Volume 20, Issue 3, March 2020, Page 24-27.

‘Shared’ decision-making is heralded as the gold standard of how medical decisions should be reached, yet how does one ‘share’ a decision when any attempt to do so will undermine _autonomous_ decision-making? And what exactly is being shared? While some authors have described parallels in literature, philosophical examination of shared agency remains largely uninvestigated as an explanation in bioethics. In the following, shared decision-making will be explained as occurring when a group, generally comprised of a patient and or their family, (...) and the medical team become a genuine intentional subject which acts as a collective agent. Collective agency can better explain how some medical decisions are reached, contrary to the traditional understanding and operationalization of ‘autonomy’ in bioethics. Paradoxically, this often occurs in the setting of high-stakes moral decision-making, where conventional wisdom would suggest individuals would _most_ want to exercise autonomous action according to their personally held values and beliefs. This explication of shared decision-making suggests a social ontology ought to inform or displace significant aspects of autonomy as construed in bioethics. It will be argued that joint commitments are a fundamental part of human life, informing and explaining much human behavior, and thus suggesting that autonomy - conceived of as discrete, individuated moral reasoning of a singular moral agent - is not an unalloyed ‘good.’. (shrink)

A two-year rounding program was initiated by the clinical ethics consult service (CECS) to improve ethics program integration and utilization at our 323-bed tertiary care pediatric hospital. Two critical variables were identified for improvement. One: identification of cases in which an ethics consult would have benefited clinical care but was not requested. Two: earlier detection of cases for which the medical team and/or family eventually sought ethics consultation but that worsened during the delay. Improvement relied on eliciting dialogue with the (...) CECS by the medical team and/or patients and families, when it had either not occurred before or had not occurred when it would have been most beneficial. The indirect nature of the improvements sought posed a specific challenge: how does one elicit such action from others? How does a small program with less than one full-time equivalent position that is dedicated to clinical ethics, and little funding, effect such a process change across an organization with more than 600 physicians, 2,000 nurses, 600 medical students, and thousands of other clinicians and staff? The following accounts such an effort and the accompanying two-year study undertaken to document the results. The data presented demonstrate improvement in both identified variables: increased overall utilization of the CECS and earlier detection of cases in which the CECS is typically engaged. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 4-7, January/February 2022.

Hastings Center Report, Volume 52, Issue 2, Page 32-40, March‐April 2022.

The fidelity provided by rich, nuanced ethics consult narratives does not proscribe efforts to advance the profession by using data to assess performance and demonstrate value. While these two approaches have been described as in conflict with one another, the former sets the bar to which the latter should aim; to achieve this, consult data should, minimally, do two things: (1) tell the story of the case, as best as possible, in language easily accessible to both ethicists and non-ethicists alike; (...) and (2) do so in a way that elements of interest can be aggregated, disambiguated, and analyzed. Here we present a three-component system designed with that in mind.First, the Armstrong Clinical Ethics Coding System (ACECS) produces a set of six codes that tell a simplified story of the case. These six codes form a meta narrative, which, like meta data, can be aggregated, disambiguated, and analyzed. Second, we use a data model to uncover the stories those data tell. The results allow us to understand relationships, recognize patterns, and reveal insights that are otherwise not discoverable when using narratives alone. Third, due to tremendous heterogeneity among cases, we represent findings visually using techniques borrowed from data storytelling, a powerful means to demonstrate the value of a consult service to administrators and others. The ability to derive meta narratives from an aggregate of case narratives allows us to describe, in detail, the work of our consult service in a manner directly comparable to other services that use the system while we preserve unprecedented case-level nuance. If adopted broadly, this functionality suggests a means to undergird the legitimacy of the ethics consult practice itself in an evidence-based manner similar to that which undergirds other domains of healthcare. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 30.2 (2006) 410-423 MuseSearchJournalsThis JournalContents[Access article in PDF]Reading Our Way To Democracy? Literature and Public EthicsSimon Stow The College of William and Mary"I believe," wrote Franz Kafka, "that we should only read those books that bite and sting us. If a book we are reading does not rouse us with a blow to the head, then why read it?" 1 Almost all of us who read (...) books for a living and/or pleasure have undoubtedly experienced that most delightfully troubling of phenomena: a novel that forces us to think differently about the world and the way that we live. In recent years, literature's capacity to generate in its readers "a rigorous scrutiny of everything they believe in and live by" 2 —what Stanley Fish calls its "dialectical" potential—has drawn the attention of a number of liberal-democratic theorists, most notably Martha Nussbaum and Richard Rorty. By "liberal-democratic" is meant here, of course, that system of government with popular rule, regular elections, a commitment to individual rights and the rule of law; one that draws on a tradition of political thought that includes the work of John Locke, John Stuart Mill and John Rawls. Although their exact formulations of the claim differ in important ways, Nussbaum and Rorty are united in the belief that reading can enhance the practice of liberal-democracy by expanding the moral imaginations of a citizenry. Such an expansion will, they believe, promote the values of tolerance, respect for other viewpoints, and a recognition of the contingency of one's own perspective, in short, the values of civil society. Whilst there is undoubtedly something intuitively appealing about their claim, there is much that is philosophically and politically problematic about their respective formulations of it. Both seem to rest for example upon an implausible theory of the impact of literature upon its readers, and an illiberal tendency to treat reader-citizens as means and not as ends. Attempting to capture what is of value [End Page 410] whilst jettisoning what is problematic, I will briefly set out their claims; identify the difficulties within them; and offer an account of how their project might be operationalized in a way that is both more philosophically plausible and more politically consistent with liberalism. My aim will not be to offer another detailed account of the connection between literature and democracy—not least because I believe that the current accounts are overly deterministic—but rather to suggest some ways in which we might nevertheless build upon the current work to capture the potential benefits of reading for liberal-democratic societies.Although Martha Nussbaum and Richard Rorty hold quite different views about the proper role of literature in philosophy—Nussbaum believes that literature is merely a valuable addition to philosophical Reason traditionally conceived, whereas for the postfoundational Rorty, the literariness goes all the way down—both suggest that reading will promote two values that they regard as essential to liberal-democratic practice. Following Rorty we might label these values contingency and solidarity. 3 Contingency arises from the recognition that even one's most deeply held beliefs are always only a perspective. It is connected to civility in that it serves, Nussbaum and Rorty believe, to undermine the vehemence of individual claims. Although this claim about the partiality of individual perspectives sounds dangerously postmodern for thinker such as Nussbaum—Rorty, who calls his political philosophy "postmodernist bourgeois liberalism," 4 has no such qualms—there are limits to this insight in her thought. Nussbaum is simply concerned to show that an excessive and over-confident reliance on philosophical Reason is likely to generate an incomplete understanding of a given situation. For this reason, she suggests, "storytelling and literary imagining are not opposed to... but can provide essential ingredients in a rational argument." 5 She argues, for example, that Hard Times by Charles Dickens will alert its readers—in particular "the person brought up solely on economic texts" who "has not been encouraged to think of workers (or indeed anybody else) as fully human... (shrink)

This book is designed to provide an introduction to the history of American thought. It does not attempt to be encyclopedia in its coverage of the subject; many familiar names of names of men and books are absent.

Politik und Moral, von A. Rüstow.--Die Staatsverfassung als moralische Anstalt betrachtet, von A. Rüstow.--Macht und Moral, von M. J. Hillenbrand.--Ethik und Aussenpolitik, von F. A. Hermens.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 28.1 (2004) 220-223 [Access article in PDF] Doing Our Own Thing. The Degradation of Language and Music and Why We Should, Like Care, by John McWhorter; xiv & 279 pp. New York: Gotham Books, 2003, $26.00. In 2002, the first anniversary of the September 11th attacks was marked in New York City by the reading of the Gettysburg Address. It was, as many commentators noted, an (...) odd choice of eulogy, comparing as it did the unwitting and innocent victims of a terrorist attack to the willing and active [End Page 220] participants in a bloody civil war. In Doing Our Own Thing, the Berkeley linguist John McWhorter asserts that this strange choice was the result of a decline in American public discourse. A "particular kind of artful English, formerly taken for granted as crucial to legitimate expression on the civic stage has" he argues, "virtually disappeared" (p. xiv). For McWhorter, this lack of contemporary public oratory is merely part of a broader linguistic decline that has affected all aspects of American life and culture.There has, he suggests, been a dumbing-down of the language. Whereas Americans once took care to craft their language, public and private, McWhorter argues, there is now a casualness to their speech and writing which affects all aspects of their existence. The nature of this decline is best captured by McWhorter's anecdote about his research into Gullah, an obscure Creole dialect. In response to his inquiries about local speech patterns, an elderly black woman in Greenwood, Mississippi responded: "Well, seems like most folks, they speak pretty good English, but some people, it seems like they just talk" (p. 2). Whereas Americans once spoke pretty good English, McWhorter believes, now, for the most part, they just talk. In Doing Our Own Thing, he seeks to identify not only evidence for his thesis, but also the causes and consequences of this decline.Evidence of linguistic decline is, McWhorter believes, to be found in our public discourse (as evidenced by the contemporary use of the Gettysburg Address), and in the rise of rap music and popular lyrics at the expense of poetry—he notes that as late as the 1960s, the poet Marianne Moore was a guest on The Tonight Show twice. Less intuitively perhaps, he identifies the same decline in the decreased popularity of piano bars, and the rising popularity of cell-phones. What all these examples of have in common, McWhorter suggests, is a turn towards an oral as opposed to a written culture. Speech has, he says, become something of a "dress-down affair" (p. 49), and this has infected both our written word and public oratory. The "modern American speech writer" he notes, "tends strongly to operate under a guiding imperative not to sound too high a note" (p. 47). McWhorter contrasts this with examples from the nineteenth-century—with letters from ordinary soldiers to their sweethearts, and with Edward Everett's two-hour plus address at Gettysburg—which show that "we live in an America with a distinctly different relationship to the English language than an America still within living memory" (p. 167).For McWhorter, the causes of this decline are clear. The 1960s counterculture, in its efforts to "Speak Truth to Power, abandoned the formal conventions of previous generations' speech, and adopted its own more casual approach to public discourse. Indeed, McWhorter feels confident enough to identify "a single year when America lost its love for its language": 1965 (p. 183). The consequences of this decline are, for McWhorter, similarly obvious. Among them, the shift to an oral culture is held to be responsible for: the election of George W. Bush—Al Gore's "studied articulateness is certainly one of the major [End Page 221] factors that blocked him from winning the presidency" (p. xxi); the decline of contemporary political debate—more formal written language is, says McWhorter, "a better vehicle for objective argument than speech" (p. 35); and the increasingly obtuse nature of academic language. Indeed, McWhorter asserts that Judith Butler... (shrink)

This is a new revised version of Dr. Laslett's standard edition of Two Treatises. First published in 1960, and based on an analysis of the whole body of Locke's publications, writings, and papers. The Introduction and text have been revised to incorporate references to recent scholarship since the second edition and the bibliography has been updated.

What is the proper role for Theory in literary study? An aid to reading? Or source of insight into the world beyond the text? Half-heartedly apologizing for the political-theoretical excesses of the past two decades, Gayatri Chakravorty Spivak and Jean-Michel Rabaté offer up more of the same, with Spivak in particular recycling the ideas of others so as to revive literature as a source of political "Othering." Noting the ways in which Theory silences the sounds of "Others," I argue Valentine (...) Cunningham's placing of Theory permits both texts and others to speak, and in so doing, teaches us to listen. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 26.2 (2002) 459-461 [Access article in PDF] The Heart of What Matters. The Role for Literature in Moral Philosophy,by Anthony Cunningham; x & 296 pp. Berkeley: University of California Press, 2001, $60.00 cloth, $24.95 paper. Despite Socrates's rejection of the written word as a source of insight in the Phaedrus, a number of theorists have in recent years sought to find a role for literature in (...) critical thought. Anthony Cunningham's The Heart of What Matters joins a list of works that includes Richard Rorty's Contingency, irony and solidarity, Richard Posner's Law and Literature, and Martha Nussbaum's Poetic Justice. Whereas a number of these previous books have sought to articulate a public role for literature, Cunningham is more concerned with private philosophical reflection, specifically with the ways in which literature might help us reflect upon Socrates's dual questions "How should I live?" and "What sort of person should I be?" (p. 9). It is, nevertheless, appropriate to mention Cunningham's work in conjunction with these other texts because The Heart of What Matters faces a number of similar problems arising from what it means to read literature with an eye towards generating critical thought.The first part of the book consists of three chapters in which Cunningham sets out his conception of ethics, the role of a convincing ethical theory, and his account of what it means to "read for life." This last chapter is, by his own admission "fairly sketchy and theoretical" (p. 69), but he attempts to compensate for this in the second part where he offers—as a means, perhaps, of "showing by doing"—detailed, philosophically motivated readings of literary works by three authors: Kazuo Ishiguro, Toni Morrison, and Zora Neale Hurston. Like many of those who write about literature and ethics—including Wayne Booth and Martha Nussbaum—Cunningham's conception of ethics is "Aristotelian in spirit" (p. 5), as such it is no surprise to find that his "primary targets" in ethical theory are "Kant and Kantian ethics" (p. 4). Kant's theory of morality and indeed its various modern formulations—formulations Cunningham critques in some detail—are, he says, simply insufficient for capturing the nuances of our lived experience. Theories that focus on some underlying principle of morality are, he suggests, too abstract to help us answer Socrates's questions about the best way to live. By contrast, literature can, Cunningham argues, provide us with insight into the complexities of modern living. In a passage that is strongly reminiscent of Poetic Justice, Cunningham asserts that literature can "filter moral experience by heightening our attention to what should be morally salient and by directing us away from less crucial elements that can distract us from more important things" (p. 84). Similarly, in a passage that further echoes Nussbaum, Cunningham suggests that "literature can help us diagnose by taking us places that are difficult and even impossible to visit, much less understand in actual experience" (p. 85). Central to his overall argument is the suggestion, also common to Nussbaum and Rorty, that the [End Page 459] "right kind of novel" can "help us refine our moral vision by giving us a studied opportunity to practice seeing and appreciating diverse ethical lores" (pp. 84-85). It is, however, this suggestion that reading is some sort of moral exercise that proves problematic for almost all work on literature and philosophy.If literature is indeed a way for us to practice exercising our moral powers, then it is not clear why philosophers such as Cunningham, Nussbaum, and Rorty lavish so much attention on their own reading of texts. Reading about reading is not, I wish to suggest, the best way to exercise this moral capacity: it is rather like expecting to benefit from watching somebody else exercise. Instead of offering us a theory of reading which might allow us to engage in this exercise ourselves, Cunningham simply gives an account of his own experience. In this way, the subtitle of Cunningham's book, "The Role for Literature in... (shrink)

In addition to being characterised as a ‘regime of truth’, Orientalist discourses also display the general properties of confessional discourses outlined in Foucault’s Will to Knowledge. The article argues that there is a similarity in the ‘effects of power’ made possible within these frameworks, particular regarding the legitimisation and application of discipline. Finally, the paper draws out a few implications for the analysis of power and resistance in confessional economies of power. The perspective this paper provides an insight into the (...) internal structure of Orientalist discourse; connects this structure with Orientalism’s ‘effects of power’; affords purchase on both Orientalism’s organisational and ontogenetic properties; helps explain the persistence of Orientalism – both overt and covert – despite three decades of post-Orientalist scholarship. In this sense, a confessional perspective on Orientalism affords a broad view of the contemporary politics of truth in which Orientalism plays such as an important part. Finally, a confessional perspective affords purchase on the nature of power, the formation of subjectivities, and the possibilities of resistance within Orientalist discursive contexts, which Said’s own analysis is often said to lack. (shrink)

The theory of evolution: The rise and impact of evolutionary ideas, by R. Scoon. Evolution in its relation to the philosophy of nature and the philosophy of culture, by F.S.C. Northrop. The genetic nature of differences among men, by T. Dobzhansky. Evolutionary thought in America: Evolution and American sociology by R.E.L. Faris. The impact of the idea of evolution on the American political and constitutional tradition, by E.S. Corwin. Evolutionism in American economics, 1800-1946, by J.J. Spengler. The influence of evolutionary (...) theory upon American psychological thought, by E.G. Boring. Naturalism in American literature, by M. Cowley. The idea of organic expression and American architecture, by D.D. Egbert. Evolution and moral theory in America, W.F. Quillian, Jr. Evolution and theology in America, by S. Persons. (shrink)

Neuroimaging evidence suggests that the left inferior frontal gyrus (LIFG) supports temporary storage of linguistic material during linguistic tasks rather than computing a syntactic representation. The LIFG is not activated by simple sentences but by complex sentences and maintenance of word lists. Under this hypothesis, agrammatism should only disturb comprehension for constructions in which storage is essential.

Children tend to view equal resource distributions as more fair than unequal ones, but will sometimes view even unequal distributions as fair. However, less is known about how children form judgments about inequality when different procedures are used. In the present study, we investigated children’s consideration of procedures, outcomes, and emotions when judging the fairness of unequal resource distributions. Participants were introduced to a Fair Coin and an Unfair Coin. In two between-subjects conditions, they watched a researcher flip either the (...) Fair or Unfair Coin in order to distribute resources unequally between two child recipients. Participants then rated the fairness of this event, provided verbal justifications for their ratings, and rated the emotional state of each recipient. Results revealed that participants rated the event as more fair in the Fair Coin than the Unfair Coin condition. References to the outcome in children’s justifications predicted lower fairness ratings, while references to the procedure only predicted lower ratings in the Unfair Coin condition. Greater Emotion Difference Scores predicted lower fairness ratings, and this effect increased with age. Together, these results show that children consider procedures, outcomes, and emotions when judging the fairness of inequality. Moreover, results suggest age-related increases in consideration of recipients’ emotions makes inequality seem less fair, even when fair procedures are used. Implications for the development of fairness are discussed. (shrink)

Event-related brain potentials (ERPs) can reveal online processing differences between native speakers and second language (L2) learners during language comprehension. Using the P600 as a measure of native-likeness, we investigated processing of grammatical gender agreement in highly proficient immersed Romance L2 learners of Dutch. We demonstrate that these late learners consistently fail to show native-like sensitivity to gender violations. This appears to be due to a combination of differences from the gender marking in their L1 and the relatively opaque Dutch (...) gender system. We find that L2 use predicts the effect magnitude of non-finite verb violations, a relatively regular and transparent construction, but not that of gender agreement violations. There were no effects of age of acquisition, length of residence, proficiency or offline gender knowledge. Additionally, a within-subject comparison of stimulus modalities (written vs. auditory) shows that immersed learners may show some of the effects only in the auditory modality; in non-finite verb violations, an early native-like N400 was only present for auditory stimuli. However, modality failed to influence the response to gender. Taken together, the results confirm the persistent problems of Romance learners of Dutch with online gender processing and show that they cannot be overcome by reducing task demands related to the modality of stimulus presentation. (shrink)

A Norton Library edition of Locke's Second Treatise of Government, edited by A. John Simmons.