Clinical ethics support (CES) for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria (CEGD) at Amsterdam University Medical Center. We specifically aimed to integrate CES (...) into daily work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

It is often claimed that irreducibly normative truths would have unacceptable metaphysical implications, and are incompatible with a scientific view of the world. The book argues, on the basis of a general account of the relevance of ontological questions, that this claim is mistaken. It is also a mistake to think that interpreting normative judgments as beliefs would make it impossible to explain their connection with action. An agent’s acceptance of a normative judgment can explain that agent’s subsequent action because (...) it is part of being a rational agent that such an agent’s beliefs about reasons normally, but not invariably, make a difference to the agent’s subsequent behavior. Because facts about reasons are not entities existing apart from us, there is no epistemological problem of how we can “be in touch with” such facts. There are serious worries about normative knowledge, but the problems involved are internal to the normative domain itself. The best solution to these problems would be an overall account of the domain of reasons in normative terms, supported by an argument from reflective equilibrium. But no existing account, constructivist, or based on desires or on an idea of rationality, is plausible, and no alternative is likely to succeed. Conclusions about reasons for action must rest on more piecemeal applications of the method of reflective equilibrium. (shrink)

This book explores the aesthetics of the objects and environments we encounter in daily life. Thomas Leddy stresses the close relationship between everyday aesthetics and the aesthetics of art, but places special emphasis on neglected aesthetic terms such as ‘neat,’ ‘messy,’ ‘pretty,’ ‘lovely,’ ‘cute,’ and ‘pleasant.’ The author advances a general theory of aesthetic experience that can account for our appreciation of art, nature, and the everyday.

In his chapter ‘Aristotle on Virtue: Wrong, Wrong, and Wrong’, Thomas Hurka advances penetrating criticisms of some of the core theses of the Aristotelian approach to virtue. Hurka challenges the Aristotelian tendency to blur the distinction between the good and the right by making the virtues, which are constitutive of a person’s goodness, objects of praise or blame. He puts into question the Aristotelian doctrine of the mean and the idea that vice can always be explained in terms of (...) either excess or deficiency. Most importantly, he challenges what he calls the foundational egoism of Aristotelian virtue theory, according to which a virtuous person’s ultimate reason for being virtuous is grounded in their concern for their own flourishing. Hurka contrasts his criticism with a sketch of his own recursive theory of virtue, which is opposed to the Aristotelian approach in crucial respects and thus suggests itself as an attractive alternative to it. (shrink)

In philosophy, as in many other disciplines and domains, stable disagreement among peers is a widespread and well-known phenomenon. Our intuitions about paradigm cases, e.g. Christensen's Restaurant Case, suggest that in such controversies suspension of judgment is rationally required. This would prima facie suggest a robust suspension of judgment in philosophy. But we are still lacking a deeper theoretical explanation of why and under what conditions suspension is rationally mandatory. In the first part of this paper I will focus on (...) this question. After a critical survey of some recent alternative approaches (diversity as a thread to the reliability, decision problem, acquisition of undercutting defeaters), I will argue that in fact discovering disagreement with an opponent provides me with a rebutting defeater, but only if some further non-trivial conditions are satisfied - among them my acknowledging her as my reliability peer. In the second part of the paper I will explore in more detail the skeptical implications this account has for philosophy. Here, I will defend two claims. First, skepticism about philosophy is mandatory only if the relevant peerness assumption can be justified. Second, in philosophy there is no basis available that would support the relevant peerness assumption. If this is correct, we are not forced into skepticism about philosophy and may rationally retain our philosophical beliefs even in the face of controversy. (shrink)

Since, it has become clear that individuality is not to be considered as a given, but rather as something which needs to be explained. How has individuality emerged through evolution, and how has it subsequently been maintained? In particular, why is it that multicellular organisms appeared and persisted, despite the obvious interest of each cell of favoring its own replication? Several biologists see the immune system as one of the key components for explaining the maintenance of multicellular organisms’ individuality. Indeed, (...) the immune system exerts a constant surveillance on all the constituents of the organism, including “cheaters” like tumor cells, which favor their own replication at the expense of the whole organism. In most cases, the immune system eliminates those cheaters. This is the “immune surveillance” hypothesis, first suggested by Burnet and Thomas. In this paper, I account for recent findings on immune surveillance in order to determine the precise role of the immune system in the emergence and maintenance of individuality. This investigation gives rise to a critical question for the domain of biological individuality: should immunity be considered as something unique to multicellular organisms? If it is indeed unique, should the multicellular organism be considered as an individual to a higher degree than any other living entity? If it is not unique, what precisely are the equivalents of the immune system in other living individuals? (shrink)

In the mid twentieth century the philosopher Ludwig Wittgenstein famously asserted that games are indefinable; there are no common threads that link them all. "Nonsense," says the sensible Bernard Suits: "playing a game is a voluntary attempt to overcome unnecessary obstacles." The short book Suits wrote demonstrating precisely that is as playful as it is insightful, as stimulating as it is delightful. Suits not only argues that games can be meaningfully defined; he also suggests that playing games is a central (...) part of the ideal of human existence, so games belong at the heart of any vision of Utopia. Originally published in 1978, The Grasshopper is now re-issued with a new introduction by Thomas Hurka and with additional material (much of it previously unpublished) by the author, in which he expands on the ideas put forward in The Grasshopper and answers some questions that have been raised by critics. (shrink)

Adam Smith is respected as the father of contemporary economics for his work on systemizing classical economics as an independent field of study in The Wealth of Nations. But he was also a significant moral philosopher of the Scottish Enlightenment, with its characteristic concern for integrating sentiments and rationality. This article considers Adam Smith as a key moral philosopher of commercial society whose critical reflection upon the particular ethical challenges posed by the new pressures and possibilities of commercial society remains (...) relevant today. The discussion has three parts. First I address the artificial separation between self-interest and morality often attributed to Smith, in which his work on economics is stripped of its ethical context. Second I outline Smith’s ethical approach to economics, focusing on his vigorous but qualified defence of commercial society for its contributions to prosperity, justice, and freedom. Third I outline Smith’s moral philosophy proper as combining a naturalistic account of moral psychology with a virtue ethics based on propriety in commercial society. (shrink)

Serena Olsaretti brings together new essays by leading moral and political philosophers on the nature of desert and justice, their relations with each other and with other values.

This is a survey article about epistemic defeaters: what is defeated, how defeaters work, different kinds of defeaters, indefeasibility and how defeaters fit into epistemic internalism and externalism.

During the Nazi regime (1933–1945), more than 300 000 psychiatric patients were killed. The well‐calculated killing of chronic mentally ‘ill’ patients was part of a huge biopolitical program of well‐established scientific, eugenic standards of the time. Among the medical personnel implicated in these assassinations were nurses, who carried out this program through their everyday practice. However, newer research raises suspicions that psychiatric patients were being assassinated before and after the Nazi regime, which, I hypothesize, implies that the motives for these (...) killings must be investigated within psychiatric practice itself. An investigation of the impact of the interplay between the notes left by nurses and those by psychiatrists illustrates the active role of the psychiatric medical record in the killing of these patients. Using theoretical insights from Michel Foucault and philosopher Giorgio Agamben and analyzing one part of a particularly rich patient file found in the Langenhorn Psychiatric Asylum in the city of Hamburg, I demonstrate the role of the record in both constructing and deconstructing patient subjectivities. De‐subjectifying patients condemned them to specific zones in the asylum within which they were reduced to their ‘bare life’‐ a precondition for their physical assassination. (shrink)

On Power (De Potentia) is one of Aquinas's ''Disputed Questions'' (a systematic series of discussions of specific theological topics). It is a text which anyone with a serious interest in Aquinas's thinking will need to read. There is, however, no English translation of the De Potentia currently in print. Fr. Richard Regan has produced this abridgement, which passes over some of the full text while retaining what seems most important when it comes to following the flow of Aquinas's thought.

This article focuses on the philosophical aspects of the Capability Approach and its foundations in the work of Amartya Sen. It discusses the development and structure of Sen’s account, how it relates to other ethical approaches, and its main contributions and criticisms. It also outlines various capability theories developed within the Capability Approach, with particular attention to that of Martha Nussbaum.

Der Beitrag zeichnet die Selbstbeschreibung der Theorie Luhmanns als »Supertheorie« nach und macht an ihr kenntlich, inwiefern die Verwiesenheit der Theorie auf andere Beschreibungen und die Uneinholbarkeit der Theorie für sich selbst unterbelichtet und unzureichend entfaltet bleiben (1). Luhmanns Konzeption wird daher Derridas Quasi-Konzept des »theoretical jetty«, des theoretischen Entwurfs, zur Seite gestellt, das es ermöglicht, den Aporien der Selbstbezüglichkeit der Theorie, den resultierenden Ungreifbarkeiten und der Verwiesenheit auf andere Theorien in anderer Weise Rechnung zu tragen (2). Das erlaubt schließlich (...) Anregungen für eine andersgeartete Theoriekonstruktion: für Möglichkeiten supplementärer statt schlicht totalisierender Theorieverhältnisse, für nicht-thematistische Markierungen der Selbstbezüglichkeit von Theorien und für eine Theoriekonstruktion, die Generalisierung und Respezifikation als Prozeßformen stärker hervorhebt (3). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:DULLES AND AQUINAS ON REVELATION 1. Beginning the Dialogue RESPECT FOR Avery Dulles' achievement in Models of Revelation 1 need not oonsist entirely in "enthusiastic recognition of its many merits " 2 even though it is " the mature reflection of an experienced teacher " and " as of now... the most comprehensive treatment on revelation in the English"'speaking world ".3 Learning from it involves recognizing the " worthwhileness (...) of dialogue with Dulles ' work ".4 In this questions,are essential to advancing the discussion. This article will proceed in appreciative dialogue by means of critical questions and wiH move in the direction of modifying aspects of Dulles' basic principle in Models of Revelation. Dialogue, according to the hermeneutical work of H.-G. Gadamer,5 is not first of all a genre for organizing,and presenting themes and ideas already attained. It belongs to the act of understanding itself, occurs in reading a text, always takes place in and through tradition and is one of the ways in which interpretation enters into every experience. In this light, the Summa Theologiae 6 of St. Thomas Aquinas belongs to a read1 Avery Dulles, Models of Revelation (Garden City, N.Y.: Doubleday, 1983). 2 Bernard Cooke, " God Revealing in Symbol", OommonweaZ 110: 308, May 20, 1983. 3 Dermot Lane, "A Review Essay: Dulles on Revelation", The Living Light, 21:74-76, Oct. 1984; p. 74. 4 William Loewe, review in New Catholic World, 226:185, July-August, 1983. 5 Hans-Georg Gadamer, Truth wnd Method (New York: Crossroad, 1982); pp. 325-341, 345-351. 6 St. Thomas.Aquinas, Summa Theofogiae, Vol. 45, Prophecy and Other 445 446 THOMAS HUGHSON, S.J. ing of 211odels of Revelation, despite the absence of evidence that it influenced Dulles' theology of revelation. It does not belong to it, that is, because it served as a source for 211odels of Revelation. Nevertheless, the Summa is within, and has significantly changed, the theological tradition shared by 211odels of Revelation. Reading Dulles' book in light of its tradition, then, brings Aquinas into the dialogue 7 in a way that would not be appropriate for a strictly historical-theological analysis of influences upon Dulles' theology of revelation. The Summa stands as a classic 8 work in the Catholic theological tradition. The inescapable magnitude of Aquinas' achievement makes it pertinent to every part of that tradition. Karl Rahner judged that, " Thomas Aquinas is to be immbered among the great figures of theology with whom any contemporary theology must engage in a genuine dialogue ".9 Rahner observed, too, the way in which attitudes toward Aquinas have changed. He noted, "From being the teacher of theology in the theological schools themselves, Thomas has acquired the status of a Father of the Church ".10 In this new and somewhat reduced condition, Aquina:s' text's can assume their true proportions as theological classics whose claim upon generation after generation arises not so much from official sanction as from their self-evidencing power to speak about subject-matter whose intr:insic significance brings it before a succession of eras and to a variety of cultures. It is easy Charisms (2a2ae, 171-8), Latin text; English translation, Introduction, Notes, Appendices & Glossary by Roland Potter, O.P. (New York: McGraw-Hill Book Co., 1969). English translations and Latin text will be from Vol. 45 through-out this article; references will be to parts of Aquinas' article. 7 M.-D. Chenu's Toward Understanding Et. Thomas, translated by A-M Landry & D. Hughes (Chicago: Henry Regnery, 1964), it is true, places the modern reader in dialogue with medieval texts through careful recovery of their contexts. But the relationship tends to lead into Aquinas's texts and their meaning rather than back from them to contemporary themes. s H.-G. Gaclamer, pp. 253-258. 9 Karl Rahner, "On Recognizing the Importance of Thomas Aquinas", Theological Investigationg Vol. XIII, translated by D. Bourke (New York: Seabury Press, 1975); pp. 3-12, 6-7. 10 Rahner, p. 4. DULLES AND AQUINAS ON REVELATION 447 enough to see that dirulogue with Aquinas inspired the work of Karl Rahner and Bernard Lonergan as well as the early writings of Edward Schillebeeckx and Johann Baptist Metz. Yet this is not to... (shrink)

Now available in a Harper Colophon edition, this classic book has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. Book jacket.

May lethal autonomous weapons systems—‘killer robots ’—be used in war? The majority of writers argue against their use, and those who have argued in favour have done so on a consequentialist basis. We defend the moral permissibility of killer robots, but on the basis of the non-aggregative structure of right assumed by Just War theory. This is necessary because the most important argument against killer robots, the responsibility trilemma proposed by Rob Sparrow, makes the same assumptions. We show that the (...) crucial moral question is not one of responsibility. Rather, it is whether the technology can satisfy the requirements of fairness in the re-distribution of risk. Not only is this possible in principle, but some killer robots will actually satisfy these requirements. An implication of our argument is that there is a public responsibility to regulate killer robots ’ design and manufacture. (shrink)