How do engineers respond to ethical dilemmas that occur in practice? How do they view their individual and collective responsibilities? How do they make decisions before all the facts are in? Using the space shuttle programme as the framework, this book examines the role of ethical decision making in the practice of engineering. In particular, the book considers the design and development of the main engines of the space shuttle as a paradigm for how individual engineers perceive, articulate, and resolve (...) ethical dilemmas in a large, complex organisation. A series of in-depth case studies show engineers at work on various stages of the project as they balance budgets, deadlines and risks. By documenting the historical development of a single system, the book provides a unique opportunity to explore the complex interactions between political, organisational and technical pressures and engineering and management decisions. (shrink)

The use of case-based reasoning in teaching professional ethics has come of age. The fields of medicine, engineering, and business all have incorporated ethics case studies into leading textbooks and journal articles, as well as undergraduate and graduate professional ethics courses. The most recent guidelines from the National Institutes of Health recognize case studies and face-to-face discussion as best practices to be included in training programs for the Responsible Conduct of Research. While there is a general consensus that case studies (...) play a central role in the teaching of professional ethics, there is still much to be learned regarding how professionals learn ethics using case-based reasoning. Cases take many forms, and there are a variety of ways to write them and use them in teaching. This paper reports the results of a study designed to investigate one of the issues in teaching case-based ethics: the role of one’s professional knowledge in learning methods of moral reasoning. Using a novel assessment instrument, we compared case studies written and analyzed by three groups of students whom we classified as: Experts in a research domain in bioengineering. Novices in a research domain in bioengineering. The non-research group—students using an engineering domain in which they were interested but had no in-depth knowledge. This study demonstrates that a student’s level of understanding of a professional knowledge domain plays a significant role in learning moral reasoning skills. (shrink)

The Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in November 1999. The report focused public attention on the errors that occur within the medical system that cause death and harm to patients. It outlined a series of changes for health care that are aimed at reducing these errors by 50 percent over the next five years. This paper examines the problem of medical mistakes historically. It documents how legal, scientific, and medical trends during (...) the years 1890Ð1934 intersected to effect the reporting of mistakes in the subspecialty of neurosurgery. At the start of this time frame, mistakes were reported openly in journal articles as an educational tool. By its end, however, mistakes had gone ÒundergroundÓ and were buried amid a more objective, scientific reporting system. Using this historical perspective as a baseline, the paper concludes by re-examining the IOMÕs suggestions for change and comments on what they mean for the culture of medicine. (shrink)

: From its founding in 1847, the AMA divided drugs into "ethical" and "unethical" preparations. Those that were ethical had a known composition and were advertised only to the profession. Others, patent medicines (technically proprietary drugs, whose trademarks were protected by copyright), were sold directly to the public. In spite of the AMA's efforts to ban the advertising and sale of these nostrums, proprietary drugs flourished during the nineteenth century. Starting in 1900, however, three major societal trends combined to bolster (...) the AMA's campaign, and by 1920 almost all advertising was directed to physicians, who would then prescribe medications to their patients. This ban on advertising pharmaceuticals directly to the public remained virtually unchanged until approximately 1980. Since then, it has slowly eroded and, as recently as 1997, the FDA created guidelines for pharmaceutical companies to advertise on television. What does this change say about the profession of medicine, the role of the physician in society, and the doctor-patient relationship? Using a comparative historical approach, this paper examines these issues. (shrink)

Philosophers have long recognized that the unique values of the individual physician effect medical-ethical decision-making. While not taking issue with this basic assumption, this article critically examines one discussion of how different philosophies (existential, utilitarian, and value realist) can influence a neurosurgeon's decision to operate upon a person having a malignant brain tumor. It also delineates and discusses a fund of ‘medical wisdom’ commonly available to any neurosurgeon and easily obtainable by both researcher and patient. The article suggests that those (...) in the humanities interested in studying the ethical decision-making process in a medical subspecialty become familiar with this fund of knowledge. It can provide a base for evaluating when and how individual medical decisions vary. In this specific instance, the medical knowledge base was used to direct attention to when and how ethical issues are identified and resolved within the staff clinical neurosurgical setting. An informal survey among resident and staff neurosurgeons supported the conclusion that philosophical analyses of medical-ethical decision-making are appreciated when case examples are carefully and accurately documented, when medical terminology is used correctly and when recognition of the practical limits placed on medical decision-making is given. CiteULike Connotea Del.icio.us What's this? (shrink)

Long-established stereotypes tend to dominate the perceptions physicians have of the philosophers and other humanists who serve as medical ethicists. They also alter the views humanists have of physicians, and those that the public have of both. These stereotypes are a formidable barrier to effective working relationships between the two groups of professionals, as well as to public understanding of medical ethics issues. To achieve a better working relationships and to foster more realistic understanding, it is important that the humanists (...) step out of their academic settings, for a time, and become part of the clinical service. (shrink)

Assessment in ethics education faces a challenge. From the perspectives of teachers, students, and third-party evaluators like the Accreditation Board for Engineering and Technology and the National Institutes of Health, assessment of student performance is essential. Because of the complexity of ethical case analysis, however, it is difficult to formulate assessment criteria, and to recognize when students fulfill them. Improvement in students’ moral reasoning skills can serve as the focus of assessment. In previous work, Rosa Lynn Pinkus (...) and Claire Gloeckner developed a novel instrument for assessing moral reasoning skills in bioengineering ethics. In this paper, we compare that approach to existing assessment techniques, and evaluate its validity and reliability. We find that it is sensitive to knowledge gain and that independent coders agree on how to apply it. (shrink)

This paper describes the first three-year experience of the Consortium Ethics Program (CEP-1) of the University of Pittsburgh Center for Medical Ethics, and also outlines plans for the second three-year phase (CEP-2) of this experiment in continuing ethics education. In existence since 1990, the CEP has the primary goal of creating a cost-effective, permanent ethics resource network, by utilizing the educational resources of a university bioethics center and the practical expertise of a regional hospital council. The CEP's conception and specific (...) components stem from recognition of the need to make each hospital a major focus of educational efforts, and to provide academic support for the in-house activities of the representatives from each institution. (shrink)

This collection of thirty-one cases and commentaries addresses ethical problems commonly encountered by the average health care professional, not just those working on such high-tech specialties as organ transplants or genetic engineering. It deals with familiar issues that are rarely considered in ethics casebooks, including such fundamental matters as informed consent, patient decision-making capacity, the role of the family, and end-of-life decisions. It also provides resources for basic but neglected ethical issues involving placement decisions for elderly or technologically dependent patients, (...) rehabilitation care, confidentiality regarding AIDS, professional responsibility, and organizational and institutional ethics. The authors describe in detail the perspectives of each party to the case, the kind of language that ethicists use to discuss the issues, and the outcome of the case. A short bibliography suggests useful articles for further reading or curriculum development. Easily understood by readers with no prior training in ethics, this book offers guidance on everyday problems from across the broad continuum of care. It will be valuable for health-care professionals, hospital ethics committees, and for students preparing for careers in health-care professions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.2 (2001) 115-116 [Access article in PDF] The Ethics of Medical Mistakes: Historical, Legal, and Institutional Perspectives Introduction In late 1999, the Institute of Medicine (IOM) released its report on medical errors, To Err is Human: Building a Safer Health System. The report estimated almost 50,000 deaths per year nationally due to medical mistakes, making it a leading cause of death. IOM speculated that (...) more than half of the deaths related to medical error are preventable. The IOM report shocked the public and medical professionals alike, sparking a national discussion of how to make the health care system safer. This multifaceted issue has profound implications for all aspects of health care, from the very personal--e.g., the relationship of caregiver and patient--to the societal--e.g., a nation's responsibility to its citizens.On 15 May 2000, the University of Pittsburgh Medical Center hosted an ethics conference devoted to the topic of medical mistakes. The goal was to bring together experts from various disciplines, before an audience of both providers and patients, to discuss medical mistakes and their implications. In this issue of the Kennedy Institute of Ethics Journal, we present selected papers resulting from that conference. These papers reflect not only the original oral presentations, but also much of the discussion those presentations generated. Three key perspectives on the ethics of medical mistakes are offered: historical, legal, and institutional.Rosa Lynn Pinkus offers a revealing historical perspective on the ethics of medical mistakes. In analyzing the history of mistake reporting in neurosurgery, she shows how the notion of a mistake developed only as the notion of a standard of practice emerged. Although much of managed care is directed toward systematically fostering a standard of care, this pursuit is relatively new in health care. One might speculate that as more standards are created, mistakes--defined as deviations from standard practice--must increase. If deviation from standard practice is overly castigated, however, then needed innovation in practice may be stifled. Interestingly, as Pinkus discusses, medical malpractice suits quickly followed the emergence of practice standards, driving the initial open reporting of mistakes underground. [End Page 115]Taking up the issue of medical malpractice, Thomas May and Mark Aulisio consider the ramifications of the current malpractice system for mistake prevention. The current system, they argue, while failing to adequately achieve its purported goals of deterring medical mistakes and compensating victims, itself creates a climate that deters the open reporting of mistakes by engendering fear and shame in clinicians. According to May and Aulisio, this failure to report medical mistakes openly has serious ramifications. Chief among these is the inability to do root cause analysis of mistakes, and then, where possible, to implement safeguards to minimize the occurrence of future mistakes. Ultimately, both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.Andy Thurman argues that even in the current climate institutions ought to have a policy (and practice) of admitting to and openly reporting medical mistakes. Thurman argues that doing so not only is the right thing to do, but is also in the interest of institutions. Interestingly, he contends that failing to admit and openly report mistakes is both at odds with the mission of health care institutions and puts them at higher risk of litigation, and liability. In light of this, Thurman then suggests an institutional process for handling medical mistakes.Michael DeVita concedes that disclosing mistakes is widely supported by the health professionals' principles of ethics, but argues that there are a number of factors that conspire to make doing so a very difficult task. In analyzing an index case, DeVita contends that platitudes about being honest are not nearly enough to foster honest behavior and that policies that offer specific guidance on handling unfavorable events are needed in health care institutions.Finally, we conclude with the policy on disclosure of unfavorable events (this terminology is chosen because it includes both iatrogenic and natural diseases and conditions) that resulted from... (shrink)

This chapter examines the role played by derogatory terms (e.g., ‘inyenzi’ or cockroach, ‘inzoka’ or snake) in laying the social groundwork for the genocide of the Tutsi in Rwanda in 1994. The genocide was preceded by an increase in the use of anti-Tutsi derogatory terms among the Hutu. As these linguistic practices evolved, the terms became more openly and directly aimed at Tutsi. Then, during the 100 days of the genocide, derogatory terms and coded euphemisms were used to direct killers (...) to their victims. Understanding these speech acts helps to illuminate the important ways that power is enacted through discourse, how speech acts can prepare the way for physical and material acts, and how speech generates permissions for actions hitherto uncountenanced. Studying the role of speech acts and linguistic practices in laying the groundwork of the genocide illuminates how patterns of speech acts become linguistic practices that constitute permissibility conditions for non-linguistic behaviors. Further, the analysis presented here helps to make sense of the view that a steady, deep, and widespread derogation of a group can be part and parcel of genocide, not only an antecedent to it. (shrink)

Hartmut Rosa advances an account of the temporal structure of society from the perspective of critical theory. He identifies three categories of change in the tempo of modern social life: technological acceleration, evident in transportation, communication, and production; the acceleration of social change, reflected in cultural knowledge, social institutions, and personal relationships; and acceleration in the pace of life, which happens despite the expectation that technological change should increase an individual's free time. According to Rosa, both the structural (...) and cultural aspects of our institutions and practices are marked by the "shrinking of the present," a decreasing time period during which expectations based on past experience reliably match the future. When this phenomenon combines with technological acceleration and the increasing pace of life, time seems to flow ever faster, making our relationships to each other and the world fluid and problematic. It is as if we are standing on "slipping slopes," a steep social terrain that is itself in motion and in turn demands faster lives and technology. As Rosa deftly shows, this self-reinforcing feedback loop fundamentally determines the character of modern life. (shrink)

INTRODUCTION Reopening a Discussion The empiricist-derived epistemology that has directed most social and natural scientific inquiry for the last three ...

Lynne Huffer's ambitious inquiry redresses the rift between feminist and queer theory, traversing the space of a new, post-moral sexual ethics that includes pleasure, desire, connection, and betrayal. She begins by balancing queer theorists' politics of sexual freedoms with a moralizing feminist politics that views sexuality as harm. Drawing on the best insights from both traditions, she builds an ethics centered on eros, following Michel Foucault's ethics as a practice of freedom and Luce Irigaray's lyrical articulation of an ethics of (...) sexual difference. Through this theoretical lens, Huffer examines everyday experiences of ethical connection and failure connected to sex, including queer sexual practices, sodomy laws, interracial love, pornography, and work-life balance. Her approach complicates sexual identities while challenging the epistemological foundations of subjectivity. She rethinks ethics "beyond good and evil" without underestimating, as some queer theorists have done, the persistence of what Foucault calls the "catastrophe" of morality. Elaborating a thinking-feeling ethics of the other, Huffer encourages contemporary intellectuals to reshape sexual morality from within, defining an ethical space that is both poetically suggestive and politically relevant, both conceptually daring and grounded in common sexual experience. (shrink)

Contingentism depicts normativity as one of our human effective possibilities rather than as a metaphysical bottleneck which we should necessary fulfill. The book is a critical survey of Richard McKay Rorty’s “neo-pragmatism”, in the light of various theoretical arguments as well as of his own resourceful attempts to renew philosophy from within its practice.

Michel Foucault was the first to embed the roots of human sexuality in discipline and biopolitics, therefore revolutionizing our conception of sex and its relationship to society, economics, and culture. Yet over the past two decades, scholars have limited themselves to the study of Foucault's _History of Sexuality_, volume 1 paying lesser attention to his equally explosive _History of Madness_. In this earlier volume, Foucault recasts Western rationalism as a project that both produces and represses sexual deviants, calling out the (...) complicity of modern science and the exclusionary nature of family morality. By reclaiming these deft moves, Lynne Huffer teases out exciting new strands of Foucauldian thought. She then revisits the theorist's ethical work in light of these discoveries, divining an ethics of eros that sees sexuality as a lived experience we are repeatedly called on to remember. Throughout her study, Huffer weaves her own experiences together with Foucault's, sampling from unpublished interviews and other archived materials in order to intimately rework the problem of sexuality as a product of reason. (shrink)

The expression ‘nonreductive materialism’ refers to a variety of positions whose roots lie in attempts to solve the mind-body problem. Proponents of nonreductive materialism hold that the mental is ontologically part of the material world; yet, mental properties are causally efficacious without being reducible to physical properties.s After setting out a minimal schema for nonreductive materialism (NRM) as an ontological position, I’ll canvass some classical arguments in favor of (NRM).1 Then, I’ll discuss the major challenge facing any construal of (NRM): (...) the problem of mental causation, pressed by Jaegwon Kim. Finally, I’ll offer a new solution to the problem of mental causation. (shrink)

A curious feature of Aztec philosophy is that the basic metaphysical question of the “Western” tradition cannot be formulated in their language, in Nahuatl. This did not, however, prevent the Aztecs from developing an account of 'reality', or whatever it is that might exist. The article is the first of its kind to compare the work of Aristotle on ousia (being) and the Aztecs on teotl and ometeotl. Through this analysis, it suggests that both of the Nahuatl terms are fundamental (...) for expressing the basic character of reality as process for the Aztecs. It also defends their notion as prima facia reasonable, despite its wide divergence from Aristotle's view. (shrink)

Resumen: El presente artículo propone que la 31ª Bienal de Sao Paulo entraña un afán emancipador para los "sin tierra" - errantes, migrantes y viajeros. Para ello se conforma como un cuerpo sin órganos, que despliega estrategias liberadoras promoviendo: desarticulación, experimentación, vagabundeo y tránsito de sujetos y pueblos. Esta Bienal, en tanto CsO, mueve intensidades como flujos sensibles por los intersticios de los proyectos artísticos dispuestos en organismo. Acá el CsO es un conjunto de prácticas reservadas a desterritorializar los estratos (...) del "organismo social" y hacer estallar los órganos estructurados en dichos sistemas.: This article shows that the 31st Sao Paulo Biennial has an emancipatory affinity for the landless - wanderers, migrants, and travelers. As such it becomes a Body without Organs that displays liberating strategies, promoting disarticulation, experimentation, wandering, and the transit of subjects and peoples. This Biennial, as a BwO, moves intensities as sensible flows through the interstices of the artistic projects inside the organism. Here, the BwO becomes a set of practices that deterritorialize the strata of the "social organism", making the structured organs in these systems explode. (shrink)

Although Nietzsche's writings clearly deliver an unhealthy dose of misogyny, it must be noticed that they also contain the seeds of a deconstruction of that misogyny. This paper exposes one set of deconstructing elements of Nietzsche's works with respect to his views on women. The wider philosophical context of Nietzsche's thought provides grounds for taking seriously several passages of The Gay Science that reveal a more sympathetic understanding of women, since these passages take seriously Nietzsche's anti-dualism, his perspectivism, and his (...) early existentialist notion of the self. The destabilizing force of these passages, combined with Nietzsche's remarks about women within this philosophical context, reveals that Nietzsche's works promise more insight than many feminists have previously noted. A feminist analysis of Nietzsche's anti-dualism, perspectivism and discussion of the power of naming promises to inform contemporary feminist concerns about the importance of women's articulating our lives. (shrink)

Rousseau et l'exegese biblique du XVIIIe siecle -- Des pratiques bibliques du XVIIIe siecle a la lecture-consolation de Rousseau -- Intertextualite biblique dans l'ouvre de Rousseau -- Intertexte biblique et representation de soi -- Le Levite d'Ephraim : reecriture biblique -- Schemes de la pensee du religieux -- Ouvre de doctrine : la lettre a Christophe de Beaumont -- Etre Chretien de Jacques : les lettres ecrites de La Montagne.

This work develops the ethical attitude of courageous vulnerability through the integration of the phenomenon of involuntary memory in Marcel Proust's work and ...

What is a human person, and what is the relation between a person and his or her body? In her third book on the philosophy of mind, Lynne Rudder Baker investigates what she terms the person/body problem and offers a detailed account of the relation between human persons and their bodies. Baker's argument is based on the 'Constitution View' of persons and bodies, which aims to show what distinguishes persons from all other beings and to show how we can be (...) fully material beings without being identical to our bodies. The Constitution View yields answers to the questions 'What am I most fundamentally?', 'What is a person?', and 'What is the relation between human persons and their bodies'? Baker argues that the complex mental property of first-person perspective enables one to conceive of one's body and mental states as one's own. (shrink)

. Undoubtedly, multinational corporations must play a significant role in the advancement of global ecological ethics. Our research offers a glimpse into the process of how goals of ecological sustainability in one multinational corporation can trickle down through the organization via the sustainability support behaviors of supervisors. We asked the question “How do supervisors in a multinational corporation internalize their corporation’s commitment to ecological sustainability and, in turn, behave in ways that convey this commitment to their subordinates?” In response, we (...) created a theoretical framework for supervisor sustainability support behavior based on Stern et al., Human Ecology Review 6(2), 81-97 (1999) value-belief-norm (VBN) theory. We then tested our framework by performing a survey-based field study of supervisors in a multinational pharmaceutical company that has publicly professed a goal of ecological sustainability. (shrink)

This paper examines, on the basis of a longitudinal corpus of 50 early modern authors, how change at the aggregate level of the community interacts with variation and change at the micro-level of the individual language user. In doing so, this study aims to address the methodological gap between collective change and entrenchment, that is, the gap between language as a social phenomenon and the cognitive processes responsible for the continuous reorganization of linguistic knowledge in individual speakers. Taking up the (...) case of the prepositional passive, this study documents a strong community-wide increase in use that is accompanied by increasing schematicity. A comparison of the 50 authors reveals that regularities arising at the macro-level conceal highly complex and variable individual behavior, aspects of which may be explained by studying the larger (social) context in which these individuals operate (e. g., age cohorts, community of practice, biographical insights). Further analysis, focusing on how authors use the prepositional passive in unique and similar ways, elucidates the role of small individual biases in long-term change. Overall, it is demonstrated that language change is an emergent phenomenon that results from the complex interaction between individual speakers, who themselves may change their linguistic behavior to varying degrees. (shrink)

For a long time, linguists more or less denied the existence of individual differences in grammatical knowledge. While recent years have seen an explosion of research on individual differences, most usage-based research has failed to address this issue and has remained reluctant to study the synergy between individual and community grammars. This paper focuses on individual differences in linguistic knowledge and processing, and examines how these differences can be integrated into a more comprehensive constructionist theory of grammar. The examination is (...) guided by the various challenges and opportunities that may be extracted from scattered research that exists across disciplines touching on these matters, while also presenting some new data that illustrate how differentiation between individuals can improve models of long-term language change. The paper also serves as the introduction to this special issue of Cognitive Linguistics, which collects seven contributions from various linguistic disciplines focusing on key aspects of individuals’ grammars. (shrink)

This article argues that the real promise of feminist philosophy of language is in its account of articulated normativity. Feminist philosophy of language began within a descriptivist framework, seeking to identify and root out sexist discursive practices, like naming practices that subsume women’s identity under men’s, descriptive practices that erase or undermine women’s accomplishments and presence as subjects, and so on. This approach had its limits, and led to increased attention to the discursive practices through which we articulate our experiences (...) and construct our lives. Examining the core frameworks through which feminists have analyzed the power of language to shape social reality and construct social selves, this article shows how language is normative in its production and reproduction of social norms by way of its content, forms, and constitutive discursive practices. The article urges feminists to use knowledge of the processes of articulation and legitimation to effect and explain feminist reconstitution of women as whole. (shrink)

Holobionts are multicellular eukaryotes with multiple species of persistent symbionts. They are not individuals in the genetic sense— composed of and regulated by the same genome—but they are anatomical, physiological, developmental, immunological, and evolutionary units, evolved from a shared relationship between different species. We argue that many of the interactions between human and microbiota symbionts and the reproductive process of a new holobiont are best understood as instances of reciprocal scaffolding of developmental processes and mutual construction of developmental, ecological, and (...) evolutionary niches. Our examples show that mother, fetus, and different symbiotic microbial communities induce or constitute conditions for the development and reproduction of one another. These include the direct induction of maternal or fetus physiological changes, the restructuring of ecological relations between communities, and evolutionary selection against undesirable competitors. The mutual scaffolding and niche constructing processes start early—prior to amniotic rupture. We are evolutionarily, physiologically, and developmentally integrated holobiont systems, strung together through mutual reliance and mutual construction. Bringing the processes of niche construction and developmental scaffolding together to interpret holobiont birth conceptually scaffolds two new directions for research: in niche construction, identifying the evolutionary implications of organisms actively constructing multiple overlapping niches and scaffolds, and in Evolutionary Developmental Biology, characterizing evolutionary and ecological processes as developmental causes. (shrink)

In this paper I present reasons for us to accept the hypothesis that suspended judgment has correctness conditions, just like beliefs do. Roughly put, the idea is that suspended judgment about p is correct when both p and ¬p might be true in view of certain facts that characterize the subject’s situation. The reasons to accept that hypothesis are broadly theoretical ones: it adds unifying power to our epistemological theories, it delivers good and conservative consequences, and it allows us to (...) assess processes of reasoning involving attitudes of suspended judgment. (shrink)

The significance of critical phenomenology for psychiatric praxis has yet to be expounded. In this paper, I argue that the adoption of a critical phenomenological stance can remedy localised instances of hermeneutical injustice, which may arise in the encounter between clinicians and patients with psychosis. In this context, what is communicated is often deemed to lack meaning or to be difficult to understand. While a degree of un-shareability is inherent to subjective life, I argue that issues of unintelligibility can be (...) addressed by shifting from individualistic conceptions of understanding to an interactionist view. This takes into account the contextual, historical and relational background within which meaning is co-constituted. I conclude by providing a corrective for hermeneutical injustice, which entails a specific attentiveness towards the person’s subjectivity, a careful sensitivity to contingent meaning-generating structures, and a degree of hermeneutical flexibility as an attitude of openness towards alternative horizons of possibility. (shrink)