BackgroundNo standard method exists to assess how many consults a healthcare ethics consultation (HCEC) service should perform. To address this, we developed a method to estimate the volume of HCEC services based on a mixed-methods approach that included a systematic review and survey data on the volume of consult services requested.MethodsOur investigation included a systematic review of studies that reported the volume of HCEC services that were requested from 2000 to 2017, institutional surveys, and statistical analyses that estimated the volume (...) of HCEC services that were adjusted to the size of the hospitals in the survey and to population acuity.ResultsWe contacted the authors of 19 studies that met our inclusion criteria; 17 authors responded to the institutional survey and five provided annualized data points. We found that standard methods of reporting the volume of HCEC services led to inaccuracies in estimating the growth of HCEC services over time. To rectify this, we proposed two means to estimate volume based on either the service goals of HCEC services or hospital size and acuity.DiscussionThe statistical limitations of our study highlight the need to standardize the sharing and reporting of data in clinical ethics. Future work should further standardize methods of HCEC quality assessment using measures similar to those we describe. (shrink)

Scholars and professional organizations in bioethics describe various approaches to “quality assessment” in clinical ethics. Although much of this work represents significant contributions to the literature, it is not clear that there is a robust and shared understanding of what constitutes “quality” in clinical ethics, what activities should be measured when tracking clinical ethics work, and what metrics should be used when measuring those activities. Further, even the most robust quality assessment efforts to date are idiosyncratic, in that they represent (...) evaluation of single activities or domains of clinical ethics activities, or a range of activities at a single hospital or healthcare system. Countering this trend, in this article we propose a framework for moving beyond our current ways of understanding clinical ethics quality, toward comprehensive quality assessment. We first describe a way to conceptualize quality assessment as a process of measuring disparate, isolated work activities; then, we describe quality assessment in terms of tracking interconnected work activities holistically, across different levels of assessment. We conclude by inviting future efforts in quality improvement to adopt a comprehensive approach to quality assessment into their improvement practices, and offer recommendations for how the field might move in this direction. (shrink)

I here defend the thesis that the best life is the life that one plays as a game—specifically, a ‘Suitsian’ game that meets the definition proposed in The Grasshopper by Bernard Suits. Even more specifically, it is a nested, open, role-playing game where the life’s quality as a game partly depends on there being no more people than players. To defend this thesis I refute two powerful challenges to it, one from Thomas Hurka (2006) and another from within The (...) Grasshopper itself. In the process, I offer a new interpretation of that enigmatic and challenging book. (shrink)

I argue that Sui-Generis Views are preferrable to Non-Belief and Higher-Order Belief Views because of the three dominant contemporary conceptions of agnosticism, only Sui-Generis Views leave room for the possibility of agnosticism-involving doxastic inconsistency. In order to establish that this constitutes a point in favour of Sui-Generis Views, this paper offers a sustained argument in support of the thesis that doxastic inconsistency consistency involving (dis)believing P and agnosticism towards P is possible. The paper concludes by responding to Thomas Raleigh’s (...) argument against the possibility of agnosticism-involving doxastic inconsistency. (shrink)

Why do some people always see the bright side, stay positive, and find fulfilment and joy in their lives? Avery outlines fifty key concepts and strategies to help you put the secrets of happiness into practice.

We often describe ourselves as agnostic on a wide range of questions, such as does God exist, is String Theory true, or will the President win re-election? But what does it mean to be agnostic and when is agnosticism justified? This monograph addresses these and related questions.

In this book, T. M. Scanlon offers new answers to these questions, as they apply to the central part of morality that concerns what we owe to each other.

The latest advances and discoveries in science have made, and continue to make, a huge impact on our lives. This book is a history of the social impact of science and technology from the beginnings of civilization up to the present. The book explains how the key inventions: agriculture, writing and printing with movable type, initiated an explosive growth of knowledge and human power over the environment. It also shows how the Industrial Revolution changed the relationship between humans and nature, (...) and initiated a massive use of fossil fuels. Problems related to nuclear power, nuclear weapons, genetic engineering, information technology, exhaustion of non-renewable resources, use of fossil fuels and climate change are examined in the later chapters of the book. Finally, the need for ethical maturity to match our scientific progress is discussed. (shrink)

Her shape and his hand -- Distractions -- The other door, it's floods of tears with consolation enclosed -- Not only the footprints but the water too and what is down there -- There are crossroads.

This volume brings together for the first time a significant number of Reid's manuscript papers on natural history, physiology and materialist metaphysics. An important contribution not only to Reid studies but also to our understanding of eighteenth-century science and its context.

The “good farmer” literature, grounded in Bourdieu’s concepts of field, habitus, and capital, has provided researchers with a socio-cultural approach to understanding conservation adoption behavior. The good farmer literature suggests that conservation practices may not be widely accepted because they do not allow farmers to demonstrate symbols of good farming. This lens has not been applied to the adoption of conservation tillage, a practice increasingly used to improve conservation outcomes, farming efficiency and crop productivity. Drawing from in-depth interviews with dryland (...) wheat farmers in the US inland Pacific Northwest, this research seeks to understand how farmers’ engagement with CT is shaped by identity as a good farmer. Some farmers also sought to bolster social capital through CT by maintaining and strengthening relationships with peers, landowners, and future generations. We further found that engagement with CT provided a link for some participants between productivist values and stewardship values within the good farming identity. The findings from this research may help contextualize the barriers and opportunities to the adoption of agricultural conservation practices within farmer-specific social, cultural, and economic forms of capital. (shrink)

The second essay of Nietzsche's Genealogy of Morality (GM) offers a naturalistic and developmental account of the emergence of conscience, a faculty uniquely responsive to remembering and honoring obligations. This article attempts to solve an interpretive puzzle that is invited by the second essay's explanation of nonmoral obligation, prior to the capacity to feel guilt. Ostensibly, Nietzsche argues that the conscience and our concept of obligation originated within contractual (“creditor-debtor”) relations, when creditors punished delinquent debtors (GM II:5). However, this interpretation, (...) which I call the contractualist reading, is incoherent and subject to an insoluble bootstrapping problem. I argue instead that Nietzsche provides two accounts of nonmoral obligation in the second essay, and that the conscience originated in the morality of custom to track rule prohibitions (“I will nots” [GM II:3]), which Nietzsche conceives of as involuntary or reciprocal obligations that, unlike contractual debts, do not require the making of promises. (shrink)

A critical opportunity for identifying children experiencing domestic minor sex trafficking exists in healthcare settings. This quantitative study documented the disconnect between youth seeking help and interventions offered by healthcare providers. Ninety-one sex youth exploited through sex trafficking answered questions detailing their experiences of seeking medical treatment for injuries associated with selling or trading sex. Healthcare providers who were aware that injuries were sustained due to sex trafficking did not always alert legal or mandated reporting authorities. This analysis identified violations (...) of the four pillars of ethical healthcare. This investigation revealed lost opportunities to intervene on behalf of youth suffering trauma and abuse from sex trafficking highlighting the necessity for a formal protocol in healthcare settings to effectively intervene. (shrink)

In several contexts Nietzsche claims that he wants to free humanity of the affect of guilt. He also argues that we are not ultimately responsible for who we are or what we do because libertarian free will is a false belief invented for the purpose of legitimizing judgments of guilt. Combining these related threads of argument, we arrive at what would seem to be an uncontroversial conclusion: Nietzsche does not think guilt is an apt response to wrongdoing, and he therefore (...) thinks we ought to dispense with the feeling of guilt altogether. I argue against this conclusion by offering a comparative analysis of two kinds of guilt Nietzsche discusses in his works, reactive guilt, which is a reaction to an act of wrongdoing, and proactive guilt, which is a drive or desire to make oneself feel guilty. Here I offer an account of Greek guilt as a species of reactive guilt, and I argue that Nietzsche only rejects proactive guilt, which is endemic to Judeo-Christianity. (shrink)

Cognitive scientists use computational models to represent the results of their experimental work and to guide further research. Neither of these claims is particularly controversial, but the philosophical and evidentiary statuses of these models are hotly debated. To clarify the issues, I return to Newell and Simon’s 1972 exposition on the computational approach; they herald its ability to describe mental operations despite that the neuroscience of the time could not. Using work on visual imagery (cf. imagination) as a guide, I (...) examine the extent to which this holds true today. Does contemporary neuroscience contain mechanisms capable of describing experimental results in imagery? I argue that it does not, first by exploring foundational achievements in imagery research then by showing that their neural basis cannot be specified. Newell and Simon’s methodological position accordingly stands, even 50 years later. Computational — as opposed to physiological — descriptions must be retained to characterize and study mental phenomena, even as we learn high-level details of their implementation via brain data. (shrink)

Nietzsche proclaims the second essay of the Genealogy of Morality to be the “long history of the origins of responsibility,” but the immediate context in which this claim is made, coupled with GM II's broader aims and themes, makes interpreting this claim immensely difficult. Not only does Nietzsche endorse an ideal of responsibility in relation to the sovereign individual, while the rest of the essay is concerned with other topics, but also, and more problematically, this ideal appears to be inconsistent (...) with his denial of free will and moral responsibility in other works. Here, I propose a Strawsonian reading of GM II, contending that GM II analyzes the idea of “responsibility” naturalistically in terms of the practice of holding oneself and others responsible, as constituted by what Nietzsche calls the “reactive affects,” namely guilt. A consequence of this interpretation is that libertarian free will is not a condition of responsible agency. (shrink)

While it is uncontroversial that the slave revolt in morality consists in a denial of the nobles as objects of value, Nietzsche’s account in the Genealogy’s first essay invites ambiguities concerning its origin, ressentiment’s relationship to value creation, and its meaning. In this paper, I address these ambiguities by analyzing the morality of good and evil as an historical artifact of Judeo-Christian tradition, and I argue for a two-stage, non-strategic interpretation of the slave revolt, according to which Judaism and Christianity (...) each made essential and different contributions. The inversion of values began with the Jewish prophets, who claimed the poor were holy and ‘good’ and the rich ‘evil’, and it was sustained throughout the Second Temple period by the Jewish priests in relation to a ‘priestly-noble’ conception of the virtuous person as holy and pure. Christ, through his espousal of egalitarianism, negated the pathos of distance essential to noble values, thus beginning the second phase of the slave revolt where goodness became associated with a distinctly slavish conception of virtue. (shrink)

Accounts of solidarity typically defend it in teleological or loyalty terms, justifying it by invoking its goal of promoting justice or its expression of support for a shared community. Such solidarity seems to be a moral option rather than an obligation. In contrast, A Moral Theory of Solidarity develops a deontological theory grounded in equity. With extended reflection on the Spanish conquest of the Americas and the US Civil Rights movement, Kolers defines solidarity as political action on others' terms. Unlike (...) mere alliances and coalitions, solidarity involves a disposition to defer to others' judgment about the best course of action. Such deference overrides individual conscience. Yet such deference is dangerous; a core challenge is then to determine when deference becomes appropriate.Kolers defends defernce to those who suffer gravest inequity. Such deference constitutes equitable treatment, in three senses: it is Kantian equity, expressing each person's equal status; it is Aristotelian equity, correcting general rules for particular cases; and deference is 'being an equitable person,' sharing others' fate rather than seizing advantages that they are denied. Treating others equitably is a perfect duty; hence solidarity with victims of inequity is a perfect duty. Further, since equity is valuable in itself, irrespective of any other goal it might promote, such solidarity is intrinsically valuable, not merely instrumentally valuable. Solidarity is then not about promoting justice, but about treating people justly. A Moral Theory of Solidarity engages carefully with recent work on equity in the Kantian and Aristotelian traditions, as well as the demandingness of moral duties, collective action, and unjust benefits, and is a major contribution to a field of growing interest. (shrink)

Territorial disputes have defined modern politics, but political theorists and philosophers have said little about how to resolve such disputes fairly. Is it even possible to do so? If historical attachments or divine promises are decisive, it may not be. More significant than these largely subjective claims are the ways in which people interact with land over time. Building from this insight, Avery Kolers evaluates existing political theories and develops an attractive alternative. He presents a novel link between political (...) legitimacy and environmental stewardship, and applies these ideas in an extended and balanced discussion of the Israeli-Palestinian dispute. The result is the first systematic normative theory of territory, and an impressive example of applied philosophy. In addition to political theorists and philosophers, scholars and students of sociology, international relations, and human geography will find this book rewarding, as will anyone with wider interests in territory and justice. (shrink)

Bioethical work on solidarity has yielded an array of divergent conceptions. But what do these accounts add to normative bioethics? What is solidarity’s distinctive social normative role? Prainsack and Buyx suggest that solidarity be understood as the ‘putty’ of justice. I argue here that the putty metaphor is deeply insightful and—when spelled out in detail—successfully explicates solidarity’s social normative function. Unfortunately, Prainsack and Buyx’s own account cannot play this role. I propose instead that the putty metaphor supports a conception of (...) solidarity as equity. This proposal enables us to answer whether and when we should act in solidarity, and with whom, while also capturing the putty metaphor and hence answering a basic question: what is solidarity for? (shrink)

On March 31, 2000, the Massachusetts Supreme Judicial court ruled that a contract awarding custody of frozen pre-embryos to the wife upon divorce was unenforceable because it violates public policy. This is the first reported case to address a contract between the clinic and the parties where the contract would have awarded the pre-embryos to one of the gamete providers. The decision in A.Z. v. B.Z. 431 Mass. 150 differs from decisions in the two other courts of last resort deciding (...) related cases where enforcement of contracts was supported. This case represents an important development in the legal doctrines associated with frozen pre-embryos as it explicitly differs from the other courts’ decisions in addressing pre-embryos at the same developmental stage. (shrink)

On March 31, 2000, the Massachusetts Supreme Judicial court ruled that a contract awarding custody of frozen pre-embryos to the wife upon divorce was unenforceable because it violates public policy. This is the first reported case to address a contract between the clinic and the parties where the contract would have awarded the pre-embryos to one of the gamete providers. The decision in A.Z. v. B.Z. 431 Mass. 150 differs from decisions in the two other courts of last resort deciding (...) related cases where enforcement of contracts was supported. This case represents an important development in the legal doctrines associated with frozen pre-embryos as it explicitly differs from the other courts’ decisions in addressing pre-embryos at the same developmental stage. (shrink)

The purpose of this study is to develop a system of corporate ethics based on an understanding and interpretation of the ethical demand of human beings who are in relation with each other according to Emmanuel Levinas' teachings and the responsibility the human being has to and for herself and others whom she encounters based on Paul Ricoeur's teachings on human action, text and hermeneutics. While the philosophies to which we will be referring may not overtly present a normative ethic, (...) we shall convey them in such a way that is reasonably germane to the development of our system of corporate ethics that would, indeed, demonstrate why (and, perhaps, how in some instances) the human being must act in response to the demand of the other whom she encounters. -/- We must not abandon the discussion as it relates to the economy but rather include it in a broader and more comprehensive dialogue about working to promote, support and protect the human dignity of all people using the advancements of technology to improve the human condition. The broader discussion must include but not be limited to developing a working definition of corporate ethics. To engage in discussions about the economy as an indicator for human success, we must speak openly and honestly about all stakeholders that participate and are affected by the economy. Without forsaking other stakeholders, we find the corporation - the entity whose actions have the farthest reaching and, in some cases, longer lasting impact on the human condition - to be an appropriate point of departure for this endeavor. (shrink)

Immanuel Kant is strict about the limits of self-knowledge: our inner sense gives us only appearances, never the reality, of ourselves. Kant may seem to begin his inquiries with an uncritical conception of cognitive limits, but in Kant and the Subject of Critique, Avery Goldman argues that, even for Kant, a reflective act must take place before any judgment occurs. Building on Kant’s metaphysics, which uses the soul, the world, and God as regulative principles, Goldman demonstrates how Kant can (...) open doors to reflection, analysis, language, sensibility, and understanding. By establishing a regulative self, Goldman offers a way to bring unity to the subject through Kant’s seemingly circular reasoning, allowing for critique and, ultimately, knowledge. (shrink)

Thomas Reid was a philosopher who founded the Scottish school of 'common sense'. Much of Reid's work is a critique of his contemporary, David Hume, whose empiricism he rejects. In this work, written after Reid's appointment to a professorship at the university of Glasgow, and published in 1785, he turns his attention to ideas about perception, memory, conception, abstraction, judgement, reasoning and taste. He examines the work of his predecessors and contemporaries, arguing that 'when we find philosophers maintaining that (...) there is no heat in the fire, nor colour in the rainbow … we may be apt to think the whole to be only a dream of fanciful men, who have entangled themselves in cobwebs spun out of their own brain'. Written by one of the Scottish Enlightenment's most important thinkers, this work brings to life the intellectual debates of the time. (shrink)

What exactly is it that makes someone a parent? Many people hold that parenthood is grounded, in the first instance, in the natural derivation of one person's genetic constitution from the genetic constitutions of others. We refer to this view as "Geneticism". In Part I we distinguish three forms of geneticism on the basis of whether they hold that direct genetic derivation is sufficient, necessary, or both sufficient and necessary, for parenthood. Parts two through four examine three arguments for geneticism: (...) the property argument, the causal argument, and the parity argument. We conclude that none of these arguments succeeds. (shrink)

Thomas Aquinas produced a voluminous body of work on moral theory, and much of that work is on virtue, particularly the status and value of the virtues as principles of virtuous acts, and the way in which a moral life can be organized around them schematically. Thomas Osborne presents Aquinas's account of virtue in its historical, philosophical and theological contexts, to show the reader what Aquinas himself wished to teach about virtue. His discussion makes the complexities of Aquinas's (...) moral thought accessible to readers despite the differences between Thomas's texts themselves, and the distance between our background assumptions and his. The book will be valuable for scholars and students in ethics, medieval philosophy, and theology. (shrink)

In a series of recent papers, Jane Friedman has argued that attitudes like wondering, enquiring, and suspending judgement are question-directed and have the function of moving someone from a position of ignorance to one of knowledge. Call such attitudes interrogative attitudes. Friedman insists that all IAs are governed by the following Ignorance Norm: Necessarily, if one knows Q at t, then one ought not have an IA towards Q at t. However, I argue that key premisses in Friedman’s argument actually (...) point towards an opposing conclusion; namely, that IAs are not governed by the Ignorance Norm, and IAs have functions other than moving someone from a position of ignorance to one of knowledge. I conclude that the Ignorance Norm should be rejected. (shrink)

Recognising and responding to injustices that benefit us is a pervasive problem of contemporary life, and arguably a mark of moral seriousness in anyone who presumes to take moral stands at all. In response, a number of authors have defended the view that such benefits normally bring with them prima facie obligations of compensation. This ‘wrongful-benefits’ approach has considerable intuitive plausibility, much of it founded in the financial metaphor that gives it an appearance of precision. Yet while the compensation scenario (...) works reasonably well in one-off cases such as receiving stolen property, it yields incoherent results when facing ongoing structural injustices. In such cases ‘innocence’ is ambiguous and our status as beneficiaries and victims is complex. In contrast, solidarity — understood as a principle of equity requiring that we side with the least well off — provides a better account of duties to respond to structural injustice. In solidarity the agent follows the lead of organised out-groups and defers to their judgment about collective actions to overcome injustice. Solidarity leads us to support the organised group that suffers from the greatest inequity. Solidarity does not use a financial metaphor and thus it neither requires full disgorgement, nor absolves us of further action when we reach the point of net-zero benefit. Rather, solidarity is a principal means for ordinary citizens to promote equity by affirming the equal status of the victims, and to atone for having benefited from injustice, whether they did so willingly or otherwise. (shrink)

Most accounts of why physicians have a duty to treat patients during a pandemic look to the special ethical standards of the medical profession. An adequate account must be deeper and broader: it must set the professional duty alongside other individual commitments and broader social values.

Rising sea levels may sink entire countries. Individualistic solutions to this climate catastrophe, such as those proposed by Meisels and Risse, are inadequate on both Kantian and Lockean criteria. This article concurs with Cara Nine's recent argument that such ‘ecological refugee states’ are entitled to territorial remedies. But Nine's proposal, founded on Locke's ‘sufficiency’ proviso and Nozick's famous application of it to waterholes in the desert, is instructively incorrect. Careful consideration of the distinction between land and territory, and of the (...) structure of Proviso arguments, supports a new theory of how territorial claims can be positive-sum — how the amount of territory can increase even as the land base remains constant or decreases. This normative conception of territory as the ratio of justice to land use provides a better foundation for a political solution to the problem of ecological refugee states and also generates deeper insight into the nature of territory itself. The article thus contributes not only to our thinking about redress for ecological refugees, but also to the burgeoning literatures on territory and on the Lockean Provisos. (shrink)

Solidarity is a significant but poorly understood feature of political life. It is typically conceived, in “associative and teleological” terms, as working together for common political aims. But this conception misses the fact that solidarity requires individuals to will collective ends despite incompletely shared interests. Careful consideration of these elements reveals four “dynamics of solidarity”: its characteristic duties, the durability of commitments made in solidarity, the deference it involves, and its effects over time on agents’ habits and capacities. In this (...) article I describe these dynamics, first contrasting solidarity-given duties with duties of beneficence, justice, and loyalty. These contrasts lay bare the distinctive durability of solidarity, which differs from both the liberal’s commitment to justice and the loyalist’s commitment to the group. I then discuss deference, a feature of solidarity that has implications for individual engagement in political life more generally. Finally, I discuss the effects of solidarity on agents’ intellectual and physical capacities. I conclude by drawing out implications of these dynamics, challenging Tommie Shelby’s influential conception and justification of black solidarity and buttressing Philip Soper’s rejection of the Principle of Autonomy. (shrink)

Based on an earlier analysis that tries to show that existence is a real predicate, I now argue that Descartes’s dream and malicious demon arguments are fallacious. An object that stands external to me (i.e., that exists) is the one thing that I cannot produce by my dreams, and, on phenomenological grounds, I am immediately experiencing an existing object right now. Therefore, in accepting that it is a logical possibility that I am dreaming, either I illicitly conflate an existing object (...) and an object of a dream, or Descartes’s claimthat there are never any sure signs by which being awake can be distinguished from being asleep is a presupposed but unfounded premise. Similarly, Descartes’s malicious demon argument must also be rejected. (shrink)

Based on an earlier analysis that tries to show that existence is a real predicate, I now argue that Descartes’s dream and malicious demon arguments are fallacious. An object that stands external to me (i.e., that exists) is the one thing that I cannot produce by my dreams, and, on phenomenological grounds, I am immediately experiencing an existing object right now. Therefore, in accepting that it is a logical possibility that I am dreaming, either I illicitly conflate an existing object (...) and an object of a dream, or Descartes’s claimthat there are never any sure signs by which being awake can be distinguished from being asleep is a presupposed but unfounded premise. Similarly, Descartes’s malicious demon argument must also be rejected. (shrink)