Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool. ECQAT enables raters to assess the (...) quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation, established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT,.. (shrink)

According to the received account of guilt in the philosophical literature, one cannot feel guilt unless one takes oneself to have done something morally wrong. But ordinary people feel guilt in many cases in which they do not take themselves to have done anything morally wrong. In this paper, I focus on one kind of guilt without perceived wrongdoing, guilt about being merely causally responsible for a bad state-of-affairs. I go on to present a novel account of guilt that explains (...) guilt about mere causal responsibility, according to which guilt represents part of the self as bound up with what is bad. (shrink)

Effective Altruism is a popular social movement that encourages individuals to donate to organizations that effectively address humanity’s most severe poverty. However, because Effective Altruists are committed to doing the most good in the most effective ways, they often argue that it is wrong to help those nearest to you. In this paper, I target a major subset of Effective Altruists who consider it a moral obligation to do the most good possible. Call these Obligation-Oriented Effective Altruists (OOEAs), and their (...) movement Obligation-Oriented Effective Altruism (OOEA). I argue that insofar as this variety of OOEA seems to commit us to refrain from helping the people right in front of us, there is something intuitively wrong about it. In response, I introduce an alternative model that embraces partiality: Mutual Aid. Mutual Aid is a network of community members, usually from the same geographical region, who share a commitment to offer, receive, and exchange material goods, wealth, and social support. I recommend Mutual Aid as a liberatory model, which—through empathy, solidarity, and care—mobilizes community building and provides a catalyst for community advocacy. As such, we should resist the claims of OOEAs that partially distributing our funds to people or causes we care about is morally wrong or even less than ideal. We do not have a moral obligation to use our funds “effectively;” rather, we have a broader obligation to address human suffering, and Mutual Aid is one moral alternative for discharging this duty. (shrink)

Marie was 15 when her abdominal pain began. After two years of negative work-ups, countless visits to gastroenterologists, and over 70 days of high school missed, she found herself readmitted to the hospital. “Refractory abdominal pain” was her ostensible diagnosis; “troubled teen” who was “going to be difficult” was embedded in the emergency department’s sign-out. When the medical team arrived to meet Marie, she was huddled in the corner of her hospital bed, silent and withdrawn. Her intern noted the numerous (...) scars cutting across her forearms as she felt for her radial pulses. Marie squirmed in pain when the intern palpated her abdomen.The ED’s work-up had been negative for abdominal pathology. When the... (shrink)

In this paper we argue that moral deference is prima facie obligatory in cases in which the testifier is a member of a marginalized social group that the receiver is not and testifies about their marginalized experience. We distinguish between two types of deference: epistemic deference, which refers to believing p in virtue of trusting the testifier, and actional deference, which involves acting appropriately in response to the testimony given. The prima facie duty we propose applies to both epistemic and (...) actional deference, though defeaters may quash either or both obligations. Even if one fails to epistemically defer to the marginalized testifier, we argue that they may still be ethically obligated to act in accordance with their testimony. (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)

What is the relation between small-scale collaborative plans and the execution of those plans within interactive contexts? I argue here that joint attention has a key role in explaining how shared plans and shared intentions are executed in interactive contexts. Within singular action, attention plays the functional role of enabling intentional action to be guided by a prior intention. Within interactive joint action, it is joint attention, I argue, that plays a similar functional role of enabling the agents to act (...) in a collaborative way such that their actions are rationally guided by a prior shared intention. This understanding of joint attention – as having a key functional role of enabling the rational guidance of joint intentional action by a prior shared intention – allows for an alternative understanding of the kind of minimal cooperation that infants can engage in. On this understanding, infants’ capacity to engage in joint actions is already an incipient capacity to engage in rational and intentional joint actions, albeit a capacity that is necessarily scaffolded by an adult rational co-partner. (shrink)

This a clear and concise introduction to Danish philosopher Soren Kierkegaard.ichael Watts uses Kierkegaard's own writings to introduce his theoriesbout living a truthfu; and spiritual life, while explaining the enormousnfluence of the philosopher's personal life on his work and beliefs. As theounder of 20th century existentialism, and the first philosopher to definehe idea of angst, Kierkegaard's profound influence on modern life is clearlyefined in accessible terms in this guide for students and general readers.

Common knowledge is ubiquitous in our lives and yet there remains considerable uncertainty about how to model or understand it. Standard analyses of common knowledge end up being challenged by either regress or circularity which then give rise to well-known paradoxes of practical reasoning, such as the Two Generals’ Paradox. This paper argues that the nature and utility of common knowledge can be illuminated by appeal to Wittgenstein’s Hinge Epistemology. It is argued that those things that we standardly think of (...) as being common knowledge in our lives are the same as those that Wittgenstein identified as hinge certainties. This identification of common knowledge with hinge certainties allows us to resolve the regress problem for common knowledge and explain how the Two Generals’ Paradox arises. (shrink)

It is a commonplace in economics that we should disregard sunk costs. The sunk cost effect might be widespread, goes the conventional wisdom, but we would be better off if we could rid ourselves of it. In this paper, I argue against the orthodoxy by showing that the sunk cost effect is often beneficial. Drawing on discussions of related topics in dynamic choice theory, I show that, in a range of cases, being disposed to honor sunk costs allows an agent (...) to mimic a resolute chooser, someone who adopts the best plan at the outset of a decision problem and sticks with it, even when resoluteness is unfeasible. I discuss several kinds of cases in which honoring sunk costs coincides with resolute choice. (shrink)

Our aim in this paper is to present the distinct ways in which Wolff, Baumgarten, and Kant understand the relationship between necessitation, constraint, and reluctant action in an effort to illustrate the subtle ways in which their conceptions of obligation differ from each another. Whereas Wolff conceives of natural or moral obligation as incompatible with constraint, Baumgarten holds that constraint and reluctant action are, in some instances, compatible with natural obligation. Kant departs from Baumgarten by conceiving of obligation as necessarily (...) involving constraint: as Kant’s reply to Schiller’s famous objection reveals, obligation must take on the character of constraint to reluctant action on account of the fact that human beings possess inclinations that always threaten to impel them in directions that oppose morality. (shrink)

What is the relation between joint attention and common knowledge? On the one hand, the relation seems tight: the easiest and most reliable way of knowing something in common with another is for you and that other to be attentively aware of what you are together experiencing. On the other hand, they couldn’t seem further apart: joint attention is a mere perceptual phenomena that infants are capable of engaging in from nine months of age, whereas common knowledge is a cognitive (...) phenomenon involving (so it seems) complex, overlapping metarepresentational states that require the kind of sophisticated mindreading skills that developmental psychology has shown to be beyond the capabilities of young children. In 'The Shared World: Perceptual Common Knowledge, Demonstrative Communication, and Shared Social Space', Axel Seemann attempts, inter alia, to makensense of this conundrum. (shrink)

The fact that Gilbert Ryle and J.L. Austin seem to disagree about the ordinary use of words such as ‘voluntary’, ‘involuntary’, ‘voluntarily’, and ‘involuntarily’ has been taken to cast doubt on the methods of ordinary language philosophy. As Benson Mates puts the worry, ‘if agreement about usage cannot be reached within so restricted a sample as the class of Oxford Professors of Philosophy, what are the prospects when the sample is enlarged?’ (Mates, Inquiry 1:161–171, 1958, p. 165). In this chapter, (...) we evaluate Mates’s criticism alongside Ryle’s and Austin’s specific claims about the ordinary use of these words, assessing these claims against actual examples of ordinary use drawn from the British National Corpus (BNC). Our evaluation consists in applying a combination of methods: first aggregating judgments about a large set of samples drawn from the corpus, and then using a clustering algorithm to uncover connections between different types of use. In applying these methods, we show where and to what extent Ryle’s and Austin’s accounts of the use of the target terms are accurate as well as where they miss important aspects of ordinary use, and we demonstrate the usefulness of this new combination of methods. At the heart of our approach is a commitment to the idea that systematically looking at actual uses of expressions is an essential component of any approach to ordinary language philosophy. (shrink)

An Essay on Human Action seeks to provide a comprehensive, detailed, enlightening, and (in its detail) original account of human action. This account presupposes a theory of events as abstract, proposition-like entities, a theory which is given in the first chapter of the book. The core-issues of action-theory are then treated: what acting in general is (a version of the traditional volitional theory is proposed and defended); how actions are to be individuated; how long actions last; what acting intentionally is; (...) what doing one thing by doing another is; what basic action is; and what omitting to do something is. Attention is also given to the concepts of causation, intention, volition, deciding, choosing, and trying. Finally, a libertarian account of free action is tentatively proposed and defended. (shrink)

Much ink has been spilled on the pros and cons of U.S. president Barack Obama's decision not to strike the regime of Syrian president Bashar al-Assad after that regime launched a deadly chemical weapons attack in 2013. Often missing from those debates, however, are the perspectives of Syrians themselves. While not all Syrians oppose Assad, and not all opponents endorsed intervention, many Syrian oppositionists resolutely called for Obama to uphold his “red line” militarily. As part of the roundtable “The Ethics (...) of Limited Strikes,” this essay analyzes diverse expressions of such opinion and finds that they highlight three dimensions of the ethical case for limited strikes against Assad. First, they remind us that the ethical context of the red line question was many Syrians’ sense of abandonment by the international community. Second, they emphasize the ethical stakes of the limited strikes; namely an opportunity to hold the Syrian regime accountable, weaken it from within, and thus change the equation of the war. Third, they make sense of the ethical consequences of the nonintervention outcome, and especially its effect in deepening civilians’ despair, accelerating extremism, and convincing Assad and his allies that they could kill with impunity. These views controvert both legalistic arguments precluding military intervention and assumptions that U.S. intervention is always imperialist and warmongering. In this case, consideration of the case for military intervention from the viewpoint of those on whose behalf the intervention would have taken place challenges us to think deeply about circumstances in which limited strikes might be not only ethically justified but also imperative. (shrink)

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death (...) discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine. (shrink)

Using William Shakespeare’s Hamlet and the play-within-the play, The Murder of Gonzago, as a case study, this essay argues that theatrical utterances constitute a special case of language usage not previously elucidated: the utterance of a statement with propositional content in theatre functions as an event. In short, the propositional content of a particular p (e.g. p1, p2, p3 …), whether or not it is true, is only understood—and understood to be true—if p1 is uttered in a particular time, place, (...) and situation (i.e. during a theatrical event); otherwise, the propositional content in those theatrical utterances can either be false or contingently true. (shrink)

A particular feature of this book is substantial "Stretch and Challenge" material throughout which allows students to develop further.

Concepts and Cases in Nursing Ethics is an introduction to contemporary ethical issues in health care, designed especially for Canadian audiences. The book is organized around six key concepts: beneficence, autonomy, truth-telling, confidentiality, justice, and integrity. Each of these concepts is explained and discussed with reference to professional and legal norms. The discussion is then supplemented by case studies that exemplify the relevant concepts and show how each applies in health care and nursing practice. This new fourth edition includes an (...) added chapter on end-of-life issues, and it is revised throughout to reflect the latest developments on topics such as global health ethics, cultural competence, social media, and palliative sedation. (shrink)

Als Philosoph, Literat, Prediger und Pädagoge gehört Herder zu den bedeutendsten Vertretern der Weimarer Klassik. Diese aktuelle und kenntnisreiche Biografie bringt Leben und Werk Herders einem breiteren Publikum nahe.

Despite increasing evidence that the traditional lecture is inefficient for student learning, such methods remain the central paradigm for teaching logic. In this paper, I identify the deficits of the lecture model and outline the many benefits of flipping the logic classroom—namely that students can absorb information at their own pace, freeing classroom time for active learn- ing activities, and allowing the students to come prepared to actively engage in deeper levels of learning. I provide advice for curricular change from (...) the traditional model, and guidance for flipped classroom implementation. I also offer suggestions for the best use of newly available class time, and advice for keeping students accountable for learning the information prior to class. Last, I consider common challenges with the flipped classroom model. I acknowledge possible obstacles to flipping the undergraduate logic course and address these challenges with potential solutions. (shrink)

I show that the common reading of Thomson, that she argues by analogy for the conclusion that abortion is permissible, is mistaken. The correct reading of Thomson is that she argues by counterexample, showing that arguments against abortion are unsound. The remainder of the paper highlights the lessons learned from Thomson once we read her aright.

Opponents of medically assisted dying have long appealed to ‘slippery slope’ arguments. One such slippery slope concerns palliative care: that the introduction of medically assisted dying will lead to a diminution in the quality or availability or palliative care for patients near the end of their lives. Empirical evidence from jurisdictions where assisted dying has been practiced for decades, such as Oregon and the Netherlands, indicate that such worries are largely unfounded. The failure of the palliation slope argument is nevertheless (...) instructive with respect to how slippery slope arguments can be appraised without having to await post-facto evidence regarding the effects of a proposed change in public policy. Close attention in particular to the norms operative in a given institution and how changes to policy will interact with those norms enable slippery slopes to be credibly appraised. (shrink)

While it is largely agreed upon that solidarity is a kind of unity among persons, this agreement is short-lived – for if solidarity involves unity, what kind of unity is this? That is, does solidarity coalesce around shared identity or simply fellow-feeling? Shared action or fate? Or is solidarity merely a matter of commitment to a particular cause to achieve certain ends? Below, I look to examples of Mutual Aid to reject a piece-meal model of solidarity (where solidarity is this (...) but not that) in favor of a more pluralistic account. The notion of solidarity need not be constrained, all or nothing, by a specific strain of interpretation. Instead, we should recognize that solidarity is a matter of variety and degree. (shrink)

Filmmaking is one of the most complexly layered forms of artistic production. It is a deeply interactive process, socially, culturally, and technologically. Yet the bulk of popular and academic discussion of filmmaking continues to attribute creative authorship of films to directors. Texts refer to “a Scorsese film,” not a film by “Scorsese et al.” We argue that this kind of attribution of sole creative responsibility to film directors is a misapprehension of filmmaking processes, based in part on dubious individualist assumptions (...) about creative minds. Such a misapprehension is effacing the public value that a more inclusive and accurate understanding of filmmaking offers. By “public value” we mean the potential to enhance social and cultural well-being, particularly in working lives and collaborative undertakings in the screen industries. Better understanding of the systemic and social nature of creativity in filmmaking can potentially help in democratising aesthetics, which we consider a clear public good. (shrink)

From 1956, when the complex ultrastructure of meiotic chromosomes was discovered, 1 until 1985, when the isolation of meiotic chromosome cores was reported, knowledge of the molecular structure of the meiotic chromosome was at best a dream. The dissection of meiotic chromosome structures has become a realistic challenge through the arrival of isolated symptonemal complexes (SCs), monoclonal and polyclonal antibodies against SCs, the possibility for screening expression libraries for genes that encode SC proteins, the isolation of SC‐associated DNA, and the (...) development of techniques for the in situ recognition of DNA sequences in the context of the meiotic chromosome structure. (shrink)