As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)

We resolve the two problems that Hardman raises. The first problem arises from a misunderstanding: the crucial distinction is between one-model and multiple-model problems. The second problem illuminates a deeper principle: conclusions depend on the procedures for interpreting models. We describe an algorithm that obviates the problem and empirical work that reveals a new view of syllogistic reasoning.

Van der Henst argues that the theory of mental models lacks a pragmatic component. He fills the gap with the notion that reasoners draw the most relevant conclusions. We agree, but argue that theories need an element of “nondeterminism.” It is often impossible to predict either what will be most relevant or which particular conclusion an individual will draw.

Language’s intentional nature has been highlighted as a crucial feature distinguishing it from other communication systems. Specifically, language is often thought to depend on highly structured intentional action and mutual mindreading by a communicator and recipient. Whilst similar abilities in animals can shed light on the evolution of intentionality, they remain challenging to detect unambiguously. We revisit animal intentional communication and suggest that progress in identifying analogous capacities has been complicated by (i) the assumption that intentional (that is, voluntary) production (...) of communicative acts requires mental-state attribution, and (ii) variation in approaches investigating communication across sensory modalities. To move forward, we argue that a framework fusing research across modalities and species is required. We structure intentional communication into a series of requirements, each of which can be operationalised, investigated empirically, and must be met for purposive, intentionally communicative acts to be demonstrated. Our unified approach helps elucidate the distribution of animal intentional communication and subsequently serves to clarify what is meant by attributions of intentional communication in animals and humans. (shrink)

Modes of rationality in nursing documentation: biology, biography, and the ‘voice of nursing’ This article is based on a discourse analysis of the complete nursing records of 45 patients, and concerns the modes of rationality that mediated text‐based accounts relating to patient care that nurses recorded. The analysis draws on the work of the critical theorist, Jürgen Habermas, who conceptualised rationality in the context of modernity according to two types: purposive rationality based on an instrumental logic, and value rationality based (...) on ethical considerations and moral reasoning. Our analysis revealed that purposive rationality dominated the content of nursing documentation, as evidenced by a particularly bio‐centric and modernist construction of the workings of the body within the texts. There was little reference in the documentation to central themes of contemporary nursing discourses, such as notions of partnership, autonomy, and self‐determination, which are associated with value rationality. Drawing on Habermas, we argue that this nursing documentation depicted the colonisation of the sociocultural lifeworld by the bio‐technocratic system. Where nurses recorded disagreements that patients had with medical regimes, the central struggle inherent in the project of modernity became transparent — the tension between the rational and instrumental control of people through scientific regulation and the autonomy of the subject. The article concludes by problematising communicative action within the context of nursing practice. (shrink)

The Scottish Mental Health Arts and Film Festival has seen hundreds of arts, public and community groups coproduce over 300 events to over 25,000 audience members. Integral to this arts-based approach, in contrast to social marketing or public education models, is the notion that mental health is an essentially contested concept whereby meanings are negotiated and debate encouraged. With emerging evidence that the festival is an ef ective way of engaging people intellectually and emotionally, we explore ethical issues, challenges and (...) paradoxes that have emerged as the festival has developed. Consideration is given to issues of power, purpose, opportunity costs, reach, impact, programming risks, and participation from those with experience of mental ill-health. Throughout, we explore practical implications for funding, managing, programming, marketing and evaluation of this and similar endeavours. (shrink)

The terminology surrounding the dispute between higher-order and first-order theories of consciousness is piled so high that it sometimes obscures the view. When the debris is cleared away, there is a real prospect.

In lieu of an abstract, here is a brief excerpt of the content:Comments on “Moral Complicity in Induced Pluripotent Stem Cell Research”W. Malcolm Byrnes, Ph.D. and Edward J. FurtonIn his article titled “Moral Complicity in Induced Pluripotent Stem Cell Research,” Mark T. Brown (2009) unfortunately mischaracterizes my ethical analysis of the use of induced pluripotent stem (iPS) cells for replacement therapies, or treatments (Byrnes 2008). In my paper, which Brown cites, I argue that, just as it is ethically acceptable for (...) parents to allow their children and themselves to be immunized using vaccines produced by cell lines derived from human fetuses aborted in the past, it is also acceptable for persons in the future to benefit from treatments that use iPS cells validated using human embryonic stem (ES) cell lines [End Page 202] derived in the past. The assumption I make is that iPS cells would have to be shown to be functionally equivalent to human ES cells—i.e., validated—before they could be used for cell replacement treatments. (If it turns out that this assumption is incorrect, and primate or even mouse ES cells can be used for the validation, then all residual ethical problems will disappear and there will be no ethical problems whatsoever associated with iPS cells.) I wrote:... [I]n both cases, the origin of the treatment is in a one-time event: either the one-time use of aborted fetuses to obtain cell lines (e.g., MRC-5 and WI- 38) to grow weakened virus strains for vaccine production, or the one-time destruction of human embryos to validate iPS cells, which then effectively replace embryonic stem cells. In the latter case, if no additional embryonic stem cell lines are derived, then derivation of the existing lines could be considered a “one-time” event in the past, albeit an event that extended over a several-year period(Byrnes 2008, p. 287, emphasis added).Note the phrase “if no additional embryonic stem cell lines are derived.” The derivation of ES cell lines inherently involves destruction of embryos; indeed, that is why many people, including me, are opposed to human ES cell research. In my article, I am arguing that, if no additional ES cell lines are derived, then no additional human embryos will be destroyed, and the destruction of human embryos will lie in the past. In this case, embryo destruction could be considered a past event, just as the abortion of a human fetus from which vaccine-producing cell lines were derived is a past, albeit tragic, event.In the process of building his argument that proponents of iPS cell research are morally complicit in embryo destruction, Brown (2009, p. 15) casts me as being in favor of the “derivation of new embryonic stem [cell lines].” This is the exact opposite of my position. In fact, I am opposed to further destruction of human embryos. I believe that the hundreds of ES cell lines already in existence are more than sufficient to validate iPS cells and so no additional lines need to be derived. This means that no additional human embryos will need to be destroyed.Apparently based on the misperception that I support future destruction of human embryos, Brown concludes that “Byrnes’s endorsement of ongoing iPSC validation studies would seem to implicate him and those who follow his lead in formal and material complicity in what they perceive as moral evil” (p. 16). He writes that “explicit formal complicity would attach because he [Byrnes] knowingly and intentionally recommends that embryos be killed in order to facilitate a transition to a future in which no more embryos need be destroyed” (p. 16). Additionally, my “followers” and I would be guilty of “proximate material complicity” as well as “remote material complicity” (p. 16). Unfortunately, this broad condemnation is based on a misconception of my actual position.An additional problem involves Brown’s use of a quotation he attributes to me: [End Page 203]Once embryonic stem cells are used to successfully validate iPS cells, they will no longer be needed and their association with iPS cells will lie in the past. Is there not an element of sadness and resignation in accepting something (iPS cells) associated with an unjust act (destruction of an... (shrink)

O’BYRNE P and WATTS J. Nursing Inquiry 2012 [Epub ahead of print] Include, differentiate and manage: gay male youth, stigma and healthcare utilizationIn Canada, there has been a recent increase in HIV incidence among young men who have sex with men. However, gay male youth (GMY) may forego HIV testing due to fear of stigmatization. Therefore, the aim of this research was to explore the perceptions of stigma in health care within this population. The research was conducted through a (...) series of semi‐structured interviews with eight GMY aged 20–29, who frequented a gay‐friendly clinic in downtown Ottawa, Canada. In a sub‐analysis of the interviews utilizing the work of Hardt and Negri’s three‐part sequence – inclusion, differentiation and management – we found that homosexuality‐related stigmatization affects the interaction between GMY and health professionals. Interview participants perceived HIV‐related risk counselling as a manifestation of stigma. These findings reveal that the experience of stigma and stigmatization is not necessarily based on health professionals’ intentions, but rather, on patients’ perceptions of the interactions they have with health professionals. Specific modifications to the delivery of health care may help to overcome stigmatization. (shrink)

O’BYRNE P. Nursing Inquiry 2012; 19: 357–367 Nomadic sexualities: an in‐depth case study about unsafe sexIn an era when researchers are identifying increased rates of unsafe sex among gay and bisexual men, it is important that the practice of unsafe sex be adequately explored. While much literature is already dedicated to this topic, only recently have researchers begun to develop in‐depth understandings of the personal meanings that people ascribe to unsafe sex. This study continues such explorations by examining (i) (...) why one self‐defined gay man engaged in unsafe sex, and (ii) how he defined unsafe sex. The findings suggest that, for this man, his sexuality is nomadic and that what he feels is unsafe sex is the outcome of his nomadic sexuality conflicting with social imperatives for sexual stratification. (shrink)

“Avowals” are utterances that “ascribe [current] states of mind”; for instance utterances of ‘I have a terrible headache’ and ‘I’m finding this painting utterly puzzling’ (Bar-On 2004: 1). And avowals, “when compared to ordinary empirical reports…appear to enjoy distinctive security” (1), which Bar-On elaborates as follows: A subject who avows being tired, or scared of something, or thinking that p, is normally presumed to have the last word on the relevant matters; we would not presume to criticize her self-ascription or (...) to reject it on the basis of our contrary judgement. Furthermore, unlike ordinary empirical reports, and somewhat like apriori statements, avowals are issued with a very high degree of confidence and are not easily subjected to doubt. (3) The project of this ambitious, original, and challenging book is to explain why avowals have this distinctive security. Bar-On’s guiding idea is that avowals “can be seen as pieces of expressive behavior, similar in certain ways to bits of behavior that naturally express subjects’ states” (227). Crying and moaning are natural expressions of pain, yawning is a natural expression of tiredness, reaching for beer is a natural expression of the desire for beer, and so on. In some important sense, avowals are supposed to be like that. In what sense, though? It will be useful to begin with the simplest answer. (shrink)

Seyla Benhabib has presented us with the first English translation of a work of Marcuse which was published originally in 1932 as Hegels Ontologie und die Grundlegung einer Theorie der Geschichtlichkeit, and was reissued in 1968 by Klostermann in an unrevised edition under the abbreviated title, Hegels Ontologie und die Theorie der Geschichtlichkeit. Benhabib’s fluent and readable translation begins with a thoughtful and informative introduction and ends with a glossary which explains not only key terms, but also the relations between (...) them upon which Marcuse draws. For example, sich verhalten receives the following explanation on p. 342. (shrink)

In this paper, I aim to discuss E. J. Lowe's view of the synergy between metaphysics and natural science. In doing so, I will extend Lowe’s synergistic model to develop a realist account of theological claims thereby responding to Byrne’s strong form of eliminativism and agnosticism about theological claims. The paper is divided up as follows. In section 1, I will discuss Lowe’s view of metaphysics. In section 2, I will explain how Lowe thinks metaphysics and natural science are (...) related. In section 3, I will respond to objections against Lowe’s conception of metaphysics. In section 4, I will discuss the implications of Lowe’s conception of metaphysics for a realist account of theological claims. In section 5, I will conclude this paper by claiming that there are excellent reasons to extend the synergy between metaphysics and natural science to that of theology as well. (shrink)

" All major religious traditions are equal in respect of making common reference to a single transcendent sacred reality. All major traditions are likewise equal in respect of offering some means or other to human salvation. All traditions are to be seen as containing revisable, limited, accounts of the nature of the sacred: none is certain enough in its particular dogmatic formulations to provide the norm for interpreting the others." P. Byrne, Prolegomena to Religious Pluralism, p. 12. In this (...) paper, I argue that of the three claims that constitute the form of Religious Pluralism outlined by Peter Byrne in his Prolegomena to Religious Pluralism, the first is something proponents of the theory can't think of themselves as having the resources to defend; the second is something that is in danger of being rendered trivial by the definition of religions offered; however, if one makes it non-trivial, it becomes implausible ; and, even if the first half of the third is right, the second half is wrong. (shrink)

A brief description of the goal and main lines of argument of The Quest for Reality, in reply to the responses of Paul Boghossian and Alex Byrne.

According to a long interpretative tradition, Aristotle holds that the formal cause is the ultimate object of induction when investigating perceptible substances. For, the job of induction is to find the essential nature common to a set of individuals, and that nature is captured solely by their shared formal cause. Against this view, I argue that Aristotle understands perceptible individuals as irreducibly composite objects whose nature is constituted by both their formal and their material cause. As a result, when investigating (...) perceptible objects, the job of induction is to discover their composite, formal and material nature. The process by which universal claims about this composite nature are justified, I argue, is similar to what we now know as mathematical induction. In particular, such claims are grounded in a non-enumerative, but replicable process in which things are resolved into their simplest components. As a result, the observation of past uniformities has, at most, a heuristic function in scientific inquiry. (shrink)