Background: International developments suggest that providing clinical ethics services to help clinicians negotiate ethical issues that arise in clinical practice is beneficial and reflects best practice in promoting high ethical standards and patient-centered care. The aim of this study was to explore the needs and experiences of clinical staff members to inform the development of future clinical ethics support. Methods: Health professionals at a large regional health service completed an online survey containing questions about the frequency of ethical and legal (...) issues encountered in clinical practice, the type of situations that gave rise to the ethical and/or legal uncertainty or concern, how clinicians currently address these issues, and what support would be welcome. Results: The survey was completed by 369 staff members, including 61% with more than 10 years in the profession and 51% in nursing/midwifery. Two-thirds (66%) indicated they often considered ethical implications of their clinical decisions, and half (49%) often considered the legal implications. More than half (58%) were often/occasionally concerned about the ethically right thing to do. Patient requests for borderline treatment (47%), staff disagreements about patient care (48%), and patients declining recommended treatment (54%) were the most frequent reasons given for ethical or legal uncertainty. Sixty-nine percent of respondents indicated that the way their department addressed ethical issues could be improved and 85% agreed that there is a need for more discussion on ethical issues. The majority (82%) of respondents had encountered ethically challenging clinical situations where additional support would have helped. Common approaches to issues were discussion with colleagues/supervisor (91.1%), discussion at handover/group forums (50.8%), and consultation with guidelines/protocols (60.9%). Conclusions: A majority of clinical staff members surveyed have encountered ethically/legally challenging cases daily for which they have often sought additional advice. This study indicates that many clinical staff members would welcome some form of additional clinical ethics support including advice and education. (shrink)

Many extant theories of placebo focus on their causal structure wherein placebo effects are those that originate from select features of the therapy (e.g., client expectations or “incidental” features like size and shape). Although such accounts can distinguish placebos from standard medical treatments, they cannot distinguish placebos from everyday occurrences, for example, when positive feedback improves our performance on a task. Providing a social-epistemological account of a treatment context can rule out such occurrences, and furthermore reveal a new way to (...) distinguish clinical placebos from standard medical treatments. (shrink)

On a version of consent theory that tempts many, predatory sexual relations involving significant power imbalances (e.g. between professors and students, adults and teenagers, or employers and employees) are wrong because they violate consent-centric norms. In particular, the wronged party is said to have been _incapable_ of consenting to the predation, and the sexual wrong is located in the encounter’s nonconsensuality. Although we agree that these are sexual wrongs, we resist the idea that they are always nonconsensual. We argue instead (...) that it is possible for students, teenagers, employees, etc. to fully consent to sexually predatory encounters; denying as much renders survivors of predation vulnerable to compounding harms. Survivors face a dilemma: give up either their understanding of their experience as wrong, or their self-conception as an agent capable of consenting. We call the latter phenomenon _agential demotion_. (shrink)

Competition among scientists for funding, positions and prestige, among other things, is often seen as a salutary driving force in U.S. science. Its effects on scientists, their work and their relationships are seldom considered. Focus-group discussions with 51 mid- and early-career scientists, on which this study is based, reveal a dark side of competition in science. According to these scientists, competition contributes to strategic game-playing in science, a decline in free and open sharing of information and methods, sabotage of others’ (...) ability to use one’s work, interference with peer-review processes, deformation of relationships, and careless or questionable research conduct. When competition is pervasive, such effects may jeopardize the progress, efficiency and integrity of science. (shrink)

Where do our ideas about politics come from? What can we learn from the Greeks and Romans? How should we exercise power? Melissa Lane teaches politics at Princeton University, and previously taught political thought at the University of Cambridge, where she was a Fellow of King's College. She has received a Guggenheim Fellowship in the field of classics, and the historian Richard Tuck called her book Eco-Republic 'a virtuoso performance by one of our best scholars of ancient philosophy.'.

Ethics researchers advise managers of organizations to link rewards and punishments to ethical and unethical behavior, respectively. We build on prior research maintaining that organizations operate at Kohlbergs stages of moral reasoning, and explain how the over-reliance on rewards and punishments encourages employees to operate at Kohlbergs lowest stages of moral reasoning. We advocate designing organizations as ethical communities and relying on different assumptions about employees in order to foster ethical reasoning at higher levels. Characteristics associated with ethical communities are (...) identified and AES Corporation and Semco S/A serve as examples of corporations exhibiting the design characteristics and assumptions of ethical organizations. (shrink)

With candid, witty, and compelling experiences of yoga from renowned memoirists, including Cheryl Strayed (author of the number-one New York Times bestseller Wild), Claire Dederer (author of national bestseller Poser: My Life in 23 Yoga Poses), Dinty W. Moore (author of The Accidental Buddhist), Neal Pollack (author of Stretch: The Making of a Yoga Dude) and many others, Going Om shares a range of observations about this popular practice. Unlike books on yoga that provide instruction on technique, Going Om is (...) a unique collection of personal narratives from celebrated authors. This anthology of original material values the quality of writing over the authors' flexibility. Ira Sukrungruang shares his heartbreaking struggle as a 375 pound yoga student discovering self-worth on his mat; Gloria Munoz explores the practice of stillness with lyrical elegance in the midst of her busy mind; Neal Pollack's signature sarcasm leads to surprising turns at yoga class with his dad; Elizabeth Kadetsky uses yogic wisdom while coping with her mother's devastating Alzheimer's. (shrink)

Many prescriptions offered in the literature for enhancing creativity and innovation in organizations raise ethical concerns, yet creativity researchers rarely discuss ethics. We identify four categories of behavior proffered as a means for fostering creativity that raise serious ethical issues: (1) breaking rules and standard operating procedures; (2) challenging authority and avoiding tradition; (3) creating conflict, competition and stress; and (4) taking risks. We discuss each category, briefly identifying research supporting these prescriptions for fostering creativity and then we delve into (...) ethical issues associated with engaging in the prescribed behavior. These four rubrics illustrate ethical issues that need to be incorporated into the creativity and innovation literature. Recommendations for how organizations can respond to the ethical issues are offered based on practices of exemplary organizations and theories of organizational ethics. A research agenda for empirically investigating the ethical impact these four categories of behavior have on organizations concludes the article. (shrink)

Programs, policies, and technologies — particularly those concerned with health equity — are often designed with justice envisioned as the end goal. These policies or interventions, however, frequently fail to recognize how the beneficiaries have historically embodied the cumulative effects of marginalization, which undermines the effectiveness of the intended justice. These well-meaning attempts at justice are bounded by greater socio-historical constraints. Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic social and physical (...) infrastructures underlying them have been eroded by racism and other historically entrenched isms. Using the case of Brazil’s National Health Policy for the Black Population, this paper proposes that bounded justice can contribute to justice discourses by serving as a concept, a proffering to a multi-disciplinary conceptual framework, and a potential analytic for those interested in the design of policy, technology, and programmatic interventions towards health equity. (shrink)

Journal of Philosophy of Education, EarlyView.

Within the growing developmental literature on children's testimonial learning, the emphasis placed on children's evaluations of testimonial evidence has shielded from view some of the more collaborative dimensions of testimonial learning. Drawing on recent philosophical work on testimony and interpersonal trust, we argue for an alternative way of conceptualizing the social nature of testimonial learning. On this alternative, some testimonial learning is the result of a jointly collaborative epistemic activity, an activity that aims at the epistemic goal of true belief, (...) but that does so by means of an irreducibly social process. (shrink)

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for rational choice in (...) alignment with one's values and goals). (shrink)

In recent essays, Jürgen Habermas endorses an account of political liberalism much like John Rawls'. Like Rawls, he argues that laws and public policies should be justified only in neutral terms, i.e. in terms of reasons that people holding conflicting world-views could accept. Habermas also, much like Rawls, distinguishes reasonable religious citizens, whose views should be included in public discourse, from unreasonable citizens in his expectation that religious citizens self-modernize. But in sharing these Rawlsian features, Habermas is vulnerable to some (...) of the same objections posed to Rawls. In this article I assess Habermas' ability to overcome two objections frequently posed to Rawls: (1) that religious citizens are unfairly expected to split their identities in public discourse, and (2) that the burdens of citizenship are asymmetrically distributed. I conclude that while he may be able to overcome the second, the first remains a problem for him. (shrink)

I propose a unified solution to two puzzles: Ross's puzzle and free choice permission. I begin with a pair of cases from the decision theory literature illustrating the phenomenon of act dependence, where what an agent ought to do depends on what she does. The notion of permissibility distilled from these cases forms the basis for my analysis of 'may' and 'ought'. This framework is then combined with a generalization of the classical semantics for disjunction — equivalent to Boolean disjunction (...) on the diagonal, but with a different two-dimensional character — that explains the puzzling facts in terms of semantic consequence. (shrink)

Doctoral students receive many kinds of assistance from faculty members, but much of this support falls short of mentoring. This paper takes the perspective that it is more important to find out what kinds of help students receive from faculty than to assume that students are taken care of by mentors, as distinct from advisors or role models. The findings here are based on both survey and interview data collected through the Acadia Institute’s project on Professional Values and Ethical Issues (...) in the Graduate Education of Scientists and Engineers. The paper describes various kinds of assistance that students receive (or do not receive) from faculty members in their roles as teacher/coach, sponsor, and counselor, It concludes with a section on advisors assigned to doctoral students, notably the extent of their contact with and influence on students. (shrink)

Observers have difficulty detecting visual changes. However, they are unaware of this inability, suggesting that people do not have an accurate understanding of visual processes. We explored whether this error is related to participants’ beliefs about the roles of intention and scene complexity in detecting changes. In Experiment 1 participants had a higher failure rate for detecting changes in an incidental change detection task than an intentional change detection task. This effect of intention was greatest for complex scenes. However, participants (...) predicted equal levels of change detection for both types of changes across scene complexity. In Experiment 2, emphasizing the differences between intentional and incidental tasks allowed participants to make predictions that were less inaccurate. In Experiment 3, using more sensitive measures and accounting for individual differences did not further improve predictions. These findings suggest that adults do not fully understand the role of intention and scene complexity in change detection. (shrink)

Delving into the images and technique that made the daguerreotype a cutting-edge technology in 1839, the author uses her access to Harvard's collection of images to explore the early phases of this format.

Building trust between academic medical centers and certain communities they depend on in the research process is hard, particularly when those communities consist of minoritized or historically marginalized populations. Some believe that engagement activities like the creation of advisory boards, town halls, or a research workforce that looks more like community members will establish or reestablish trust between academic medical centers and racialized communities. However, without systematic approaches to dismantle racism, those well‐intended actions become public performativity, and trust building will (...) fail. In this essay, we draw upon foundational ethical principles of trust, distrust, and trust building; apply the concept of bounded justice to performative trust acts; and center the works of Black and Indigenous feminist bioethicists to revisit some of the wisdom and valuable lessons they have contributed. Rebuilding trust is hard to do because people and institutions are often not honest about how hard it is and there is no simple box‐checking task that can disentangle our society's injustices, but there are steps to take in this direction. Individuals and institutions can recognize valuable relevant work that has already been written, partake in critical reflection, and then apply insights gained to take both small and sustainable steps toward transformational change and deeper trust. (shrink)

To what extent does a person who prefers hip-hop rather than opera have legitimate reasons for doing so? Should we immediately classify such a judgment as incompetent because it runs counter to the verdicts of experts, including professional art critics? These questions are often associated with the problem of aesthetic akrasia, a concept taken from the vocabulary of ethics, which involves acting against one’s better judgment, that is, demonstrating irrationality by failing to react in what is, theoretically, the most appropriate (...) way. In ethical terms, it would be analogous to failing to help a person in distress when we know very well that it is immoral not to... (shrink)

I respond to a dilemma for Causal Decision Theory (CDT) under determinism, posed in Adam Elga's paper “Confessions of a Causal Decision Theorist”. The treatment I present highlights (i) the status of laws as predictors, and (ii) the consequences of decision dependence, which arises natively out of Jeffrey Conditioning and CDT's characteristic equation.My argument leverages decision dependence to work around a key assumption of Elga's proof: to wit, that in the two problems he presents, the CDTer must employ subjunctive-suppositional (rather (...) than evidential) transformations of a shared prior. (shrink)

In her first book, _Cross-Cultural Existentialism: On the Meaning of Life in Asian and Western Thought_, Leah Kalmanson draws on a wide range of Asian ritual and philosophical repertoires in making a case for the role of practical exercises of self-cultivation in the work of existential inquiry. This review considers some of the ways in which Kalmanson’s selection of sources is consonant with the intervention she seeks to make, and suggests some possible avenues for beginning to think in a similarly (...) expansive way with and about western traditions. (shrink)

Some hold that W.K. Clifford's arguments are inconsistent, appealing to the disvalue of likely consequences of nonevidential belief-formation, while also insisting that the consequences are irrelevant to the wrongness of so believing. My thesis is that Clifford's arguments are consistent; one simply needs to be clear on the role consequences play in the "Ethics of Belief" (and, for that matter, in William James's "The Will to Believe"). The consequences of particular episodes of nonevidential belief-formation are, as Clifford insists, irrelevant to (...) the epistemic, and so moral, status of believing. The moral matter is that adopting a policy of nonevidential belief-formation constitutes commitment to antithetical principles, viz. (i) our antecedent moral obligation to minimize the risk of harming ourselves and others and (ii) the flagrant disregard for (i) entailed by employing a policy of risk, i.e. nonevidentialism. Clifford's arguments should be read as demonstrating that a nonevidentialist approach to belief-management constitutes the kind of risk that, in fact, is at odds with this antecedent moral obligation - hence the discussion of likely consequences, despite his claims that they are irrelevant to the moral status of the beliefs yielding them. They are irrelevant to the moral status of nonevidentialism but not irrelevant to the fact of risk. The moral impermissibility of nonevidentialism inheres in the inconsistency of it and our antecedent moral obligations, not in the value or disvalue of the particular consequences of that belief-management style. (shrink)

Astrophysics faces methodological challenges as a result of being a predominantly observation-based science without access to traditional experiments. In light of these challenges, astrophysicists frequently rely on computer simulations. Using collisional ring galaxies as a case study, I argue that computer simulations play three roles in reasoning in astrophysics: (1) hypothesis testing, (2) exploring possibility space, and (3) amplifying observations.

Scholars exploring the logic of Rousseau's voting rules have typically turned to the connection between Rousseau and the Marquis de Condorcet. Though Condorcet could not have had a direct influence on Rousseau's arguments about the choice of decision rules in "Social Contract," the possibility of a connection has encouraged the view that Rousseau's selection of voting rules was based on epistemic reasons. By turning to alternative sources of influence on Rousseau--the work of Hugo Grotius and particularly that of Samuel Pufendorf--a (...) moral, and not purely epistemic, logic of rules governing collective decision making emerges. For Rousseau, as for Pufendorf, the proper choice of voting rule can elicit the appropriate attitude of an individual with respect to the decision of the whole, and can support the morally significant activity of acknowledging error upon discovering that one has voted against the general will. (shrink)

Data from two national surveys of 4,000 faculty and doctoral students in chemistry, civil engineering, microbiology and sociology indicate that both faculty and students subscribe strongly to traditional norms but are more likely to see alternative counternorms enacted in their departments. They also show significant effects of departmental climate on normative orientations and suggest that many researchers express some degree of ambivalence about traditional norms.

Why might it be beneficial for adults to process fractions componentially? Recent research has shown that college-educated adults can capitalize on the bipartite structure of the fraction notation, performing more successfully with fractions than with decimals in relational tasks, notably analogical reasoning. This study examined patterns of relational priming for problems with fractions in a task that required arithmetic computations. College students were asked to judge whether or not multiplication equations involving fractions were correct. Some equations served as structurally inverse (...) primes for the equation that immediately followed it. Students with relatively high math ability showed relational priming both with and without high perceptual similarity. Students with relatively low math ability also showed priming, but only when the structurally inverse equation pairs were supported by high perceptual similarity between numbers. Several additional experiments established boundary conditions on relational priming with fractions. These findings are interpreted in terms of componential processing of fractions in a relational multiplication context that takes advantage of their inherent connections to a multiplicative schema for whole numbers. (shrink)

Realists about practical reasons agree that judgments regarding reasons are beliefs. They disagree, however, over the question of how such beliefs motivate rational action. Some adopt a Humean conception of motivation, according to which beliefs about reasons must combine with independently existing desires in order to motivate rational action; others adopt an anti-Humean view, according to which beliefs can motivate rational action in their own right, either directly or by giving rise to a new desire that in turn motivates the (...) action. I argue that the realist who adopts a Humean model for explaining rational action will have a difficult time giving a plausible account of the role that desire plays in this explanation. I explore four interpretations of this role and argue that none allows a Humean theory to explain rational action as convincingly as an anti-Humean theory does. The first two models, in different ways, make acting on a reason impossible. The third allows this possibility, but only by positing a reason-sensitive desire that itself demands an explanation. The fourth avoids this explanatory challenge only by retreating to an empty form of the Humean view. In contrast, an anti-Humean theory can provide an intuitively plausible explanation of rational action. I conclude that the realist about reasons should adopt an anti-Humean theory to explain rational action. (shrink)

There can be no doubt that Kant thought we should be reflective: we ought to care to make up our own minds about how things are and what is worth doing. Philosophical objections to the Kantian reflective ideal have centred on concerns about the excessive control that the reflective person is supposed to exert over her own mental life, and Kantians who feel the force of these objections have recently drawn attention to Kant’s conception of moral virtue as it is (...) developed in his later work, chiefly the Metaphysics of Morals. Melissa Merritt’s book is a distinctive contribution to this recent turn to virtue in Kant scholarship. Merritt argues that we need a clearer, and textually more comprehensive, account of what reflection is, in order not only to understand Kant’s account of virtue, but also to appreciate how it effectively rebuts long-standing objections to the Kantian reflective ideal. (shrink)

This article discusses the concept of publicity in Kant’s moral philosophy. Insofar as the concepts of ‘public’ and ‘private’ can describe our relations with others, they can be considered to be moral concepts. I argue that we can find in Kant a moral duty not to keep our maxims of action private, or secret. Whereas Korsgaard argues that sometimes in the face of evil it is permissible to sidestep the moral law, I argue that it is rather through publicity that (...) we can deal with evil in the non-ideal world. Moreover, by being open with our maxims, moral progress is possible. View HTML Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.Making the Ideal Real: Publicity and Morality in KantVolume 21, Issue 2Melissa Zinkin DOI: https://doi.org/10.1017/S1369415416000042Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. Making the Ideal Real: Publicity and Morality in KantVolume 21, Issue 2Melissa Zinkin DOI: https://doi.org/10.1017/S1369415416000042Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. Making the Ideal Real: Publicity and Morality in KantVolume 21, Issue 2Melissa Zinkin DOI: https://doi.org/10.1017/S1369415416000042Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation. (shrink)

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant in (...) a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

This article explains the problems with Alan Shewmon’s critique of brain death as a valid sign of human death, beginning with a critical examination of his analogy between brain death and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper metaphysical analysis, I offer a revised (...) rationale for the validity of the neurological criterion of human death. (shrink)