Surgical devices are often marketed before there is good evidence of their safety and effectiveness. Our paper discusses the ethical issues associated with the early marketing and use of new surgical devices from the perspectives of the six groups most concerned. Health Canada, which is responsible for licensing new surgical devices, should amend their requirements to include rigorous clinical trials that provide data on effectiveness and safety for each new product before it is marketed. Industry should comply with all Health (...) Canada requirements to obtain licenses for new products. Until Health Canada requires effectiveness and safety data, industry should cooperate with physicians in appropriate studies before releasing new products and should make balanced presentations of all the available evidence. Surgeons should, before using a new surgical device, assess the evidence on its effectiveness and safety and ensure they are properly trained and competent in using the device. Surgeons should provide their patients with an evaluation of the available evidence and inform them about possible complications and the surgeon's level of experience with the new device. Patients, who should be given an honest evaluation of the available evidence, possible complications, and the surgeon's experience, should be encouraged to evaluate the evidence and information to their own satisfaction to ensure that fully informed consent is given. Health institutions, responsible for regulating practice within their walls, should review new devices for safety, effectiveness, and economic impacts, before allowing their use. They should also limit the use of new surgical devices to surgeons trained and competent in the new technology. Professional societies should provide guidance on the early adoption of new surgical devices and technologies. We urge all those involved in the development, licensing, and use of new surgical devices to aim for higher ethical standards to protect the health and safety of patients requiring surgery. The lowest acceptable ethical standard would require device manufacturers to provide surgeons with accurate and timely information on the efficacy and safety of their products, allowing surgeons and patients to evaluate the evidence (and the significance of information not yet available) before surgery. (shrink)

It is becoming more common that the decision-makers in private and public institutions are predictive algorithmic systems, not humans. This article argues that relying on algorithmic systems is procedurally unjust in contexts involving background conditions of structural injustice. Under such nonideal conditions, algorithmic systems, if left to their own devices, cannot meet a necessary condition of procedural justice, because they fail to provide a sufficiently nuanced model of which cases count as relevantly similar. Resolving this problem requires deliberative capacities uniquely (...) available to human agents. After exploring the limitations of existing formal algorithmic fairness strategies, the article argues that procedural justice requires that human agents relying wholly or in part on algorithmic systems proceed with caution: by avoiding doxastic negligence about algorithmic outputs, by exercising deliberative capacities when making similarity judgments, and by suspending belief and gathering additional information in light of higher-order uncertainty. (shrink)

We discuss the variety of sorts of sympathy Hume recognizes, the extent to which he thinks our sympathy with others’ feelings depends on inferences from the other’s expression, and from her perceived situation, and consider also whether he later changed his views about the nature and role of sympathy, in particular its role in morals.

The influence of liberal political ideology on nursing sciencePrevious notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy — individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy — are primarily manifested in relation to: (i) the (...) individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health. (shrink)

In this paper, I identify a theoretical and political role for ‘white ignorance’, present three alternative accounts of white ignorance, and assess how well each fulfils this role. On the Willful Ignorance View, white ignorance refers to white individuals’ willful ignorance about racial injustice. On the Cognitivist View, white ignorance refers to ignorance resulting from social practices that distribute faulty cognitive resources. On the Structuralist View, white ignorance refers to ignorance that results as part of a social process that systematically (...) gives rise to racial injustice, and is an active player in the process. I argue that, because of its greater power and flexibility, the Structuralist View better explains the patterns of ignorance that we observe, better illuminates the connection to white racial domination, and is overall better suited to the project of ameliorating racial injustice. As such, the Structuralist View should be preferred. (shrink)

David Hume's essay Of Moral Prejudices offers a spirited defense of "all the most endearing sentiments of the hearts, all the most useful biases and instincts, ...

In this paper, I identify a theoretical and political role for ‘white ignorance’, present three alternative accounts of white ignorance, and assess how well each fulfils this role. On the Willful Ignorance View, white ignorance refers to white individuals’ willful ignorance about racial injustice. On the Cognitivist View, white ignorance refers to ignorance resulting from social practices that distribute faulty cognitive resources. On the Structuralist View, white ignorance refers to ignorance that (1) results as part of a social process that (...) systematically gives rise to racial injustice, and (2) is an active player in the process. I argue that, because of its greater power and flexibility, the Structuralist View better explains the patterns of ignorance that we observe, better illuminates the connection to white racial domination, and is overall better suited to the project of ameliorating racial injustice. As such, the Structuralist View should be preferred. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

" By the end, we can see the cause to which Hume has been true throughout the work.

Annette Baier's aim is to make sense of David Hume's Treatise as a whole. Hume's family motto, which appears on his bookplate, was True to the End. Baier argues that it is not until the end of the Treatise that we get his full story about truth and falsehood, reason and folly. By the end, we can see the cause to which Hume has been true throughout the work. Baier finds Hume's Treatise of Human Nature to be a carefully (...) crafted literary and philosophical work which itself displays a philosophical progress of sentiments. His starting place is an overly abstract intellectualism that deliberately thrusts passions and social concerns into the background. In the three interrelated books of the Treatise, his self-understander proceeds through partial successes and dramatic failures to emerge with new-found optimism, expecting that the exact knowledge the morally self-conscious anatomist of human nature can acquire will itself improve and correct our vision of morality. Baier describes how, by turning philosophy toward human nature instead of toward God and the universe, Hume initiated a new philosophy, a broader discipline of reflection that can embrace Charles Darwin and Michel Foucault as well as William James and Sigmund Freud. Hume belongs both to our present and to our past. (shrink)

What is it to deceive someone? And how is it possible to deceive oneself? Does self-deception require that people be taken in by a deceitful strategy that they know is deceitful? The literature is divided between those who argue that self-deception is intentional and those who argue that it is non-intentional. In this study, Annette Barnes offers a challenge to both the standard characterisation of other-deception and current characterizations of self-deception, examining the available explanations and exploring such questions as (...) the self-deceiver's false consciousness, bias, and the irrationality and objectionability of self-deception. She arrives at a non-intentional account of self-deception that is deeper and more complete than alternative non-intentional accounts and avoids the reduction of self-deceptive belief to wishful belief. (shrink)

Nurse practitioners (NPs) are increasingly called on to provide high‐quality health‐care particularly for people who face significant barriers to accessing services. Although discourses of social justice have become relatively common in nursing and health services literature, critical analyses of how NP roles articulate with social justice issues have received less attention. In this study, we examine the role of NPs from a critical social justice perspective. A critical social justice lens raises morally significant questions, for example, why certain individuals and (...) groups bear a disproportionate burden of illness and suffering; what social conditions contribute to disparities in health and social status; and what social mandate NPs ought to develop in response to these realities. In our analysis, we draw on lessons learned from the initial Canadian experience with the introduction of NPs in the 1970s to consider the renewed and burgeoning interest in NPs in Canada, Australia and elsewhere. As we argue, a critical social justice perspective (in addition to the biomedical foci of NP practice) will be essential to sustaining long‐term, socially responsive NP roles and achieving greater equity in health and health‐care. (shrink)

_Postures of the Mind _was first published in 1985. Minnesota Archive Editions uses digital technology to make long-unavailable books once again accessible, and are published unaltered from the original University of Minnesota Press editions. Annette Baier develops, in these essays, a posture in philosophy of mind and in ethics that grows out of her reading of Hume and the later Wittgenstein, and that challenges several Kantian or analytic articles of faith. She questions the assumption that intellect has authority over (...) all human feelings and traditions; that to recognize order we must recognize universal laws—descriptive or prescriptive; that the essential mental activity is representing; and that mental acts can be analyzed into discrete basic elements, combined according to statable rules of synthesis. In the first group of essays—"Varieties of Mental Postures"—Baier evaluates the positions taken by philosophers ranging from Descartes to Dennett and Davidson. Among her topics are remembering, intending, realizing, caring, representing, changing one's mind, justifying one's actions and feelings, and having conflicting reasons for them. The second group of essays—"Varieties of Moral Postures" - explores the sort of morality we get when all of these capacities become reflective and self-corrective. Some deal with particular moral issues—our treatment of animals, our policies regarding risk to human life, our contractual obligations; others, with more general questions on the role of moral philosophers and the place of moral theory. These essays respond to the theories of Hobbes, Kant, Rawls, and MacIntyre, but Baier's most positive reaction is to David Hume; _Postures of the Mind _ affirms and cultivates his version of a moral reflection that employs feeling and tradition as well as reason. (shrink)

We show that a popular class of connectionist models (which we label 'first order connectionism') looks unlikely to provide the kind of resources required by the hypothesis. We examine some alternative hybrid models that seem more promising. Finally, we raise a more purely philosophical issue concerning the conditions under which a being can count as a genuine believer or cognizer.".

Kaum ein Zeitabschnitt war von solch grundlegenden technischen, politischen und philosophischen Umbruchen gepragt wie die 100 Jahre bis zur Jahrtausendwende - vom Kaiserreich zur globalen Weltgesellschaft, vom Idealismus zum Werterelativismus. Die juristische Grundlagenforschung - auch die Rechtsphilosophie - ist gegenwartig in keiner guten Verfassung: Ihr fehlt die gesellschaftliche Resonanz, und damit einhergehend der qualifizierte wissenschaftliche Nachwuchs. Der Band mochte einen Anstoss geben, durch eine Ruckbesinnung auf die grossen Leistungen in der Rechtsphilosophie des letzten Jahrhunderts an diese anzuknupfen, Problemlosungen fur die (...) Zukunft zu suchen und die Unverzichtbarkeit der Rechtsphilosophie dabei wieder ernst zu nehmen. (shrink)

This is an essay at the intersection of metaethics and the history of contemporary analytic philosophy. It explores the relationships between Allan Gibbard’s mature quasi-realist expressivism and (i) three non-naturalistic varieties of what I call “non-inflationary realism” and (ii) moral fictionalism. Moral or normative realism is frequently (if mistakenly) taken to involve certain existence-affirming external assumptions about the metaphysical status of substantive normative thought and discourse. The non-inflationary realists seek to embrace moral or normative objectivity and truth without any distinctly—as (...) they see it, “inflated”—moral or normative ontology. This position, along with a shared emphasis on the primacy of substantive moral or normative thought and discourse, brings them very close to Gibbard, and so to what it is tempting to treat as a strikingly different metaethical account. Focusing on the non-inflationary realists Ronald Dworkin, T.M. Scanlon, and Derek Parfit, I examine similarities among their views, and between each of these views and Gibbard’s. I argue that the non-inflationary realist project should be understood as including the work not only of these figures, characteristically seen as among its paradigmatic representatives, but also, crucially, that of Gibbard. They all agree that our moral or normative claims purport to state normative truths and that such claims are capable of being true or false and that when true they do not depend on the particular standpoint anyone happens to take. Our moral or normative thoughts can be characterized as beliefs. We can have moral knowledge. There are substantive moral and normative facts. These facts are not reducible to non-normative facts. Normative concepts cannot be analyzed in purely naturalistic terms; and normative facts do not depend on any robustly existent truth-makers. Focusing on these shared commitments enables me to home in on the apparent differences that nonetheless remain. They differ in significant respects, for instance, about whether—and, if so, to what extent—we can make any meaningful external (non-substantive) judgments about the moral or normative and about whether there is a role for property-based explanations that minimalism about the normative fails to capture. By investigating these and other differences, I shed light on what is at stake in giving an adequate account of our moral and normative thought and talk. I pursue this aim further by considering why it might seem that quasi-realist expressivism was a form of normative fictionalism or error theory—though it is not. I attempt here to clear up confusions stemming from common assumptions associated with terms like “realism,” “cognitivism,” or “fictionalism” with respect to morality or normativity. I distinguish some differences in the ways in which normative properties can be understood by non-inflationary realists and the roles they can play in explaining normativity. I underscore the implausibility of treating the moral domain as completely autonomous. And I attempt to offer suggestions regarding some conceptual options that remain to be further explored. I maintain that Gibbard makes explicit otherwise unacknowledged implications of Scanlon’s or Dworkin’s accounts, implications regarding deep differences between normative or moral and other domains, implications which might help explain the uneasiness that prompts Scanlon and Dworkin to resist Gibbard’s account and that pushes Parfit toward what seems to be a sort of intermediate position between non-inflationary and more ontologically committed realism. Non-inflationary realism forces us to rethink metaethics in interesting and promising ways. (shrink)

The democratic boundary problem raises the question of who has democratic participation rights in a given polity and why. One possible solution to this problem is the all-affected principle, according to which a polity ought to enfranchise all persons whose interests are affected by the polity’s decisions in a morally significant way. While AAP offers a plausible principle of democratic enfranchisement, its supporters have so far not paid sufficient attention to economic participation rights. I argue that if one commits oneself (...) to AAP, one must also commit oneself to the view that political participation rights are not necessarily the only, and not necessarily the best, way to protect morally weighty interests. I also argue that economic participation rights raise important worries about democratic accountability, which is why their exercise must be constrained by a number of moral duties. (shrink)

Disagreement persists about when, if at all, disenfranchisement is a fitting response to criminal wrongdoing of type X. Positive retributivists endorse a permissive view of fittingness: on this view, disenfranchising a remarkably wide range of morally serious criminal wrongdoers is justified. But defining fittingness in the context of criminal disenfranchisement in such broad terms is implausible, since many crimes sanctioned via disenfranchisement have little to do with democratic participation in the first place: the link between the nature of a criminal (...) act X (the ‘desert basis’) and a fitting sanction Y is insufficiently direct in such cases. I define a new, much narrower account of the kind of criminal wrongdoing which is a more plausible desert basis for disenfranchisement: ‘political wrongdoing’, such as electioneering, corruption, or conspiracy with foreign powers. I conclude that widespread blanket and post-incarceration disenfranchisement policies are overinclusive, because they disenfranchise persons guilty of serious, but non-political, criminal wrongdoing. While such overinclusiveness is objectionable in any context, it is particularly objectionable in circumstances in which it has additional large-scale collateral consequences, for instance by perpetuating existing structures of racial injustice. At the same time, current policies are underinclusive, thus hindering the aim of holding political wrongdoers accountable. (shrink)

ZusammenfassungDie aktuellen Entwicklungen und Anforderungen in der pflegeberuflichen Bildung, das Ausbildungsziel im Pflegeberufegesetz vom 17. Juli 2017 und die Explikationen in der dazugehörigen Ausbildungs- und Prüfungsverordnung für die Pflegeberufe fordern eine stärkere Ausrichtung auf die Entwicklung ethischer Kompetenzen explizit ein. Bislang liegen tendenziell übergreifende Definitionen und Darlegungen zu ethischen Kompetenzen in der Pflege vor, deren Verdienst es ist, das Spezifische der Pflegeethik zu konturieren und erstmals ethische Kompetenzen für das Feld zu konkretisieren. In methodischer und didaktischer Hinsicht ist indes eine (...) spezifische Differenzierung gemäß unterschiedlicher Bildungsniveaus relevant. Lehrende werden ihre Lehre nicht mehr nur im Sinne einer allgemeinen Förderung ethischer Kompetenz entwickeln können, sondern müssen dabei den jeweiligen Verantwortungsbereich und das angezielte Qualifikationsniveau der Lernenden berücksichtigen. Ziel der Darlegungen ist es, konkrete Kompetenzniveaus für die Anbahnung professionsethischer Kompetenzen zu operationalisieren, die einerseits die Anforderungen aus dem zukünftigen Pflegeberufegesetz aufgreifen und andererseits anstehende curriculare Entwicklungsprozesse unterstützen. (shrink)

Norman Daniels’ theory of justice and health faces a serious practical problem: his theory can ground the special moral importance of health and allows distinguishing just from unjust health inequalities, but it provides little practical guidance for allocating resources when they are especially scarce. Daniels’ solution to this problem is a fair process that he specifies as "accountability for reasonableness". Daniels claims that accountability for reasonableness makes limit-setting decisions in healthcare not only legitimate, but also fair. This paper assesses the (...) latter claim. Does accountability for reasonableness result in fair limit-setting decisions? It is argued that the answer to this question is not a clear yes. Daniels is remarkably unclear about the criterion of fairness that accountability for reasonableness satisfies. The paper discusses different options for resolving this lack of clarity and examines how they apply to Daniels’ accountability for reasonableness framework. It is concluded, first, that accountability for reasonableness is not a paradigm case of any of the classic notions of procedural justice; second, that what might be called "constrained pure procedural justice" best reflects how accountability for reasonableness results in fair limit-setting decisions; and third, that the procedural conditions of accountability for reasonableness must be further specified and amended to better achieve a fair process, and hence fair limit-setting decisions. (shrink)

This article explores the civic republican conception of citizenship underlying the Labour government's programme of civil renewal and the introduction of education for democratic citizenship. It considers the importance of the cultivation of civic virtue through political participation for such developments and it reviews the research into how service learning linked to character education can lead to the civic virtue of duty or social responsibility.

It has recently been proposed to incorporate the use of a “Patient Preference Predictor” (PPP) into the process of making treatment decisions for incapacitated patients. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Including a PPP in the shared decision-making process between clinicians and surrogates has the potential to better realize important ethical goals for making treatment decisions (...) for incapacitated patients. However, developing and implementing a PPP poses significant practical challenges. The present paper discusses these practical challenges and considers ways to address them. (shrink)

In these Carus Lectures, Annette Baier looks at the relation between individual and shared reasoning, intending, and moral reflection. In each case she emphasizes the interdependence of minds and the role of social practices in setting the norms governing these activities.

A recent message on one of the e-mail bulletin boards sent by a college student read, “I believe that the AIDS virus was developed in government labs for the purpose of controlling black folks.” In September 1990, Essence, an African American magazine with a circulation of 900,000, had as a lead article “AIDS: Is It Genocide?” In 1991, the New York Times quoted Clarence Page, African American columnist and Pulitzer prize winner: “You could call conspiracy theories about AIDS and drugs (...) fringe ideas, but they seem, to have a large following among the black intelligentsia. … [And] you find it at all levels.” In April 1992, Lorene Gary explained in Newsweek “Why it's not just paranoia.” In that same month, another New York Times article reported: “Bizarre as it may seem to most people, many black Americans believe that AIDS and the health measures used against it are part of a conspiracy to wipe out the black race.”4 In February 1992, Science quoted Peter Breggin, director of the Center for the Study of Psychiatry in Bethesda, Maryland, as saying that research on violence “cloaks the intention to identify problem black children and then … prescribe pacifying drugs.”. (shrink)

The Cautious Jealous Virtue is an illuminating meditation that will interest not only Hume scholars but also those interested in the issues of justice and in ...

In recent decades in North American social and moral philosophy, alongside the development and discussion of widely influential theories of justice, taken as Rawls takes it as the ‘first virtue of social institutions,’ there has been a counter-movement gathering strength, one coming from some interesting sources. For some of the most outspoken of the diverse group who have in a variety of ways been challenging the assumed supremacy of justice among the moral and social virtues are members of those sections (...) of society whom one might have expected to be especially aware of the supreme importance of justice, namely blacks and women. Those who have only recently won recognition of their equal rights, who have only recently seen the correction or partial correction of long-standing racist and sexist injustices to their race and sex, are among the philosophers now suggesting that justice is only one virtue among many, and one that may need the presence of the others in order to deliver its own undenied value. Among these philosophers of the philosophical counterculture, as it were - but an increasingly large counterculture - I include Alasdair MacIntyre, Michael Stocker, Lawrence Blum, Michael Slote, Laurence Thomas, Claudia Card, Alison Jaggar, Susan Wolf and a whole group of men and women, myself included, who have been influenced by the writings of Harvard educational psychologist Carol Gilligan, whose book In a Different Voice caused a considerable stir both in the popular press and, more slowly, in the philosophical journals. (shrink)

One of the key ethical requirements for biomedical research is that it have an acceptable risk-benefit profile (Emanuel, Wendler, and Grady 2000). The International Conference of Harmonization guidelines mandate that clinical trials should be initiated and continued only if “the anticipated benefits justify the risks” (1996). Guidelines from the Council for International Organizations of Medical Sciences state that biomedical research is acceptable only if the “potential benefits and risks are reasonably balanced” (2002). U.S. federal regulations require that the “risks to (...) subjects” be “reasonable in relation to anticipated benefits, if any, to subjects and the importance of the knowledge” to be gained from the .. (shrink)