There are at least a few plausible grounds for our use of the term Beta in our title, notwithstanding that there is a key departure, in our framework, from classical Beta Existential Graphs. The situation, in brief, is as follows.The reader accustomed to Peirce’s graphical development of quantificational logic may, if desired, continue to think of formulas being written on a “sheet of assertion.” We retain the “cut” notation for negation and continue to represent conjunction simply by juxtaposition of diagrams. (...) However, on the side of departure, we dispense with the sometimes problematic “lines of identity” of classical Beta and instead represent a quantification by a.. (shrink)

For over three decades, clinical ethicists in the United States have recorded their consulting activities to supplement documentation in the medical record, often using locally developed instrument...

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

This paper considers the view that medicine is both “science” and “art.” It is argued that on this view certain clinical knowledge – of patients’ histories, values, and preferences, and how to integrate them in decision-making – cannot be scientific knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as “scientific” knowledge. I claim there are varying degrees of (...) objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the “art” of medicine is amenable to objective methods of inquiry, and so, may be understood as “science”. As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unified, multifaceted epistemology of medicine should be developed to replace it. (shrink)

Although ethics is an essential component of undergraduate medical education, research suggests current medical ethics curricula face considerable challenges in improving students’ ethical reasoning. This paper discusses these challenges and introduces a promising new mode of graduate and professional ethics instruction for overcoming them. We begin by describing common ethics curricula, focusing in particular on established problems with current approaches. Next, we describe a novel method of ethics education and assessment for medical students that we have devised, the Medical Ethics (...) Bowl. Finally, we suggest pedagogical advantages to MEBs when compared to other ethics curricula. (shrink)

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles help to (...) understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (shrink)

Responding to research indicating unsettling results with regard to the ability of University students to recognize and reflect on questions of morality, this paper aims to discuss these issues and to introduce a promising mode of ethics instruction for overcoming such challenges. The Curricular Ethics Bowl (CEB) is a method of ethics education and assessment for a wide range of students and is a descendent of the Medical Ethics Bowl (MEB) (Merrick et al., “Introducing the Medical Ethics Bowl”). We seek (...) in this article to show the similarities of CEB to MEB and to distinguish this model from the Intercollegiate Ethics Bowl (ICEB) sponsored by the Association for Professional and Practical Ethics (Landenson 2001). The CEB institutionalizes this mode of ethics education at the program, rather than at the individual course level, and shows advantages over other ethics curricula. (shrink)

Responding to research indicating unsettling results with regard to the ability of University students to recognize and reflect on questions of morality, this paper aims to discuss these issues and to introduce a promising mode of ethics instruction for overcoming such challenges. The Curricular Ethics Bowl (CEB) is a method of ethics education and assessment for a wide range of students and is a descendent of the Medical Ethics Bowl (MEB) (Merrick et al., “Introducing the Medical Ethics Bowl”). We seek (...) in this article to show the similarities of CEB to MEB and to distinguish this model from the Intercollegiate Ethics Bowl (ICEB) sponsored by the Association for Professional and Practical Ethics (Landenson 2001). The CEB institutionalizes this mode of ethics education at the program, rather than at the individual course level, and shows advantages over other ethics curricula. (shrink)

This paper explores how current United States policies for funding nonreproductive cloning are justified and argues against that justification. I show that a common conceptual framework underlies the national prohibition on the use of public funds for cloning research, which I call the simple argument. This argument rests on two premises: that research harming human embryos is unethical and that embryos produced via fertilization are identical to those produced via cloning. In response to the simple argument, I challenge the latter (...) premise. I demonstrate there are important ontological differences between human embryos (produced via fertilization) and clone embryos (produced via cloning). After considering the implications my argument has for the morality of publicly funding cloning for potential therapeutic purposes and potential responses to my position, I conclude that such funding is not only ethically permissible, but also humane national policy. (shrink)

No abstract available. First paragraph: In this issue’s target article, Stier and Schoene-Siefert purport to ‘depotentialize’ the argument from potentiality based on their claim that any human cell may be “converted” into a morally significant entity, and consequently, the argument from potentiality finally succumbs to a reductio ad absurdum. I aim to convey two reasons for skepticism about the innocuousness of the notion of cell convertibility, and hence, the cogency of their argument.

This paper proposes a Rawlsian conception of moral justification as a social activity. Through a close reading, Rawls’ view of ethical justification is shown to be significantly more dialogical and deliberative than is commonly appreciated. The result is a view that emphasizes the social nature of ethical justification and identifies information sharing between persons as the crux of justification in metaethics, in contrast to normative ethics. I call it Rawlsian reflective equilibrium to distinguish it from other varieties.

The concepts, health and disease, have received considerable attention in philosophy of medicine. The first goal of this paper is to demonstrate that three prominent analyses of health and disease can be synthesized if one assumes that medicine is both theoretical and practical, and, therefore, value-laden. The second goal of this paper is to give an account of one route by which evaluative and factual claims come together in medical knowledge, during medical conversations between clinicians and patients. Accomplishing these two (...) goals together yields an epistemology of medicine that moves past debates about health and disease. On this view the conceptual foundations of medicine rest on subjective and objective claims about health states and their evaluations. By making subjective and objective claims, patients and clinicians negotiate whether patients’ health states are sufficiently dysfunctional to warrant medical intervention, leading to the formation of complementary illness narratives, which are anchored to different degrees in personal experience and medical theory. On this view, health and disease are supplanted as the conceptual foundations of medicine. Rather, medicine is better understood in terms of two basic aims: The first aim of medicine is to fully understand patients in scientific and personal terms; the second aim is to intervene upon patients’ states of illness in ways that are consistent with full understanding. (shrink)

Recent work on the semantic view of scientific theories is highly critical of the position. This paper identifies two common criticisms of the view, describes two popular alternatives for responding to them, and argues those responses do not suffice. Subsequently, it argues that retuning to Patrick Suppes’ interpretation of the position provides the conceptual resources for rehabilitating the semantic view.

This paper explores how current United States policies for funding nonreproductive cloning are justified and argues against that justification. I show that a common conceptual framework underlies the national prohibition on the use of public funds for cloning research, which I call the simple argument. This argument rests on two premises: that research harming human embryos is unethical and that embryos produced via fertilization are identical to those produced via cloning. In response to the simple argument, I challenge the latter (...) premise. I demonstrate there are important ontological differences between human embryos (produced via fertilization) and clone embryos (produced via cloning). After considering the implications my argument has for the morality of publicly funding cloning for potential therapeutic purposes and potential responses to my position, I conclude that such funding is not only ethically permissible, but also humane national policy. (shrink)

Philosophers of science deploy mathematical models to describe epistemic communities, or groups of people creating and sharing knowledge for individual and collective purposes. These models capture...

Ellen Fox and collaborators have produced the most detailed description of healthcare ethics practices in the United States available. Some findings are shocking for anyone committed to promoting q...

BackgroundNo standard method exists to assess how many consults a healthcare ethics consultation (HCEC) service should perform. To address this, we developed a method to estimate the volume of HCEC services based on a mixed-methods approach that included a systematic review and survey data on the volume of consult services requested.MethodsOur investigation included a systematic review of studies that reported the volume of HCEC services that were requested from 2000 to 2017, institutional surveys, and statistical analyses that estimated the volume (...) of HCEC services that were adjusted to the size of the hospitals in the survey and to population acuity.ResultsWe contacted the authors of 19 studies that met our inclusion criteria; 17 authors responded to the institutional survey and five provided annualized data points. We found that standard methods of reporting the volume of HCEC services led to inaccuracies in estimating the growth of HCEC services over time. To rectify this, we proposed two means to estimate volume based on either the service goals of HCEC services or hospital size and acuity.DiscussionThe statistical limitations of our study highlight the need to standardize the sharing and reporting of data in clinical ethics. Future work should further standardize methods of HCEC quality assessment using measures similar to those we describe. (shrink)

With the increasing professionalization of clinical ethics, some hospitals and health systems utilize both ethics committees and professional clinical ethicists to address their ethics needs. Drawing upon historical critiques of ethics committees and their own experiences, the authors argue that, in ethics programs with one or more professional clinical ethicists, ethics committees should be dissolved when they fail to meet minimum standards of effectiveness. The authors outline several criteria for assessing effectiveness, describe the benefits of a model that places primary (...) responsibility for ethics work with professional clinical ethicists—the PCE-primary model, and offer suggestions for alternative ethics program structures that empower healthcare professionals to contribute to ethics work in ways more tailored to their strengths and skills while minimizing the shortcomings of ethics committees. (shrink)

Harrowing stories reported in the media describe Covid‐19 ravaging through families. This essay reports professional experiences of this phenomenon, family clustering, as encountered during the pandemic's spread across Southern California. We identify three ethical challenges following from it: Family clustering impedes shared decision‐making by reducing available surrogate decision‐makers for incapacitated patients, increases the emotional burdens of surrogate decision‐makers, and exacerbates health disparities for and the suffering of people of color at increased likelihood of experiencing family clustering. We propose that, in (...) response to these challenges, efforts in advance care planning be expanded, emotional support offered to surrogates and family members be increased, more robust state guidance be issued on ethical decision‐making for unrepresented patients, ethics consultation be increased in the setting of conflict following from family clustering dynamics, and health care professionals pay more attention to systemic and personal racial biases and inequities that affect patient care and the surrogate experience. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 34.3 (2001) 207-224 [Access article in PDF] Virtual Witnessing and the Role of the Reader in a New Natural Philosophy Richard Cunningham [Figures]How did the self-described new natural philosophies of the early modern period displace other philosophic (moral, ethical, legal), and specifically religious, discourses as the locus of truth in our culture? Natural philosophy's rejection of disputation and of revelation as means of producing truth (...) in favor of the "discovery" of truth was more accurately an introduction of the invention of truth than of its discovery, and this invention demanded the creation of and participation of a certain kind of reader. Rhetorical examination of the early modern magnetic philosopher William Gilbert's most influential work, De Magnete, 1 will help us understand the "paradigm change," to use Thomas Kuhn's oft-misquoted term, 2 from a culture that accepted probabilistic truth in the natural realm to one that expected moral certainty, from a culture that accepted revelation as a legitimate means of access to truth to one that increasingly recognized only the "discovery" of truth through sensual experience disciplined through experiment.One way this paradigm change was effected was through the inclusion of the reader as an active participant in the new natural philosophies. The reader was included in the new natural philosophies by engendering in him desires for particular forms of knowledge and particular ways of attaining that knowledge. Peter Dear notes that "in the seventeenth century old practices changed and new ones appeared. Those changing practices represent shifts in the meaning of experience itself" (12-13), and he then asks the question that might well have been on the tongues of many as the old practices gave way to the new: "how can a universal knowledge-claim about the natural world be justified on the basis of singular items of individual experience?" (13). A crucially important way to justify the universal knowledge-claim on singular items of individual experience [End Page 207] was through the employment of a technique Steven Shapin and Simon Schaffer have labeled "virtual witnessing" (60-65). Briefly, "virtual witnessing" describes the use of linguistic resources to produce a vicarious experience enabling a reader to confer agreement as though she had actually been present when an experiment was conducted. Virtual witnessing alone, however, cannot explain how the scientific became the dominant truth-producing paradigm in our culture. Virtual witnessing intermingled with a variety of other elements in early modern natural philosophy to encourage readers to participate in the invention of "true" accounts of the world in which we live. In this article I will apply the tools of rhetorical analysis as I use the example of De Magnete to elaborate on how a Foucauldian form of disciplinary impulse combined in the early modern period with the technology of virtual witnessing to create an audience inculcated with desire, interest, and belief in the new natural philosophy, which had to precede and accompany expansion of the scientific into the dominant truth-producing paradigm it has long since become.For the sake of clarity I should expound upon the two key elements of my argument, "discipline," in the Foucauldian sense in which I use the term, and "virtual witnessing." According to Michel Foucault, "discipline" is "a political anatomy of detail... situated on the axis that links the singular and the multiple" (139-49), and I argue that this point, on the "axis that links the singular and the multiple," is exactly the point that enables modern science. William Gilbert's De Magnete can help us understand how knowledge and power--or epistemê and technê, to use another, perhaps more rhetorically inflected, vocabulary--combined in the early modern period to produce the effects that would become those of modern science. Gilbert provides an excellent example of the movement from the production of truth through revelation to the production of truth through discovery and the experimental method. De Magnete persuades its reader by rendering visible a formerly invisible "universal nature," 3 so that truth is no longer warranted by the invisible workings... (shrink)

At the 2022 Clinical Ethics Unconference, the authors perceived a significant lack of racial and ethnic diversity, which was consistent with their experiences in other clinical ethics settings. As a result, they convened a working group to address the pervasive lack of diversity present in the field of clinical ethics and to propose strategies to increase the representation of people from racial and ethnic minority populations. This article identifies the harms associated with the lack of diversity in the healthcare setting (...) and translates these to the field of clinical ethics. The article then proposes a framework that may be used to help diversify the field of clinical ethics. Specifically, the authors identify existing barriers to appropriate diversity, actionable steps to increase diversity, and tools the field can utilize to systematically assess its progress with respect to achieving diversity. (shrink)

Scholars and professional organizations in bioethics describe various approaches to “quality assessment” in clinical ethics. Although much of this work represents significant contributions to the literature, it is not clear that there is a robust and shared understanding of what constitutes “quality” in clinical ethics, what activities should be measured when tracking clinical ethics work, and what metrics should be used when measuring those activities. Further, even the most robust quality assessment efforts to date are idiosyncratic, in that they represent (...) evaluation of single activities or domains of clinical ethics activities, or a range of activities at a single hospital or healthcare system. Countering this trend, in this article we propose a framework for moving beyond our current ways of understanding clinical ethics quality, toward comprehensive quality assessment. We first describe a way to conceptualize quality assessment as a process of measuring disparate, isolated work activities; then, we describe quality assessment in terms of tracking interconnected work activities holistically, across different levels of assessment. We conclude by inviting future efforts in quality improvement to adopt a comprehensive approach to quality assessment into their improvement practices, and offer recommendations for how the field might move in this direction. (shrink)

First published in 1986. Routledge is an imprint of Taylor & Francis, an informa company.

In lieu of an abstract, here is a brief excerpt of the content:Keeping Philosophy in Mind:Shadworth H. Hodgson's Articulation of the Boundaries of Philosophy and ScienceThomas W. StaleyIntroductionShadworth H. Hodgson's (1832–1912) contributions to Victorian intellectual discourse have faded from prominence over the past century. However, despite his current anonymity, Hodgson's case is important to an understanding of the historical split between philosophy and science in late nineteenth century Britain. In particular, his example illuminates the specific role played by developing concepts (...) of the mind in a period of deep transition in the British intellectual community. His virtual disappearance from the record, I contend, is indicative also of the disappearance of his form of philosophy as a vital social project. His ideas, rather than being rejected, were instead largely neglected—they became lost as philosophical discussion moved elsewhere, both conceptually and institutionally. However, in the inaugural volume of Mind in 1876, Hodgson's ideas initially found a prominent place in a central dialogue over the position of philosophy with respect to science. There, and throughout his career, Hodgson engaged in the defense of an intellectual tradition he regarded as under threat from psychological science. Both his particular formulation of an ongoing role for philosophy and his own uneasy position in the intellectual environment of late Victorian Britain shed significant light on an under-examined issue [End Page 289] of the period: the fraught relationship between philosophy and science as competing enterprises engaged in the study of the human mind."Philosophy" and "science" are easily construed as partnered intellectual complexes in modern Western society. However, closer scrutiny of the historical record shows that the two terms—whether as theoretical referents or actors' categories—have often reflected divergent priorities and that transitions from "philosophical" to "scientific" terms have been contentious. In examining the birth of natural science out of natural philosophy during the Enlightenment, the historian Andrew Cunningham has emphasized how the reordering of intellectual fields created new conflictive relationships between philosophy, science, and religion.1 He reminds us that the process of scientific secularization was but one of a set of constitutive shifts among these human activities, and that the earlier natural philosophy thus played by fundamentally different rules than its successor. A similar story can be told about the late nineteenth-century transition I am considering: in a nutshell, to borrow a phrase from Cunningham, men did not start doing mental science until they stopped doing moral philosophy. However, this time, philosophy already stood in competition with existing scientific institutions, sparking a more severe contest for authority. As mental science began to develop along the lines of the natural disciplines, Hodgson and others feared little would remain as a distinctive domain for philosophy as such, moral or otherwise. His efforts on the part of philosophy thus represent one front in an intellectual "turf war"—what recent scholars have called "boundary work," shoring up the institutional positions of different intellectual enterprises competing for authority in the world.2 Gieryn's formative analysis of boundary work was based on the contemporaneous example of John Tyndall's campaign to promote scientific over religious authority in Victorian Britain, but this was much more than a two-way struggle. The early career of Mind bears witness to a closely related, but less discussed, battle for influence between philosophy and science, in which the journal itself served as a critical "boundary object," a medium for enforcement of the distinctions between these two intellectual fields.3 [End Page 290]Thomas Dixon has recently surveyed the origins of this shift. Like Cunningham, Dixon emphasizes the constitutive differences in scope and orientation of the two intellectual enterprises, salient among them the secularization of the new human sciences.4 This process—begun tentatively by Thomas Brown and brought to fruition by Bain, Spencer, and Darwin—involved wholesale shifts in the scholarly linguistic complex, from a set of several mental categories rooted in Christian philosophical categories—affections, passions, sentiments, etc.—to a novel, explicitly "scientific," and singular grouping of emotions. While the older tradition dominant until mid-century had understood the broad range of mental phenomena as largely rational and voluntary, the new emotions were formulated as more circumscribed in purview, subconscious or autonomic in action... (shrink)