The aim of this study was to explore how Belgian nurses view issues related to the development, dissemination and implementation of a code of ethics for nurses. Fifty nurses took part in eight focus groups. The participants stated that, on the whole, a code of ethics for nurses would be useful. They stressed that a code should be a practical and useful instrument developed by nurses for nurses, and that it should be formulated and presented in a practical way, just (...) as educational courses dealing specifically with codes of ethics require a practical approach to be effective. They emphasized that the development of a code should be an ongoing process, enabling nurses to provide input as they reflect on the ethical issues dealt with in the code and apply the code in their practice. Finally, they stressed the need for support at institutional level for the effective implementation of a code. (shrink)

In this paper, I submit that it is the controlled part of skilled action, that is, that part of an action that accounts for the exact, nuanced ways in which a skilled performer modifies, adjusts and guides her performance for which an adequate, philosophical theory of skill must account. I will argue that neither Jason Stanley nor Hubert Dreyfus have an adequate account of control. Further, and perhaps surprisingly, I will argue that both Stanley and Dreyfus relinquish an account of (...) control for precisely the same reason: each reduce control to a passive, mechanistic, automatic process, which then prevents them from producing a substantive account of how controlled processes can be characterized by seemingly intelligent features and integrated with personal-level states. I will end by introducing three different kinds of control, which are constitutive of skilled action: strategic control, selective, top–down, automatic attention, and motor control. It will become clear that Dreyfus cannot account for any of these three kinds of control while Stanley has difficulty tackling the two latter kinds. (shrink)

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

The problem of plant individuality is something which has vexed botanists throughout the ages, with fashion swinging back and forth from treating plants as communities of individuals (Darwin 1800 ; Braun and Stone 1853 ; Münch 1938 ) to treating them as organisms in their own right, and although the latter view has dominated mainstream thought most recently (Harper 1977 ; Cook 1985 ; Ariew and Lewontin 2004 ), a lively debate conducted mostly in Scandinavian journals proves that the issues (...) are far from being resolved (Tuomi and Vuorisalo 1989b ; Fagerström 1992 ; Pan and Price 2001 ). In this paper I settle the matter once and for all, by showing which elements of each side are correct. (shrink)

When reflecting on the nature of skilled action, it is easy to fall into familiar dichotomies such that one construes the flexibility and intelligence of skill at the level of intentional states while characterizing the automatic motor processes that constitute motor skill execution as learned but fixed, invariant, bottom-up, brute-causal responses. In this essay, I will argue that this picture of skilled, automatic, motor processes is overly simplistic. Specifically, I will argue that an adequate account of the learned motor routines (...) that constitute embodied skills cannot be given in a purely bottom-up, brute-causal fashion. Rather, motor control is intelligent all the way down. To establish this, I will first review two recent accounts of skill, Stanley and Krakauer and Papineau, which characterize the automatic motor control responsible for the fine-grained movements constitutive of motor skill as brute, low-level phenomena. I will then isolate five key features that should apply to skilled motor control, if these accounts are correct. Together, the accounts posit that motor control is: ballistic, invariant, independent of general action trajectories, Insensitive to semantic content, and independent of personal-level intentions. In the final section of this paper, I will appeal to optimal control theory for empirical evidence to challenge the commitment to skilled action as qualified by the above features. (shrink)

Biological theory demands a clear organism concept, but at present biologists cannot agree on one. They know that counting particular units, and not counting others, allows them to generate explanatory and predictive descriptions of evolutionary processes. Yet they lack a unified theory telling them which units to count. In this paper, I offer a novel account of biological individuality, which reconciles conflicting definitions of ‘organism’ by interpreting them as describing alternative realisers of a common functional role, and then defines individual (...) organisms as essentially possessing some mechanisms that play this role. (shrink)

It is not rare in philosophy and psychology to see theorists fall into dichotomous thinking about mental phenomena. On one side of the dichotomy there are processes that I will label “unintelligent.” These processes are thought to be unconscious, implicit, automatic, unintentional, involuntary, procedural, and non-cognitive. On the other side, there are “intelligent” processes that are conscious, explicit, controlled, intentional, voluntary, declarative, and cognitive. Often, if a process or behavior is characterized by one of the features from either of the (...) above lists, the process or behavior is classified as falling under the category to which the feature belongs. For example, if a process is implicit this is usually considered sufficient for classifying it as “unintelligent” and for assuming that the remaining features that fall under the “unintelligent” grouping will apply to it as well. Accordingly, if a process or behavior is automatic, philosophers often consider it to be unintelligent. It is my goal in this paper to challenge the conceptual slip from “automatic” to “unintelligent”. I will argue that there are a whole range of properties highlighted by the existing psychological literature that make automaticity a much more complex phenomenon than is usually appreciated. I will then go on to discuss two further important relationships between automatic processes and controlled processes that arise when we think about automatic processes in the context of skilled behavior. These interactions should add to our resistance to classifying automaticity as unintelligent or mindless. In Sect. 1, I present a few representative cases of philosophers classifying automatic processes and behaviors as mindless or unintelligent. In Sect. 2, I review trends in the psychology of automaticity in order highlight a complex set of features that are characteristic, though not definitive, of automatic processes and behaviors. In Sect. 3, I argue that at least some automatic processes are likely cognitively penetrable. In Sect. 4, I argue that the structure of skilled automatic processes is shaped diachronically by practice, training and learning. Taken together, these considerations should dislodge the temptation to equate “automatic” with “unintelligent”. (shrink)

This chapter develops the idea that the germ-soma split and the suppression of individual fitness differences within the corporate entity are not always essential steps in the evolution of corporate individuals. It illustrates some consequences for multilevel selection theory. It presents evidence that genetic heterogeneity may not always be a barrier to successful functioning as a higher-level individual. This chapter shows that levels-of-selection theorists are wrong to assume that the central problem in transitions is always that of minimizing within-group competition. (...) Evidence of intralevel conflict does not qualify as evidence against the existence of a higher level of selection. (shrink)

Darwin’s classic ‘Origin of Species’ (Darwin 1859) described forces of selection acting upon individuals, but there remains a great deal of controversy about what exactly the status and definition of a biological individual is. Recently some authors have argued that the individual is dispensable – that an inability to pin it down is not problematic because little rests on it anyway. The aim of this paper is to show that there is a real problem of biological individuality, and an urgent (...) need to arbitrate over the current plethora of solutions to it. (shrink)

When reflecting on the nature of skilled action, it is easy to fall into familiar dichotomies such that one construes the flexibility and intelligence of skill at the level of intentional states while characterizing the automatic motor processes that constitute motor skill execution as learned but fixed, invariant, bottom-up, brute-causal responses. In this essay, I will argue that this picture of skilled, automatic, motor processes is overly simplistic. Specifically, I will argue that an adequate account of the learned motor routines (...) that constitute embodied skills cannot be given in a purely bottom-up, brute-causal fashion. Rather, motor control is intelligent all the way down. To establish this, I will first review two recent accounts of skill, Stanley and Krakauer (Front Hum Neurosci, 2013. doi:10.3389/fnhum.2013.0050) and Papineau (R Inst Philos Suppl 73:175–196, 2013), which characterize the automatic motor control responsible for the fine-grained movements constitutive of motor skill as brute, low-level phenomena. I will then isolate five key features that should apply to skilled motor control, if these accounts are correct. Together, the accounts posit that motor control is: (1) ballistic, (2) invariant, (3) independent of general action trajectories, (4) Insensitive to semantic content, and (5) independent of personal-level intentions. In the final section of this paper, I will appeal to optimal control theory for empirical evidence to challenge the commitment to skilled action as qualified by the above features. (shrink)

Microbes are generally thought of as unicellular organisms, but we know that many microbes live as parts of biofilms—complex, surface-attached microbial communities numbering millions of cells. Some authors have recently argued in favour of reconceiving biofilms as biological entities in their own right. In particular, some have claimed that multispecies biofilms are evolutionary individuals : 10126–10132 2015). Against this view, I defend the conservative consensus that selection acts primarily upon microbial cells.

There is strong theoretical support for a relationship between various characteristics of religiousness and attitudes towards business ethics. This paper examines three frequently- studied dimensions of religiousness (fundamentalism, conservatism, and intrinsic religiousness) and their ability to predict students' willingness to behave unethically. Because prior research indicated a possible relationship between the religious affiliation of an institution and its members' ethical orientation, we studied students at universities with three different types of religious affiliation: evangelical, Catholic, and none.Results of the study lend (...) support to a negative relationship between the above-mentioned dimensions of religiousness and willingness to behave unethically. In addition, students at the Evangelical university were far less willing to engage in unethical behavior than were students at either the Catholic or the unaffiliated institutions. (shrink)

Although affective facial pictures are widely used in emotion research, standardised affective stimuli sets are rather scarce, and the existing sets have several limitations. We therefore conducted a validation study of 490 pictures of human facial expressions from the Karolinska Directed Emotional Faces database (KDEF). Pictures were evaluated on emotional content and were rated on an intensity and arousal scale. Results indicate that the database contains a valid set of affective facial pictures. Hit rates, intensity, and arousal of the 20 (...) best KDEF pictures for each basic emotion are provided in an appendix. (shrink)

Mainstream ethical debates concerning responsibility for climate change tend to overemphasise emissions and consumption while ignoring or downplaying the structural drivers of climate change and vulnerability. Failure to examine the political-economic dynamics that have produced climate change and made certain people more susceptible to its harms results in inapposite accounts of responsibility. Recognition of the structural character of the problem suggests duties beyond emissions reduction and redistribution - including, potentially, a responsibility to fundamentally restructure our political and economic institutions.

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

In recent years, a debate concerning the nature of knowing-how has emerged between intellectualists who claim that knowledge-how is reducible to knowledge-that and anti-intellectualists who claim that knowledge-how comprises a unique and irreducible knowledge category. The arguments between these two camps have clustered largely around two issues: intellectualists object to Gilbert Ryle's assertion that knowing-how is a kind of ability, and anti-intellectualists take issue with Jason Stanley and Timothy Williamson's positive, intellectualist account of knowing-how. Like most anti-intellectualists, in this paper (...) I will raise objections to Stanley and Williamson's account of knowing-how and also defend the claim that ability is necessary for knowing-how attributions. Unlike most discussions of knowing-how, however, I will return to more Rylean considerations in order to illustrate that any intellectualist account of knowing-how, not simply Stanley and Williamson's preferred variety, will fail because it will be unable to account for fundamental differences in the knowledge required to instantiate an ability and the knowledge involved in propositional thought. (shrink)

Deleuze's readings of Hume, Spinoza, Bergson and Nietzsche respond to philosophical critiques of classical and modern empiricism. However, Deleuze's arguments against those critiques - by Kant, Hegel, Husserl and Heidegger - consolidate the philosophy of immanence that can be called 'transcendental empiricism'. Marc Rolli offers us a detailed examination of Gilles Deleuze's philosophy of transcendental empiricism. He demonstrates that Deleuze takes up and radicalises the empiricist school of thought developing a systematic alternative to the mainstreams of modern continental philosophy.

We are told modernity's end will destabilize familiar ways of knowing, doing, and being, but are these changes we should dread--or celebrate? Four significant events catalyze this question: the consecration of openly gay Episcopalian Bishop Gene Robinson, the mistreatment of prisoners at Abu Ghraib prison, the politicization of the death of Terri Schiavo, and the disastrous response to Hurricane Katrina. Framed by an original appropriation of Michel Foucault, and drawing on resources in visual culture theory and the history of photography, (...) Ellen T. Armour explores the anxieties, passions, and power dynamics bound up in the photographic representation and public reception of these events. Together, these phenomena expose modernity's benevolent and malevolent disruptions and reveal the systemic fractures and fissures that herald its end, for better and for worse. In response to these signs and wonders, Armour lays the groundwork for a theology and philosophy of life better suited to our modern moment: one that owns up to the vulnerabilities that modernity sought to disavow and better enables us to navigate the ethical issues we now confront. (shrink)

In his most recent book, Stanley (2011b) defends his Intellectualist account of knowledge how. In Know How, Stanley produces the details of a propositionalist theory of intelligent action and also responds to several objections that have been forwarded to this account in the last decade. In this paper, I will focus specifically on one claim that Stanley makes in chapter one of his book: I will focus on Stanley’s claim that automatic mechanisms can be used by the intellectualist in order (...) to terminate Ryle’s regress. I will argue that this proposed solution to the regress, regardless of how propositions are individuated, cannot provide an adequate intellectualist account of skillful action. I should note that the solution to Ryle’s regress is central to the intellectualist agenda. If Stanley fails to stop the regress or stops the regress by appealing to nonpropositional knowledge, then his intellectualist project fails. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

ABSTRACTHow does practice change our behaviors such that they go from being awkward, unskilled actions to elegant, skilled performances? This is the question that I wish to explore in this paper. In the first section of the paper, I will defend the tight connection between practice and skill and then go on to make precise how we ought to construe the concept of practice. In the second section, I will suggest that practice contributes to skill by structuring and automatizing the (...) motor routines constitutive of skilled actions. I will cite how this fact about skilled action has misled many philosophers to conclude that skills are mindless or bodily. In the third section of the paper, I will challenge this common misconception about automaticity by appealing to empirical evidence of motor chunking. This evidence reveals that there are two opposing processes involved in the automaticity of skilled action: one process that is largely associative, which I will call “concatenation,” and a second which is a contro... (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

BackgroundWhile previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.MethodsTo address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.ResultsNew findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; (...) 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.ConclusionsThese findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research. (shrink)

I identify and characterize the kind of personal-level control-structure that is most relevant for skilled action control, namely, what I call, “practical intention”. I differentiate between practical intentions and general intentions not in terms of their function or timing but in terms of their content. I also highlight a distinction between practical intentions and other control mechanisms that are required to explain skilled action. I’ll maintain that all intentions, general and practical, have the function specifying, sustaining, and structuring action but (...) that several functions that have been attributed to proximal intentions are actually implemented by other control mechanisms that are not themselves best identified as intentions. Specifically, I will claim that practical intentions do not initiate, monitor, specify or guide the fine-grained, online, kinematic aspects of action. Finally, I suggest that the way in which practical and general intentions should be differentiated is in terms of their content, where general intentions specify the overall goal, outcome, or end of an action as it is conceived of by the agent at a time, and practical intentions determine the means to that end. I conclude by providing empirical evidence to support this way of characterizing the intentions that “interface” with the mechanisms of motor control. Though this discussion has repercussions for action in general, I will limit my discussion to cases of skill. (shrink)

One of the hallmarks of virtue is reliably acting well. Such reliable success presupposes that an agent is able to recognize the morally salient features of a situation, and the appropriate response to those features and is motivated to act on this knowledge without internal conflict. Furthermore, it is often claimed that the virtuous person can do this in a spontaneous or intuitive manner. While these claims represent an ideal of what it is to have a virtue, it is less (...) clear how to make good on them. That is, how is it actually possible to spontaneously and reliably act well? In this paper, we will lay out a framework for understanding how it is that one could reliably act well in an intuitive manner. We will do this by developing the concept of an action schema, which draws on the philosophical and psychological literature on skill acquisition and self-regulation. In short, we will give an account of how self-regulation, grounded in skillful structures, can allow for the accurate intuitions and flexible expertise required for virtue. While our primary goal in this paper is to provide a positive theory of how virtuous intuitions might be accounted for, we also take ourselves to be raising the bar for what counts as an explanation of reliable and intuitive action in general. (shrink)

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, these (...) variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity. (shrink)

Philosophical questions surrounding skill and expertise can be traced back as far as Ancient Greece, China, and India. In the twentieth century skilled action was an important factor in the work of phenomenologists such as Heidegger and Merleau-Ponty and analytic philosophers including Gilbert Ryle. However, as a subject in its own right it has, until now, remained largely in the background. The Routledge Handbook of Philosophy of Skill and Expertise is an outstanding reference source and the first major collection of (...) its kind, reflecting the explosion of interest in the topic recent years. Comprising thirty-nine chapters written by leading international contributors, the Handbook is organised into six clear parts: Skill in the History of Philosophy Skill in Epistemology Skill, intelligence, and agency Skill in Perception, Imagination, and Emotion Skill, Language, and, Social Cognition Skill and Expertise in Normative Philosophy. Essential reading for students and researchers in philosophy of mind and psychology, epistemology and ethics, The Routledge Handbook of Philosophy of Skill and Expertise is also suitable for those in related disciplines such as social psychology and cognitive science. It is also relevant to those who are interested in conceptual issues underlying skill and expertise in fields such as sport, the performing arts, and medicine. (shrink)

The concept of adaptation is pivotal to modern evolutionary thinking, but it has long been the subject of controversy, especially in respect of the relative roles of selection versus constraints in explaining the traits of organisms. This paper tackles a different problem for the concept of adaptation: its interpretation in light of multilevel selection theory. In particular, I arbitrate a dispute that has broken out between the proponents of rival perspectives on multilevel adaptations. Many experts now say that multilevel and (...) kin selection views are mathematically equivalent to one another—that the mathematical accounting of evolution can be carried out at any hierarchical level one chooses. But what does this formal equivalence imply - are they equivalent in other ways too? I show here that significant conceptual non-equivalence has survived: the two sides commit to different views regarding how much selection has to act at a level before we can call traits at that level adaptations; about whether policing mechanisms are adaptations, and about whether non-organisms can bear adaptations. (shrink)

In the midst of greed, corruption, the economic crash and the general disillusionment of business, current conceptions of leadership, organizational values, and authenticity are being questioned. In this article, we fill a prior research gap by directly exploring the intersection of these three concepts. We begin by delving into the relationship between individual values and organizational values. This analysis reveals that the “value fit” approach to creating authenticity is limited, and also indicates that a deeper exploration of the nature of (...) values and the role of leadership is necessary. More specifically, we propose that organizational values should be viewed as an opportunity for ongoing conversations about who we are and how we connect. Through this type of dialogue which we define as “value through conversation”, we can create what we call poetic organizations. A typology of four interconnected values each of which forms a foundation for the critical questioning and inquiry that might be found in poetic organizations is developed. We suggest that this conceptualization offers a new and dynamic approach for thinking about the relationships between leadership, values, and authenticity and has important implications for both research and practice. (shrink)

Doctoral programmes in nursing are charged with developing the next generation of nurse scholars, scientists, and healthcare leaders. The American Association of Colleges of Nursing (AACN) endorses the inclusion of philosophy of science content in research‐focused doctoral programmes. Because a philosophy course circumscribed to the natural or social sciences does not address the broad forms of knowledge that are relevant to nursing practice, we have developed and co‐taught a course on the philosophy of knowledge that introduces students to competing claims (...) regarding the nature of knowledge, truth, and rationality. In addressing broad themes related to science and knowledge of the body, health and illness, and ethics, the course equips students to tread the rough and shifting ground of nursing scholarship and practice. Providing doctoral students with this philosophical footing is intended to give future scholars, researchers, and healthcare leaders the intellectual skills to critically reflect on knowledge claims, to challenge the hegemony of science, and to recognize the disciplinary forms of knowledge that are left out or trivialized. Our pedagogical approach to knowledge development does not denigrate scientific knowledge, but elevates forms of inquiry and notions of clinical knowledge that are too often marginalized in doctoral education and the academy in general. (shrink)