The paper defends the thesis that institutional virtue is properly modeled as a ‘‘consensual’’ property, along the lines of the Lehrer–Wagner model of consensus (LWC). In a first step, I argue that institutional virtue is not exhausted by duty-fulfilling, since institutions, contrary to natural individuals, are designed to fulfill duties. To avoid the charge of vacuity, virtue, if attributed to institutions, must be able to motivate supererogatory action. In a second step, I argue against dis- continuity of institutional virtue with (...) individual virtue. Two main arguments for discontinuity of collective properties display serious shortcomings when applied to virtues of institutions. Given that motivation for supererogatory action is neither inferred from statutory duties nor accommodates a right of reprobation, modeling institutional virtue on collective rationality or explaining it in terms of joint com-mitment both prove problematic. In a third step, I argue that LWC has the explanatory potential to account for institutional virtue. Due to its main features,iteration and evaluation, it provides a non-trivial analysis of continuity and thereby satisfies basic constraints on the notion of genuine institutional virtue. (shrink)

A significant amount of discussion in the bioethics community has been devoted to the question of whether individuals performing ethics consultations in healthcare institutions have any special expertise. In addition, articles in the lay press have questioned the “added value” that bioethicists bring to ethical dilemmas. Those at the forefront of the bioethics community have argued repeatedly that those doing ethics consults cannot simply be well-intentioned individuals, that some training in bioethics, group process, and facilitation is necessary to competently execute (...) a consult. As one bioethicist commented:if you approach any endeavor as an amateur activity, you will get, in the end, an amateurish version of the activity. Without a sufficient commitment of personnel, time, support, and financial resources, a healthcare organization will get the ‘ethics’ program … it set out to create: an inept, unskilled, inefficient, and highly risky ‘program’ in healthcare ethics and bioethics. (shrink)

Dominant paradigms in science foster integration of research findings, but at what cost? Forcing convergence requires centralizing decision-making authority, and risks reducing the diversity of methods and contributors, both of which are essential for the breakthrough ideas that advance science.

State medical boards are beginning to take a more balanced approach to monitoring and disciplining for prescribing of pain medications, according to this survey of state medical boards across the country. Overall, respondents indicated that they are becoming more educated and more sophisticated in their approach to complaints of opioid overprescribing. In addition, their responses reflect a heightened awareness of the appropriateness of treating chronic pain with controlled substances.Yet, despite these inroads, boards generally demonstrate a continued tolerance of pain undertreatment, (...) the survey found. There is a discrepancy in the weight given to violation of standard of care, patient harm, and gross negligence for opioid overprescribing versus undertreatment of pain. Boards appear to have a higher threshold for patient harm in cases involving pain undertreatment — particularly for chronic nonmalignant pain. (shrink)

Are emotion-producing processes modular? Jerry Fodor, in his classic introduction of the notion of modularity, holds that its most important feature is cognitive impenetrability or information encapsulation. If a process possesses this feature, then, as standardly understood, “what we want or believe makes no difference to how [it] works”.In this paper, we will start with the issue of the cognitive impenetrability of emotion-producing processes. It turns out that, while there is abundant evidence of emotion-producing processes that are not cognitively impenetrable, (...) some nonetheless are. We will look at two sorts of case. The first concerns emotional reactions to observed faces, and the second involves what we can call “primitive emotions,” emotions that can be activated by non-doxastic input into regions of the brain we share with more primitive animals.In seeing how some emotion-producing processes can be cognitively impenetrable while others are not, we need to use two commonsensical theses. First, a discussion of modularity must in general operate with a taxonomy that allows for sub-processes or stages of processes. (shrink)

Communities, scientists, policy-makers and industries are requiring farmers to address environmental and wellbeing challenges in their on-farm management, transitioning away from a productivity dominated focus towards a multi-faceted system focus that includes environmental and social values. This paper analyses how Miraka Ltd., an Aotearoa-New Zealand indigenous owned and operated milk company, has taken on the role of institutional entrepreneur to enable and support change towards a multi-faceted system amongst its supply farmers. Observations and interviews were carried out to: (i) identify (...) farmers’ changes in practices, beliefs and values over the last ten years; and (ii) identify how Miraka functions as an indigenous entrepreneur in the agricultural sector. Findings show that interviewees were initially guided by business and family-oriented values, beliefs and practices, but in response to the institutional entrepreneurship by Miraka, approximately half of the interviewees changed these values, beliefs and practices, by internalising people and environmental values. The main strategies employed by Miraka were mobilisation of material resources such as incentives and awards, creation of a rationale addressing environmental and social concerns in the dairy sector, and proactive connection with new actors. The research shows an indigenous owned small-medium enterprise can make changes in values, beliefs and practices amongst its supply farmers, but requires a stronger shared base of values to contribute to a wider economic change. The discussion connects these findings to wider literature on diverse economies and indigenous entrepreneurship to identify to what extent an indigenous small-medium enterprise can contribute to a system change. (shrink)

The paper discusses Bernard Bolzano’s epistemological approach to believing and knowing with regard to the epistemic requirements of an axiomatic model of science. It relates Bolzano’s notions of believing, knowing and evaluation to notions of infallibility, immediacy and foundational truth. If axiomatic systems require their foundational truths to be infallibly known, this knowledge involves both evaluation of the infallibility of the asserted truth and evaluation of its being foundational. The twofold attempt to examine one’s assertions and to do so by (...) searching for the objective grounds of the truths asserted lies at the heart of Bolzano’s notion of knowledge. However, the explanatory task of searching for grounds requires methods that cannot warrant infallibility. Hence, its constitutive role in a conception of knowledge seems to imply the fallibility of such knowledge. I argue that the explanatory task contained in Bolzanian knowing involves a high degree of epistemic virtues, and that it is only through some salient virtue that the credit of infallibility can distinguish Bolzanian knowing from a high degree of Bolzanian believing. (shrink)

Agoraphobia is commonly considered to be a fear of outside, open, or crowded spaces, and is treated with therapies that work on acclimating the agoraphobic to external places she would otherwise avoid. I argue, however, that existential phenomenology provides the resources for an alternative interpretation and treatment of agoraphobia that locates the problem of the disorder not in something lying beyond home, but rather in a flawed relationship with home itself. More specifically, I demonstrate that agoraphobia is the lived body (...) expression of a person who has developed an inward-turning tendency with respect to being-at-home, and who finds herself, as a result, vulnerable and even incapacitated when attempting to emerge into the public arena as a fully participatory agent. I consider this thesis in light of the fact that since World War I agoraphobia has been diagnosed significantly more in women than in men; indeed, one study found women to be 89% more likely than men to suffer from agoraphobia. I conclude that agoraphobia is a disorder that stands as an emblematic expression of the ongoing pathology of being a woman in contemporary society–a disorder that reflects that even today women belong to a political world in which they are not able to feel properly at-home. (shrink)

The second of five commentaries on “Bloomberg's Health Legacy: Urban Innovator or Meddling Nanny?” from the September‐October 2013.

The intersection of ethics, computing, and genetics plots a space not yet adequately mapped, despite its importance, indeed, its rapidly growing importance. Its subdomains are well-enough known: or the study of ethical issues in genetics and genomics, is part of core curricula everywhere. Ethics and computing is an established subfield. Computing and geneticshas in little more than a decade progressed from subsubspecialty to the sine qua non of contemporary biomedical research, and it bids fair to transform clinical practice. We must (...) prepare for the complete digitization of the genomes of individual patients and the storage of millions of these genomes in very large databases. (shrink)

(1996). Multi‐modal thinking in soft systems methodology's rich pictures. World Futures: Vol. 47, Unity and Diversity in Contemporary Systems Tinking: Systematic Pictures at an Exhibition, pp. 79-92.

The quality of end-of-life care in this country is often poor. There is abundant literature indicating that dying individuals do not receive adequate pain medication or palliative care, are tethered to machines and tubes in a way that challenges their dignity and autonomy, and are not helped to deal with the emotional grief and psychological angst that may accompany the dying process. While this is true for individuals in many settings, it seems to be especially true for individuals in nursing (...) homes. This is somewhat puzzling given that considerable resources have been devoted to bringing public attention to this problem, we have the knowledge and expertise to provide such care, and we have a government-financed benefit that covers this type of care - the Medicare hospice benefit.While utilization of hospice care has increased during the last decade, there is considerable evidence that hospice care remains underutilized particularly in the long term care setting. (shrink)

Multiple groups, including the National Bioethics Advisory Commission, the American Society of Clinical Oncology, the National Coalition of Comprehensive Cancer Centers, Workgroup 6 of the Summit Series on Cancer, PRIM&R, the Bell Report, and prominent ethicists have called for replacing the current system of local institutional review with central review for multisite national trials. We argue that this need is particularly acute in pediatric oncology, as shown by the experience of the Children's Oncology Group.

The aim of this study was to deepen nurses’ understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient’s suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson’s caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content analysis. (...) A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty. (shrink)

This paper reports on an ongoing ARC Discovery Project that is conducting design research into learning in collaborative virtual worlds (CVW).The paper will describe three design components of the project: (a) pedagogical design, (b)technical and graphics design, and (c) learning research design. The perspectives of each design team will be discussed and how the three teams worked together to produce the CVW. The development of productive failure learning activities for the CVW will be discussed and there will be an interactive (...) demonstration of the project's CVW. (shrink)

It has long been known that there is a significant connection between Aphrodite and Semitic goddesses. In Walter Burkert's recent words, ‘Behind the figure of Aphrodite there clearly stands the ancient Semitic goddess of love, Ishtar-Astarte.’ This was already recognized by Herodotus and Philo of Byblos. I want here to note a curious and striking item of connection that has not been noticed.

Horace recommended that poets "mingle the useful and the sweet"; but the champions of an ethical function for art have yet to explain how moral and aesthetic values can truly be mingled. Their proposed ethical functions too often seem irrelevant to what we most care about in art. Moreover, we need an explanation of what art has to show us that is of ethical significance, and that we don't already know. ;The answer is to be found in the "thick concepts" (...) , which purport to provide reasons to feel and to act. Thick concepts are response-dependent, in that our application of them is guided by certain quasi-emotional responses, which they purport to warrant. These responses, I argue, are given content by their role in an ethical perspective, a value-laden "way of seeing" the world. Morality's aspirations to objectivity require that we gain imaginative acquaintance with the thick concepts of alien perspectives, without which real normative confrontation would be impossible. Fiction thus serves an ethical function by expanding our capacities of moral perception. ;Narrative art is uniquely well-suited to this task, because to give a reading of a story is to make sense of its characters and events in value-laden, emotional terms. Our engagement with fiction thus involves understanding the ethical perspectives that inform the text. This model of art's ethical function is immune to formalist challenges. Moreover, it answers the formidable hermeneutic and epistemological problems on which traditional theories founder. (shrink)