The American Society for Bioethics and Humanities has created a quality attestation process for clinical ethics consultants; the pilot phase of reviewing portfolios has begun. One aspect of the QA process which is particularly challenging is assessing the interpersonal skills of individual clinical ethics consultants. We propose that using case simulation to evaluate clinical ethics consultants is an approach that can meet this need provided clear standards for assessment are identified. To this end, we developed the Assessing Clinical Ethics Skills (...) tool, which identifies and specifies specific behaviors that a clinical ethics consultant should demonstrate in an ethics case simulation. The aim is for the clinical ethics consultant or student to use a videotaped case simulation, along with the ACES tool scored by a trained rater, to demonstrate their competence as part of their QA portfolio. The development and piloting of the tool is described. (shrink)

As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted (...) a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male, white, between 50 and 69 years old, of non-Hispanic origin, and of Roman Catholic faith. Nearly half were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making, goals of care/treatment, and end-of-life. More specifically, capacity, patient’s wishes/autonomy, and surrogate decision maker were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment, patient wishes/autonomy, and capacity. Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field. (shrink)

The field of clinical ethics consultation has matured into a multidisciplinary profession, with clinical ethics consultants (CECs) being trained in bioethics, philosophy, theology, law, medicine, n...

In this paper, we present a survey of the development of the technique of argument diagramming covering not only the fields in which it originated - informal logic, argumentation theory, evidence law and legal reasoning – but also more recent work in applying and developing it in computer science and artificial intelligence. Beginning with a simple example of an everyday argument, we present an analysis of it visualised as an argument diagram constructed using a software tool. In the context of (...) a brief history of the development of diagramming, it is then shown how argument diagrams have been used to analyze and work with argumentation in law, philosophy and artificial intelligence. (shrink)

The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called (...) A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide). In this article, we also enumerate how the Study Guide could be used in teaching and learning, and we identify areas that are ripe for future work. (shrink)

This paper looks at a dispute decision theory about how best to characterize expected utility maximization and express the logic of rational choice. Where A1, … , An are actions open to some particular agent, and S1, … , Sn are mutually exclusive states of the world such that the agent knows at least one of which obtains, does the logic of rational choice require an agent to consider the conditional probability of choice Ai given that some state Si obtains, (...) Prob(Ai/Si). Or, is the logic of choice better represented by considering the probability of the counterfactual if Ai then Si, Prob(Ai ⟥-> Si). Causal decision theory, developed by Allan Gibbard, William Harper, and David Lewis defend the counterfactual analysis; whereas, Richard Jeffrey and others defend the conditional probability analysis, evidential decision theory. I argue that the problems posed by cases of decision instability favor evidential decision theory. (shrink)

Volume 20, Issue 3, March 2020, Page 27-29.

People are unable to report how they decide whether to move backwards or forwards to catch a ball. When asked to imagine how their angle of elevation of gaze would change when they caught a ball, most people are unable to describe what happens although their interception strategy is based on controlling changes in this angle. Just after catching a ball, many people are unable to recognise a description of how their angle of gaze changed during the catch. Some people (...) confidently choose incorrect descriptions that would guarantee failure of interception demonstrating unconscious knowledge co-existing with systematically different conscious beliefs. Where simple solutions to important evolutionary problems exist, unconscious perception needs to be impervious to conscious beliefs. (shrink)

Volume 19, Issue 11, November 2019, Page 69-70.

Martin Heidegger’s existential account of care in _Being and Time_ (2010) provides us with an opportunity to reimagine what the proper theoretical grounding of an ethic of care might be. Heidegger’s account of care serves to deconstruct the two primary foundations that an ethic of care is often based upon. Namely, that we are inevitably interdependent upon one another and/or possess an innate disposition to care for fellow humans in need. Heidegger’s account reveals that both positions are founded upon an (...) ontic (meaning factual existence), as opposed to an ontological (which refers to the nature of being), understanding of care. The distinctions between an ontic and ontological understanding of care are significant. Yet, I maintain that they are not completely incompatible. Both Heidegger and care ethicists contend that our existence with others is understood through a relational ontology. Furthermore, there are certain ontological structures from Heidegger which resonate with an ethic of care. Two key existential structures are leaping-ahead and being-guilty. These existential structures are latent in care ethics, and by explicitly revealing them I reinforce the connection between Heidegger’s account and care theory. Lastly, I develop the theoretical foundations of care ethics by proposing an existential ethic of care. (shrink)

A familiar post-Kantian criticism contends that Kant enslaves sensibility under the yoke of practical reason. Friedrich Schiller advanced a version of this criticism to which Kant publicly responded. Recent commentators have emphasized the role that Kant’s reply assigns to the pleasure that accompanies successful moral action. In contrast, I argue that Kant’s reply relies primarily on the sublime feeling that arises when we merely contemplate the moral law. In fact, the pleasures emphasized by other recent commentators depend on this sublime (...) feeling. These facts illuminate Kant’s views regarding the relationship between morality, freedom, and the development of moral feelings. (shrink)

It is known that the spaces of orders on orderable computable fields can represent all Π10 classes up to Turing degree. We show that the spaces of orders on orderable computable abelian and nilpotent groups cannot represent Π10 classes in even a weak manner. Next, we consider presentations of ordered abelian groups, and we show that there is a computable ordered abelian group for which no computable presentation admits a computable set of representatives for its Archimedean classes.

A shift from top-down, hierarchical decision-making toward collaborative, consensus-oriented decision-making is taking place across many settings, leading to meetings in which diverse participants seek to reach agreement on issues of significance. This article proposes a new approach to analyzing such meetings that integrates conversation analysis and issue framing. While CA and IF have both been applied to collaborative decision-making, each approach, on its own, suffers from significant limitations. Combined, they allow negotiation talk in meetings to be examined holistically, integrating a (...) consideration of both process and content. New relationships among interactional sequences and framing processes are revealed, leading to the discovery of patterns across the decision-making activity as a whole. These patterns, in turn, can be situated in the context of the institutions within which the negotiations take place. This novel integrative approach is illuminated through application to a 162-turn decision-making activity. (shrink)

Reflection in medical education is becoming more widespread. Drawing on our Jesuit Catholic heritage, the Loyola University Chicago Stritch School of Medicine incorporates reflection in its formal curriculum and co–curricular programs. The aim of this type of reflection is to help students in their formation as they learn to step back and analyze their experiences in medical education and their impact on the student. Although reflection is incorporated through all four years of our undergraduate medical curriculum, this essay will focus (...) on three areas where bioethics faculty and medical educators have purposefully integrated reflection in the medical school, specifically within our bioethics education and professional development efforts: 1) in our three–year longitudinal clinical skills course Patient Centered Medicine (PCM), 2) in our co–curricular Bioethics and Professionalism Honors Program, and 3) in our newly created Physician’s Vocation Program (PVP). (shrink)

This article asks how military ethics should respond to adversaries deliberately conducting hostilities below the threshold of war. Three options are considered: a novel, limited force paradigm; an expanded hostilities paradigm, i.e., within the law of armed conflict; and an international law enforcement paradigm derived primarily from human rights law. None is problem-free. Mindful of under-deployed classic just war reasoning arguments for discrimination between vices opposed to peace, this article argues against an expanded hostilities paradigm and shows that the retributive, (...) ‘equilibrium of justice’ test used sometimes to support such an expansion is necessary but not sufficient. It explains the need for further examination of whether/how Aquinas and his interpreters can/should conceive of actions under the paradigm of war occurring against non-state actors. (shrink)

This book provides a systematic analysis of many common argumentation schemes and a compendium of 96 schemes. The study of these schemes, or forms of argument that capture stereotypical patterns of human reasoning, is at the core of argumentation research. Surveying all aspects of argumentation schemes from the ground up, the book takes the reader from the elementary exposition in the first chapter to the latest state of the art in the research efforts to formalize and classify the schemes, outlined (...) in the last chapter. It provides a systematic and comprehensive account, with notation suitable for computational applications that increasingly make use of argumentation schemes. (shrink)

At a time of increasing interest and advocacy in integrated and policy-oriented research, this paper offers an empirically-based view of the intellectual and practical challenges of undertaking such research. It analyses the experience of a long-standing university research and postgraduate training centre from 1973-2004: the Centre for Resource and Environmental Studies at The Australian National University. The paper discusses staff development issues, cross-disciplinary understanding, organisational requirements for collaborative research, postgraduate and early career considerations, a range of integrative frameworks, and the (...) tensions that arise for interdisciplinary research in the political and economic operating environments of modern universities. (shrink)

Catholic ethical teaching has increasingly relied on a concept of the common good for making and evaluating social decisions. The authors have argued that the common good is a maximal and ideal concept about which people and communities differ fundamentally. In practice, it does not resolve moral and social disagreements. The concept of the common harm is preferable because it is a minimal standard that can be more clearly identified and agreed for individuals and society, providing a basis for legislative (...) and social action. Bioethics and public health both have strong roots in doing no harm and preventing harm to both individuals and communities in society. The authors argue that the application of the concept of the common harm from these disciplines into wider use in the health professions and public policy would be beneficial. National Catholic Bioethics Quarterly 14.3 : 449–455. (shrink)

The fundamental question in reverse mathematics is to determine which set existence axioms are required to prove particular theorems of mathematics. In addition to being interesting in their own right, answers to this question have consequences in both effective mathematics and the foundations of mathematics. Before discussing these consequences, we need to be more specific about the motivating question.Reverse mathematics is useful for studying theorems of either countable or essentially countable mathematics. Essentially countable mathematics is a vague term that is (...) best explained by an example. Complete separable metric spaces are essentially countable because, although the spaces may be uncountable, they can be understood in terms of a countable basis. Simpson gives the following list of areas which can be analyzed by reverse mathematics: number theory, geometry, calculus, differential equations, real and complex analysis, combinatorics, countable algebra, separable Banach spaces, computability theory, and the topology of complete separable metric spaces. Reverse mathematics is less suited to theorems of abstract functional analysis, abstract set theory, universal algebra, or general topology.Section 2 introduces the major subsystems of second order arithmetic used in reverse mathematics: RCA0, WKL0, ACA0, ATR0 and – CA0. Sections 3 through 7 consider various theorems of ordered group theory from the perspective of reverse mathematics. Among the results considered are theorems on ordered quotient groups, groups and semigroup conditions which imply orderability, the orderability of free groups, Hölder's Theorem, Mal'tsev's classification of the order types of countable ordered groups. (shrink)

This paper proposes a view uniformly extending expected utility calculations to both individual and group choice contexts. Three related cases illustrate the problems inherent in applying expected utility to group choices. However, these problems do not essentially depend upon the tact that more than one agent is involved. I devise a modified strategy allowing the application of expected utility calculations to these otherwise problematic cases. One case, however, apparently leads to contradiction. But recognizing the falsity of proposition (1) below allows (...) the resolution of the contradiction, and also allows my modified strategy to resolve otherwise paradoxical cases of group choice such as the Prisoners' Dilemma: -/- (1) lf an agent x knows options A and B are both available, and x knows that were he to do A he would be better off (in every respect) than were he to do B, then doing A is more rational for x than doing B. (shrink)

This book provides a systematic analysis of many common argumentation schemes and a compendium of 96 schemes. The study of these schemes, or forms of argument that capture stereotypical patterns of human reasoning, is at the core of argumentation research. Surveying all aspects of argumentation schemes from the ground up, the book takes the reader from the elementary exposition in the first chapter to the latest state of the art in the research efforts to formalize and classify the schemes, outlined (...) in the last chapter. It provides a systematic and comprehensive account, with notation suitable for computational applications that increasingly make use of argumentation schemes. (shrink)

In §76 of the 3rd Critique, Kant claims that an intuitive understanding would represent no distinction between possible and actual things. Prior interpretations of §76 take Kant to claim that an intuitive understanding would produce things merely in virtue of thinking about them and, thus, could not think of merely possible things. In contrast, I argue that §76’s modal claims hinge on Kant’s suggestion that God represents things in their thoroughgoing determination, including in their connection to God’s actual will. I (...) conclude by using my interpretation to argue that §76’s modal claims do not entail Spinozism. (shrink)

Background: Direct–to–consumer genetic testing (DTCGT) offers risk estimates for a variety of complex diseases and conditions, yet little is known about its impact on actual users, including their decisions about sharing the information gleaned from testing. Ethical considerations include the impact of unsolicited genetic information with variable validity and clinical utility on relatives, and the possible burden to the health care system if revealed to physicians. Aims: The qualitative study explored primary care patients’ views, attitudes, and decision making considerations regarding (...) DTCGT. This article focuses on the disclosure decisions participants made regarding participation, testing, and results of DTCGT, a topic which arose as a secondary aim of the study. Methods: Through four longitudinal interviews (pre–test, results, 3 and 12 months post–test) we examined twenty primary care patients’ decisions, expressed intentions, and actions regarding disclosure to immediate and extended family, friends and coworkers, and physicians about participation in and results of DTCGT. Individual interviews were analyzed using qualitative content analysis and a summative approach to describe the global themes. Results: Most participants disclosed to some immediate family; less than half disclosed to extended family; approximately half talked to friends. Most participants stated they would or might disclose to physicians about DTCGT and a few did. Conceptual themes that emerged from the data analysis include ambivalence about disclosure, consistency between intention and actual disclosure behavior and decisions, and conditional information sharing. Conclusions: Participants’ intentional and actual disclosure patterns offer insight into how they view DTCGT, weigh results, and the potential impact of DTCGT. (shrink)

Hegel famously criticizes Kant’s resolution of the antinomies. According to Sedgwick, Hegel primarily chastises Kant’s resolution for presupposing that concepts are ‘one-sided’, rather than identical to their opposites. If Kant had accepted the dialectical nature of concepts, then (according to Sedgwick) Kant would not have needed to resolve the antinomies. However, as Ameriks has noted, any such interpretation faces a serious challenge. Namely, Kant’s first antinomy concerns the universe’s physical dimensions. Even if we grant that the concept of the finite (...) is necessarily related to that of the infinite, the physical universe cannot both have and lack a temporal beginning. I argue that Hegel neither adopts Sedgwick’s view that Kant’s antinomies require no resolution nor absurdly accepts that the physical universe both has and lacks a temporal beginning. Instead, Hegel proposes a sophisticated resolution of Kant’s first antinomy (including its physical aspect) that depends on Hegel’s theory of the Absolute. (shrink)

Kant claims that an intuitive understanding—such as God would possess—could cognize things in themselves. This claim has prompted many interpreters of Kant's theoretical philosophy to propose that things in themselves correspond to how an intuitive understanding would cognize things. In contrast, I argue that Kant's theoretical philosophy does not endorse the common proposal that all things in themselves correspond to how an intuitive understanding would cognize things. Instead, Kant's theoretical philosophy maintains that things in themselves might or might not correspond (...) to how an intuitive understanding would cognize things. I then consider whether Kant's moral philosophy and theory of reflecting judgment might provide alternative grounds for claiming that we should regard things in themselves as corresponding to how an intuitive understanding would cognize things. I argue that Kant's moral philosophy does not provide such grounds, but his theory of reflecting judgment does. Thus, interpretations of Kant's transcendental idealism should attend to the differences between Kant's theoretical philosophy, moral philosophy, and theory of reflecting judgment in assessing the relationship between intuitive understanding and things in themselves. (shrink)