What is God doing about a world marked by conflict and division? What about a world in which our technologies promise great good but also threaten our existence? What is God doing in a world where the demands for accumulation and acquisition create division and despair? Can Christians hope to be of positive influence in a world that does not always support, reflect, or even understand Christian commitments? Christian ethics often raises such questions as these, and the possible answers vary (...) widely. Paul's Letter to the Ephesians is a tremendous resource for exploring a faithful response to perhaps the toughest question of all: what is God doing about evil? The role of Christian ethics is to take seriously the challenge that, whatever God is doing, God calls us to participate in a distinctive task that embraces our own commitments and labors within the divine purpose. Ephesians says that God has taken the initiative to pursue that purpose and, remarkably, offers that we ourselves are part of the answer to the question, what is God doing about evil? (shrink)

This study used a partial least squares structural equation modelling (PLS-SEM) to estimate curriculum management's direct and indirect effects on university graduate programmes' viability. The study also examined the role of institutional effectiveness in mediating the nexus between the predictor and response variables. This is a correlational study with a factorial research design. The study's participants comprised 149 higher education administrators (23 Faculty Deans and 126 HODs) from two public universities in Nigeria. A structured questionnaire designed by the researchers was (...) used for data collection. The questionnaire was duly validated with an acceptable scale and item content validity indices. The dimensionality of the instrument was determined using exploratory factor analysis (EFA). Convergent validity was based on Average Variance Extracted (AVE), whereas discriminant validity was based on Fornell-Lacker criteria and the Hetero-Trait Mono-Trait (HTMT) ratio. Acceptable composite reliability estimates of internal consistency were reached for the three sub-scales. Following ethical practices, the questionnaire was physically administered to respondents and retrieved afterwards. Smart PLS (version 3.2.9) and SPSS (version 26.0) programs were used for all the statistical analyses. This study uncovered significant direct and indirect effects of curriculum management on the viability of graduate programmes. Institutional effectiveness significantly impacted graduate programmes’ viability while mediating the nexus between curriculum management and graduate programmes’ viability. Curriculum management and institutional effectiveness jointly explained a significant proportion of graduate programmes’ viability variance. The result of this study proved that graduate programmes’ viability depends, to a great extent, on how much curriculum is managed and how effective institutions are with their services. The result of this study can enable institutions seeking to run viable graduate programmes to re-evaluate their curriculum management practices and the effectiveness of their services. (shrink)

The final book of O'Leary's trilogy, Conventional and Ultimate Truth deals with the nature of theological rationality today, drawing on Buddhist ideology.

Are there natural kinds of things around which our theories cut? The essays in this volume offer reflections by a distinguished group of philosophers on a series of intertwined issues in the metaphysics and epistemology of classification.

Researchers designing a clinical trial may be aware of disputed evidence of serious risks from previous studies. These researchers must decide whether and how to describe these risks in their model informed consent document. They have an ethical obligation to provide fully informed consent, but does this obligation include notice of controversial evidence? With ACCORD as an example, we describe a framework and criteria that make clear the conditions requiring inclusion of important controversial risks. The ACCORD model consent document did (...) not include notice of prior trials with excess death. We develop and explain a new standard labeled risk in equipoise. We argue that our approach provides an optimal level of integrity to protect the informational needs of the reasonable volunteers who agree to participate in clinical trials. We suggest language to be used in a model consent document and the informed consent discussion when such controversial evidence exists. (shrink)

ABSTRACTIn this paper I argue that a remotely piloted aircraft pilot’s act of killing remotely, when it is done in the defense of another person, can be viewed as an act of sacrifice. This argument concludes from two premises. First, the RPA pilot faces psychological risk to self by carrying out such an action; second, the RPA pilot is motivated to some significant degree by something other than self-interest. Moreover, I challenge both the view that RPA represent merely an incremental (...) development in technology yielding an incremental expansion of the distance between the war-fighter and the target and the view that RPA is revolutionary in some fundamental sense. I instead argue that, based upon the natural geometric boundary imposed by the earth’s shape, RPA have maximized the physical distance between the war-fighter and the target and, over time, this fact will change, not only the psychological effects on the RPA pilot, but also the way we view killing and distance in general. When taken togethe... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Beauty, Transcendence, and the Inclusive Hierarchy of Creation1Thomas Joseph White, O.P.Interpreters of Thomas Aquinas have long argued about whether he holds that beauty is a “transcendental,” a feature of reality coextensive with all that exists, like unity, goodness, and truthfulness.2 In the first part of this article, I will argue that Aquinas can [End Page 1215] be read to affirm in an implicit way that beauty is a transcendental. (...) In the second part, I will consider what it might mean from a Thomistic point of view to speak of a transcendent divine beauty, given Aquinas’s metaphysical commitments, particularly with respect to his doctrine of divine simplicity. In the final part, I will treat the question of how the beauty of the creation both manifests and conceals divine beauty.Beauty as a Transcendental Feature of RealityAquinas does not list beauty as a transcendental term in texts on transcendental notions. Perhaps, then, one should simply exclude it from a responsible account of his teaching on this subject. However, at least two well-known texts should give us reason to pause before reaching such a conclusion. One is found in his Commentary on Dionysius’ Divine Names, chapter 4, lectio 5. The other is in his discussion of the beauty of the eternal Son of God in a discussion of the Holy Trinity in the Summa theologiae I, q. 39, a. 8.In the first of these texts, Aquinas is commenting on Dionysius. The extended text is analytically dense. Aquinas is discussing ways in which one might say that God is beautiful and in what ways one might not say so. I will return to his topic below. Here, however, it is pertinent to consider Aquinas’s discussion of the presence of beauty in all that exists. He makes six main points.3 First, all beauty comes [End Page 1216] from God insofar as God is the cause of all that exists. Second, he gives a first definition of beauty: beauty can be defined ontologically as the splendor (claritas) that results from form; everything has a formal determination of some kind insofar as it has existence (esse); therefore, insofar as anything exists (and has some formal ontological content) it has some degree of beauty. Third, the splendor of the form in created things is a participation in the divine splendor from which it originates. The divine nature is the transcendent exemplar of beauty in diverse finite created realities. Fourth, then (and perhaps most importantly), “ex divina pulchritudine esse omnium derivatur”: literally, the existence of everything originates from divine beauty. Fifth, a second definition of beauty is considered: beauty can be defined ontologically as a property of being that emerges from proportion or harmony (consonantia). For example, authentic relationships of personal friendship imply spiritual harmony or concord and are beautiful and noble in this respect. Sixth, then, the concord or beautiful harmonies we find in the created order are expressive of the wisdom of God, who is the author of creation.Evidently, if the existence of everything derives from divine beauty, and if everything that has existence is in some way beautiful by virtue of its intrinsic form, then it would seem to follow logically that beauty, for Aquinas, is a characteristic of being that is coextensive with all that exists. We see a similar idea expressed in the aforementioned passage of ST. Here, however, Aquinas gives a more synthetic definition of beauty in things that combines both the definitions found in our previous discussion, claritas and proportio, but it also adds a third, integritas: ontological integrity or wholeness.Species or beauty has a likeness to the property of the Son. For beauty includes three conditions, “integrity” or “perfection,” [End Page 1217] since those things which are impaired are by the very fact ugly; due “proportion” or “harmony”; and lastly, “brightness” or “clarity,” whence things are called beautiful which have a bright color.4The implication of this point of view is readily apparent. God is essentially beautiful, and God has created all that exists in light of the eternal Word and Wisdom of God, who is the Son. Consequently, all that exists and that... (shrink)

The concepts of time and identity seem at once unproblematic and frustratingly difficult. Time is an intricate part of our experience -- it would seem that the passage of time is a prerequisite for having any experience at all -- and yet recalcitrant questions about time remain. Is time real? Does time flow? Do past and future moments exist? Philosophers face similarly stubborn questions about identity, particularly about the persistence of identical entities through change. Indeed, questions about the metaphysics of (...) persistence take on many of the complexities inherent in philosophical considerations of time. This volume of original essays brings together these two essentially related concepts in a way not reflected in the available literature, making it required reading for philosophers working in metaphysics and students interested in these topics. The contributors, distinguished authors and rising scholars, first consider the nature of time and then turn to the relation of identity, focusing on the metaphysical connections between the two, with a special emphasis on personal identity. The volume concludes with essays on the metaphysics of death, issues in which time and identity play a significant role. This groundbreaking collection offers both cutting-edge epistemological analysis and historical perspectives on contemporary topics. Contributors:_ _Harriet Baber, Lynne Rudder Baker, Ben Bradley, John W. Carroll, Reinaldo Elugardo, Geoffrey Gorham, Mark Hinchliff, Jenann Ismael, Barbara Levenbook, Andrew Light, Lawrence B. Lombard, Ned Markosian, Harold Noonan, John Perry, Harry S. Silverstein, Matthew H. Slater, Robert J. Stainton, Neil A. Tognazzini The hardcover edition does not include a dust jacket. (shrink)

In 2014, Colonel M. Shane Riza published an article in this journal arguing that remotely piloted aircraft and robotic weapons threaten the US Air Force’s warrior ethos. Riza has clearly articulated the sentiments of one side of a vibrant debate within our service. This paper presents an alternative view; a view held by some who have experienced these new forms and tools of war, and who have wrestled with their implications first-hand. In this paper, we address some methodological concerns with (...) Riza’s approach and then engage some misunderstandings about RPA’s relationship to military history and to risk. The second part of this paper takes a close look at some of the early Just War thinkers to determine what implications the tradition may have on the warrior ethos. We propose, as an alternative to Riza’s position, a return to an ethos grounded in humility, charity, and a conception of war as a last resort; in short, a return to the Just Warrior Ethos. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Seeking the Sources of a Theologian:In Memory of Fr. Roch Kereszty, O.Cist. (1933–2022)Joseph Van House O.Cist.Fr. Roch Kereszty long enjoyed thinking about how, and how much, we can discover the truth about Jesus of Nazareth through historical research into his earthly life. Fr. Roch also often enjoyed indicating that at least part of the answer is that research about a human being can never be content with descriptions of (...) any number of empirical facts or ideas from that person's life. The true goal of one who writes or reads about the life of another is insight into the meaning of that person's life. Such insight is possible some extent while the person's life is ongoing, but it calls for a more decisive kind of assessment after the person's death. The meaning of a life also cannot truly reveal itself when viewed through the lens of an inadequate philosophy or theology. Indeed, Fr. Roch tended to think that philosophy itself is adequate to show that any quest to understand another human being cries out to be structured by love, or at least some form of empathy: I can truly understand another only in my proportion to my ability to discover communion or affinity with that person, to find in him or her another self who is in some deep way similar to my own self.1 [End Page 781] Although Fr. Roch elaborated such ideas to guide historians seeking to write a "biography" of Jesus, and although they make great demands of many kinds, it nevertheless seems fitting to consider them when beginning to memorialize Fr. Roch himself.Last December, God granted Fr. Roch the gift of a passage from this life that was surrounded by the love of many people who had known him on earth. Among them were many who had known him through his theological writings and had found them to offer a special combination of intellectual vigor and personal relevance. It is a blessing now to be able to offer a short memorial for the benefit of his sympathetic readers of the past and the future. Attempting to explain the golden thread that unites his many books and articles seems unreasonable; the writings themselves remain their own best explanation. Such an approach could also perhaps suggest that we are most loved in our productivity rather than in the ways we are dependent on God and others. For both of these reasons, one good way to serve love and communion with a theologian of interest would be to portray him in some of the ways that he himself was loved, fathered forth and shaped, by the One from whom all fatherhood is named. In this essay, then, I offer a simple and very fragmented portrait of the sources of a theologian, the fontes theologi: the different ways that God fathered in Roch Kereszty a theological writer who was a blessing to people who read periodicals such as this one. If I provoke either fresh appreciation of his writings or deeper reflection on the variety and patterns in the ways God leads his children generally (and especially those who are interested in theology), then this act of thanksgiving to God for a good teacher will have been successful.A Reader Raised in RomeIt is suggestive to notice that Fr. Roch was born in central Europe just six years after Joseph Ratzinger, and died seventeen days before him; their lifespans as theologians roughly overlapped and were formed by engagement with many of the same theological movements and crises. This said, moving quickly to the specifics of the person in question, it seems especially natural to attend to the character of Fr. Roch's formal theological education. This education took place in Rome, in the company of a handful of fellow bright young refugee Hungarian Cistercians, from 1957 to 1962 (during which time he also made his solemn vows and was ordained). In those days leading up to the Second Vatican Council, theology in the Roman universities was dominated by an increasingly stale and self-contained Neo-Scholasticism. The Benedictine Athenaeum of Sant'Anselmo, where young Roch and his [End... (shrink)

Introduction Joseph Dunne, Attracta Ingram, Frank Litton This volume of essays has two main objectives: first, to pay tribute to Fergal O'Connor, ...

Tout s’est passé très vite, prenant l’Église au dépourvu. Le mouvement pour la reconnaissance des mariages et des unions civiles entre personnes du même sexe a connu un succès extraordinaire. La hiérarchie de l’Église catholique oppose une fin de non-recevoir à toute reconnaissance positive des couples homosexuels, en invoquant une morale sexuelle qu’on dit ancienne et invariable,..

This collection of contemporary essays by prominent contemporary thinkers on the topics of determinism and free agency concentrates primarily on two areas: the compatibility problem and the metaphysics of moral responsibility. There are also essays on the related fields of determinism and action theory. The book is unique in that it contains up-to-date summaries of the life-work of five influential philosophers: John Earman, Ted Honderich, Keith Lehrer, Robert Kane, and Peter van Inwagen. There are also contributions by other familiar and (...) distinguished authors, including Richard Feldman, John Martin Fischer, Carl Ginet, and John Perry, as well as important rising philosophers. While most of the articles are written from a Western, analytic perspective, the volume includes a paper that addresses Buddhist perspectives on freedom of the will. With an opening essay written by the editors -- "Freedom and Determinism: A Framework" -- that sets the terms of the discussion, the book provides a remarkably comprehensive set of articles that are of value to a wide audience, from students of philosophy to scholars. (shrink)

Is the tick a machine or a machine operator? Is it a mere object or a subject? With these questions, the pioneering biophilosopher Jakob von Uexküll embarks on a remarkable exploration of the unique social and physical environments that individual animal species, as well as individuals within species, build and inhabit. This concept of the umwelt has become enormously important within posthumanist philosophy, influencing such figures as Heidegger, Merleau-Ponty, Deleuze and Guattari, and, most recently, Giorgio Agamben, who has called Uexküll (...) "a high point of modern antihumanism." A key document in the genealogy of posthumanist thought, _A Foray into the Worlds of Animals and Humans_ advances Uexküll's revolutionary belief that nonhuman perceptions must be accounted for in any biology worth its name; it also contains his arguments against natural selection as an adequate explanation for the present orientation of a species' morphology and behavior. _A Theory of Meaning_ extends his thinking on the _umwelt_, while also identifying an overarching and perceptible unity in nature. Those coming to Uexküll's work for the first time will find that his concept of the _umwelt_ holds out new possibilities for the terms of animality, life, and the whole framework of biopolitics itself. (shrink)

Most philosophical explorations of responsibility discuss the topic solely in terms of metaphysics and the "free will" problem. By contrast, these essays by leading philosophers view responsibility from a variety of perspectives -- metaphysics, ethics, action theory, and the philosophy of law. After a broad, framing introduction by the volume's editors, the contributors consider such subjects as responsibility as it relates to the "free will" problem; the relation between responsibility and knowledge or ignorance; the relation between causal and moral responsibility; (...) the difference, if any, between responsibility for actions and responsibility for omissions; the metaphysical requirements for making sense of "collective" responsibility; and the relation between moral and legal responsibility. The contributors include such distinguished authors as Alfred R. Mele, John Martin Fischer, George Sher, and Frances Kamm, as well as important rising scholars. Taken together, the essays in _Action, Ethics, and Responsibility_ offer a breadth of perspectives that is unmatched by other treatments of the topic. Contributors: Joseph Keim Campbell, David Chan, Randolph Clarke, E.J. Coffman, John Martin Fischer, Helen Frowe, Todd Jones, Frances Kamm, Antti Kauppinen, Alfred R. Mele, Michael O'Rourke, Paul Russell, Robert F. Schopp, George Sher, Harry S. Silverstein, Saul Smilansky, Donald Smith, Charles T. Wolfe The hardcover edition does not include a dust jacket. (shrink)

New essays by leading philosophers explore topics in epistemology, offering both contemporary philosophical analysis and historical perspectives. There are two main questions in epistemology: What is knowledge? And: Do we have any of it? The first question asks after the nature of a concept; the second involves grappling with the skeptic, who believes that no one knows anything. This collection of original essays addresses the themes of knowledge and skepticism, offering both contemporary epistemological analysis and historical perspectives from leading philosophers (...) and rising scholars. Contributors first consider knowledge: the intrinsic nature of knowledge—in particular, aspects of what distinguishes knowledge from true belief; the extrinsic examination of knowledge, focusing on contextualist accounts; and types of knowledge, specifically perceptual, introspective, and rational knowledge. The final chapters offer various perspectives on skepticism. Knowledge and Skepticism provides an eclectic yet coherent set of essays by distinguished scholars and important new voices. The cutting-edge nature of its contributions and its interdisciplinary character make it a valuable resource for a wide audience—for philosophers of language as well as for epistemologists, and for psychologists, decision theorists, historians, and students at both the advanced undergraduate and graduate levels. Contributors Kent Bach, Joseph Keim Campbell, Joseph Cruz, Fred Dretske, Catherine Z. Elgin, Peter S. Fosl, Peter J. Graham, David Hemp, Michael O'Rourke, George Pappas, John L. Pollock, Duncan Pritchard, Joseph Salerno, Robert J. Stainton, Harry S. Silverstein, Joseph Thomas Tolliver, Leora Weitzman. (shrink)

One criticism of revisionist just war thought is often called the “contingent pacifism” objection. According to this objection, revisionist just war theory fails because it requires combatants on the just side to evaluate the moral responsibility for wrongful harm of each combatant on the unjust side to determine liability to defensive harming in each case. Combatants on the just side are epistemically barred from making these determinations. Moreover, many combatants on the unjust side (e.g., cooks and administrative soldiers) fail to (...) meet the threshold of responsibility for wrongful harm to make them liable to lethal defensive harm. Therefore, ex hypothesi, combatants on the just side will inevitably target enemy combatants who are not liable to be killed. In this paper, I offer a novel response to the contingent pacifism objection. I argue that, even on the revisionist account, participation in a military engaged in an unjust war is sufficient for liability to lethal defensive harm. First, I show merely signaling a threat of unjust harm—even if one lacks the means to actualize the threat—is sufficient for liability to defensive harm. Second, I argue that almost all participants in military activity signal a threat. Finally, I conclude that, in general, combatants on the unjust side of a conflict signal threats of unjust harm and are therefore liable to lethal defensive harming. This novel account of signaling-as-threatening disarms the contingent pacifist objection. (shrink)

Gottfried Wilhelm Leibniz presents the idea of monads, as non-communicative, self-actuating system of beings that are windowless, closed, eternal, deterministic and individualistic. For him, the whole universe and its constituents are monads and that includes humans. In fact, any ‘body’, such as the ‘body’ of an animal or man has, according to Leibniz, one dominant monad which controls the others within it. This dominant monad, he often refers to as the soul. If Leibniz’s conception of monads is accepted, it merely (...) establishes human subjectivity, idiosyncrasies, biases, prejudices and individual points of view as the norm. How then do we ensure inter-subjectivity and the kind of social interaction requisite for the achievement of social order, since Leibniz’s system forecloses the possibility of interaction and communication among monads? In this essay, we argue that just as Leibniz’s monads synchronize only through the Supreme Monad (Monas Monadum), humans as social monads should also interact through a matrix of ideals like truth, honesty, sincerity, integrity, altruism, impartiality, compassion and trust. Since social order is actualised only within the context of linked social structures, relations and values, these utopian ideals would form the fulcrum through which humans relate and the very foundation that would anchor a viable social order. Our aim here is to establish a relationship between Leibniz’s metaphysics and the physical domains of life by showing that metaphysical constructs can impinge on human social relations and wellbeing. The study employed the qualitative method of research through critical analysis of texts, library and archival materials. (shrink)

This collection of original essays on the topics of causation and explanation offers readers a state-of-the-art view of current work in these areas. The book is notable for its interdisciplinary character, and the essays, by distinguished authors and important rising scholars, will be of interest to a wide readership, including philosophers, computer scientists, and economists. Students and scholars alike will find the book valuable for its wide-ranging treatment of two difficult philosophical topics.The volume focuses first on the development of theories (...) of causation and explanation, and then on the application of those theories. Theoretical discussions include Patrick Suppes's investigation of the causal issues surrounding intentional activities such as computation and decision making, and Clark Glymour and Frank Wimberly's analysis of technical issues encountered in formulating an account of actual causation. The essays exploring applications include Nancy Cartwright's examination of the application of counterfactuals to economics and Alfred Mele's criticism of the work of Benjamin Libet on the applicability of experimental results in psychology to philosophical analyses of free will and self-control.Causation and Explanation offers a remarkably wide-ranging set of essays on two topics that present difficult philosophical issues. (shrink)

These essays by leading scholars illustrate the complexity and range of philosophical issues raised by consideration of law and social justice. The contributors to Law and Social Justice examine such broad foundational issues as instrumentalist versus Kantian conceptions of rights as well as such specific problems as the admissibility or inadmissibility of evidence of causation in toxic tort cases. They consider a variety of subjects, including the implications of deliberative democracy for privacy rights, equality as a principle of distributive justice, (...) the paradox of "moral luck," the treatment of intellectual property in China and its roots in Chinese tradition, and the extent to which initial acquisition of goods yields full property rights. Two special sections at the end of the volume discuss the treatment of law and social justice issues in the work of two philosophers: "Wittgenstein and Legal Theory," on the influence of Wittgenstein's thought on legal philosophy, and a discussion of Jules L. Coleman's The Practice of Principle, which concludes with a contribution, "Facts, Fictions, and the Grounds of Law," by Coleman himself. (shrink)

In this article, I ask whether the martial virtues can serve as a role morality for soldiers. In it I compare three role morality theories and ask, according to each, whether the role of ‘soldier’ is the kind of role that generates a role morality. I conclude that the cultivation of the martial virtues may be a necessary condition for martial morality, but it is not a sufficient one. Finally, I present a positive account of a role morality for soldiers (...) that creates the space for crucial, if not traditionally martial, virtues such as respect for human life and human dignity. (shrink)

In this article, I ask whether the martial virtues can serve as a role morality for soldiers. In it I compare three role morality theories and ask, according to each, whether the role of ‘soldier’ is the kind of role that generates a role morality. I conclude that the cultivation of the martial virtues may be a necessary condition for martial morality, but it is not a sufficient one. Finally, I present a positive account of a role morality for soldiers (...) that creates the space for crucial, if not traditionally martial, virtues such as respect for human life and human dignity. (shrink)

The case of Twin B involves the decision to send a newborn to a less intensive Level 2 special care nursery (SCN) than to the Level 3 neonatal intensive care unit (NICU) that is considered optimal by the physician. The physician’s acceptance of the transfer is against the child’s best interest and is due to parental convenience. In analyzing the case, we reject the best interest standard. Our rejection is partly supported by the views of Douglas Diekema, John Hardwig, and (...) Lannie Ross. Instead of the best interest standard, we offer and defend an approach we base on a microeconomic analysis of externalities, such as those involved with automobile emissions. This extends our previously presented general microeconomic approach to patient decision-making. It provides a clearer way to evaluate situations, like those of Twin B, in which burdens faced by family members may be used to determine the appropriate level of treatment for a decisionally incapable patient. (shrink)

Patient autonomy, as exercised in the informed consent process, is a central concern in bioethics. The typical bioethicist's analysis of autonomy centers on decisional capacity—finding the line between autonomy and its absence. This approach leaves unexplored the structure of reasoning behind patient treatment decisions. To counter that approach, we present a microeconomic theory of patient decision-making regarding the acceptable level of medical treatment from the patient's perspective. We show that a rational patient's desired treatment level typically departs from the level (...) yielding an absence of symptoms, the level we call ideal. This microeconomic theory demonstrates why patients have good reason not to pursue treatment to the point of absence of physical symptoms. We defend our view against possible objections that it is unrealistic and that it fails to adequately consider harm a patient may suffer by curtailing treatment. Our analysis is fruitful in various ways. It shows why decisions often considered unreasonable might be fully reasonable. It offers a theoretical account of how physician misinformation may adversely affect a patient's decision. It shows how billing costs influence patient decision-making. It indicates that health care professionals' beliefs about the ‘unreasonable’ attitudes of patients might often be wrong. It provides a better understanding of patient rationality that should help to ensure fuller information as well as increased respect for patient decision-making. (shrink)