A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

When reflecting on the nature of skilled action, it is easy to fall into familiar dichotomies such that one construes the flexibility and intelligence of skill at the level of intentional states while characterizing the automatic motor processes that constitute motor skill execution as learned but fixed, invariant, bottom-up, brute-causal responses. In this essay, I will argue that this picture of skilled, automatic, motor processes is overly simplistic. Specifically, I will argue that an adequate account of the learned motor routines (...) that constitute embodied skills cannot be given in a purely bottom-up, brute-causal fashion. Rather, motor control is intelligent all the way down. To establish this, I will first review two recent accounts of skill, Stanley and Krakauer and Papineau, which characterize the automatic motor control responsible for the fine-grained movements constitutive of motor skill as brute, low-level phenomena. I will then isolate five key features that should apply to skilled motor control, if these accounts are correct. Together, the accounts posit that motor control is: ballistic, invariant, independent of general action trajectories, Insensitive to semantic content, and independent of personal-level intentions. In the final section of this paper, I will appeal to optimal control theory for empirical evidence to challenge the commitment to skilled action as qualified by the above features. (shrink)

When reflecting on the nature of skilled action, it is easy to fall into familiar dichotomies such that one construes the flexibility and intelligence of skill at the level of intentional states while characterizing the automatic motor processes that constitute motor skill execution as learned but fixed, invariant, bottom-up, brute-causal responses. In this essay, I will argue that this picture of skilled, automatic, motor processes is overly simplistic. Specifically, I will argue that an adequate account of the learned motor routines (...) that constitute embodied skills cannot be given in a purely bottom-up, brute-causal fashion. Rather, motor control is intelligent all the way down. To establish this, I will first review two recent accounts of skill, Stanley and Krakauer (Front Hum Neurosci, 2013. doi:10.3389/fnhum.2013.0050) and Papineau (R Inst Philos Suppl 73:175–196, 2013), which characterize the automatic motor control responsible for the fine-grained movements constitutive of motor skill as brute, low-level phenomena. I will then isolate five key features that should apply to skilled motor control, if these accounts are correct. Together, the accounts posit that motor control is: (1) ballistic, (2) invariant, (3) independent of general action trajectories, (4) Insensitive to semantic content, and (5) independent of personal-level intentions. In the final section of this paper, I will appeal to optimal control theory for empirical evidence to challenge the commitment to skilled action as qualified by the above features. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

BackgroundWhile previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.MethodsTo address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.ResultsNew findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; (...) 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.ConclusionsThese findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research. (shrink)

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, these (...) variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity. (shrink)

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on (...) the following key issues: § 1.Providing information about research integrity § 2.Providing education, training and mentoring § 3.Strengthening a research integrity culture § 4.Facilitating open dialogue § 5.Wise incentive management § 6.Implementing quality assurance procedures § 7.Improving the work environment and work satisfaction § 8.Increasing transparency of misconduct cases § 9.Opening up research § 10.Implementing safe and effective whistle-blowing channels § 11.Protecting the alleged perpetrators § 12.Establishing a research integrity committee and appointing an ombudsperson § 13.Making explicit the applicable standards for research integrity. (shrink)

Philosophical questions surrounding skill and expertise can be traced back as far as Ancient Greece, China, and India. In the twentieth century skilled action was an important factor in the work of phenomenologists such as Heidegger and Merleau-Ponty and analytic philosophers including Gilbert Ryle. However, as a subject in its own right it has, until now, remained largely in the background. The Routledge Handbook of Philosophy of Skill and Expertise is an outstanding reference source and the first major collection of (...) its kind, reflecting the explosion of interest in the topic recent years. Comprising thirty-nine chapters written by leading international contributors, the Handbook is organised into six clear parts: Skill in the History of Philosophy Skill in Epistemology Skill, intelligence, and agency Skill in Perception, Imagination, and Emotion Skill, Language, and, Social Cognition Skill and Expertise in Normative Philosophy. Essential reading for students and researchers in philosophy of mind and psychology, epistemology and ethics, The Routledge Handbook of Philosophy of Skill and Expertise is also suitable for those in related disciplines such as social psychology and cognitive science. It is also relevant to those who are interested in conceptual issues underlying skill and expertise in fields such as sport, the performing arts, and medicine. (shrink)

This paper provides an account of the strategic control involved in skilled action. When I discuss strategic control, I have in mind the practical goals, plans, and strategies that skilled agents use in order to specify, structure, and organize their skilled actions, which they have learned through practice. The idea is that skilled agents are better than novices not only at implementing the intentions that they have but also at forming the right intentions. More specifically, skilled agents are able formulate (...) and modify, adjust and adapt their practical intentions in ways that are appropriate, effective, and flexible given their overall goals. Further, to specify the kind of action plans that are involved in strategic control, I’ll rely on empirical evidence concerning mental practice and mental imagery from sports psychology as well as evidence highlighting the systematic differences in the cognitive representations of skills between experts and non-experts. I’ll claim that, together, this evidence suggests that the intentions that structure skilled actions are practical and not theoretical, that is, that they are perceptual and motor and not abstract, amodal, or linguistic. Importantly, despite their grounded nature, these plans are still personal-level, deliberate, rational states. That is, the practical intentions used to specify and structure skilled actions are best conceived of as higher-order, motor-modal structures, which can be manipulated and used by the agent for the purpose of reasoning, deliberation, decision-making and, of course, the actual online structuring and organizing of action. (shrink)

This book takes a new approach to ethics by focusing on the kinds of dilemmas that confront people almost daily on the job.

Recent empirical work suggests that intuitions may be less reliable than previously assumed. However, given the ubiquity of intuition in philosophical reasoning, it is tempting to give intuitions some evidential weight. This chapter develops an account called ‘moderate intuitionism’, a view whereby intuitions are generally reliable, but nonetheless capable of substantial degrees of error. Believing that the general reliability of intuition emerges from the nature of language, the chapter develops an outline for a disposition-based metasemantic theory which can ground the (...) link between intuition and truth: terms refer to whatever a speaker would be disposed to apply them to when in possession of all relevant information. Well-constructed thought experiments can elicit intuitions and generally reflect the semantic facts but this account can also explain why intuitions occasionally err — i.e. when a thought experiment fails to specify information that would influence the speaker’s dispositions. (shrink)

This article explores Mary Shelley’s Frankenstein as an “object of care” for use in examining the relationship between creativity and responsibility in the sciences and beyond. Through three short sketches from different disciplinary lenses—literature, science and technology studies, and feminist studies—readers get a sense of the different ways scholars might consider Shelley’s text as an object of care. Through an analysis and synthesis of these three sketches, the authors illustrate the value of such an object in thinking about broad cultural (...) issues. The article acts as a kind of boundary object by creating distinct, yet overlapping narratives from an object that is owned by many social worlds. The three sketches reveal Frankenstein as a thoughtful consideration about what it means to care for, or fail to care for, one’s creation, rather than as a cautionary tale about the evils of scientific hubris. Although infrastructures at universities often prevent interdisciplinary dialogue, the article concludes that purposeful boundary objects created around objects of care like Frankenstein can help build bridges and create shared meanings for new interdisciplinary spaces. (shrink)

Nanotechnology will allegedly have a revolutionary impact in a wide range of fields, but has also created novel concerns about health, safety and the environment (HSE). Nanotechnology regulation has nevertheless lagged behind nanotechnology development. In 2004 the International Organization for Standardization established a technical committee for producing nanotechnology standards for terminology, measurements, HSE issues and product specifications. These standards are meant to play a role in nanotechnology development, as well as in national and international nanotechnology regulation, and will therefore have (...) consequences for consumers, workers and the environment. This paper gives an overview of the work in the technical committee on nanotechnology and discusses some challenges with regard to legitimacy in such work. The paper focuses particularly on stakeholder involvement and the potential problems of scientific robustness when standardising in such early stages of the scientific development. The intention of the paper is to raise some important issues rather than to draw strong conclusions. However, the paper will be concluded with some suggestions for improving legitimacy in the TC 229 and a call for increased public awareness about standardisation in the field of nanotechnology. (shrink)

Culture, defined as shared behavior or information within a community acquired through some form of social learning from conspecifics, is now suggested to act as a second inheritance system. Cultural processes are important in a wide variety of vertebrate species. Birdsong provides a classic example of cultural processes: cultural transmission, where changes in a shared song are learned from surrounding conspecifics, and cultural evolution, where the patterns of songs change through time. This form of cultural transmission of information has features (...) that are different in speed and form from genetic transmission. More recently, culture, vocal traditions and an extreme form of song evolution has been documented in cetaceans. Humpback whale song ‘revolutions’, where the single population-wide shared song type is rapidly replaced by a new, novel song type introduced from a neighbouring population, represents an extraordinary example of ocean basin-wide cultural transmission rivalled in its geographic extent only by humans. In this review, we examine the cultural evolutions and revolutions present in some birdsong and whale song, respectively. By taking a comparative approach to these cultural processes, we review the existing evidence to understand the similarities and differences for their patterns of expression and the underlying drivers, including anthropogenic influences, which may shape them. Finally, we encourage future studies to explore the role of innovation vs. production errors in song evolution, the fitness information present in song, and how human-induced changes in population sizes, trajectories and migratory connections facilitating cultural transmission may be driving song revolutions. (shrink)

Liberal societies are characterized by respect for a fundamental value pluralism; i.e., respect for individuals’ rights to live by their own conception of the good. Still, the state must make decisions that privilege some values at the cost of others. When public ethics committees give substantial ethical advice on policy related issues, it is therefore important that this advice is well justified. The use of explicit tools for ethical assessment can contribute to justifying advice. In this article, I will discuss (...) one approach to ethical assessment, the ethical matrix method. This method is a variant of intuitionist balancing. Intuitionism is characterized by stressing the existence of several (at least two) fundamental prima facie moral principles, between which there is no given rank order. For some intuitionist approaches, coherentism has been proposed as a model of justification. This article will discuss justification of ethical advice and evaluate the appropriateness of coherentism as a justificatory approach to intuitionist tools. (shrink)

Asian Texts -- Asian Contexts helps bring Asian philosophy and religion into wider classroom consideration by giving nonspecialists entree to primary texts from ...

The ethical matrix approach was developed by Prof Ben Mepham and his colleagues at the University of Nottingham in the early 1990s. Since then the approach has received increasing attention and has been used by several researchers in different projects related to assessing ethical impacts of different food production technologies and other policy options of societal concern. The ethical matrix is sometimes understood simply as a checklist of ethical concerns, but might also be seen as a guide to coming to (...) conclusions on moral questions. The problem I discuss in this paper relates to how using the ethical matrix method as a decision guide can be combined with respecting pluralism. The aim of the paper is to suggest a framework making it possible to – at the same time – enhance public justification of judgments and respect pluralism. I argue that pluralism is fundamental to the ethical matrix approach; I distinguish between intuitionist principled pluralism and societal value pluralism; and I show how both kinds of pluralism imply restrictions on how conclusions can be made. No substantive moral decision principles can be allowed. Still, I argue, decision principles of a more epistemological or procedural character can be acceptable even within pluralism. The pragmatist principle of inquiry is defended as an account of moral problem solving compatible with both principled pluralism and value pluralism. When an ethical matrix is used within such a participatory inquiry process substantive conclusions can be drawn. (shrink)

A biography of the theologian/scientist/philosopher who became famous for his archeological research and for his efforts to reconcile religion and science through a synthesis of evolutionary theory and Christian doctrine.

Context: Although ethics consultation is commonplace in United States hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the “best informant” within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services were found in 81% of all general hospitals in the U.S., and in 100% (...) of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians, nurses, social workers, or chaplains. Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Most readers of Louis Althusser first enter his work through his writings on ideology. In an important new essay Étienne Balibar, friend and colleague of Althusser, offers an original reading of Althusser’s idea of ideology, drawing on both recently published posthumous writing and Althusser's work on the Piccolo Teatro di Milano. Balibar’s essay uncovers the intricate workings of interpellation through Althusser’s essays on the theater. If debates on dialectical materialism belong to a distant history, Balibar suggests, the question of ideology (...) remains crucial for thinking the present. The issue includes commentaries on Balibar’s essay from five influential scholars who engage critically with Althusser’s philosophy: Judith Butler, Banu Bargu, Adi Ophir, Warren Montag, and Bruce Robbins. This issue reanimates Althusser’s concept of ideology as an analytic tool for contemporary cultural and political critique. (shrink)

Concerns have been voiced about the ethical implications of patenting practices in the field of biotechnology. Some of these have also been incorporated into regulation, such as the European Commission Directive 98/44 on the legal protection of biotechnological inventions. However, the incorporation of ethically based restrictions into patent legislation has not had the effect of satisfying all concerns. In this article, we will systematically compare the richness of ethical concerns surrounding biotech patenting, with the limited scope of ethical concerns actually (...) addressed in the patent system. As sources of our analyses we will use literature and document studies and a survey with important stakeholders and experts related to Norwegian patenting in the aquacultural biotechnology sector. We will structure the analyses with an ethical matrix, developed for this purpose. Showing the misalignment of the discussions within and outside the patent system, we suggest that an important reason for the ethical controversy still surrounding patenting is that ethical questions keep being framed in a narrow way within the system. Until a richer set of ethical considerations is addressed head-on within the patent system, the patent system will continue to evoke academic and interest group criticism, potentially contributing to a legitimacy crisis of the whole system. (shrink)

ABSTRACTThe retrospective evaluation of an event tends to be based on how the experience felt during the most intense moment and the last moment. Two experiments tested whether this so-called peak-end effect influences how primary school students are affected by peer assessments. In both experiments, children assessed two classmates on their behaviour in school and then received two manipulated assessments. In Experiment 1, one assessment consisted of four negative ratings and the other of four negative ratings with an extra moderately (...) negative rating added to the end. In Experiment 2, one assessment consisted of four positive ratings, and the other added an extra moderately positive rating to the end. Consistent with the peak-end effect, the extended assessment in Experiment 1 and the short assessment in Experiment 2 were remembered as more pleasant and less difficult to deal with, which shaped children’s peer assessment preferences and prospective choices of which assessm... (shrink)

The central goal of this essay is to develop a theory of justified paternalism that will be useful in evaluating and designing paternalistic public policies. The theory is designed for a society that promotes the development of characteristics of autonomy in its members. In the opening chapter I analyze widely-held legal, familial and philosophic conceptions of paternalism, discuss the inadequacies of each of those conceptions and develop a "unified" conception of paternalism. In Chapter II I analyze what it means to (...) be "morally responsible" and base this analysis on the legal, psychological and psychiatric accounts of responsibility that inform an autonomist society. From these analyses I develop two principles which inform an autonomist society: Respect for Others and Non-Interference and discuss the restraints on justifiable paternalism entailed by them. In Chapter III I discuss the roles of voluntariness and consent in the legal, phychiatric and philosophic concepts of moral responsibility and turn to an analysis of the disappointing treatments of these concepts in traditional philosophic justifications for paternalism. I argue that "unencumbered consent" is an appropriate concept of consent to utilize in any philosophic justification for paternalism that would be consistent with the concepts of moral responsibility and autonomy and the principles of respect for others and of non-interference. Chapter IV offers a decision-theoretic model justifying acting paternalistically for others. Each of the necessary conditions for justified paternalism is drawn from the aforementioned concepts and principles. In Chapter V, I show that if Rawls is to be consistent, he must adopt a theory of paternalism similar to mine, and I argue that my theory of paternalism overcomes libertarian, utilitarian and statistical arguments against it. I then apply the theory to specific forms of paternalism including involuntary commitment and guardianship, mandatory blood transfusions, flouridation of public water supplies, mandatory motorcycle helmets and seatbelts, social security taxation, mandatory education of children and suicide intervention. A 267-entry bibliography is appended. (shrink)

This book presents a multidisciplinary perspective on chance, with contributions from distinguished researchers in the areas of biology, cognitive neuroscience, economics, genetics, general history, law, linguistics, logic, mathematical physics, statistics, theology and philosophy. The individual chapters are bound together by a general introduction followed by an opening chapter that surveys 2500 years of linguistic, philosophical, and scientific reflections on chance, coincidence, fortune, randomness, luck and related concepts. A main conclusion that can be drawn is that, even after all this time, (...) we still cannot be sure whether chance is a truly fundamental and irreducible phenomenon, in that certain events are simply uncaused and could have been otherwise, or whether it is always simply a reflection of our ignorance. Other challenges that emerge from this book include a better understanding of the contextuality and perspectival character of chance (including its scale-dependence), and the curious fact that, throughout history (including contemporary science), chance has been used both as an explanation and as a hallmark of the absence of explanation. As such, this book challenges the reader to think about chance in a new way and to come to grips with this endlessly fascinating phenomenon. (shrink)

BackgroundBeing pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant.MethodWe interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy (...) controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire and were diagnosed by using the Eating Disorder Examination.ResultsOn becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.”ConclusionPregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention. (shrink)