Zusammenfassung. Das Arzt-Patient-Verhältnis wird zunehmend von ökonomischen Interessen überlagert. Diese explorative Studie fragt nach konsensfähigen Lösungsstrategien für die Vermittlung dieser ökonomischen Hintergründe an Patienten und nach der ärztlichen Aufklärungspraxis im klinischen Alltag. Methodisch wird eine Kombination aus einer Fragebogenstudie mit Vertretern relevanter Organisationen im Gesundheitswesen (n=132) und Interviews mit Ärztinnen und Ärzten aus unterschiedlichen klinischen Bereichen (n=15) gewählt. Ergebnisse: Trotz einer mehrheitlichen Präferenz für die wahrheitsgemäße Aufklärung über ökonomische Aspekte erfährt dieses Prinzip vielfältige Relativierungen. In der klinischen Praxis dominiert das (...) Bestreben, ökonomische Motive hinter medizinischen Begründungen zu verschweigen. Die ärztliche Informationspolitik weist eine völlig uneinheitliche und für Patienten undurchschaubare Praxis sowie eine extreme Spannbreite subjektiver Wertpräferenzen auf. (shrink)

Definition of the problems: The physician-patient-relationship is influenced by economically driven decisions. This study explores the ethical consensus in explaining economical backgrounds of therapeutic and diagnostic interventions to patients, and the clinical practices of patient information.Method: A combination of questionnaire send to members of relevant health care organisations (n=132) and interviews with physicians working in different clinical resorts (n=15).Results and conclusion: In general there is a consensus in truth-telling about the economical background, however this ethical principle in many cases is (...) neglected. Whenever possible physicians try to translate economically driven decisions into medical terms. There is a broad disagreement and a wide range of individual ethical preferences regarding patient information, that can not be controlled by patients in any way. (shrink)

Das vorliegende Open-Access-Buch zeigt, wie Kinder im Grundschulalter auf philosophische Gedanken reagieren. Diese werden den Kindern in Form von Kürzesttexten dargeboten. Auf Veranschaulichungen wird bewusst verzichtet. Dieser Zugang zum Philosophieren erscheint ungewöhnlich, wird doch in der Regel beim Philosophieren mit Kindern auf anschauliche Zugänge zurückgegriffen. Es zeigt sich jedoch, dass Kinder auf diese ungewöhnliche Einladung auf ebenso ungewöhnliche, eigenwillige und kreative Weise reagieren. Die vorliegende empirische Studie kommt mithin zu dem Ergebnis: Der Einsatz von Kürzesttexten erweist sich als lohnend. Die (...) Autorin Ellen Franziska Möller ist ausgebildete Lehrerin (Sek I und Sek II) für die Fächer Philosophie, praktische Philosophie und Physik. Zwischen 2019 und 2022 hat sie am Philosophischen Seminar der Universität zu Köln das Forschungsprojekt "Philosophie in der Primarstufe" vertreten. (shrink)

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)

Der Aufsatz rekonstruiert die Entwicklung von Ralph Waldo Emersons Denken als Teil einer philosophischen Lebenskunst, deren mehrfache Anpassung und Veränderung sich jeweils als Reaktion auf einschneidende Verlusterfahrungen verstehen lässt. Der Tod seiner ersten Ehefrau Ellen Tucker sowie das plötzliche Dahinscheiden seines Sohnes Waldo sind nicht nur biographisch-existenziell prägend, sondern diese Ereignisse markieren zugleich bedeutende Wendepunkte innerhalb von Emersons philosophischem Schaffen. Von der christlich-protestantischen Tradition einer Selbstkultivierung nach Maßgabe einer imitatio christi über die Zurückweisung epistemischer und metaphysischer Gewissheitsansprüche und eine (...) experimentierfreudige pragmatische Weltanschauung führt der gedankliche Weg Emersons schließlich zu einer intensiven Beschäftigung mit der tragischen Dimension einer Welt ohne Gewissheiten und Sinngarantien. Am Ende dieser Entwicklung steht die Einsicht in die Flüchtigkeit und Vergänglichkeit alles Seienden, die sich mit einer Haltung lebensbejahender und heiterer Gelassenheit verbindet. (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)

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)

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)

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)

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)

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)

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)