Within any organization (e.g. a hospital or clinic) the perception of the way things operate may vary dramatically as a function of one’s location in the organizational hierarchy as well as one’s professional discipline. Interorganizational variability depends on organizational coherence, safety, and stability. In this four-nation (Canada, Ireland, Australia, and Korea) qualitative study of 42 nurses, we explored their perception of how ethical decisions are made, the nurses’ hospital role, and the extent to which their voices were heard. These nurses (...) suggested that their voices were silenced (often voluntarily) or were not expressed in terms of ethical decision making. Finally, they perceived that their approach to ethical decision making differed from physicians. (shrink)

Objectives—To evaluate a departmental computer system.Design—a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Setting—Within a department of respiratory medicine serving a hospital of 1323 beds.Main Outcome Measures—a. Time (...) taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.Results—a. The computer system (CS) was significantly faster than the manual system (MS) for lung function evaluation (CS=7.63 min/test, MS=12.25 min/test), loan of equipment (CS=0.40 min/loan, MS=2.07 min/loan), and checking for overdue equipment (CS=0.49 s/record, MS=9 s/record). The production of correspondence was slightly slower with the computer (CS=9.30 min/letter, MS=8.54 min/letter). b. All outpatient episodes, but only 43 of 65 (66%) of inpatient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988–1990 were high (£72 178). Only £1200 to £1845 per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice (£4049–4765). After 10 years the projected deficit is £10 000 per annum in running costs.Conclusions—In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay. (shrink)

Objectives—To evaluate a departmental computer system.Design—a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Setting—Within a department of respiratory medicine serving a hospital of 1323 beds.Main Outcome Measures—a. Time (...) taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.Results—a. The computer system was significantly faster than the manual system for lung function evaluation, loan of equipment, and checking for overdue equipment. The production of correspondence was slightly slower with the computer. b. All outpatient episodes, but only 43 of 65 of inpatient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988–1990 were high. Only £1200 to £1845 per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice. After 10 years the projected deficit is £10 000 per annum in running costs.Conclusions—In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay. (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren Holm (...) in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

The idea that intuition plays a basic role in moral knowledge and moral philosophy probably began in the eighteenth century. British philosophers such as Anthony Shaftsbury, Francis Hutcheson, Thomas Reid, and later David Hume talk about a “moral sense” that they place in John Locke’s theory of knowledge in terms of Lockean reflexive perceptions, while Richard Price seeks a faculty by which we obtain our ideas of right and wrong. In the twentieth century intuitionism in moral philosophy was revived (...) by the works of G. E. Moore, H. A. Prichard, and W. D. Ross. These philosophers reject Kantian deontological ethics and utilitarianism insisting that intuition is the only source of moral knowledge. Recently, there is a renewed interest in intuition by philosophers doing meta-philosophy by reflecting on what philosophers do, and why they disagree. In this essay we plan to take some of this recent literature on intuition and apply it to moral philosophy. We will proceed by defining a conception of intuition, answering some skeptical challenges, delimiting its target, and arguing that intuition is often a source of moral knowledge. (shrink)

The contents of this book were originally published in the September 1966 issue of Scientific American. A more appropriate-but perhaps less "catchy"—title would have been "Computers." The book is all about them and what they can—and cannot—do. Conspicuously missing is a chapter on the underlying mathematical theories of information, control, and computation. Nevertheless, there is a good deal of interesting material between the covers of this book. Of greatest concern to philosophers are the chapters on "Information" by John McCarthy, "Computer (...) Logic and Memory" by David C. Evans, "The Uses of Computers in Science" by Anthony G. Oettinger, "The Uses of Computers in Education" by Patrick Suppes, and "Artificial Intelligence" by Marvin L. Minsky. The first of these consists of a brief history of computing machines, an outline of the general principles of digital computers, and an interesting discussion of some of the moral and social issues which such machines raise. Evans' article is a popular description of binary logics and logic devices. The present reviewer has used some of the material in this chapter as embellishments in an undergraduate course in logic. Oettinger's article describes the novel way in which computers may aid in the formation of scientific theories. The paper by Suppes ought to be required reading for members of the "Teaching machines undermine intellectual development" school of thought. Finally, a philosopher of mind might have a field day with some of the remarkable and outrageous notions in Minsky's article; what, for example, is the difference between "thinking" and "exhibiting intelligence"? In sum, this is a stimulating book about a technological development which, for good or ill, is going to affect all of us.—H. P. K. (shrink)

Michael Potts, Paul A. Byrne, an David W. Evans are critical of donation after cardiac death (DCD). Contrary to the authors’ assertion that the removal of vital organs is the proximate cause of death, the eventual fulfillment of the neurological criteria of death is solely dependant on the rate of brain cell death in the absence of circulation. Consistent with the “dead donor rule,” DCD is not the cause of death. There are also procedural mechanisms to address the (...) potential conflicts of interest that concern the authors. Rather than being prohibited, DCD may be an ethically justifiable exception to the rule that organ donors must be dead prior to organ recovery. (shrink)

This book is the result of an idea launched by the present editors of providing a gift to Dr. Runner in the form of a Festschrift written by former students. The response was overwhelming. Glenn Andreas, one of Dr. Runner's closest friends, and Paul Schrotenboer, secretary of the Reformed Ecumenical Synod, enthusiastically joined us, together with Bernard Zylstra of the Institute for Christian Studies and Harry Van Dyke of the Free University of Amsterdam, to form a committee for this purpose... (...) Upon the appearance of this publication the editors wish to express their sincere thanks to the members of the committee for the advice and encouragement they gave and for the work they have done. (shrink)

At least since Descartes, philosophers have been interested in the special knowledge or authority that we exhibit when we speak about our own thoughts, attitudes, and feelings. This book contends that even the best work in contemporary philosophy of mind fails to account for this sort of knowledge or authority because it does not pay the right sort of attention to the notion of expression. What's at stake is not only how to understand self-knowledge and first-person authority, but also what (...) it is that distinguishes conscious from unconscious psychological states, what the mental life of a nonlinguistic animal has in common with our sort of mental life, and how to think about Wittgenstein's legacy to the philosophy of mind. (shrink)

In the past two to three decades health behavior scientists have increasingly emphasized affect-related concepts (including, but not limited to emotion) in their attempts to understand and facilitate change in important health behaviors, such as smoking, eating, physical activity, substance abuse, and sex. This article provides a narrative review of this burgeoning literature, including relevant theory and research on affective response (e.g., hedonic response to eating and drug use), incidental affect (e.g., work-related stress as a determinant of alcohol use), affect (...) processing (e.g., anticipated regret for illicit sex or skipping an exercise session), and affectively charged motivation (e.g., cigarette craving). An integrative dual-processing framework is presented that suggests pathways through which affect-related concepts may interrelate to influence health behavior. (shrink)

Self-consciousness and the self -- Diachronic unity, diachronic singularity, and the subject of consciousness -- A modal argument for immateriality -- Intelligibility concerns and causal objections -- Concluding remarks.

A quarter of a century ago, the first systematic behavioral experiments were performed to clarify the nature of color constancy—the effect whereby the perceived color of a surface remains constant despite changes in the spectrum of the illumination. At about the same time, new models of color constancy appeared, along with physiological data on cortical mechanisms and photographic colorimetric measurements of natural scenes. Since then, as this review shows, there have been many advances. The theoretical requirements for constancy have been (...) better delineated and the range of experimental techniques has been greatly expanded; novel invariant properties of images and a variety of neural mechanisms have been identified; and increasing recognition has been given to the relevance of natural surfaces and scenes as laboratory stimuli. Even so, there remain many theoretical and experimental challenges, not least to develop an account of color constancy that goes beyond deterministic and relatively simple laboratory stimuli and instead deals with the intrinsically variable nature of surfaces and illuminations present in the natural world. (shrink)

This paper considers an application of work on probabilistic measures of coherence to inference to the best explanation. Rather than considering information reported from different sources, as is usually the case when discussing coherence measures, the approach adopted here is to use a coherence measure to rank competing explanations in terms of their coherence with a piece of evidence. By adopting such an approach IBE can be made more precise and so a major objection to this mode of reasoning can (...) be addressed. Advantages of the coherence - based approach are pointed out by comparing it with several other ways to characterize ‘ best explanation ’ and showing that it takes into account their insights while overcoming some of their problems. The consequences of adopting this approach for IBE are discussed in the context of recent discussions about the relationship between IBE and Bayesianism. (shrink)

Locke thought it was a necessary truth that no two material bodies could be in the same place at the same time. Leibniz wasn't so sure. This paper sides with Leibniz. I examine the arguments of David Wiggins in defense of Locke on this point (Philosophical Review, January 1968). Wiggins’ arguments are ineffective.

In this collection of provocative essays, historians and literary theorists assess the influence of Michel Foucault, particularly his History of Sexuality, on the study of classics. Foucault's famous work presents a bold theory of sexuality for both ancient and modern times, and yet until now it has remained under-explored and insufficiently analyzed. By bringing together the historical knowledge, philological skills, and theoretical perspectives of a wide range of scholars, this collection enables the reader to explore Foucault's model of Greek culture (...) and see how well his interpretation accounts for the full range of evidence from Greece and Rome. Not only do the essays bring to light the assumptions, ideas, and practices that constituted the intimate lives of men and women in the ancient Mediterranean world, but they also demonstrate the importance of the History of Sexuality for fields as diverse as Greco-Roman antiquity, women's history, cultural studies, philosophy, and modern sexuality. The essays include "Situating The History of Sexuality" (the editors), "Taking the Sex Out of Sexuality: Foucault's Failed History" (Joel Black), "Incipit Philosophia" (Alain Vizier), "The Subject in Antiquity after Foucault" (Page duBois), "This Myth Which Is Not One: Construction of Discourse in Plato's Symposium" (Jeffrey S. Carnes), "Foucault's History of Sexuality: A Useful Theory for Women?" (Amy Richlin), "Catullan Consciousness, the 'Care of the Self,' and the Force of the Negative in History" (Paul Allen Miller), "Reversals of Platonic Love in Petronius' Satyricon" (Daniel B. McGlathery), and an essay from Dislocating Masculinity (Lin Foxhall). (shrink)

This new edition includes three new chapters, updating the book to take into account developments in the field over the past fifteen years.

To accommodate vague statements and predicates, I propose an infinite-valued, non-truth-functional interpretation of logic on which the tautologies are exactly the tautologies of classical two-valued logic. iI introduce a determinacy operator, analogous to the necessity operator in alethic modal logic, to allow the definition of first-order and higher-order borderline cases. On the interpretation proposed for determinacy, every statement corresponding to a theorem of modal system T is a logical truth, and I conjecture that every logical truth on the interpretation corresponds (...) to a theorem of T. the interpretation is extended to predicate logic. A borderline case of a predicate 'F’ is neither determinately F nor determinately not-F. Traditional sorites arguments are seen to fall apart early in their gradual stepwise passage from truth to falsity. (shrink)

Two of the probabilistic measures of coherence discussed in this paper take probabilistic dependence into account and so depend on prior probabilities in a fundamental way. An example is given which suggests that this prior-dependence can lead to potential problems. Another coherence measure is shown to be independent of prior probabilities in a clearly defined sense and consequently is able to avoid such problems. The issue of prior-dependence is linked to the fact that the first two measures can be understood (...) as measures of coherence as striking agreement, while the third measure represents coherence as agreement. Thus, prior (in)dependence can be used to distinguish different conceptions of coherence. (shrink)

This paper presents a new argument for the likelihood ratio measure of confirmation by showing that one of the adequacy criteria used in another argument can be replaced by a more plausible and better supported criterion which is a special case of the weak likelihood principle. This new argument is also used to show that the likelihood ratio measure is to be preferred to a measure that has recently received support in the literature.

Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one (...) that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research. (shrink)

In an anthology on panentheism, Keith Ward assesses the appropriateness of the metaphor of embodiment for God, as well as the viability of the concept of panentheism itself, as he considers the theologies of Ramanuja, Hegel, and process thought. Ward frames polar problems with respect to the analogy of self-body/God-world and to the concept of panentheism. Ramanuja and Hegel’s theologies ultimately deny the freedom and compromise the independence and otherness of the creatures. Process theology compromises divine sovereignty and perfection, making (...) God too passible to the world’s evils. This article attempts to transcend such one-sided approaches as it develops a balanced concept of panentheism and a metaphor of divine embodiment that provide for mutual influence between God and the world, wherein both the suffering and happiness of the world affect God, while maintaining sole divine causal ultimacy with respect to the world. (shrink)

A primary purpose of argument is to increase the degree of reasonable confidence that one has in the truth of the conclusion. A question begging argument fails this purpose because it violates what W. E. Johnson called an epistemic condition of inference. Although an argument of the sort characterized by Robert Hoffman in his response (Analysis 32.2, Dec 71) to Richard Robinson (Analysis 31.4, March 71) begs the question in all circumstances, we usually understand the charge that an argument is (...) question begging with reference to the beliefs of the person, or the sort of person, to whom the argument is directed. (shrink)

Many philosophic arguments concerned with infinite series depend on the mutual inconsistency of statements of the following five forms: (1) something exists which has R to something; (2) R is asymmetric; (3) R is transitive; (4) for any x which has R to something, there is something which has R to x; (5) only finitely many things are related by R. Such arguments are suspect if the two-place relation R in question involves any conceptual vagueness or inexactness. Traditional sorites arguments (...) show that a statement of form (4) can fail to be true even though it has no clear counter-example. Conceptual vagueness allows a finite series not to have any definite first member. I consider the speculative possibilities that there have been only finitely many non-overlapping hours although there has been no first hour and that space and time are only finitely divisible even though there are no smallest spatial or temporal intervals. (shrink)

In the form of inference known as inference to the best explanation there are various ways to characterise what is meant by the best explanation. This paper considers a number of such characterisations including several based on confirmation measures and several based on coherence measures. The goal is to find a measure which adequately captures what is meant by 'best' and which also yields the truth with a high degree of probability. Computer simulations are used to show that the overlap (...) coherence measure achieves this goal, enabling the true explanation to be identified almost as often as an approach which simply selects the most probable explanation. Further advantages to this approach are also considered in the case where there is uncertainty in the prior probability distribution. (shrink)

We present a conceptual framework on the experience of time and provide a coherent basis on which to base further inquiries into qualitative approaches concerning time experience. We propose two Time-Layers and two Time-Formats forming four Time-Domains. Micro-Flow and Micro-Structure represent the implicit phenomenal basis, from which the explicit experiences of Macro-Flow and Macro-Structure emerge. Complementary to this theoretical proposal, we present empirical results from qualitative content analysis obtained from 25 healthy participants. The data essentially corroborate the theoretical proposal. With (...) respect to Flow, the phenomenally accessible time experience appeared as a continuous passage reaching from the past through the present into the future. With respect to Structure, the individual present was embedded in the individual biography, emerging from past experiences and comprising individual plans and goals. New or changing plans and goals were being integrated into the existing present, thus forming a new present. The future appeared as changeable within the present, by means from the past, and therefore as a space of potential opportunities. Exemplarily, we discuss these results in relation to previous empirical findings on deviant experiences of time in Autism Spectrum Disorder that is presumably characterized by a breakdown of Flow and concomitant compensatory repetition resulting in an overly structured time. Finally, we speculate about possible implications of these findings both for psychopathological and neuroscientific research. (shrink)

Consensus conferences, also known as citizens’ panels—a collection of lay citizens akin to a jury but charged with deliberating on policy issues with a high technical content—are a potentially important way to conduct technology assessments, inform policy makers about public views of new technologies, and improve public understanding of and participation in technological decision making. The first citizens’ panel in the United States occurred in April 1997 on the issue of “Telecommunications and the Future of Democracy.” This article evaluates the (...) impact of this citizens’ panel. The standard criteria to evaluate the impact of analyses focus on the “actual impact” and on the “impact on general thinking.” To these standard criteria, this article introduces the evaluation of two impacts related to learning: impact on the training of knowledgeable personnel and the interaction with lay knowledge. The impact evaluation is based on a nearly comprehensive set of semistructured telephone interviews with the participants in the panel. (shrink)

Everything red is colored, and all squares are polygons. A square is distinguished from other polygons by being four-sided, equilateral, and equiangular. What distinguishes red things from other colored things? This has been understood as a conceptual rather than scientific question. Theories of wavelengths and reflectance and sensory processing are not considered. Given just our ordinary understanding of color, it seems that what differentiates red from other colors is only redness itself. The Cambridge logician W. E. Johnson introduced the terms (...) determinate and determinable to apply to examples such as red and colored. Chapter XI, of Johnson's Logic, Part I (1921), “The Determinate and the Determinable,” is the main text for discussion of this distinction. (shrink)

This paper provides a new approach to inference to the best explanation based on a new coherence measure for comparing how well hypotheses explain the evidence. It addresses a number of criticisms of the use of probabilistic measures in this context by Clark Glymour, including limitations of earlier work on IBE. Computer experiments are used to show that the new approach finds the truth with a high degree of accuracy in hypothesis selection tasks and that in some cases its accuracy (...) is greater than hypothesis selection based on maximizing posterior probability. Hence, by overcoming some of the problems with the previous approach, this work provides a more adequate defence of IBE and suggests that IBE not only tracks truth but also has practical advantages over the previous approach. Applications of the new approach to parameter estimation and model selection are also explored. (shrink)

As theorists, developers, and practitioners of the anticipatory governance of emerging technologies, we applaud Ankeny et al.’s...