BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, 97% (...) of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

BackgroundTo help inform the development of more accessible, acceptable, and effective ethics consultation (EC) training programs, we conducted an EC training needs assessment, exploring ethics practitioners’ opinions on: the relative importance of various EC practitioner competencies; the potential market for EC training (that is, how many individuals would benefit and how much individuals and hospitals would be willing to pay); and the preferred content, format, and characteristics of EC training.MethodsAs part of a multipart study, we surveyed “best informants” who self-identified (...) as the person most actively involved in EC or healthcare ethics in a random sample of 600 U.S. general hospitals, stratified for bed size.ResultsThe competency that was ranked most important for a lead or solo ethics consultant was knowledge of ethics, while common sense was ranked least important. The median estimated number of individuals at each hospital who would benefit from EC training was six at the basic level, three at the advanced level, and two for EC management training. In 19.1 percent of hospitals, respondents thought their hospital would not be willing to pay anything for EC training within the next two years. Respondents thought potential trainees would be likely to participate in EC training on multiple different topics. Opinions varied widely on preferred formats. Most respondents thought it very important to be able to interact with instructors and with other trainees, practice EC skills, receive a certificate for completing EC training, and complete EC training during work hours.ConclusionsThese findings provide U.S. population data that may be useful to healthcare educators and bioethics leaders in their efforts to develop EC training programs and products that match trainees’ preferences and needs. (shrink)

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, these (...) variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity. (shrink)

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

BackgroundWhile previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.MethodsTo address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.ResultsNew findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; (...) 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.ConclusionsThese findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research. (shrink)

BackgroundAdherence to widely accepted practice standards is a frequently used measure of healthcare quality. In the U.S., the most widely recognized authoritative source of practice standards for ethics consultation (EC) is the second edition of the American Society for Bioethics and Humanities’ Core Competencies for Healthcare Ethics Consultation report.MethodsTo determine the extent to which EC practices in U.S. hospitals adhere to these practice standards, we developed and analyzed 12 evaluative measures from a national survey.ResultsOnly three of the 12 standards achieved (...) over 75% adherence with reported EC practices: allowing anyone involved in a case to request an EC (100%), not requiring an attending physician’s permission to conduct an EC (97.6%), and having at least one person on the ethics consultation service (ECS) with advanced level EC proficiency (79.3%).ConclusionsImplications are discussed for achieving consensus on EC standards as they continue to evolve. (shrink)

In an age where issues like climate change and the unintended consequences of technological innovation are high on the ethical and political agenda, questions about the nature and extent of our responsibilities to future generations have never been more important, yet simultaneously so difficult to answer. This book takes a unique approach to the problem by drawing on diverse traditions of thinking about care (including developmental psychology, phenomenology and feminist ethics) to explore the nature and meaning of our relationship with (...) the future. Demonstrating that many influential perspectives on intergenerational ethics, including positions advanced by John Rawls, Brian Barry, and Ulrich Beck are undermined by problems relating to uncertainty, it shows that an approach based on care ethics can confront the uncertain future successfully and give a viable account of the nature and scope of future-oriented responsibilities. (shrink)

This book is available either individually, or as part of the specially-priced Arguments of the Philosphers Collection.

Suppose we believe that God created the world. Then surely we want it to be the case that he intended, in some sense at least, to create THIS world. Moreover, most theists want to hold that God didn't just guess or hope that the world would take one course or another; rather, he KNEW precisely what was going to take place in the world he planned to create. In particular, of each person P, God knew that P was to exist. (...) Call this the "standard" conception. Most theists find the standard conception appealing. Unfortunately, the view seems to conflict with the equally appealing idea — call it "temporal actualism" — that there are no "future" individuals beyond those that already exist in the present moment. For, on this view, for any historical person P, prior to creation, there was no such person as P and hence nothing about P for God to know. Hence, in particular, God couldn't have known that P was to exist. This is of course not a new problem. But past solutions to it are highly problematic. In this paper, after canvassing previous approaches, I will propose a solution that seems to preserve both temporal actualism and a suitably robust form of the standard conception while avoiding the pitfalls of the past. (shrink)

It is often thought that the correct metaphysics and epistemology of reasons will be broadly unified across different kinds of reason: reasons for belief, and reasons for action. This approach is sometimes thought to be undermined by the contrasting natures of belief and of action: whereas belief appears to have the ‘constitutive aim’ of truth (or knowledge), action does not appear to have any such constitutive aim. I develop this disanalogy into a novel challenge to metanormative approaches by thinking about (...) disagreement. The constitutive aim of belief can play a role in adjudicating epistemic disagreements for which there is no analogue in practical disagreements. Consequently, we have more reason, all else being equal, to expect convergence in epistemic judgment than in practical judgment. This represents a prima facie challenge to the metanormative theorist because the extent of (suitably specified) disagreement in an area of thought is of prima facie significance for the metaphysics of that area of thought. (shrink)

Aristotle attaches particular significance to the homonymy of many central concepts in philosophy and science: that is, to the diversity of ways of being common to a single general concept. His preoccupation with homonymy influences his approach to almost every subject that he considers, and it clearly structures the philosophical methodology that he employs both when criticizing others and when advancing his own positive theories. Where there is homonymy there is multiplicity: Aristotle aims to find the order within this multiplicity, (...) and believes that doing so is crucial to scientific inquiry and philosophical progress.Christopher Shields investigates and evaluates Aristotle's approach to questions about homonymy, characterizing the metaphysical and semantic commitments necessary to establish the homonymy of a given concept. Then, in a series of case-studies, Shields examines in detail some of Aristotle's principal applications of homonymy--to the body, sameness and oneness, life, goodness, and being. Shields's aim is not only to give a fuller understanding of Aristotle's methodology and to illuminate his specific doctrines in a variety of areas, but to show that this methodology remains fruitful today. (shrink)

This book offers an historically-informed critical assessment of Dummett's account of abstract objects, examining in detail some of the Fregean presuppositions whilst also engaging with recent work on the problem of abstract entities.

Christopher Hookway presents a series of studies of themes from the work of the great American philosopher and pragmatist, Charles S. Peirce (1839-1913). These themes center on the question of how we are to investigate the world rationally. Hookway shows how Peirce's ideas about this continue to play an important role in contemporary philosophy.

What is required for an individual to entertain a singular thought about an object they have encountered before but that is currently no longer within their perceptual range? More specifically, does the individual have to think about the object as having been encountered in the past? I consider this question against the background of the assumption that non-human animals are cognitively ‘stuck in the present’. Does this mean that, for them, ‘out of sight is out of mind’, as, e.g., Schopenhauer (...) seems to have thought? I suggest an alternative answer, also drawing on some empirical work on animal cognition. (shrink)

Moral error theories are often rejected by appeal to ‘companions in guilt’ arguments. The most popular form of companions in guilt argument takes epistemic reasons for belief as a ‘companion’ and proceeds by analogy. I show that this strategy fails. I claim that the companions in guilt theorist must understand epistemic reasons as evidential support relations if her argument is to be dialectically effective. I then present a dilemma. Either epistemic reasons are evidential support relations or they are not. If (...) they are not, then the companions in guilt argument fails. If they are, then a reduction of epistemic reasons to evidential support relations becomes available and, consequently, epistemic reasons cease to be a viable ‘companion’ for moral reasons. I recommend this structure of argument over existing strategies within the literature and defend my claims against recent objections from companions in guilt theorists. (shrink)

This essay uses citational analyses to argue that most of the philosophers considered "postanalytic" - Wittgenstein, McDowell, Davidson, and Rorty - are not, in fact, genuine figures of rapprochement, since the particular essays cited, and/or the background literature that is cited, are not shared in common between the standard-bearing analytic and continental journals.

Though it is acknowledged that Nietzsche read Ludwig Feuerbach, little attention has been given to the significance of Feuerbach’s anthropological re-imagination of religion for the trajectory of Nietzsche’s own vision for liberated humanity, the Übermensch. For Feuerbach, the Christian religion represents a form of wish-fulfillment and subconscious worship of the human being as divine, where many of the presuppositions of orthodox Christianity (monotheism, human fallenness, other-worldliness, etc.) only impede human flourishing. The acknowledgement of the psychological damage wrought by the scheme (...) and implications of Christian metaphysics is, for Feuerbach and Nietzsche alike, a necessary step in liberating humans from their own self-imposed shackles and enabling the human spirit to actualize its latent potentialities. This paper aims to identify Feuerbachian themes that Nietzsche appropriates for his own purposes in Thus Spoke Zarathustra, attending to Nietzsche’s early reading of Feuerbach’s The Essence of Christianity (1841) during a key period of his intellectual development (1861-1863), and arguing that Feuerbach’s impact on Nietzsche is far more subtle and profound than commonly recognized. (shrink)

Name der Zeitschrift: Archiv für Geschichte der Philosophie Jahrgang: 99 Heft: 4 Seiten: 1-18.

This original new book argues for a reassessment of Plato's challenge to the arts. Plato was the first great figure in Western philosophy to assess the value of the arts; he argued in the Republic that traditionally accepted forms of poetry, drama, and music are unsound. While this view has been widely rejected, Janaway argues that Plato's hostile case is a more coherent and profound challenge to the arts than has sometimes been supposed. Denying that Plato advocates "good art" in (...) any modern sense, Janaway seeks both to understand Plato's critique in the context of his own philosophy and to locate him in today's philosophy of art, showing how issues in aesthetics arise from responses to his charges. (shrink)

This long-awaited new edition contains eight of the dialogues of Plato, and is the first in a new five-volume complete edition of his works in the OCT series.

林毓生先生是研究近、現代中國思想史的著名學者，畢生思考自由、理性、法治、民主等議題，提出過深邃只見解，在中文世界有著廣泛而深刻的影響。《自由的追尋》是他的思想傳記，前半部分著重敘寫林毓生成長與學思之路 ，突出在此道路上曾經對他產生關鍵影響的人與事；後半部分深入探討林毓生學術思想與代表著述，探討其旨意與論證、說明不同論著之間的邏輯關係，並揭示這些學術研究的實質意義，及其與我們這個時代的互動關係。.

Plato is one of the key ancient authors studied by both classicists and philosophers. This long-awaited new edition contains seven of the dialogues of Plato, and is the first in the five-volume complete edition of his works in the Oxford Classical Texts series. The result of many years of painstaking scholarship, the new volume will replace the now nearly 100 year old original edition, and is destined to become just as long-lasting a classic.

Plato's Utopia Recast is an illuminating reappraisal of Plato's later works, which reveals radical changes in his ethical and political theory. Christopher Bobonich examines later dialogues, with a special emphasis upon the Laws, and argues that in these late works, Plato both rethinks and revises the basic ethical and poltical positions that he held in his better-known earlier works, such as the Republic. This book will change our understanding of Plato. His controversial moral and political theory, so influential in (...) Western thought, will henceforth be seen in a new light. (shrink)

DMet 10: Prime matter is the origin of all quantities. Hence it is the origin of every dimension of continuous quantity whatever. ...

Do famous athletes have special obligations to act virtuously? A number of philosophers have investigated this question by examining whether famous athletes are subject to special role model obligations (Wellman 2003; Feezel 2005; Spurgin 2012). In this paper we will take a different approach and give a positive response to this question by arguing for the position that sport and gaming celebrities are ‘ambassadors of the game’: moral agents whose vocations as rule-followers have unique implications for their non-lusory lives. According (...) to this idea, the actions of a game’s players and other stakeholders—especially the actions of its stars—directly affect the value of the game itself, a fact which generates additional moral reasons to behave in a virtuous manner. We will begin by explaining the three main positions one may take with respect to the question: moral exceptionalism, moral generalism, and moral exemplarism. We will argue that no convincing case for moral exemplarism has thus far been made, which gives us reason to look for new ways to defend this position. We then provide our own ‘ambassadors of the game’ account and argue that it gives us good reason to think that sport and game celebrities are subject to special obligations to act virtuously. (shrink)

According to the snapshot view of temporal experience, instances of movement and change cannot, strictly speaking, be objects of sensory perception. Perceptual consciousness instead consists of a succession of individual momentary experiences, none of which is itself an experience of movement or change. The snapshot view is often presented as an intuitively appealing view of the nature of temporal experience, even by philosophers who ultimately reject it. Yet, it is puzzling how this can be so, given that its central claim (...) – that we can never just perceive things moving or changing – clearly flies in the face of our common sense view of the phenomenology of experience. In this paper, I offer a diagnosis of how it is possible that the deep conflict between the snapshot view and our phenomenological intuitions can sometimes go unnoticed. The materials for this diagnosis can, I think, be found in some passages in Thomas Reid’s Essays on the Intellectual Powers of Man, in which he criticises John Locke’s account of the origins of the idea of succession, as presented in chapter 14 of book II of An Essay Concerning Human Understanding. As I argue, a crucial aspect of Reid’s criticisms can be seen to turn on the idea that Locke fails to distinguish between two quite different variants of the snapshot view, which I call the memory theory and the mirroring theory of temporal experience, respectively. It is the failure to distinguish between these two different variants of the snapshot view, I suggest, that can also make the snapshot view appear more compatible with our phenomenological intuitions than it in fact is. (shrink)

According to commonsense psychology, one is conscious of everything that one pays attention to, but one does not pay attention to all the things that one is conscious of. Recent lines of research purport to show that commonsense is mistaken on both of these points: Mack and Rock (1998) tell us that attention is necessary for consciousness, while Kentridge and Heywood (2001) claim that consciousness is not necessary for attention. If these lines of research were successful they would have important (...) implications regarding the prospects of using attention research to inform us about consciousness. The present essay shows that these lines of research are not successful, and that the commonsense picture of the relationship between attention and consciousness can be. (shrink)

The psychological writing of Jung and the post-Jungians is all too often ignored as anachronistic, archaic and mystic. In Jung and the Postmodern, Christopher Hauke challenges this, arguing that Jungian psychology is more relevant now than ever before - not only can it be a response to modernity, but it can offer a critique of modernity and Enlightenment values which brings it in line with the postmodern critique of contemporary culture. After introducing Jungians to postmodern themes in Jameson, Baudrillard, (...) Jencks and Foucault, the author introduces postmodernists to Jung's cultural critique and post-Jungian discussions of representation, individuation, consciousness, and the alternatives to Enlightenment rationality. He also takes a totally fresh approach to topics such as hysteria and the body, Jung and Nietzsche, architecture and affect, Princess Diana and the 'death' of the subject, postmodern science and synchronicity, and to psychosis and alternative 'rationalities'. Jung and the Postmodern is vital reading for everyone interested in contemporary culture, not only Jungians and other psychotherapists who want to explore the social relevance of their discipline, but anyone who shares a assionate concern for where we are heading in postmodern times. (shrink)

What is involved in the consciousness of a conscious, "occurrent" propositional attitude, such as a thought, a sudden conjecture or a conscious decision? And what is the relation of such consciousness to attention? I hope the intrinsic interest of these questions provides sufficient motivation to allow me to start by addressing them. We will not have a full understanding either of consciousness in general, nor of attention in general, until we have answers to these questions. I think there are constitutive (...) features of these states which can be identified by broadly philosophical investigation, and in the early part of this paper I will try to do some of that identification. -/- Beyond the intrinsic interest of the topic, the nature of such conscious attitudes is highly pertinent to a philosophical account of psychological self-knowledge. So I will also say something about the significance of the constitutive features of these conscious attitudes for a philosophical account of how it can be that a thinker has a distinctive kind of knowledge of some of his mental states. The general challenge in this area is to find anything intermediate between the unexceptionable but uninformative, on the one hand, and the absolutely unbelievable on the other. (shrink)

This paper examines the debate between permissive and impermissive forms of Bayesianism. It briefly discusses some considerations that might be offered by both sides of the debate, and then replies to some new arguments in favor of impermissivism offered by Roger White. First, it argues that White’s (Oxford studies in epistemology, vol 3. Oxford University Press, Oxford, pp 161–186, 2010) defense of Indifference Principles is unsuccessful. Second, it contends that White’s (Philos Perspect 19:445–459, 2005) arguments against permissive views do not (...) succeed. (shrink)

In apparent motion experiments, participants are presented with what is in fact a succession of two brief stationary stimuli at two different locations, but they report an impression of movement. Philosophers have recently debated whether apparent motion provides evidence in favour of a particular account of the nature of temporal experience. I argue that the existing discussion in this area is premised on a mistaken view of the phenomenology of apparent motion and, as a result, the space of possible philosophical (...) positions has not yet been fully explored. In particular, I argue that the existence of apparent motion is compatible with an account of the nature of temporal experience that involves a version of direct realism. In doing so, I also argue against two other claims often made about apparent motion, viz. that apparent motion is the psychological phenomenon that underlies motion experience in the cinema, and that apparent motion is subjectively indistinguishable from real motion. (shrink)

This article presents an overview of the basic philosophical motivations for, and some recent work in, modal set theory.

Representation theorems are often taken to provide the foundations for decision theory. First, they are taken to characterize degrees of belief and utilities. Second, they are taken to justify two fundamental rules of rationality: that we should have probabilistic degrees of belief and that we should act as expected utility maximizers. We argue that representation theorems cannot serve either of these foundational purposes, and that recent attempts to defend the foundational importance of representation theorems are unsuccessful. As a result, we (...) should reject these claims, and lay the foundations of decision theory on firmer ground. (shrink)

Ectogestation involves the gestation of a fetus in an ex utero environment. The possibility of this technology raises a significant question for the abortion debate: Does a woman’s right to end her pregnancy entail that she has a right to the death of the fetus when ectogestation is possible? Some have argued that it does not Mathison & Davis. Others claim that, while a woman alone does not possess an individual right to the death of the fetus, the genetic parents (...) have a collective right to its death Räsänen. In this paper, I argue that the possibility of ectogestation will radically transform the problem of abortion. The argument that I defend purports to show that, even if it is not a person, there is no right to the death of a fetus that could be safely removed from a human womb and gestated in an artificial womb, because there are competent people who are willing to care for and raise the fetus as it grows into a person. Thus, given the possibility of ectogestation, the moral status of the fetus plays no substantial role in determining whether there is a right to its death. (shrink)

The difference between training and education has been recognised at least since the days when Socrates searched Athens for someone who knew more than he himself did—and was disappointed to find many craftsmen but no philosophers. The distinction persisted strongly when the universities developed in the twelfth and thirteenth Christian centuries. It was continuously vindicated by poets, novelists, essayists, and generation after generation of teachers, from the Renaissance until about the time Kenneth Baker became Education Secretary, whereupon it vanished from (...) English consciousness—so completely, that the polytechnics were renamed universities, the universities made polytechnics and the Departments of Education and Employment merged, as if that were not only obviously sensible in itself but perfectly consistent with two-and-a-half thousand years of previous thought and practice. The English educated classes are now composed of amnesiacs. (shrink)