When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. (...) In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making. (shrink)

Therapieentscheidungen lösen in klinischen Teams häufig Unsicherheiten und Konflikte aus, insbesondere wenn es um schwerkranke Patienten geht. Fallen Entscheidungen vornehmlich situationsgeleitet, sind bestimmte Patientengruppen einem Risiko der Unter-, Über- oder Ungleichversorgung ausgesetzt. Der Metap-Leitfaden unterstützt Ärzte, Pfleger und Therapeuten daher in ihrer ethisch reflektierten Entscheidungskompetenz mit verschiedenen Orientierungs- und Entscheidungsinstrumentarien. Diese berücksichtigen eine gerechte Zuteilung der Ressourcen.

Die qualitative Interviewstudie analysiert informelle Wissensstrukturen von Pflegenden und Ärzten hinsichtlich der beiden Einflussfaktoren „Alter“ und „Kosten“ auf Therapieentscheide am Lebensende als Grundlage ethischer Meinungsbildung. Als Auswertungsmaterial dienen spontane Aussagen zu „Alter“ und „Kosten“, die nicht im Kontext von Fragestellungen zu Ageism oder Rationierung erhoben wurden. Diese Aussagen wurden einer Inhaltsanalyse unterzogen, und zwar anhand von qualitativen und quantitativen Analyseschritten.Die Studie zeigt, dass der Faktor „Alter“ wesentlich häufiger als Einflussfaktor auf Therapieentscheide am Lebensende genannt wird als der Faktor „Kosten“. Zudem (...) gibt es Hinweise auf mögliche Ungleichbehandlung sowie auf Überversorgung von Patienten am Lebensende. Die Befunde stützen die Annahme, dass Therapieentscheidungen eher auf informellen, nicht-institutionalisierten Prozessen beruhen. Eine stärker explizite Strukturierung des Prozesses zur Therapieentscheidung könnte die Risiken von Ungleichbehandlung und Überversorgung reduzieren und dadurch zu ethisch besser vertretbaren Ergebnisse führen. (shrink)

ZusammenfassungDie qualitative Interviewstudie analysiert informelle Wissensstrukturen von Pflegenden und Ärzten hinsichtlich der beiden Einflussfaktoren „Alter“ und „Kosten“ auf Therapieentscheide am Lebensende als Grundlage ethischer Meinungsbildung. Als Auswertungsmaterial dienen spontane Aussagen zu „Alter“ und „Kosten“, die nicht im Kontext von Fragestellungen zu Ageism oder Rationierung erhoben wurden. Diese Aussagen wurden einer Inhaltsanalyse unterzogen, und zwar anhand von qualitativen und quantitativen Analyseschritten.Die Studie zeigt, dass der Faktor „Alter“ wesentlich häufiger als Einflussfaktor auf Therapieentscheide am Lebensende genannt wird als der Faktor „Kosten“. Zudem (...) gibt es Hinweise auf mögliche Ungleichbehandlung sowie auf Überversorgung von Patienten am Lebensende. Die Befunde stützen die Annahme, dass Therapieentscheidungen eher auf informellen, nicht-institutionalisierten Prozessen beruhen. Eine stärker explizite Strukturierung des Prozesses zur Therapieentscheidung könnte die Risiken von Ungleichbehandlung und Überversorgung reduzieren und dadurch zu ethisch besser vertretbaren Ergebnisse führen. (shrink)

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two (...) geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and staff can be overcome when people are convinced that the benefits justify the effort. (shrink)

Medizinethische Entscheidungsfindungsmodelle müssen nachweisen können, weshalb die mit ihnen getroffenen Entscheidungen richtig oder zumindest „belastbar“ sind. Hierfür sind theoretische Rechtfertigungsansätze aus der Ethik unverzichtbar. Der Klinischen Ethik wird aber mitunter ein Mangel an theoretischer Fundierung vorgeworfen. Um diesem Vorwurf entgegenzutreten, soll unter Bezugnahme auf ein Projekt der Klinischen Ethik („METAP“) die ethische Unterstützung in Form der ethischen Fallbesprechung und der Ethikkonsultation mittels Prinzipienethik und Diskursethik gerechtfertigt werden. Prinzipienethik und Diskursethik können einander über das Medium der ethischen Fallbesprechung oder Ethikkonsultation fruchtbar (...) ergänzen. So können einige theoretische und praktische Schwächen der beiden Ansätze durch den jeweils anderen abgefedert werden. Die Diskursethik übernimmt bspw. die Sicherung der ethischen Gültigkeit von moralischen Entscheidungen bzw. Handlungsnormen und vermindert dadurch ein Rechtfertigungsdefizit, welches bei einem rein prinzipienorientierten Verfahren auftritt. Umgekehrt antwortet die Prinzipienethik u. a. auf Fragen der ethischen Angemessenheit und dient v. a. der adäquaten Einzelfallentscheidung. Durch die Integration des einen Ansatzes in den anderen ist eine umfassendere Rechtfertigungsleistung erzielbar als bei einem alleinigen Einsatz von Prinzipienethik oder Diskursethik. Selbst wenn einige Herausforderungen bestehen bleiben und auch das integrierte Modell moralische Dissense nicht immer verhindern kann, vermag es durch seine „doppelte“ Absicherung (Prinzipien und Diskurs) ein praktisches Vertrauen in die getroffene ethische Entscheidung zu stärken und so der Klinischen Ethik mehr „Robustheit“ zu geben, als sie bisher besitzt. (shrink)

ZusammenfassungMedizinethische Entscheidungsfindungsmodelle müssen nachweisen können, weshalb die mit ihnen getroffenen Entscheidungen richtig oder zumindest „belastbar“ sind. Hierfür sind theoretische Rechtfertigungsansätze aus der Ethik unverzichtbar. Der Klinischen Ethik wird aber mitunter ein Mangel an theoretischer Fundierung vorgeworfen. Um diesem Vorwurf entgegenzutreten, soll unter Bezugnahme auf ein Projekt der Klinischen Ethik („METAP“) die ethische Unterstützung in Form der ethischen Fallbesprechung und der Ethikkonsultation mittels Prinzipienethik und Diskursethik gerechtfertigt werden. Prinzipienethik und Diskursethik können einander über das Medium der ethischen Fallbesprechung oder Ethikkonsultation fruchtbar (...) ergänzen. So können einige theoretische und praktische Schwächen der beiden Ansätze durch den jeweils anderen abgefedert werden. Die Diskursethik übernimmt bspw. die Sicherung der ethischen Gültigkeit von moralischen Entscheidungen bzw. Handlungsnormen und vermindert dadurch ein Rechtfertigungsdefizit, welches bei einem rein prinzipienorientierten Verfahren auftritt. Umgekehrt antwortet die Prinzipienethik u. a. auf Fragen der ethischen Angemessenheit und dient v. a. der adäquaten Einzelfallentscheidung. Durch die Integration des einen Ansatzes in den anderen ist eine umfassendere Rechtfertigungsleistung erzielbar als bei einem alleinigen Einsatz von Prinzipienethik oder Diskursethik. Selbst wenn einige Herausforderungen bestehen bleiben und auch das integrierte Modell moralische Dissense nicht immer verhindern kann, vermag es durch seine „doppelte“ Absicherung (Prinzipien und Diskurs) ein praktisches Vertrauen in die getroffene ethische Entscheidung zu stärken und so der Klinischen Ethik mehr „Robustheit“ zu geben, als sie bisher besitzt. (shrink)

Ethische Leitlinien für die klinische Praxis erfreuen sich zunehmender Beliebtheit. Damit klinisch-ethische Leitlinien aber überhaupt erfolgreich wirksam werden können, ist noch Pionierarbeit zu leisten. Solche Leitlinien müssen wissenschaftlich stärker fundiert und ihre praktische Anwendbarkeit muss verbessert werden. In dieser Arbeit werden die ersten Schritte des Projekts METAP zur methodischen Entwicklung und praktischen Implementierung einer Leitlinie für eine patientengerechte Versorgung am Krankenbett beschrieben und zur Diskussion gestellt. Das Projekt orientiert sich methodisch an der Entwicklung medizinischer Leitlinien und generiert damit eine forschungs- (...) und konsensgestützte Leitlinie, die systematischer Evaluation und Modifikation unterliegt und Rechenschaft über ihre wissenschaftliche Fundierung gibt. Zusätzlich zur Leitlinie bietet das Projekt in der Form eines Handbuchs ein Entscheidungsfindungsverfahren an, welches unter anderem deliberative Aspekte unterstützt. Das Handbuch konzentriert sich auf ethische Fragen der Mikroallokation und liefert darüber hinaus Informationen über empirische, ethische und rechtliche Grundlagen für Therapieentscheidungen. Anhand eines Eskalationsmodells können unterschiedliche Instrumente nach Bedarf als ethische Lösungsstrategien eingesetzt werden, von der Kurzfassung im Kitteltaschenformat („Leporello“) mit den wichtigsten Fakten, weiterführenden Texten und Empfehlungen mit normativen und prozeduralen Hinweisen, über stationsinterne Lösungsversuche bis hin zum Ethikkonsil. Klinische Partner sind von Beginn an aktiv in den Entwicklungsprozess eingebunden und verbessern so die Praxistauglichkeit und Akzeptanz sowie die Ausrichtung des Instrumentariums an den tatsächlichen Bedürfnissen. Dieses partnerschaftliche, partizipative Vorgehen scheint eine wichtige Voraussetzung dafür zu sein, dass METAP in der Klinik Fuß fassen konnte. (shrink)

Recently, ethical guidelines for clinical practice have gained increased popularity, but in order to become useful they require more pioneer’s work. Clinical-ethical guidelines need to be based on a scientific foundation and their practicability must be improved. We present and put to discussion the initial steps of the METAP Project about the development and practical implementation of a clinical-ethical guideline dedicated to a fair resource-allocation at the bedside. -/- With its methodological orientation, the project represents a guideline which is based (...) on both research and consensus-building, undergoing systematic evaluation and modification. In addition to the guideline, the project comes with a manual (a tool kit) including a procedural instrument for making decisions supporting deliberative aspects. It focuses on issues of micro-allocation; furthermore, it provides empirical, ethical and legal basics for making fair treatment decisions that should help to prevent overtreatment, undertreatment or discrimination in patient care. We propose an Escalation Model with various instruments serving as problem solving strategies that correspond to the respective needs; these instruments include a pocket-summary (“Leporello”) with the most important facts; further reading material; normative and procedural recommendations; ward-specific strategies, and also the option of clinical ethics consultation. -/- Clinical partners have been actively involved in the developmental process from the beginning and contributed to the practical applicability, acceptance and a valid need-orientation of the whole tool kit. This partnership and the participatory approach seem to have helped METAP to gain a foothold in the clinic. (shrink)

In “Semantics of Fictional Terms,” Garcia-Carpintero critically surveys the most recent literature on the topic of fictional names. One of his targets is realism about fictional discourse. Realists about fictional discourse believe that: (a) it contains true sentences that have fictional names as their subjects; (b) sentences containing names can be true only if those names have referents; (c) fictional names have fictional characters – abstract objects – as their referents. The fundamental problem that arises for realists is that not (...) all true sentences containing fictional names are plausibly about abstract objects. This leads to the need to introduce disjunctive conceptions of property attribution that Garcia-Carpintero claims are implausible, and that realism should therefore be rejected. He also maintains, however, that (a) is correct. I agree. Furthermore, I am also committed to anti-realism about fictional discourse – that fictional names have no referents. Garcia-Carpintero claims that my view is simply a notational variant of realism. I argue that this is false – that my view could not possibly be a notational variant of any extant realist theory. (shrink)

This book explores the thesis that legal roles force people to engage in moral combat, an idea which is implicit in the assumption that citizens may be morally required to disobey unjust laws, while judges may be morally required to punish citizens for civil disobedience. Heidi Hurd advances the surprising argument that the law cannot require us to do what morality forbids. The 'role-relative' understanding of morality is shown to be incompatible with both consequentialist and deontological moral philosophies. In (...) the end, Hurd shows that our best moral theory is one which never makes one actor's moral success turn on another's moral failure. Moral Combat is a sophisticated, well-conceived and carefully argued book on a very important and controversial topic at the junction between legal and political philosophy. It will be of interest to moral, legal, and political philosophers, as well as teachers and students of professional ethics in law. (shrink)

Fictional names present unique challenges for semantic theories of proper names, challenges strong enough to warrant an account of names different from the standard treatment. The theory developed in this paper is motivated by a puzzle that depends on four assumptions: our intuitive assessment of the truth values of certain sentences, the most straightforward treatment of their syntactic structure, semantic compositionality, and metaphysical scruples strong enough to rule out fictional entities, at least. It is shown that these four assumptions, taken (...) together, are inconsistent with referentialism, the common view that names are uniformly associated with ordinary individuals as their semantic value. Instead, the view presented here interprets names as context-sensitive expressions, associated in a context of utterance with a particular act of introduction, or dubbing, which is then used to determine their semantic value. Some dubbings are referential, which associate names with ordinary individuals as their semantic values; others are fictional, which associate names, instead, with sets of properties. Since the semantic values of names can be of different sorts, the semantic rule interpreting predication must be complex as well. In the body of the paper, I show how this new treatment of names allows us to solve our original puzzle. I defend the complexity of the semantic predication rule, and address additional worries about ontological commitment. (shrink)

We regularly wield powers that, upon close scrutiny, appear remarkably magical. By sheer exercise of will, we bring into existence things that have never existed before. With but a nod, we effect the disappearance of things that have long served as barriers to the actions of others. And, by mere resolve, we generate things that pose significant obstacles to others' exercise of liberty. What is the nature of these things that we create and destroy by our mere decision to do (...) so? The answer: the rights and obligations of others. And by what seemingly magical means do we alter these rights and obligations? By making promises and issuing or revoking consent When we make promises, we generate obligations for ourselves, and when we give consent, we create rights for others. Since the rights and obligations that are affected by means of promising and consenting largely define the boundaries of permissible action, our exercise of these seemingly magical powers can significantly affect the lives and liberties of others. (shrink)

Having enjoyed more than twenty years of development, feminist epistemology and philosophy of science are now thriving fields of inquiry, offering current scholars a rich tradition from which to draw. In addition to a recognition of the power of knowledge itself and its effects on women’s lives, a central feature of feminist epistemology and philosophy of science has been the attention they draw to the role of power dynamics within knowledge-seeking practices and the implications of these dynamics for our understandings (...) of knowledge, science, and epistemology. Feminist Epistemology and Philosophy of Science: Power in Knowledge collects new works that address today’s key challenges for a power-sensitive feminist approach to questions of knowledge and scientific practice. The essays build upon established work in feminist epistemology and philosophy of science, offering new developments in the fields, and representing the broad array of the feminist work now being done and the many ways in which feminists incorporate power dynamics into their analyses. (shrink)

In modern urbanized and densely populated societies - such as the contemporary Netherlands, which forms the geographical setting of the present analysis - hunting has lost its meaning as a mode of subsistence to become a symbolic strategy. Hunting is a cultural enclave in which the boundaries between humans and animals are blurred and the relations of dominance and submission symbolically reversed. Hunting challenges the legitimacy of apparently "given" power relations between humans and animals. Hunters construct, reproduce and legitimize hunting (...) by crossing the boundaries between humans and animals. Hunting "for pleasure" is regarded as truly pleasurable only if it allows a reversal of the asymmetrical power relations between humans and animals, attributing almost human characteristerics to the game-species. In theircognitive schemes hunters measure their power and abilities with strong, cunning and preferably male opponents. Game-species share an ambivalent status between the human and the animal realms, the tame and the wild, and between their instrumental and expressive signifccance. Hunting "for pleasure" is justified by this very ambivalence. (shrink)

This study examines how individual members of the public make moral sense of the potentially conflicting “economic problem” or “public health problem” representations of the COVID-19 crisis when judging responsible business behavior. The data are based on a qualitative survey involving a thought experiment with 119 participants in the United States conducted at the initial stage of the pandemic. This article proposes a typology matrix using the theories of cognitive polyphasia and cognitive dissonance to understand better individual moral sensemaking of (...) responsible business behavior in the context of a societal paradox in which there are contradictory and interdependent demands between important social objectives. The typology, referred to as the 4R Model of Moral Sensemaking of Competing Social Problems, provides insights for how companies may be perceived when responding to competing social problems, expanding the micro-CSR (corporate social responsibility) and paradox literatures. (shrink)

This article explores two very different forms in which immoral conduct was problematized over the course of the 19th century. It does this by contrasting the sexual purity politics of the Vice Society and the medicalization of morality as `moral insanity'. Early in the century the Vice Society promoted coercive legislation with the aim of `suppressing vice'. From mid-century, moral insanity theories sought to grapple with vice by disaggregating `moral' from other forms of insanity. These two movements had quite distinct (...) and incompatible lines of development; and they never overtly engaged with each other. The article makes its key argument by demonstrating the way in which such dissimilar trajectories came together towards the end of the century in the `moral hygiene' movement, mobilizing discourses of `degeneration' (and `feeblemindedness') with projects promoting sexual purity. (shrink)

Abstract: Many, if not most philosophers, deny that a sentence like ‘Sherlock Holmes smokes’ could be true. However, this attitude conflicts with the assignment of true to that sentence by natural language speakers. Furthermore, this process of assigning truth values to sentences like ‘Sherlock Holes smokes’ seems indistinguishable from the process that leads speakers to assign true to other sentences, those like ‘Bertrand Russell smokes’. I will explore the idea that when speakers assign the value true to the first sentence, (...) they are not mistaken or confused — that we ought to take these assignments at face value. I show how the most popular alternative to this idea is inadequate for explaining various sentences involving fictional names. In addition, I offer evidence that these truth value assignments to sentences are tracking semantic content rather than pragmatic effects. (shrink)

Recently, and rather startlingly, given the history of the debate about a name's semantic content, some claim that names are in fact predicates -- predicativism. Some of predicativists claim that a name's semantic content involves the concept of being called -- calling accounts that have been traditionally meta-linguistic. However, these accounts fail to be informative. Inspired by Burge's claim that proper names are literally true of the individuals that have them, Fara develops a non-meta-linguistic concept of being called analysed in (...) terms of property attributions. I offer seven separate reasons for rejecting the account, one of which is that Fara's development of the view, at least, has implausible consequences for a theory of name acquisition. I sketch an alternative account of name acquisition that is meta-linguistic in nature, but because it is not offered as a theory of name's content, the standard worries fail to apply. In fact, I argue that an account of name acquisition must be meta-linguistic, and therefore a more nuanced conception of meta-linguistic speech acts is required. The account invokes Austin's performative-constative distinction. It analyses name acquisition as due to performative meta-linguistic speech acts. (shrink)

This volume, written by a new generation of scholars engaged with contemporary global movements for social justice and peace, reflects their efforts in trying ...

It is widely assumed that Christianity enjoins its followers to practice universal, unconditional forgiveness. But universal, unconditional forgiveness is regarded by many as morally problematic. Some Christian scholars have denied that Christianity in fact requires universal, unconditional forgiveness, but I believe they are mistaken. In this essay, I show two things: that Christianity does enjoin universal, unconditional forgiveness of a certain sort, and that Christians, and perhaps other theists, are always justified in exercising unconditional forgiveness. Though most philosophers treat forgiveness (...) as grounded in our beliefs about the offender's current state, I argue that we might more fruitfully ground forgiveness in hope for the wrongdoer. Christianity's commitment to the existence of an omnipotent God who is concerned about the moral status of His creatures always justifies such hope and thus always justifies forgiveness. (shrink)

Food media have become a formidable part of adolescents’ food environments. This study sought to explore how and why adolescents use food media by focusing on selectivity and motives for consumption. We conducted in-depth, semi-structured interviews with 31 Flemish adolescents aged 12 to 16. Food media were both incidentally consumed and selectively sought for education, social utility, and entertainment. The levels of selectivity and motives for consumption varied among the different food media platforms. Incidental consumption was more prevalent with TV (...) cooking shows compared to online food media. The dominant motives for TV cooking show consumption were companionship and entertainment, while online food media were used for a more diverse range of motives dominated by information/inspiration and social interaction. Some participants consumed food media to get motivation and inspiration to improve health and fitness while others consumed food media to watch appetizing and aesthetically pleasing food content. The social environment in the form of friends and family as well as existing food preferences were dominant psychosocial factors for both traditional and online food media use. Future research is warranted to explore how incidental exposure and the identified motives for use relate to food media effects. (shrink)

Im Gesamtwerk des Pädagogen und Philosophen Theodor Litt (1880-1962) spielt das Verhältnis von Erkenntnis und Verantwortung eine zentrale Rolle. Es bestimmt sein wissenschaftliches Selbstverständnis und zeigt sich vor allem in seiner Haltung gegenüber dem Nationalsozialismus. Dieser These wird an Hand ausgewählter Quellen nachgegangen. Besondere Berücksichtigung erfahren dabei die bislang unveröffentlichten, handgeschriebenen Vorlesungsmanus-kripte aus dem Zeitraum von 1933 bis zu seiner vorzeitigen Emeritierung 1937. Die Manuskripte stammen aus dem Nachlass Theodor Litts und sind bislang der Forschung nur begrenzt zugänglich. Die Analyse (...) des Gesamtwerks geht über eine rein historische Betrachtung hinaus und orientiert sich auch an der Frage, inwieweit die pädagogisch-philosophischen Grundeinsichten Litts bis heute ihre Gültigkeit haben und damit nach einem Stellenwert innerhalb der Pädagogik verlangen"--From publisher's web site. (shrink)

Over the past 3 years, the authors have pursued unique cross-college collaboration. They have hosted a National Endowment for the Humanities (NEH)–funded Humanities Gaming Institute and team-taught a cross-listed course that brought together students from the humanities and computer science. Currently, they are overseeing the development of an NEH-supported social history game called Desperate Fishwives. In the process, the authors have realized that “game” is not the most appropriate designator for the kind of projects they are pursuing. Instead, they propose (...) critical interactives, a term that suggests projects that mobilize ludic methods in order to engage participants in socially and politically sensitive, indeed controversial, subject matter. Their most recent project, Ghosts of the Horseshoe, offers an initial look at how critical interactives are particularly apt at raising awareness about the relations among institutional policy, broader public policy, and the ways that people negotiate the public history of a particular place. (shrink)

Background:Healthcare personnel in the municipal healthcare systems experience many ethical challenges in their everyday work. In Norway, 243 municipalities participated in a national ethics project, aimed to increase ethical competence in municipal healthcare services. In this study, we wanted to map out what participants in ethics reflection groups experienced as promoters or as barriers to successful reflection.Objectives:To examine what the staff experience as promoters or as barriers to successful ethics reflection.Research design:The study has a qualitative design, where 56 participants in (...) municipal healthcare participated in 10 different focus-group interviews.Ethical considerations:The data collection was based on the participants’ informed consent and approved by the Data Protection Official of the Norwegian Centre for Research Data.Results:The informants had different experiences from ethics reflection group. Nevertheless, we found that there were several factors that were consistently mentioned: competence, facilitator’s role, ethics reflection groups organizing, and organizational support were all experienced as promoters and as a significant effect on ethics reflection groups. The absence of such factors would constitute important barriers to successful ethics reflection.Discussion:The results are coincident with other studies, and indicate some conditions that may increase the possibility to succeed with ethics reflection groups. A systematic approach seems to be important, the systematics of the actual reflections, but also in the organization of ethics reflection group at the workplace. Community healthcare is characterized by organizational instabilities as many vacancies, high workloads, and lack of predictability. This can be a hinder for ethics reflection group.Conclusion:Both internal and external factors seem to influence the organization of ethics reflection group. The municipalities’ instabilities challenging this work, and perceived as a clear inhibitor for the development. The participants experienced that the facilitator is the most important success factor for establishing, carrying out, and to succeed with ethics reflection groups. (shrink)

Many ethical concerns have been voiced about Clinical Decision Support Systems (CDSSs). Special attention has been paid to the effect of CDSSs on autonomy, responsibility, fairness and transparency. This journal has featured a discussion between Rosalind McDougall and Ezio Di Nucci that focused on the impact of IBM’s Watson for Oncology (Watson) on autonomy. The present article elaborates on this discussion in three ways. First, using Jonathan Pugh’s account of rational autonomy we show that how Watson presents its results might (...) impact decisional autonomy, while how Watson produces knowledge might affect practical autonomy. Second, by drawing an analogy with patient decision aids we identify an empirical way of estimating Watson’s impact on autonomy (ie, value-congruence). Lastly, McDougall introduced the notion of value-flexible design as a way to account for the diverging preferences patients hold. We will clarify its relation with the established domain of value-sensitive design. In terms of the tripartite methodology of value-sensitive design, we offer aconceptualclarification using Pugh’s account of rational autonomy, anempiricaltool to evaluate Watson’s impact on autonomy and situate a group oftechnicaloptions to incorporate autonomy in Watson’s design. (shrink)

Many previous treatments of voluntary behavior have viewed intentions as causes of behavior. This has resulted in several dilemmas, including a dilemma concerning the origin of intentions. The present article circumvents traditional dilemmas by treating intentions as constraints that restrict degrees of freedom for behavior. Constraints self-organize as temporary dynamic structures that span the mind-body divide. This treatment of intentions and voluntary behavior yields a theory of intentionality that is consistent with existing findings and supported by current research.

This chapter contains sections titled: The Rule of Rescue The Argument from Compassion An External Justification Notes.

Standard rigid designator accounts of a name’s meaning have trouble accommodating what I will call a descriptive name’s “shifty” character -- its tendency to shift its referent over time in response to a discovery that the conventional referent of that name does not satisfy the description with which that name was introduced. I offer a variant of Kripke’s historical semantic theory of how names function, a variant that can accommodate the character of descriptive names while maintaining rigidity for proper names. (...) A descriptive name’s shiftiness calls for a semantic account of names that makes their semantic values bipartite, containing both traditional semantic contents and what I call "modes of introduction." Both parts of a name's semantic value are derived from the way a name gets introduced into discourse -- from what I refer to as its "context of introduction." Making a name's semantic value bipartite in this way allows for a definite description to be a part of proper name's meaning without thereby sacrificing that name’s status as a rigid designator. On my view, a definite description is part of descriptive name’s mode of introduction. That is, it is part of what determines the content assigned to that name. As it turns out, making a definite description part of a descriptive name’s mode of introduction allows for that definite description to play the role of a mere reference-fixer regarding that name’s content, as Kripke would have it. However, my account allows a definite description to fix a descriptive name’s content actively over time, thereby explaining its inherent shiftiness. (shrink)

This paper examines the competing ‘languages’ of line in Julie Mehretu’s series, Grey Area and elaborates on the implications these lines have for theories of space, bodies and, in particular, the relationship between the two. Grey Area explores what Mehretu describes as a grey and in-between space. The series is composed of seven large abstract canvases covered in an assortment of gestural tracings and neatly traced rational lines. The juxtaposition of these competing linely narratives not only creates a grey space (...) visually, but compels viewers to stretch their bodies across the canvases and between the lined layers thus, facilitating a brief inhabitance of grey space. Building from this analysis, the paper reflects on the relevance of the lines and the stretching they elicit for examining the complexities of contemporary modes of inhabitation that often extend across multiple geographical sites and temporal modes. Thus, engaging with Mehretu’s lined abstractions draws attention to the importance of space in the production of bodily boundaries, what I call geographical and temporal bodily outlines. In addition to contributing to body-space theories, the paper also demonstrates the valuable insights gained by attending to the unique social-aesthetic analyses of visual art and artists. (shrink)

In Commit to Win, Heidi Reeder, PhD, unpacks over forty years of research by psychologists and economists to show that the key to reaching any goal, whether it' to hit the gym more often or to finally quit that dead-end job, isn' motivation, willpower, or determination. It' commitment. Busting the myths most of us believe about commitment, Reeder shows that it all comes down to four variables: treasures, troubles, contributions, and choices. Together, these variables make up a formula that (...) not only measures how committed we are, but also shows which factors we can change to get our commitment level in sync with what we want to do. (shrink)