Notwithstanding the fact that care ethics has received increased attention, it has also faced much criticism. One of the focal points of critics is the normativity of care. Only when the objective normative basis of care is sufficiently clarified can care practices be evaluated and optimized from an ethical point of view. We emphasize that two levels of normativity can be identified: the context level and the foundational anthropology level. The personalist approach to care ethics is normatively stronger, at least (...) on one level, namely the foundational anthropology level. This personalist approach to care ethics indicates in which direction action must be taken so that human action may be considered ethically sound. (shrink)

To generate empathy in the care of vulnerable older persons requires care providers to reflect critically on their care practices. Ethics education and training must provide them with tools to accomplish such critical reflection. It must also create a pedagogical context in which good care can be taught and cultivated. The care-ethics lab ‘sTimul’ originated in 2008 in Flanders with the stimulation of ethical reflection in care providers and care providers in training as its main goal. Also in 2008, sTimul (...) commenced the organization of empathy sessions as an attempt to achieve this goal by simulation. The empathy session is a practical and fairly straightforward way of working to provoke care providers and care providers in training to engage in ethical reflection. Characteristic of the empathy session in the care-ethics lab is the emphasis on experience as a basis for ethical reflection. (shrink)

At a Body Worlds exhibition, human corpses are displayed as museum pieces for educational purposes. The bodies are preserved by plastination, a technique invented by Gunther von Hagens and engineered at the Institute for Plastination in Heidelberg, Germany. Because of the wide controversy surrounding the displays, it is necessary to study how justice obtains. Understood from a Thomistic perspective, the use of a plastinate by Body Worlds is unjust because it dishonors the donor. The goodness of that use fails in (...) terms of object, end, and circumstance. National Catholic Bioethics Quarterly 10.4 : 667–676. (shrink)

Research ethics, once a platform for declaring intent, discussing moral issues and providing advice and guidance to researchers, has developed over time into an extra-legal regulatory system, complete with steering documents (ethics guidelines), overseeing bodies (research ethics committees) and formal procedures (informed consent). The process of institutionalizing distrust is usually motivated by reference to past atrocities committed in the name of research and the need to secure the trustworthiness of the research system. This article examines some limitations of this approach. (...) First, past atrocities cannot provide the necessary justification unless institutionalized distrust is a necessary or efficient means to prevent future ones – and there are several reasons to doubt this. Second, the efficacy of ethics review in safeguarding morally acceptable research depends on the moral competence and integrity of individual researchers – the very qualities that institutionalized distrust calls into question. Third, ethics guidelines cannot, as is sometimes assumed, educate or guide researchers in moral behaviour unless they already possess considerable capacity for moral judgment. Fourth, institutionalized distrust is a potential threat to the moral competence and integrity of researchers by encouraging a blinkered view of ethical issues, inducing moral heteronomy through incentives, and alienating them to research ethics. We conclude that the moral problem posed by inappropriate short-term behaviour on behalf of researchers is dwarfed by the potential long-term consequences if their moral competence is allowed to deteriorate. Measures must therefore be taken to ensure that researchers are equipped to take their individual responsibility and are not obstructed from so doing. (shrink)

Providing good care requires nurses to reflect critically on their nursing practices. Ethics education must provide nurses with tools to accomplish such critical reflection. It must also create a pedagogical context in which a caring attitude can be taught and cultivated. To achieve this twofold goal, we argue that the principles of a right-action approach, within which nurses conform to a number of minimum principles, must be integrated into a virtue ethics approach that cultivates a caring attitude. Ethics education that (...) incorporates both the `critical companionship' method and the use of codes of ethics contributes positively to cultivating critical reflection by nurses. (shrink)

§1. Introduction. Asymptotic cones of metric spaces were first invented by Gromov. They are metric spaces which capture the ‘large-scale structure’ of the underlying metric space. Later, van den Dries and Wilkie gave a more general construction of asymptotic cones using ultrapowers. Certain facts about asymptotic cones, like the completeness of the metric space, now follow rather easily from saturation properties of ultrapowers, and in this survey, we want to present two applications of the van den Dries-Wilkie approach. Using ultrapowers (...) we obtain an explicit description of the asymptotic cone of a semisimple Lie group. From this description, using semi-algebraic groups and non-standard methods, we can give a short proof of the Margulis Conjecture. In a second application, we use set theory to answer a question of Gromov.§2. Definitions. The intuitive idea behind Gromov's concept of an asymptotic cone was to look at a given metric space from an ‘infinite distance’, so that large-scale patterns should become visible. In his original definition this was done by gradually scaling down the metric by factors 1/nfornϵ ℕ. In the approach by van den Dries and Wilkie, this idea was captured by ultrapowers. Their construction is more general in the sense that the asymptotic cone exists for any metric space, whereas in Gromov's original definition, the asymptotic cone existed only for a rather restricted class of spaces. (shrink)

In recent approaches to ethics, the personal involvement of health care providers and their empathy are perceived as important elements of an overall ethical ability. Experiential working methods are used in ethics education to foster, inter alia, empathy. In 2008, the care-ethics lab ‘sTimul’ was founded in Flanders, Belgium, to provide training that focuses on improving care providers' ethical abilities through experiential working simulations. The curriculum of sTimul focuses on empathy sessions, aimed at care providers' empathic skills. The present study (...) provides better insight into how experiential learning specifically targets the empathic abilities of care providers. Providing contrasting experiences that affect the care providers' self-reflection seems a crucial element in this study. Further research is needed to provide more insight into how empathy leads to long-term changes in behaviour. (shrink)

Should people be involved as active participants in longitudinal medical research, as opposed to remaining passive providers of data and material? We argue in this article that misconceptions of ‘autonomy’ as a kind of feat rather than a right are to blame for much of the confusion surrounding the debate of dynamic versus broad consent. Keeping in mind two foundational facts of human life, freedom and dignity, we elaborate three moral principles – those of autonomy, integrity and authority – to (...) better see what is at stake. Respect for autonomy is to recognize the other's right to decide in matters that are important to them. Respect for integrity is to meet, in one's relationship with the other, their need to navigate the intersection between private and social life. Respect for authority is to empower the other – to help them to cultivate their responsibility as citizens. On our account, to force information onto someone who does not want it is not to respect that person's autonomy, but to violate integrity in the name of empowerment. Empowerment, not respect for autonomy, is the aim that sets patient-centred initiatives employing a dynamic consent model apart from other consent models. Whether this is ultimately morally justified depends on whether empowerment ought to be a goal of medical research, which is questionable. (shrink)

Non-therapeutic research on children raises ethical concerns. Such research is not only conducted on individuals who are incapable of providing informed consent. It also typically involves some degree of risk or discomfort, without prospects of medically benefiting the participating children. Therefore, these children seem to be instrumentalized. Some ethicists, however, have tried to sidestep this problem by arguing that the children may indirectly benefit from participating in such research, in ways not related to the medical intervention as such. It has (...) been argued, for example, that non-therapeutic pediatric research does not instrumentalize the children enrolled since it has the prospects of furthering their moral development. We argue that this argument is far too undeveloped to be taken seriously. (shrink)

Using as a springboard a three-way debate between theoretical physicist Lee Smolin, philosopher of science Nancy Cartwright and myself, I address in layman’s terms the issues of why we need a unified theory of the fundamental interactions and why, in my opinion, string and M-theory currently offer the best hope. The focus will be on responding more generally to the various criticisms. I also describe the diverse application of string/M-theory techniques to other branches of physics and mathematics which render the (...) whole enterprise worthwhile whether or not “a theory of everything” is forthcoming. (shrink)

Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, the decision that ought to be made for the incompetent patient is the decision the patient would have made, had he or she been competent. Although the merits of this standard have been extensively debated, some important issues have not been sufficiently explored. One fundamental problem is that the substituted judgment standard, as commonly formulated, is indeterminate in content (...) and thus offers the surrogate little or no guidance. What the standard does not specify is just how competent one should imagine the patient to be, and what else one ought to envision about the patient’s hypothetical outlook and the circumstances surrounding his or her decision making. The article discusses this problem of underdetermined decision conditions. (shrink)

We present evidence that mainstream Anglophone philosophy is insular in the sense that participants in this academic tradition tend mostly to cite or interact with other participants in this academic tradition, while having little academic interaction with philosophers writing in other languages. Among our evidence: In a sample of articles from elite Anglophone philosophy journals, 97% of citations are citations of work originally written in English; 96% of members of editorial boards of elite Anglophone philosophy journals are housed in majority-Anglophone (...) countries; and only one of the 100 most-cited recent authors in the Stanford Encyclopedia of Philosophy spent most of his career in non-Anglophone countries writing primarily in a language other than English. In contrast, philosophy articles published in elite Chinese-language and Spanish-language journals cite from a range of linguistic traditions, as do non-English-language articles in a convenience sample of established European-language journals. We also find evidence that work in English has more influence on work in other languages than vice versa and that when non-Anglophone philosophers cite recent work outside of their own linguistic tradition it tends to be work in English. (shrink)

Twentieth century philosophers introduced the distinction between “objective rightness” and “subjective rightness” to achieve two primary goals. The first goal is to reduce the paradoxical tension between our judgments of what is best for an agent to do in light of the actual circumstances in which she acts and what is wisest for her to do in light of her mistaken or uncertain beliefs about her circumstances. The second goal is to provide moral guidance to an agent who may be (...) uncertain about the circumstances in which she acts, and hence is unable to use her standard moral principle directly in deciding what to do. This paper distinguishes two important senses of “moral guidance”; proposes criteria of adequacy for accounts of subjective rightness; canvasses existing definitions for “subjective rightness”; finds them all deficient; and proposes a new and more successful account. It argues that each comprehensive moral theory must include multiple principles of subjective rightness to address the epistemic situations of the full range of moral decision-makers, and shows that accounts of subjective rightness formulated in terms of what it would reasonable for the agent to believe cannot provide that guidance. (shrink)

Patients who are incompetent need a surrogate decision maker to make treatment decisons on their behalf. One of the main ethical questions that arise in this context is what standard ought to govern such decision making. According to the Substituted Judgment Standard, a surrogate ought to make the decision that the patient would have made, had he or she been competent. Although this standard has sometimes been criticized on the grounds of being difficult to apply, it has found wide appeal, (...) since it it is alleged to protect incompetent patients? right to autonomy. The main purpose of the thesis is to evaluate SJS, from a conceptual and ethical perspective. It argues that the traditional formulation of SJS is seriously incomplete, and discusses alternative ways of completing it. Moreover, it questions the received view on how SJS should be morally justified, by offering arguments against the view that decision making in accordance with this standard extends the patient's opportunities for self-determination. Instead it suggests a virtue-ethical approach according to which the moral point of SJS-based decision making is not to protect the patient's interests, but to express respect for person. The thesis also critically assesses empirical studies according to which surrogates often fail to correctly predict patients? actual treatment preferences. It is shown that such results cannot, for a number of reasons, support the conclusion drawn that surrogates are ill-equipped to make decisions that comply with SJS. (shrink)

In Sweden, most patients are recruited into biobank research by non-researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different (...) set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good. (shrink)

Listening to someone from some distance in a crowded room you may experience the following phenomenon: when looking at them speak, you may both hear and see where the source of the sounds is; but when your eyes are turned elsewhere, you may no longer be able to detect exactly where the voice must be coming from. With your eyes again fixed on the speaker, and the movement of her lips a clear sense of the source of the sound will (...) return. This ‘ventriloquist’ effect reflects the ways in which visual cognition can dominate auditory perception. And this phenomenological observation is one what you can verify or disconfirm in your own case just by the slightest reflection on what it is like for you to listen to someone with or without visual contact with them. (shrink)

We argue that thoughts are structures of concepts, and that concepts should be individuated by their origins, rather than in terms of their semantic or epistemic properties. Many features of cognition turn on the vehicles of content, thoughts, rather than on the nature of the contents they express. Originalism makes concepts available to explain, with no threat of circularity, puzzling cases concerning thought. In this paper, we mention Hesperus/Phosphorus puzzles, the Evans-Perry example of the ship seen through different windows, and (...) Mates cases, and we believe that there are many additional applications. (shrink)

A large body of literature agrees that persons with schizophrenia suffer from a Theory of Mind deficit. However, most empirical studies have focused on third-person, egocentric ToM, underestimating other facets of this complex cognitive skill. Aim of this research is to examine the ToM of schizophrenic persons considering its various aspects, to determine whether some components are more impaired than others. We developed a Theory of Mind Assessment Scale and administered it to 22 persons with a DSM-IV diagnosis of schizophrenia (...) and a matching control group. Th.o.m.a.s. is a semi-structured interview which allows a multi-component measurement of ToM. Both groups were also administered a few existing ToM tasks and the schizophrenic subjects were administered the Positive and Negative Symptoms Scale and the WAIS-R. The schizophrenic persons performed worse than control at all the ToM measurements; however, these deficits appeared to be differently distributed among different components of ToM. Our conclusion is that ToM deficits are not unitary in schizophrenia, which also testifies to the importance of a complete and articulated investigation of ToM. (shrink)

The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment—a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range from worries (...) that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed. (shrink)

Recently two distinct forms of rule-utilitarianism have been introduced that differ on how to measure the consequences of rules. Brad Hooker advocates fixed-rate rule-utilitarianism, while Michael Ridge advocates variable-rate rule-utilitarianism. I argue that both of these are inferior to a new proposal, optimum-rate rule-utilitarianism. According to optimum-rate rule-utilitarianism, an ideal code is the code whose optimum acceptance level is no lower than that of any alternative code. I then argue that all three forms of rule-utilitarianism fall prey to two fatal (...) problems that leave us without any viable form of rule-utilitarianism. (shrink)

In his article ‘Saints and Heroes’, Urmson argues that traditional moral theories allow at most for a threefold classification of actions in terms of their worth, and that they are therefore unsatisfactory. Since the conclusion of his argument has led to the widespread use of the term ‘acts of supererogation’, and since I do not believe that such acts exist, I propose to argue that the actions with which he is concerned not only can, but should, be contained within the (...) traditional classification. (shrink)

In the years 1878 and 1879 the American physicist Alfred Marshall Mayer published his experiments with floating magnets as a didactic illustration of molecular actions and forms. A number of physicists made use of this analogy of molecular structure. For William Thomson they were a mechanical illustration of the kinetic equilibrium of groups of columnar vortices revolving in circles round their common centre of gravity . A number of modifications of Mayer's experiments were described, which gave configurations which were more (...) or less analogous to Mayer's arrangements. It was Joseph John Thomson who, in publications between 1897 and 1907, used Mayer's results to obtain a good deal of insight into the general laws which govern the configuration of the electrons in his atomic model. This article is mainly concerned with Mayer's experiments with floating magnets and their use by a number of physicists. Through his experiments Mayer made a significant, although small, contribution to the theory of atomic structure. (shrink)

R. M. Adams’s essay, “Must God Create the Best?” can be interpreted as offering a theodicy for God’s creating morally less perfect beings than he could have created. By creating these morally less perfect beings, God is bestowing grace upon them, which is an unmerited or undeserved benefit. He does so, however, in advance of the free moral misdeeds that render them undeserving. This requires that God have middle knowledge, pace Adams’s version of the Free Will Theodicy, of what would (...) result from his actualization of possible free persons. It is argued that God’s possession of such middle knowledge negates the freedom of created beings, since God completely determines every action of every created person. And since they are not free, they cannot qualify as morally unmeritorious or undeserving. And, with that, Adams’s theodicy of grace-in-advance collapses. (shrink)

Theaetetus, asked what knowledge is, replies that geometry and the other mathematical disciplines are knowledge, and so are crafts like cobbling. Socrates points out that it does not help him to be told how many kinds of knowledge there are when his problem is to know what knowledge itself is, what it means to call geometry or a craft knowledge in the first place—he insists on the generality of his question in the way he often does when his interlocutor, asked (...) for a definition, cites instead cases of the concept to be defined. (shrink)

I had a strange dream, or half-waking vision, not long ago. I found myself at the top of a mountain in the mist, feeling very pleased with myself, not just for having climbed the mountain, but for having achieved my life's ambition, to find a way of answering moral questions rationally. But as I was preening myself on this achievement, the mist began to clear, and I saw that I was surrounded on the mountain top by the graves of all (...) those other philosophers, great and small, who had had the same ambition, and thought they had achieved it. And I have come to see, reflecting on my dream, that, ever since, the hard-working philosophical worms have been nibbling away at their systems and showing that the achievement was an illusion. True, their skeletons, indigestible to worms, remained, and were surprisingly similar to one another. But I was led to think again about what one can, and what one cannot, achieve in this direction. (shrink)