Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised (...) report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

In “Tracking, Competence, and Knowledge,” Ernest Sosa notes that in attempting to account for the conditions for knowledge, externalists have proposed that the justification condition be replaced or supplemented by the requirement that a certain modal relation be obtained between a fact and a subject's belief concerning that fact. While assessing attempts to identify such a relation, he focuses on an account labeled “Cartesian‐tracking”, which accounts for the relation in the form of two conditionals. If a person S believes a (...) proposition P → P P → S believes P. Sosa suggests that be abandoned as a requirement, and that, equipped with his modifications, can offer promising results in connection with skepticism. He argues that modified coupled with the requirement that S's belief be “virtuous” can illuminate the nature of propositional knowledge. (shrink)

A competence model describes the abstract structure of a solution to some problem. or class of problems, facing the would-be intelligent system. Competence models can be quite derailed, specifying far more than merely the function to be computed. But for all that, they are pitched at some level of abstraction from the details of any particular algorithm or processing strategy which may be said to realize the competence. Indeed, it is the point and virtue of such models to specify some (...) equivalence class of algorithms/processing strategies so that the common properties highlighted by the chosen class may feature in psychologically interesting accounts. A question arises concerning the type of relation a theorist might expect to hold between such a competence model and a psychologically real processing strategy. Classical work in cognitive science expects the actual processing to depend on explicit or tacit knowledge of the competence theory. Connectionist work, for reasons to be explained, represents a departure from this norm. But the precise way in which a connectionist approach may disturb the satisfying classical symmetry of competence and processing has yet to be properly specified. A standard ?Newtonian? connectionist account, due to Paul Smolensky, is discussed and contrasted with a somewhat different ?rogue? account. A standard connectionist understanding has it that a classical competence theory describes an idealized subset of a network's behaviour. But the network's behaviour is not to be explained by its embodying explicit or tacit knowledge of the information laid out in the competence theory. A rogue model, by contrast, posits either two systems, or two aspects of a single system, such that one system does indeed embody the knowledge laid out in the competence theory. (shrink)

Mental competence, or decision‐making capacity, is an important concept in law, psychiatry, and bioethics. A major problem faced in the development and implementation of standards for assessing mental competence is the issue of objectivity. The problem is that objective standards are hard to formulate and apply. The aim here is to review the limited philosophical literature on the place of value in competence in an attempt to introduce the issues to a wider audience. The thesis that the assessment of competence (...) must incorporate elements of value and rationality is defended, and some tentative suggestions offered about how this might be achieved in a clinical setting. (shrink)

According to the principle of patient autonomy, patients have the right to be self-determining in decisions about their own medical care, which includes the right to refuse treatment. However, a treatment refusal may legitimately be overridden in cases where the decision is judged to be incompetent. It has recently been proposed that in assessments of competence, attention should be paid to the evaluative judgments that guide patients' treatment decisions.In this paper I examine this claim in light of theories of practical (...) rationality, focusing on the difficult case of an anorexic person who is judged to be competent and refuses treatment, thereby putting themselves at risk of serious harm. I argue that the standard criteria for competence assess whether a treatment decision satisfies the goals of practical decision-making, and that this same criterion can be applied to a patient's decision-guiding commitments. As a consequence I propose that a particular understanding of practical rationality offers a theoretical framework for justifying involuntary treatment in the anorexia case. (shrink)

I argue against traditional virtue epistemology on which knowledge is a success due to a competence to believe truly, by revealing an in-principle problem with the traditional virtue epistemologist’s explanation of Gettier cases. The argument eliminates one of the last plausible explanation of Gettier cases, and so of knowledge, in terms of non-factive mental states and non-mental conditions. I then I develop and defend a different kind of virtue epistemology, on which knowledge is an exercise of a competence to know. (...) I show how the account, while circular, is not viciously so. It explains both how knowledge is a mental state, as well as the relationship between knowledge and justification, including justified false beliefs and Gettier cases. Moreover, although direct virtue epistemology is compatible with many views on the nature of belief, it can explain how knowledge might be metaphysically more fundamental than belief as well. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how-to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist (...) in North‐America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how‐to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end‐of‐life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi‐centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

After establishing that the requirement that those criminals who stand for execution be mentally competent can be given a recognizably retributivist rationale, I suggest that not only it is difficult to show that executing the incompetent is more cruel than executing the competent, but that opposing the execution of the incompetent fits ill with the recent abolitionist efforts on procedural concerns. I then propose two avenues by which abolitionists could incorporate such opposition into their efforts.

Because corporate social responsibility can be beneficial to both companies and its stakeholders, interest in factors that support CSR performance has grown in recent years. A thorough integration of CSR in core business processes is particularly important for achieving effective long-term CSR practices. Here, we explored the individual CSR-related competencies that support CSR implementation in a corporate context. First, a systematic literature review was performed in which relevant scientific articles were identified and analyzed. Next, 28 CSR directors and managers (...) were interviewed. The literature review complemented with interview data resulted in the following eight distinct CSR-related competencies: Anticipating CSR challenges; Understanding CSR-relevant systems and subsystems; Understanding CSR-relevant standards; CSR management competencies, including Leading CSR programs, Managing CSR programs, and Identifying and realizing CSR-related business opportunities; Realizing CSR-supportive interpersonal processes; Employing CSR-supportive personal characteristics and attitudes; Personal value-driven competencies, including Ethical normative competencies, Balancing personal ethical values and business objectives, and Realizing self-regulated CSR-related behaviors and active involvement; and Reflecting on personal CSR views and experiences. Based on these results, implications for further research on this topic, as well as implications for practitioners, are discussed. (shrink)

This paper identifies the phenomenon of conceptual competence injustice, a form of epistemic injustice that occurs when a marginalized epistemic agent makes a conceptual claim and is illegitimately regarded as having failed to grasp one or more of the concepts expressed in her testimony. The notion of a conceptual claim is given a deflationary account that is coextensive with the class of a priori knowable claims. This study reveals a form of oppression that severely hinders marginalized epistemic agents who seek (...) to create or communicate conceptual knowledge. Conceptual competence injustice is compared and contrasted with three other forms of epistemic injustice: testimonial injustice, hermeneutical injustice, and contributory injustice. The final section investigates a number of damaging effects that conceptual competence injustice has on marginalized persons pursuing a career in academic philosophy. (shrink)

Questions about the relationship between linguistic competence and expertise will be examined in the paper. Harry Collins and others distinguish between ubiquitous and esoteric expertise. Collins places considerable weight on the argument that ordinary linguistic competence and related phenomena exhibit a high degree of expertise. His position and ones which share close affinities are methodologically problematic. These difficulties matter because there is continued and systematic disagreement over appropriate methodologies for the empirical study of expertise. Against Collins, it will be argued (...) that the term ‘expertise’ should be reserved for expertise (esoteric experts) and exclude everyday performance (ubiquitous experts). Wittgensteinian ideas will be employed to maintain that it is mistaken and misleading to derive substantive conclusions about the epistemology of expertise from ordinary linguistic competence and vice versa. Significant attention will be devoted to the notion of following a rule with particular reference to the intelligibility of tacit rule following. A satisfactory theoretical approach to expertise should not involve making important claims about ordinary linguistic competence. (shrink)

I argue that wrongdoers may be open to moral blame even if they lacked the capacity to respond to the moral considerations that counted against their behavior. My initial argument turns on the suggestion that even an agent who cannot respond to specific moral considerations may still guide her behavior by her judgments about reasons. I argue that this explanation of a wrongdoer’s behavior can qualify her for blame even if her capacity for moral understanding is impaired. A second argument (...) is based on the observation that even when a blameworthy wrongdoer could have responded to moral considerations, this is often not relevant to her blameworthiness. Finally, I argue against the view that because blame communicates moral demands, only agents who can be reached by such communication are properly blamed. I contend that a person victimized by a wrongdoer with an impaired capacity for moral understanding may protest her victimization in a way that counts as a form of moral blame even though it does not primarily express a moral demand or attempt to initiate moral dialogue. (shrink)

Competent patients’ refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on (...) the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a ‘negotiated reliance’ response where nurses and others tread as lightly as possible on the patient’s autonomy while negotiating a compromise, but are obligated to match the patient’s sacrifice by extending themselves beyond their usual professional practice. (shrink)

In the study of cognitive processes, limitations on computational resources (computing time and memory space) are usually considered to be beyond the scope of a theory of competence, and to be exclusively relevant to the study of performance. Starting from considerations derived from the theory of computational complexity, in this paper I argue that there are good reasons for claiming that some aspects of resource limitations pertain to the domain of a theory of competence.

ABSTRACTAchievements are among the things that make a life good. Assessing the plausibility of this intuitive claim requires an account of the nature of achievements. One necessary condition for achievement appears to be that the achieving agent acted competently, i.e. was not just lucky. I begin by critically assessing existing accounts of anti-luck conditions for achievements in both the ethics and epistemology literature. My own proposal is that a goal is reached competently, only if the actions of the would-be-achiever make (...) success likely, and that this is the reason why she acts that way. (shrink)

This study offers a proposal about which competencies should be fostered in organizations to promote a culture in favor of sustainability in line with Pope Francis' encyclical letter Laudato Si. As a result, seven main competencies are proposed, with their interpretation in the light of the encyclical letter, and some suggestions on how to implement them in organizations are presented. The competencies are systemic vision, critical thinking, capacity for dialog, inclusion, proper use of goods, creativity, and spirituality. (...) In addition, the study offers a discussion of the relevance of these competencies in today's business context. This study offers a novelty with respect to other theoretical proposals on competencies for sustainability since it includes competencies that require an authentic concern for other people and for a vision of the human being open to transcendence, thus breaking with instrumentalism and technocratic paradigm that underlies other proposals. In this way, it also offers a new key to interpreting the integral ecology proposed by Pope Francis, which goes beyond other approaches to sustainability in that it includes not only the person–nature relationship but also the person–person and person–transcendence or person–God relationships. The conclusions of this theoretical research can be especially useful for those who intend to promote a culture of sustainability inspired by the Catholic Social Teaching, also making use of the knowledge and good practices of competency-based management. (shrink)

Habit plays a central role in Peirce's pragmatic account of human signification. What he means by meaning is, hence, fully intelligible only in reference to the role he accords to habit in this account. While the main focus of Peirce's critical attention is, especially in the mature articulation of his thoroughgoing pragmatism, upon deliberately acquired habits, it is reasonable to suggest that often his concern is actually with something broader in one sense and narrower in another than individual or isolated (...) habits. Any given disposition to act in certain ways in certain circumstances is taken by him to be an integral part of more or less integrated dispositions to act, feel, and even imagine: it is not taken to be operative apart from these other habits. In this sense, then, his concern is primarily with such integrated dispositions, not isolated habits. Thus, it is broader than the inattentive reader is likely to suspect. But, since those deliberately cultivated dispositions of rational agents that are at the center of Peirce's concerns are ones specifiable only in reference to some human practice such as experimental inquiry or everyday conversations, religious worship or artistic innovation, these dispositions are appropriately taken to be not simply habits in any way whatsoever but primarily habits to act in a competent or expert manner. More simply put, these deliberately cultivated dispositions are, in many instances, best conceived as competencies or expertise. While not all habits equip agents with expert or even competent ways of addressing the shifting demands of experiential situations (that is, while not all habits are instances of competence or expertise), all cases of competence and expertise are, at bottom, more or less harmoniously integrated clusters of flexible, nuanced, and alterable habits. Accordingly, any account of Peirce's conception of habit, especially as it pertains to his pragmatic theory of meaning, must bring into sharper focus the complex relationship among habits, competence, and expertise than Peirce and even his most imaginative expositors have done thus far. The aim of this paper is to push our investigation of the Peircean notion of human habituation in precisely this direction. Against an evolutionary background, the historical foreground of historically evolved and evolving practices will be sketched. Habits in their guise as competencies and expertise will then be seen in the context of such practices, with equal emphasis on initiation into a practice and the open-ended process of acquiring ever more refined expertise. (shrink)

This article reflects on the skills required in trades services to people dedicated to coordinate services in complex clinical situations because of their multidimensionality and chronicity. All human activity requires for its proper effectuation, the coordination of interdependencies between actors. Coordination of interdependencies is done in ordinary mode, in everyday activities, but also in dedicated mode, that is to say, through a practice that has a primary mandate to manage them in a conscious, voluntary and accountable for intervention situations whose (...) complexity is high. This passage from the ordinary form in the form of dedicated coordination undertakes a transformation of skills and professional knowledge mobilized in the professional gesture. Further skills and knowledge relating to the disciplinary control of clinical objects, the case manager or professional figure who best embodies this form of coordination, should mobilize expertise and procedural knowledge (assessment, planning, communication, negotiation, activation networks, etc..) required to control the interfaces between technical systems and professional and organizational actors, posing as the interdependence of actants primary purpose in work. For this he must do it in a time of temporality combining organizational project in clinical time. Le présent article réfléchit aux compétences requises dans les métiers de services aux personnes dédiés à coordonner les services dans les situations cliniques complexes en raison de leur multi-dimensionnalité et leur chronicité. Toute activité humaine exige, pour sa bonne effectuation, la coordination des interdépendances entre les acteurs concernés. La coordination des interdépendances se réalise en mode ordinaire, dans les activités de tous les jours, mais aussi en mode dédié, c’est-à-dire à travers une pratique qui a pour mandat principal de les gérer de manière consciente, volontaire et imputable pour les situations d’intervention dont la complexité est grande. Ce passage de la forme ordinaire à la forme dédiée de coordination engage une transformation des compétences et savoirs professionnels mobilisés dans le geste professionnel. En outre des compétences et savoirs relatifs à la maîtrise des objets cliniques disciplinaires, le gestionnaire de cas, soit la figure professionnelle qui incarne le mieux cette modalité de coordination, doit mobiliser des compétences et savoirs procéduraux (évaluation, planification, communication, négociation, activation de réseaux, etc.) requis à la maîtrise des interfaces entre systèmes techniques et acteurs professionnels et organisationnels, en posant l’interdépendance des actants comme objet premier de son action professionnelle. Pour cela, il doit effectuer cette dernière dans une temporalité conjuguant le temps du projet organisationnel au temps clinique. (shrink)

This article reflects on the skills required in trades services to people dedicated to coordinate services in complex clinical situations because of their multidimensionality and chronicity. All human activity requires for its proper effectuation, the coordination of interdependencies between actors. Coordination of interdependencies is done in ordinary mode, in everyday activities, but also in dedicated mode, that is to say, through a practice that has a primary mandate to manage them in a conscious, voluntary and accountable for intervention situations whose (...) complexity is high. This passage from the ordinary form in the form of dedicated coordination undertakes a transformation of skills and professional knowledge mobilized in the professional gesture. Further skills and knowledge relating to the disciplinary control of clinical objects, the case manager or professional figure who best embodies this form of coordination, should mobilize expertise and procedural knowledge (assessment, planning, communication, negotiation, activation networks, etc..) required to control the interfaces between technical systems and professional and organizational actors, posing as the interdependence of actants primary purpose in work. For this he must do it in a time of temporality combining organizational project in clinical time. e présent article réfléchit aux compétences requises dans les métiers de services aux personnes dédiés à coordonner les services dans les situations cliniques complexes en raison de leur multi-dimensionnalité et leur chronicité. Toute activité humaine exige, pour sa bonne effectuation, la coordination des interdépendances entre les acteurs concernés. La coordination des interdépendances se réalise en mode ordinaire, dans les activités de tous les jours, mais aussi en mode dédié, c’est-à-dire à travers une pratique qui a pour mandat principal de les gérer de manière consciente, volontaire et imputable pour les situations d’intervention dont la complexité est grande. Ce passage de la forme ordinaire à la forme dédiée de coordination engage une transformation des compétences et savoirs professionnels mobilisés dans le geste professionnel. En outre des compétences et savoirs relatifs à la maîtrise des objets cliniques disciplinaires, le gestionnaire de cas, soit la figure professionnelle qui incarne le mieux cette modalité de coordination, doit mobiliser des compétences et savoirs procéduraux (évaluation, planification, communication, négociation, activation de réseaux, etc.) requis à la maîtrise des interfaces entre systèmes techniques et acteurs professionnels et organisationnels, en posant l’interdépendance des actants comme objet premier de son action professionnelle. Pour cela, il doit effectuer cette dernière dans une temporalité conjuguant le temps du projet organisationnel au temps clinique. (shrink)

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving kindness, compassion, sympathetic joy, (...) equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand. (shrink)

Competing Explanations of Competing Explanations: Accounting for Conflict Between Scientific and Folk ExplanationsThis paper focuses on the level of people’s explanatory reasoning. It examines why laypeople prefer folk explanations of various physical or biological phenomena to alternative, well‐understood scientific explanations. Shtulman and Legare call this psychological phenomenon “explanatory co‐existence.” On the basis of new experimental data, they evaluate two possible accounts of explanatory co‐existence, a theory‐based and an associative account, and argue that a theory‐based account is the better supported.

In this paper I discuss the view that the appropriate concept of competence is a decision‐relative one: that a person may be competent to make one decision but not another. The argument that I present is that neither of the two competing theories supporting the decision‐relative approach, internalism and externalism, can provide a coherent explanation of why a person’s competence should be thought to be relative to a particular decision. On the one hand, internalism, which regards competence as exhaustively a (...) matter of the person’s understanding, fails to identify the specific skills or content that would warrant linking a specific decision with competence, and thus cannot provide an account of decision‐relative that parallels task‐relative. On the other hand, externalism, which regards competence as a matter of the person’s understanding in relation to external elements such as risk, cannot adequately defend why a person’s competence to make a decision should ‘track’ the level of probable harm that results from the decision. (shrink)

In this chapter, I explore moral competence as a central condition on moral responsibility. I distinguish two main conceptions. On the first, a morally competent agent is someone who knows right from wrong. On the second, a morally competent agent is someone who responds aptly to reasons. These two conceptions merit separate treatment as they offer different insights on how and why moral competence might be compromised. This distinction is of particular relevance since the chapter critically examines a standard assumption (...) stating that whenever a mental disorder impacts moral competence, it decreases its scope (on the first conception) or precision (on the second). In close conversation with the memoir literatures on bipolar disorder, autism and schizophrenia, I argue that moral competence may also be affected by what looks like increases in scope or precision; moreover, neither impact – decrease or increase – necessarily undermines moral competence in and of itself; oftentimes, either could enhance it in a reliable way. Finally, by critically revisiting the ecological or scaffolding approach to moral responsibility, I show that moral competence is best understood as a practical way of knowing right from wrong embedded in daily routines and habits, and irreducible to propositional understanding or intellectual skills. (shrink)

In this paper I argue that reflection on competence and enfranchisement in relation to profound disability forces re-examination of the grounds of citizenship, with implications for theories of distributive justice in education. The primary purpose is less to point up that some people are disenfranchised without injustice; it is more to advance the view that, since enfranchisement is not an option for some profoundly disabled people, we require a conception of citizenship that is more sensitive to their distinctive needs and (...) interests. (shrink)

The controversy regarding the unit of selection is fundamentally a dispute about what is the correct causal structure of the process of evolution by natural selection and its ontological commitments. By characterizing the process as consisting of two essential steps--interaction and transmission--a singular answer to the unit question becomes ambiguous. With such an account on hand, two recent defenses of competing units of selection are considered. Richard Dawkins maintains that the gene is the appropriate unit of selection and Robert Brandon, (...) in response, argues that the individual organism is better suited to the role. This paper argues that by making explicit the underlying questions that each of these views addresses, the apparent conflict can be resolved. Furthermore, such a resolution allows for a more complete and realistic understanding of the process of evolution by natural selection. (shrink)

Some bioethicists have argued in favor of a sliding scale notion of competence, paternalistically requiring greater competence in relation to more significant risk. I argue against a sliding scale notion, taking issue with the positions of Allen E. Buchanan and Dan W. Brock, Ian Wilkes, and Joel Feinberg. Rejecting arguments that a sliding scale is supported by legal cases, by ordinary usage, and by fallible judgments about competence, I argue in favor of greater evidence of competence when risk is greater. (...) Two clinical cases are examined, both involving amputation, to show that my fixed concept of competence, with a requirement of clearer evidence of competence when risk is high, better accounts for good moral decisions in bioethics. (shrink)

The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social–historical construction (ASBH Core Competencies for Health Care Ethics Consultation , 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011 ). Core Competencies fails to recognize that the ethics of health care ethics consultants is (...) not ethics in the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered. (shrink)

In this monograph we contrast two prominent models of education, Competence-Based Education (CBE), more recent and currently dominant in most school systems of the world, and Bildung-Oriented Education (BOE), once the basis of school systems of Northern Europe. CBE interprets learning as the acquisition of clearly definable and allegedly measurable competences, and is supported by supranational organisations, such as the OECD, which approach education from the perspective of the human capital theory. BOE instead characterises learning holistically as aimed at the (...) progressive articulation of a meaningful ‘big picture’ in the student’s mind. Emerged in Northern Europe under the influence of the ideals of the Enlightenment and Neo-Humanism of individual and collective autonomy and responsibility, BOE was subsequently enriched with a hermeneutical approach to teaching and socio-political objectives of emancipation and solidarity originating within Critical Theory. We argue that, in spite of its celebrated ‘scientificity’, CBE is internally incoherent and unreliable, contributes to structural forms of oppression and injustice, fosters social pathologies, and fails to provide students with the kind of intellectual autonomy they need as both human beings and citizens of our complex post-industrial societies. We also defend BOE from objections made by critical theorists, poststructuralists and postcolonial thinkers, and argue that it is a coherent and flexible model of education that endows students with autonomy and responsibility, and can help heal social pathologies. (shrink)

El artículo tiene como objetivo describir las competencias informacionales a desarrollar durante la formación profesional. Se presenta los referentes teóricos a partir del empleo de un enfoque de sistema que supone el análisis y la síntesis, la inducción y la deducción como métodos de investigación, con el propósito de dar conocer los hitos en las universidades y organizaciones internacionales relacionadas. La modelación fue empleada para la construcción de un nuevo proyecto de desarrollo de competencias informacionales desde la perspectiva de la (...) formación profesional universitaria ajustada a las necesidades de la educación superior en Cuba. El nuevo proyecto se configura en tres unidades básicas, con sus respectivos elementos de competencia, saberes esenciales e indicadores para la evaluación del desempeño. El artículo fundamenta la tesis de que el desarrollo de competencias informacionales debe ser sistemáticamente estructurado, planificado y ejecutado como parte integral de la formación curricular en interacción con los contenidos de las disciplinas docentes, bajo la dirección del profesor y la participación protagónica de los profesionales en formación. The article aims at describing the competence to be developed during professional training. It presents the theoretical referents by means of an approach system that includes synthesis and analysis, induction and deduction as research methods in order to reveal the milestones of information skills development in universities and related international organizations. Modeling was used for the construction of a new skills development project from the perspective of university professional training according to the needs of Higher Education in Cuba. The new project is composed of three basic units, with their respective competence elements, essential knowledge and indicators for the evaluation of the performance. The article supports the theory that information development skills must be systematically structured, planned and implemented as an integral part of the curricular training in interaction with the contents of subjects, under the teacher´s guidance and the active participation of profesionals in training. (shrink)

The authors examine recent arguments purporting to show that mental incompetence (lack of decision-making capacity) is not a necessary condition for intervention in a person's best interests without consent. It is concluded that these arguments fail to show that competent wishes could justifiably be overturned. Nonetheless, it remains an open question whether accounts of decision-making capacity based solely on the notions of understanding and appreciation can adequately deal with various complexities. Different possible ways of resolving these complexities are outlined, all (...) of which need further exploration. (shrink)

This paper summarises the author 's doctoral research on the development of interpersonal/interorganisational trust in relationships between expatriate and Russian staff working in east‐west enterprises in Russia. There is strong evidence from a variety of researchers to suggest that in order for western businesses investing in Russia to succeed, the dif.cult process of building trust needs to be understood and managed since in the Russian business climate western standards and norms of ethical business have not yet been established. According to (...) research.ndings, western investors doing business in Russia and the long‐term, personal trust that characterises family and friend relationships more congenial and more productive than formal, arm's‐length contacts and contracts. In such a context, it becomes important to identify what creates and destroys trust in the post‐Soviet business environment. This paper describes the causal factors leading to trust or lack of trust in relationships within western‐invested strategic alliances in Russia. The key relationship under consideration is the one between expatriate western staff and managers seconded to the venture on the one hand, and their local Russian staff, counterparts and superiors on the other. (shrink)

Clinical ethics training programs are responsible for preparing their trainees to be competent ethics consultants worthy of the trust of patients, families, surrogates, and healthcare professionals. While the American Society for Bioethics and Humanities (ASBH) offers a certification examination for healthcare ethics consultants, no tools exist for the formal evaluation of ethics trainees to assess their progress toward competency. Medical specialties accredited by the Accreditation Council for Graduate Medical Education (ACGME) use milestones to report trainees’ progress along a continuum of (...) professional development as a means of “operationalizing and implementing” medical competencies. Utilizing the Core Competencies for Healthcare Ethics Consultation and the ACGME and American Board of Pediatrics’ (ABP) Pediatric Milestones Project, we developed milestones for 17 subcompetencies in clinical ethics consultation and academic bioethics. As the field of clinical ethics becomes more standardized, such tools will be needed to promote the development of robust training programs and to certify that their graduates are competent practitioners. (shrink)

This paper explores the ethical and conceptual implications of the findings from an empirical study (reported elsewhere) of decision-making capacity in anorexia nervosa. In the study, ten female patients aged thirteen to twenty-one years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semistructured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient-participants were also tested using the (...) MacArthur Competence Assessment Tool—Treatment test of competence. This is a formalized, structured, interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief, self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches. (shrink)

Recent increases in the rates of parental refusal of routine childhood vaccination have eroded many countries’ “herd immunity” to communicable diseases. Some parents who refuse routine childhood vaccines do so because they deny the mainstream medical consensus that vaccines are safe and effective. I argue that one reason these vaccine denialists disagree with vaccine proponents about the reasons in favor of vaccination is because they also disagree about the sorts of practices that are conducive to good reasoning about healthcare choices. (...) Vaccine denialists allocate epistemic authority more democratically than do mainstream medical professionals. They also sometimes make truth ascriptions for nonepistemic reasons, fail to recognize legitimate differences in expertiseand competence, and seek uncritical affirmation of their existing beliefs. By focusing on the different epistemic values and practices of vaccine denialists and mainstream medical professionals, I locate my discussion of vaccine denialism within broader debates about rationality. Furthermore, I argue that gender inequality and gendered conceptions of reason are important parts of the explanation of vaccine denialism. Accordingly, I draw upon feminist work—primarily feminist social epistemology—to help explain and evaluate this form of vaccine refusal. (shrink)

Over the last 80 years, a major goal of medical educators has been to improve the quality of applicants to medical school and, hence, the resulting doctors. To do this, academic standards have been progressively strengthened. The Medical College Admission Test (MCAT) in the United States and the undergraduate science grade point average (GPA) have long been correlated with success in medical school, and graduation rates have been close to 100 percent for many years. Recent studies have noted that some (...) doctors having difficulties in practice were found to have had similar problems while in school. In this essay, we present a brief historical account of attitudes and approaches to admissions requirements, then discuss basic broad areas of accomplishment in clinical practice: academic mastery, clinical acumen, and professionalism. We then review data that suggest that lack of competency can often be detected very early in a student’s career and may or may not be immune to remediation efforts. We end with a recommendation for a course of action that upholds and fulfills the profession’s social responsibility. This will be a moral argument, defending an aggressive but equitable approach to maintaining both public accountability and trust. (shrink)