Americans who are afraid of living for many years with Alzheimer's might seek a way to end their lives early, when their dementia has just entered the moderate phase. There is no legal process for doing so. In this paper I argue that advance directives, in particular, are not a legal solution for those who prefer to die rather than suffer years of dementia. The problem is that an advance directive only works to hasten death when there is a life-threatening (...) illness for which one can refuse treatment; more often than not, Alzheimer's kills the self long before it kills the body. (shrink)

Young children spend a large portion of their time pretending about non-real situations. Why? We answer this question by using the framework of Bayesian causal models to argue that pretending and counterfactual reasoning engage the same component cognitive abilities: disengaging with current reality, making inferences about an alternative representation of reality, and keeping this representation separate from reality. In turn, according to causal models accounts, counterfactual reasoning is a crucial tool that children need to plan for the future and learn (...) about the world. Both planning with causal models and learning about them require the ability to create false premises and generate conclusions from these premises. We argue that pretending allows children to practice these important cognitive skills. We also consider the prevalence of unrealistic scenarios in children's play and explain how they can be useful in learning, despite appearances to the contrary. (shrink)

Why is evolutionary theory controversial among members of the American public? We propose a novel explanation: allegiance to different criteria for belief. In one interview study, two online surveys, and one nationally representative phone poll, we found that evolutionists and creationists take different justifications for belief as legitimate. Those who accept evolution emphasize empirical evidence and scientific consensus. Creationists emphasize not only the Bible and religious authority, but also knowledge of the heart. These criteria for belief remain predictive of views (...) about evolution even when taking into account other related factors like religion, political affiliation, and education. Each view is supported by its own internally specified criteria for what constitutes a justified belief. Changing minds may thus require changing epistemic norms. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority. Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and information (...) about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18. This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

Sibley et al. (2008) report a recurrent neural network model designed to learn wordform representations suitable for written and spoken word identification. The authors claim that their sequence encoder network overcomes a key limitation associated with models that code letters by position (e.g., CAT might be coded as C‐in‐position‐1, A‐in‐position‐2, T‐in‐position‐3). The problem with coding letters by position (slot‐coding) is that it is difficult to generalize knowledge across positions; for example, the overlap between CAT and TOMCAT is lost. Although we (...) agree this is a critical problem with many slot‐coding schemes, we question whether the sequence encoder model addresses this limitation, and we highlight another deficiency of the model. We conclude that alternative theories are more promising. (shrink)

In this paper we examine a puzzle recently posed by Aaron Preston for the traditional realist assay of property (quality) instances. Consider Socrates (a red round spot) and red1—Socrates’ redness. For the traditional realist, both of these entities are concrete particulars. Further, both involve redness being `tied to’ the same bare individuator. But then it appears that red1 is duplicated in its ‘thicker’ particular (Socrates), so that it can’t be predicated of Socrates without redundancy. According to Preston, this suggests that (...) a concrete particular and its property instances aren’t genuinely related. We argue that Preston’s proffered solution here—to treat property instances as “mental constructs”—is fraught with difficulty. We then go on to show how, by fine-tuning the nature of bare particulars, treating them as abstract modes of things rather than concrete particulars, the traditional realist can neatly evade Preston’s puzzle. (shrink)

SummaryThe incidence of family breakdown and stress has been examined in an unselected group of 92 South Wales families, each containing a patient suffering from Huntington's chorea, and related to the onset and duration of the disease, age of the patient, and behavioural symptoms shown. The frequency of actual and attempted suicide is analysed and the effects of the disorder on the primary care agent for the patient discussed. Some of the effects on children and the needs of the families (...) for support and practical help are outlined. It is concluded that family support is an essential factor in any programme aimed at the long-term alleviation and prevention of Huntington's chorea. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority . Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and (...) information about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18 . This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

We argue that Bayesian models are best categorized as methodological or theoretical. That is, models are used as tools to constrain theories, with no commitment to the processes that mediate cognition, or models are intended to approximate the underlying algorithmic solutions. We argue that both approaches are flawed, and that the Enlightened Bayesian approach is unlikely to help.

Mastery imagery (i.e., images of being in control and coping in difficult situations) is used to regulate anxiety. The ability to image this content is associated with trait confidence and anxiety, but research examining mastery imagery ability's association with confidence and anxiety in response to a stressful event is scant. The present study examined whether trait mastery imagery ability mediated the relationship between confidence and anxiety, and the subsequent associations on performance in response to an acute psychological stress. Participants (N= (...) 130; 55% male;Mage= 19.94 years;SD= 1.07 years) completed assessments of mastery imagery ability and engaged in a standardized acute psychological stress task. Immediately prior to the task, confidence, cognitive and somatic anxiety intensity, and interpretation of anxiety symptoms regarding the task were assessed. Path analyses supported a model whereby mastery imagery ability mediated the relationship between confidence and cognitive and somatic anxiety interpretation. Greater mastery imagery ability and confidence were both directly associated with better performance on the stress task. Mastery imagery ability may help individuals experience more facilitative anxiety and perform better during stressful tasks. Improving mastery imagery ability by enhancing self-confidence may help individuals successfully cope with anxiety elicited during stressful situations. (shrink)

Many people feel the pull of both creationism and evolution as explanations for the origin of species, despite the direct contradiction. Some respond by endorsing theistic evolution, integrating the scientific and religious explanations by positing that God initiated or guided the process of evolution. Others, however, simultaneously endorse both evolution and creationism despite the contradiction. Here, we illustrate this puzzling phenomenon with interviews with a diverse sample. This qualitative data reveals several approaches to coping with simultaneous inconsistent explanations. For example, (...) some people seem to manage this contradiction by separating out ideological claims, which prioritize identity expression, from fact claims, which prioritize truth. Fitting with this interpretation, ambivalent individuals tended to call explanations “beliefs”, avoid mention of truth or falsity, and ground one or both beliefs in identity and personal history. We conclude with a brief discussion of the affordances of this distinction. (shrink)

An English language translation accompanies the original Greek text of Aristotle's book about the nature of the state, constitutions, revolutions, democracy, and oligarchy.

In part 4 of Meaning, Expression, and Thought, Davis rejects what he calls Fregean ideational theories, according to which the meaning of an expression is an idea; and then presents his own account, which states that, e.g., the meaning of 'Primzahl' in German is the property of meaning prime number. Before casting doubt on the latter ontology of meanings, I come to Frege's defence by pointing out that he was not an advocate of the position Davis named after (...) him because Fregean senses are not lexical meanings and Fregean thoughts are not types of mental events. (shrink)

The problem of the will has long been viewed as central to Heidegger's later thought. In the first book to focus on this problem, Bret W. Davis clarifies key issues from the philosopher's later period--particularly his critique of the culmination of the history of metaphysics in the technological "will to will" and the possibility of Gelassenheit or "releasement" from this willful way of being in the world--but also shows that the question of will is at the very heart of (...) Heidegger's thinking, a pivotal issue in his path from Being and Time (1926) to "Time and Being" (1962). Moreover, the book demonstrates why popular critical interpretations of Heidegger's relation to the will are untenable, how his so-called "turn" is not a simple "turnaround" from voluntarism to passivism. Davis explains why the later Heidegger's key notions of "non-willing" and " Gelassenheit " do not imply a mere abandonment of human action; rather, they are signposts in a search for an other way of being, a "higher activity" beyond the horizon of the will. While elucidating this search, his work also provides a critical look at the ambiguities, tensions, and inconsistencies of Heidegger's project, and does so in a way that allows us to follow the inner logic of the philosopher's struggles. As meticulous as it is bold, this comprehensive reinterpretation will change the way we think about Heidegger's politics and about the thrust of his philosophy as a whole. (shrink)

In recent years there has been a resurgence of interest in the work of Emmanuel Levinas, widely recognized as one of the most important yet difficult philosophers of the 20th century. In this much-needed introduction, Davis unpacks the concepts at the centre of Levinas's thought - alterity, the Other, the Face, infinity - concepts which have previously presented readers with major problems of interpretation. Davis traces the development of Levinas's thought over six decades, describing the context in which (...) he worked, and the impact of his writings. He argues that Levinas's work remains tied to the ontological tradition with which he wants to break, and demonstrates how his later writing tries to overcome this dependency by its increasingly disruptive, sometimes opaque, textual practice. He discusses Levinas's theological writings and his relationship to Judaism, as well as the reception of his work by contemporary thinkers, arguing that the influence of his work has led to a growing interest in ethical issues among poststructuralist and postmodernist thinkers in recent years. Comprehensive and clearly written, this book will be essential reading for students and researchers in continental philosophy, French studies, literary theory and theology. (shrink)

According to act theories, propositions are structured cognitive act‐types. Act theories appear to make propositions inherently representational and truth‐evaluable, and to provide solutions to familiar problems with alternative theories, including Frege’s and Russell’s problems, and the third‐realm and unity problems. Act theories have critical problems of their own, though: acts as opposed to their objects are not truth evaluable, not structured in the right way, not expressed by sentences, and not the objects of propositional attitudes. I show how identifying propositions (...) with other cognitive event‐types, namely thoughts, has the perceived virtues of act theories without the defects. (shrink)

Since its inception, the concept of `intersectionality' — the interaction of multiple identities and experiences of exclusion and subordination — has been heralded as one of the most important contributions to feminist scholarship. Despite its popularity, there has been considerable confusion concerning what the concept actually means and how it can or should be applied in feminist inquiry. In this article, I look at the phenomenon of intersectionality's spectacular success within contemporary feminist scholarship, as well as the uncertainties and confusion (...) which it has generated. Drawing upon insights from the sociology of science, I shall show how and why intersectionality could become a feminist success story. I shall argue that, paradoxically, it is precisely the concept's alleged weaknesses — its ambiguity and open-endedness — that were the secrets to its success and, more generally, make it a good feminist theory. (shrink)

There is abundant evidence of contextual variation in the use of “S knows p.” Contextualist theories explain this variation in terms of semantic hypotheses that refer to standards of justification determined by “practical” features of either the subject’s context (Hawthorne & Stanley) or the ascriber’s context (Lewis, Cohen, & DeRose). There is extensive linguistic counterevidence to both forms. I maintain that the contextual variation of knowledge claims is better explained by common pragmatic factors. I show here that one is variable (...) strictness. “S knows p” is commonly used loosely to implicate “S is close enough to knowing p for contextually indicated purposes.” A pragmatic account may use a range of semantics, even contextualist. I use an invariant semantics on which knowledge requires complete justification. This combination meets the Moorean constraint as well as any linguistic theory should, and meets the intuition constraint much better than contextualism. There is no need for ad hoc error theories. The variation in conditions of assertability and practical rationality is better explained by variably strict constraints. It will follow that “S knows p” is used loosely to implicate that the condition for asserting “p” and using it in practical reasoning are satisfied. (shrink)

The pioneering work of Johann Winckelmann (1717-1768) identified a homoerotic appreciation of male beauty in classical Greek sculpture, a fascination that had endured in Western art since the Greeks. Yet after Winckelmann, the value (even the possibility) of art's queer beauty was often denied. Several theorists, notably the philosopher Immanuel Kant, broke sexual attraction and aesthetic appreciation into separate or dueling domains. In turn, sexual desire and aesthetic pleasure had to be profoundly rethought by later writers. Whitney Davis follows (...) how such innovative thinkers as John Addington Symonds, Michel Foucault, and Richard Wollheim rejoined these two domains, reclaiming earlier insights about the mutual implication of sexuality and aesthetics. Addressing texts by Arthur Schopenhauer, Charles Darwin, Oscar Wilde, Vernon Lee, and Sigmund Freud, among many others, Davis criticizes modern approaches, such as Kantian idealism, Darwinism, psychoanalysis, and analytic aesthetics, for either reducing aesthetics to a question of sexuality or for removing sexuality from the aesthetic field altogether. Despite these schematic reductions, sexuality always returns to aesthetics, and aesthetic considerations always recur in sexuality. Davis particularly emphasizes the way in which philosophies of art since the late eighteenth century have responded to nonstandard sexuality, especially homoeroticism, and how theories of nonstandard sexuality have drawn on aesthetics in significant ways. Many imaginative and penetrating critics have wrestled productively, though often inconclusively and "against themselves," with the aesthetic making of sexual life and new forms of art made from reconstituted sexualities. Through a critique that confronts history, philosophy, science, psychology, and dominant theories of art and sexuality, Davis challenges privileged types of sexual and aesthetic creation imagined in modern culture-and assumed today. (shrink)

The use of ‘S knows p’ varies from context to context. The contextualist theories of Cohen, Lewis, and DeRose explain this variation in terms of semantic hypotheses: ‘S knows p’ is indexical in meaning, referring to features of the ascriber’s context like salience, interests, and stakes. The linguistic evidence against contextualism is extensive. I maintain that the contextual variation of knowledge claims results from pragmatic factors. One is variable strictness (Davis, Philos Stud, 132(3):395–438, 2007). In addition to its strict (...) use, ‘S knows p’ may be used loosely to implicate that S is close enough to knowing p for contextually indicated purposes. Here I explore another variable: belief about what is known. This factor is pragmatic rather than semantic in that it affects the use of ‘S knows p’ without affecting its truth conditions. While variation in strictness accounts for the variation in the bank, parking, and some lottery cases, variation in belief accounts for the variation in other lottery cases and the epistemology cases. Along the way, I sketch an insensitive invariantist semantics that is strict but non-skeptical, and show how it works with these pragmatic factors. (shrink)

This book is a critical introduction to contemporary French philosopher Jacques Rancière. It is the first introduction in any language to cover all of his major work and offers an accessible presentation and searching evaluation of his significant contributions to the fields of politics, pedagogy, history, literature, film theory and aesthetics. This book traces the emergence of Rancière’s thought over the last forty-five years and situates it in the diverse intellectual contexts in which it intervenes. Beginning with his egalitarian critique (...) of his former teacher Louis Althusser, the book tracks the subsequent elaboration of Rancière’s highly original conception of equality. This approach reveals that a grasp of his early archival and historiographical work is vital for a full understanding both of his later politics and his ongoing investigation of art and aesthetics. Along the way, this book explains and analyses key terms in Rancière’s very distinctive philosophical lexicon, including the ‘police’ order, ‘disagreement’, ‘political subjectivation’, ‘literarity’, the ‘part which has no part’, the ‘regimes of art’ and ‘the distribution of the sensory’. This book argues that Rancière’s work sets a new standard in contestatory critique and concludes by reflecting on the philosophical and policy implications of his singular project. (shrink)

This paper reconsiders Tommie Shelby's (2016) analysis of procreation in poor black communities. I identify three conceptual frames within which Shelby situates his analysis—feminization, choice-as-control, and moralization. I argue that these frames should be rejected on conceptual, empirical, and moral grounds. As I show, this framing engenders a flawed understanding of poor black women's procreative lives. I propose an alternative framework for reconceiving the relationship between poverty and procreative justice, one oriented around reproductive flourishing instead of reproductive responsibility. More generally, (...) the paper develops a methodological challenge for nonideal moral and political philosophy, especially concerning the obligations of the oppressed. Specifically, I argue that in the absence of descriptive and conceptual accountability, the moral gaze of the philosopher risks preserving, rather than destabilizing, oppressive ideologies. (shrink)

Low-level dishonesty is rife everywhere, in the form of exaggeration, selective use of facts, economy with the truth, careful drafting - from Trump and the Brexit debate to companies that tell us 'your call is important to us'. How did we get to a place where bullshit is not just rife but apparently so effective that it's become the communications strategy of our times? This brilliantly insightful book steps inside the panoply of deception employed in all walks of life and (...) assesses how it has come to this. It sets out the surprising logic which explains why bullshit is both pervasive and persistent. Why are company annual reports often nonsense? Why should you not trust estate agents? And above all, why has political campaigning become the art of stretching the truth? Drawing on behavioural science, economics, psychology and of course his knowledge of the media, Evan ends by providing readers with a tool-kit to handle the kinds of deceptions we encounter every day, and charts a route through the muddy waters of the post-truth age." -- Publisher's website. (shrink)

Academic philosophy has a novelty problem. Novelty has become a litmus test for a contribution’s value. This results in a common undertaking for academic researchers. Read a bunch. Look for holes and gaps. Figure out what hasn’t been said. Try to insert yourself in a conversation by saying something new. On first glance, this approach might appear to make sense. If it’s not new, why do we need it? Yet a fixation on novelty sculpts a landscape of philosophical inquiry that (...) is inhospitable and self-undermining. (shrink)

Abstract MacFarlane distinguishes “context sensitivity” from “indexicality,” and argues that “nonindexical contextualism” has significant advantages over the standard indexical form. MacFarlane’s substantive thesis is that the extension of an expression may depend on an epistemic standard variable even though its content does not. Focusing on ‘knows,’ I will argue against the possibility of extension dependence without content dependence when factors such as meaning, time, and world are held constant, and show that MacFarlane’s nonindexical contextualism provides no advantages over indexical contextualism. (...) The discussion will shed light on the definition of indexicals as well as the meaning of ‘knows,’ and highlight important constraints on the way meaning can be represented in semantics. Content Type Journal Article Pages 1-14 DOI 10.1007/s11098-011-9831-1 Authors Wayne A. Davis, Georgetown University, Washington, DC, USA Journal Philosophical Studies Online ISSN 1573-0883 Print ISSN 0031-8116. (shrink)

First published in German in 1995, volume 77 of Heidegger’s Complete Works consists of three imaginary conversations written as World War II was coming to an end. Composed at a crucial moment in history and in Heidegger's own thinking, these conversations present meditations on science and technology; the devastation of nature, the war, and evil; and the possibility of release from representational thinking into a more authentic relation with being and the world. The first conversation involves a scientist, a scholar, (...) and a guide walking together on a country path; the second takes place between a teacher and a tower-warden, and the third features a younger man and an older man in a prisoner-of-war camp in Russia, where Heidegger’s two sons were missing in action. Unique because of their conversational style, the lucid and precise translation of these texts offers insight into the issues that engaged Heidegger’s wartime and postwar thinking. (shrink)

This book focuses on the significance of the body in contemporary feminist scholarship. Whether the body is treated as biological bedrock or subversive metaphor, it is implicated in the cultural and historical construction of sexual difference as well as asymmetrical power relations. The contributors to this volume examine the role of the body as socially shaped and historically colonized territory and as the focus of individual womenÆs struggles for autonomy and self-determination. They also analyze its centrality to the feminist critique (...) of male-stream science as dualistic, distanced, and decontextualized. While the body has become a "hot item" in contemporary social theory and research, the renewed interest has received a mixed reaction from feminists. The body may be back, but the "new" body theory often proves to be just as disembodied as it ever was. The body revival seems to be less an attempt to re-embody masculinist science than just another expression of the same condition that evoked the feminist critique in the first place: a flight from femininity and everything that is associated with it in Western culture. Drawing on insights from contemporary feminist theories of gender and power, this book offers a timely critical appraisal of the recent "body revival." Embodied Practices not only sets an agenda for research about the body, but for an embodied perspective on the body as well. It will be a valuable and thought-provoking resource for students of womenÆs studies, social theory, cultural studies, and medical sociology. (shrink)

The authors outline a program for understanding the semantics and pragmatics of slur terms, proposing that slurs are mixed expressives that predicate membership in some social group G while simultaneously invoking a complex of historical facts and social attitudes about G. The authors then point to the importance of distinguishing between the potential offensive and derogatory effects of slur terms, with the former deriving from the impact on the listener of the invoked content itself, and the latter deriving from inferences (...) about speaker attitudes and intentions. The authors use the resulting framework to discuss several controversial cases of slurs and slurring: terms targeting political views such as ‘Nazi’ and ‘terf’, and cases in which non-slurs are used to derogate, as in cases of misgendering. The authors conclude that what counts as a slur is in part dependent on a background system of ideological assumptions, meaning that whether a particular term counts as a slur will depend in part on one’s ideological commitments and assumptions. (shrink)

Perceived behavioral integrity involves the employee’s perception of the alignment of the manager’s words and deeds. This meta-analysis examined the relationship between perceived behavioral integrity of managers and the employee attitudes of job satisfaction, organizational commitment, satisfaction with the leader and affect toward the organization. Results indicate a strong positive relationship overall (average r = 0.48, p<0.01). With only 12 studies included, exploration of moderators was limited, but preliminary analysis suggested that the gender of the employees and the number of (...) levels between the employee and the manager are potential moderators of the relationship. In the current sample of studies, country where the research was conducted did not seem to have any moderating effects. In addition to suggesting further investigation of potential moderators, we call for research that examines the relationship between behavioral integrity and outcomes that include individual behavior and organizational performance. (shrink)

Heidegger's writings are among the most formidable in the philosophy. The pivotal concepts of his thought are for many the source of both fascination and frustration. This title includes chapters that introduce and explain a key Heideggerian concept, or a cluster of closely related concepts.

There is a morally questionable laxity in our practices of apologising. A genuine apology involves substantially more than regret about offence caused by one’s behaviour. I argue that it is in fact possible to unpack a normative paradigm (or essence) underlying the practice of apologising. This essence involves doxastic, affective, and dispositional elements, related at the moral phenomenological level. The Consummate apologiser believes that he has transgressed because of identifiable moral saliences of his conduct, feels reproachful towards himself as a (...) result, and as a result resolves to avoid repetition of the same conduct. The latter might require the cultivation of new dispostions or the sharpening of existing ones. It is rational to accept an apology insofar as the preceding doxastic, affective, and dispositional elements are believed to be present and rational in the apologiser. In accepting an apology, the recipient agrees to the attempt at normalisation of relations with the transgressor. (shrink)

Most people who defend physician-assisted death (PAD) endorse the Joint View, which holds that two conditions—autonomy and welfare—must be satisfied for PAD to be justified. In this paper, we defend an Autonomy Only view. We argue that the welfare condition is either otiose on the most plausible account of the autonomy condition, or else is implausibly restrictive, particularly once we account for the broad range of reasons patients cite for desiring PAD, such as “tired of life” cases. Moreover, many of (...) the common objections to an Autonomy Only view fail once we understand the extent of the autonomy condition’s requirements—in particular, the importance of one’s values for autonomous choices. If our view is correct, then the scope of permissible PAD is broader than is currently accepted in both the philosophical literature and the law, and therefore poses an important challenge to this widely accepted view on justified PAD. (shrink)

Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un- Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was apparent (...) that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery. In this article, we grapple with how to satisfy the need for demonstrable value in a field in which metrics alone may not capture the scope of clinical ethics practice. We suggest that capturing the value of a CES has been difficult because the benefits of ethics consultation may be overt or attributable to the CES, but are often hidden due to the systems-level and process-oriented nature of clinical ethics work. Part of the difficulty in demonstrating the value of CESs is capturing and conveying all of the ways the integration of a CES throughout an institution positively affects patients, families, visitors, healthcare professionals, administrators, and the institution itself. Our aim is to (1) elucidate the multifaceted value added by a CES, including value that tends to be hidden and (2) suggest how to demonstrate value to others in a way that is not simplistic or reductionistic. (shrink)

Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her precedent autonomy by giving her what she used to want? There is a similar problem with subsequent consent: How can we justify interfering with someone''s autonomy on the grounds that she will later consent to the interference, if she refuses now?Both problems arise on the assumption that, to respect someone''s autonomy, (...) any preferences we respect must be among that person''s current preferences. I argue that this is not always true. Just as we can celebrate an event long after it happens, so can we respect someone''s wishes long before or after she has that wish. In the contexts of precedent autonomy and subsequent consent, the wishes are often preferences about which of two other, conflicting preferences to satisfy. When someone has two conflicting preferences, and a third preference on how to resolve that conflict, to respect his autonomy we must respect that third preference. People with declining competence may have a resolution preference earlier, favoring the earlier conflicting preference (precedent autonomy), whereas those with rising competence may have it later, favoring the later conflicting preference (subsequent consent). To respect autonomy in such cases we must respect not a current, but a former or later preference. (shrink)

Bioethicists are widely agreed that patients have a right of self-determination over how they are treated. Our duty to respect this is said to be based on the principle of respect for autonomy. In end-of-life care the patient may be incompetent and unable to exercise that right. One solution is to exercise it in advance. Advance directives, which include living wills and powers of attorney for health care, enable people to decide what medical treatment they will receive later, when they (...) become incompetent. Advance directives have been criticized in two general ways. First, many critics contend that advance directives fail on a practical level to effect a patient's autonomous choices because, for example, people cannot foresee their futures well enough to make informed decisions in advance. Second, many critics contend that, practical problems aside, there is no moral authority for exercising control over one's incompetent future self. (shrink)