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)

This paper argues that we should replace the common classification of theories of welfare into the categories of hedonism, desire theories, and objective list theories. The tripartite classification is objectionable because it is unduly narrow and it is confusing: it excludes theories of welfare that are worthy of discussion, and it obscures important distinctions. In its place, the paper proposes two independent classifications corresponding to a distinction emphasised by Roger Crisp: a four-category classification of enumerative theories (about which items constitute (...) welfare), and a four-category classification of explanatory theories (about why these items constitute welfare). (shrink)

Are we witnessing progress or regress in the recent increasing popularity and electoral success of populist politicians and parties in consolidated democratic nations? ... Is the innovative use of popular referendum in Great Britain to settle fundamental constitutional questions a progressive or regressive innovation? ... Similarly, is the increasing use of constituent assemblies to change constitutions across the world evidence of progress in democratic constitutionalism, or, a worryingly regressive change back toward unmediated popular majoritarianism? ... This paper reflects on some (...) of the perils and promise of framing such questions with the conceptual couplet of progress and regress. It considers four compelling critiques of the use of ‘progress’ and its cognates in sociopolitical theory, as well as arguing that such concepts are nevertheless ineliminable for our normative theories. The paper concludes by suggesting that we can avoid the most serious problems by employing only conceptions of political progress and regress that are piecemeal, pragmatic, and processual. (shrink)

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.

This chapter surveys hybrid theories of well-being. It also discusses some criticisms, and suggests some new directions that philosophical discussion of hybrid theories might take.

Group-based reasons are reasons to play one’s part in some pattern of action that the members of some group could perform, because of the good features of the pattern. This paper discusses three broad conceptions of such reasons. According to the agency-first conception, there are no group-based reasons in cases where the relevant group is not or would not be itself an agent. According to the behaviour-first conception, what matters is that the other members of the group would play their (...) parts in the relevant pattern, not whether they would have the cooperative intentional states constitutive of group agency in doing so. This paper argues against these conceptions and in favour of the powers-first conception, according to which what matters is that the members of the group have practically relevant powers. (shrink)

Difficult Atheism shows how contemporary French philosophy is rethinking the legacy of the death of God in ways that take the debate beyond the narrow confines of atheism into the much broader domain of post-theological thinking. Christopher Watkin argues that Alain Badiou, Jean-Luc Nancy and Quentin Meillassoux each elaborate a distinctive approach to the post-theological, but that each approach still struggles to do justice to the death of God.

Theorists of public reason such as John Rawls often idealize constitutional courts as exemplars of public reason. This paper raises questions about the seduction and limits of analogies between theorists’ account of public reason and actual constitutional jurisprudence. Examining the work product of the United States Supreme Court, the paper argues that while it does engage in reason-giving to support its decisions—as the public reason strategy suggests— those reasons are (largely) legalistic and specifically juristic reasons—not the theorists’ idealized moral-political reasons (...) on matters of fundamental principle. But if constitutional courts do not engage on matters of fundamental principle, then a public reason strategy for assuaging democratic worries about judicial review would no longer be open: prominent liberal and deliberative democratic theorists could no longer point to the alleged superiority of constitutional courts to speak in the name of, and for, the people’s shared political principles. The paper extends beyond the U.S. case study by pointing to three institutional factors explaining the disanalogy between what some constitutional courts do and what public reason theories require them to do. It concludes with considerations about whether the public reason strategy might be more successfully applied to international courts. (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.

This article proposes a way of understanding Kantianism, act-utilitarianism and some other important ethical theories according to which they are all versions of the same kind of theory, sharing a common structure. I argue that this is a profitable way to understand the theories discussed. It is charitable to the theories concerned; it emphasizes the common ground between them; it gives us insights into the differences between them; and it provides a method for generating new ethical theories worth studying. The (...) article briefly discusses the relationship between these ideas and some other recent proposals that emphasize the common ground between Kantianism and versions of consequentialism. (shrink)

One recently popular strategy for avoiding the moral error theory is via a ‘companions in guilt’ argument. I focus on those recently popular arguments that take epistemic facts as a companion in guilt for moral facts. I claim that there is an internal tension between the two main premises of these arguments. It is a consequence of this that either the soundness or the dialectical force of the companions in guilt argument is undermined. I defend this claim via (i) analogy (...) with philosophical debates concerning the indispensability of mathematical objects to natural science, and (ii) discussion of the ‘entanglement’ of epistemic concepts and moral concepts in deliberation. I conclude by proposing a positive view of what kind of argument must be used if moral error theories are to be successfully undermined. (shrink)

Authentizitat ist ein in unserem kulturellen Raum allgegenwartiges Phanomen. Doch wem oder was begegnen wir, wenn wir meinen, uns selbst verwirklichen oder alternativ einfach uns selbst treu sein zu mussen? Christoph Wiesinger zeigt, dass wir auf ein Selbst geworfen werden, das zwar als homogener Nukleus der Person projiziert werden kann, sich aber bei genauerem Hinsehen als komplexe sozial verinnerlichte Struktur entpuppt. Das Selbst ist keineswegs objektiv zu fassen, sondern unterliegt sozialen Genesen und wird durch soziale Adressierung unterschiedlich formiert. Das Ereignis (...) von Authentizitat gibt somit Anlass zur Reflexion der Differenz zwischen Erwartung und Erfahrung. Christoph Wiesinger legt die Strukturen des Phanomens der Authentizitat frei, zeigt die theologischen Implikationen auf und diskutiert die praktisch-theologischen Konsequenzen. (shrink)

Die Kernthese der Paracelsischen Naturphilosophie, die Ahnlichkeit von Mensch und Welt, festgelegt in der Analogie von Mikro- und Makrokosmos, enthullt einen -Code-, der als konstitutives Moment samtliche Aussagen auf einer prakonzeptionellen Ebene organisiert, samtliche Teilbereiche in ihrer funktionalen Bedeutung fur das -Ganze- markiert und schliesslich im Sinne Foucaults zu einer -diskursiven Formation- werden lasst. Die auf diese Weise vorgefuhrte Erfahrungsform von Welt und Natur steht zu dem neuzeitlich-technischen Verfugungswissen in einer historischen Diskontinuitat.".

Basing his view on the object relations theories of the "British School" of psychoanalysis, Christopher Bollas examines the human subject's memories of its earliest experiences (during infancy and childhood) of the object, whether it be mother, father, or self. He explains in well-written and non-technical language how the object can affect the child, or "cast in shadow," without the child being able to process this relation through mental representations of language.

In this article Cristoph Wulf examines the basic concepts of pedagogy and educational science in the German-speaking world, looking at education and socialization from the perspective of educational anthropology. He makes evident that the complex German concept of Bildung, in particular, can only be fully understood by means of a historical and philosophical analysis.

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)

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.

One of the most important elements of Hegel’s philosophical anthropology is his moral psychology. In particular, his understanding of the relation between motivations and reason plays a crucial intermediate role in connecting his anthropological meditations on the complete nature of the human being with his political theory of actualized freedom. Whereas recent important work on Hegel’s moral psychology has detected a Kantian distinction between natural desires and the rational perspective, the activity of practical reason actually takes place within motivations themselves (...) on Hegel’s view. The exercise of the free, rational will is best understood in terms of its role in shaping the experience of malleable, indeterminate motivations. Rather than stepping back, the free agent on Hegel’s account delves further into the motivation, acting on it in the dual sense of being guided by and transforming it. This is what it means for Hegel to conceive of agency as self-expression while maintaining the centrality of reason for Free Will. Hegel says that when we go further into the motivations in this way, we should stop speaking of motivation in terms of drives and instead begin speaking of character. (shrink)

This paper connects two ideas. The first is that some common responses to ethical views are responses to their degrees of pragmatism, where a view’s degree of pragmatism is its sensitivity to ethically relevant changes in the actor’s circumstances. I claim that we feel the pull of opposing pro-pragmatic and antipragmatic intuitions in certain cases. This suggests a project, of searching for an ethical view capable of doing justice to these opposing intuitions in some way. The second central idea is (...) that a theory of pattern-based reasons looks more promising than the obvious alternatives to fulfil this role, amongst Teleological theories at least. Pattern-based reasons are reasons to perform some action because of the goodness or rightness of a larger pattern of action—such as a pattern that a group could perform or that the actor could perform over an extended period—of which the immediate action is a mere part. Existing theories of such reasons share two features that prevent them explaining the intuitions we wish to explain: they consider only one pattern at a time (they are monist), and they treat patterns as eligible only if the agents concerned are willing to realise them (they accept the Willingness Requirement). But we need not accept these doctrines. Moreover, a theory of patternbased reasons without them is able to explain the pro- and anti-pragmatic intuitions in an elegant way, and has other attractive features. (shrink)

What makes philosophy on the continent of Europe so different and exciting? And why does it have such a reputation for being 'difficult'? Continental philosophy was initiated amid the revolutionary ferment of the 18th century, philosophers such as Kant and Hegel confronting the extremism of the time with theories that challenged the very formation of individual and social consciousness. Covering the great philosophers of the modern and postmodern eras – from Nietzsche, Heidegger, Derrida and Deleuze right to up Agamben and (...) Žižek – and philosophical movements from German idealism to deconstruction and feminism – Christopher Kul-Want and Piero brilliantly elucidate some of the most thrilling and powerful ideas ever to have been discussed. (shrink)

This chapter examines Karl Jaspers’s influential distinction between understanding and explaining, and its significance in psychiatry. It first outlines one way of interpreting the distinction, on which it is connected to the distinction between singular and general causal claims. It then discusses one reason for thinking that understanding has an essential role to play in psychiatry: Not achieving at least some level of understanding in the context of dealing with psychiatric patients would constitute a particular kind of epistemic failure—a failure (...) to recognize their illness for the particular type of illness it is. Drawing on some ideas recently put forward by Kenneth Kendler and John Campbell, it also illustrates the particular kind of understanding that is crucial in this context. (shrink)

Details the role that giants have played in the history of humankind. _...style is breezy and accessible...a pleasant browse._ --BOOKLIST.

Here, for the first time, Christopher Kul-Want brings together twenty-five texts on art written by twenty philosophers. Covering the Enlightenment to postmodernism, these essays draw on Continental philosophy and aesthetics, the Marxist intellectual tradition, and psychoanalytic theory, and each is accompanied by an overview and interpretation. The volume features Martin Heidegger on Van Gogh's shoes and the meaning of the Greek temple; Georges Bataille on Salvador Dal’'s The Lugubrious Game; Theodor W. Adorno on capitalism and collage; Walter Benjamin and (...) Roland Barthes on the uncanny nature of photography; Sigmund Freud on Leonardo Da Vinci and his interpreters; Jacques Lacan and Julia Kristeva on the paintings of Holbein; Freud's postmodern critic, Gilles Deleuze on the visceral paintings of Francis Bacon; and Giorgio Agamben on the twin traditions of the Duchampian ready-made and Pop Art. Kul-Want elucidates these texts with essays on aesthetics, from Hegel and Nietzsche to Badiou and Rancire, demonstrating how philosophy adopted a new orientation toward aesthetic experience and subjectivity in the wake of Kant's powerful legacy. (shrink)

This chapter discusses the analysis of Joseph Raz on coercion, trust, and citizenship. The chapter starts with a number of brief comments on some of his observations regarding the doctrine of liberty and the preference for minimum government. The chapter also includes one of Raz's arguments that states that some people favour non-perfectionist forms of government out of a misunderstanding of the implications of perfectionism for liberty.

What would it look like for researchers to take non-human animal rights seriously? Recent discussions foster the impression that scientific practice needs to be reformed to make animal research ethical: just as there is ethically rigorous human research, so there can be ethically rigorous animal research. We argue that practically little existing animal research would be ethical and that ethical animal research is not scalable. Since animal research is integral to the existing scientific paradigm, taking animal rights seriously requires a (...) radical, wholesale reimagining of science.Trial registration: ClinicalTrials.gov identifier: NCT05340426. (shrink)

I defend a new reading of Spinoza's account of causation that reconciles the strengths of the mechanist and formal cause interpretations by locating instances of nature's fixed and unchanging laws inside individual natures; natures are efficacious because that's where the laws are. God's necessity, for instance, follows from certain logical principles contained within God's nature. Causes between finite particulars likewise stem entirely from finite natures. They do so, I argue, because finite instances of nature's fixed and unchanging laws are inscribed (...) within those natures. In each of these instances, effects follow from natures on account of laws contained within them. (shrink)