such a showing, mandatory disclosure should be retained. (shrink)

We sometimes strive to achieve difficult goals when our evidence suggests that success is unlikely – not just because it will require strength of will, but because we are targets of prejudice and discrimination or because success will require unusual ability. Optimism about one’s prospects can be useful for persevering in these cases. That said, excessive optimism can be dangerous; when our evidence is unfavourable, we should be at most agnostic about whether we will succeed. This paper explores the nature (...) and rational significance of agnostic practical commitments. Most importantly, the rationality of striving against the odds can depend on investing in a plan for failure: a plan B. I aim to make headway on an account of what backup plans are, how they are related to primary plans, and whether the standard norms of plan rationality apply to our agnostic commitments. (shrink)

Many of our most important goals require months or even years of effort to achieve, and some never get achieved at all. As social psychologists have lately emphasized, success in pursuing such goals requires the capacity for perseverance, or "grit." Philosophers have had little to say about grit, however, insofar as it differs from more familiar notions of willpower or continence. This leaves us ill-equipped to assess the social and moral implications of promoting grit. We propose that grit has an (...) important epistemic component, in that failures of perseverance are often caused by a significant loss of confidence that one will succeed if one continues to try. Correspondingly, successful exercises of grit often involve a kind of epistemic resilience in the face of failure, injury, rejection, and other setbacks that constitute genuine evidence that success is not forthcoming. Given this, we discuss whether and to what extent displays of grit can be epistemically as well as practically rational. We conclude that they can be (although many are not), and that the rationality of grit will depend partly on features of the context the agent normally finds herself in. In particular, grit-friendly norms of deliberation might be irrational to use in contexts of severe material scarcity or oppression. (shrink)

In Logik der Forschung (1934) and later works, Karl Popper proposed a set of methodological rules for scientists. Among these were requirements that theories should evolve in the direction of increasing content, and that new theories should only be accepted if some of their novel predictions are experimentally confirmed. There are currently two, viable theories of cosmology: the standard cosmological model, and a theory due to Mordehai Milgrom called MOND. Both theories can point to successes and failures, but only MOND (...) has repeatedly made novel predictions that were subsequently found to be correct. Standard-model cosmologists, by contrast, have almost always responded to new observations in a post-hoc manner, adjusting or augmenting their theory as needed to obtain correspondence with the facts. I argue that these methodological differences render a comparison of the two theories in terms of their ‘truthlikeness’ or ‘verisimilitude’ essentially impossible since the two groups of scientists achieve correspondence with the facts in fundamentally different ways, and I suggest that a better guide to the theories’ progress toward the truth might be the methodologies themselves. (shrink)

The idea that virtue can be profitably conceived as a certain sort of skill has a long history. My aim is to examine a neglected episode in this history — one that focuses on the pivotal role that Moses Mendelssohn played in rehabilitating the skill model of virtue for the German rationalist tradition, and Immanuel Kant’s subsequent, yet significantly qualified, endorsement of the idea. Mendelssohn celebrates a certain automatism in the execution of skill, and takes this feature to be instrumental (...) in meeting an objection against perfectionist, agent-based ethics: namely, that a virtuous person would seem to act for the sake of realising his own perfection in everything that he does, thereby taking a morally inappropriate interest in his own character. Kant rejects the automatism featured in Mendelssohn’s account, on grounds that it would make virtue mindless and unreflective. But he does not reject the skill model of virtue wholesale. Rather, he calls for considering how reflection can be embedded in the expression of certain kinds of skill, enabling him to endorse, and arguably adopt, the model on his own terms. (shrink)

Alix Cohen argues that the function of feeling in Kantian psychology is to appraise and orient activity. Thus she sees feeling and agency as importantly connected by Kant’s lights. I endorse this broader claim, but argue that feeling, on her account, cannot do the work of orientation that she assigns to it.

Ducks lay eggs' is a true sentence, and `ducks are female' is a false one. Similarly, `mosquitoes carry the West Nile virus' is obviously true, whereas `mosquitoes don't carry the West Nile virus' is patently false. This is so despite the egg-laying ducks' being a subset of the female ones and despite the number of mosquitoes that don't carry the virus being ninety-nine times the number that do. Puzzling facts such as these have made generic sentences defy adequate semantic treatment. (...) However complex the truth conditions of generics appear to be, though, young children grasp generics more quickly and readily than seemingly simpler quantifiers such as `all' and `some'. I present an account of generics that not only illuminates the strange truth conditions of generics, but also explains how young children find them so comparatively easy to acquire. I then argue that generics give voice to our most cognitively primitive generalizations and that this hypothesis accounts for a variety of facts ranging from acquisition patterns to cross-linguistic data concerning the phonological articulation of operators. I go on to develop an account of the nature of these cognitively fundamental generalizations and argue that this account explains the strange truth-conditional behavior of generics. (shrink)

An examination of the state of journalism and the need for change. For students and professionals on journalism fields.

The increasing workplace use of artificially intelligent (AI) technologies has implications for the experience of meaningful human work. Meaningful work refers to the perception that one’s work has worth, significance, or a higher purpose. The development and organisational deployment of AI is accelerating, but the ways in which this will support or diminish opportunities for meaningful work and the ethical implications of these changes remain under-explored. This conceptual paper is positioned at the intersection of the meaningful work and ethical AI (...) literatures and offers a detailed assessment of the ways in which the deployment of AI can enhance or diminish employees’ experiences of meaningful work. We first outline the nature of meaningful work and draw on philosophical and business ethics accounts to establish its ethical importance. We then explore the impacts of three paths of AI deployment (replacing some tasks, ‘tending the machine’, and amplifying human skills) across five dimensions constituting a holistic account of meaningful work, and finally assess the ethical implications. In doing so we help to contextualise the meaningful work literature for the era of AI, extend the ethical AI literature into the workplace, and conclude with a range of practical implications and future research directions. (shrink)

Some omissions seem to be causes. For example, suppose Barry promises to water Alice’s plant, doesn’t water it, and that the plant then dries up and dies. Barry’s not watering the plant – his omitting to water the plant – caused its death. But there is reason to believe that if omissions are ever causes, then there is far more causation by omission than we ordinarily think. In other words, there is reason to think the following thesis true.

Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary principle), to (...) show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed. (shrink)

Unethical pro-organizational behaviors are unethical, but prosocially-motivated, acts intended to benefit one’s organization. This study examines the extent to which employees are willing to perform UPB to benefit a liked leader. Based on social exchange theory, we hypothesized that LMX would mediate the association of interpersonal justice with UPB willingness. Moral identity and positive reciprocity beliefs were examined as moderators. Higher LMX was significantly and positively related to UPB willingness, and the indirect effect of interpersonal justice on UPB via LMX (...) was significant and positive. These findings suggest that LMX and interpersonal justice could have a previously-unexplored dark side. Moral identity had a negative direct relationship with UPB, but it did not moderate the relationship of LMX with UPB. Thus, LMX facilitates UPB willingness even when employees are high in moral identity. LMX is associated with many positive outcomes, but our results show that high LMX may also increase willingness to perform unethical behaviors to benefit one’s leader. These results contribute to the literature by identifying a potential negative outcome associated with high LMX. (shrink)

Traditionally, discussions of moral participation – and in particular moral agency – have focused on fully formed human actors. There has been some interest in the development of morality in humans, as well as interest in cultural differences when it comes to moral practices, commitments, and actions. However, until relatively recently, there has been little focus on the possibility that nonhuman animals have any role to play in morality, save being the objects of moral concern. Moreover, when nonhuman cases are (...) considered as evidence of moral agency or subjecthood, there has been an anthropocentric tendency to focus on those behaviors that inform our attributions of moral agency to humans. For example, some argue that the ability to evaluate the principles upon which a moral norm is grounded is required for full moral agency. Certainly, if a moral agent must understand what makes an action right or wrong, then most nonhuman animals would not qualify (and perhaps some humans too). However, if we are to understand the evolution of moral psychology and moral practice, we need to turn our attention to the foundations of full moral agency. We must first pay attention to the more broadly normative practices of other animals. Here, we begin that project by considering evidence that great apes and cetaceans participate in normative practices. (shrink)

The prospect of using genome technologies to modify the human germline has raised profound moral disagreement but also emphasizes the need for wide-ranging discussion and a well-informed policy response. The Hinxton Group brought together scientists, ethicists, policymakers, and journal editors for an international, interdisciplinary meeting on this subject. This consensus statement formulated by the group calls for support of genome editing research and the development of a scientific roadmap for safety and efficacy; recognizes the ethical challenges involved in clinical reproductive (...) applications of genome editing but, importantly, rejects the idea that human reproductive germline modification is necessarily morally unacceptable; and highlights the importance of meaningful engagement in discussions of genome editing and the development of regulation and oversight mechanisms to govern future uses of such technologies. (shrink)

The chapter replies to Paul Guyer’s (2020) account of the debate between Mendelssohn and Kant about whether humankind makes continual moral progress. Mendelssohn maintained that progress can only be the remit of individuals, and that humankind only “continually fluctuates within fixed limits”. Kant dubs Mendelssohn’s position “abderitism” and explicitly rejects it. But Guyer contends that Kant’s own theory of freedom commits him, malgré lui, to abderitism. Guyer’s risky interpretive position is not supported by examination of the relevant texts in their (...) intellectual context. I first identify the historical origins of the term abderitism, which here signifies the independence of individual progress from social conditions. By contrast, Kant argues that individual progress cannot be independent of the progress of the species, acting as a corporate agent. This arresting position, I argue, must be understood in light of the Stoic ethical-teleological presuppositions generally accepted in eighteenth-century German discussion of human progress. (shrink)

This chapter offers a sustained analysis of the two major feminist critiques of analytic philosophy of religion: Grace Jantzen’s Becoming Divine and Pamela Sue Anderson’s A Feminist Philosophy of Religion. Jantzen’s project draws on Lacan’s and Irigaray’s account of psycholinguistics to insist that analytic philosophy of religion is thoroughgoingly “phallocentric” and “necrophiliac;” a new “feminine imaginary” is needed to replace its “masculinist” obsession with empirical demonstration and epistemic realism. Anderson’s book mounts a similar critique of the analytic school but is (...) more concerned to expand the understanding of “rationality” found there by means of a revised, feminist Kantianism than it is to reject the discourse altogether. I criticize Jantzen for a “sectarian” epistemology that ironically reinstates the gender binary she seeks to up end; and Anderson for a less than coherent account of “standpoint epistemology” which appears to undo her own original appeal to “gender.” I argue, instead, that recent trends in analytic philosophy of religion have already suggested an implicit “turn to gender” which, if made more explicit, can enable a fruitful interaction with feminist thought. (shrink)

The first major publication in English on the bamboo slips excavated from a late fourth century B.C. Chu-state tomb at Guodian, Hubei, in 1993. The slip texts include both Daoist and Confucian works, many previously unknown. Thie monograph is a full account of the international conference held on these texts, at which leading scholars from China, the United States, Europe, and Japan analyzed the Laozi materials and a previously unknown cosmological text. In addition, the contents include nine essays on topics (...) such as the archaeological background of the discovery, conservation of the slip-texts, and the relation of the Guodian Laozi materials to the received Laozi text. An annotated edition of the Guodian Laozi materials and the cosmological text are included, as well as a critical bibliography with summary of Chinese scholarship on the Guodian texts in the year following the conference. (shrink)

Since Mill's seminal work On Liberty, philosophers and political theorists have accepted that we should respect the decisions of individual agents when those decisions affect no one other than themselves. Indeed, to respect autonomy is often understood to be the chief way to bear witness to the intrinsic value of persons. In this book, Sarah Conly rejects the idea of autonomy as inviolable. Drawing on sources from behavioural economics and social psychology, she argues that we are so often irrational (...) in making our decisions that our autonomous choices often undercut the achievement of our own goals. Thus in many cases it would advance our goals more effectively if government were to prevent us from acting in accordance with our decisions. Her argument challenges widely held views of moral agency, democratic values and the public/private distinction, and will interest readers in ethics, political philosophy, political theory and philosophy of law. (shrink)

A methodology of science must satisfy two requirements: (i) It must be ampliative: the theories which it generates must make statements that go far beyond any data or observations that may have motivated those theories in the first place. (ii) It must be epistemically probative: it must somehow provide a warrant for believing that the theories so produced are correct, or at least partially correct, even if they can never be fully confirmed. These two requirements pull in opposite directions, and (...) attempts to specify the “scientific method” often focus on one to the exclusion of the other. On a few points there now exists something approaching a consensus. (i) Scientific hypotheses — including, particularly, statements about unobserved or unobservable entities or mechanisms — remain conjectural, no matter how frequently predictions based on those hypotheses are found to coincide with data. (ii) A good (best?) indicator of a theory’s verisimilitude is its ability to successfully predict phenomena which it was not specifically designed to predict. I discuss these ideas with particular reference to cosmological theories. (shrink)

Advances in AI are powering increasingly precise and widespread computational propaganda, posing serious threats to national security. The military and intelligence communities are starting to discuss ways to engage in this space, but the path forward is still unclear. These developments raise pressing ethical questions, about which existing ethics frameworks are silent. Understanding these challenges through the lens of “cognitive security,” we argue, offers a promising approach.

Introduction: Thinking, writing, and reading about the real -- Dialectic and the real : Lacan, Hegel, and the alchemy of après-coup -- 'Reality' and the real : culture as anamorphosis -- The real of sexual difference : imagining, thinking, being -- Ethics and the real : the ungodly virtues of psychoanalysis -- Politics, or, the art of the impossible.

When we define something as a crime, we generally thereby criminalize the attempt to commit that crime. However, it is a vexing puzzle to specify what must be the case in order for a criminal attempt to have occurred, given that the results element of the crime fails to come about. I argue that the philosophy of action can assist the criminal law in clarifying what kinds of events are properly categorized as criminal attempts. A natural thought is that this (...) project should take the form of specifying what it is in general to attempt or try to perform an action, and then to define criminal attempts as attempts to commit crimes. Focusing on Gideon Yaffe's resourceful work in Attempts (Oxford University Press, 2010) as an example of this strategy, I argue that it results in a view that is overly inclusive: one will count as trying to commit a crime even in the far remote preparatory stages that we in fact have good reason not to criminalize. I offer an alternative proposal to distinguish between mere preparations and genuine attempts that has its basis not in trying, but doing: a criminal attempt is underway once what the agent is doing is a crime. Working out the details of this schema turns out to have important implications for action theory. A recently burgeoning view known as Naive Action Theory holds that all action can be explained by appeal to some further thing that the agent is doing, and that that the same explanatory nexus is at work even when we appeal to what the agent is intending, trying, or preparing to do -- these notions do explanatory work because they too refer to actions that are in progress, albeit in their infancy. If this is right, than the notion of 'doing' will also be too inclusive for the purposes of the criminal law. I argue that we should draw the reverse conclusion: the distinctions between pure intending, trying, preparing, and doing serve an important purpose in the criminal law, and this fact lends support to the view that they are genuine metaphysical and explanatory distinctions. (shrink)

Cyberfeminism and Artificial Life examines construction, manipulation and re-definition of life in contemporary technoscientific culture. It takes a critical political view of the concept of life as information, tracing this through the new biology and the changing discipline of artificial life and its manifestation in art, language, literature, commerce and entertainment. From cloning to computer games, and incorporating an analysis of hardware, software and 'wetware', Sarah Kember demonstrates how this relatively marginal field connects with, and connects up global networks (...) of information systems. As well as offering suggestions for the evolution of [cyber]feminism in Alife environments, the author identifies the emergence of posthumanism; an ethics of the posthuman subject mobilized in the tension between cold war and post-cold war politics, psychological and biological machines, centralized and de-centralized control, top-down and bottom-up processing, autonomous and autopoietic organisms, cloning and transgenesis, species-self and other species. Ultimately, this book aims to re-focus concern on the ethics rather than on the 'nature' of life-as-it-could-be. (shrink)

As the usual regulatory framework did not fit well during the last Ebola outbreak, innovative thinking still needed. In the absence of an outbreak, randomised controlled trials of clinical efficacy in humans cannot be done, while during an outbreak such trials will continue to face significant practical, philosophical, and ethical challenges. This article argues that researchers should also test the safety and effectiveness of novel vaccines in wild apes by employing a pluralistic approach to evidence. There are three reasons to (...) test vaccines in wild populations of apes: i) protect apes; ii) reduce Ebola transmission from wild animals to humans; and iii) accelerate vaccine development and licensing for humans. Data obtained from studies of vaccines among wild apes and chimpanzees may even be considered sufficient for licensing new vaccines for humans. This strategy will serve to benefit both wild apes and humans. (shrink)

This indispensible collection brings together feminist theory and cultural studies, looking at issues such as pop culture and the media, science and technology, ...

Artificially intelligent (AI) technologies are increasingly being used in many workplaces. It is recognised that there are ethical dimensions to the ways in which organisations implement AI alongside, or substituting for, their human workforces. How will these technologically driven disruptions impact the employee–employer exchange? We provide one way to explore this question by drawing on scholarship linking Integrative Social Contracts Theory (ISCT) to the psychological contract (PC). Using ISCT, we show that the macrosocial contract’s ethical AI norms of beneficence, non-maleficence, (...) autonomy, justice, and explicability can feed into national- and organisational-level microsocial contracts. We also outline the role of employees’ technology frames in this process. We then use an illustrative example to demonstrate how this multilevel normative background helps to inform the content of individuals’ PCs in the context of working with AI technologies. (shrink)

Gils-Schmidt and Salloch recognise that human and climate health are inextricably linked, and that mitigating healthcare-associated climate harms is essential for protecting human health.1 They argue that physicians have a duty to consider how their own practices contribute to climate change, including during their interactions with patients. Acknowledging the potential for conflicts between this duty and the provision of individual patient care, they propose the application of Korsgaard’s neo-Kantian account of practical identities to help navigate such scenarios. In this commentary, (...) we argue that by focusing attention on this physician–patient level, the authors overlook the complexity of climate change, both within the healthcare sector and beyond. We recognise the importance of individual agency in tackling this issue, and we also recognise that the authors do briefly acknowledge the importance of considering these broader complexities; however, we emphasise the need for climate and health discussions/action to be situated in a wider framework of systemic change. Our concern is that overemphasis on patient-level interactions risks normalising the prioritisation of individual-level approaches to addressing climate change, detracting from such a broader approach. Physician training emphasises the need for trust, confidentiality and shared decision-making in the doctor–patient relationship. …. (shrink)