BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

An important and supposedly impactful form of clinical ethics support is moral case deliberation. Empirical evidence, however, is limited with regard to its actual impact. With this literature review, we aim to investigate the empirical evidence of MCD, thereby a) informing the practice, and b) providing a focus for further research on and development of MCD in healthcare settings. A systematic literature search was conducted in the electronic databases PubMed, CINAHL and Web of Science. Both the data collection and the (...) qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of our decisions. The qualitative analysis was supported by ATLAS.ti. Based on a qualitative analysis of 25 empirical papers, we identified four clusters of themes: 1) facilitators and barriers in the preparation and context of MCD, i.e., a safe and open atmosphere created by a facilitator, a concrete case, commitment of participants, a focus on the moral dimension, and a supportive organization; 2) changes that are brought about on a personal and inter-professional level, with regard to professional’s feelings of relief, relatedness and confidence; understanding of the perspectives of colleagues, one’s own perspective and the moral issue at stake; and awareness of the moral dimension of one’s work and awareness of the importance of reflection; 3) changes that are brought about in caring for patients and families; and 4) changes that are brought about on an organizational level. This review shows that MCD brings about changes in practice, mostly for the professional in inter-professional interactions. Most reported changes are considered positive, although challenges, frustrations and absence of change were also reported. Empirical evidence of a concrete impact on the quality of patient care is limited and is mostly based on self-reports. With patient-focused and methodologically sound qualitative research, the practice and the value of MCD in healthcare settings can be better understood, thus making a stronger case for this kind of ethics support. (shrink)

One tradition of solving the surprise exam paradox, started by Robert Binkley and continued by Doris Olin, Roy Sorensen and Jelle Gerbrandy, construes surpriseepistemically and relies upon the oddity of propositions akin to G. E. Moore’s paradoxical ‘p and I don’t believe that p.’ Here I argue for an analysis that evolves from Olin’s. My analysis is different from hers or indeed any of those in the tradition because it explicitly recognizes that there are two distinct reductios at work (...) in the student’s paradoxical argument against the teacher. The weak reductio is easy to fault. Its invalidity determines the structure of the strong reductio, so-calledbecause it is more difficult to refute, but ultimately unsound because of reasons associated with Moore-paradoxicality. Previous commentators have not always appreciated this difference, with the result that the strong reductio is not addressed, or the response to the weak reductio is superfl uous. This is one reason why other analyses in the tradition are vulnerable to objections to which mine is not. (shrink)

One tradition of solving the surprise exam paradox, started by Robert Binkley and continued by Doris Olin, Roy Sorensen and Jelle Gerbrandy, construes surpriseepistemically and relies upon the oddity of propositions akin to G. E. Moore’s paradoxical ‘p and I don’t believe that p.’ Here I argue for an analysis that evolves from Olin’s. My analysis is different from hers or indeed any of those in the tradition because it explicitly recognizes that there are two distinct reductios at work (...) in the student’s paradoxical argument against the teacher. The weak reductio is easy to fault. Its invalidity determines the structure of the strong reductio, so-calledbecause it is more difficult to refute, but ultimately unsound because of reasons associated with Moore-paradoxicality. Previous commentators have not always appreciated this difference, with the result that the strong reductio is not addressed, or the response to the weak reductio is superfl uous. This is one reason why other analyses in the tradition are vulnerable to objections to which mine is not. (shrink)

One tradition of solving the surprise exam paradox, started by Robert Binkley and continued by Doris Olin, Roy Sorensen and Jelle Gerbrandy, construes surpriseepistemically and relies upon the oddity of propositions akin to G. E. Moore’s paradoxical ‘p and I don’t believe that p.’ Here I argue for an analysis that evolves from Olin’s. My analysis is different from hers or indeed any of those in the tradition because it explicitly recognizes that there are two distinct reductios at work (...) in the student’s paradoxical argument against the teacher. The weak reductio is easy to fault. Its invalidity determines the structure of the strong reductio, so-calledbecause it is more difficult to refute, but ultimately unsound because of reasons associated with Moore-paradoxicality. Previous commentators have not always appreciated this difference, with the result that the strong reductio is not addressed, or the response to the weak reductio is superfl uous. This is one reason why other analyses in the tradition are vulnerable to objections to which mine is not. (shrink)

The book deals with the notion of Downward Causation from a wide array of perspectives, including physics, biology, psychology, social science, communication studies, text theory, and philosophy. The book includes proponents as well as opponents discussing the validity of the notion.

This paper argues that episodic thoughts are always unconscious. Whether consciousness is understood in terms of global broadcasting/widespread accessibility or in terms of non-interpretive higher-order awareness, the conclusion is the same: there is no such thing as conscious thought. Arguments for this conclusion are reviewed. The challenge of explaining why we should all be under the illusion that our thoughts are often conscious is then taken up.

This paper is about the good side of modal logic, the bad side of modal logic, and how hybrid logic takes the good and fixes the bad.In essence, modal logic is a simple formalism for working with relational structures . But modal logic has no mechanism for referring to or reasoning about the individual nodes in such structures, and this lessens its effectiveness as a representation formalism. In their simplest form, hybrid logics are upgraded modal logics in which reference to (...) individual nodes is possible.But hybrid logic is a rather unusual modal upgrade. It pushes one simple idea as far as it will go: represent all information as formulas. This turns out to be the key needed to draw together a surprisingly diverse range of work . Moreover, it displays a number of knowledge representation issues in a new light, notably the importance of sorting. (shrink)

There have been many claims that quantum mechanics plays a key role in the origin and/or operation of biological organisms, beyond merely providing the basis for the shapes and sizes of biological molecules and their chemical affinities. These range from Schr¨odinger’s suggestion that quantum fluctuations produce mutations, to Hameroff and Penrose’s conjecture that quantum coherence in microtubules is linked to consciousness. I review some of these claims in this paper, and discuss the serious problem of decoherence. I advance some further (...) conjectures about quantum information processing in bio-systems. Some possible experiments are suggested. © 2004 Elsevier Ireland Ltd. All rights reserved. (shrink)

The place of the emotions among the passions -- The analytic of the emotions I -- The analytic of the emotions II -- The dialectic of the emotions -- Pride, arrogance, and humility -- Shame, embarrassment, and guilt -- Envy -- Jealousy -- Anger -- Love -- Friendship -- Sympathy and empathy.

Open peer commentary on the article “Perception-Action Mutuality Obviates Mental Construction” by Martin Flament Fultot, Lin Nie & Claudia Carello. Upshot: In my view, the clash between ecological psychology, enactivism, and constructivism in general has more to do with irreconcilable metaphysical and theoretical incommensurabilities than disagreements about specific mechanisms or processes of perception. Even with mutual enabling of action and perception, some internal process of self-modification is still needed if novel behavior is to be adequately explained.

Studies in Stoicism contains six unpublished and seven republished essays, the latter incorporating additions and changes which Brunt wished to be made. The papers have been integrated and arranged in chronological order by subject matter, with an accessible lecture to the Oxford Philological Society serving as Brunt's own introduction.

Richard Taylor was born in Charlotte, Michigan on 5 November 1919. He received his A. B. from the University of illinois in 1941, his M. A. from Oberlin College in 1947, and his Ph. D. from Brown University in 1951. He has been William H. P. Faunce Professor of Philosophy at Brown University, Professor of Philosophy (Graduate Faculties) at Columbia University, and Professor of Philosophy at the University of Rochester. He is the author of about fifty articles and of five (...) philosophical books. This volume consists of essays presented to Richard Taylor on the occa sion of his sixtieth birthday. Some of the contributors have been Taylor'S students; some have been his colleagues; and all have been, and continue to be, his admirers. I have made several attempts to articulate what it is I (I would not presume to speak for anyone else) admire about Richard Taylor: (1) There is a particular 'flavor' to Taylor's philosophical writing and con versation that is wholly delightful. Like any other flavor, it can be tasted and enjoyed and remembered but never adequately described. (If there should be someone who has picked up this book who does not know what I mean, I recommend that he read the chapter on 'God' in Taylor's Metaphysics. ) (2) Taylor is a masterful dialectician. (shrink)

Philosophers often distinguish in some way between two senses of life's meaning. Paul Edwards terms these a ‘cosmic’ and ‘terrestrial’ sense. The cosmic sense is that of an overall purpose of which our lives are a part and in terms of which our lives must be understood and our purposes and interests arranged. This overall purpose is often identified with God's divine scheme, but the two need not necessarily be equated. The terrestrial sense of meaning is the meaning people find (...) in their own lives apart from the place of their lives in any ultimate end or context. (shrink)

This article examines the origin of experiential organization, especially whether it is salient or selective. Aron Gurwitsch believes it is salient and William James that it is selective. I argue that Gurwitsch is right, and recount his argument and his critique of James, but I also pose my own critique and critical questions on the issue. -/- Gurwitsch's argument attempts to show that the organization of consciousness is not arbitrary or merely selected in some way by the subject. He claims (...) that when consciousness is organized it is found as already organized. -/- This is important for Gurwitsch's philosophical system because if he can establish that consciousness is always originally organized, then his famous claim that the theme, thematic-field, margin structure of consciousness is an invariant patterning impervious to the subject's whim, mood, or possible noetic training, is protected at the very start. (shrink)

P. Kyle Stanford - The Manifest Connection: Causation, Meaning, and David Hume - Journal of the History of Philosophy 40:3 Journal of the History of Philosophy 40.3 339-360 The Manifest Connection: Causation, Meaning, and David Hume P. Kyle Stanford 1. Introduction exciting recent hume scholarship has challenged the traditional view that Hume's theory of meaning leads him to deny the very intelligibility or coherence of supposing that there are objective causal powers or intrinsic necessary connections between causally related entities. Influential (...) recent interpretations have variously held that Hume himself accepted the existence of such powers and connections, that he was genuinely agnostic about them, or that he denied their existence while nonetheless holding it to be a perfectly coherent possibility, indeed one that we routinely think actual. In this paper I will argue against all three of these lines of interpretation and in favor of what I consider a neglected alternative: that Hume rejects the existence of objective necessary connections or causal powers as literally incoherent or meaningless, but on subtle and sophisticated semantic grounds, rather than simplistic ones. I find support for this semantic reading and against the alternatives not only in passages whose significance to the debate is widely appreciated, but also in Hume's discussions "Of Liberty and Necessity" and "Of the Immateriality of the Soul." The.. (shrink)

The criminal law presently distinguishes between actions and omissions, and only rarely proscribes failures to avert consequences that it would be an offense to bring about. Why? In recent years it has been persuasively argued by both Glover and Bennett that, celeris paribus, omissions to prevent a harm are just as culpable as are actions which bring that harm about. On the other hand, and acknowledging that hitherto “lawyers have not been very successful in finding a rationale for it,” Tony (...) Honoré has sought to defend the law's differential treatment. He proposes a “distinct-duties theory” that in addition to the general duties we owe to everyone, we also owe distinct duties to a more limited collection of people and associations, specified by features of our relationship with them. Where a distinct duty holds, breach by omission may well be no better than breach by positive action. But absent a distinct duty, omissions, per Honoré, are less culpable. They are mere failures to intervene and improve or rectify things, whereas actions are positive interventions which make things worse. And, thus, the law has good reason to differentiate between them. (shrink)

A numerical classification was performed on 69 elements with 54 chemicaland physicochemical properties. The elements fell into clusters in closeaccord with the electron shell s-, p- andd-blocks. The f-block elements were not included forlack of sufficiently complete data. The successive periods ofs- and p-block elements appeared in an ovalconfiguration, with d-block elements lying to one side. Morethan three axes were required to give good representation of thevariation, although the interpretation of the higher axes is difficult.Only 15 properties were scorable for (...) the noble gases, but despite thepaucity of properties reflecting chemical reactivity, analysis of the 69elements on these properties still showed the major features seen fromthe full set. (shrink)

This article examines the origin of experiential organization, especially whether it is salient or selective. Aron Gurwitsch believes it is salient and William James that it is selective. I argue that Gurwitsch is right, and recount his argument and his critique of James, but I also pose my own critique and critical questions on the issue. -/- Gurwitsch's argument attempts to show that the organization of consciousness is not arbitrary or merely selected in some way by the subject. He claims (...) that when consciousness is organized it is found as already organized. -/- This is important for Gurwitsch's philosophical system because if he can establish that consciousness is always originally organized, then his famous claim that the theme, thematic-field, margin structure of consciousness is an invariant patterning impervious to the subject's whim, mood, or possible noetic training, is protected at the very start. (shrink)

The free energy principle, an influential framework in computational neuroscience and theoretical neurobiology, starts from the assumption that living systems ensure adaptive exchanges with their environment by minimizing the objective function of variational free energy. Following this premise, it claims to deliver a promising integration of the life sciences. In recent work, Markov blankets, one of the central constructs of the free energy principle, have been applied to resolve debates central to philosophy (such as demarcating the boundaries of the mind). (...) The aim of this paper is twofold. First, we trace the development of Markov blankets starting from their standard application in Bayesian networks, via variational inference, to their use in the literature on active inference. We then identify a persistent confusion in the literature between the formal use of Markov blankets as an epistemic tool for Bayesian inference, and their novel metaphysical use in the free energy framework to demarcate the physical boundary between an agent and its environment. Consequently, we propose to distinguish between “Pearl blankets” to refer to the original epistemic use of Markov blankets and “Friston blankets” to refer to the new metaphysical construct. Second, we use this distinction to critically assess claims resting on the application of Markov blankets to philosophical problems. We suggest that this literature would do well in differentiating between two different research programmes: “inference with a model” and “inference within a model.” Only the latter is capable of doing metaphysical work with Markov blankets, but requires additional philosophical premises and cannot be justified by an appeal to the success of the mathematical framework alone. (shrink)

Extended cognition theorists claim that the definition of cognition can be extended to include not only the brain, but also the body and environment. In a series of works, Mark Rowlands has envisioned a new science of mind that explores the externalism of consciousness and cognition. This paper connects Rowlands’ work with the phenomenology of Aron Gurwitsch. It shows how Gurwitsch’s field of consciousness, in particular his conception of the marginal halo, can provide a distinct, organized way of thinking about (...) extended cognition. A key question considered is from where do cognitive processes project and disclose meanings? By thinking of location as locus—a projecting pathway of points of intentional opportunity—organization in extended cognition becomes organization in a field of consciousness. The marginal halo in the field of consciousness is articulated as this locus of intentionality, what Rowlands calls “the noneliminable intentional core”. Problems of cognitive bloat and personal character are addressed in light of the findings. In addition to situating Gurwitsch’s work within the extended mind movement for the first time, this study highlights the importance of the marginal halo, largely neglected in previous Gurwitsch scholarship. (shrink)

The review of Prof. Bywater′s new edition of the Poetics once more raised the question of the interpretation of dfuipria in Aristotle′s definition of the tragic hero.