Importance: Given the importance of apathy for stroke, we felt it was time to scrutinize the psychometric properties of the commonly used Starkstein Apathy Scale for this purpose.Objectives: The objectives were to: estimate the extent to which the SAS items fit a hierarchical continuum of the Rasch Model; and estimate the strength of the relationships between the Rasch analyzed SAS and converging constructs related to stroke outcomes.Methods: Data was from a clinical trial of a community-based intervention targeting participation. A total (...) of 857 SAS questionnaires were completed by 238 people with stroke from up to 5 time points. SAS has 14 items, rated on a 4-point scale with higher values indicating more apathy. Psychometric properties were tested using Rasch partial-credit model, correlation, and regression. Items were rescored so higher scores are interpreted as lower apathy levels.Results: Rasch analysis indicated that the response options were disordered for 8/14 items, pointing to unreliability in the interpretation of the response options; they were consequently reduced from 4 to 3. Only 9/14 items fit the Rasch model and therefore suitable for creating a total score. The new rSAS was deemed unidimensional. Apathy was correlated weakly with anxiety/depression and uncorrelated with physical capacity. Regression showed that the effect of apathy on participation and health perception was similar for rSAS/SAS versions: R2 participation measures ranged from 0.11 to 0.29; R2 for health perception was ∼0.25. When placed on the same scale, rSAS value was 6.5 units lower than SAS value with minimal floor/ceiling effects. Estimated change over time was identical which was not substantial but greater than expected assuming no change.Conclusion: The retained items of the rSAS targeted domains of behaviors more than beliefs and results support the rSAS as a robust measure of apathy in people with chronic stroke. (shrink)

Human cooperation is highly unusual. We live in large groups composed mostly of non-relatives. Evolutionists have proposed a number of explanations for this pattern, including cultural group selection and extensions of more general processes such as reciprocity, kin selection, and multi-level selection acting on genes. Evolutionary processes are consilient; they affect several different empirical domains, such as patterns of behavior and the proximal drivers of that behavior. In this target article, we sketch the evidence from five domains that bear on (...) the explanatory adequacy of cultural group selection and competing hypotheses to explain human cooperation. Does cultural transmission constitute an inheritance system that can evolve in a Darwinian fashion? Are the norms that underpin institutions among the cultural traits so transmitted? Do we observe sufficient variation at the level of groups of considerable size for group selection to be a plausible process? Do human groups compete, and do success and failure in competition depend upon cultural variation? Do we observe adaptations for cooperation in humans that most plausibly arose by cultural group selection? If the answer to one of these questions is “no,” then we must look to other hypotheses. We present evidence, including quantitative evidence, that the answer to all of the questions is “yes” and argue that we must take the cultural group selection hypothesis seriously. If culturally transmitted systems of rules that limit individual deviance organize cooperation in human societies, then it is not clear that any extant alternative to cultural group selection can be a complete explanation. (shrink)

We present data from an exploratory qualitative interview-based pedagogical research project on the development of student agency in higher education. Our aim was to respond to Nick Zepke’s claim that what is often missing from the current neoliberal discourse of higher education ‘is students having a voice in what and how they learn and how they can action their voice in the wider community as agentic citizens.’ Informed by Lacanian discourse analysis, our project investigated the opportunities and threats facing some (...) of our undergraduate students as they struggled to exercise agency and develop autonomy in the marketised university. Repeat interviews with final year students focussed on the psychosocial categories of power, affect, intersubjectivity and desire. The analysis was guided by Lacan’s theory of the four discourses, an account of the vicissitudes of agency. We found that students can move between discourses depending on the extent to which their agency was enabled or thwarted. Our critique of the metaphor of the ‘student journey’ addresses the implications for learning and teaching and the university’s mission to develop its students in light of perceived commercial pressures. (shrink)

Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents, healthcare professionals and policy decision makers in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information (...) attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities ; parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs. (shrink)

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients' health and how their (...) medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (shrink)

Provider claims to conscientious objection have generated a great deal of heated debate in recent years. However, the conflicts that arise when providers make claims to the "conscience" are only a subset of the more fundamental challenges that arise in health care practice when patients and providers come into conflict. In this piece, the author provides an account of patient-provider conflict from within the moral tradition of St. Thomas Aquinas. He argues that the practice of health care providers should be (...) understood as a form of practical reasoning and that this practical reasoning must necessarily incorporate both "moral" and "professional" commitments. In order to understand how the practical reasoning of provider should account for the needs and commitments of the patient and vice versa, he explores the account of dependence provided by Alasdair MacIntyre in his book Dependent Rational Animals. MacIntyre argues that St. Thomas’ account of practical reasoning should be extended and adapted to account for the embodied vulnerability of all humans. In light of this insight, providers must view patients not only as the subjects of their moral reflection but also as fellow humans upon whom the provider depends for feedback on the effectiveness and relevance of her practical reasoning. The author argues that this account precludes responsive providers from adopting either moral or professional conclusions on the appropriateness of interventions outside the individual circumstances that arise in particular situations. The adoption of this orientation toward patients will neither eradicate provider-patient conflict nor compel providers to perform interventions to which they object. But this account does require that providers attend meaningfully to the suffering of patients and seek feedback on whether their intervention has effectively addressed that suffering. (shrink)

Last year (1998) saw the celebration of the 50th Anniversaryof the British National Health Service (NHS). One ofthe few completely nationalised systems of health carein the world, the NHS is seen by many as a moralbeacon of what it means to provide equitable medicaltreatment to all citizens on the basis of need andneed alone. However, others argue that it has failedto achieve the overall goals for which it was created.Because of scarce resources, some urgently needed careis not available at all, (...) while that which is receivedis sometimes second class. For these reasons, it isclaimed that the NHS should be scrapped and replacedby other systems of health care delivery.This paper outlines the history of the NHS,indicating some of the problems and innovations whichhave led to its current organization and structure.The philosophical foundations of the NHS are then articulated and defended on the grounds that it stillrepresents a morally coherent and economicallyefficient approach to the delivery of health care.Scarce resources are the key problem facing the NHS,making rationing inevitable and it is shown thatthis is not incompatible with the moral foundations ofthe service. However, there can be little doubt thatthe NHS is now becoming dangerously under-funded. Thepaper concludes with arguments about why this is soand what might be done about it. (shrink)

The Edinburgh Medical Group Research Project is unique in Britain. Part of its function is to experiment with teaching medical ethics both inside and outside of the Medical School. The papers which follow have been written by two full-time reseach fellows working with the Project and two of the professional advisers, one nursing and one medical. Together they give a picture of the wide scope of exerimental teaching taking place in Edinburgh and present some preliminary results from these experiments.

In lieu of an abstract, here is a brief excerpt of the content:Past, Present—and Future Perfect?Taking Psychiatry Beyond Its Single Message MythologiesK. W. M. Fulford (bio)I am grateful to John Sadler and his colleagues for their generous invitation to contribute to this collection marking Philosophy, Psychiatry, & Psychology (PPP)'s thirtieth birthday. True to our editorial tradition of "no nonsense" publishing, the "ask" was a reflection on PPP's past, present and future, limited to 500 words. In fact, one word does it (...) for me—collegiality.Collegiality was our watch word from the start. I still treasure a group photo taken at an early pre-meeting of the Association for the Advancement of Philosophy and Psychiatry (AAPP) convened by Michael Schwartz at his home in 1992, when, among other initiatives, PPP was conceived through transferring our then-nascent journal proposal from a small British publishing house to its current international publisher, the Johns Hopkins University Press. Michael and I had met earlier by phone when he had called the Royal College of Psychiatrists in London to enquire about its recently launched Philosophy Group and (by mere chance) I happened to be standing next to the person who took the call! PPP, with John and myself its founder editors, was subsequently born as, and has remained, a joint venture between our two groups: and Peter Zachar's recent initiative in building closer links with the International Network for Philosophy and Psychiatry (INPP) has taken us an important step towards the vision shared by Michael, John and myself that PPP should grow to reflect and represent a global open society of philosophy and mental health.As a pointer to the future, this global open society was no mere utopian vision but a joint commitment to what we conceived as a necessary ambition. Contemporary disenchantment with the repeated failures of translation of current narrowly empirical models of psychiatry, points to the truth of our German colleague, Paul Hoff's, characterization of the history of psychiatry as a history of serial collapses into single message mythologies. This disenchantment might seem to offer an opportunity for colonial expansion of philosophy into psychiatry (a re-assertion, perhaps, of phenomenology?). But PPP was born out of the "decade of the brain" and has remained throughout an ally of, not competitor to, the neurosciences. [End Page 3] So, while it is true that, with Peter's initiative, and with editorial and other innovations introduced by John, PPP is actively extending its reach (to new areas of philosophy, and to new voices, informed notably by experience as well as by training), this expansion remains a collegial not colonial enlargement of the field. I need hardly point to the challenges presented by the inclusive ambitions of such enlargement (not least to maintaining the highest standards of editorial and peer review). But PPP's collegiality provides the foundation for the work needed to deliver on these challenges. Even if imperfectly realized, this collegiality will help to take us beyond the single message mythologies by which our discipline has too long been hobbled. [End Page 4]K. W. M. Fulford K.W.M. (Bill) Fulford is a Fellow of St Catherine's College and Member of the Philosophy Faculty, University of Oxford; Emeritus Professor of Philosophy and Mental Health, University of Warwick Medical School; and Founder Director of the Collaborating Centre for Values-based Practice, St Catherine's College, Oxford (valuesbasedpractice.org).Copyright © 2023 Johns Hopkins University Press... (shrink)

We describe new results in parametrized complexity theory. In particular, we prove a number of concrete hardness results for W[P], the top level of the hardness hierarchy introduced by Downey and Fellows in a series of earlier papers. We also study the parametrized complexity of analogues of PSPACE via certain natural problems concerning k-move games. Finally, we examine several aspects of the structural complexity of W [P] and related classes. For instance, we show that W[P] can be characterized in (...) terms of the DTIME ) and NP. (shrink)

In research textbooks, and much of the research practice, they describe, qualitative processes and interpretivist epistemologies tend to dominate visual methodology. This article challenges the assumptions behind this dominance. Using exemplification from three existing visual data sets produced through one large education research project, this article considers the affordances and constraints of the research process focusing particularly on analysis. It examines how and when the visual can be incorporated, gives some critical reflections on the role and use of visual methods (...) to fulfil different research intents, and, in particular, considers combining large, open-ended data sets with acceptable and rigorous analysis techniques. We then explore arguments about the nature of visual data, what is considered epistemologically appropriate and the decision-making which accompanies any appraisal of process in education research. The intention is to challenge ourselves, and fellow visual methods researchers, to develop a more complete understanding of the theory and practice of visual research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Method in Ancient PhilosophyDavid K. GliddenJyl Gentzler, editor. Method in Ancient Philosophy. Oxford: Clarendon Press, 1998. Pp. viii + 398. Cloth, $72.00.The fifteen papers in this collection constitute revisions of conference proceedings and reflect the varied interests of participants. The ensemble exhibits a thoroughly modern methodology. Whatever and however various ancient methods of philosophy may have been, in Anglo-American scholarship it is standard practice to first address established (...) scholarly interpretations as the primary entry point to critical discussionóoften displacing antiquity with a critical vocabulary of philosophical modernity. Scholars may come to understand each other better, but at the risk of asking the wrong questions or sacrificing ancient texts themselves as mere means of producing papers.Most scholars are progressives. They believe philosophy has advanced past the comparatively primitive wisdom of antiquity, and so such scholars feel perfectly entitled to make better sense of ancient texts, by patiently explaining what the ancients would have meant had they only been able to get it right. There are, of course, exceptions. And some papers in this collection suggest deeper faith in our philosophic fathers. So, the battle between the ancients and the moderns is joined once more, between those who would adorn their papers with footnotes for their peers and those who would attempt more anthropological an inquiry into ancient philosophic practices.Ian Mueller and Robert Bolton each address the same passage in Plato's Phaedo, both beginning with an article from Vlastos, first published in 1969. Mueller thoughtfully explores three different yet related accounts of what we might call scientific method in explaining Plato's views on natural change. Bolton wonders whether scholars are asking the wrong questions. Patricia Curd attempts a progressivist account of Eleatic thought, notwithstanding her recognition of the paucity of ancient sources. Complete with elaborately numbered sentences, Gail Fine focuses primarily on Burnyeat (1976) on Plato on Protagoras. Constance Meinwald presents a rather near-sighted account of two passages in the Philebus that employ the peras-apeiron distinction, with a view toward Plato's allegedly modernist mathematization of understanding. Lesley Brown revisits five pages of the Sophist that were hotly debated in the 1960s. With charity and elegance, she offers several plausible solutions to puzzles posed by previous scholars. Sometimes time smoothes over differences.A. A. Long's essay on Plato's presentation of Socrates in the Theaetetus might appear more philosophically anthropological. Yet Long reveals progressive sympathies, suggesting that Plato dispatches Socrates in the Theaetetus, so as to prepare the way for a more rigorously academic form of philosophizing, such as that exhibited in the Sophist. [End Page 111] In this way, Long speculates, Plato abandoned practical ethics for the academic life of research, so familiar to university professors and conference participants. It might be hard to square such speculation with Plato's Laws and the reception of Plato's writings among his own contemporaries. Still, Socrates' shifting role in Plato's dialogues is well worth pondering.By comparison, T. H. Irwin's contribution is wonderfully old-fashioned. His paper addresses the background knowledge to be presumed by ancient readers of Plato's dialogues and how that knowledge is artfully put to use in Plato's depiction of Socrates' reflections on the unity of virtue. By speculating on Plato's relation to his ancient readers, Irwin displaces many modernist preoccupations, though not without himself falling victim to that peculiar scholarly obsession of dating Plato's dialogues by their doctrines.With characteristic conservatism, Gisela Striker cautions scholars not to over-read Aristotle's Prior Analytics. While that extraordinary work may have deep implications for the history of formal logic, it probably was instead intended to be part of a general account of argument. In a similar vein, Charlotte Witt attempts to rescue Aristotle from scholars who would delimit Aristotle's multifarious uses of the "for the sake of" explanation, which altogether pervade his metaphysics, physics, biology and ethics. Yet, Witt soon finds herself competing in a contest over interpretive distinctions, a sport that will certainly never capture Aristotle's own authorial intentions.Facing another mass of scholarship, in this case on Aristotle's dialectic, C. D. C. Reeve sensibly attempts to... (shrink)

Industries of production and scientific research rely on the use of nonhuman animals and plants, remaking environments, populations, and even genetic information to suit human designs. This issue of _Social Text_ considers the radical implications of questioning the exceptional status of humans among the planet’s species. Responding to growing interest in animal studies and posthumanism, the contributors draw on racial, feminist, queer, postcolonial, and disability theories to probe the diversity of human relationships with other forms of biosocial life. “Interspecies” queries (...) the politics of traditional species taxonomy and examines the ways humans use the material characteristics of other species to pursue their economic, political, and social aims. This collection goes beyond companionate species to examine less charismatic life forms: viruses, vermin, transgenic pigs, and commodified plants. Bringing together prominent scholars and artists from a range of fields, the issue examines the histories of species collection and display. In the context of current public health challenges, including the swine flu epidemic and the scarcity of donor organs, the contributors explore the limits of transgressing species boundaries that arise when human bodies contain other species, such as viruses or transplanted organs from genetically customized pigs. “Interspecies” analyzes the use of nonhuman species in the biopolitics of warfare and torture and examines how interspecies relationships shape conditions of colonialism, imprisonment, and violence. The issue also complicates romanticized narratives of human/nonhuman animal dynamics without resorting to oversimplified portrayals of human exploitation of animal and plant life. _Julie Livingston _is Associate Professor of History at Rutgers University. _Jasbir Puar _is Associate Professor of Women’s and Gender Studies at Rutgers University. She is the author of _Terrorist Assemblages: Homonationalism in Queer Times_. _Contributors: _Neel Ahuja, Suzanne Anker, Ed Cohen, James Delbourgo, Sarah Franklin, Carla Freccero, Alphonso Lingis, Julie Livingston, Chakanetsa Clapperton Mavhunga, Jasbir Puar, Kingsley Rothwell, Lesley Sharp. (shrink)

In a world fraught with violence in its macabre form, it is essential to have a broad and clear understanding of the principle of non-violence (ahimsa), its various nuances, its potential and limitations. Covering a span of wisdom literature on the Indian ethos from the times of the Upanishads to the works of modern seers like Gandhi, Tagore and Aurobindo, the author presents the notions of non-violence and violence along a finely graduated scale instead of going into sharp polarities. While (...) making a clear distinction between gross physical violence and the subtle play of violence in words, thoughts and ideas, the paper goes on to offer a critique of modern technology and nuclear proliferation for perpetrating violence on nature and fellow human beings in the name of progress and development. While expressing his admiration for the Gandhian principle of non-violence, the author advocates practical idealism that admits violence with caution but without hatred for the purpose of general welfare (lokasamgraha), along the lines of the messages of Krishna in the Gita. This is of practical necessity till such time as the world has been awakened to a heightened level of spiritual consciousness. (shrink)

Scholars generally agree that, according to Aristotle, factionalizers are motivated by a sense of injustice (the ‘first cause’) to redress imbalances in wealth and honor (the ‘second cause’). Recent discussions, however, have offered a misleading interpretation of Aristotle’s third cause, which he identifies as the origin of the factionalizers’ sense of injustice. It involves, most importantly, greed, hubris, and other factors such as fear and ‘disproportionate growth’. In conversation with a recent publication in Polis, this article restores the third cause (...) to its proper place in Aristotle’s account. Abusive power holders, driven by greed, hubris, and overreaching, oppress their fellow citizens – following in the tradition of Homer’s Agamemnon, Hesiod’s basileis, and Solon’s aristocrats. These power holders prompt a sense of anger, indignation, and injustice in their fellow citizens, who ultimately form factions and take action on their own behalf. (shrink)

1.1 Are commercial societies unfriendly to friendship? Many critics of commercial societies, from both the left and the right, have thought so. They claim that the free-market system of property rights, freedom of contract, and other liberty rights – the “negative” right of individuals to peacefully pursue their own ends – is impersonal and dehumanizing, or even inherently divisive and adversarial. Yet (their complaint goes) the psychology and morality of markets and liberty rights pervade far too many relationships in a (...) commercial society, eroding the bonds of personal and civic friendship. My main aim in this paper is to analyze and evaluate this claim. In this section I will give an overview of the critics’ complaints against various features of the free-market system, discuss the empirical data that might be thought to support their complaints, and show why they largely fail to do so. In Section II I will get to the heart of the matter: the nature of the market and of friendship. I will address the thesis that the modes of valuation proper to production are radically opposed to the modes of valuation proper to friendship, love, sexuality, and so on, arguing that the thesis rests on a misunderstanding of both markets and friendship. A proper understanding of the two reveals that, as voluntary, reciprocal relationships, market relationships and friendship share important moral and psychological properties, and are not the natural enemies, or even the odd bed-fellows, many critics take them to be. In Section III I will address the related thesis that market societies – societies based on the free-market system of property rights, freedom of contract, and other liberty rights - tend to commodify relationships and, thereby, weaken the bonds of personal and civic friendship. I will argue that free markets are the most powerful force for decommidifying or, more generally (since commodification is not the only way of objectifying people), deobjectifying people and relationships.. (shrink)

A completeness theory for parameterized computational complexity has been studied in a series of recent papers, and has been shown to have many applications in diverse problem domains including familiar graph-theoretic problems, VLSI layout, games, computational biology, cryptography, and computational learning [ADF,BDHW,BFH, DEF,DF1-7,FHW,FK]. We here study the parameterized complexity of two kinds of problems: (1) problems concerning parameterized computations of Turing machines, such as determining whether a nondeterministic machine can reach an accept state in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} (...) \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $k$\end{document} steps (the Short TM Computation Problem), and (2) problems concerning derivations and factorizations, such as determining whether a word \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $x$\end{document} can be derived in a grammar \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $G$\end{document} in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $k$\end{document} steps, or whether a permutation has a factorization of length \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $k$\end{document} over a given set of generators. We show hardness and completeness for these problems for various levels of the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $W$\end{document} hierarchy. In particular, we show that Short TM Computation is complete for \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $W[1]$\end{document}. This gives a new and useful characterization of the most important of the apparently intractable parameterized complexity classes. (shrink)

Environmental problems often outstrip the abilities of any single scientist to understand, much less address them. As a result, collaborations within, across, and beyond the environmental sciences are an increasingly important part of the environmental science landscape. Here, we explore an insufficiently recognized and particularly challenging barrier to collaborative environmental science: value pluralism, the presence of non-trivial differences in the values that collaborators bring to bear on project decisions. We argue that resolving the obstacles posed by value pluralism to collaborative (...) environmental science requires detecting and coordinating the underlying problematic value differences. We identify five ways that a team might coordinate their problematic value differences and argue that, whichever mode is adopted, it ought to be governed by participatory virtues, pragmatic resolve, and moral concern. Relying on our experiences with the Toolbox Dialogue Initiative, as well as with other dialogical approaches that support team inquiry, we defend the claim that philosophical dialogue among collaborators can go a long way towards helping teams of environmental scientists and fellow travelers detect their problematic value differences. Where dialogical approaches fare less well is in helping teams coordinate these differences. We close by describing several principles for augmenting philosophical dialogue with other methods, and we list several of these methods in an appendix with brief descriptions and links for further learning. Overall, the article makes three main contributions to the research collaboration and values in science literatures: It deepens our understanding of problematic value pluralism in team science; It provides actionable guidance and methods for improving values-oriented philosophical dialogue interventions; and It demonstrates one way of doing engaged philosophy. (shrink)

abstract The term ‘moralism’ is often used to pick out a set of vices in judgment, such as hypocrisy, officiousness, arrogance, presumption, and sanctimony. I relate these vices to notions of standing and office and the roles they play in proper moral judgment. Behind these notions, I suggest, lie broad moral injunctions to think generously of our fellows and sternly of ourselves. These injunctions are manifested in both serious discourse and popular opinion. Finally, I explore the possibility that the (...) distinction I urge between moralism (the counterfeit) and morality (the genuine) can't ultimately be sustained, and conclude that the distinction stands. (shrink)

The proposed volumes are aimed at a multidisciplinary audience and seek to fill the gap between law, semiotics and visuality providing a comprehensive theoretical and analytical overview of legal visual semiotics. They seek to promote an interdisciplinary debate from law, semiotics and visuality bringing together the cumulative research traditions of these related areas as a prelude to identifying fertile avenues for research going forward. Advance Praise for Law, Culture and Visual Studies This diverse and exhilarating collection of essays explores the (...) many facets both historical and contemporary of visual culture in the law. It opens a window onto the substantive, jurisdictional, disciplinary and methodological diversity of current research. It is a cornucopia of materials that will enliven legal studies for those new to the field as well as for established scholars. It is a 'must read' that will leave you wondering about the validity of the long held obsession that reduces the law and legal studies to little more than a preoccupation with the word. Leslie J Moran Professor of Law, Birkbeck College, University of London Law, Culture and Visual Studies is a treasure trove of insights on the entwined roles of legality and visuality. From multiple interdisciplinary perspectives by scholars from around the world, these pieces reflect the fullness and complexities of our visual encounters with law and culture. From pictures to places to postage stamps, from forensics to film to folklore, this anthology is an exciting journey through the fertile field of law and visual culture as well as a testament that the field has come of age. Naomi Mezey, Professor of Law, Georgetown University Law Center, Washington, D.C., USA This highly interdisciplinary reference work brings together diverse fields including cultural studies, communication theory, rhetoric, law and film studies, legal and social history, visual and legal theory, in order to document the various historical, cultural, representational and theoretical links that bind together law and the visual. This book offers a breath-taking range of resources from both well-established and newer scholars who together cover the field of law's representation in, interrogation of, and dialogue with forms of visual rhetoric, practice, and discourse. Taken together this scholarship presents state of the art research into an important and developing dimension of contemporary legal and cultural inquiry. Above all, Law Culture and Visual Studies lays the groundwork for rethinking the nature of law in our densely visual culture: How are legal meanings produced, encoded, distributed, and decoded? What critical and hermeneutic skills, new or old, familiar or unfamiliar, will be needed? Topical, diverse, and enlivening, Law Culture and Visual Studies is a vital research tool and an urgent invitation to further critical thinking in the areas so well laid out in this collection. Desmond Manderson, Future Fellow, ANU College of Law / Research School of Humanities and the Arts, Australian National University, Australia. (shrink)

abstract The term ‘moralism’ is often used to pick out a set of vices in judgment, such as hypocrisy, officiousness, arrogance, presumption, and sanctimony. I relate these vices to notions of standing and office and the roles they play in proper moral judgment. Behind these notions, I suggest, lie broad moral injunctions to think generously of our fellows and sternly of ourselves. These injunctions are manifested in both serious discourse and popular opinion. Finally, I explore the possibility that the (...) distinction I urge between moralism and morality can't ultimately be sustained, and conclude that the distinction stands. (shrink)

In this essay I present the postmodern phenomenological approach of Levinas, Derrida, and Marion to the problem of naming the unnameable God. For Levinas, God is never experienced directly but only as a third person whose infinity is testified to in the infinity of responsibility to the hungry. For Derrida, God remains the unnameable “wholly other” accessible only as the indeterminate term of pure reference in prayer. For Marion, God remains the object of “de-nomination” through praise. In all three, the (...) problem of naming the unnameable God is necessarily linked to how we relate to fellow human beings, to the hungry in Levinas, justice in Derrida, and charity in Marion. I also reflect on the merits and adequacy of phenomenology as such for speaking of divine transcendence. (shrink)

For ten years, 1971–1981, the Institute onHuman Values in Medicine (IHVM) played a keyrole in the development of Bioethics as afield. We have written this history andanalysis to bring to new generations ofBioethicists information about the developmentof their field within both the humanitiesdisciplines and the health professions. Thepioneers in medical humanities and ethics cametogether with medical professionals in thedecade of the 1960s. By the 1980s Bioethics wasa fully recognized discipline. We show the rolethat IHVM programs played in defining thefield, training (...) faculty and helping schools todevelop programs. We review the beginnings ofthe IHVM in the crucible of social andtechnological change that led to theestablishment of the IHVM's parentorganization, the Society for Health and HumanValues. We then turn to the IHVM programsthrough which Faculty members receivedfellowships to explore new crossovers betweenthe humanities and the health professions. Wehave not only described the Fellows Program asit existed in 1973–1980, but have completed asurvey of the fellows a quarter of a centuryafter they held their fellowships. We describeother IHVM programs designed to facilitate theinitiation and development of new humanitiesprograms, to explore conceptual issues betweenmedicine and five humanities fields, to conductissue driven or educational method conferencesand to advance humanities programs intograduate education through the Directors ofMedical Education. (shrink)

Context Physicians are regularly confronted with research that is funded or presented by industry. Objective To assess whether physicians discount for conflicts of interest when weighing evidence for prescribing a new drug. Design and setting Participants were presented with an abstract from a single clinical trial finding positive results for a fictitious new drug. Physicians were randomly assigned one version of a hypothetical scenario, which varied on conflict of interest: ‘presenter conflict’, ‘researcher conflict’ and ‘no conflict’. Participants 515 randomly selected (...) Fellows in the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network; 253 surveys (49%) were returned. Main object measures The self-reported likelihood that physicians would prescribe the new drug as a first-line therapy. Results Physicians do not significantly discount for conflicts of interest in their self-reported likelihood of prescribing the new drug after reading the single abstract and scenario. However, when asked explicitly to compare conflict and no conflict, 69% report that they would discount for researcher conflict and 57% report that they would discount for presenter conflict. When asked to guess how favourable the results of this study were towards the new drug, compared with the other trials published so far, their perceptions were not significantly influenced by conflict of interest information. Conclusion While physicians believe that they should discount the value of information from conflicted sources, they did not do so in the absence of a direct comparison between two studies. This brings into question the effectiveness of merely disclosing the funding sources of published studies. (shrink)

We have witnessed the athleticization of political discourse, whereby debate is treated like an athletic contest in which the aim is to vanquish one's opponents. When political discourse becomes a zero-sum game, it is characterized by suspicions, accusations, belief polarization, and ideological entrenchment. Unfortunately, athleticization is ailing the classroom as well, making it difficult for educators to prepare students to make valuable contributions to healthy civic discourse. Such preparation requires an educational environment that fosters the intellectual virtues that characterize an (...) examined life. This, in turn, requires an amicable and hospitable atmosphere in which a student enjoys the freedom to discover and articulate what she believes, how well her beliefs hang together, and what underlying assumptions or biases might be at work—without the fear that her self-disclosure will trigger immediate accusations and pigeonholing from fellow students. Educating for intellectual virtue is crucial for meeting these challenges and in this chapter we contribute to this strategy by offering some tools and guidance for promoting productive discussion of controversial issues. In the first two sections, we identify and explain two fallacious patterns of thought that often encumber discussion of controversial issues: assailment-by-entailment and the attitude-to-agent fallacy. In effect, these sections diagnose two diseases of discourse. We conclude each section with practical suggestions—in the form of thinking routines—for curing these ills. We will argue that part of the cure is to be found in the intellectual virtues. In particular, we will discuss how the virtues of intellectual charity, humility and carefulness can inoculate the mind against the fallacies we identify. (shrink)

Worte verletzen und kränken. Woher aber kommt diese Verletzungsmacht? Während in der deutschsprachigen Philosophie Sprache meist als Gegenmittel zur Gewalt begriffen wird, hat die US-amerikanische Debatte um "hate speech" gezeigt, dass das Sprechen Gewalt nicht nur androhen oder verhindern, sondern selbst eine Form von Gewaltausübung sein kann. Wie nun sind sprachliche Verletzung, Ausgrenzung und Missachtung zu erklären und zu verstehen? Aus der Sicht verschiedener Disziplinen untersuchen die Beiträge dieses Bandes, welcher Logik, Grammatik und Rhetorik unser verletzendes Sprechen gehorcht. Mit Beiträgen (...) von u.a. Pierre Bourdieu, Penelope Brown/Stephen Levinson, Harold Garfinkel und Rae Langton. Steffen Kitty Herrmann und Hannes Kuch sind wissenschaftliche Mitarbeiter am Institut für Philosophie der Freien Universität Berlin und arbeiten im Forschungsprojekt”Zur Performanz sprachlicher Gewalt“am Sonderforschungsbereich 447”Kulturen des Performativen“. Sybille Krämer ist Professorin für Philosophie an der FU Berlin und Permanent Fellow am Wissenschaftskolleg Berlin. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Christian Ethics: A Very Short Introduction, and: Christian Ethics: A Brief History, and: Behaving in Public: How to Do Christian EthicsBeth K. HaileChristian Ethics: A Very Short Introduction D. Stephen Long Oxford: Oxford University Press, 2010. 144 pp. $11.95Christian Ethics: A Brief History Michael Banner West Sussex, UK: Wiley-Blackwell, 2009. 160 pp. $24.95Behaving in Public: How to Do Christian Ethics Nigel Biggar Grand Rapids, Mich.: Eerdmans, 2011. 142 (...) pp. $16.00In calling ethics “Christian,” the question of distinctiveness, or the normative force of theological claims, inevitably arises. Three new books explore what Christian ethics looks like if it is to take seriously its theological basis for engaging the world.Stephen D. Long, professor of systematic theology at Marquette University, attends to the difficulties in predicating “Christian” of “ethics,” yet he is concerned more with explaining how Christianity can be ethical rather than vice versa. His Christian Ethics: A Very Short Introduction opens with a quote from Christopher Hitchens and later dedicates almost an entire chapter to analyzing the failures of Christian ethics. From the Crusades to colonialism, the Galileo affair to slavery, Long provocatively asks whether modern ethics emerges as a result of the failure of Christian moral claims. While not sidestepping the difficulties in Christian history, Long is careful to note how this history is often distorted to serve the goals of contemporary secular politics, goals which he points out have resulted in the bloody failures of the twentieth century. Perhaps a renewed interest in Christian ethics, Long notes, is a result of the failures of secularism.Long manages to cover a surprising breadth of material in his brief book, from a sweeping historical overview of Christian theology to a final chapter on [End Page 195] the practical matters of sex, money, and political power. Long also summarizes some important theological differences among Christians that lead to practical disagreements about the nature of Christian ethics. His overview of the Catholic-Lutheran convergence on matters of faith and works is particularly helpful in establishing the theological basis for an ecumenical Christian ethics. This historical survey serves to illustrate that ethics is both an integral part of and a contradiction to Christianity. Still, argues Long, while Christianity may claim to be more than ethical, it may never claim to be less.While commendable in breadth, the genre of the “very short introduction” precludes depth and must necessarily omit important information. In his summary of Catholic ethics, for example, Long addresses nominalism and probabilism but omits the Catholic social tradition, a particularly glaring omission given his topic. In the end, the target audience is the educated and curious layperson, more suitable for a church group than a classroom, though this is reflective of the nature of “the very short introduction” series and does not indicate any limitation in Long’s skill as a scholar.In the spirit of brevity, Michael Banner, Fellow of Trinity College in Cambridge, offers Christian Ethics: A Brief History, which, like any brief history, paints with broad and admittedly selective strokes. The aim of this work is not to evaluate the normative value of Christian claims but rather to establish the ethical implications of Christian belief. Unlike Long, who directly addresses the ethical failures of the church, Banner is more apologetic. In clarifying the difficulties of writing a text such as this one, he observes that Christian history has not been guided by texts as much as by action. In this vein, Banner begins not chronologically but with the Rule of St. Benedict and its call to live in a relationship with God and neighbor characterized by love.Banner grounds the theoretical dimension of Christian ethics in this emphasis on practice. Given the way of life Christians are called to, what are its limitations and possibilities? Banner turns to Augustine’s notion of the weakness of the will and the human creature’s need for grace, which he then places in creative tension with Aquinas’s emphasis on the harmony between faith and reason. In somewhat breathtaking conciseness, Banner describes how the Scholastic emphasis on natural law, casuistry, and the categorizing of sins led to what he calls... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction:Remarks in Memory of David W. ChappellDonald K. SwearerOn December 8, 1996, David Chappell delivered the Bodhi Day lecture, titled "Bodhisattva in the Twenty-first Century," at the Hompa Hongwanji Temple in central Oahu. The lecture wasn't autobiographical—David was much too unassuming to have thought of himself in these terms—but those of us who loved David and who had the privilege of working with him over many years have no (...) such qualms. David's dedication, sincerity of spirit, generosity, and compassion were truly bodhisattva-like.In his lecture David contrasts the superficial, electronic Internet connectedness of our lives today with the common ground discovered at Awakening based on what David called "heart connection," an insight into the shared nature of all sentient beings that leads to empathy, compassion, and kindness. In contrast to enlightened heart connectedness, Internet interaction lacks the capacity of an intimacy with the varied phenomena of life at each moment. "The Internet," he observes, "allows us to ease our solitude by getting access to things that are compatible with our own interests. However, Buddhism considers that the achievement of enlightenment involves being able to be compatible and have empathy with things that may seem foreign or offensive or a threat to us by seeing them as connected and similar to ourselves. This involves not just new information, or a new perspective on things, but a new understanding of ourselves and our relationship to others at a level that touches what is beyond manipulation or even rational expression."I've quoted rather extensively from David's 1996 Bodhi Day talk because it reveals several dimensions of his bodhisattva-like nature: his sense of connectedness with those around him and a heart-to-heart intimacy with a wide network of friends, acquaintances, and even those at a greater personal distance. David's simpatico nature was manifested in many ways—from his body language to his dedication to peacemaking.On a visit to the United States during the Vietnam War, Thich Nhat Hanh was speaking to a large audience gathered in the auditorium of a large Midwestern church. Following the talk a middle-aged man jumped to his feet, shook his clenched [End Page 3] fist in anger, and shouted in a loud voice, "Well, Mr. Hanh, if you're so concerned about your fellow Vietnamese dying in the rice paddies, why are you here?! Why aren't you there with them?!" Thây stood silently for what seemed like minutes and then replied in calm, quiet tones, "I'm here because some of the roots of the war are here in the United States. When one waters a plant, it's insufficient to water the leaves. One has to water the roots." He then turned and walked slowly through the side door of the auditorium. Jim Forest, Thây's Catholic Peace Fellowship friend who was in the audience, sensed something was wrong and quickly followed him outside. There he found his friend bent over, hands on his knees, trying to catch his breath. Slowly Thây stood erect and, breathing normally, explained that in order not to respond in anger but with understanding and compassion he had entered into deep breathing; however, the state he had achieved had been too deep and left him short of breath. Jim Forest later observed in a memoir that for the first time in his life he realized the profound connection between breathing and one's actions.David's inner nature was expressed in an act as simple as breathing: his trademark bodhisattva-like smile. At the 1980 Oahu conference that launched the Society for Buddhist-Christian Studies, convened by David and his colleague Bob Bobilin, there were more than just one or two frustrating logistical snafus. Whatever the crisis, however, David never lost his cool. He would smile and in his typically unhurried manner offer a helping hand or a word of calm advice, seemingly in the belief that good karma, compassionate Buddha nature, or God's grace would help rectify the situation.David stories abound—humorous, poignant, moving. Those who worked with him as colleagues in religious studies, the Society for Buddhist-Christian Studies... (shrink)

In the quest for Buddhist reality, the inevitable comparison is made between it and the Brahmanic concept of supreme reality. In some quarters, it is alleged that both systems point at an identical nature of reality and maintain a similar method in arriving at it. After all, the historical Buddha was a Brahmin oriented in the Upaniṣadic tradition. He also engaged himself in the prevailing disciplinary practice of yoga to overcome the ill‐nature of the ordinary self (ātman) and like other (...) fellow Brahmins, he consummated his goal by immersing himself in the Supreme Self (Ātman/Brahman). Proponents go even further to identify this Supreme Self with the contents of Buddhist nirvāna and conclude rather facilely that Buddhism is nothing but an extension of Brahmanic thought. (shrink)

The members of the Medieval Academy of America are happy to be holding this year's annual meeting — its sixtieth and a kind of Golden Anniversary — at the University of Indiana in Bloomington. Although this is the first time the Academy has met in this university, relations between the two institutions have been personal and warm. Four years ago your Talbot Donaldson was the Academy's President, and a beloved one he was to be sure. In the tradition of institutional (...) and personal friendship, it seems fitting that my address today should focus on a remarkable event that took place in 1940 when Etienne Gilson, a Corresponding Fellow of the Academy since its second annual meeting in 1927, delivered here, under the auspices of the Mahlon Powell Foundation, his memorable lectures on God and Philosophy. (shrink)

Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United (...) States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their “experience in the NICU.” Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects. (shrink)

Objectives: To investigate life scientists’ views of accountability and the ethical and societal implications of research. Design: Qualitative focus group and one-on-one interviews. Participants: 45 Stanford University life scientists, including graduate students, postdoctoral fellows and faculty. Results: Two main themes were identified in participants’ discussions of accountability: the “how” of science and the “why” of science. The “how” encompassed the internal conduct of research including attributes such as honesty and independence. The “why,” or the motivation for conducting research, was (...) two-tiered: first was the desire to positively impact the research community and science itself, and second was an interest in positively impacting the external community, broadly referred to as society. Participants noted that these motivations were influenced by the current systems of publications, grants and funding, thereby supporting a complex notion of boundary-setting between science and non-science. In addition, while all participants recognised the “how” of science and the two tiers of “why,” scientists expressed the need to prioritise these domains of accountability. This prioritisation was related to a researcher’s position in the academic career trajectory and to the researcher’s subsequent “perceived proximity” to scientific or societal concerns. Our findings therefore suggest the need for institutional change to inculcate early-stage researchers with a broader awareness of the implications of their research. The peer review processes for funding and publication could be effective avenues for encouraging scientists to broaden their views of accountability to society. (shrink)

In this essay I present the postmodern phenomenological approach of Levinas, Derrida, and Marion to the problem of naming the unnameable God. For Levinas, God is never experienced directly but only as a third person whose infinity is testified to in the infinity of responsibility to the hungry. For Derrida, God remains the unnameable "wholly other" accessible only as the indeterminate term of pure reference in prayer. For Marion, God remains the object of "de-nomination" through praise. In all three, the (...) problem of naming the unnameable God is necessarily linked to how we relate to fellow human beings, to the hungry in Levinas, justice in Derrida, and charity in Marion. I also reflect on the merits and adequacy of phenomenology as such for speaking of divine transcendence. (shrink)

Background and objectives: Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues. Methods: To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians (including three women), (...) aged 33–66 years, residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner. Results: Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients’ lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position. Conclusions: Physicians’ vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity. (shrink)

Background and objectives: Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues.Methods: To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians , aged 33–66 years, (...) residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner.Results: Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients’ lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position.Conclusions: Physicians’ vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity. (shrink)

The disclosure of prognosis to terminally ill patients has emerged as a recent concern given greater demands for patient involvement in medical decision‐making in the United States. As part of the informed consent process, American physicians are legally and ethically obligated to provide information to such patients about the risks, benefits, and alternatives of all available treatment options including the use of experimental therapies. Although not legally required, the disclosure of a terminal prognosis is ethically justified because it upholds the (...) principle of self‐determination and enables patients to make treatment decisions consistent with their life goals. To understand oncologists’ attitudes about disclosing prognostic information to cancer patients with advanced disease, we interviewed fourteen oncologists and conducted one focus group of medical fellows. Although oncologists reported to disclose prognosis in terms of cancer not being curable, they tend to avoid using percentages to convey prognosis. Oncologists’ reported reluctance to disclosing prognosis was conveyed through the use of metaphors depicting the perceived violent impact of such information on patients. Oncologists’ reluctance to disclose prognosis and preserve patient hope are held in check by their need to ensure that patients have ‘realistic expectations’ about therapy. We discuss these data in light of the cultural, ethical, and legal dimensions of prognosis disclosure, patient hope and the doctor–patient relationship, and recommend ways to enhance the communication process. (shrink)

IntroductionDespite the need for trained physician ethicists, fellowships in clinical ethics are limited and primarily offered to thosewho have completed a graduate degree. The standardization of credentialing for clinical ethics consultants (CECs) and the restructuring of undergraduate medical education allow innovative models to train CECs that can provide an expanded opportunity for formal ethics training at an earlier stage.MethodsAt the University of Michigan Medical School we developed, implemented, and evaluated a pre-doctoral clinical ethics fellowship program from 2017 to 2019 for (...) senior medical students, designed to meet established competencies for CECs. Consultation notes from the beginning and end of the fellowship program were randomly selected for each fellow and independently rated by two faculty ethicists who used the validated Ethics Consultation Quality Assessment Tool (ECQAT).1 Inter rater reliability and trends in scores over time were calculated.ResultsThree students successfully completed the fellowship at the University of Michigan Medical School, conducted at least 50 formal ethics consultations, and spent approximately 40 hours a week on service for a minimum of six months. All students finished the fellowship with teaching and policy development experience, first-authored peer-reviewed manuscripts, and national presentations. The fellows demonstrated improvement in their ECQAT overall holistic rating score; all ended their fellowship with a holistic score of adequate or above. There was 92 percent agreement between raters withrespect to the acceptability of the fellows’ ethics consult notes. Two fellows have taken and passed the Healthcare Ethics Consultant-Certification (HEC-C) exam offered by the American Society for Bioethics and Humanities (ASBH).ConclusionsIntegration of a pre-doctoral fellowship model that meets professional certification standards for clinical ethics consultation creates an opportunity for medical students to become trained CECs early in their career. (shrink)