James is a seventy‐two‐year‐old man with end‐stage dementia who was transferred from another hospital. At the time of transfer James had sepsis from two multidrug‐resistant organisms, respiratory failure requiring ventilatory support, renal insufficiency, pancytopenia, and hypotension requiring vasopressors. He has severe contractures and foot drop, has a feeding tube, and has been nonverbal for several months. His son, Paul, is requesting full code and treatment focused on recovery despite James's extremely poor prognosis.Paul is James's only child, and James's wife is (...) deceased. Paul says he has the “gift of prophecy” and knows for certain when God is speaking to him. “God,” he says, “doesn't lie.” He says that he and his father spent years preaching together and have witnessed many healings. He believes that they are being “rebuked” because at a time when his father was too tired to travel much, they held fewer revivals and did not save enough souls.James's condition has worsened slowly. He has almost no urine output and does not breathe over the ventilator. He is extremely volume overloaded; his toenails have bloodied and popped off. By hospital‐day twenty‐one, he had only corneal reflexes. The medical team is troubled; if James is to stay on the ventilator, he will need a tracheostomy, but this would only further prolong what has already been an agonizingly prolonged dying process.Paul continues to pray for his father to get up. (shrink)

An ethically sound discharge from the hospital can be impeded by a number of factors, including a lack of payor for a patient’s care, a lack of appropriate discharge options, and a lack of authority to sign a patient into a long-term facility. In some cases, the primary barrier involves the patient’s lack of financial decision-making capacity.When a patient’s income comes primarily from government assistance, financial decision making is connected to both the individual’s well-being and to fair allocation of resources. (...) Taking away another person’s financial independence is a substantial intrusion on autonomy and should not be considered lightly. However, poor management of funds can lead to homelessness, medical noncompliance, vulnerability to financial exploitation, and other threats to human flourishing. As with medical decision-making capacity, poor decisions alone do not invalidate an individual’s right to self-determination. And as with medical decision-making capacity, such determinations should not be made ad hoc or be capricious, but should rely on sound assessment criteria. When there are justified concerns that a patient may be vulnerable due to limited financial decision-making capacity, an evaluation should be completed and a surrogate payee be sought, when appropriate. (shrink)

Three of the most contentious issues in contemporary American society—allocation of medical resources, end of life care, and immigration—converge when undocumented immigrant patients are facing the terminal phase of chronic illness. The lack of consistent, pragmatic policy in each of these spheres leaves us with little guidance for how to advocate for undocumented patients at the end of life. Limited resources and growing need compound the problem. Care for patients in this unfortunate situation should be grounded in clinical and economic (...) reality as well as respect for the dignity of the individual to avoid exacerbating inequalities. (shrink)

Background:Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives.Research hypothesis:We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a (...) person or an action that overcomes fears or other challenges to achieve something of great moral worth.Research design:The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable.Participants and research context:A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency.Ethical considerations:The study was approved by the Internal Review Board of the authors’ university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary.Findings:Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person’s dying and death, and the challenge of adequately conveying the advance directive’s meaning and accurately recording a homeless person’s end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants reported having encountered those obstacles. So, while participants required moral courage to assist homeless persons with advance directives, they required greater moral courage as they anticipated their meetings than during those meetings.Discussion:Our study breaks new ground at the intersection of nursing, moral courage, and advance directives. It might also have important implications for how to improve the training that US nursing students receive before they provide this service.Conclusion:Our results cannot be generalized, but portions of our approach are likely to be transferable to similar social contexts. For example, because homeless persons are misunderstood and marginalized throughout the United States, our design for training nursing students to provide this service is also likely to be useful across the United States. Internationally, however, it is not yet known whether our participants’ fears and the challenge they faced are also experienced by those who assist homeless persons or members of other vulnerable populations in documenting healthcare wishes. (shrink)

" By the end, we can see the cause to which Hume has been true throughout the work.

In these Carus Lectures, Annette Baier looks at the relation between individual and shared reasoning, intending, and moral reflection. In each case she emphasizes the interdependence of minds and the role of social practices in setting the norms governing these activities.

David Hume's essay Of Moral Prejudices offers a spirited defense of "all the most endearing sentiments of the hearts, all the most useful biases and instincts, ...

It is becoming more common that the decision-makers in private and public institutions are predictive algorithmic systems, not humans. This article argues that relying on algorithmic systems is procedurally unjust in contexts involving background conditions of structural injustice. Under such nonideal conditions, algorithmic systems, if left to their own devices, cannot meet a necessary condition of procedural justice, because they fail to provide a sufficiently nuanced model of which cases count as relevantly similar. Resolving this problem requires deliberative capacities uniquely (...) available to human agents. After exploring the limitations of existing formal algorithmic fairness strategies, the article argues that procedural justice requires that human agents relying wholly or in part on algorithmic systems proceed with caution: by avoiding doxastic negligence about algorithmic outputs, by exercising deliberative capacities when making similarity judgments, and by suspending belief and gathering additional information in light of higher-order uncertainty. (shrink)

Currently, advanced art education is in the process of developing (doctorate or PhD) research programs throughout Europe. Therefore, it seems to us urgent to explore what the term research actually means in the topical practice of art. After all, research as such is often understood as a method stemming from the alpha, beta or gamma sciences directed towards knowledge production and the development of a certain scientific domain. How is artistic research connected with those types of scientific research, taking into (...) account that the artistic domain so far has tended to continually exceed the parameters of knowledge management? One could claim that the artistic field comprises the hermeneutic question of the humanities, the experimental method of the sciences, and the societal commitment of the social sciences. Will that knowledge influence the domain, the methodology, and the outcome of artistic research? Another major topic concerns not only the specificity of the object of knowledge of artistic research but above all whether and how artistic research and its institutional programs will influence topical visual art, its artworks and its exhibitions. These complex problematics with their various points of view and management models are mapped out through the contributions of theorists, curators, and institutions, from Belgium, France, Great-Britain, Italy, The Netherlands, Finland, Germany, and Sweden. May these contributions be a constructive impetus for a versatile debate which may influence the future role of advanced art institutions and the position of artistic research in the next decade. (shrink)

1 Where to begin? 'Life and times' Roland Barthes is generally acknowledged, even by those not conversant with his books, as one of the leading figures of ...

We discuss the variety of sorts of sympathy Hume recognizes, the extent to which he thinks our sympathy with others’ feelings depends on inferences from the other’s expression, and from her perceived situation, and consider also whether he later changed his views about the nature and role of sympathy, in particular its role in morals.

The influence of liberal political ideology on nursing sciencePrevious notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy — individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy — are primarily manifested in relation to: (i) the (...) individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health. (shrink)

In this paper, I identify a theoretical and political role for ‘white ignorance’, present three alternative accounts of white ignorance, and assess how well each fulfils this role. On the Willful Ignorance View, white ignorance refers to white individuals’ willful ignorance about racial injustice. On the Cognitivist View, white ignorance refers to ignorance resulting from social practices that distribute faulty cognitive resources. On the Structuralist View, white ignorance refers to ignorance that results as part of a social process that systematically (...) gives rise to racial injustice, and is an active player in the process. I argue that, because of its greater power and flexibility, the Structuralist View better explains the patterns of ignorance that we observe, better illuminates the connection to white racial domination, and is overall better suited to the project of ameliorating racial injustice. As such, the Structuralist View should be preferred. (shrink)

This issue investigates the meaning of photographic image for contemporary art. In Malraux' dream, photography offers the ultimate guarantee for a coherent presentation of art. However, as Douglas Crimp has stated, the appearance and enhancement of photography as a form of art among other art forms disrupted the center of the art world. What does this mean for art and philosophy in our time? Various artists and theorists will delve into that question: Christian Boltanski, Benjamin H.D. Buchloh, Jean-François Chevrier, Douglas (...) Crimp, Jos de Mul, Mirjam de Zeeuw, Rineke Dijkstra, Michael Gibbs, Rodney Graham, Gerald van der Kaap, Karen Knorr, Zoe Leonard, Ken Lum, Hermann Pitz, Liza-May Post, John Roberts, Allan Sekula, Andres Serrano, Jan Simons, Beat Streuli, John M. Swinnen, Renée van de Vall, Hilde van Gelder, Hripsimé Visser, Jeff Wall, Ian Wallace and Herta Wolf. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

This contribution is concerned with what Hume means by reflection and sentiment. Hume’s Treatise is devoted to an account of the extent to which the mind is able to bear its own reflexion or turn mental states on themselves. This theme is likely the “new scene of thought” that inspired Hume’s major concerns in the Treatise. Although Hume found that the understanding fails to understand itself, the passions do better in satisfying curiosity about curiosity, and, most importantly, moral sentiment is (...) able to approve of itself. The author contends that the whole task of the moral sentiment is to get us to fulfill our part to mankind and society, and that, according to Hume, the sentiments are the noble source of morality itself. (shrink)

In this paper, I identify a theoretical and political role for ‘white ignorance’, present three alternative accounts of white ignorance, and assess how well each fulfils this role. On the Willful Ignorance View, white ignorance refers to white individuals’ willful ignorance about racial injustice. On the Cognitivist View, white ignorance refers to ignorance resulting from social practices that distribute faulty cognitive resources. On the Structuralist View, white ignorance refers to ignorance that (1) results as part of a social process that (...) systematically gives rise to racial injustice, and (2) is an active player in the process. I argue that, because of its greater power and flexibility, the Structuralist View better explains the patterns of ignorance that we observe, better illuminates the connection to white racial domination, and is overall better suited to the project of ameliorating racial injustice. As such, the Structuralist View should be preferred. (shrink)

English summary: Medicine is not only a technique or skill for obtaining or restoring health in the face of illness and death; it strives to be a component of life that has learned to deal with the inevitability of suffering and death. As meditatio vitae et mortis, it can become a field of reflection on being human par excellence. The increasing possibility of anti-aging, plastic surgery and enhancement procedures, however, again bring about questions of the limits of human medicine, even (...) moreso if, as in transhumanist utopia and cryonic practice, the possibility of postponement or even of overcoming human finitude becomes possible. Medicine, society and the presence of death and dying must respond to these challenges. Herein ies the focus of this volume: the authors reflect on finiteness and immortality in medicine from historical, philosophical, social science, and ethical perspectives. German text. German description: Die Medizin ist nicht nur Technik oder Kunst, das Leben und die Gesundheit angesichts von Krankheit und Tod zu erhalten bzw. wiederherzustellen, sondern strebt eine Praxis der Lebensfuehrung an, die mit der Unvermeidbarkeit von Leiden und Sterben umzugehen lernt. Als meditatio vitae et mortis kann sie zu einem Feld der Reflexion ueber das Menschsein par excellence werden. Die zunehmenden Moglichkeiten von Anti-Aging, Plastischer Chirurgie und Enhancement stellen dabei die Fragen nach Grenzen einer humanen Heilkunde wieder neu, noch dazu, wenn - wie in transhumanistischen Utopien und kryonischer Praxis - die Moglichkeit der Verschiebung oder gar Uberwindung menschlicher Endlichkeit in Aussicht gestellt wird. Medizin, Gesellschaft und Sterbekultur der Gegenwart muessen auf die Herausforderungen reagieren. In diesem Themenfeld liegt der Schwerpunkt des Bandes: Die Autoren reflektieren Endlichkeit und Unsterblichkeit in der Medizin aus historischer, philosophischer, sozialwissenschaftlicher wie auch ethischer Perspektive. (shrink)

Annette Baier's aim is to make sense of David Hume's Treatise as a whole. Hume's family motto, which appears on his bookplate, was True to the End. Baier argues that it is not until the end of the Treatise that we get his full story about truth and falsehood, reason and folly. By the end, we can see the cause to which Hume has been true throughout the work. Baier finds Hume's Treatise of Human Nature to be a carefully (...) crafted literary and philosophical work which itself displays a philosophical progress of sentiments. His starting place is an overly abstract intellectualism that deliberately thrusts passions and social concerns into the background. In the three interrelated books of the Treatise, his self-understander proceeds through partial successes and dramatic failures to emerge with new-found optimism, expecting that the exact knowledge the morally self-conscious anatomist of human nature can acquire will itself improve and correct our vision of morality. Baier describes how, by turning philosophy toward human nature instead of toward God and the universe, Hume initiated a new philosophy, a broader discipline of reflection that can embrace Charles Darwin and Michel Foucault as well as William James and Sigmund Freud. Hume belongs both to our present and to our past. (shrink)

What is it to deceive someone? And how is it possible to deceive oneself? Does self-deception require that people be taken in by a deceitful strategy that they know is deceitful? The literature is divided between those who argue that self-deception is intentional and those who argue that it is non-intentional. In this study, Annette Barnes offers a challenge to both the standard characterisation of other-deception and current characterizations of self-deception, examining the available explanations and exploring such questions as (...) the self-deceiver's false consciousness, bias, and the irrationality and objectionability of self-deception. She arrives at a non-intentional account of self-deception that is deeper and more complete than alternative non-intentional accounts and avoids the reduction of self-deceptive belief to wishful belief. (shrink)

Kaum ein Zeitabschnitt war von solch grundlegenden technischen, politischen und philosophischen Umbruchen gepragt wie die 100 Jahre bis zur Jahrtausendwende - vom Kaiserreich zur globalen Weltgesellschaft, vom Idealismus zum Werterelativismus. Die juristische Grundlagenforschung - auch die Rechtsphilosophie - ist gegenwartig in keiner guten Verfassung: Ihr fehlt die gesellschaftliche Resonanz, und damit einhergehend der qualifizierte wissenschaftliche Nachwuchs. Der Band mochte einen Anstoss geben, durch eine Ruckbesinnung auf die grossen Leistungen in der Rechtsphilosophie des letzten Jahrhunderts an diese anzuknupfen, Problemlosungen fur die (...) Zukunft zu suchen und die Unverzichtbarkeit der Rechtsphilosophie dabei wieder ernst zu nehmen. (shrink)

This is an essay at the intersection of metaethics and the history of contemporary analytic philosophy. It explores the relationships between Allan Gibbard’s mature quasi-realist expressivism and (i) three non-naturalistic varieties of what I call “non-inflationary realism” and (ii) moral fictionalism. Moral or normative realism is frequently (if mistakenly) taken to involve certain existence-affirming external assumptions about the metaphysical status of substantive normative thought and discourse. The non-inflationary realists seek to embrace moral or normative objectivity and truth without any distinctly—as (...) they see it, “inflated”—moral or normative ontology. This position, along with a shared emphasis on the primacy of substantive moral or normative thought and discourse, brings them very close to Gibbard, and so to what it is tempting to treat as a strikingly different metaethical account. Focusing on the non-inflationary realists Ronald Dworkin, T.M. Scanlon, and Derek Parfit, I examine similarities among their views, and between each of these views and Gibbard’s. I argue that the non-inflationary realist project should be understood as including the work not only of these figures, characteristically seen as among its paradigmatic representatives, but also, crucially, that of Gibbard. They all agree that our moral or normative claims purport to state normative truths and that such claims are capable of being true or false and that when true they do not depend on the particular standpoint anyone happens to take. Our moral or normative thoughts can be characterized as beliefs. We can have moral knowledge. There are substantive moral and normative facts. These facts are not reducible to non-normative facts. Normative concepts cannot be analyzed in purely naturalistic terms; and normative facts do not depend on any robustly existent truth-makers. Focusing on these shared commitments enables me to home in on the apparent differences that nonetheless remain. They differ in significant respects, for instance, about whether—and, if so, to what extent—we can make any meaningful external (non-substantive) judgments about the moral or normative and about whether there is a role for property-based explanations that minimalism about the normative fails to capture. By investigating these and other differences, I shed light on what is at stake in giving an adequate account of our moral and normative thought and talk. I pursue this aim further by considering why it might seem that quasi-realist expressivism was a form of normative fictionalism or error theory—though it is not. I attempt here to clear up confusions stemming from common assumptions associated with terms like “realism,” “cognitivism,” or “fictionalism” with respect to morality or normativity. I distinguish some differences in the ways in which normative properties can be understood by non-inflationary realists and the roles they can play in explaining normativity. I underscore the implausibility of treating the moral domain as completely autonomous. And I attempt to offer suggestions regarding some conceptual options that remain to be further explored. I maintain that Gibbard makes explicit otherwise unacknowledged implications of Scanlon’s or Dworkin’s accounts, implications regarding deep differences between normative or moral and other domains, implications which might help explain the uneasiness that prompts Scanlon and Dworkin to resist Gibbard’s account and that pushes Parfit toward what seems to be a sort of intermediate position between non-inflationary and more ontologically committed realism. Non-inflationary realism forces us to rethink metaethics in interesting and promising ways. (shrink)

Disagreement persists about when, if at all, disenfranchisement is a fitting response to criminal wrongdoing of type X. Positive retributivists endorse a permissive view of fittingness: on this view, disenfranchising a remarkably wide range of morally serious criminal wrongdoers is justified. But defining fittingness in the context of criminal disenfranchisement in such broad terms is implausible, since many crimes sanctioned via disenfranchisement have little to do with democratic participation in the first place: the link between the nature of a criminal (...) act X (the ‘desert basis’) and a fitting sanction Y is insufficiently direct in such cases. I define a new, much narrower account of the kind of criminal wrongdoing which is a more plausible desert basis for disenfranchisement: ‘political wrongdoing’, such as electioneering, corruption, or conspiracy with foreign powers. I conclude that widespread blanket and post-incarceration disenfranchisement policies are overinclusive, because they disenfranchise persons guilty of serious, but non-political, criminal wrongdoing. While such overinclusiveness is objectionable in any context, it is particularly objectionable in circumstances in which it has additional large-scale collateral consequences, for instance by perpetuating existing structures of racial injustice. At the same time, current policies are underinclusive, thus hindering the aim of holding political wrongdoers accountable. (shrink)

Nurse practitioners (NPs) are increasingly called on to provide high‐quality health‐care particularly for people who face significant barriers to accessing services. Although discourses of social justice have become relatively common in nursing and health services literature, critical analyses of how NP roles articulate with social justice issues have received less attention. In this study, we examine the role of NPs from a critical social justice perspective. A critical social justice lens raises morally significant questions, for example, why certain individuals and (...) groups bear a disproportionate burden of illness and suffering; what social conditions contribute to disparities in health and social status; and what social mandate NPs ought to develop in response to these realities. In our analysis, we draw on lessons learned from the initial Canadian experience with the introduction of NPs in the 1970s to consider the renewed and burgeoning interest in NPs in Canada, Australia and elsewhere. As we argue, a critical social justice perspective (in addition to the biomedical foci of NP practice) will be essential to sustaining long‐term, socially responsive NP roles and achieving greater equity in health and health‐care. (shrink)

_Postures of the Mind _was first published in 1985. Minnesota Archive Editions uses digital technology to make long-unavailable books once again accessible, and are published unaltered from the original University of Minnesota Press editions. Annette Baier develops, in these essays, a posture in philosophy of mind and in ethics that grows out of her reading of Hume and the later Wittgenstein, and that challenges several Kantian or analytic articles of faith. She questions the assumption that intellect has authority over (...) all human feelings and traditions; that to recognize order we must recognize universal laws—descriptive or prescriptive; that the essential mental activity is representing; and that mental acts can be analyzed into discrete basic elements, combined according to statable rules of synthesis. In the first group of essays—"Varieties of Mental Postures"—Baier evaluates the positions taken by philosophers ranging from Descartes to Dennett and Davidson. Among her topics are remembering, intending, realizing, caring, representing, changing one's mind, justifying one's actions and feelings, and having conflicting reasons for them. The second group of essays—"Varieties of Moral Postures" - explores the sort of morality we get when all of these capacities become reflective and self-corrective. Some deal with particular moral issues—our treatment of animals, our policies regarding risk to human life, our contractual obligations; others, with more general questions on the role of moral philosophers and the place of moral theory. These essays respond to the theories of Hobbes, Kant, Rawls, and MacIntyre, but Baier's most positive reaction is to David Hume; _Postures of the Mind _ affirms and cultivates his version of a moral reflection that employs feeling and tradition as well as reason. (shrink)

We show that a popular class of connectionist models (which we label 'first order connectionism') looks unlikely to provide the kind of resources required by the hypothesis. We examine some alternative hybrid models that seem more promising. Finally, we raise a more purely philosophical issue concerning the conditions under which a being can count as a genuine believer or cognizer.".