BackgroundContemporary medical practice is complicated by many dilemmas requiring ethical sensitivity and moral reasoning.ObjectiveTo investigate physicians’ experience in ethical decision-making and their attitude towards ethics consultation.MethodsIn a cross-sectional survey 126 physicians representing the main clinics of Pleven University hospital were investigated by a self-administered questionnaire. The following variables were measured: occurrence, nature and ways of resolving ethical problems; physicians’ attitudes towards ethics consultation; physicians’ opinions on qualities and skills of an ethics consultant, and socio-demographic characteristics. Data analysis included descriptive statistics, (...) χ2 and t-test.ResultsResponse rate was 88.9% (n = 112). Men and women were equally represented (48.2%–51.8%). The sample consisted of experienced physicians: 42.9% had 11–20 years experience, and 33% had 21–30 years. According to 84.8% of respondents, ethical problems have been discussed in their specialty. Predominant dilemmas included relationships with patients and relatives (76.8%) and team work (67.6%). Over ¾ of physicians needed an advice in solving ethical problems. Ninety six percent responded positively to ethics consultation. They would mainly request it for resolving conflicts (72.5%), and in case of concern for the rightness of their decisions (52.7%). The image of an ethics consultant was built of clinical competence (70.9%), ability to deal with conflicts (59.1%), communication skills (58.2%), tolerance for different views (55.4%), and a special qualification in ethics (52.7%).ConclusionsThe study underlined that Pleven University hospital physicians face similar ethical dilemmas as their colleagues in other countries do. The expressed positive attitudes to ethics consultation should serve as a basis for further research and development of ethics consultation services. (shrink)

Although clinical ethics consultation has existed for more than 40 years in the USA and Europe, it was not available in Bulgaria until recently. In introducing clinical ethics consultation into our country, the Modular, Ethical, Treatment, Allocation of resources, Process methodology has been preferred because of its potential to be used in resource-poor settings and its strong educational function. This paper presents the results of a METAP evaluation in a hospital palliative care ward in the town of Vratsa. The evaluation (...) was based on Beauchamp and Childress’ four principles of biomedical ethics and involves implementation of specific instruments for clinical ethics decision-making. Research tasks emphasised analyses of ethics meetings in the ward. Data were processed by SPSS v.24 using descriptive statistical analysis. Altogether, 32 ethics meetings of an average duration 20.63 min were conducted on cases involving critically ill patients. Most of the participants expressed satisfaction with the ethics process. The principlist approach supported resolution of conflicts between autonomous patients and their relatives, clarified definitions of “medical benefit” and “social good,” and enabled assessments of the risk of unequal treatment. Even as the specific research tasks were achieved, further participant follow-up is necessary to identify any improvement in healthcare personnel’s ethical competence. METAP worked well in end-of-life care settings. Participants experienced several benefits, including improved team communication, better understanding of patient preferences, and confidence in the correctness of decisions. Despite the significant educational potential of METAP, the need for additional and ongoing ethics training of health professionals should not be underestimated. (shrink)

BackgroundOver the years, Bulgarian bioethics has been mainly an academic enterprise and fallen short of providing health professionals with skills for ethical decision-making. Clinical ethics support (CES) was piloted by the author through two bottom-up models – METAP (Modular, Ethical, Treatment, Allocation of resources, Process) and MCD (Moral Case Deliberation).AimsThis paper aims to present and analyse developments in the area of clinical ethics and the first experiences in CES in Bulgaria.MethodologyThe project reported here included a review of relevant literature on (...) CES methods and evaluation and a documentary review of data from two CES pilot projects: METAP and MCD.ResultsMost of the 69 METAP ethics meetings reviewed were first time meetings (88,4%); the average duration was 36 min and the average number of participants was four (44,9%). The meetings were organized in response to cases of severely or critically ill patients. The ethical dilemmas included choice of treatment (31,9%) and conflicts with the patient or their relatives (23,2%). Consensus was achieved in 34,8% of the cases. The situation was clarified with the patient (27,5%) and within the team (15,9%). The rights and obligations of both sides were discussed in 7,2% of the cases. The experience of the members of the Bulgarian Association of Bioethics and Clinical Ethics (BABCE) with MCD was also presented to justify the inference about the applicability of the two CES models in a Bulgarian context.ConclusionAmong Eastern European countries Bulgaria has made progress in CES. Both METAP and MCD have been found to be useful methods. (shrink)

The category of anarchy is conventionally associated with the emergence of an autonomous discipline of International Relations. Recently, Donnelly has argued that anarchy has never been central to IR. His criticism targets not just concepts of anarchy but theories of anarchy and thereby expresses an anti-theory ethos tacitly accepted in the discipline. As a form of conceptual atomism, this ethos is hostile to structuralist and normative theories. This article aims to reinstate theoretical holism against conceptual atomism and to defend the (...) enduring relevance of theories of international anarchy for IR. This is done by revisiting two classic, structuralist accounts of international anarchy articulated in Kenneth Waltz’s Theory of International Politics and Hedley Bull’s Anarchical Society. It will be shown that both represent coherent theoretical ‘wholes’ which reveal a more complex relationship between anarchy and hierar... (shrink)

The main objective of this article is to demonstrate why despite the growing interest in justifying AI’s trustworthiness, one can argue for AI’s reliability. By analyzing why trustworthiness ethics in Nickel’s sense provides some wellgrounded hints for rethinking the rational, affective and normative accounts of trust in respect to AI, I examine some concerns about the trustworthiness of Savulescu and Maslen’s model of moral AI as an adviser. Specifically, I tackle one of its exemplifications regarding Klincewicz’s hypothetical scenario of John (...) which is refracted through the lens of the HLEG’s fifth requirement of trustworthy artificial intelligence (TAI), namely, that of Diversity, non-discrimination and fairness. (shrink)

Seth Vannatta’s book Conservatism and Pragmatism in Law, Politics, and Ethics is a thought-provoking inquiry challenging the reader to go beyond the clichés imposed by contemporary American everyday discourse, namely, to overcome associating conservatism with right wing politics, and pragmatism with the formula that practice determines what should work best in politics. He sets the ambitious goal of demonstrating how comparing rather than contrasting the visions of classical British conservative thought and classical American pragmatist philosophy contributes to revealing the complex (...) genealogy of a normative methodology that can be applied in many disciplines. The normative methodology can question the universal.. (shrink)

The main objective of this paper is to demonstrate why AI researchers’ attempts at developing projects of moral machines are a cause for concern regarding the way in which such machines can reach a certain level of morality. By comparing and contrasting Howard and Muntean’s model of a virtuous Artificial Autonomous Moral Agent and Bauer’s model of a two-level utilitarian Artificial Moral Agent, I draw the conclusion that both models raise, although in a different manner, some crucial issues. The latter (...) are recognized as deriving from the complex relationships between human cognition and moral reasoning, as refracted through the lens of the idea of moral AI. In this context, special attention is paid to the complications which are triggered by the analogical thinking regarding the processes of replication of human morality in the field of machine ethics. (shrink)

The article discusses the genealogy of 20th-century Norwegian ecophilosophies as deriving from a specific philosophy of climbing, one which is irreducible to philosophy of alpinism so far as it is based on the principle of cooperation and on the intrinsic value of interacting with the mountain rather than on competition, which makes the mountain an arena for sport activities. In this context, the expression to think like a mountain will be analyzed as something more than an impressive metaphor, and examined (...) as a new way of thinking that avoids the extremes of both radical anthropocentrism and biocentrism. (shrink)

Are social practices actions, or institutional frameworks of interaction structured by common rules? How do social practices such as signing a cheque differ from international practices such as signing a peace treaty? Traversing the fields of international relations and philosophy, this book defends an institutionalist conception of practices as part of a general practice theory indebted to Oakeshott, Wittgenstein and Hegel. The proposed practice theory has two core aspects: practice internalism and normative descriptivism. In developing a philosophical analysis of social (...) practices that has a special relevance for international relations, Silviya Lechner and Mervyn Frost depart from Pierre Bourdieu's sociology of practice that dominates the current 'practice turn' in IR. The authors show that the contemporary global realm is constituted by two distinct macro practices - the practice of sovereign states and that of global rights. (shrink)

This book sets out to re-examine the foundations of Thomas Hobbes’s political philosophy, and to develop a Hobbesian normative theory of international relations. Its central thesis is that two concepts – anarchy and authority – constitute the core of Hobbes's political philosophy whose aim is to justify the state. The Hobbesian state is a type of authority (juridical, public, coercive, and supreme) which emerges under conditions of anarchy ('state of nature'). A state-of-nature argument makes a difference because it justifies authority (...) without appeal to moral obligation. The book shows that the closest analogue of a Hobbesian authority in international relations is Kant's confederation of free states, where states enjoy 'anarchical' (equal) freedom. At present, this crucial form of freedom is being threatened by economic processes of globalisation, and by the resurgence of private authority across state borders. (shrink)

Cet article étudie les moyens d’argumentation dans les lettres familières rédigées par les apprenants sinophones du français langue étrangère de niveau B2. Les lettres sont contrastées à celles des francophones et des sinophones natifs représentant un groupe de contrôle. Les résultats montrent certains contrastes entre les groupes des natifs. Quant aux apprenants, on voit qu’ils utilisent en partie les mêmes stratégies argumentatives que les francophones, mais on atteste également des influences de leur langue maternelle dans le choix des procédés persuasifs.

For a non-zero natural number n, we work with finitary $$\Sigma ^0_n$$ -formulas $$\psi (x)$$ without parameters. We consider computable structures $${\mathcal {S}}$$ such that the domain of $${\mathcal {S}}$$ has infinitely many $$\Sigma ^0_n$$ -definable subsets. Following Goncharov and Kogabaev, we say that an infinite list of $$\Sigma ^0_n$$ -formulas is a $$\Sigma ^0_n$$ -classification for $${\mathcal {S}}$$ if the list enumerates all $$\Sigma ^0_n$$ -definable subsets of $${\mathcal {S}}$$ without repetitions. We show that an arbitrary computable $${\mathcal {S}}$$ (...) always has a $${{\mathbf {0}}}^{(n)}$$ -computable $$\Sigma ^0_n$$ -classification. On the other hand, we prove that this bound is sharp: we build a computable structure with no $${{\mathbf {0}}}^{(n-1)}$$ -computable $$\Sigma ^0_n$$ -classifications. (shrink)

Globalization challenges the state-centric realist view of space and authority within International Relations. Using multifaceted concepts of territoriality and non-territoriality, this article goes into three versions of current territorial fragmentation or connectivity – deterritorialization, extraterritorialization and reterritorialization. They are to enable us to reveal the proliferation of globally relevant social and power dynamics above, below and within the state domain. At the same time, they are to illuminate the ambivalent role of states played in an era of global interconnectedness.

Im Zentrum des Werkes von Michael Oakeshott (1901-1990) steht die Frage nach der Vernunft der Praxis und der Praxis der Vernunft. Dieses klassische Thema der praktischen Philosophie, das heute im Hintergrund verschiedener Debatten in Philosophie und Politikwissenschaft steht, leitete Oakeshott in seiner Auseinandersetzung mit der modernen Politik. Die in dem Sammelband vereinigten Beitrage bieten einen Uberblick uber die internationale Forschungslage; ihr gemeinsamer Angelpunkt ist Oakeshotts Praxisbegriff: Diskutiert wird seine praktische Bedeutung im Durchgang durch die grundlegenden politischen und gesellschaftlichen Problemfragen der (...) Gegenwart, seine theoretische Leistungsfahigkeit ist Gegenstand vergleichender Perspektiven, die vor allem die deutschen Zeitgenossen wie H. Arendt, H.-G. Gadamer, G. Simmel oder L. Strauss einbeziehen. Der vorliegende Band unternimmt es, die seit mehr als zwei Jahrzehnten intensiv gefuhrte, vor allem angelsachsische Debatte um Oakeshotts Denken in die einschlagigen deutschen Diskussionen zu tragen und die Anknupfungspunkte sichtbar zu machen, die sein facettenreiches Werk fur die Verstandigung uber eine humane Praxis in den Konflikten des 21. Jahrhunderts bietet. Mit Beitragen von: Josiah Lee Auspitz, Michael Becker, Wendell John Coats Jr., Peter Finn, Jurgen Gebhardt, Steven A. Gerencser, Michael Grossheim, Michael Henkel, Hans Jorg Hennecke, Bart van Klink, Silviya Lechner, Oliver W. Lembcke, Kenneth B. McIntyre, Efraim Podoksik, Rainer Schmidt, Suvi Soininen, Judith A. Swanson, Martyn P. Thompson. (shrink)