Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)

The worldwide COVID-19 pandemic has shed more light on the difficulty of making health care decisions integrating scientific knowledge and values associated to life and death issues, human suffering, quality of life, economic losses, liberty of movement, etc. But the difficulties related to health care decisions and the use of innovative drugs or technologies are not new, and many countries have created agencies that have the mandate to evaluate new technologies in health care. Health Technological Assessment (HTA) reports’ aim is (...) to guide the decision makers in these difficult matters. There are two ethical components in HTA. The first is the report’s presentation of an ethical evaluation of the technology. The second is the value-ladenness of the HTA decision-making process itself. When implicit value judgments are not elicited, the justification of the final decision cannot be transparent. The present paper aims to identify and elicit the implicit value-judgments related to each step of the HTA process. This research is grounded on an applied ethics decision-making paradigm based on the role of value judgments in the decision-making process. The first part discusses two different approaches to values and value judgments in HTA. In the second part, citations mentioning value judgments extracted from a systematic review on the integration of ethics into HTA were categorized to elicit the value judgments and their criteria for each different HTA decision-making steps. The results show that there are 18 decision-making steps in the HTA process where 23 implicit value-judgments can be recognized. The range of these value judgments encompasses the whole HTA process: from the initial request, the presenting of the principal issues, to the final report’s dissemination. Since stakeholders need to understand which value judgments the conclusion of a report relies on, eliciting the implicit value judgments in the HTA decision-making process should yield more transparency. (shrink)

The Just War principle of jus ad bellum explicitly requires a reasonable prospect of success; the prevailing view about personal self-defence is that it can be justified even if the prospect of success is low. This chapter defends the existence of this distinction and goes on to explore the normative basis of this difference between defensive war and self-defence and its implications. In particular, the chapter highlights the rationale of the ‘success condition’ within Just War thinking and argues that this (...) condition is grounded in assumptions about the nature of political authority and responsibility that do not apply to personal self-defence. This important difference is commonly ignored or side-lined by contemporary theorists who regard the principles of these two types of conflict as very closely aligned and the moral differences between them as matters of degree only. (shrink)

La tension entre le non-dualisme et le dualisme domine toute l’histoire du Vedanta. En face de l’advaita de Śaṅkara, le système de Madhva, auquel cette étude est consacrée, représente l’extrême dualisme, dvaita. Cependant Madhva, après avoir posé la réalité irréductible de la différence entre Dieu et le monde, a comme compensé cette scission de l’être par l’affirmation que tout être autre que l’Être absolu est dépendant de celui-ci, seul Dieu ne dépendant que de lui-même. L’originalité du système de Madhva est (...) d’inventer une relation nouvelle entre l’Être et les êtres. Seul l’Être est capable de faire exister des êtres différents de lui et totalement dépendants de lui ; Dieu permet à toute réalité d’être, et d’être ce qu’elle est. (shrink)

In this chapter, I offer an overview of current scholarly debates on Plato's Lysis. I also argue for my own interpretation of the dialogue. In the Lysis, Socrates argues that all love is motivated by the desire for one’s own good. This conclusion has struck many interpreters as unattractive, so much so that some attempt to reinterpret the dialogue, such that it either does not offer an account of interpersonal love, or that it offers an account on which love is, (...) in fact, an other-regarding state. Others, notably Vlastos, criticize Socrates’ theory as implausibly and repellently egoistic. I maintain, against the first group, that Socrates is indeed offering an egoistic theory of love. I argue, against the second, that, while Socrates’ theory may be repellent, it possesses considerable explanatory power and avoids certain weaknesses which infect contemporary approaches to love. (shrink)

In his Confessions, Saint Augustine narrates the intense struggle of a self divided and dissociated from itself in the throes of becoming other than what it is. His attempts at conversion and self-transformation involve a struggle with his habituated self; his habits, ever resistant to change, impede his becoming. Insofar as Augustine disavows the significance of his self ’s multiplicity to enabling his capacity to convert, he comes short of providing us with an account of the self ’s capacity for (...) change. It is on this point that reading Confessions with Deleuze and Guattari’s concept of “the body without organs” (a term that describes creative experimentation with forms of life and subjectivity) helps deepen our insights into the self ’s becoming. Such a minor reading of Confessions can be achieved by extracting the concept of “formless matter” (a term Augustine uses to designate the primacy of the capacity for mutability in creation) from his reading of Genesis in order to bring it to bear on thinking through the work of the self that enables his capacity for conversion. Beneath the theological account that privileges heaven, because of its changeless “cleaving to God,” over the ever-transient creatures of the earth, there lies an ontological account wherein formless matter, the capacity to change, plays a pivotal role in ethical becoming and capacitation. In his process of conversion, Augustine breaks his habituated patterns of sensing and makes himself into a “body without organs” in order to be capacitated by alterity, and in so doing enables a becoming different that takes place with and through difference. (shrink)

What are the moral challenges that confront doctors as they manage healthcare institutions? How do we build trust in medical organisations? How do we conceptualize moral action? Based on accounts given by senior doctors from organisations throughout the UK, this book discusses the issues medical leaders find most troubling and identifies the moral tensions they face. Moral Leadership in Medicine examines in detail how doctors protect patients' interests, implement morally controversial change, manage colleagues in difficulty and rebuild trust after serious (...) medical harm. The book discusses how leaders develop moral narratives to make sense of these situations, how they behave while balancing conflicting moral goals and how they influence those around them to do the right thing in difficult circumstances. Based on empirical ethical analysis, this volume is essential reading for clinicians in leadership roles and students and academics in the fields of healthcare management, medical law and healthcare ethics"--Provided by publisher. (shrink)

Interviews met tien hedendaagse Nederlandse filosofen over hun manier van denken.

Contesting Extinctions: Decolonial and Regenerative Futures critically interrogates the discursive framing of extinctions and how they relate to the systems that bring about biocultural loss. The chapters in this multidisciplinary volume examine approaches to ecological and social extinction and resurgence from a variety of fields, including environmental studies, literary studies, political science, and philosophy. Grounding their scholarship in decolonial, Indigenous, and counter-hegemonic frameworks, the contributors advocate for shifting the discursive focus from ruin to regeneration. -/- .

The Educational Significance of Human and Non-Human Animal Interactions explores human animal/non-human animal interactions from different disciplinary perspectives, from education policy to philosophy of education and ecopedagogy. The authors refute the idea of anthropocentrism (the belief that human beings are the central or most significant species on the planet) through an ethical investigation into animal and human interactions, and 'real-life' examples of humans and animals living and learning together. In doing so, Rice and Rud outline the idea that interactions between (...) animals and humans are educationally significant and vital in the classroom. (shrink)

" L'expérience esthétique, n'est autonome, écrit Adorno, que lorsqu'elle se débarrasse du goût culinaire, la voie qui y conduit passe par le désintéressement.... ", à ce lointain écho de la rupture transcendantale au sein de l'Esthétique du goût, à ce déni pur et simple de la sensibilité et du plaisir " sensuel et grossier ", comme principes du goût, on préfèrera, ici, une présentation non morale, ou non kantienne, de la notion de goût ; une réflexion qui, de Voltaire et (...) Montesquieu à Brillat-Savarin, prend en compte le goût " lui-même " et non seulement sa métaphore ; on cherchera le raffinement et la délicatesse du goût non seulement dans les sphères supérieures de l'existence, mais aussi dans les relations primordiales de la vie, celle de la consommation, de la préparation et de la production, ainsi que le voulait Charles Fourier, (beau) frère de Brillat-Savarin. Dans les deux essais, ici étudiés, s'impose, en effet, la dimension organique et sensuelle mais néanmoins esthétique du goût, dans les choses de la nature et de l'art. L'Essai sur le goût de Montesquieu et La Physiologie du goût de Brillat-Savarin, témoignent, dans des domaines distincts mais étroitement liés, de l'Esthétique comme " science de la sensibilité ". Par leur rapprochement, on entend montrer que le goût n'est pas une " chose mentale " mais l'affaire de tous les sens, que l'âme qui goûte est l'âme qui sent. On cherchera à dépasser le divorce, qui semble s'être installé, entre le jugement esthétique et le plaisir esthétique, on tentera par là, de restaurer la continuité entre les deux pôles de la sensibilité gustative et de redonner, par une réévaluation du goût culinaire, une assise réelle, vitale et réconfortante à la notion de goût, comme sentiment délicat. (shrink)

This research aims to explore the relationship between corporate governance and CSR: What are the major factors that play a direct role in the establishment of this relationship? How does context and institutional background impact upon the relationship between CSR and Governance? Using in-depth semi-structured interviews from two types of governance systems in three countries over three years, this study has demonstrated that in practice, within different settings, CSR is being used both as a strategy as well as a reaction (...) to different drivers. We call this adaptive governance where governance can be defined as a flexible system of action incorporating strategic and monitoring activities that determines the way a company enacts its responsibilities to its shareholders and stakeholders and which is determined at any given time by the interrelationship of institutional drivers and behavioural norms. Governance systems and their interrelationships with CSR are demonstrated as fluid according to the national and institutional context, economic situation and industry impact. In the eyes of practitioners corporate governance includes both structural and behavioural factors as well as responsibilities and actions towards shareholders and stakeholders. Contextual factors that this research highlights to be important to the incorporation of CSR into governance include the economic environment, national governance system, regulation and soft law, shareholders, national culture, behavioural norms and industry impacts. Hypotheses on the impact of institutional contexts, industry impacts and economic situations on different types of CSR actions are proposed for further research. (shrink)

"In recent years, we have grown accustomed to philosophical language that is intensely self-conscious and rhetorically thick, often tragic in tone. It is enlivening to read Bergson, who exerts so little rhetorical pressure while exacting such a substantial effort of thought.... Bergson's texts teach the reader to let go of entrenched intellectual habits and to begin to think differently—to think in time.... Too much and too little have been said about Bergson. Too much, because of the various appropriations of his (...) thought. Too little, because the work itself has not been carefully studied in recent decades."—from Thinking in Time Henri Bergson, whose philosophical works emphasized motion, time, and change, won the Nobel Prize for Literature in 1927. His work remains influential, particularly in the realms of philosophy, cultural studies, and new media studies. In Thinking in Time, Suzanne Guerlac provides readers with the conceptual and contextual tools necessary for informed appreciation of Bergson's work. Guerlac's straightforward philosophical expositions of two Bergson texts, Time and Free Will and Matter and Memory, focus on the notions of duration and memory—concepts that are central to the philosopher's work. Thinking in Time makes plain that it is well worth learning how to read Bergson effectively: his era and our own share important concerns. Bergson's insistence on the opposition between the automatic and the voluntary and his engagement with the notions of "the living," affect, and embodiment are especially germane to discussions of electronic culture. (shrink)

Translator's Preface LA LOGIQUE DE HUSSERL, etude sur "Logique for- melle et logique transcendentale" the original of the present translation, was published ...

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of Practice throughout the (...) study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)

Individuals are faced with the many opportunities to pirate. The decision to pirate or not may be related to an individual''s attitudes toward other ethical issues. A person''s ethical and moral predispositions and the judgments that they use to make decisions may be consistent across various ethical dilemmas and may indicate their likelihood to pirate software. This paper investigates the relationship between religion and a theoretical ethical decision making process that an individual uses when evaluating ethical or unethical situations. An (...) ethical decision making model was studied for general unethical scenarios and for the unethical behavior of software piracy. The research model was tested via path analysis using structural equation modeling and was found to be appropriate for the sample data. The results suggest that there is a relationship between religion and the stages of an ethical decision making process regarding general ethical situations and software piracy. (shrink)

Some jurisdictions that have decriminalized assisted dying exclude psychiatric patients on the grounds that their condition cannot be determined to be irremediable, that they are vulnerable and in need of protection, or that they cannot be determined to be competent. We review each of these claims and find that none have been sufficiently well-supported to justify the differential treatment psychiatric patients experience with respect to assisted dying. We find bans on psychiatric patients’ access to this service amount to arbitrary discrimination. (...) Proponents of banning the practice ignore or overlook alternatives to their proposal, like an assisted dying regime with additional safeguards. Some authors have further criticized assisted dying for psychiatric patients by highlighting allegedly problematic practices in those countries which allow it. We address recent evidence from the Netherlands, showing that these problems are either misrepresented or have straightforward solutions. Even if one finds such evidence troubling despite our analysis, other jurisdictions need not adopt every feature of the Dutch system. (shrink)

: This essay examines the increasing commodification of the body with respect to tissues, gametes, and embryos. Such commodification contributes to a diminishing sense of human personhood on an individual level, even as it erodes commitments to human flourishing at the societal level. After the case for social harm resulting from the increasing commodification of the body is made, the question becomes whether that harm is best remedied by following any of three approaches by which government traditionally seeks to promote (...) the flourishing of its citizens. The author concludes that it is not, and that what is needed is a pragmatic and somewhat casuistic approach to the regulation of contested commodities--that which legal scholar Margaret Jane Radin calls "incomplete commodification.". (shrink)

summary, crtiques, strengths and limitation of the article.

From yoga to the Anthropocene to feminist theory, recent calls to ‘decolonise’ have resulted in a resurgence of the term. This article problematises the language of the decolonial within feminist theory and pedagogy, problematising its rhetoric, particularly in the context of the US. The article considers the romanticised transnational solidarities produced by decolonial rhetoric within feminist theory, asking, among other questions: What are the assumptions underpinning the decolonial project in feminist theory? How might the language of ‘decolonising’ serve to actually (...) de-politicise feminism, while keeping dominant race logics in place? Furthermore, how does decolonial rhetoric in sites such as the US continue to romanticise feminist solidarities while positioning non-US-born women of colour at the pedagogical end of feminist theory? I argue that ‘decolonial’, in its current proliferation, is mainstreamed uncritically while serving as a catachresis within feminist discourse. This article asks feminism to reconsider its ease at an incitement to decolonise as a caution for resisting the call to decolonise as simply another form of multicultural liberalism that masks oppression through imagined transnational solidarities, while calling attention to the homogenous construction of the ‘Global South’ within decolonising discourse. (shrink)

The current process towards formalization within evaluation research, in particular the use of pre-set standards and the focus on predefined outcomes, implies a shift of ownership from the people who are actually involved in real clinical ethics support services in a specific context to external stakeholders who increasingly gain a say in what ‘good CESS’ should look like. The question is whether this does justice to the insights and needs of those who are directly involved in actual CESS practices, be (...) it as receivers or providers. We maintain that those actually involved in concrete CESS practices should also be involved in its evaluation, not only as respondents, but also in setting the agenda of the evaluation process and in articulating the criteria by which CESS is evaluated. Therefore, we propose a participatory approach to CESS evaluation. It focuses on the concrete contexts in which CESS takes place, reflective and dialogical learning processes, and how to be democratic and inclusive. In particular, this approach to CESS evaluation is akin to realist evaluation, dialogical evaluation, and responsive evaluation. An example of a participatory approach to evaluating CESS is presented and some critical issues concerning this approach are discussed. (shrink)

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a case (...) was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. (shrink)

Discusses the ethical issues involved in the use of human embryonic stem cells in regenerative medicine.

The standard medical case report often reduces patients and caregivers to complexes of medical facts and clinical decisions. Restructuring the genre itself to acknowledge the human dimensions of both patients and physicians allows questions of human values to regain their stature as integral components of the discourse.

A wider social stage -- Girls will be boys : gender, envy, and the Freudian social contract -- Anna-Antigone : experiments in group upbringing -- The defense of psychoanalysis/the anxiety of politics -- Conclusion : ego politics.

Scientists and decision makers rely on climate models for predictions concerning future climate change. Traditionally, physical processes that are key to predicting extreme events are either directly represented or indirectly represented. Scientists are now replacing physically based parameterizations with neural networks that do not represent physical processes directly or indirectly. I analyze the epistemic implications of this method and argue that it undermines the reliability of model predictions. I attribute the widespread failure in neural network generalizability to the lack of (...) process representation. The representation of climate processes adds significant and irreducible value to the reliability of climate model predictions. (shrink)

I argue that in the Phaedo, Plato maintains that the soul is located in space and is capable of locomotion and of interacting with the body through contact. Numerous interpreters have dismissed these claims as merely metaphorical, since they assume that as an incorporeal substance, the soul cannot possess spatial attributes. But careful examination of how Plato conceives of the body throughout his corpus reveals that he does not distinguish it from the soul in terms of spatiality. Furthermore, assigning spatial (...) attributes to the soul plays an important role in Plato’s account of the relation of body and soul. (shrink)

The medical record, as a managerial, historic, and legal document, serves many purposes. Although its form may be well established and many of the cases documented in it routine in medical experience, what is written in the medical record nevertheless records decisions and actions of individuals. Viewed as an interpretive text, it can itself become the object of interpretation. This essay applies literary theory and methodology to the structure, content, and writing style(s) of an actual medical record for the purpose (...) of exploring the relationship between the forms and language of medical discourse and the daily decisions surrounding medical treatment. The medical record is shown to document not only the absence of a consistent treatment plan for the patient studied but also a breakdown in communication between different health professionals caring for that patient. The paper raises questions about the kind of education being given to house staff in this instance. The essay concludes with a consideration of how such situations might be more generally avoided. (shrink)