The medical ethicist is a fairly recent addition to the clinical setting. The following four potential roles of the clinical ethicist are identified and discussed: consultant in difficult cases, educator of health care providers, counselor for health care providers and finally patient advocate to protect the interests of patients. While the various roles may sometimes overlap, the roles of educator and counselor are viewed as being more congruent with the education and training of medical ethicists than are the roles of (...) consultant and patient advocate. (shrink)

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value (...) judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

In recent years, the theoretical work of Gilligan in women's psychological development has led to the development of the concept of moral orientation or moral voice in contrast to the concept of moral reasoning or moral judgment developed by Kohlberg. These concepts have been of particular interest in gender studies, especially as applied to adolescence. These concepts of moral orientation and moral reasoning are being increasingly employed in healthcare ethics studies in a wide variety of settings. The recent work has (...) included studies of physicians, nurses, dentists, veterinarians, social workers, teachers of medical ethics, and hospital ethics committees. However, the study of moral development in healthcare providers has been hampered because collecting the necessary data from healthcare workers has been labor intensive and extremely time consuming. More efficient methods are needed. (shrink)

In the wake of a pilot study that indicated that the experience of medical education appears to Inhibit moral development In medical students, increased attention needs to be given to the structure of medical education and the Influence it has on medical students. Interest in ethics and moral reasoning has become widespread in many aspects of professional and public life. Society has exhibited great interest in the ethical issues confronting physicians today. Considerable effort has been undertaken to train medical students, (...) interns, and residents In how to reason through medical-ethical dilemmas. Media attention has focused on Issues such as abortion, euthanasia, care of severely handicapped infants, organ transplantation, and so forth, producing heated debates in both the professional and lay literature over the morality of the various positions. The curriculum of medical education has paralleled and reflected this general Interest in medical ethics. Most medical schools now offer, and frequently require, course work in ethics. However, further research Is needed to better characterize and understand the relationship of medical education to moral development. (shrink)

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while (...) nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way they function as clinical ethicists. (shrink)

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether (...) there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults. (shrink)

This descriptive study is an attempt to characterize the field known as clinical ethics, with regard to the function of humanities scholars in the clinical setting, e.g., hospitals and ambulatory care clinics. It is not a strict epidemiological study but a qualitative survey, although it reports some empirical data. Most discussions of medical humanities in the literature are conceptual analyses of particular issues, such as informed consent, abortion, confidentiality, etc. Virtually no empirical studies with data on how many clinical ethicists (...) function in what roles and with what educational backgrounds have been reported. This is the first such study of humanities scholars in clinical ethics and will be followed by companion reports of physicians and hospital chaplains who are, by self-report, involved in clinical ethics. This report is an effort to stimulate and encourage dialogue and is in no way definitive. It is a preliminary study, and other needed studies are already underway. (shrink)

In his 1922/1923 articles for the Japanese magazine _Kaizō_, Edmund Husserl identifies a particular “humanity” or human culture by the purposeful idea [_Zweckidee_] consciously embraced by the community. This purposeful idea is attained through rational self-formation on the part of the community in a manner analogous to the rational self-formation of the individual human being. Thereafter, it can be referenced to distinguish different cultures (or stages of cultural development) from one another through its objective manifestation in communal groups and cultural (...) products, as Husserl retraces in a historical account of the development of Western history. This paper explores the essential character of this conception of the purposeful idea from both an exegetical and a systematic perspective, examining in particular the relationship between such an idea and the values experienced by individual subjects within a culture (which are, according to Husserl, also available at the level of objective culture in relation to a communal subject). The paper argues that Husserl’s basic conception of the purposeful idea is a good model for understanding certain essential characteristics of cultural constitution in general, although some of his fundamental assumptions—especially the strict identity he attempts to establish between a purposeful idea as such and the specific goal of universal, rational self-understanding—turn out to be somewhat more questionable in light of the connection between the purposeful idea and the genuinely felt values underlying it. (shrink)

The Doomsday Argument says we should increase our subjective probability that Doomsday will occur once we take into account how many humans have lived before us. One objection to this conclusion is that we should accept the Self-Indication Assumption (SIA): Given the fact that you exist, you should (other things equal) favor hypotheses according to which many observers exist over hypotheses on which few observers exist. Nick Bostrom argues that we should not accept the SIA, because it can be used (...) without knowledge of birth rank. Bradley Monton tries to construct a Doomsday Argument without knowledge of birth rank. I argue that Monton fails. The argument he constructs has implicit knowledge of birth rank and it is this knowledge that does the work. Furthermore, I argue that provided we dont have certain specific information about the future, the Doomsday Argument requires knowledge of birth rank. (shrink)

Invitation to Holy CommunionParticipation in Holy Communion raises a number of questions. The Church is compelled to see to it that the Sacrament is not desecrated and on the other hand, the Church is obliged to encourage participation. The problem arises when visitors of the same confession turn up at the celebration. Can they be allowed to participate? In some churches the answer is an undoubted: No. For other churches it is self-evident - there are not obstacles. In between are (...) a number of churches who are more hesitant and a number of safeguards are adopted. In this case - as is the case in the Nederduitsch Hervormde Kerk - the responsibility rests mainly with the participant, as he must be aware of the preconditions set by the church and whether he can honestly declare that as far as he is concerned he is unaware of anything prohibiting him from participation. Thus no changes in the church statute are required. (shrink)

In 1736 Colin MacLaurin, Professor of Mathematics in the University of Edinburgh petitioned the Town Council for permission to erect an astronomical observatory in the College to broaden the research and teaching base of the University. After MacLaurin's death, the Town Council and University Senate, more concerned with the promotion of the Infirmary and associated medical teaching, took no further action. The funds raised by MacLaurin were lent to his successor, and largely dissipated. In 1776 the balance was transferred to (...) the proposed Calton Hill Observatory. This private scheme was to be financially self-sufficient, generating income from the casual visitor and fees charged to students. It too failed. Funds were wasted on unnecessary architectural elaboration, the Town Council failed to meet their financial obligations, the University acquiesced in the total inactivity of the Regius Professor of Astronomy, whilst the commercial management-base of the Observatory vitiated any serious scientific activity. (shrink)

Interpreting European reactions to the outside world from the beginning of European history to the end of the nineteenth century, Baudet discusses Utopian literature, the idea of the "noble savage," and the search for the temporal and geographical location of paradise. Baudet argues that the more historically oriented and self-satisfied cultures were less inclined toward a nostalgic paradise. All in all, this is a fascinating little essay in social history.—D. J. B.

In this engaged and engaging survey Piers Benn examines the major currents of ethical theory, concentrating on sound reasoning about morality. Benn's account offers a qualified defence of Aristotelian virtue theory, while bringing out what is distinctive and valuable in a broad range of approaches, such as those of Kant and the Utilitarians. His examples emphasize the ordinary choices of everyday life - gossip, friendship, honesty, sexual relations, work, and self-realization.

This contribution honours the memory of Hans- Georg Gadamer from a theological perspective. A first section reflects on the complex and often ambiguous nature of his relationship with theology and theologians, and with issues of faith and religion. Anecdotes and biographical information point to the seeming lack of interest, at least in contemporary theology, reflected in his work, but also to the warm reception that he continued to receive in theological circles, both with regard to his person and his work. (...) A second section briefly illus trates how his description of the hermeneutical conversation is practically demonstrated in what is called ecumenical hermeneutics, and how many of the notions and convictions of contemporary hermeneutical theory have indeed become common in these circles. The official study document A Treasure in Earthen Vessels. An Instru ment for an Ecumeni cal Re flection on Hermeneutics (1998, Faith and Order Paper No. 182) of the World Council of Churches is used to illustrate this. A third and final section underlines some of the formal similarities between this form of ecumenical hermeneutics and Gadamer's self- understanding of his own life project. It is argued that, whether his impact on the ecumenical church was direct or indirect, the matter-of-factness with which present-day ecumenism uses hermeneutical categories and convictions underscores Gadamer's own insight that “theologians see in my work a confirmation of their own needs.” S. Afr. J. Philos. Vol.22(1) 2003: 19-39. (shrink)

Using rather standard techniques of linguistic philosophy, the author develops an historical and critical analysis of Ghazali's doctrine of God as utterly unique and unknowable. Divine uniqueness and unknowability are logically implied by the statement "There is one god, Allah" and are therefore not "self-refuting" but are simply analytic statements of honorific and not descriptive value. The important historical question arises then as to how Ghazali can logically talk about God "revealing" himself. Shehadi attempts to rescue Ghazali from this logical (...) bind by arguing that the Moslem creed is not a description of God but a practical directive for men. Once given the belief in divine unknowability, if Ghazali wants Allah to "authenticate" a religious creed this would be "inconsistent." Reading these sorts of arguments, gives one the impression that this volume is a Moslem imitation of a Christian original. Somehow this type of philosophical approach does not seem to do justice to either religion.—D. J. B. (shrink)

We assume that a statute permitting physician assisted death has been passed. We note that the rationale for the passage of such a statute would be respect for individual autonomy, the avoidance of suffering and the possibility of death with dignity. We deal with two moral issues that will arise once such a law is passed. First, we argue that the rationale for passing an assistance in dying law in the first place provides a justification for assisting patients to die (...) who are motivated by altruistic reasons as well as patients who are motivated by reasons of self-interest. Second, we argue that the reasons for passing a physician assisted death law in the first place justify extending the law to cover some nonterminal patients as well as terminal patients. (shrink)

Increasing ethical attention and debate is focusing on whether individuals who take part in clinical trials should be given access to post-trial care. However, the main focus of this debate has been upon drug trials undertaken in low-income settings. To broaden this debate, we report findings from interviews with individuals (n = 24) who participated in a clinical trial of a closed-loop system, which is a medical device under development for people with type 1 diabetes that automatically adjusts blood glucose (...) to help keep it within clinically recommended ranges. Individuals were recruited from UK sites and interviewed following trial close-out, at which point the closed-loop had been withdrawn. While individuals were stoical and accepting of the requirement to return the closed-loop, they also conveyed varying degrees of distress. Many described having relaxed diabetes management practices while using the closed-loop and having become deskilled as a consequence, which made reverting back to pre-trial regimens challenging. Participants also described unanticipated consequences arising from using a closed-loop. As well as deskilling, these included experiencing psychological and emotional benefits that could not be sustained after the closed-loop had been withdrawn and participants reevaluating their pre- and post-trial life in light of having used a closed-loop and now perceiving this life much more negatively. Participants also voiced frustrations about experiencing better blood glucose control using a closed-loop and then having to revert to using what they now saw as antiquated and imprecise self-management tools. We use these findings to argue that ethical debates about post-trial provisioning need to be broadened to consider potential psychological and emotional harms, and not just clinical harms, that may result from withdrawal of investigated treatments. We also suggest that individuals may benefit from information about potential nonclinical harms to help make informed decisions about trial participation. (shrink)

Researchers have begun to explore animals' capacities for uncertainty monitoring and metacognition. This exploration could extend the study of animal self-awareness and establish the relationship of self-awareness to other-awareness. It could sharpen descriptions of metacognition in the human literature and suggest the earliest roots of metacognition in human development. We summarize research on uncertainty monitoring by humans, monkeys, and a dolphin within perceptual and metamemory tasks. We extend phylogenetically the search for metacognitive capacities by considering studies that have tested less (...) cognitively sophisticated species. By using the same uncertainty-monitoring paradigms across species, it should be possible to map the phylogenetic distribution of metacognition and illuminate the emergence of mind. We provide a unifying formal description of animals' performances and examine the optimality of their decisional strategies. Finally, we interpret animals' and humans' nearly identical performances psychologically. Low-level, stimulus-based accounts cannot explain the phenomena. The results suggest granting animals a higher-level decision-making process that involves criterion setting using controlled cognitive processes. This conclusion raises the difficult question of animal consciousness. The results show that animals have functional features of or parallels to human conscious cognition. Remaining questions are whether animals also have the phenomenal features that are the feeling/knowing states of human conscious cognition, and whether the present paradigms can be extended to demonstrate that they do. Thus, the comparative study of metacognition potentially grounds the systematic study of animal consciousness. Key Words: cognition; comparative cognition; consciousness; memory monitoring; metacognition; metamemory; self-awareness; uncertainty; uncertainty monitoring. (shrink)

Recent findings indicate that frontal brain asymmetry may be a marker of for depression. However, the psychological predispositions that account linkage between frontal brain asymmetry and depression are unclear. approach-withdrawal hypothesis is the primary framework that has been to account for the linkages between frontal brain asymmetry and or emotional disorders. We review evidence consistent with this and suggest several directions for its extension. One such direction is to constrain the approach-withdrawal hypothesis by linking frontal asymmetry to the known functions (...) of the prefrontal cortex. On this we propose that frontal brain asymmetry may be preferentially linked processes that promote the temporal continuity and shifting of or emotional priorities and the suppression of interference by sources of motivation or emotion. We review evidence from and neurobiological studies of depression that is broadly consistent with these predictions. We emphasise the need for future studies testing our hypotheses. (shrink)

There is a growing consensus in Britain on the importance of character, and on the belief that the virtues that contribute to good character are part of the solution to many of the challenges facing modern society. Parents, teachers and schools understand the need to teach basic moral virtues to pupils, such as honesty, self-control, fairness, and respect, while fostering behaviour associated with such virtues today. However, until recently, the materials required to help deliver this ambition have been missing in (...) Britain. The Knightly Virtues Programme, devised by the Jubilee Centre for Character and Virtues, aims to help solve this challenge. The programme, designed for 9 to 11 year olds, draws on selected classic stories to help teach moral character in schools. This approach has proved to be popular with children and teachers, with more than 5,000 pupils from one hundred schools having participated in the programme so far. Fifty-five of these schools and 3,272 pupils were directly involved in different stages of the research. Based at the University of Birmingham, the Jubilee Centre houses leading academics dedicated to researching the various ways in which good character, which underpins the building blocks of society, can be developed. Recent research from the Centre has shown that the qualities that make up character can be learnt and taught, and suggests that we need a new emphasis on their importance in schools and in professional education. This report from the Centre into the use of classic literature within schools sets out the ways in which the Knightly Virtues Programme is able to develop the virtue literacy of school pupils, and the extent to which an understanding and awareness of good moral character can make positive changes to behaviour. The impact of the programme has been tested using several rigorous research methods, detailed in this report alongside their findings, which provide substantial empirical evidence for the effectiveness of using stories to develop virtue literacy. (shrink)

The self seems to be a unitary entity remaining stable across time. Nevertheless, current theorizing conceptualizes the self as a number of interacting sub-systems involving perception, intention and action (self-model). One important function of such a self-model is to distinguish between events occurring as a result of one's own actions and events occurring as the result of somebody else's actions. We conducted an fMRI experiment that compared brain activation after an abrupt mismatch between one's own movement and its visual consequences (...) with an abrupt mismatch between one's own movement and somebody else's visually perceived hand movement. A right fronto-parietal network was selectively active during a sudden mismatch between one's own observed and performed hand action. (shrink)

Hypnagogic and hypnopompic experiences (HHEs) accompanying sleep paralysis (SP) are often cited as sources of accounts of supernatural nocturnal assaults and paranormal experiences. Descriptions of such experiences are remarkably consistent across time and cultures and consistent also with known mechanisms of REM states. A three-factor structural model of HHEs based on their relations both to cultural narratives and REM neurophysiology is developed and tested with several large samples. One factor, labeled Intruder, consisting of sensed presence, fear, and auditory and visual (...) hallucinations, is conjectured to originate in a hypervigilant state initiated in the midbrain. Another factor, Incubus, comprising pressure on the chest, breathing difficulties, and pain, is attributed to effects of hyperpolarization of motoneurons on perceptions of respiration. These two factors have in common an implied alien ''other'' consistent with occult narratives identified in numerous contemporary and historical cultures. A third factor, labeled Unusual Bodily Experiences, consisting of floating/flying sensations, out-of-body experiences, and feelings of bliss, is related to physically impossible experiences generated by conflicts of endogenous and exogenous activation related to body position, orientation, and movement. Implications of this last factor for understanding of orientational primacy in self-consciousness are considered. Central features of the model developed here are consistent with recent work on hallucinations associated with hypnosis and schizophrenia. (shrink)

Abstract:The Analects and the Mencius are among the most influential early Confucian texts. They emphasize the importance of moral self-cultivation. The individual is expected to identify what is good, and freely choose it regardless of their internal predispositions or external conditions. Curiously, in their philosophical frameworks they do not posit anything outside of contingencies. This means there is no non-contingency-based notion of "good" or "agency." This paper contributes to the current discourse by explaining how morality and agency can be possible (...) in a completely contingent system. Instead of positing a pregiven principle, self, will, or even capacity for agency, I will argue that Confucian texts assume that morality and agency emerge out of contingencies. As such, morality and agency are categorically distinct from contingencies, and are thereby able to reflect on them, without being ultimately sourced from any power outside of contingencies. (shrink)

A self-admittedly unorthodox attempt to apply the teachings of Buddha to the problems of contemporary India. Unostentatious in design, it is a highly personal interpretation of Buddhist teaching by a sensitive Indian thinker.--J. D. T. Jr.

As in the transmigration of souls after death in the Pythagorean myth that Socrates recounts in the Phaedo, for G.W.F. Hegel, in the Philosophy of Right, individuals are also 'reborn' out of their original nature into a 'second nature'. This article asks whether the Hegelian transmigration aims at their becoming nothing higher than that 'race of tame and social creatures . . . bees perhaps, wasps, or ants' which the Pythagorean myth relates is the fate of those who 'practiced popular (...) and social goodness . . . but devoid of philosophy and intelligence'. Through an analysis of duty, virtue, rectitude, custom and habit, this article argues that Hegel's account of the nature of fully ethical self-consciousness contains within it a robust, practical knowledge that resists the 'bees problem', shifts the focus of criticism from the truncation of human possibilities to the vitality of life, and ultimately furnishes resources that can secure the latter -- all without abandoning conventionality as the ethical horizon. (shrink)

Some argue that animals and non-human figures in the Zhuangzi help displace the significance of humans. According to others the Zhuangzi suggests a certain time of ‘animalism,’ asking us to be more like various types of fauna and flora that do not share our self-centeredness. In this paper the use of non-human characters in the Zhuangzi will be examined through a survey of traditional Chinese commentary, comparisons with the Lunyu, and placing the use of non-human characters within the larger context (...) of the Zhuangzi. Thus we find that while anti-anthropocentric and animalistic perspectives can be philosophized with the Zhuangzi, the text itself is not overly concerned with these subjects. Animals and non-human characters are mainly allegorical or metaphorical, allowing the Zhuangzito 1) make broadly applicable arguments; 2) playfully discuss ideas that may be unappealing at first glance, and; 3) create a distance that allows the text to resist ossification. (shrink)