The ideal moral standard for surgical informed‐consent calls upon surgeons to carry out a disclosure dialogue with patients so they have as full as possible an understanding of the procedure before they sign the informed‐consent form. This study is the first to empirically explore patient preferences regarding disclosure dialogue. Twelve Israelis who underwent life‐saving surgeries participated in a narrative study. Three themes emerged from the analysis: objectification of patients, anxiety provoking processes and information, and lack of information that was essential (...) for patients. Findings contribute to existing debates among surgeons regarding the scope and importance of some disclosure components. Analysis led to our formulation of an augmented subjective model of information disclosure that participants prefer, which extends beyond the immediate present of the surgery to the period after discharge, and until return to routine. Surgeons should be aware of patient preferences in disclosure, and gaps between perceptions of surgeons, and preferences and needs of patients. (shrink)

Background There is little dispute that the ideal moral standard for surgical informed consent calls for surgeons to carry out a disclosure dialogue with patients before they sign the informed consent form. This narrative study is the first to link patient experiences regarding the disclosure dialogue with patient-surgeon trust, central to effective recuperation and higher adherence. Methods Informants were 12 Israelis, aged 29–81, who underwent life-saving surgeries. A snowball sampling was used to locate participants in their initial recovery process upon (...) discharge. Results Our empirical evidence indicates an infringement of patients’ right to receive an adequate disclosure dialogue that respects their autonomy. More than half of the participants signed the informed consent form with no disclosure dialogue, and thus felt anxious, deceived and lost their trust in surgeons. Surgeons nullified the meaning of informed consent rather than promoted participants’ moral agency and dignity. Discussion Similarity among jarring experiences of participants led us to contend that the conduct of nullifying surgical informed consent does not stem solely from constraints of time and resources, but may reflect an underlying paradox preserving this conduct and leading to objectification of patients and persisting in paternalism. We propose a multi-phase data-driven model for informed consent that attends to patients needs and facilitates patient trust in surgeons. Conclusions Patient experiences attest to the infringement of a patient’s right to respect for autonomy. In order to meet the prima facie right of respect for autonomy, moral agency and dignity, physicians ought to respect patient’s needs. It is now time to renew efforts to avoid negligent disclosure and implement a patient-centered model of informed consent. (shrink)

Porcine-derived medical products represent an effective solution for a wide range of human suffering, yet this may contradict Muslim and Jewish religious prohibitions against consuming pig. The present study evaluated the level to which Muslim and Jewish participants are knowledgeable about the conditions permitting porcine-based treatments and explored their attitudes toward the permissibility of these treatments. A questionnaire that presented fifteen medical uses of porcine-derived products was completed by 809 Muslims and 714 Jews. Neither Muslim nor Jewish participants are knowledgeable (...) about the religious rulings of their religions which permit the use of pig for life saving. Participants of both groups objected to the view that porcine-derived materials should be permitted. The findings imply that the attitude toward porcine-derived materials for medical use is contingent upon the knowledge or lack thereof that individuals have regarding the permissibility of such use. We offer useful recommendations to improve the informed consent process before conducting porcine-based treatments. (shrink)

Feelings of guilt are human emotions that may arise if a person committed an action that contradicts basic moral mores or failed to commit an action that is considered moral according to their ethical standards and values. Psychological scholarship distinguishes between altruistic guilt (AG) and deontological guilt (DG). AG results from having caused harm to an innocent victim, either by acting or failing to act, whereas DG is caused by violating a moral principle. Although physicians may be expected to experience (...) frequent feelings of guilt in their demanding and intensive work, it is surprising to find that this issue has not been explored in the professional literature on medical ethics. To that end, we conducted a qualitative study that included personal in-depth interviews with Sunni Muslim gynaecologists. These doctors provide underground infertility care and perform religiously forbidden treatments involving sex selection and gamete donation. They opened their hearts and spoke about the emotionally taxing pangs of conscience they suffer. Analysing their narratives led us to characterize their feelings of guilt as DG. We discuss the causes for their plight and the way they cope with it, compare DG to the concept of moral distress, and call for future research on clinicians’ feelings of guilt and pangs of conscience. (shrink)

Porcine-derived products serve as an effective solution for a wide range of human ailments; however, there may be objections to their use due to Islamic religious prohibitions on consuming products derived from pigs. In order to enhance the cultural competence of medical practitioners who treat Muslim individuals, which constitute about one fifth of the world population, this study aimed at evaluating the knowledge and positions of Muslim patients on this subject. A questionnaire presenting 15 uses of porcine-derived materials was filled (...) out by 809 Muslims. The level of knowledge about the permissibility of these uses and participants’ position on whether it should be approved was assessed. Findings show that Muslims are not familiar with Islamic religious jurisprudence that permits the use of porcine products to save lives after it has undergone an essential transformation known as Istihala. The respondents expressed a negative attitude towards the medical use of porcine-derived substances based on imprecise knowledge about the permissibility of use of porcine-derived materials, devices and treatments. We offer recommendations for improving the informed consent obtained from Muslim patients prior to conducting porcine-based treatments. (shrink)

One of the unspoken issues in public discourse in most countries is the racism of patients toward nurses who originate from a different ethnic group than theirs. The aim of the present study is to examine whether patients' racism toward nurses increases as the invasiveness of treatment rises. This study was conducted in Israel, a highly conflictual society where Jews and Arabs live together and meet in the same health facilities. Despite the tension and sometimes animosity caused by the political (...) situation, members of each group regularly encounter members of the other group during the provision of health‐care, both as patients and as medical and nursing staff. A study questionnaire which presented nine nursing treatments of diverse levels of invasiveness was filled out by Arab and Jewish participants. They were asked to convey their preference for an Arab or a Jewish nurse for each treatment. Results of Logistic Regression Analyses reveal that in both sectors, racism toward nurses increases as the treatment invasiveness rises. These findings are discussed in light of the concept of social distance, and serve as an empirical basis for several proposed practical recommendations for eradicating racism against nurses. (shrink)

A rich literature in bioethics argues against the use of anonymous gamete donation in the name of the ‘interest in knowing one’s genetic origins’. This interest stems from medical as well as psychosocial and identity reasons. The term ‘genealogical bewilderment’ has been coined to express the predicament of those deprived of access to information about their origins. Another rich body of literature in bioethics discusses arguments for and against posthumous-assisted reproduction (PAR), with a recent focus on PAR that is initiated (...) by the parents of a deceased man (rather than his partner). This paper revisits arguments against PAR, in light of arguments regarding the interest in knowing one’s genetic origins. Limiting the discussion to the specific context of parent-initiated PAR (PIPAR), we argue that the use of cryopreserved sperm from a deceased identifiable man in the context of PIPAR may be ethically preferable when compared with the use of anonymous donor sperm, since it allowsgenealogical certainty, that is, giving the prospective child access to information about the identity, life story and ancestry of the genetic progenitor as well asgenealogical embeddedness, that is, close relationship with extended family members. (shrink)

While extensive scholarship has been dedicated to the emotional experiences of transplant patients, little is known about the emotional experiences of transplant co‐ordinators. Semi‐structured face‐to‐face interviews conducted with ten transplant co‐ordinators who have worked for more than 20 years in this job. The transplant co‐ordinators spoke of negative feelings and moral distress with regard to futile care of deceased donor family members as well as of living donors. Transplant co‐ordinators experience intense negative feelings, emotional pain, and moral distress on a (...) daily basis. Transplant co‐ordinators play a pivotal role in the process of obtaining consent for live or dead donation of organ; however, their well‐being and job satisfaction are impaired by contradictions between their moral values and the tasks they are instructed to perform. The study exposes the silent emotional suffering of transplant co‐ordinators; main findings show that the transplant co‐ordinators are torn between contradictory expectations and a gap between values and praxis. It is recommended to offer them training and support for the sake of their retention. (shrink)

Transplant coordinators play a pivotal role in the process of obtaining consent for live or dead donation of organs. The objective of the project is to unveil emotional experiences and ethical conduct of transplant coordinators using a qualitative research methodology. Ten transplant coordinators who have worked for more than 20 years in this job were recruited by using a purposive sampling technique. The transplant coordinators spoke of negative feelings and moral distress with regard to futile care of family members of (...) deceased donors as well as of living donors. Transplant coordinators experience moral distress on a daily basis; being compelled to compromise their integrity causes moral distress and moral residue, hence, training and support should be offered to them. (shrink)

This study examines the impact of the level of religious observance on the attitudes toward end‐of‐life (EOL) decisions and euthanasia of Jews in Israel—where euthanasia is illegal—as compared to Jews living in the USA, in the states where euthanasia is legal. A self‐reporting questionnaire on religiosity and personal beliefs and attitudes regarding EOL care and euthanasia was distributed, using a convenience sample of 271 participants from Israel and the USA. Findings show that significant differences were found in attitudes between Jews (...) of different levels of religious observance with respect to patient autonomy, right to die with dignity, and dying in familiar and supportive surroundings. The USA and Israeli Jews have similar knowledge regarding EOL care and expressed similar attitudes and perceptions toward the issues of authority of medical staff and religious figures and patient's autonomy. Findings indicate that the level of religious observance has more potency in shaping their attitudes and perceptions of EOL decisions than the state law. We conclude by discussing the implications of our findings with regard to multicultural health systems and providing practical recommendations. (shrink)

Purpose To examine process factors that either facilitate or inhibit learning medical ethics during case-based learning. Methods A qualitative research approach using microanalysis of transcribed videotaped discussions of three consecutive small-group learning sessions on medical ethics teaching for three groups, each with 10 students. Results This research effort revealed 12 themes of learning strategies, divided into 6 coping and 6 evasive strategies. Cognitive-based strategies were found to relate to Kamin's model of critical thinking in medical education, thereby supporting our distinction (...) between the themes of coping and evasive strategies. The findings also showed that cognitive efforts as well as emotional strategies are involved in discussions of ethical dilemmas. Based on Kamin's model and the constructivist learning theory, an examination of the different themes within the two learning strategies—coping and evasive—revealed that these strategies may be understood as corresponding to process factors either facilitating or inhibiting MET in SGL, respectively. Conclusions Our classification offers a more nuanced observation, specifically geared to pinpointing the desired and less desired process factors in the learning involved in MET in the SGL environment. Two key advantages of this observation are: it brings to the forefront process factors that may inhibit and not merely facilitate MET in SGL and it acknowledges the existence of emotional and not just cognitive process factors. Further enhancement of MET in SGL may thus be achieved based on these observations. (shrink)

In this paper, I explore the possibility of developing a Kantian account of the ethics of belief by deploying the tools provided by Kant's ethics. To do so, I reconstruct epistemic concepts and arguments on the model of their ethical counterparts, focusing on the notions of epistemic principle, epistemic maxim and epistemic universalizability test. On this basis, I suggest that there is an analogy between our position as moral agents and as cognizers: our actions and our thoughts are subject to (...) the same rational norm. (shrink)

In Mindblindness, Simon Baron-Cohen presents a model of the evolution and development of "mindreading." He argues that we mindread all the time, effortlessly, automatically, and mostly unconsciously. It is the natural way in which we interpret, predict, and participate in social behavior and communication. We ascribe mental states to people: states such as thoughts, desires, knowledge, and intentions. Building on many years of research, Baron-Cohen concludes that children with autism, suffer from "mindblindness" as a result of a selective impairment in (...) mindreading. For these children, the world is essentially devoid of mental things. Baron-Cohen develops a theory that draws on data from comparative psychology, from developmental, and from neuropsychology. He argues that specific neurocognitive mechanisms have evolved that allow us to mindread, to make sense of actions, to interpret gazes as meaningful, and to decode "the language of the eyes." A Bradford Book. (shrink)

Deliberation and democratic legitimacy -- Moral pluralism and political consensus -- Associations and democracy (with Joel Rogers) -- Freedom of expression -- Procedure and substance in deliberative democracy -- Directly-deliberative polyarchy (with Charles Sabel) -- Democracy and liberty -- Money, politics, political equality -- Privacy, pluralism, and democracy -- Reflections on deliberative democracy -- Truth and public reason.

We use a new model of metarepresentational development to predict a cognitive deficit which could explain a crucial component of the social impairment in childhood autism. One of the manifestations of a basic metarepresentational capacity is a ‘ theory of mind ’. We have reason to believe that autistic children lack such a ‘ theory ’. If this were so, then they would be unable to impute beliefs to others and to predict their behaviour. This hypothesis was tested using Wimmer (...) and Perner’s puppet play paradigm. Normal children and those with Down’s syndrome were used as controls for a group of autistic children. Even though the mental age of the autistic children was higher than that of the controls, they alone failed to impute beliefs to others. Thus the dysfunction we have postulated and demonstrated is independent of mental retardation and specific to autism. (shrink)

An examination of the controversial "theory of mind" hypothesis, which states that children with autism are unable to comprehend other people's mental states. The theory relates to the most fundamental questions of normal development as well as to autism i.

The use of artificial intelligence (AI) to aid legal decision making has become prominent. This paper investigates the use of AI in a critical issue in employment law, the determination of a worker’s status—employee vs. independent contractor—in two common law countries (the U.S. and Canada). This legal question has been a contentious labor issue insofar as independent contractors are not eligible for the same benefits as employees. It has become an important societal issue due to the ubiquity of the gig (...) economy and the recent disruptions in employment arrangements. To address this problem, we collected, annotated, and structured the data for all Canadian and Californian court cases related to this legal question between 2002 and 2021, resulting in 538 Canadian cases and 217 U.S. cases. In contrast to legal literature focusing on complex and correlated characteristics of the employment relationship, our statistical analyses of the data show very strong correlations between the worker’s status and a small subset of quantifiable characteristics of the employment relationship. In fact, despite the variety of situations in the case law, we show that simple, off-the-shelf AI models classify the cases with an out-of-sample accuracy of more than 90%. Interestingly, the analysis of misclassified cases reveals consistent misclassification patterns by most algorithms. Legal analyses of these cases led us to identify how equity is ensured by judges in ambiguous situations. Finally, our findings have practical implications for access to legal advice and justice. We deployed our AI model via the open-access platform, https://MyOpenCourt.org/, to help users answer employment legal questions. This platform has already assisted many Canadian users, and we hope it will help democratize access to legal advice to large crowds. (shrink)

The aim of this paper is to explore Kant’s account of normativity through the prism of the distinction between the natural and the human sciences. Although the pragmatic orientation of the human sciences is often defined in contrast with the theoretical orientation of the natural sciences, I show that they are in fact regulated by one and the same norm, namely reason’s demand for autonomy.

If updating with E has the same result across all epistemically possible worlds, then the agent has no uncertainty as to the behavior of the update, and we may call it a transparent update. If an agent is uncertain about the behavior of an update, we may call it opaque. In order to model the uncertainty an agent has about the result of an update, the same update must behave differently across different possible worlds. In this paper, I study opaque (...) updates using a simple system of dynamic epistemic logic suitably modified for that purpose. The paper highlights the connection between opaque updates and the dynamic-epistemic principles Perfect-Recall and No-Miracles. I argue that opaque updates are central to contemporary discussions in epistemology, in particular to externalist theories of knowledge and to the related problem of epistemic bootstrapping, or easy knowledge. Opaque updates allow us to explicitly investigate a dynamic form of uncertainty, using simple and precise logical tools. (shrink)

While it is well known that Kant’s transcendental idealism forbids the transcendent use of reason and its ideas, what had been underexplored until the last decade or so is his account of the positive use of reason’s ideas as it is expounded in the “Appendix” of the Critique of Pure Reason. The main difficulty faced by his account is that while there is no doubt that for Kant we need to rely on the ideas of reason in order to gain (...) knowledge of the empirical world, the justificatory grounds for our use remain unclear. Commentators have suggested various ways of addressing this worry. Some emphasize that reason’s demand for systematicity is purely methodological; others that the assumption that nature itself is systematically unified is transcendentally necessary. Some simply deem Kant’s account “extremely self-contradictory.” What is clear is that if neither the presupposition of nature’s systematic unity nor the command to seek this unity have any justification, reason’s regulative function, which plays a crucial role in Kant’s account of cognition, also lacks justification. This would be a disastrous result, for it would threaten the very possibility of cognition and its progress. This chapter proposes to tackle this problem from a new angle by exploring the role of reason’s feelings in Kant’s account. While the relationship between practical reason and feeling has been explored at length in the literature, the relationship between theoretical reason and feeling has not, and my aim is to suggest that doing so can shed new light on reason’s cognitive activity. For focusing on the fact that theoretical reason’s need manifests itself as a feeling will enable me to reassess how this need is met through reason’s regulative use of its ideas. (shrink)

This paper argues that contrary to what is often thought, virtue for Kant is not just a matter of strength of will; it has an essential affective dimension. To support this claim, I show that certain affective dispositions, namely moral feelings and desires, are virtuous in the sense that they are constitutive of virtue at the affective level. There is thus an intrinsic connection between an agent’s practice of virtue and the cultivation of her affective dispositions.

In the recent literature on the issue, a number of commentators have argued that Kant’s aesthetic theory commits him to the position that nothing is ugly. For instance, in ‘Why Kant finds nothing ugly’, Shier argues that ‘within Kant’s aesthetics, there cannot be any negative judgments of taste’ (Shier (1998): 413). And in ‘Kant’s problems with ugliness’, Thomson claims that ‘Kant’s aesthetic theory precludes […] ugliness’ (Thomson (1992): 107). In other words, as it is presented in some of the literature, (...) Kant’s account of aesthetic judgment seems to preclude him from accounting for the possibility of ugliness. A number of reasons have been put forward to explain why there can be no ugliness for Kant. Some have to do with his account of experience in general. Others have to do with the very nature of the free play between imagination and understanding. Of course, the real source of the problem is that the Critique of Judgment does not actually discuss ugliness, so commentators are left with the task of filling in the gaps. This paper aims to argue that Kant’s account of aesthetic judgment commits him not only to the existence of the ugly, but to the distinction between two kinds of ugliness. To support this claim, I will start from the premise that if there is to be room for ugliness, it should be defined as the contrary of beauty. However, I will suggest that Kant’s account of beauty can be negated in two ways, one that gives rise to impure ugliness and the other to pure ugliness. I will examine them in turn, first by showing that impure ugliness is the contrary of beauty insofar as it contravenes our interests and produces a desire to dispose of it, whereas beauty is necessarily disinterested for Kant. In the second section, I will use Kant’s definition of judgments of pure beauty to carve a space for an account of pure ugliness. For, it should present all the characteristics that make it “pure” whilst replacing the characteristics that make it beautiful with the ones that make it ugly. On this basis, I will define pure ugliness as the disinterested displeasure caused by the experience of what I will call “foul play” between the imagination and the understanding. (shrink)

Why do children with autism have such trouble developing normal social understanding of other people's feelings? This new edition updates the field by linking autism research to the newest methods for studying the brain.

In line with familiar portrayals of Kant's ethics, interpreters of his philosophy of education focus essentially on its intellectual dimension: the notions of moral catechism, ethical gymnastics and ethical ascetics, to name but a few. By doing so, they usually emphasise Kant's negative stance towards the role of feelings in moral education. Yet there seem to be noteworthy exceptions: Kant writes that the inclinations to be honoured and loved are to be preserved as far as possible. This statement is not (...) only at odds with Kant's general claim that education should not encourage feelings, but more importantly, it encourages a feeling that is in many ways paradigmatically un-Kantian. How are we to understand the fact that of all feelings, the love of honour should be preserved? To answer this question, I begin by clarifying the reasons behind Kant's negative stance towards feelings in moral education. I then turn to his account of the feeling of love of honour. After distinguishing between its good and its bad forms, I consider two ways of making sense of the positive role Kant assigns to it. The first, modest reading will suggest that the feeling of love of honour is morally useful because it has two functions: an epistemic one, and a motivational one. The second, more ambitious reading will suggest that the feeling of love of honour enables the child to experience her inner worth as bearer of value. (shrink)

The aim of this paper is to show that for Kant, a combination of epigenesis and monogenesis is the condition of possibility of anthropology as he conceives of it and that moreover, this has crucial implications for the biological dimension of his account of human nature. More precisely, I begin by arguing that Kant’s conception of mankind as a natural species is based on two premises: firstly the biological unity of the human species (monogenesis of the human races); and secondly (...) the existence of ‘seeds’ which may or may not develop depending on the environment (epigenesis of human natural predispositions). I then turn to Kant’s account of man’s natural predispositions and show that far from being limited to the issue of races, it encompasses unexpected human features such as gender, temperaments and nations. These predispositions, I argue, are means to the realisation of Nature’s overall purpose for the human species. This allows me to conclude that man’s biological determinism leads to the species’ preservation, cultivation and civilisation. (shrink)

On my interpretation of Kant, feeling plays a central role in the mind: it has the distinct function of tracking and evaluating our activity in relation to ourselves and the world so as to orient us. In this article, I set out to defend this view against a number of objections raised by Melissa Merritt and Uri Eran. I conclude with some reflections on the fact that, despite being very different, Merritt and Eran’s respective views of Kantian feelings turn out (...) to have something potentially problematic in common: they blur the boundary between feelings and other kinds of mental states. (shrink)

This article concerns kime, a somatic code used in the ‘empty hand’ Japanese martial art of karate. Kime is a tactile-kinesthetic entity born out of practice, coming into being in a social setting through the specific organization of the body-self, fusing body and self into one stance and movement. Kime is entirely embodied, yet can only be operated and recognized inter-subjectively. It plays a crucial role in combat and at the same time also indicates a spiritual possibility that depends on (...) eradication of emotion and volition. An analysis of kime shows how cultural understandings can emerge without necessarily using symbolic representations or verbal discourse in their construction. These somatic non-dual understandings can come to form an entire world-of-meaning directly through the moving body. The moving body shapes itself within itself even as it interacts with and contributes to shape its immediate environment. This is a world-of-meaning that includes complex inter-subjectivity founded on the speed and ambiguity of the interface between the innerness and the outerness of the body. (shrink)

The man behind the New York Times Magazine ’s immensely popular column “The Ethicist”–syndicated in newspapers across the United States and Canada as “Everyday Ethics”–casts an eye on today’s manners and mores with a provocative, thematic collection of advice on how to be good in the real world. Every week in his column on ethics, Randy Cohen takes on conundrums presented in letters from perplexed people who want to do the right thing (or hope to get away with doing the (...) wrong thing), and responds with a skillful blend of moral authority and humor. Cohen’s wisdom and witticisms have now been collected in The Good, the Bad & the Difference , a collection of his columns as wise and funny as a combination of “Dear Abby,” Plato, and Mel Brooks. The columns are supplemented with second thoughts on (and sometimes complete reversals of) his original replies, follow-up notes on how his advice affected the actions of various letter writers, reactions from readers both pro and con, and observations from such “guest ethicists” as David Eggers and the author’s mom. Each chapter also features an “Ethics Pop Quiz,” and readers will be invited to post their answers on the book’s Web site. The best of them will appear in a future paperback edition of the book. The Good, the Bad & the Difference is divided into seven sections: •Civic Life (what we do in public) •Family Life (what we do at home) •Social Life (what we do in other people’s homes) •Commercial Life (what we do in situations where money is a factor) •Medical Life (the rights and obligations of patients and caregivers) •Work Life (ethics for the professional sphere) •School Life (moral questions from and about kids) Each section provides a window into how we live today, shedding light on the ways in which a more ethical approach to the decisions we make, and to our daily behavior, can make a big difference in how we feel about ourselves tomorrow. (shrink)

Neokantismes: la marque du pluriel indique d'emblee que le mot d'ordre des annees 1865 Retour a Kant! regroupe differentes ecoles. Les auteurs dont les textes inedits en francais se trouvent ici rassembles et traduits, appartiennent en effet soit a l'ecole de Marbourg (H. Cohen, P. Natorp et E. Cassirer) soit a l'ecole de Bade (W. Windelband, H. Rickert, E. Lask, J. Cohn). Le point commun du neokantisme logique des premiers et du neokantisme axiologique des seconds consiste en une volonte d'asseoir (...) le positivisme sur un fondement philosophique respectueux de l'attitude phenomenologique. Kant apparut donc a tous ces penseurs comme science rigoureuse a condition toutefois de ne considerer le sujet transcendantal que comme une fonction logique de la pensee qui elabore la forme et le contenu de la connaissance. A condition egalement de ne pas limiter l'entreprise critique a la physique, mais de l'etendre au fondement de toutes les sciences de l'esprit. (shrink)