It is a popular view thatpractical deliberation excludes foreknowledge of one's choice. Wolfgang Spohn and Isaac Levi have argued that not even a purely probabilistic self-predictionis available to thedeliberator, if one takes subjective probabilities to be conceptually linked to betting rates. It makes no sense to have a betting rate for an option, for one's willingness to bet on the option depends on the net gain from the bet, in combination with the option's antecedent utility, rather than on the offered (...) odds. And even apart from this consideration, assigning probabilities to the options among which one is choosing is futile since such probabilities could be of no possible use in choice. The paper subjects these arguments to critical examination and suggests that, appearances notwithstanding, practical deliberation need not crowd outself-prediction. (shrink)

Explores the ethical issues faced by GPs in their everyday practice, addressing two central themes; the uncertainty of outcomes and effectiveness in general practice and the changing pattern of general practitioners' responsibilities.

The aim of this book is to provide an accessible account of ethics in general practice, addressing concerns identified by practitioners. It contains many examples and allows the reader to gain practical insights into how to identify and analyze the ethical issues they encounter in everyday general practice.

Modifying images for scientific publication is now quick and easy due to changes in technology. This has created a need for new image processing guidelines and attitudes, such as those offered to the research community by Doug Cromey (Cromey 2010). We suggest that related changes in technology have simplified the task of detecting misconduct for journal editors as well as researchers, and that this simplification has caused a shift in the responsibility for reporting misconduct. We also argue that the concept (...) of best practices in image processing can serve as a general model for education in best practices in research. (shrink)

General practice consultation has often been characterized by pragma-dialecticians as an argumentative activity type. These characterizations are typically derived from theoretical insights and qualitative analyses. Yet, descriptions that are based on quantitative data are thus far lacking. This paper provides a detailed account of the development of an instrument to guide the quantitative analysis of argumentation in doctor–patient consultation. It describes the implementation and preliminary results of a content analysis of seventy videotaped medical consultations of which the extent and type (...) of doctors’ argumentative support for medical opinions and advice are analyzed. Based on the study results, this paper addresses the merits of observational studies using content analysis as a method for the analysis of argumentative discourse in context as well as some of its key challenges and limitations, laying bare the opportunities for future research. (shrink)

This paper analyzes four instances in talk of generalization about people, that is, of using statements about one or more people as the basis of stating something about a category. Generalization can be seen as a categorization practice which involves a reflexive relationship between the generalized-from person or people and the generalized-to category. One thing that is accomplished through generalization is instruction in how to understand the identity of the generalized-from person or people, so in addition to being understood as (...) a practice of categorization, generalization can also be understood as a practice of identification. Somewhat incidentally, this paper also illustrates the importance of certain methodological issues related to membership categorization analysis and contributes to the growing body of work that connects membership categorization analysis with sequential conversation analysis. (shrink)

Abstraction and generalization are two processes of reasoning that have a special role in the construction of scientific theories and models. They have been important parts of the scientific method ever since the nineteenth century. A philosophical and historical analysis of scientific practices shows how abstraction and generalization found their way into the theory of the logic of science of the nineteenth-century philosopher Charles S. Peirce. Our case studies include the scientific practices of Francis Galton and John Herschel, who introduced (...) composite photographs and graphical methods, respectively, as technologies of generalization and thereby influenced Peirce’s logic of abstraction. Herschel’s account of generalization is further supported by William Whewell, who was very influential on Peirce. By connecting Herschel’s scientific technology of abstraction to Peirce’s logical technology of abstraction—namely, diagrams—we highlight the role of judgments in scientific observation by hypostatic abstractions. We also relate Herschel’s discovery-driven logic of science and Peirce’s open-ended diagrammatic logic to the use of models in science. Ultimately, Peirce’s theory of abstraction is a case of showing how logic applies to reality. (shrink)

Many philosophers hold that if an agent acts intentionally, she must know what she is doing. Although the scholarly consensus for many years was to reject the thesis in light of presumed counterexamples by Donald Davidson, several scholars have recently argued that attention to aspectual distinctions and the practical nature of this knowledge shows that these counterexamples fail. In this paper I defend a new objection against the thesis, one modelled after Timothy Williamson’s anti-luminosity argument. Since this argument relies (...) on general principles about the nature of knowledge rather than on intuitions about fringe cases, the recent responses that have been given to defuse the force of Davidson’s objection are silent against it. Moreover, the argument suggests that even weaker theses connecting practical entities with knowledge are also false. Recent defenders of the thesis that there is a necessary connection between knowledge and intentional action are motivated by the insight that this connection is non-accidental. I close with a positive proposal to account for the non-accidentality of this link without appeal to necessary connections by drawing an extended analogy between practical and perceptual knowledge. (shrink)

Bioethics, Volume 36, Issue 7, Page 733-734, September 2022.

Working relationships between practice nurses and general practitioners in Australia: a critical analysisThis research set out to explore shared care between practice nurses and general practitioners in South Australia. Nine practice nurses (PNs), two nurse practitioners and 10 general practitioners (GPs) were interviewed in urban and rural practices in order to build up a picture of how GPs and PNs worked together. The interviews showed that shared care was not a reality, although practice nurses were very busy, enjoyed their work (...) and were no longer performing as receptionists doing a little nursing on the side, but as highly skilled nurses. Questions that emerged included whether or not practice nurses are specialists or generalists; their relationship to nurse practitioners; the extent to which the doctor–nurse game explains the relationship between practice nurses and general practitioners; and the potential for expanding the practice nurse role. (shrink)

BackgroundThe principles of informed consent, confidentiality and privacy are often neglected during patient care in developing countries. We assessed the degree to which doctors in Lahore adhere to these principles during outpatient consultations.Material & MethodThe study was conducted at medical out-patient departments (OPDs) of two tertiary care hospitals (one public and one private hospital) of Lahore, selected using multi-stage sampling. 93 patients were selected from each hospital. Doctors' adherence to the principles of informed consent, privacy and confidentiality was observed through (...) client flow analysis performed by trained personnel. Overall patient perception was also assessed regarding these practices and was compared with the assessment made by our data collectors.ResultsSome degree of informed consent was obtained from only 9.7% patients in the public hospital and 47.8% in the private hospital. 81.4% of patients in the public hospital and 88.4% in the private hospital were accorded at least some degree of privacy. Complete informational confidentiality was maintained only in 10.8% and 35.5% of cases in public & private hospitals respectively. Informed consent and confidentiality were better practiced in the private compared to the public hospital (two-sample t-test > 2, p value < 0.05). There was marked disparity between the patients' perspective of these ethical practices and the assessment of our trained data collectors.ConclusionObservance of medical ethics is inadequate in hospitals of Lahore. Doctors should be imparted formal training in medical ethics and national legislation on medical ethics is needed. Patients should be made aware of their rights to medical ethics. (shrink)

Practical wisdom eliminativism has recently been proposed in both philosophy and psychology, on the grounds of the alleged redundancy of practical wisdom (Miller 2021 ) and its purported developmental/psychological implausibility (Lapsley 2021 ). Here we respond to these challenges by drawing on an improved version of a view of practical wisdom, the “Aretai model”, that we have presented elsewhere (De Caro et al. 2021 ; Vaccarezza et al. 2023 ; De Caro et al. forthcoming ). According to (...) this model, practical wisdom is conceptualized: (i) as virtuousness _tout court_, i.e., as the _ratio essendi_ of the virtues, and (ii) as a form of ethical expertise. By appealing to the first thesis, we counter the charge of psychological implausibility, while we rely on the second thesis to address the accusation of redundancy. In conclusion we argue that the Aretai model implies a significant paradigm shift in virtue ethics. Practical wisdom emerges as both necessary and sufficient for virtuousness, thereby downsizing – without eliminating entirely – the role that individual virtues play in our ethical lives. (shrink)

The paper has two aims. The first is to propose a general framework for organizing some central questions about normative practical reasons in a way that separates importantly distinct issues that are often run together. Setting out this framework provides a snapshot of the leading types of view about practical reasons as well as a deeper understanding of what are widely regarded to be some of their most serious difficulties. The second is to use the proposed framework to (...) uncover and diagnose what I believe is a structural problem that plagues the debate about practical reasons. A common move in the debate involves a proponent of one type of view offering what she and others proposing that type consider to be a devastating criticism of an opposing type of view, only to find that her criticism is shrugged off by her opponents as easy to answer, misguided, or having little significance for their view. This isn’t due to conceptual blindness or mere slavish devotion to a theory but something fundamental about the argumentative structure of a debate over genuinely shared issues. Hence, the debate about practical reasons suffers from argumentative gridlock. The proposed framework helps us to see why this is so, and what we might do to move beyond it. (shrink)

OBJECTIVES: To study and report the attitudes of patients and general practitioners (GPs) concerning the obligation of doctors to act for the good of their patients, and to provide a practical account of beneficence in general practice. DESIGN: Semi-structured interviews administered to GPs and patients. SETTING AND SAMPLE: Participants randomly recruited from an age and gender stratified list of GPs in a geographically defined region of South Australia. The sample comprised twenty-one general practitioners and seventeen patients recruited by participating (...) GPs. RESULTS: In practice, acting for the good of the patient not only accommodates the views of patients and GPs on expertise and knowing best, but also responds to the particular details of the clinical situation. Patients had a complex understanding of the expertise necessary for medical practice, describing a contextual domain in which they were expert, and which complemented the scientific expertise of their GPs. General practitioners identified multiple sources for their expertise, of which experience was the most significant. The role of the GP included responding to individual patients and particular clinical problems and ranged from the assumption of responsibility through to the proffering of medical advice. CONCLUSION: This study found that GPs acting for the good of their patients covered a variety of GP actions and patient preferences. Beneficence was not justified by presumed patient vulnerability or the inability of patients to understand medical problems, but furthered through a recognition of the different areas of expertise contributed by both parties to the consultation. (shrink)

A general practice of precedent is one that can plausibly apply to any well-functioning legal system. This practice, which can be grounded in the Rule of Law, needs to make it the case that courts always have a legal reason for following relevant precedent – even if the precedent is morally suboptimal, so long as it is not evil. Without this reason, a precedent may be treated as having no legal influence for the later court (‘the Null Model’), and this (...) runs counter to the Rule of Law. On top of this reason, courts may have a general legal obligation to follow precedent – stare decisis – but this risks entrenching morally bad decisions in the law. We need, therefore, a type of reason that lies in between the Null Model and stare decisis as a necessary step for any future justification of stare decisis. But how can courts have a legal reason for following morally suboptimal precedent? They can have that reason, I argue, in virtue of a specific judicial duty, positively laid down in a legal source, which aims to advance the Rule of Law in an institutionalised way. In this article, I aim to explain and justify that judicial duty. (shrink)

Objective: To identify problem solving strategies in general practice. Basic procedures: Three styles of scientific reasoning were defined and modelled on the medical environment. These models were tested in a simulated doctor-patient encounter.

Philosophical concerns cannot be excluded from even a cursory examination of the physician-patient relationship. Two possible alternatives for determining what this relationship entails are the teleological (outcome) approach vs the deontological (process) one. Traditionally, this relationship has been structured around the 'clinical model' which views the physician-patient relationship in teleological terms. Data on the actual content of general medical practice indicate the advisability of reassessing this relationship, and suggest that the 'clinical model' may be too limiting, and that a more (...) appropriate basis for the physician-patient relationship is one described in this paper as the 'relational model'. (shrink)

Evidence coming from several studies into memory and awareness during general anesthesia suggests that in surgical patients who seem to be adequately anesthetized , some form of cognitive functioning is preserved. This finding has important implications both for clinical practice and for memory research. In order to give the methodological background of the present situation in this field of research, this article deals, on the basis of recent experiments, with important methodological aspects of studies into perception and memory during general (...) anesthesia. (shrink)

The paper addresses the epistemological and theoretical assumptions that underpin the concept of Work and Organizational Psychology as idiographic, situated, and transformative social science. Positioning the connection between uniqueness and generalization inside the debate around organization studies as applied approaches, the contribution highlights the ontological, gnoseological, and methodological implications at stake. The use of practical instead of scientific rationality is explored, through the perspective of a hermeneutic lens, underlining the main features connected to the adoption of an epistemology of (...) practice. Specifically, the contribution depicts the configuration of the applied research as a relational practice, embedded in the unfolding process of generating knowledge dealing with concrete social contexts and particular social objects. The discussion of a case study regarding a field research project allows one to point out challenges and constraints connected to the enactment of the research process as a social accomplishment. (shrink)

My objective in this paper is to contribute to our understanding of Aristotle’s science of ethics by defending two claims. There is a way in which generalizations hold only for the most part that is unlike any of the types of generalizations in the natural sciences that hold only for the most part. These ethical generalizations depict ideals that, although grounded in and perfective of our human nature, are only rarely realized. Aristotle’s account of practical wisdom (...) provides all the resources we need for understanding how the person with practical wisdom can tell when the for the most part generalization in ethics is true and when it is not. (shrink)

UK general practitioners (GPs) are self-employed entrepreneurs running small businesses with commercial considerations. In this situation there is no clear distinction between information, self-promotion and advertising. In response to the growing public demand for more information about medical services, the medical profession should voluntarily accept the notion of soft self-promotion in the form of 'notices' or 'announcements' placed in newspapers. Newspapers are the most effective way of giving easy access to information. The resistance to newspapers may be more concerned with (...) preserving certain medical traditions than consideration of the public interest. The General Medical Council's (GMC's) arguments against soft self-promotion are seen as misguided paternalism, inconsistent and irrational. (shrink)

Quality improvement (QI) is fundamental to maintaining high standards of health care. Significant debate exists concerning the necessity for an ethical approval system for those QI projects that push the boundaries, appearing more similar to research than QI. The authors discuss this issue identifying the core ethical issues in family medicine (FM), drawing upon the fundamental principles of medical ethics, including principles of autonomy, utility, justice and non-maleficence. Recent debate concerning the application of QI ethics boards is discussed with relevance (...) to primary care and issues such as general practitioner (GP) intentions, the impact of QI on patients and the use of confidential patient data and the impact of dissemination. The authors conclude that a system of QI ethical approval leaves many issues unresolved and potentially creates several barriers to implementing QI. To ensure ethical QI work is generated within FM it is essential for GPs to learn about and engage in more ethical reflection so that they can better judge and resolve these issues. (shrink)

In all systems of health care there are certain essential levels of care and service. These take the form of self-care within the family unit; primary professional care by general medical nursing or social practitioners within a local neighbourhood; general specialist care in a district and super-specialist care in a region. Each of these has its own special roles and responsibilities and each is considered in this paper.

According to an attractive and widely held view, all practical reasons are explained in terms of the (instrumental or final) value of the action supported by the reason. I argue that this theory is incompatible with plausible assumptions about the practical reasons that correspond to certain moral rights, including the right to a promised action and the right to an exclusive use of one’s property. The argument is an explanatory rather than extensional one: while the actions supported by (...) the relevant reasons (e.g. keeping a valid promise or respecting property) can be argued to have a certain kind of value, I argue that this value presupposes a moral right, and therefore cannot explain the reason. Reflection on such cases suggest the conclusion that reasons that are subject to normative powers are generally not value-based. This also has important implications for the dialectic between ‘value-first’ and ‘reasons-first’ approaches to normativity. (shrink)

Part I: The representation of life -- Can life be given a real definition? -- The representation of the living individual -- The representation of the life-form itself -- Part II: Naive action theory -- Types of practical explanation -- Naive explanation of action -- Action and time -- Part III: Practical generality -- Two tendencies in practical philosophy -- Practices and dispositions as sources of the goodness of individual actions -- Practice and disposition as sources of (...) individual action. (shrink)

Next SectionWhilst there has been considerable debate about the fit between moral theory and moral reasoning in everyday life, the way in which moral problems are defined has rarely been questioned. This paper presents a qualitative analysis of interviews conducted with 15 general practitioners (GPs) in South Australia to argue that the way in which the bioethics literature defines an ethical dilemma captures only some of the range of lay views about the nature of ethical problems. The bioethics literature has (...) defined ethical dilemmas in terms of conflict and choice between values, beliefs and options for action. While some of the views of some of the GPs in this study about the nature of their ethical dilemmas certainly accorded with this definition, other explanations of the ethical nature of their problems revolved around the publicity associated with the issues they were discussing, concern about their relationships with patients, and anxiety about threats to their integrity and reputation. The variety of views about what makes a problem a moral problem indicates that the moral domain is perhaps wider and richer than mainstream bioethics would generally allow. (shrink)

This paper draws on classical theories of wisdom to explore the organisational impact of nurses on Australian general practice. Between 2004 and 2008, numbers of general practice nurses doubled, the most rapid influx of nurses into any Australian workplace over the decade. Using data from the Australian General Practice Nurses Study, we argue that nurses had a positive impact because they introduced techne at the organisational level and amplified phronesis in clinical activities. In its Hippocratic formulation, techne refers to a (...) field of definable knowledge, which is purposeful and useful and requires mastery of rational principles. Nursing, with its focus on system and accountability, brought techne out of the GP’s consulting room and into the general practice as a whole. Nurses also exemplify phronesis, an Aristotelian virtue connoting a reasoned and honourable capacity to make judgements: the practical wisdom that defines the interaction between clinician and patient in general practice. At a time of significant GP shortage, doctors and nurses began to collaborate around their more complex and time-consuming patients, leading to a deepening of phronesis in the workplace. By bringing techne to bear on the organisation, and complementing and enhancing phronesis, nurses propel organisational wisdom in general practices. (shrink)

In A General View of Positivism French philosopher Auguste Comte gives an overview of his social philosophy known as Positivism. Comte, credited with coining the term 'sociology' and one of the first to argue for it as a science, is concerned with reform, progress and the problem of social order in society. In this English edition of the work, published in 1865, he addresses the practical problems of implementing his philosophy or doctrine, as he also refers to Positivism, into (...) society. He believes that society evolves through a series of stages that are ruled by social laws and culminate in a superior form of social life. During this reorganisation of society, which will find its greatest supporters among women and the working class, a 'new moral power' will emerge. Under the motto 'love, order and progress' Comte wishes humanism to replace organised religion as the object of spiritual worship. (shrink)

The power of skepticism depends on the apparent possibility of rationally asking, for virtually any kind of proposition commonly thought to be known,howit is known or what justifies believing it. Moral claims are among those commonly subjected to skeptical challenges and doubts, even on the part of some people who are not skeptical about ordinary claims regarding the external world. There may be even more skepticism about the possibility of justifying moralactions,particularly if they are against the agent's self-interest. Both problems-how (...) to justify moral claims and how to justify moral action - come within the scope of the troubling question “Why be moral?” Even a brief response to moral skepticism should consider both kinds of targets of justification, cognitive and behavioural, and should indicate some important relations between the two types of skeptical challenge. I will begin with the cognitive case- with skepticism about the scope of theoretical reason in ethics - proceed to practical skepticism, which concerns the scope of practical reason, and then show how an adequate account of rationality may enable us to respond to moral skepticism. (shrink)