Clinical ethics support services are experiencing a phase of flourishing and of growing recognition. At the same time, however, the expectations regarding the acceptance and the integration of traditional CES services into clinical processes are not met. Ethics rounds as an additional instrument or as an alternative to traditional clinical ethics support strategies might have the potential to address both deficits. By implementing ethics rounds, we were able to better address the needs of the clinical sections and to develop a (...) more comprehensive account of ethics quality in our hospital, which covers the level of decisions and actions, and also the level of systems and processes and aspects of ethical leadership. (shrink)

A wealthy eccentric bought a house in a neighborhood I know.  The house was surrounded by a beautiful display of grass, plants, and flowers, and it was shaded by a huge old avocado tree. But the grass required cutting, the flowers needed tending, and the man wanted more sun. So he cut the whole lot down and covered the yard with asphalt. After all it was his property and he was not fond of plants. (Hill 1983: 98).

With Hegel’s metaphysics attracting renewed attention, it is time to address a long-standing criticism: Scholars from Marx to Popper and Habermas have worried that Hegel’s metaphysics has anti-individualist and authoritarian implications, which are particularly pronounced in his Philosophy of History, since Hegel identifies historical progress with reason imposing itself on individuals. Rather than proposing an alternative non-metaphysical conception of reason, as Pippin or Brandom have done, this article argues that critics are broadly right in their metaphysical reading of Hegel’s central (...) concepts. However, they are mistaken about what Hegel’s approach entails, when one examines the specific types of states discussed by the philosopher in his Philosophy of History. Even on a traditional metaphysical reading, Hegel is not only non-authoritarian; he also makes a powerful argument concerning freedom, whereupon the freest society involves collective oversight and the shaping of social structures so as to ensure that they benefit everybody. (shrink)

This article discusses an interpretation of Kant's conception of transcendental subjectivity, which manages to avoid many of the concerns that have been raised by analytic interpreters over this doctrine. It is an interpretation put forward by selected C19 and early C20 neo-Kantian writers. The article starts out by offering a neo-Kantian interpretation of the object as something that is constituted by the categories and that serves as a standard of truth within a theory of judgment. The second part explicates transcendental (...) subjectivity as the system of categories, which is self-referential and constitutes objects, in order to then evaluate this conception by means of a comparison with Hegel's absolute subject. Rather than delineating the differences between neo-Kantian writers, the article systematically expounds a shared project, which consists in providing the ultimate foundation for judgments by means of an anti-psychologist and non-metaphysical interpretation of transcendental subjectivity. (shrink)

The neo-Kantian Hermann Cohen is famously anti-empiricist in that he denies that sensations can make a definable contribution to knowledge. However, in the second edition of Kant’s Theory of Experience (1885), Cohen considers a proposition that contrasts with both his other work and that of his followers: a Kantian who studies scientific claims to truth—and the grounds on which they are made—cannot limit himself to studying mathematics and logical principles, but needs to also investigate underlying presuppositions about the empirical element (...) of science. Due to his subjectivist approach, Cohen argues, Kant not only failed to explain how scientific observation and experiments are possible, but also misconceived the role of the ideas, particularly the idea of a system of nature. (shrink)

Aristotle's defense of Dunamis -- Power and potentiality -- Rational and nonrational powers -- The priority of actuality -- Ontological hierarchy, normativity, and gender.

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 39.2 (2001) 292-294 [Access article in PDF] Secada, Jorge. Cartesian Metaphysics: The Scholastic Origins of Modern Philosophy. New York: Cambridge University Press, 2000. Pp. xii + 333. Cloth, $59.95. Descartes scholars can welcome this book. Secada supports trends in scholarship that criticize seeing Descartes as merely an anti-skeptical foundationalist, and he challenges many prominent interpretations of Descartes's metaphysics. In addition, Secada helpfully references (...) Scholastic sources to provide context for Descartes's views. This book is also valuable for philosophers in contemporary metaphysics and epistemology. Secada uses the tools and idiom of analytic philosophy to explain and defend Descartes, and he is sympathetic to Descartes's project, even if he grants that aspects of it "are difficult to articulate clearly and convincingly" (174).The book's central theme is the contrast between Descartes's "essentialism" and the "existentialism" of Scholastics. Secada explains the distinction as follows: "Essentialism (existentialism) is the doctrine, first, that one cannot know the existence (essence) of any substance without first knowing its essence (existence), and, secondly, that one can know the essence (existence) of some substance without knowing its existence (essence)" (8). Cartesian Metaphysics interprets Descartes's corpus as a defense of essentialism in the light of Scholastic existentialism.The first three chapters set the stage. Chapter One distinguishes essentialism from existentialism. Chapter Two provides historical background necessary to understand the role of Scholasticism in Descartes's thought. Chapter Three discusses the role of Christian Platonism in both Descartes and the Scholastics, especially their shared Augustinian presupposition that knowledge of essences is of "how things are in themselves" (56).The next three chapters discuss the metaphysical status of ideas. In Chapter Four, Secada contrasts Descartes's "immanent" theory according to which "the immediate objects of ideas must exist in the mind" (85) with the "realist Scholastic" theory that "takes mental acts to be immediately directed towards things" (83). In Chapter Five, this account is applied to an interpretation of the Second Meditation as a defense of intellectualist essentialism against Scholastics and empiricists. "Contrary to the Scholastics and other empiricists, Descartes attributed to the intellect and not to the senses the power to reach the world of substances existing outside of the inner theatre of the mind" (116). Through comparing Descartes with Suarez and Gassendi, Secada argues that all the proofs of existence in the Meditations, including for the cogito, argue from [End Page 292] knowledge of essence to knowledge of existence. Chapter Six turns to Descartes's proofs for the existence of God. According to Secada, even for a posteriori proofs, knowledge of God's existence depends on knowledge of his essence.The last three chapters examine Descartes's theory of substance. Chapter Seven reconstructs Descartes's distinction between substances and properties. A substance is something that "exists without inhering" and "exists uncaused" (185). Secada discusses the nature of substance, how substances other than God can be "uncaused," and the plausibility of Descartes's sharp distinction between substances and properties. The chapter ends by arguing that Descartes's doctrine about the relationship between substances and properties inadvertently "heralds Spinoza's pantheism" (185). Chapter Eight examines real and essential properties in Cartesian metaphysics in contrast to Suarez and Fonseca, and ends with a partial defense of Descartes's ontological argument. Chapter Nine offers a detailed discussion of two fundamental substances in Descartes's metaphysics: body and mind. Secada argues that Descartes offers no satisfactory explanations of body, mind, or the relationship between the two.As is clear from this brief summary, Cartesian Metaphysics is a rich book. It presents important historical details without endless irrelevant details (see especially the sketch of Descartes's Scholastic background on 27-33). The exegetical arguments make strong cases for new interpretations of Descartes. Secada effectively shows that Descartes is more concerned with metaphysics than with refuting skepticism. Comparisons with Suarez and Fonseca shed new light on Cartesian arguments. Reconstructions of Cartesian arguments even tempt one to take Descartes seriously in contemporary metaphysics. And the criticisms of Descartes are thought-provoking.Unfortunately, the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Descartes and Method: A Search for a Method in MeditationsPatrick FriersonDaniel E. Flage and Clarence A. Bonnen. Descartes and Method: A Search for a Method in Meditations. New York: Routledge, 1999. Pp. 332. Cloth, $90.00.The book has two parts. The first (Chapters 1-3 and an appendix) outlines Descartes's method of analysis, a method for discovering laws and clarifying ideas. The second (Chapters 4-10) offers a running commentary of (...) the Meditations that can be read on its own and is valuable not only for specialists as a challenging comprehensive account but also for anyone looking for a concise and coherent secondary source.The method is taken from the Discourse and illustrated using the Optics. According to the authors, analysis in the search for laws "is a type of argument to the best explanation" (23) that involves "two different issues, discovery and confirmation" (21). In discovery, one isolates a phenomenon and posits one or more explanations (or causes) for it. In confirmation, one tests this explanation for "material truth" (whether it is recognized as true by the natural light). Then one shows how the phenomenon is "caused" by the explanation, and that it is the best explanation, and that it can be included in a systematic science.The discussion of analysis in the clarification of ideas argues against " 'the epistemic thesis,' that is, the thesis that all innate ideas are (materially) true and known to be true as soon as they are considered"(45). Most of the arguments here address the claim that innate ideas are known to betrue. These arguments are followed by an account of how analysis clarifies ideas through successive refinement, and an illustration of this method from Descartes's clarification of the idea of light in the Optics. The final chapter of the section on method defends the claim that Descartes uses "cause" to refer to formal rather than efficient causation.The authors then turn to the Meditations, offering a virtually line by line treatment of major themes, with attention to showing how the method outlined in part one structures the arguments of the Meditations. Meditations 1-3 "ascend" through discovery and preliminary confirmation, ending with a perfect, non-deceiving God as the best explanation of our idea of God. The final meditations "descend" from that best explanation to its implications. This descent confirms the explanation by showing its place in a system.The second part of the book also includes explanations of the part that conceptual clarifications play in the Meditations. Flage and Bonnen discuss the cogito argument, the account of the wax, the arguments for the existence of God, and the distinction of mind and body, all as examples of conceptual clarification through the method of analysis. In the case of God, for instance, Descartes begins with Hobbes's crude conception of God and clarifies it into the simple, clear, and distinct notion of a "most perfect being."The last chapter addresses the circle ascribed to Descartes by Arnauld: that the argument for the existence of God depends on the truth of clear and distinct ideas, which is only established on the basis of the existence of God. The authors argue that this is not a true circle, since Descartes assumes the material truth of clear and distinct ideas (which is indubitable) in his early argument and draws on their formal truth (in the mind of God) only after he proves the existence of God. They suggest their own circle, however: in his response to other concerns of Arnauld, Descartes suggests that God [End Page 436] stops a causal regress and thus commits himself to the formal truth of the idea of God, which he cannot independently justify.As one would expect in a book that offers a concise and unified interpretation of the Meditations, readers will find unnecessary asides and wish for attention to issues that are passed over. Moreover, though the authors support some views with extensive quotations, they leave others without textual support. The most unfortunate example is the identification of formal truth with actuality. The authors have several accounts of the distinction between formal and material truth and end their book with... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 38.1 (2000) 125-126 [Access article in PDF] Margaret Dauler Wilson. Ideas and Mechanism: Essays on Early Modern Philosophy. Princeton: Princeton University Press, 1999. Pp. xx + 524. Cloth, $70.00. Ideas and Mechanism is a record of remarkable scholarship. It collects thirty-one essays by one of the most influential scholars in early modern philosophy. (Wilson herself did most of the editing, though Anne Jaap (...) Jacobson brought the book to completion after Wilson's death.) All but one of essays have been published previously. (The one new essay is "The Issue of 'Common Sensibles' in Berkeley's New Theory of Vision." There is also an essay on "True and Immutable Natures" previously published only in Portuguese.) Many are classics, united here with essays less well known. The collection begins with "Skepticism without Indubitability," an application of Wilson's scholarly might to Rorty's criticisms of the early modern legacy of foundationalism. Chapters 2-8 focus on Descartes. Several of these emphasize Descartes's accounts of sensation and representation. Chapters 9-12 discuss Spinoza. Then follows Wilson's influential essay on "Superadded Properties" and her related response to M. R. Ayers. Chapter 15-21 comprise an extended defense of Berkeley. The book ends with a long essay on the role of history of philosophy and a brief essay on animal ideas.In her essays, Wilson does not limit herself to one side of the classic divide between empiricists and rationalists. She succeeds in this ambitious endeavor by focusing on a problem common to both: the relation between mechanistic science and early modern views of ideas. Wilson is concerned with how philosophers' scientific views bear on their metaphysics, epistemology, and philosophy of mind. This involves, in many cases, showing how philosophical positions take on new meaning as one considers the science underlying them. For example, Descartes's repeated claims that primary qualities "resemble" qualities in bodies are not taken to imply that any particular extension one sees is in a body. Extension in general, on which mechanistic explanations are based, is in bodies; color (and even perceived extension) is reducible by scientific explanation. The emphasis on the role of science also furnishes a platform for attention to neglected works. Wilson is exemplary in drawing from a wide range of texts to elucidate familiar points. In essays on Descartes and Berkeley, Wilson shows how their works on vision in particular enrich discussions of their epistemology. (One unfortunate limitation to Wilson's emphasis on mechanistic science is a neglect of political and theological works. Thus, she neglects to investigate the implications of, say, Spinoza's work in politics on his metaphysical views about man.)Of particular note is Wilson's defense of Berkeley. Wilson does not draw lines in terms of empiricists (Locke and Berkeley) and rationalists (Leibniz). Instead, she argues that Berkeley's defense of the common sense view that "physical things are as they are perceived" provides an alternative to the scientific realisms of Locke, Leibniz, and Kant. Defenders of Locke, for example, have claimed that Berkeley was insufficiently attentive to the role of mechanistic science in Locke's justifications of the primary-secondary distinction. Wilson shows how Berkeley took these Lockean arguments into account and why he objects to them. Rather than being a cure-all that saves Locke from Berkeley, the role of mechanistic science in his philosophy implicates Locke in the scientific realism against which Berkeley consistently defends common sense. [End Page 125]Not all of the essays directly relate to ideas and mechanism. Several deal with the closely related issue of mind-body interaction. One essay explains the epistemological argument for mind-body dualism in Descartes and another attacks Spinoza's account of mind and body. Wilson also writes on more general themes in Leibniz, such as necessity and contingency, causality, and confused and distinct ideas. She spends two chapters on the relationship between animals and humans. In one, she challenges appropriations of Spinoza that find in him the appealing view that there is no "radical ontological chasm" between humans and... (shrink)

Many interpreters argue that irrational acts of exchange can count as rational and civic-minded for Hegel—even though, admittedly, the persons who are exchanging their property are usually unaware of this fact. While I do not want to deny that property exchange can count as rational in terms of ‘mutual recognition’ as interpreters claim, this proposition raises an important question: What about the irrationality and arbitrariness that individuals as property owners and persons consciously enjoy? Are they mere vestiges of nature in (...) Hegel’s system, or do they constitute a simple yet valid form of freedom that is not only a part of Hegel’s rational system of right, but its necessary starting point? I will argue the latter: The arbitrary, purely egoist self-definition of property owners is the simplest possible type of freedom for Hegel, which he dissects in order to show how the very arbitrary self-definition implicitly relies on an identity between persons, and hence foreshadows the more social forms of freedom Hegel will discuss later in his book. I make this argument by highlighting Hegel’s references to his discussion of atoms and freedom in his Logic of Being. (shrink)

Garrett Cullity contends that fairness is appropriate impartiality (See Cullity (2004) Chapters 8 and 10 and Cullity (2008)). Cullity deploys his account of fairness as a means of limiting the extreme moral demand to make sacrifices in order to aid others that was posed by Peter Singer in his seminal article ‘Famine, Affluence and Morality’. My paper is founded upon the combination of (1) the observation that the idea that fairness consists in appropriate impartiality is very vague and (2) the (...) fact that psychological studies show the self-serving bias is especially likely to infect one’s judgements when the ideas involved are vague. I argue that Cullity’s solution to extreme moral demandingness is threatened by these findings. I then comment on whether some other theories of fairness are vulnerable to the same objection. (shrink)

While Hegel's metaphysics was long reviled, it has garnered more interest in recent years, with even the so-called non-metaphysical Hegelians starting to explicitly discuss Hegel’s metaphysical commitments. This brings up the old question: what are the social-philosophical implications of Hegel’s metaphysics? This chapter provides a unique answer to this question by contrasting the former non-metaphysical reading (as developed by Robert Pippin) with a traditional way of interpreting Hegel’s metaphysics and social philosophy, whose lineage includes not Wittgenstein, Sellars, or Brandom, but (...) rather Schelling, Marx, and Adorno. After discussing the two varieties of metaphysics (Sections 1–3), I will argue that a traditional metaphysical Hegel is more realist when it comes to assessing the power of social structures (Section 4), focused on structural freedom rather than agency (Sections 5 and 6), and more empowering for and lenient towards individuals who can make their interests count and are free to be irrational and egoist (Section 7). (shrink)

Picking up on Marx’s and Hegel’s analyses of human beings as social and individual, the article shows that what is at stake is not merely the possibility of individuality, but also the correct conception of the universal good. Both Marx and Hegel suppose that individuals must be social or political as individuals, which means, at least in Hegel’s case, that particular interests must form part of the universal good. The good and the rational is not something that requires sacrificing one’s (...) interests for the community or denying one’s particular character so as to become an equal rational agent. Very much to the contrary, the rational or the common good is nothing but the harmonious structuring of particular interests. While Section I introduces Marx’s and Hegel’s conceptions of individual and social beings, Sections II and III discuss their respective views of individuality, and Sections IV and V discuss the notion of a universal good containing individual interests. (shrink)

Animals do a wide range of work in our society, but they are rarely recognized as workers or accorded any labour rights, and their working conditions are often oppressive and exploitative. Drawing on law, ethics, and labour studies, the essays in this volume explore the potential and dangers of animal labour.

Patients have to be respected with dignity as the masters of their own lives. The problem, however, is that autonomy may become so dominant and the fundamental value of caring in professional nursing that the patient’s dignity is affected. The aim of this article is to point out some of the issues with the interplay between autonomy, also called self-management and dignity. Given voice to the patient perspective the background is provided by cases from research conducted through qualitative interviews with (...) patients and expanded by summarizing empirical research concerning the interplay between autonomy and dignity. The search strategy and the research question gave five empirical research papers and three theoretical studies and concept analyses. A concise overview of the relevant research contains information about all the major elements of the studies. The background research and an interpretative summary address new issues to be taken into account in dignity conserving care. (shrink)

This study focuses on how moral aspects of purpose shape collaborative processes. It does so by analyzing the unfolding of 21 relationships between four nonprofits and their funders using a framework based on French pragmatist sociology to help uncover the deeply held, ideological and moral beliefs that underscore assumptions about what the overarching purpose of a collaborative effort is or should be. This study contributes to the literature on single and cross-sectoral collaboration by showing that the way partners handle and (...) reconcile differences about purpose is related to the forms of agreement likely to be achieved. It also suggests that certain forms of agreement are inherently more enduring than others. Taken as a whole, this study provides some plausible explanations as to why so many collaborations fail despite their seeming benefits for all the parties involved. (shrink)

Although it is clear in Schelling's Freiheitsschrift that he takes an agent's atemporal choice between good and evil to be central to understanding human freedom, there is no consensus in the literature and no adequate account of how to understand this choice. Further, the literature fails to render intelligible how existential freedom is possible in the light of this atemporal choice. I demonstrate that, despite their differences, the dominant accounts in the literature are all guilty of these failings and argue (...) that this is due to their misunderstanding of Schelling's conception of the relationship between essence and form. After outlining what I take Schelling's account of this relationship to be, I return to the Freiheitsschrift to demonstrate that with this account in mind we can make intelligible Schelling's claims about the agent's atemporal act, and the possibility of existential freedom on his account. (shrink)

Throughout his life, Kant was concerned with questions about empirical psychology. He aimed to develop an empirical account of human beings, and his lectures and writings on the topic are recognizable today as properly 'psychological' treatments of human thought and behavior. In this book Patrick R. Frierson uses close analysis of relevant texts, including unpublished lectures and notes, to study Kant's account. He shows in detail how Kant explains human action, choice, and thought in empirical terms, and how a (...) better understanding of Kant's psychology can shed light on major concepts in his philosophy, including the moral law, moral responsibility, weakness of will, and cognitive error. Frierson also applies Kant's accounts of mental illness to contemporary philosophical issues. His book will interest students and scholars of Kant, the history of psychology, philosophy of psychology, and philosophy of action. (shrink)

ABSTRACT When does a state of affairs constitute a harm to someone? Comparative accounts say that being worse off constitutes harm. The temporal version of the comparative account is seldom taken seriously, due to apparently fatal counterexamples. I defend the temporal version against these counterexamples, and show that it is in fact more plausible than the prominent counterfactual version of the account. Non-comparative accounts say that being badly off constitutes harm. However, neither the temporal comparative account nor the non-comparative account (...) can correctly classify all harms. I argue that we should combine them into a hybrid account of harm. The hybrid account is extensionally adequate and presents a unified view on the nature of harm. (shrink)

Patients in around 20 countries worldwide are now offered online access to at least some of their medical records. Access includes test results, medication lists, referral information, and/or the very words written by clinicians (so-called ‘open notes’). In this paper, I discuss the possibility of one unintended negative consequence of patient access to their clinical notes—the potential to increase ‘nocebo effects’. A growing body of research shows that nocebo effects arise by engaging perceptual and cognitive processes that influence negative expectancies, (...) and as a consequence, adverse health effects. Studies show that increased awareness about the side effects of medications, the framing of information and the socioemotional context of care can increase the risk of nocebo effects. Connecting research into the nocebo effect with open notes provides preliminary support for the hypothesis that patient access to clinical notes might be a forum for facilitating unwanted nocebo effects. Furthermore, current findings indicate that we might expect to see systematic differences in how nocebo effects are experienced among different patient populations. The ethical implications of the tension between transparency and the potential for harm are discussed, with an emphasis on what open notes might mean for justice and equity in clinical care for a range of already marginalised patient populations. I argue that to resolve these challenges does not thereby justify ‘closed notes’, and conclude with suggestions for how health systems and clinicians might adapt to this innovation to reduce the risk of potential nocebo effects arising via this novel route. (shrink)

In a criminal trial, a judge or jury needs to reason about what happened based on the available evidence, often including statistical evidence. While a probabilistic approach is suitable for analysing the statistical evidence, a judge or jury may be more inclined to use a narrative or argumentative approach when considering the case as a whole. In this paper we propose a combination of two approaches, combining Bayesian networks with scenarios. Whereas a Bayesian network is a popular tool for analysing (...) parts of a case, constructing and understanding a network for an entire case is not straightforward. We propose an explanation method for understanding a Bayesian network in terms of scenarios. This method builds on a previously proposed construction method, which we slightly adapt with the use of scenario schemes for the purpose of explaining. The resulting structure is explained in terms of scenarios, scenario quality and evidential support. A probabilistic interpretation of scenario quality is provided using the concept of scenario schemes. Finally, the method is evaluated by means of a case study. (shrink)

This article discusses anglophone readings of G. W. F. Hegel against the backdrop of German-language scholarship. The article starts by differentiating types of metaphysics (I). Following a taxonomy introduced by Paul Redding, I then discuss Charles Taylor’s Christian-mystical (II), the so-called »non-metaphysical« (III) and the »revised metaphysical« reading (IV). Terry Pinkard’s work serves as an example of (III) and Stephen Houlgate’s as an example of (IV). I highlight problematic aspects of each reading that concern: the meaning of »reason in the (...) world« (II), the anti-relativist clout of Hegel’s philosophy (III) and the difference between the development of logical concepts and the empirical origin of the world and human thinking (IV). The text ends (V) by pointing to the social implications of each type of reading. (shrink)

The core argument of this article is that Adorno adopts the distinction between an abstract and a concrete universal from Hegel and criticizes Hegel, on that basis, as abstract. The first two parts of the article outline that both thinkers take the abstract universal to be the form of a false type of knowledge and society, and the concrete universal to be a positive aim. However, as the third part argues, Adorno rejects how the concrete universal is understood in Hegel’s (...) philosophy and formulates a different conception of it. The fourth part questions if Adorno manages to overcome the problems he identifies in Hegel or whether they are inherent to the programme of dialectics both endorse. (shrink)

Researchers have begun to use response times to emotion items as an indirect measure of emotional clarity. Our first aim was to scrutinise the properties of this RT measure in more detail than previously. To be able to provide recommendations as to whether emotional intensity – as a possible confound – should be controlled for, we investigated the specific form of the relation between emotional intensity and RTs to emotion items. In particular, we assumed an inverted U-shaped relation at the (...) item level. Moreover, we analysed the RT measure’s convergent validity with respect to individuals’ confidence in their emotion ratings. As a second aim, we compared the predictive validity of emotional clarity measures with respect to daily emotion regulation. The results of three experience sampling studies showed that the association between emotional intensity and RT followed an inverted U shape. RT was in part related to confidence. Emotional clarity measures were unrelated to reappraisal. There was some evidence that lower emotional clarity was related to a greater use of suppression. The findings highlight that emotional intensity and squared emotional intensity should be controlled for when using the RT measure of emotional clarity in future research. (shrink)

In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians. However, even in countries that have implemented (...) the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety. (shrink)

« If there was one development we did not predict it was that, as well as getting larger, corpora would also get smaller! » McEnery et Wilson (2001 : 191) Doit-on qualifier de « petit corpus » tout corpus qui n’est pas grand? Et d’ailleurs, pourquoi faudrait-il se poser la question? Celle-ci peut paraître triviale mais elle signale un moment particulier des sciences du langage. L’informatique a permis l’établissement de grands corpus et le traitement d’impressionnantes quantités de données...

In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (‘open notes’). However, even in countries that (...) have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety. (shrink)

David Hume is widely regarded as the greatest English thinker in the history of philosophy. His contributions to a huge range of philosophical debates are as important and influential now as they were in the eighteenth century. This book provides an introduction to the ideas of this hugely significant thinker.

In a criminal trial, evidence is used to draw conclusions about what happened concerning a supposed crime. Traditionally, the three main approaches to modeling reasoning with evidence are argumentative, narrative and probabilistic approaches. Integrating these three approaches could arguably enhance the communication between an expert and a judge or jury. In previous work, techniques were proposed to represent narratives in a Bayesian network and to use narratives as a basis for systematizing the construction of a Bayesian network for a legal (...) case. In this paper, these techniques are combined to form a design method for constructing a Bayesian network based on narratives. This design method is evaluated by means of an extensive case study concerning the notorious Dutch case of the Anjum murders. (shrink)

The doctor-patient relationship is built on an implicit covenant of trust, yet it was not until the post-World War Two era that respect for patient autonomy emerged as an article of mainstream medical ethics. Unlike their medical forebears, physicians today are expected to furnish patients with adequate information about diagnoses, prognoses and treatments. Against these dicta there has been ongoing debate over whether placebos pose a threat to patient autonomy. A key premise underlying medical ethics discussion is the notion that (...) the placebo effect necessitates patient deception. Indeed, the American Medical Association guidelines imply that placebo treatment necessary entails a form of deception. As a consequence of this assumption, the fulcrum of debate on the use of placebo treatment has hinged on whether that deception is ever justified. Recently performed experiments with open-label transparently prescribed placebos have begun to challenge the notion that deception is necessary in eliciting the placebo effect and such effects necessarily involve a binary distinction between autonomy and beneficence. In this article we focus on the content of disclosures in distinctive open-label, transparently disclosed placebo studies and inquire whether they might be said to invoke deception in clinical contexts, and if so, whether the deception is unethical. We find that open placebos may be said to involve equivocation over how placebos work. However, drawing on surveys of patient attitudes we suggest that this equivocation appears to be acceptable to patients. We conclude that open placebos fulfil current American Medical Association guidelines for placebo use, and propose future research directions for harnessing the placebo effect ethically. (shrink)

Many people believe that we have moral duties towards those we bring into existence in the short term: our children. Many people also believe that we have moral duties towards those we bring into existence in the long term: future generations. In this article, I explore how these beliefs are connected. I argue that the present generation is morally responsible for future generations in virtue of bringing them into existence. This responsibility entails moral duties to ensure that future people have (...) adequate life prospects. These duties are held directly towards future generations. I argue that this direct argument can overcome challenges that indirect arguments, which justify moral duties concerning future generations via moral duties towards present children, face. The upshot is that considerations from procreative ethics help to illustrate that the present generation stands in a morally relevant special relationship to future generations, a fact that is often overlooked in intergenerational ethics. (shrink)

My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...) distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain (interpreted nociception) to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

This book offers a comprehensive account of Kant's theory of freedom and his moral anthropology. The point of departure is the apparent conflict between three claims to which Kant is committed: that human beings are transcendentally free, that moral anthropology studies the empirical influences on human beings, and that more anthropology is morally relevant. Frierson shows why this conflict is only apparent. He draws on Kant's transcendental idealism and his theory of the will and describes how empirical influences can (...) affect the empirical expression of one's will in a way that is morally significant but still consistent with Kant's concept of freedom. As a work which integrates Kant's anthropology with his philosophy as a whole, this book will be an unusually important source of study for all Kant scholars and advanced students of Kant. (shrink)

InThe Second Sex, Simone de Beauvoir argues that women are often complicit in reinforcing their own unfreedom. But why women become complicit remains an open question. The aim of this article is to offer a systematic analysis of complicity by focusing on the Heideggerian strands of Beauvoir's account. I begin by evaluating Susan James's interpretation of complicity qua republican freedom, which emphasizes the dependent situation of women as the primary cause of their complicity. I argue that James's analysis is compelling (...) as far as it goes, but that it implies complicity is the inevitable outcome of women's current existence and fails to adequately account for Beauvoir's claim that women actively embrace their own unfreedom. I then draw out the Heideggerian strands of Beauvoir's analysis, demonstrating how this enables us to systematize Beauvoir's account of women's oppressive situation with her claims regarding the active role women can play in reinforcing their own unfreedom. I argue that this approach preserves the strengths of the republican interpretation, but provides a better account of cases where complicity may not be inevitable and yet some women still act to reinforce rather than resist their own unfreedom. (shrink)

This chapter focuses on Schelling’s philosophy of nature and shows that it contains an original theory of freedom. I argue that human freedom is a potentiated form of a kind of freedom that can already be found in organic life: my claim is that human freedom and other forms of productivity within nature are instances of the same process. I argue that we should see the relationship between different forms of natural productivity and human freedom in the same way that (...) the Schelling of the Naturphilosophie argues that we should see the relationship between mechanical, chemical, and organic phenomena. To say that there is no difference between these phenomena would be absurd; the claim is rather that they are all different manifestations of the same process (the process which drives nature as a whole), and therefore that their difference is one of degree rather than kind. I further demonstrate that Schelling’s Freedom essay builds upon this notion of freedom introduced in the philosophy of nature and offers a solution to the problem of the human ownership of freedom. (shrink)

Sentience is the capacity to have feelings, such as feelings of pain, pleasure, hunger, thirst, warmth, joy, comfort and excitement. It is not simply the capacity to feel pain, but feelings of pain, distress or harm, broadly understood, have a special significance for animal welfare law. Drawing on over 300 scientific studies, we evaluate the evidence of sentience in two groups of invertebrate animals: the cephalopod molluscs or, for short, cephalopods (including octopods, squid and cuttlefish) and the decapod crustaceans or, (...) for short, decapods (including crabs, lobsters and crayfish). We also evaluate the potential welfare implications of current commercial practices involving these animals. (shrink)

In the development of governmental policy for artificial intelligence that is informed by ethics, one avenue currently pursued is that of drawing on “AI Ethics Principles”. However, these AI Ethics Principles often fail to be actioned in governmental policy. This paper proposes a novel framework for the development of ‘Actionable Principles for AI’. The approach acknowledges the relevance of AI Ethics Principles and homes in on methodological elements to increase their practical implementability in policy processes. As a case study, elements (...) are extracted from the development process of the Ethics Guidelines for Trustworthy AI of the European Commission’s “High Level Expert Group on AI”. Subsequently, these elements are expanded on and evaluated in light of their ability to contribute to a prototype framework for the development of 'Actionable Principles for AI'. The paper proposes the following three propositions for the formation of such a prototype framework: preliminary landscape assessments; multi-stakeholder participation and cross-sectoral feedback; and, mechanisms to support implementation and operationalizability. (shrink)

ABSTRACT:This paper explores how corporations, through their Corporate Social Responsibility (CSR) activities, can help to effect positive developmental change. We use research on institutional change, deinstitutionalization, and institutional work to develop our central theoretical framework. This framework allows us to suggest more explicitly how CSR can potentially be mobilized as a purposive form of institutional work aimed at disrupting existing institutions in favor of positive change. We take the gender institution in the Arab Middle East as a case in point. (...) Our suggestion is that the current context of the Arab Spring, which combined with increasingly obvious endogenous institutional contradictions, has created a fertile ground for shaping change processes within the gender institution. Finally, we provide concrete examples of CSR initiatives that regional corporate actors can engage in for positive developmental change supporting women. (shrink)

In cases of complicity in one’s own unfreedom and in structural injustice, it initially appears that agents are only vicariously responsible for their complicity because of the roles circumstantial and constitutive luck play in bringing about their complicity. By drawing on work from the phenomenological tradition, this paper rejects this conclusion and argues for a new responsive sense of agency and responsibility in cases of complicity. Highlighting the explanatory role of stubbornness in cases of complicity, it is argued that although (...) agents may only be vicariously responsible for becoming complicit, they can be held more directly responsible for entrenching their complicity. The complicit agent is responsible for their complicity to the extent that they fail to take responsibility for it. (shrink)

Increasing numbers of health organisations are offering some or all of their patients access to the visit notes housed in their electronic health records. In some countries, including Sweden and the USA, this innovation is advanced with patients using online portals to access their clinical records including the visit summaries written by clinicians. In many countries, patients can legally request copies of their records; however, open notes are different because this innovation offers patients rapid, real-time access via electronic devices. In (...) this brief report, we explore what open notes might mean for placebo use in clinical care. Survey research into patient access to their clinical notes shows that increased transparency enhances patients’ understanding about their medications and augments engagement with their care. We reflect on the consequences of access for placebo prescribing, particularly for the common practice of deceptive placebo use, in which patients are not aware they are being offered a placebo. In addition, we explore how open notes might facilitate placebo and nocebo effects among patients. Bridging placebo studies with medical ethics, we identify a range of empirical research gaps that now warrant further study. (shrink)