Shared decision making has become the standard of care, yet there remains no consensus about how it should be conducted. Most accounts are concerned with threats to patient autonomy, and they address the dangers of a power imbalance by foregrounding the patient as a person whose complex preferences it is the practitioner's task to support. Other corrective models fear that this level of mutuality risks abdicating the practitioner's responsibilities as an expert, and they address that concern by recovering a nuanced (...) but genuinely directive clinical role. Cribb and Entwistle helpfully categorize models of shared decision making as ‘narrower’ and ‘broader’ and praise the latter's ‘open‐ended and fully dialogical ways of relating’. However, they stop short of providing a philosophical account of how that dialogue works. In this paper, a nurse–midwife and a philosopher collaborate to argue that the Socratic model of dialogue offers a solution to the practitioner–patient dilemma. In the Theaetetus, Socrates compares dialogical reasoning to ‘midwifery with all its standard features’. By means of a three‐way analogy, elements of midwifery practice are used to illuminate features of Socrates' claim that his dialogue is like midwifery; those features are then translated into an approach to shared decision making as the ‘midwifery of good thinking’ which both midwives and physicians would do well to adopt. A key concept that emerges is the need for practitioners to make a risk‐confidence assessment of the particular content of any decision to appropriately modulate their role in the practice of shared decision making. (shrink)

In this paper, we first briefly describe neuroimaging technology, our reasons for studying magnetic resonance imaging (MRI) technology, and then provide a discussion of what we have identified as priority issues for paediatric MRI research. We examine the issues of respectful involvement of children in the consent process as well as privacy and confidentiality for this group of MRI research participants. In addition, we explore the implications of unexpected findings for paediatric MRI research participants. Finally, we explore the ethical issues (...) concerning advances in functional MRI. This paper aims to provide a clear description of priority paediatric MRI research ethics issues to make some preliminary recommendations regarding next steps. (shrink)

Providing up-to-date and comprehensive information, this practical guide uses clinical case examples and professional codes of ethics to help addiction counselors learn and apply ethical standards. Real-life examples of ethical dilemmas in clinical practice illustrate potential pitfalls and the actions needed when faced with a dilemma.Since most ethical decisions are not clear cut, the author explores the grey area of each dilemma and provides guidelines on how to determine the best course of action when the best course is unclear. This (...) book emphasizes ethics as a set of guidelines aimed at protecting the client, the clinician, and the profession as a whole. (shrink)

How should we understand the Confucian doctrine of the rectification of names (zhengming): what does it mean that an object’s name must be in accordance with its reality, and why does it matter? The aim of this paper is to answer this question by advocating a novel interpretation of the later Confucian, Xunzi’s account of the doctrine. Xunzi claims that sage-kings ascribe names and values to objects by convention, and since they are sages, they know the truth. When we misuse (...) names, we are departing from a sagely convention of naming. As sagely convention determines moral truth, departure from the linguistic convention of the sages is a departure from moral truth. On my interpretation of Xunzi, the rectification of names is not a doctrine about what is true, but a doctrine about how we aim at truth. We are aiming at descriptive truth when our language conforms to the correct name of an object according to what I call ‘Confucian conventionalism’. When we correctly aim at descriptive truth we can aim at moral truth. Therefore, I claim that the doctrine of the rectification of names is concerned with discerning the literal accordance of language with an object (what is descriptively, linguistically true), to determine what is normatively, or morally, true. According to Xunzi, moral truth is grounded in linguistic truth. (shrink)

This study explores the general problems associated with marketing across international markets and focuses specifically on the role of corruption in deterring international marketing success. The authors do this by introducing a broader conceptualization of corruption. The dimensions of corruption and their importance in explaining the exporters’ successes in international markets are developed empirically. Partial Least Squares formative indicators are used in a comprehensive model including consumer resources (wealth and information resources), physical distance (kilometers and time zones), and cultural distance (...) (linguistic and values differences) as alternative explanatory variables. Finally, differences in the model’s performance across data from three exporting countries (France, Japan, and the US) are delineated and discussed. For example, the successes of French and Japanese exporters in international markets are in part determined by the levels of corruption in target countries. Alternatively, corruption in target countries does not appear to affect the successes of American exporters in global markets. The conceptualization of corruption in this study extends the more narrow view of corruption solely as bribery. (shrink)

"You have to come to my wedding," Kavita told me, turning to face me where I sat next to her on the couch. "You can come with the other people from the street. You will get everything you need for your *research* there." "I will come, I will come!" I replied enthusiastically. I had only met Kavita and her two younger sisters, Arthi and Deepti (see Figure 2.1), mere minutes before this invitation was extended. I had initially come to Pulan (...) that day in October 2012 to meet another woman, Heena, whose family rents a room on the third story of Kavita's family's home. Heena and I had been sitting in the furniture refurbishing store she operates with her husband on the main street of Pulan when Deepti, Kavita's youngest sister, passed by. Heena introduced us and told me to go with Deepti to meet her family. When we reached the family's three-story house-the largest in the gali-Deepti led me past the empty rooms on the ground floor, which I would eventually begin renting, to the second-story living room. There, we found Kavita and Arthi organizing clothing and jewelry they had purchased earlier in the day for the upcoming wedding festivities. Kavita made room for me to sit next to her on the couch and began asking me about myself. I immediately warmed to her because of her open, friendly smile and sharp, staccato Hindi, which I delighted in being able to understand. I explained that I had come to India to study how women's lives are different in rural and urban areas, and Kavita assured me that she and her family could help. She noted that her parents had come to Udaipur from Ram Nagar, a large village thirty-five kilometers north of the city, and that the family would be returning for her and her older brother Krishna's weddings the following month. Their weddings would be held five days apart to help reduce the difficulties of family members traveling from outside Udaipur. Prompted by the description of my research, Kavita commented on differences that she recognized between the village and the city. The biggest difference, she suggested, was the experience of caste, namely that in the village, people from different jatis live separately, whereas in the city, people are "mixed." As I would come to learn when visiting Ram Nagar for various functions, there is a fair amount of caste and religious diversity in the village. Although spatial and ritual segregation was rather strictly maintained during religious observances, it is likely more flexible in everyday life. The segregation during ritual functions-the occasions for which Kavita also traveled to the village-likely informed her sense of a lack of "mixing" in the village as. The majority of residents in the area of Ram Nagar where the family maintains a home were also from the Mali (lit: gardener) jati, although Mali was not a majority jati in Pulan. (shrink)

Religion and faith are often central aspects of an individual’s self-concept, and yet they are typically avoided in the workplace. The current study seeks to replicate the findings about the role of religious beliefs and practices in shaping an employee’s reactions to stress/burnout and job attitudes. Second, we extend the literature on faith in the workplace by investigating possible relationships between religious beliefs and practices and citizenship behaviors at work. Third, we attempted to study how one’s perceived freedom to express (...) his/her religious identity at work was related to workplace attitudes and behaviors. Mixed results suggest that religiosity can be related to stress and burnout, job satisfaction, organizational commitment, and Organizational Citizenship Behavior. More research is needed to further qualify the results and explore the effects of one’s perceived freedom to express his/her religious identity in the workplace. (shrink)

While the theory of belief change has attracted a lot of interest from researchers, work on implementing belief change and actually putting it to use in real-world problems is still scarce. In this paper, we present an implementation of propositional belief change using Binary Decision Diagrams. Upper complexity bounds for the algorithm are presented and discussed. The approach is presented both in the general case, as well as on specific belief change operators from the literature. In an effort to gain (...) a better understanding of the empirical efficiency of the algorithms involved, a fault diagnosis problem on combinational circuits is presented, implemented and evaluated. (shrink)

Ryan Recalls is not a typical autobiography for while it contains personal memoirs and preoccupations, it also contains book reviews, book launches, published and unpublished papers as well as various newspaper articles put together by the author" --Page 2 of cover.

How should we understand the Confucian doctrine of the rectification of names (zhengming): what does it mean that an object’s name must be in accordance with its reality, and why does it matter? The aim of this paper is to answer this question by advocating a novel interpretation of the later Confucian, Xunzi’s account of the doctrine. Xunzi claims that sage-kings ascribe names and values to objects by convention, and since they are sages, they know the truth. When we misuse (...) names, we are departing from a sagely convention of naming. As sagely convention determines moral truth, departure from the linguistic convention of the sages is a departure from moral truth. On my interpretation of Xunzi, the rectification of names is not a doctrine about what is true, but a doctrine about how we aim at truth. We are aiming at descriptive truth when our language conforms to the correct name of an object according to what I call ‘Confucian conventionalism’. When we correctly aim at descriptive truth we can aim at moral truth. Therefore, I claim that the doctrine of the rectification of names is concerned with discerning the literal accordance of language with an object (what is descriptively, linguistically true), to determine what is normatively, or morally, true. According to Xunzi, moral truth is grounded in linguistic truth. (shrink)

This commentary serves as a reply to Hoffart and Johnson’s article contending that psychodynamic psychotherapy (PDT) models cannot be examined with regard to mechanism of change or represent within-person causal relationships. Hoffart and Johnson cite purportedly paradigmatic examples of PDT and cognitive therapy and examine them with respect to Kazdin’s requirements for investigation of mechanisms of change. We highlight inaccuracies in Hoffart and Johnson’s representation of PDT and, in doing so, provide reasoning in support of the empirical examinability of PDT. (...) We conclude by recommending a metatheoretical system (i.e., functionalism) and empirical methodologies that clinical scientists may consider when investigating mechanisms of PDT in the future. (shrink)

While experience often affords important knowledge and insight that is difficult to garner through observation or testimony alone, it also has the potential to generate conflicts of interest and unrepresentative perspectives. We call this tension the paradox of experience. In this paper, we first outline appeals to experience made in debates about access to unproven medical products and disability bioethics, as examples of how experience claims arise in bioethics and some of the challenges raised by these claims. We then motivate (...) the idea that experience can be an asset by appealing to themes in feminist and moral epistemology, distinguishing between epistemic and justice-based appeals. Next, we explain the concern that experience may be a liability by appealing to empirical work on cognitive biases and theoretical work about the problem of partial representation. We conclude with preliminary recommendations for addressing the paradox and offer several questions for future discussion. (shrink)

Most presentations of the problem of moral luck invoke the notion of control, but little has been said about what control amounts to. We propose a necessary condition on an agent's having been in control of performing an action: that the agent's effort to perform the action ensured that the agent performed the action. The difficulty of satisfying this condition leads many on both sides of the moral luck debate to conclude that much of what we do is not within (...) our control, and, at the limit, underpins agential skepticism, the view that no one has ever been in control of having performed an action in the external world. We propose a response to the agential skeptic modeled on the epistemological disjunctivist's response to the skeptic about perceptual experience. According to agential disjunctivism, the necessary condition on control can be met, thus undermining agential skepticism and one motivation for the problem of moral luck. Our view can be understood as resisting moral luck not by shrinking the domain of robust moral evaluation but by refusing to contract the realm of robust control. (shrink)

Constitutivism holds that an account of what a thing is yields those normative standards to which that thing is by nature subject. We articulate a minimal form of constitutivism that we call _formal, non-epistemological constitutivism_ which diverges from orthodox versions of constitutivism in two main respects. First: whereas orthodox versions of constitutivism hold that those ethical norms to which people are by nature subject are sui generis because of their special capacity to motivate action and legitimate criticism, we argue that (...) these features are compatible with treating these norms as of a piece with those ‘formal’ natural-historical norms which can be used to assess living things. Second: unlike orthodox versions of constitutivism, our version does not seek to use a non-normative account of that kind of being which we are as a means of identifying those normative claims to which we are are by nature subject. We then indicate how our position can afford us the resources to address some of the familiar difficulties that face cognitivism in ethics. (shrink)

The contemporary process of financialization has been a major driver of the remarkable changes witnessed in global food and agricultural markets over the past decade, contributing to the rise and subsequent volatility of food and agricultural commodity prices since 2006. In the wake of these developments it has become clear that the turmoil has intensified the relationship between agriculture and finance in ways that have profound and enduring implications for the sector, and the people whose lives and livelihoods depend upon (...) it. This symposium brings together four original research articles that contemplate the contemporary relationship between the agrifood and financial sectors. They examine a variety of overlapping themes, including the creation of financial assets from farmland and agricultural commodities, the activities of different types of investors in these assets in specific geographic contexts, and the challenges of governing this activity at the global scale. These articles show that the period of market volatility that began a decade ago re-invigorated investor interest in financial products linked to agriculture and farming, and inspired the packaging of new forms of financial assets in ways that have affected politics and practice on the ground, and are likely to leave a lasting legacy. (shrink)

This paper argues that Kantians face a little discussed problem in accounting for how actions that fulfill imperfect duties can be morally motivated. It is widely agreed that actions that are performed from the motive of duty are performed through a recognition of the objective necessity of the action. It is also generally held that the objective necessity of an action consists in its rational non-optionality. Many actions that fulfill imperfect duties, however, are rationally optional. Given these constraints, it is (...) impossible that such rationally optional actions could be performed from the motive of duty. After presenting the problem as one that Kantians should find genuinely pressing, this paper offers a solution by advancing an alternative to the conception of rational necessity widely shared by Kantians. On the alternative view presented here, an action is rationally necessary if and only if the justifying reasons that speak in favor of performing the action do not depend on any empirical and therefore contingent motivational source on the part of an agent. Such actions may well be rationally optional. Moral motivation is therefore possible even in the case of rationally optional actions. Abbreviations: The following abbreviations are used for Kant’s works. All translations are from Practical Philosophy, ed. Mary J. Gregor. Citations are given by the abbreviation, the volume, and the page number from Kant’s Gesammelte Schriften, edited by the Royal Prussian Academy of Sciences. G.Grundlegung zur Metaphysik der Sitten.KpVKritik der praktischen Vernunft.MSDie Metaphysik der Sitten. (shrink)

Aristotelian naturalism (AN) holds that the norms governing the human will are special instances of a broader type of normativity that is also found in other living things: natural goodness and natural defect. Both critics and defenders of AN have tended to focus on the thorny issues that are specific to human beings. But some philosophers claim that AN faces other difficulties, arguing that its broader conception of natural normativity is incompatible with current biological science. This paper has three aims. (...) First, we consider a distinctive and nuanced critique of AN’s general understanding of natural normativity put forward by Tim Lewens. Second, after giving a defense of AN, we explore and evaluate Lewens’ proposed alternative view—Kantian projectivism about life forms. We present a problem for Kantian projectivism and suggest reasons for thinking that AN is, after all, the superior position. Finally, we clarify and explain how AN’s claims about life forms and our knowledge of them, relate to empirical observation and to contemporary biological science. (shrink)

won a shopping spree on her birthday, but the 99-year-old Californian wanted nothing for herself. Instead, she used the opportunity to make well-stuffed holiday stockings for children in need, which she plans to distribute through her church. “I’m going to cry, I’m so happy,” she said last week as she filled her cart with toys and candy, along with essentials like toothbrushes and socks, at a 99-cent store in Beverly Hills. “I feel bad that I can’t do it for every (...) [poor child],” Goldstein said. “But it makes me feel very good that I am able to do what I can.”. (shrink)

The traditional understanding of Kant and Kierkegaard is that their views on the good will and inwardness, respectively, commit them to denying moral luck in an attempt to isolate an omnipotent moral subject from involvement with the external world. This leaves them vulnerable to the criticism that their ethical thought unrealistically insulates morality from anything that happens in the world. On the interpretation offered here, inwardness and the good will are not contrasted with worldly happenings, but are instead a matter (...) of worldly happenings that exhibit a particular temporal structure. Kant and Kierkegaard should not be understood as denying moral luck. (shrink)

The Ontology for Biomedical Investigations (OBI) is an ontology that provides terms with precisely defined meanings to describe all aspects of how investigations in the biological and medical domains are conducted. OBI re-uses ontologies that provide a representation of biomedical knowledge from the Open Biological and Biomedical Ontologies (OBO) project and adds the ability to describe how this knowledge was derived. We here describe the state of OBI and several applications that are using it, such as adding semantic expressivity to (...) existing databases, building data entry forms, and enabling interoperability between knowledge resources. OBI covers all phases of the investigation process, such as planning, execution and reporting. It represents information and material entities that participate in these processes, as well as roles and functions. Prior to OBI, it was not possible to use a single internally consistent resource that could be applied to multiple types of experiments for these applications. OBI has made this possible by creating terms for entities involved in biological and medical investigations and by importing parts of other biomedical ontologies such as GO, Chemical Entities of Biological Interest (ChEBI) and Phenotype Attribute and Trait Ontology (PATO) without altering their meaning. OBI is being used in a wide range of projects covering genomics, multi-omics, immunology, and catalogs of services. OBI has also spawned other ontologies (Information Artifact Ontology) and methods for importing parts of ontologies (Minimum information to reference an external ontology term (MIREOT)). The OBI project is an open cross-disciplinary collaborative effort, encompassing multiple research communities from around the globe. To date, OBI has created 2366 classes and 40 relations along with textual and formal definitions. The OBI Consortium maintains a web resource providing details on the people, policies, and issues being addressed in association with OBI. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 42-50, January/February 2022.

This paper distinguishes between two rationalist readings of Either/Or: the Rational Argument Interpretation, according to which the aim of the book is ultimately to offer a rational argument in favor of living ethically, and the Rational Presupposition Interpretation, according to which the pseudonymous authors presuppose that it is rational to live ethically. The paper argues in favor of . In particular, it argues that the fundamental presuppositions of Either/Or are those of Kant’s moral philosophy and rational religion. At the heart (...) of Kant’s arguments for the practical postulates lies an “existential moment”: Kant’s practical arguments are subjectively valid in virtue of the personal decision of the individual to do his duty. According to the Rational Presupposition Interpretation advanced here, Either/Or is best understood as an attempt to communicate indirectly and to confront the reader with the significance of personal choice for inhabiting a hopeful moral life-view. (shrink)

Active inference offers a unified theory of perception, learning, and decision-making at computational and neural levels of description. In this article, we address the worry that active inference may be in tension with the belief–desire–intention model within folk psychology because it does not include terms for desires at the mathematical level of description. To resolve this concern, we first provide a brief review of the historical progression from predictive coding to active inference, enabling us to distinguish between active inference formulations (...) of motor control and active inference formulations of decision processes. We then show that, despite a superficial tension when viewed at the mathematical level of description, the active inference formalism contains terms that are readily identifiable as encoding both the objects of desire and the strength of desire at the psychological level of description. We demonstrate this with simple simulations of an active inference agent motivated to leave a dark room for different reasons. Despite their consistency, we further show how active inference may increase the granularity of folk-psychological descriptions by highlighting distinctions between drives to seek information versus reward—and how it may also offer more precise, quantitative folk-psychological predictions. Finally, we consider how the implicitly conative components of active inference may have partial analogues in other systems describable by the broader free energy principle to which it conforms. (shrink)

Social psychologists have found that stereotypes correlate with moral judgments about agents and actions. The most commonly studied stereotypes are race/ethnicity and gender. But atheists compose another stereotype, one with its own ignominious history in the Western world, and yet, one about which very little is known. This project endeavored to further our understanding of atheism as a social stereotype. Specifically, we tested whether people with non-religious commitments were stereotypically viewed as less moral than people with religious commitments. We found (...) that participants’ moral appraisals of atheists were more negative than those of Christians who performed the same moral and immoral actions. They also reported immoral behavior as more consistent for atheists, and moral behavior more consistent for Christians. The results contribute to research at the intersection of moral theory, moral psychology, and psychology of religion. (shrink)

Background While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes. Methods Survey of 1200 paediatric surgeons, neonatologists and maternal–fetal medicine specialists. Results Of 1176 eligible physicians, 670 responded. In the setting of a lethal condition for which prenatal surgery would likely result in the child (...) surviving with a severe disability, most respondents either disagreed or strongly disagreed that they would recommend the surgery. Male physicians were twice as likely to recommend surgery for the lethal condition, as were physicians who believe that abortion is morally wrong. Older physicians were less likely to recommend surgery. For non-lethal conditions, most respondents agreed that they would recommend prenatal surgery, even if the surgery increases the risk of prematurity or fetal death. Compared with MFMs, surgeons were less likely to recommend such surgery, as were physicians not affiliated with a fetal centre, and physicians who were religious. Conclusion Physician’s attitudes about prenatal surgery relate to physicians’ beliefs about disability as well as demographic, cultural and religious characteristics. Given the variety of views, parents are likely to receive different recommendations from their doctors about the preferable treatment choice. (shrink)

Patients who experience difficulty making medical decisions are often referred to as “ambivalent.” However, the current lack of attention to the nuances between a cluster of phenomena that resemble...

We used a retrospective survey to model the patterns of appraisal, motivation, and coping that uniquely correspond with 12 positive emotions (affection/love, amusement, awe, challenge/det...

In his paper, ‘Patients, doctors and risk attitudes,’ Nicholas Makins1 argues that healthcare professionals should defer to a patient’s higher-order risk attitudes (ie, the risk attitudes they desire to have or endorse within themselves upon reflection) when making medical decisions. We argue against Makins’ deference to higher-order risk attitudes on the basis that (1) there are significant practical concerns regarding our ability to easily and consistently access and verify the higher-order risk attitudes of patients, (2) there is a lack of (...) a theoretical limit on higher-order risk attitudes (eg, second, third, fourth order), and (3) the consideration of higher-order risk attitudes is actually more paternalistic than Makins suggests because it narrows what counts as an autonomous preference to the limited occasions in which an individual actually reflects on his or her own risk attitude. On the issue of practicality, we can reasonably expect that healthcare professionals would find difficulty eliciting the higher-order risk attitudes of their patients. Take for example the patient who has never expressed his higher-order desire to be more risk adverse and who is not willing nor comfortable expressing this desire. What is the healthcare professional expected to do in this situation? This is even more of a concern for the incapacitated patient, to which Makins seems to imply that …. (shrink)

sirIn a scholarly and thought-provoking paper, Clarke sets out to debunk the concept of “rational suicide” as nonsensical.1 His motivation in this is to undermine any support that the notion of rational suicide might give to a “categorical right to suicide”. If his enterprise were successful, however, it would go far beyond the “rights issue” and would have a profound impact on all arguments raised in support of euthanasia or physician-assisted suicide.Clarke's major thrust might be termed the argument from posthumous (...) ignorance. He begins with a claim that the process of making a rational decision involves the process of “gaining all possible facts and `imagining' all possible consequences”. He goes on to say that making a rational decision “in the consideration of life or death . . . would seem to be impossible”. It is “impossible” …. (shrink)

Recent research has shown a memory advantage for minimally counterintuitive concepts, over concepts that are either intuitive or maximally counterintuitive, although the general result is heavily affected by context. Items from one such study were given to subjects who were asked to create novel stories using at least three concepts from a list containing all three types. Results indicated a preference for using MCI items, and further disclosed two styles of usage, an accommodative style and an assimilative style. The results (...) extend recent memory research and suggest extensions to recent theories intended to explain the prevalence of counterintuitive religious concepts. (shrink)