Patient autonomy, as exercised in the informed consent process, is a central concern in bioethics. The typical bioethicist's analysis of autonomy centers on decisional capacity—finding the line between autonomy and its absence. This approach leaves unexplored the structure of reasoning behind patient treatment decisions. To counter that approach, we present a microeconomic theory of patient decision-making regarding the acceptable level of medical treatment from the patient's perspective. We show that a rational patient's desired treatment level typically departs from the level (...) yielding an absence of symptoms, the level we call ideal. This microeconomic theory demonstrates why patients have good reason not to pursue treatment to the point of absence of physical symptoms. We defend our view against possible objections that it is unrealistic and that it fails to adequately consider harm a patient may suffer by curtailing treatment. Our analysis is fruitful in various ways. It shows why decisions often considered unreasonable might be fully reasonable. It offers a theoretical account of how physician misinformation may adversely affect a patient's decision. It shows how billing costs influence patient decision-making. It indicates that health care professionals' beliefs about the ‘unreasonable’ attitudes of patients might often be wrong. It provides a better understanding of patient rationality that should help to ensure fuller information as well as increased respect for patient decision-making. (shrink)

Patient noncompliance with physician prescriptions, especially in nonsymptomatic chronic diseases, is frequently characterized in the literature as harmful and economically costly (Miller 1997).1 Nancy Houston Miller views patient noncompliance as harmful because noncompliance can result in continued or new health problems leading to hospital admissions. Further, she places the annual monetary cost of noncompliance at $100 billion.Patient noncompliance with prescribed treatment is considered the least understood form of health behavior (Coons 2001). Despite the plethora of attention in journal articles, the (...) issue of noncompliance remains unresolved even in terms of understanding the main correlates to .. (shrink)

Volume 19, Issue 11, November 2019, Page 78-80.

Researchers designing a clinical trial may be aware of disputed evidence of serious risks from previous studies. These researchers must decide whether and how to describe these risks in their model informed consent document. They have an ethical obligation to provide fully informed consent, but does this obligation include notice of controversial evidence? With ACCORD as an example, we describe a framework and criteria that make clear the conditions requiring inclusion of important controversial risks. The ACCORD model consent document did (...) not include notice of prior trials with excess death. We develop and explain a new standard labeled risk in equipoise. We argue that our approach provides an optimal level of integrity to protect the informational needs of the reasonable volunteers who agree to participate in clinical trials. We suggest language to be used in a model consent document and the informed consent discussion when such controversial evidence exists. (shrink)

The case of Twin B involves the decision to send a newborn to a less intensive Level 2 special care nursery (SCN) than to the Level 3 neonatal intensive care unit (NICU) that is considered optimal by the physician. The physician’s acceptance of the transfer is against the child’s best interest and is due to parental convenience. In analyzing the case, we reject the best interest standard. Our rejection is partly supported by the views of Douglas Diekema, John Hardwig, (...) and Lannie Ross. Instead of the best interest standard, we offer and defend an approach we base on a microeconomic analysis of externalities, such as those involved with automobile emissions. This extends our previously presented general microeconomic approach to patient decision-making. It provides a clearer way to evaluate situations, like those of Twin B, in which burdens faced by family members may be used to determine the appropriate level of treatment for a decisionally incapable patient. (shrink)

Each contributor to this book has used personal experience as the basis from which to frame his individual sociological perspectives. Because they have personalized their work, their accounts are real, and recognizable as having come from 'real' persons, about 'real' experiences. There are no objectively-distanced disembodied third person entities in these accounts. These writers are actual people whose stories will make you laugh, cry, think, and want to know more.

Johnstone, H. W., Jr. Rhetoric and communication in philosophy.--Smith, C. R. and Douglas, D. G. Philosophical principles in the traditional and emerging views of rhetoric.--Wallace, K. R. Bacon's conception of rhetoric.--Thonssen, L. W. Thomas Hobbes's philosophy of speech.--Walter, O. M., Jr. Descartes on reasoning.--Douglas, D. G. Spinoza and the methodology of reflective knowledge in persuasion.--Howell, W. S. John Locke and the new rhetoric.--Doering, J. F. David Hume on oratory.--Douglas, D. G. A neo-Kantian approach to the epistomology of (...) judgment in criticism.--Bevilacqua, V. M. Lord Kames's theory of rhetoric.--Brockriede, W. E. Bentham's philosophy of rhetoric.--Anderson, R. E. Kierkegaard's theory of communication.--Macksoud, S. J. Ludwig Wittgenstein, radical operationism and rhetorical stance.--Stewart, J. J. L. Austin's speech act analysis.--Torrence, D. L. A philosophy of rhetoric from Bertrand Russell.--Clark, A. Martin Buber, dialogue, and the philosophy of rhetoric.--Bennett, W. Kenneth Burke--a philosophy in defense of un-reason.--Dearin, R. D. The philosophical basis of Chaim Perelman's theory of rhetoric. (shrink)

Philosophers are often thought to be in the business of analysing concepts, in particular, concepts taken to be fundamental in human thought and practice: truth, goodness, beauty, knowledge, meaning, rightness, causation, to name just a few. But what can we expect from such analyses? Can we expect a comprehensive account of one concept in terms of one or more others? Can we expect to reduce these kinds of concepts to concepts which are taken to be more fundamental? This study is (...) concerned with a particular approach to conceptual analysis, minimalism, which, in general, offers very modest answers to these questions. Minimalist theories, by and large, hold that the strategy for analysing concepts ought not to go much further than the collection of some rather ordinary, ‘platitudinous’ thoughts about those concepts. Accordingly, minimalist theories do not often encourage ambitious pro jects of giving a comprehensive analysis of one concept in terms of another, where this process encourages the construction of such biconditional claims as ‘X falls under concept F iff X falls under concept G’. Just how far we are to extend our analysis beyond the point of a collection of platitudinous principles is a point of contention between different types of minimalist theories. This study has three main aims. Firstly, it aims to give a taxonomy of minimalist theories. Secondly, it aims to examine in detail the types of minimalist theories pertinent to the study of truth, and propose the best view available. Thirdly, it aims to examine how the minimalist methodology may be extended to other normative concepts, taking the concept of goodness as a case study. (shrink)

BackgroundSocio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among diverse populations have not (...) been studied.ObjectivesIn order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations.Study appraisalA search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria.Results32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained.ConclusionsOur review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death. (shrink)

Ethical instruction is critical for trainee accountants. Various teaching methods, both active and passive, are normally utilised when teaching accounting ethics. However, students’ learning styles are rarely assessed. This study evaluates the learning styles of accounting students and assesses the interaction of teaching methods and learning styles in an ethics instruction environment. The ethical attitudes and preferred learning styles of a cohort (137) of final year accounting students were evaluated pre-instruction. They were then subject to three different teaching methods while (...) studying ethics during an auditing course. When ethical attitudes and preferred learning styles were re-assessed post-instruction, the teaching methods were found to have influenced active learners more than passive ones. Furthermore, when learning styles matched teaching methods used, usefulness was assessed as high but when learning styles and teaching methods differed, usefulness deteriorated significantly. Students displayed a preference for passive learning styles, despite being so advanced in their education. The implications are that instructors should consider learning styles before deciding on appropriate teaching methods, in accounting ethics environments. (shrink)

This paper examines the impact of the introduction of Western (European) technical civilization on regional cultures in Nigeria, using Igboland in South-EasternNigeria as a test case. It begins with a discussion of some general features of Western technical civilization whose evolution has been profoundly influenced by technological advances in Europe and her cultural colonies in North America and elsewhere. Consequences of the contact between Western technical civilization and traditional Igbo culture are also examined. The paper concludes by discussing the challenging (...) problem of Africa’s contribution to technical civilization. (shrink)

Thomas S. Kuhn’s theory of normal science (NS), aside from being a provocative philosophical reconstruction of the relatively conservative phase of scientific research, contains useful ideas for systematic analysis of specific episodes in the history of science. Therefore, although the theory has been looked at from different angles since the first edition of The Structure of Scientific Revolutions (TSSR) was published in 1962, its detailed exploration of the cumulative phase of research in mature science is of abiding relevance in the (...) philosophy of science. This is because NS provides a compelling account of how and why members of scientific communities succeed, largely, to produce reliable knowledge about an incompletely known phenomenal world. Again, the theory elucidates special features of scientific research that differentiate it from other creative enterprises. In that regard, this paper reconstructs Arthur Compton’s research into x-ray scattering as a good instantiation of NS. Discussion of Compton’s convincing demonstration of the particulate properties of electromagnetic radiation within the framework of NS showcases the elucidatory power of Kuhn’s theory with respect to selected episodes in science, and corroborates the notion that the bulk of scientific work is a conservative puzzle-solving activity with the potential for precipitating scientific revolutions. To the best of my knowledge, this is the first time that Compton’s groundbreaking work on x-ray scattering has been analysed within the framework of Kuhn’s philosophy of science. (shrink)

Sallust used Fortuna to. give his story specialized political meaning and to incorporate materials and judgments that extend the purview of his narrative to all of Roman history. Fortuna is a configuration of events that appears at certain moments in a state's existence and presents demands for careful application of intelligence, virtus, animus or ingenium, if things are to proceed well and a new era is to begin . If virtus is not present, fortuna rages and destroys . Admirable men (...) seek gloria through virtus, but also require an historian to reconstruct actions. Fortuna offers men of leisure the opportunity to apply intelligence to a course of events and to write and therefore to create history in a secondary but more lasting sense. (shrink)

The American environmental movement has a longstanding tradition of respect for American Indians. Recently, however, there has been a noticeable erosion of that tradition. The most volatile issues in the Indian/environmentalist controversey at present are those involving the right of many Indians to hunt and fish unrestricted by state or federal conservation regulations. Especially where endangered species areinvolved, some environmentalists have been quick to recommend that this unique privilege accorded to Indians be curtailed. While I share a deep concem for (...) the preservation of endangered species and ecosystems, I suggest that the environmental movement has so far been insensitive to the concems of the American Indian community. Rather than simply seeking to take away rights to which Indians havebeen entitled for decades, environmentalists should be prepared to negotiate on such matters. As an example, I suggest that-in exchange for the Indians’ voluntary surrender of some of their treaty rights--environmentalists might agree to seek legislation opening national forest lands to Indians who wish to live subsistence life styles, as some Alaskan wildemess lands are now open to the Inuit. (shrink)

This article systematically reviews studies investigating the effect of three operationalizations of complexity in emotion experience on situat...

Studies repeatedly find that women and men experience life in academia differently. Importantly, the typical female academic portfolio contains less research but more teaching and administrative duties. The typical male portfolio, on the other hand, contains more research but less teaching and administration. Since previous research has suggested that research is a more valued assignment than teaching in academia, we hypothesise that men will be ranked higher in the peer-evaluations that precede hirings to tenured positions in Swedish academia. We analyze (...) 861 peer review assessments of applicants in 111 recruitment processes in Economics, Political Science, and Sociology at the six largest Swedish universities. Our findings confirm that the premises established in previous research are valid in Sweden too: Women have relatively stronger teaching merits and men relatively stronger research merits, and also that, on balance, research is rewarded more when applicants are ranked by reviewers. Accordingly, male applicants are ranked higher compared to female applicants. (shrink)

This paper describes a cross-cultural research project on the relation between how people conceptualize nature and how they act in it. Mental models of nature differ dramatically among and within populations living in the same area and engaged in more or less the same activities. This has novel implications for environmental decision making and management, including dealing with commons problems. Our research also offers a distinct perspective on models of culture, and a unified approach to the study of culture and (...) cognition. We argue that cultural transmission and formation does not consist primarily in shared rules or norms, but in complex distributions of causally-connected representations across minds in interaction with the environment. The cultural stability and diversity of these representations often derives from rich, biologically-prepared mental mechanisms that limit variation to readily transmissible psychological forms. This framework addresses a series of methodological issues, such as the limitations of conceiving culture to be a well-defined system or bounded entity, an independent variable, or an internalized component of minds. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Decision-Making as a Broader ConceptJacinta O. A. Tan (bio), Anne Stewart (bio), and Tony Hope (bio)KeywordsCompetence, decision-making, capacity, anorexia nervosa, autonomy, values, identityWe thank Demian Whiting for the thoughtful critique of aspects of our paper (Tan et al. 2006a). A primary aim of our research was to provide empirical grounds on which to stimulate discussion about the nature of decision-making capacity (DMC). Whiting criticizes in particular the concept (...) of 'pathological values' that we suggested might be relevant in the assessment of DMC and in the related issue of deciding when a patient's refusal of beneficial treatment should be overridden.Whiting's central concern is with DMC. Whiting argues that the absence of pathological values should not be a criterion for DMC. We are unclear whether he is also arguing that pathological values do not provide a reason of any kind for overriding treatment refusal. At the end of the paper he writes: "we cannot justify compulsory treatment of patients who have pathological values... on the grounds that these patients lack DMC" (2009, XX). This seems to leave open the possibility that we may be able to justify compulsory treatment of patients who have pathological values on grounds other than that they lack DMC. As we wrote in our response to the discussants of our original paper, "The primary issue for us is whether the reasons for refusal to which we draw attention provide grounds for overriding refusal, and if they do how they can be characterized in such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests" (Tan et al. 2006b, 300).In deciding on whether to use compulsory treatment, there are other relevant factors that may need to be considered, such as the seriousness of the decision, which determines the threshold for competence. However, in this response we consider three issues. First, we argue that the current concept of DMC is by no means so clear cut or generally agreed upon as Whiting implies, and that some of the lack of clarity relates to pathological values. Second, that the concept of DMC is itself dependent on accounts of autonomy, and that it is plausible that pathological values can affect autonomy. Third, we directly consider the question of whether a coherent account of pathological values might be given based on a concept of authenticity.The Current Criteria for DMCWhiting argues that the current criteria for DMC are correct and that an additional criterion along the lines of absence of pathological values should not be added. This argument assumes that there is a clear and agreed understanding of the current criteria. We believe this is not the case for three reasons.(i) Whiting begins his account of DMC by saying that it is normally taken to include: "(1) [End Page 345] understanding (and appreciation)" (2009, 341). Already there is an area of dispute, and the use of parentheses reflects this. The concept of 'appreciation' was developed by Grisso and Applebaum (Grisso, Appelbaum, and Hill-Fotouhi 1997). It is not included in either English common law development, for example (ReC), nor in the criteria specified in the Mental Capacity Act 2005. More important, Grisso and Appelbaum in their comment on our original paper (2006) argue that our work advances thinking about 'appreciation' rather than requiring that we add new elements. The implication is that they believe that what we have called pathological values are relevant to the assessment of capacity and are already included in an account of capacity that incorporates the criterion of 'appreciation.' In our response, we argued that pathological values are not entirely captured within the account of appreciation that Grisso and Appelbaum had previously given. We do not want to revisit that issue here, but the point of relevance is that on one view (that of Grisso and Appelbaum) pathological values are already included in the current criteria for DMC as part of the concept of appreciation, whereas on Whiting's view they are not.(ii) Even if there were agreement over the wording and concepts relevant to DMC there is a further important issue: how are those concepts... (shrink)

This research note analyzes the relationship between indicators of corporate social and financial performance within a comprehensive theoretical framework. The results, based on data for 67 large U.S. corporations for 1982-1992, reveal no significant negative social-financial performance relationships and strong positive correlations in both contemporaneous and lead-lag formulations.

This chapter aims to get away from the ‘psychological attitude’ approach framing current philosophical discussion of delusion. We ask not what kind of attitude a delusion is – a belief or an imagination? Something else? – as if it were already clear what the ‘content’ of a delusion could be. We aim instead to shift attention to the question of the ‘object’ of delusions. What is delusion of? What is the object of this form of thinking? This focus on a (...) delusion’s object, over its attitudinal nature, is partly motivated by a desire properly to connect delusory thought with ordinary forms of fantastical thinking that are ubiquitous in the experiences faced by reflective humans in everyday life. We aim at securing a continuity, in a way that much extant discussion of delusion fails to, between delusory thought with more ordinary forms of thinking present in, for example, fantastical or magical thinking. Exploring familiar expressions of such thinking, especially those involved in love and loss, enables us to bring out the way in which such expressions convey forms of affective self-consciousness – that have the subject and her relations as an object – that are not naturally taken as reports liable to investigation as true or false. This raises the question about what how to think about what someone is doing when they give expression to a delusion should we think of them as expressing an attitude towards a truth or false content, or may they be doing something rather different? (shrink)