Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Theological engagement with quantum mechanics has been dominated by the Copenhagen interpretation, failing to reflect the fact that philosophers and physicists alike are increasingly moving away from the Copenhagen interpretation in favor of other approaches. One such approach, Hugh Everett's so-called Many Worlds Interpretation (MWI), is being taken increasingly seriously. As the MWI's credibility grows, it is imperative that metaphysicians, theologians, and philosophers of religion engage with its ideas and their implications. This article does just that, setting out some implications (...) of Everettian Quantum Mechanics that are particularly relevant to theism. It argues that taking seriously the radical consequences of the Everett interpretation means facing at least three major worries for theism pertaining to personal identity, the problem of evil, and salvation. The article concludes by calling on theologians and philosophers of religion to address these worries, in order that these matters of religious significance remain both coherent and credible if the MWI turns out to be correct. (shrink)

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

Moral distress, is, at its core, an organizational problem. It is experienced on a personal level, but its causes originate within the system itself. In this commentary, we argue that moral distress is not inherently good, that effective interventions must address the external sources of moral distress, and that while there is a place for resilience in the healthcare professions, it cannot be an effective antidote to moral distress.

This article applies Paul Tillich's existentialist analysis of the human predicament, particularly what it means to exist and to be fallen, to social media. I argue that social media heightens feelings of alienation and estrangement, supporting this claim with evidence from empirical research in psychiatry and communication studies. Thus, I offer an application of a Tillichian approach to an area of culture previously unexamined in this way. I identify three primary ways in which social media exacerbates existentialist emotional states: social (...) media allows us to construct artificial versions of ourselves through the use of filters and photo editing software; it provides the means to quantify social approval in groups the size of which the human brain has not evolved for; it extends the size of our social networks but decreases the quality of interactions. Social media is yet to receive significant philosophical or theological engagement despite its prevalence, particularly within younger generations. I argue that this is a mistake – philosophy has a duty to engage with such a ubiquitous feature of modern life. (shrink)

According to what is perhaps the dominant picture of reference, what a referential term refers to in a context is determined by what the speaker intends for her audience to identify as the referent. I argue that this sort of broadly Gricean view entails, counterintuitively, that it is impossible to knowingly use referential terms in ways that one expects or intends to be misunderstood. Then I sketch an alternative which can better account for such opaque uses of language, or what (...) I call “sneaky reference.” I close by reflecting on the ramifications of these arguments for the theory of meaning more broadly. (shrink)

Frege famously claimed that variations in the sense of a proper name can sometimes be ‘tolerated’. In this paper, we offer a novel explanation of this puzzling claim. Frege, we argue, follows Trendelenburg in holding that we think in language—sometimes individually and sometimes together. Variations in sense can be tolerated in just those cases where we are using language to coordinate our actions but are not engaged in thinking together about an issue.

Significant variations in the way objects appear across different viewing conditions pose a challenge to the view that they have some true, determinate color. This view would seem to require that we break the symmetry between multiple appearances in favor of a single variant. A wide range of philosophical and non-philosophical writers have held that the symmetry can be broken by appealing to daylight viewing conditions—that the appearances of objects in daylight have a stronger, and perhaps unique, claim to reveal (...) their true colors. In this note we argue that, whatever else its merits, this appeal to daylight is not a satisfactory answer to the problem posed by perceptual variation. (shrink)

In “Demonstratives”, David Kaplan introduced a simple and remarkably robust semantics for indexicals. Unfortunately, Kaplan’s semantics is open to a number of apparent counterexamples, many of which involve recording devices. The classic case is the sentence “I am not here now” as recorded and played back on an answering machine. In this essay, I argue that the best way to accommodate these data is to conceive of recording technologies as introducing special, non-basic sorts of contexts, accompanied by non-basic conventions governing (...) the use of indexicals in those contexts. The idea is that recording devices allow us to use indexicals in new and innovative ways to coordinate on objects. And, given sufficient regularity in the use of indexicals on such devices, linguistic conventions will, over time, come to reflect this innovation. I consider several alternatives to this ‘character-shifting’ theory, but none is able to account for the data as well as the present proposal. Many face additional theoretical difficulties as well. I conclude by explaining how the character-shifting theory not only retains many of the virtues of Kaplan’s original semantics, but also coheres with a plausible view on the nature of semantic theorizing more generally. (shrink)

Evans (1973)’s Madagascar case and other cases like it have long been taken to represent a serious challenge for the Causal Theory of Names. The present essay answers this challenge on behalf of the causal theorist. The key is to treat acts of uttering names as events. Like other events, utterances of names sometimes turn out to have features which only become clear in retrospect.

As an empirical inquiry into the nature of meaning, semantics must rely on data. Unfortunately, the primary data to which philosophers and linguists have traditionally appealed—judgments on the truth and falsity of sentences—have long been known to vary widely between competent speakers in a number of interesting cases. The present article constitutes an experiment in how to obtain some more consistent data for the enterprise of semantics. Specifically, it argues from some widely accepted Gricean premises to the conclusion that judgments (...) on lying are semantically relevant. It then endeavors to show how, assuming the relevance of such judgments, we can use them to generate a useful, widely acceptable test for semantic content. (shrink)

This dissertation sets out to answer the question ''What fixes the semantic values of context-sensitive referential terms—like names, demonstratives, and pronouns—in context?'' I argue that it is the speaker's intentions that play this role, as constrained by the conventions governing the use of particular sorts of referential terms. These conventions serve to filter the speaker's intentions for just those which meet these constraints on use, leaving only these filtered-for intentions as semantically relevant. By considering a wide range of cases, including (...) many involving confused and deceptive speakers, I argue that this 'constraint theory' provides a better account of linguistic reference than does any extant alternative, whether intentionalist or non-intentionalist. Along the way, I argue that semantics cannot depend on the reactions of idealized listeners, that speaker meaning is far less clear, and helpful, a notion than it is standardly taken to be, and that speakers needn't aim to be cooperative in order to fix the meaning of their terms in context. (shrink)

Background Although methods proposed for the conduct of ethics consultation tend to be viewed as competing approaches, they may in fact function in a complementary manner. Methods We describe the experience of ethics consultation in two ethics committees at the University Hospitals of Geneva, Switzerland. Results Both committees provide case consultation by a multi-disciplinary team of committee members, but with different processes. These differences in process do not necessarily lead to differences in outcome. Discussion Different methods of ethics consultation are (...) not mutually exclusive, and can co-exist within the same institution. The practical application of one method of ethics consultation can lead to substantial variations in process between different groups of consultants. Conclusion Despite the importance of clarifying theoretical groundings, and consultation and deliberation processes, in ethics consultation, choosing between different processes may not be pressing. To assist these choices, exploration of the practical strengths and weaknesses of different methods will be necessary to assist clinical ethicists, and clinical ethics committees, in acquiring a flexible and evidence-based set of approaches to their work. (shrink)

Quantum mechanics has recently indicated that, at the fundamental level, temporal order is not fixed. This phenomenon, termed Indefinite Causal Order, is yet to receive metaphysical or theological engagement. We examine Indefinite Causal Order, particularly as it emerges in a 2018 photonic experiment. In this experiment, two operations A and B were shown to be in a superposition with regard to their causal order. Essentially, time, intuitively understood as fixed, flowing, and fundamental, becomes fuzzy. We argue that if Indefinite Causal (...) Order is true, this is good evidence in favor of a B‐theory of time, though such a B‐theory requires modification. We then turn to theology, suggesting that a B‐theoretic temporal ontology invites serious reconsideration of the doctrine of salvation. This paper concludes that the best explanation for salvation given a B‐theory is mind‐dependent salvific becoming, a type of psychological soteriological change that occurs through downward causation. (shrink)

There are some names which cannot be spoken and others which cannot be written, at least on certain very natural ways of conceiving of them. Interestingly, this observation proves to be in tension with a wide range of views about what names are. Prima facie, this looks like a problem for predicativists. Ultima facie, it turns out to be equally problematic for Millians. For either sort of theorist, resolving this tension requires embracing a revisionary account of the metaphysics of names. (...) Revisionary Millianism, I argue, offers some important advantages over its predicativist competitor. (shrink)

Jessica Keiser’s Non-Ideal Foundations of Language is a serious, sustained attempt to engage in systematic philosophy of language while leaving aside some of th.

Special relativity has been understood by many as vindicating a tenseless conception of time, denying the existence of tensed facts and a fortiori objective temporal passage. The reason for this is straightforward: both passage and the obtaining of tensed facts require a universal knife-edge present moment—yet this structure is not easily reconcilable with the relativity of simultaneity. The above being said, the prospects for tense and passage are sometimes claimed to be improved on moving to cosmological solutions of general relativity. (...) In this paper, we evaluate in detail these arguments, finding that there remain several open questions to be addressed if the introduction of tensed facts into the relativistic context is to be compelling. Moreover, we argue that, even setting aside these issues, objective tense stands and falls in relativity for exactly the same reasons that it does in classical philosophical discussions on the matter. (shrink)

In addition to ordinary conversations among relatively small numbers of individuals, human societies have public conversations. These are diffuse, ongoing discussions about various topics, which are largely sustained by journalistic activities. They are conversations about news – what is happening now – that members of various groups (such as the residents of a certain country, a certain town, or practitioners of a certain profession) need to know about in their capacity as members of those groups, and about how to react (...) to the news. Our topic in this chapter is a type of resistance to evidence that can arise at the level of these public conversations, rather than at the level of individual agents. We call it “relevance-based resistance to evidence”. A public conversation exhibits this kind of evidence resistance when it becomes overly focused on topics that members of the group that the conversation concerns do not in fact need to know about qua members of the group – topics which are, in a word, irrelevant. We argue that the risks of such relevance-based knowledge resistance are significantly amplified by certain structural features of online discourse. (shrink)

The term "fake news" ascended rapidly to prominence in 2016 and has become a fixture in academic and public discussions, as well as in political mud-slinging. In the flurry of discussion, the term has been applied so broadly as to threaten to render it meaningless. In an effort to rescue our ability to discuss—and combat—the underlying phenomenon that triggered the present use of the term, some philosophers have tried to characterize it more precisely. A common theme in this nascent philosophical (...) discussion is that contemporary fake news is not a new kind of phenomenon, but just the latest iteration of a broader kind of phenomenon that has played out in different ways across the history of human information-dissemination technologies. While we agree with this, we argue that newer sorts of fake news reveal substantial flaws in earlier understandings of this notion. In particular, we argue that no deceptive intentions are necessary for fake news to arise; rather, fake news arises when stories which were not produced via standard journalistic practice are treated as though they had been. Importantly, this revisionary understanding of fake news allows us to accommodate and understand the way that fake news is plausibly generated and spread in a contemporary setting, as much by non-human actors as by ordinary human beings. (shrink)

A variety of eating and purchasing practices, in particular vegetarianism, are often motivated via an appeal to their expected good consequences. Lurking in the background, however, is the question: can I really hope to make a difference via my purchases in a social world as complex and wasteful as our own? I review the evidence as it stands and conclude that there are good reasons to suspect that one probably does not make a difference directly via one's purchases. That said, (...) there may be some related, though less direct, reasons to be vegetarian. (shrink)

Each year, many young professionals forego advanced education in the traditional doctoral programs of medicine, law, and philosophy in favor of pursuing a PhD or professional doctorate in bioethics or healthcare ethics that is offered by several major institutes of higher education across the United States. These graduates often leverage their degrees into careers within the broader field of bioethics. As such, they represent a growing percentage of professional bioethicists in both academia and healthcare nationwide. Given the significant role that (...) doctoral bioethics programs play in the training of future professional bioethicists, it is imperative that programs conferring bioethics degrees are attuned to the knowledge and skills students will need as they transition to professional positions, especially where this training substantially differs from more traditional doctoral degree tracks. Yet, even given this need, there is nothing in the professional literature regarding doctoral bioethics graduates’ perspectives or the overall efficacy of a bioethics doctorate as compared to more traditional doctoral degree tracks for future professional bioethicists. This paper then gives the perspective of five recent doctoral bioethics graduates on the utility of a bioethics doctorate and areas where the doctorate prepared or underprepared them in their roles as early-career professional bioethicists. (shrink)

Due in no small part to Kant's own seemingly dim views on the value of animals, Kantian ethics has traditionally been understood to be rather unfriendly ground for arguments in favor of vegetarianism. This has started to change recently, which raises the question: do Kantian approaches offer a way of defending vegetarianism that doesn't run afoul of the sorts of futility worries that afflict consequentialist arguments for vegetarianism? I argue that Kantian approaches in fact face an analogous worry, due to (...) their need to explain why eating meat ought to be understood as a disrespectful act simpliciter, rather than only in certain circumstances. (shrink)

Over-time variability characterizes not only individual-level emotions, but also group-level emotions, those that occur when people identify with social groups and appraise events in terms of their implications for those groups. We discuss theory and research regarding the role of emotions in intergroup contexts, focusing on their dynamic nature. We then describe new insights into the causes and consequences of emotional dynamics that flow from conceptualizing emotions as based in group membership, and conclude with research recommendations.

Background Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Method Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The findings (...) revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one’s interests unjustly considered. Results Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient’s needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. Conclusion Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient’s interests and the care provided, despite existing compensation systems. (shrink)

In this chapter we discuss some of the central ethical issues specific to eating and harvesting fish. We survey recent research on fish intelligence and cognition and discuss possible considerations that are distinctive to questions about the ethics of eating fish as opposed to terrestrial and avian mammals. We conclude that those features that are distinctive to the harvesting and consumption of fish, including means of capture and the central role that fishing plays in many communities, do not suggest that (...) eating fish is less morally problematic than eating terrestrial of avian animals. (shrink)

Annotation. "This trim publication satisfies a much-felt need among teachers of Indian philosophy, who badly want introductions to the several systems of classical Indian thought such as Professor Deutsch provides."--Journal of Asian Studies.

This article brings time and theology together constructively in response to a pressing problem for the doctrine of personal salvation. The problem arises within the physics and metaphysics of time, as these support a so-called temporal B-theory in which time does not pass and reality is comprised of a block universe. Within this static temporal metaphysic, objective change is highly problematized. Yet salvation requires an objective change from fallenness to redemption. So, how can we understand a salvation-transformation in the block (...) universe? In other words, can sinners really change? I argue that on a B-theory of time, a salvation-transformation is best understood as a form of qualitative, phenomenological, and subjective change, rather than a robust ontological change. I conclude that the individual's transformation from fallen to saved is one of mind-dependent becoming. So, sinners can change. But, in this lifetime, that change can only be subjective. (shrink)

Non‐Interventionist Objective Divine Action (NIODA), introduced by Robert John Russell, is a model of divine action drawing upon insights from quantum mechanics. It presents an intriguing and significant challenge to classical conceptions of divine action with far‐reaching consequences. When applying NIODA to theistic evolution, however, significant questions emerge that require attention. We identify and assess two sets of concerns. The first relates to quantum physics, particularly whether and how quantum occurrences influence mutations and evolution. We argue that the current empirical (...) evidence is ambiguous in its support of the kinds of quantum action that Russell proposes, though emerging data from quantum biology look promising. The second set of concerns is metaphysical, especially concerning the problem of evil. NIODA gives Godextensive agency over evolution and genetics, which has adverse consequences for theodicy. We propose potential solutions to the problems highlighted in our article, both metaphysical and physical, to improve the viability of NIODA's application to theistic evolution. (shrink)

Quantum mechanics has recently indicated that temporal order is not always fixed, a finding that has far-reaching philosophical and theological implications. The phenomena, termed “indefinite causal order,” shows that events can be in a superposition with regard to their order. In the experimental setting with which this article is concerned, two events, A and B, were shown to be in the ordering relations “A before B” and “B before A” at the same time. This article introduces an ongoing project that (...) seeks to make sense of this result, with a particular focus on the methodology by which this research will be undertaken. Specific research questions, particularly regarding what indefinite causal order might mean for the metaphysics of time and the doctrine of salvation, are introduced. The collaborative approach detailed brings together the disciplinary skills of a working scientist and a working theologian. What is offered is a collaborative methodology for interaction between science and religion that is more than the sum of its parts. Alister McGrath’s idea of multiple rationalities is employed as an epistemological framework within which this research takes place. Within an epistemologically pluralistic model, collaborative efforts are not only encouraged but necessary. Complex reality requires an equally complex, usually interdisciplinary, explanation. I argue that such dialogue is both theologically justified and culturally valuable and indicates the direction in which this research will be taken. (shrink)

Despite a predominantly digital, 21st century music production landscape, analogue hardware professional audio technologies persist. In the discoursal throes of the leading online audio technology message forum Gearslutz, such technologies are routinely objectified, sexualized, fetishized and socialized into gear. Situated in a contemporary critical, interdisciplinary framework of fetish, masculinity and sexuality studies, this research interrogates how audio technologies manufactured and intended for music production contexts become sexy. Applying a mixed-mode methodology, including an intensive discourse, image and material-semiotic analysis of an (...) ‘epic’ sexy gear thread, we collated extensive data about technological fetishization. Sexy gear discourse articulates themes of voyeurism, acquisition, control and animation – linking the fetish value of technological objects and their connoisseurship with the erotic potential of sexualized objects. Such discourses ultimately serve to maintain social order, and become sites for performing the maintenance work of hegemonic masculine formations. This research provides new insights into how hegemonic masculinities depend upon the organization of online and offline sociability around fetishized material objects. Furthermore, our findings align with those of current scholarship focused on representational politics of technoculture. (shrink)

B C Hurst; Cooper on Equality and Excellence in Education, Journal of Philosophy of Education, Volume 15, Issue 1, 30 May 2006, Pages 119–124, https://doi.org/1.

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes (...) be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. (shrink)

It is increasingly common for philosophers to rely on the notion of an idealised listener when explaining how the semantic values of context-sensitive expressions are determined. Some have identified the semantic values of such expressions, as used on particular occasions, with whatever an appropriately idealised listener would take them to be. Others have argued that, for something to count as the semantic value, an appropriately idealised listener should be able to recover it. Our aim here is to explore the range (...) of ways that such idealisation might be worked out, and then to argue that none of these results in a very plausible theory. We conclude by reflecting on what this negative result reveals about the nature of meaning and responsibility. (shrink)