The objective of this study was to review the design and delivery of medical ethics education within medical programs across Australia and New Zealand, how current teaching has been informed by the proposed core curriculum published in 2001 by the ATEAM and how it could look moving forward. We conducted a mixed methods study using an online questionnaire consisting of 51 items. This included both binary and open-ended questions to categorise and explore similarities and differences in medical ethics curricula in (...) medical programs accredited by the Australian Medical Council across ANZ. Participants were asked about curriculum design format, duration, goals, assessments, content areas of their own ME curriculum. Convenors from 18 universities responded. The main commonality was that ME curricula were integrated both longitudinally and laterally with other content. There was also commonality in content areas addressed. The goals, format, educators, and assessments of the ME curricula were highly variable. Most respondents described a curriculum which prioritised knowledge and skill development related to ME. Although the core goals of including knowledge, skills, and attitudinal development in ME curricula are still present, there is no uniformity in terms of format, delivery, or assessment across medical programs in ANZ. This is an area for collaborative development. (shrink)

ABSTRACTThe standard view in philosophy of mind is that the way to understand the difference between perception and misperception is in terms of accuracy. On this view, perception is accurate while...

Pacific Philosophical Quarterly, March 2006. Significant effort has been devoted to locating a good argument for Kant ’s Formula of Humanity. In this paper, I contrast two arguments, based on Kant ’s text, for the Formula of Humanity. The first, which I call the “Valued Ends” argument, is an influential and appealing argument developed most notably by Christine Korsgaard and Allen Wood. Notwithstanding the appeal and influence of this argument, it ultimately fails on several counts. I therefore present as an (...) alternative the “Autonomy” argument, which is largely inspired by the failings of the Valued Ends argument. (shrink)

The standard foil for recent theories of hope is the belief-desire analysis advocated by Hobbes, Day, Downie, and others. According to this analysis, to hope for S is no more and no less than to desire S while believing S is possible but not certain. Opponents of the belief-desire analysis argue that it fails to capture one or another distinctive feature or function of hope: that hope helps one resist the temptation to despair;2 that hope engages the sophisticated capacities of (...) human agency, such as planning;3 or that hope involves the imagination in ways desire need not.4 Here, I focus on the role of imagination in hope, and discuss its implications for hope’s relation to practical commitment or end-setting. (shrink)

What exactly is hope and how does it influence our decisions? In How We Hope, Adrienne Martin presents a novel account of hope, the motivational resources it presupposes, and its function in our practical lives. She contends that hoping for an outcome means treating certain feelings, plans, and imaginings as justified, and that hope thereby involves sophisticated reflective and conceptual capacities. Martin develops this original perspective on hope--what she calls the "incorporation analysis"--in contrast to the two dominant philosophical conceptions (...) of hope: the orthodox definition, where hoping for an outcome is simply desiring it while thinking it possible, and agent-centered views, where hoping for an outcome is setting oneself to pursue it. In exploring how hope influences our decisions, she establishes that it is not always a positive motivational force and can render us complacent. She also examines the relationship between hope and faith, both religious and secular, and identifies a previously unnoted form of hope: normative or interpersonal hope. When we place normative hope in people, we relate to them as responsible agents and aspire for them to overcome challenges arising from situation or character. Demonstrating that hope merits rigorous philosophical investigation, both in its own right and in virtue of what it reveals about the nature of human emotion and motivation, How We Hope offers an original, sustained look at a largely neglected topic in philosophy. (shrink)

I argue for adopting a conception of obligation that is broader than the conception commonly adopted by moral philosophers. According to this broader conception, the crucial marks of an obligatory action are, first, that the reasons for the obliged party to perform the action include an exclusionary reason and, second, that the obliged party is the appropriate target of blaming reactive attitudes, if they inexcusably fail to perform the obligatory action. An obligation is directed if the exclusionary reason depends on (...) the relationship between the obliged person and the person to whom they owe the obligatory action, and the latter person is positioned to personally blame the obligated person for inexcusably failing to perform the obligatory action. Some direc- ted obligations are not owed as a matter of right, and the person to whom the obligatory action is owed is the only person positioned to blame nonperformance. Other directed obligations are owed as a matter of right, and people who are not part of the relationship grounding the obligation nevertheless are also positioned to (impersonally) blame non-performance. Only the rights-based form of directed obligation has received signifi- cant attention from moral philosophers, yet the former—which is at the heart of what I call “personal bonds”—is a pervasive and significant theme of our ordinary interpersonal lives. (shrink)

How do we encourage patients to be hopeful without exploiting their hope? A medical researcher or a pharmaceutical company can take unfair advantage of someone's hope by much subtler means than simply giving misinformation. Hope shapes deliberation, and therefore can make deliberation better or worse, by the deliberator's own standards of deliberation.

This article defends a theory of diffuse attention and distinguishes it from focal attention. My view is motivated by evidence from psychology and neuroscience, which suggests that we can deploy visual selective attention in at least two ways: by focusing on a small number of items, or by diffusing attention over a group of items taken as a whole. I argue that diffuse attention is selective and can be object‐based. It enables a subject to select an object to guide behavior, (...) albeit in a different way than focusing does. (shrink)

George Lakoff discusses how emotion metaphors reflect the discrete bodily states associated with each emotion. The analysis raises questions about the context for and frequency of use of emotion metaphors and, indeed, emotion labels, per se. An assumption implicit to most theories of emotion is that emotion language is just another channel through which people express ongoing emotion states. Drawing from recent evidence that labeling ongoing emotions reduces their intensity, we propose that a primary function of emotion language is regulatory (...) rather than expressive. (shrink)

It is a commonplace in both the popular imagination and the philosophical literature that hope has a special kind of motivational force. This commonplace underwrites the conviction that hope alone is capable of bolstering us in despairinducing circumstances, as well as the strategy of appealing to hope in the political realm. In section 1, I argue that, to the contrary, hope’s motivational essence is not special or unique—it is simply that of an endorsed desire. The commonplace is not entirely mistaken, (...) however, because standard ways of expressing hope do have motivational influence that is different in kind from that of desire. In sections 2 through 4, I examine one of these ways of expressing hope, fantasizing, and argue that fantasies can present us with reasons to modify our goals and projects in multiple ways. (shrink)

Purpose– This paper aims to consider selected results from the Arts and Humanities Research Council -funded “Managing Access to the internet in Public Libraries” project, from 2012-2014. MAIPLE has explored the ways in which public library services manage use of the internet connections that they provide for the public. This included the how public library services balance their legal obligations and the needs of their communities in a public space and the ethical dilemmas that arise.Design/methodology/approach– The researchers used a mixed-method (...) approach involving a review of the literature, legal analysis, a questionnaire survey and case studies in five public library authorities.Findings– UK public library services use a range of methods to regulate internet access. The research also confirms previous findings that filtering software is an ubiquitous tool for controlling access to and protecting library users from “inappropriate”, illegal and harmful internet content. There is a general, if sometimes reluctant, acceptance of filtering software as a practical tool by library staff, which seems to contrast with professional codes of ethics and attitudes in other countries. The research indicates that public library internet access will be a valued service for some time to come, but that some aspects of how public library services regulate internet access is currently managed can have socially undesirable consequences, including blocking legitimate sites and preventing users from accessing government services. Education could play a greater part in helping the general population to exercise judgement in selection of materials to view and use. This does not preclude implementing stricter controls to protect children, whilst allowing public libraries to continue providing a social good to those who are unable to otherwise participate in the digital age.Research limitations/implications– The response to the survey was 39 per cent meaning that findings may not apply across the whole of the UK. The findings of this study are compared with and supplemented by other quantitative sources, but a strength of this study is the depth of understanding afforded by the use of case studies.Originality/value– This paper provides both a quantitative and qualitative analysis of how internet access is managed in UK public libraries, including how library services fulfil their legal obligations and the ethical implications of how they balance their role in facilitating access to information with their perceived role as a safe and trusted environment for all members of their communities. The findings add to the international discussion on this issue and stimulate debate and policy making in the UK. (shrink)

In cases of identity crowding, a subject consciously sees items in a figure, even though they are presented too closely together for her to shift attention to each item. Block uses such cases to challenge the view that attention is necessary for consciousness. I argue that in identity crowding cases, subjects really do attend to the items. Specifically, they attend to the figure as a global object that contains the individual items as parts. To support this view, I provide evidence (...) that attention can be directed to a global object or a local object. My response helps to defend the view that attention is necessary for conscious perception. (shrink)

Apologies are strange. They are, in a certain sense, very small. An apology is just a gesture—a set of words, a physical posture, perhaps a gift. But an apology can also be very powerful—this power is implicit in the facts that it can be difficult to offer an apology and that, when we are wronged, we may want an apology very much. More, even we have been severely wronged, we are sometimes willing to forgive or pardon the wrongdoer, if we (...) receive a sincere apology. In this paper, I want to begin to figure out how a mere gesture can be so powerful. The philosophers who discuss apology generally do not go into much detail, and they discuss it almost exclusively in connection with forgiveness. 2 I, too, will discuss apology’s power to provide reason to forgive, but in order to provide the resources to examine another power. Some apologies, I will argue, fail to provide reason to forgive, but nevertheless do provide the recipient a reason to maintain a relationship with the wrongdoer, or to allow the wrongdoer to remain in her community. To be clear: the “powers” I am interested in are reason-giving powers, or powers to make certain beliefs, attitudes, or actions rational. Apologies also, no doubt, have a sort of bare causal power. The sight of a vicious, racist, cruel war criminal on his knees and in tears, sincerely begging forgiveness, may inspire in us pity or even compassion, in spite of what we believe we have reason to feel. “I can’t help but feel sorry for the bastard,” we may say, even while believing that.. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

Attention seems to raise a problem for pure representationalism, the view that phenomenal content supervenes on representational content. The problem is that shifts of attention sometimes seem to bring about a change in phenomenal content without a change in representational content. I argue that the representationalist can meet this challenge, but that doing so requires a new view of the representational content of perception. On this new view, the representational content of perception is always relative to a way of attending. (...) I call this the attention-indexed view of perceptual content. (shrink)

ABSTRACTRecognising a facial expression is more difficult when the expresser's body conveys incongruent affect. Existing research has documented such interference for universally recognisable bodil...

People with disabilities use more medical care and see health professionals more often than do those of the same age, ethnic group, or economic class who do not have impairments. An indisputable medical goal is.

In their classic, Principles of Biomedical Ethics (now in its fifth edition), Beauchamp and Childress, describe a puzzling case: A man who generally exhibits normal behavior patterns is involuntarily committed to a mental institution as the result of bizarre self-destructive behavior (pulling out an eye and cutting off a hand). This behavior results from his unusual religious beliefs. … [H]is peculiar actions follow “reasonably” from his religious beliefs. …While analysis in terms of limited competence might at first appear plausible, such (...) an analysis entails that persons with unorthodox or bizarre religious beliefs are less than competent, even if they reason clearly in light of their beliefs. (shrink)

The extent of the approval with which Western culture views the attitude of hope can scarcely be exaggerated. Hope is seen as that which sustains us through wartime, death camps, slavery, natural disaster, extreme disease and disability—it is a light, a beacon, the last spark that fuels us when all else has failed. Hope is also seen as a moral and spiritual virtue—hoping for moral progress in this world, and salvation in the next, is at the heart of a meaningful (...) human life. A positive view of hope infuses Western theology since Aquinas; utopian political philosophy, positive psychology, the self-help culture, the clinical research community, a wide range of activist groups, and a great deal of political rhetoric all maintain the affirmation of hope. The only qualm commonly expressed about hope is that it is sometimes “false:” that is, based on lies or misconceptions. False hope is bad because, first, it is bad to be deceived and, second, it may suck up resources better spent elsewhere. False hope, though, is not genuine hope, and genuine hope is an essential human good. My book Wanting to Pull Clouds will argue that the popular view of hope is vastly and dangerously oversimplified. Much more insidious than false hope is hope that is “genuine” and not based on lies or misconceptions, but that nevertheless bears important conceptual and empirical connections to passivity, inattention, excuse-making and wishful thinking. To be clear, this is not an anti-hope project. Rather, it examines the mechanisms that make hope desirable and virtuous, when it is these things; it becomes clear in the course of this examination that these very.. (shrink)

Put relationship-centered communication at the forefront of care Today, physicians face a hypercompetitive marketplace in which they must meet unique and complex patient needs as efficiently as possible. But in a culture prioritizing clinical outcomes above all, there can be a tendency to lose sight of one of the most critical aspects of providing effective care: the communication skills that build and foster physician-patient relationships. Studies have shown that good communication between doctors and patients and among all caregivers who interface (...) with patients directly results in better clinical outcomes, reduced costs, greater patient satisfaction, and lower rates of physician burnout. In Communication the Cleveland Clinic Way, Dr. Adrienne Boissy and her team tell the story of how Cleveland Clinic created and applied the R.E.D.E. to Communicate: Foundations of Healthcare program, making the world-renowned hospital system a leader in relationship-centered care. They provide a step-by-step guide for healthcare leaders and decision-makers to design, develop, and implement communication skills training in their own institutions. Learn how to: • Craft an effective, colleague-supported communication skills program to include veteran physicians, residents, and medical students • Leverage creative program design and data transparency to engage and facilitate staff physicians and advanced care providers • Identify common misperceptions and myths in healthcare communication and respond to them successfully • Cultivate a true sense of empathy—with patients and fellow caregivers alike—while maintaining professionalism In a field where difficult conversations and stressful relationships are commonplace, clinicians need a structured approach to enable them to deliver the best care possible. Communication the Cleveland Clinic Way is the blueprint for establishing a relationship-centered program that will improve patient experience, reinvigorate doctors’ passion for their work, and elevate any organization. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:I Had Never Heard Someone Use That Word BeforeAdrienne Feller NovickThe patient was dying. As the social worker, I had arranged the meeting and sat shoulder to shoulder with the family and the attending physician in the small nondescript room. The family was grief-stricken and asked intelligent questions as they made difficult decisions about end-of-life care for their loved one. The doctor spoke with gentle kindness, acknowledging their difficult (...) decision as he completed the neon pink Medical Orders for Life Sustaining Treatment (MOLST) form and left the room. I was tangled up with emotions; I felt relieved that the meeting had gone smoothly, sad for the patient and family, and in awe of the doctor for his ability to lead the difficult conversation. I stayed behind to ask the family if there was anything I could do to help them. [End Page E4]Before I could speak, the patient's wife turned to me and said, "I am so glad that k--- left the room." (Using a derogatory word for a person of the Jewish faith). My brain began processing the statement. I am a Jewish woman. Did I hear that right? Did she say what I think she said? Should I say something? I froze, and time seemed to stop. She was looking at me expectantly, waiting for a response. Her face reminded me of someone waiting for the other person to return a "high five." I was flooded with emotion. A succession of thoughts ran through my head, everything from being rude in response or getting physical. I did neither. I said nothing. I smiled and left the room feeling like I had been gut-punched.I was in denial. I made excuses for the wife; she was stressed. I kept thinking I must not have heard her correctly and that I was overreacting. I continued to work with the family as though nothing had happened until the patient died five days later. I felt ashamed and never told anyone about what happened. I regretted not saying anything. I replayed the conversation in my mind and felt depressed and angry. Inside I felt complicit for not speaking up, but I had no words. I assumed bias in healthcare was rare. I did nothing.Years later, after I completed a patient visit in the Intensive Care Unit (ICU), I observed a group of surgical residents doing rounds. The attending welcomed me to join this valuable clinical learning experience. As the group approached the next bed, the patient pointed to one resident and loudly said, "I don't want a doctor who looks like that to come near me." I gasped aloud and froze, waiting to see what would happen next. The attending looked directly at the patient and said calmly, "We are all here to help you. That is not an appropriate thing for you to say." Then, he turned to the resident and nodded, directing them to resume their bedside assessment. The patient mumbled something inaudibly and said nothing.To my astonishment, the doctor acknowledged the microaggression (a microaggression is a statement, action, or incident regarded as discrimination), addressed the issue, respectfully supported the resident, created a safe space for everyone on the healthcare team and resumed quality patient care without missing a beat. He modeled a strategy to address patient bias and taught a valuable skill. This was a learning moment for me. It helped me refocus my past experience and provided me with a useful strategy to address bias in the future.As a member of the medical ethics consultation service, I listen, provide support, and aid in challenging communications. I had the opportunity to model the communication strategy I acquired in the ICU. The medical ethics team was consulted for a patient refusing treatment. The patient was disrespectful to healthcare team members, cursing at nurses and residents, using ethnic slurs, and saying he "would rather die than let one of them touch him. I entered the patient's room with the healthcare team, introduced myself, and explained the reason for my visit. The patient defiantly agreed he had used slurs, saying he wanted to go home. I continued, everyone here... (shrink)

Recently, there has been a surge of interest in the lexicon. The demand for a fuller and more adequate understanding of lexical meaning required by developments in computational linguistics, artificial intelligence, and cognitive science has stimulated a refocused interest in linguistics, psychology, and philosophy. Different disciplines have studied lexical structure from their own vantage points, and because scholars have only intermittently communicated across disciplines, there has been little recognition that there is a common subject matter. The conference on which this (...) volume is based brought together interested thinkers across the disciplines of linguistics, philosophy, psychology, and computer science to exchange ideas, discuss a range of questions and approaches to the topic, consider alternative research strategies and methodologies, and formulate interdisciplinary hypotheses concerning lexical organization. The essay subjects discussed include: * alternative and complementary conceptions of the structure of the lexicon, * the nature of semantic relations and of polysemy, * the relation between meanings, concepts, and lexical organization, * critiques of truth-semantics and referential theories of meaning, * computational accounts of lexical information and structure, and * the advantages of thinking of the lexicon as ordered. (shrink)

A theory of word meaning developed jointly by Adrienne and Keith Lehrer is summarized, which accommodates the empirical facts of natural languages, especially the diversity of types of words. Reference characterizes the application of words to things, events, properties, etc. and sense the relationship among words and linguistic expressions. Although reference and sense are closely connected, neither can be reduced to the other. We use the metaphor of vectors to show how different, sometimes competing forces interact to provide an (...) understanding of what a word in context means. Topics discussed include vagueness, indeterminacy, the role of experts, possible worlds, pragmatic influences, semantic change, semantic networks, fields, and entailments. A formal theory for understanding the relationship of idiolects, dialects, and communal languages is proposed to account for the dynamic interaction of individuals and communities which occurs continuously. (shrink)

The vocabulary of wine is large and exceptionally vibrant -- from straight-forward descriptive words like "sweet" and "fragrant", colorful metaphors like "ostentatious" and "brash", to the more technical lexicon of biochemistry. The world of wine vocabulary is growing alongside the current popularity of wine itself, particularly as new words are employed by professional wine writers, who not only want to write interesting prose, but avoid repetition and cliche. The question is, what do these words mean? Can they actually reflect the (...) objective characteristics of wine, and can two drinkers really use and understand these words in the same way?In this second edition of Wine and Conversation, linguist Adrienne Lehrer explores whether or not wine drinkers (both novices and experts) can in fact understand wine words in the same way. Her conclusion, based on experimental results, is no. Even though experts do somewhat better than novices in some experiments, they tend to do well only on wines on which they are carefully trained and/or with which they are very familiar. Does this mean that the elaborate language we use to describe wine is essentially a charade? Lehrer shows that although scientific wine writing requires a precise and shared use of language, drinking wine and talking about it in casual, informal setting with friends is different, and the conversational goals include social bonding as well as communicating information about the wine. Lehrer also shows how language innovation and language play, clearly seen in the names of new wines and wineries, as well as wine descriptors, is yet another influence on the burgeoning and sometimes whimsical world of wine vocabulary. (shrink)

It is gratifying that thoughtful philosophers and bioethicists like Mahowald and Nelson are continuing to address the objections to prenatal testing that have been made by disability scholars and advocates. But it is frustrating to see those objections presented in ways that reflect the doubts of those who reject them more than the intentions of those who make them, in ways that make those objections appear censorious toward pregnant women and prospective parents or naïve about nonverbal expression. We recognize that (...) disability critics share the responsibility for these misunderstandings, that their objections to prenatal disability testing have not always been made as clearly or consistently as they might have been. We therefore welcome this opportunity for clarification and rebuttal. Briefly, we will argue against Mahowald that it is not apparent how prospective parents could have a duty to potential offspring requiring them to prevent the birth of any child expected to have a life worth living. And we will remind Nelson that our primary concern is with the perpetuation of stigma; that even if any reason for abortion can be framed in terms of a trait of the fetus to be aborted, only certain reasons for abortion are based on the rejection of future children because of stigmatized traits. (shrink)