This article reviews recent developments within a number of academic disciplines pointing toward an increasing importance of imagination for understanding morality and cognition. Using elements from hermeneutics and metaphor theory, it works toward a framework for a more context-sensitive understanding of human agency, especially focusing on moral deliberation and change. The analytic framework is used to analyze the story of a patient making tough decisions in the context of prenatal diagnosis. We show how a relatively stable outlook on the world, (...) here called the “baseline of choice,” is challenged by unexpected events and how imaginative processes enter into the active creation of a new moral order. The ensuing interpretation is then placed within a broader philosophical landscape. John Dewey’s notion of “dramatic rehearsal” is put forward as one particularly promising way of understanding moral imagination, deliberation, and decision-making. (shrink)

Care Ethics ist eine ethische Theorie, Pflegeethik ein Disziplinbegriff. Aber gerade in der Disziplin der Pflegethik kann die Care Ethics ein wichtiges gedankliches Werkezeug darstellen. In der Care Ethics wird nicht der Prinzipienbezug in den Vordergrund gestellt, sondern das Anerkennen von Kontext, moralischer Verantwortung und Beziehungen. In diesem Denkparadigma spielt es für die Reflexion auch eine Rolle, wer man selbst ist, und mit welcher Perspektive man sich einer ethischen Problemsituation nähert.

In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of ‘theory’ and show how it is interwoven with ‘practice’ as we go along. First, we look at theory in its foundational role: in our case ‘narrative ethics’ and ‘philosophical hermeneutics’ provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of theoretical (...) notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like ‘story’, ‘responsibility’, or ‘vulnerability’ to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice-versa. (shrink)

In today’s pluralistic society, clinical ethics consultation cannot count on a pre-given set of rules and principles to be applied to a specific situation, because such an approach would deny the existence of different and divergent backgrounds by imposing a dogmatic and transcultural morality. Clinical ethics support (CES) needs to overcome this lack of foundations and conjugate the respect for the difference at stake with the necessity to find shared and workable solutions for ethical issues encountered in clinical practice. We (...) argue that a pragmatist approach to CES, based on the philosophical theories of William James, John Dewey, and Charles Sanders Peirce, can help to achieve the goal of reaching practical solutions for moral problems in the context of today’s clinical environment, characterized by ethical pluralism. In this article, we outline a pragmatist theoretical framework for CES. Furthermore, we will show that moral case deliberation, making use of the dilemma method, can be regarded an example of a pragmatist approach to CES. (shrink)

The current process towards formalization within evaluation research, in particular the use of pre-set standards and the focus on predefined outcomes, implies a shift of ownership from the people who are actually involved in real clinical ethics support services in a specific context to external stakeholders who increasingly gain a say in what ‘good CESS’ should look like. The question is whether this does justice to the insights and needs of those who are directly involved in actual CESS practices, be (...) it as receivers or providers. We maintain that those actually involved in concrete CESS practices should also be involved in its evaluation, not only as respondents, but also in setting the agenda of the evaluation process and in articulating the criteria by which CESS is evaluated. Therefore, we propose a participatory approach to CESS evaluation. It focuses on the concrete contexts in which CESS takes place, reflective and dialogical learning processes, and how to be democratic and inclusive. In particular, this approach to CESS evaluation is akin to realist evaluation, dialogical evaluation, and responsive evaluation. An example of a participatory approach to evaluating CESS is presented and some critical issues concerning this approach are discussed. (shrink)

Predictive genetic testing may confront those affected with difficult life situations that they have not experienced before. These life situations may be interpreted as ‘absurd’. In this paper we present a case study of a predictive test situation, showing the perspective of a woman going through the process of deciding for or against taking the test, and struggling with feelings of alienation. To interpret her experiences, we refer to the concept of absurdity, developed by the French Philosopher Albert Camus. Camus' (...) writings on absurdity appear to resonate with patients' stories when they talk about their body and experiences of illness. In this paper we draw on Camus' philosophical essay ‘The Myth of Sisyphus’, and compare the absurd experiences of Sisyphus with the interviewee's story. This comparison opens up a field of ethical reflection. We demonstrate that Camus' concept of absurdity offers a new and promising approach to understanding the fragility of patients' situations, especially in the field of predictive testing. We show that people affected might find new meaning through narratives that help them to reconstruct the absurd without totally overcoming it. In conclusion, we will draw out some normative consequences of our narrative approach. (shrink)

ABSTRACT The part played by time in ethics is often taken for granted, yet time is essential to moral decision making. This paper looks at time in ethical decisions about having a genetic test. We use a patient‐centred approach, combining empirical research methods with normative ethical analysis to investigate the patients' experience of time in (i) prenatal testing of a foetus for a genetic condition, (ii) predictive or diagnostic testing for breast and colon cancer, or (iii) testing for Huntington's disease (...) (HD). We found that participants often manipulated their experience of time, either using a stepwise process of microdecisions to extend it or, under the time pressure of pregnancy, changing their temporal ‘depth of field’. We discuss the implications of these strategies for normative concepts of moral agency, and for clinical ethics. (shrink)

Reason and Value collects 15 new papers by leading contemporary philosophers on themes from the work of Joseph Raz. Raz has made major contributions in a wide range of areas, including jurisprudence, political philosophy, and the theory of practical reason; but all of his work displays a deep engagement with central themes in moral philosophy. The subtlety and power of Raz's reflections on ethical topics make his writings a fertile source for anyone working in this area. Especially significant are his (...) explorations of the connections between practical reason and the theory of value, which constitute a sustained and penetrating treatment of a set of issues at the very center of moral philosophy as it is practiced today. The contributors to the volume acknowledge the importance of Raz's contributions by engaging critically with his positions and offering independent perspectives on the topics that he has addressed. The volume aims both to honour Raz's accomplishments in the area of ethical theorizing, and to contribute to an enhanced appreciation of the significance of his work for the subject. (shrink)

In the three target articles, Ellen Fox et al. present data from their seminal study on ethics consultation in US general hospitals (Fox, Danis, et al. 2022, Fox and Duke 2022, Fox, Tarzian, et al....

Gerade im Gesundheitswesen ist die Frage nach (Gestaltungs-)Macht heikel. Aber wer anderen Gutes tun möchte, der muss wirksam tätig werden können. Dies beinhaltet immer auch soziale Gestaltungsmacht. Wie gehen Pflegende mit der ihnen übertragenen bzw. auferlegten Macht um? Wie viel Macht ist im Kontext von Medizin, Pflege und Gesundheitssorge nötig? Und wie nehmen die Patientinnen und Patienten sie wahr? *Oft fühlen sich Menschen, die unter einer akuten Krankheit leiden, ohnmächtig. Und so wirkt der Begriff der Macht, den wir oft genug (...) mit Herrschaft und Gewalt verbinden, in einem Bereich, in dem es um Fürsorge und Behandlung geht, merkwürdig fehl am Platz. Gleichwohl bringen Ressourcen wie Wissen und finanzielle Mittel automatisch die Frage nach Macht in der Fürsorge aufs Tapet. Das Buch fragt nach der moralischen Bedeutung von Gestaltungsmacht und sucht das prekäre Verhältnis von Macht und Fürsorge ethisch auszuloten. (shrink)

Despite All Critique (2014) -- World Politics and Western Reason (1980) -- The Doubled Outsides of the Modern International (2005) -- The Subject of Security (1995) -- The Protection of Nature and the Nature of Protection (2005) -- Social Movements/World Politics (1994) -- Europe is Not Where It is Supposed to Be (2000) -- They Seek it Here, They Seek it There : Looking for Politics in Clayoquot Sound (2003) -- Violence, Modernity, Silence : From Weber to International Relations (1993) (...) -- Hobbes, Origins, Limits (2011) -- War, Terror, Judgement (2002) -- International, Imperial, Exceptional (2005) -- Which Democracy for Which Demos? (2013) -- The Political Theory of Boundaries and the Boundaries of Political Theory : Interview With Raia Prokhovnik (2012). (shrink)

This book focuses upon the perennial question of the existence and nature of an obligation to obey the law. Leading writers have, at one time or another, emphasized considerations such as gratitude, 'divine ordering, ' prudence, contract, autonomy, and utility in seeking to justify, or to deny any justification for, some sort of obligation to obey the positive law. The book provides relevant selections from a sampling of the historical approaches to legal obligation taken by writers such as Plato, Augustine, (...) Aquinas, Hobbes, Locke, Hume, Rousseau, Thoreau, Bentham, Marx and Engels, and Martin Luther King, Jr. These classical discussions are augmented by critical questions and commentary, by independent discussions of the question of legal obligation by a wide range of contemporary writers, and by relevant judicial cases discussing matters such as conscientious objection and civil disobedience. (shrink)

The typical kind of color realism is reductive: the color properties are identified with properties specified in other terms (as ways of altering light, for instance). If no reductive analysis is available — if the colors are primitive sui generis properties — this is often taken to be a convincing argument for eliminativism. That is, realist primitivism is usually thought to be untenable. The realist preference for reductive theories of color over the last few decades is particularly striking in light (...) of the generally anti-reductionist mood of recent philosophy of mind. The parallels between the mind—body problem and the case of color are substantial enough that the difference in trajectory is surprising. While dualism and non-reductive physicalism are staples, realist primitivism is by and large a recent addition to the color literature. And it remains a minority position, although one that is perhaps gaining support. In this paper, we investigate whether it should be accepted, and conclude it should not be. (shrink)

Information can be public among a group. Whether or not information is public matters, for example, for accounts of interdependent rational choice, of communication, and of joint intention. A standard analysis of public information identifies it with (some variant of) common belief. The latter notion is stipulatively defined as an infinite conjunction: for p to be commonly believed is for it to believed by all members of a group, for all members to believe that all members believe it, and so (...) forth. This analysis is often presupposed without much argument in philosophy. Theoretical entrenchment or intuitions about cases might give some traction on the question, but give little insight about why the identification holds, if it does. The strategy of this paper is to characterize a practical-normative role for information being public, and show that the only things that play that role are (variants of) common belief as stipulatively characterized. In more detail: a functional role for “taking a proposition for granted” in non-isolated decision making is characterized. I then present some minimal conditions under which such an attitude is correctly held. The key assumption links this attitude to beliefs about what is public. From minimal a priori principles, we can argue that a proposition being public among a group entails common commitment to believe among that group. Later sections explore partial converses to this result, the factivity of publicity and publicity from the perspective of outsiders to the group, and objections to the aprioricity of the result deriving from a posteriori existential presuppositions. (shrink)

The concept of yinyang lies at the heart of Chinese thought and culture. The relationship between these two opposing, yet mutually dependent, forces is symbolized in the familiar black and white symbol that has become an icon in popular culture across the world. The real significance of yinyang is, however, more complex and subtle. This brilliant and comprehensive analysis by one of the leading authorities in the field captures the richness and multiplicity of the meanings and applications of yinyang, including (...) its visual presentations. Through a vast range of historical and textual sources, the book examines the scope and role of yinyang, the philosophical significance of its various layers of meanings and its relation to numerous schools and traditions within Chinese philosophy. By putting yinyang on a secure and clear philosophical footing, the book roots the concept in the original Chinese idiom, distancing it from Western assumptions, frameworks and terms, yet also seeking to connect its analysis to shared cross-cultural philosophical concerns. (shrink)

Recent Work on Intrinsic Value brings together for the first time many of the most important and influential writings on the topic of intrinsic value to have appeared in the last half-century. During this period, inquiry into the nature of intrinsic value has intensified to such an extent that at the moment it is one of the hottest topics in the field of theoretical ethics. The contributions to this volume have been selected in such a way that all of the (...) fundamental questions concerning the nature of intrinsic value are treated in depth and from a variety of viewpoints. These questions include how to understand the concept of intrinsic value, what sorts of things can have intrinsic value, and how to compute intrinsic value. The editors have added an introduction that ties these questions together and places the contributions in context, and they have also provided an extensive bibliography. The result is a comprehensive, balanced, and detailed picture of current thinking about intrinsic value, one that provides an indispensable backdrop against which future writings on the topic may be assessed. (shrink)

Philosophical anthropologies that emphasise the role of the emotions can be used to expand existing notions of moral agency and learning in situations of great moral complexity. In this article we tell the story of one patient facing the tough decision of whether to be tested for Huntington’s disease or not. We then interpret her story from two different but compatible philosophical entry points: Aristotle’s conception of Greek tragedy and Karl Jaspers’ notion of Grenzsituationen (boundary situations). We continue by indicating (...) some ways in which these two positions may be used for reflecting upon different perspectives involved in clinical decision-making, those of patients, clinicians and bioethicists. We conclude that the ideas we introduce can be used as hermeneutic tools for situating learning and dialogue within a broader cultural field in which literature and art may also play important roles. (shrink)

A central tenet of contemporary moral psychology is that people typically reject active forms of utilitarian sacrifice. Yet, evidence for secularization and declining empathic concern in recent decades suggests the possibility of systematic change in this attitude. In the present study, we employ hypothetical dilemmas to investigate whether judgments of utilitarian sacrifice are becoming more permissive over time. In a cross-sectional design, age negatively predicted utilitarian moral judgment (Study 1). To examine whether this pattern reflected processes of maturation, we asked (...) a panel to re-evaluate several moral dilemmas after an eight-year interval but observed no overall change (Study 2). In contrast, a more recent age-matched sample revealed greater endorsement of utilitarian sacrifice in a time-lag design (Study 3). Taken together, these results suggest that today’s younger cohorts increasingly endorse a utilitarian resolution of sacrificial moral dilemmas. (shrink)

BLWith new text and full apparatus criticus The Eudemian Ethics was one of two ethical treatises which Aristotle wrote on the subject of ethica or `matters to do with character'. Although the two works cover much the same ground, the Nicomachean Ethics is better known; the poor manuscript tradition of the Eudemian Ethics has made correct translation and interpretation of the text extremely difficult. The subject of the work is the choice of a certain means of conduct, made by a (...) `man of practical wisdom', between two extremes of behaviour: asceticism and yielding to uncontrolled impulses. Aristotle also stresses the notion of moral intention and the importance of virtue of character. This new Oxford Classical Text of the Eudemian Ethics is the result of many years of work. After Sir David Ross's death, his original text was substantially reworked and revised by his friend and colleague R. R. Walzer, who was aided in the revision by his former pupil Mrs Jean Mingay, who continued his work after his death in 1974. Mrs Mingay was fortunate in being able to make use of previously unpublished contributions from D. J. Allan after his death in the late seventies, and more recently has been helped in her work by the suggestions of Professor D. A. Russell, David Robinson, and Christopher Rowe. (shrink)

"Williams's masterful translation satisfies (at last!) a long-standing need. There are lots of good translations of Augustine's great work, but until now we have been forced to choose between those that strive to replicate in English something of the majesty and beauty of Augustine's Latin style and those that opt instead to convey the careful precision of his philosophical terminology and argumentation. Finally, Williams has succeeded in capturing both sides of Augustine's mind in a richly evocative, impeccably reliable, elegantly readable (...) presentation of one of the most impressive achievements in Western thought--Augustine's Confessions." --Scott MacDonald, Professor of Philosophy and Norma K. Regan Professor in Christian Studies, Cornell University. (shrink)

Elliot R. Wolfson intervenes in the debate over Martin Heidegger and Nazism from a unique perspective, as a scholar of Jewish mysticism and philosophy who has been profoundly influenced by Heidegger's work. He reveals crucial aspects of Heidegger's thinking that betray an affinity with dimensions of Jewish thought.

This volume gathers together for the first time are all the key texts in a crucial debate in modern philosophy, centered on Leibniz's famous 1695 essay, the "New System of the Nature of Substances and their Communication," in which he introduced his strikingly original theory of metaphysics. His "system" became increasingly famous and drew him into discussion and development of these ideas, both in public and in private, with a variety of thinkers, most notably the great French philosopher Pierre Bayle. (...) Woolhouse's and Francks's new English edition gives the only full representation of this debate, and will therefore be essential reading for anyone who wishes to gain a proper understanding of Leibniz's philosophy and its intelletual context. All the texts are newly translated and extensively annotated; many appear in English for the first time. (shrink)

BackgroundThe need for an ethical debate about the use of coercion in intensive care units (ICU) may not be as obvious as in other areas of medicine, such as psychiatry. Coercive measures are often necessary to treat critically ill patients in the ICU. It is nevertheless important to keep these measures to a minimum in order to respect the dignity of patients and the cohesion of the clinical team. A deeper understanding of what patients and their relatives perceive during their (...) ICU stay will shed different light on intensive care management. Patients' experiences of loss of control, dependency and abandonment may lead to a new approach towards a broader approach to the concept of coercion in intensive care. The aim of our research is to explore the experiences of patients and relatives in the ICU and to determine when it might be possible to reduce feelings and memories of coercion.MethodsWe conducted and analysed 29 semi-structured interviews with patients and relatives who had been in the ICU a few months previously. Following a coding and categorisation process in MAXQDA™, a rigorous qualitative methodology was used to identify themes relevant to our research.ResultsFive main themes emerged: memory issues; interviewees’ experiences of restricting measures and coercive treatment; patients’ negative perception of situational and relational dependency with the risk of informal coercion; patients’ perceptions of good care in a context of perceived dependency; progression from perception of coercion and dependency to respect for the person. All patients were grateful to have survived. However, coercion in the form of restraint, restriction of movement, and coercive treatment in the ICU was also acknowledged by patients and relatives. These included elements of informal coercion beyond restraints, such as a perceived negative sense of dependence, surrender, and asymmetrical interaction between the patient and health providers.ConclusionsTo capture the full range of patients' experiences of coercion, it is necessary to expand the concept of coercion to include less obvious forms of informal coercion that may occur in dependency situations. This will help identify solutions to avoid or reduce negative recollections that may persist long after discharge and negatively affect the patients' quality of life. (shrink)

Being a patient and living a life -- Clinical space and traits of healing -- False starts and frequent failures -- Three journeys : A.'Ibuprofen and love', B. 'Staying tuned up', C. 'We all want the same things' -- Being a patient : the moral field -- Rethinking healthcare ethics : the patient's moral authority.

The authors of this paper earlier argued that concrete objects, such as things or persons, may have final value, which is not reducible to the value of states of affairs that concern the object in question. Our arguments have been challenged. This paper is an attempt to respond to some of these challenges, viz. those that concern the reducibility issue. The discussion presupposes a Brentano-inspired account of value in terms of fitting responses to value bearers. Attention is given to a (...) yet another type of reduction proposal, according to which the ultimate bearers of final value are abstract particulars rather than abstract states or facts. While the proposal is attractive, it confronts serious difficulties. To recognise tropes as potential bearers of final value, along with other objects, is one thing; but to reduce the final value of concrete objects to the final value of tropes is another matter. (shrink)

The young Hegel was entranced by the notion of intellectual intuition, and this notion continues to entrance many of Hegel’ commentators. I argue that Kant provided three distinct conceptions of an intuitive intellect, that none of these involve aconceptual intuitionism, and that they differ markedly from Fichte’s and Schelling’s conceptions of intellectual intuition. I further argue that by 1804 Hegel recognized that appealing to an aconceptual model, or to Schelling’s model, or to his own early model of intellectual intuition generates (...) inevitable and insoluble problems of question-begging. By incorporating several important points from Kant’s Transcendental Ideal into his reinterpretation of Kant’s Transcendental Deduction and Refutation of Idealism, Hegel’s mature discursive and conceptual account of ‘absolute knowing’ performs some of the functions Kant assigned to the intuitive intellect, though without invoking any such intuitive intellect. I discuss several of these functions. (shrink)

The aim of this paper is to analyze an Intensive Care Unit case that required ethics consultation at a University Hospital in Northern Italy. After the case was resolved, a retrospective ethical analysis was performed by four clinical ethicists who work in different healthcare contexts. Each ethicist used a different method to analyze the case; the four general approaches provide insight into how these ethicists conduct ethics consultations at their respective hospitals. Concluding remarks examine the similarities and differences among the (...) various approaches and offer a reflection concerning the possibility of a shared resolution to the case. The authors’ efforts to come to a tentative consensus may serve as an example for professionals working in medical contexts that reflect an increasing pluralism of values. This article aims to respond to some of these concerns by illustrating how different methods in clinical ethics would be used when considering a real case. The goal is not to establish the best model on a theoretical level, but to learn from actual practice in order to see if there are common elements in the different methods, and to validate their pertinence to clinical ethics consultation. (shrink)

The View from Here is a study of our must fundamental attitudes toward the past. The book explores the dynamics of affirmation and regret, tracing the connections of each to our ongoing attachments. The focus is on situations in which our attachments commit us to affirming events or decisions that we know to have been unfortunate or regrettable.

This paper is based on linked qualitative studies of the donation of human embryos to stem cell research carried out in the United Kingdom, Switzerland, and China. All three studies used semi-structured interview protocols to allow an in-depth examination of donors’ and non-donors’ rationales for their donation decisions, with the aim of gaining information on contextual and other factors that play a role in donor decisions and identifying how these relate to factors that are more usually included in evaluations made (...) by theoretical ethics. Our findings have implications for one factor that has previously been suggested as being of ethical concern: the role of gratitude. Our empirical work shows no evidence that interpersonal gratitude is an important factor, but it does support the existence of a solidarity-based desire to “give something back” to medical research. Thus, we use empirical data to expand and refine the conceptual basis of bioethically theorizing the IVF–stem cell interface. (shrink)

The philosophical papers comprising this volume range from process metaphysics and theology, through the phenomenological study of intentionality, to the foundations of geometry and of the system of real numbers. New light, it is thought, is shed on all these topics, some of them being of the highest interest and under intensive investigation in contemporary philosophical discussion. Metaphysi cians, process theologians, semanticists, theorists of knowledge, phenomenologists, and philosophers of mathematics will thus find in this book, it is hoped, helpful materials (...) and methods. The categoreal scheme of Whitehead's Process and Reality is discussed rather fully from a logical point of view in the first paper [I] in the light of the author's previous work on the logico-metaphysical theory of events. The clarification that results is thought to provide a new depth and precision to the problem of interpreting one of the most difficult books in the recent history of metaphysics and cosmol ogy. A detailed examination of some aspects of Hartshorne's recent Creative Synthesis and Philosophic Method is given in II. This book is perhaps the most significant work on process philosophy since Process and Reality itself, and its logical underpinnings thus merit a full critical discussion. (shrink)

This paper addresses some connections between conceptions of the will and the theory of practical reason. The first two sections argue against the idea that volitional commitments should be understood along the lines of endorsement of normative principles. A normative account of volition cannot make sense of akrasia, and it obscures an important difference between belief and intention. Sections three and four draw on the non-normative conception of the will in an account of instrumental rationality. The central problem is to (...) explain the grip of instrumental requirements even in cases in which agents do not fully endorse the ends they are pursuing. The solution I propose appeals to coherence constraints on the beliefs that condition the distinctive volitional stance of intention. (shrink)