To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly (...) distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)
We have found that the left side of faces displayed in Rembrandt's portraits capture how humans rank male dominance, helping to coordinate avoidance behaviors among asymmetric individuals. Moreover, the left side of faces may also coordinate approach responses, like attractiveness, in human females. Therefore, adding sexual selection to dominance paints a more realistic picture of what the contralateral right hemisphere is doing.
This paper addresses a little puzzle with a surprisingly long pedigree and a surprisingly large wake: the puzzle of Free Choice Permission. I begin by presenting a popular sketch of a pragmatic solution to the puzzle, due to Kratzer and Shimoyama, which has received a good deal of discussion, endorsement and elaboration in recent work :535–590, 2006; Fox, in: Sauerland and Stateva Presupposition and implicature in compositional semantics, 2007; Geurts, Mind Lang 24:51–79, 2009; von Fintel, Central APA session on Deontic (...) Modals, 2012). I then explain why the general form of the Kratzer and Shimoyama explanation is not extensionally adequate. This leaves us with two possibilities with regard to the original solution-sketch; either the suggested pragmatic route fails, or it succeeds in a particularly strange way: Free Choice permission is rendered a kind pragmatic illusion on the part of both speakers and hearers. Finally, I discuss some ramifications. (shrink)
This book provides practical and research-based chapters that offer greater clarity about the particular kinds of teacher reflection that matter and avoids talking about teacher reflection generically, which implies that all kinds of reflection are of equal value.
To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients and managers ; semi-structured interviews with managers, clinicians, and ethics committee chairpersons. Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on (...) patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)
We argue that human rights are best conceived as norms arising from a fiduciary relationship that exists between states and the citizens and noncitizens subject to their power. These norms draw on a Kantian conception of moral personhood, protecting agents from instrumentalization and domination. They do not, however, exist in the abstract as timeless natural rights. Instead, they are correlates of the state's fiduciary duty to provide equal security under the rule of law, a duty that flows from the state's (...) institutional assumption of irresistible sovereign powers. (shrink)
There can be no doubt that Kant thought we should be reflective: we ought to care to make up our own minds about how things are and what is worth doing. Philosophical objections to the Kantian reflective ideal have centred on concerns about the excessive control that the reflective person is supposed to exert over her own mental life, and Kantians who feel the force of these objections have recently drawn attention to Kant’s conception of moral virtue as it is (...) developed in his later work, chiefly the Metaphysics of Morals. Melissa Merritt’s book is a distinctive contribution to this recent turn to virtue in Kant scholarship. Merritt argues that we need a clearer, and textually more comprehensive, account of what reflection is, in order not only to understand Kant’s account of virtue, but also to appreciate how it effectively rebuts long-standing objections to the Kantian reflective ideal. (shrink)
This is the second of the four essays in Part II of the book on liberalism and traditionalist education; all four are by authors who would like to find ways for the liberal state to honour the self-definitions of traditional cultures and to find ways of avoiding a confrontation with differences. Melissa Williams examines citizenship as identity in relation to the project of nation-building, the shifting boundaries of citizenship in relation to globalization, citizenship as shared fate, and the role (...) of multicultural education within the view of citizenship-as-shared-fate. She argues the other side of the same coin to that presented by Shelley Burtt in the previous chapter: according to Williams, the liberal state often demands too much in the way of loyalty from traditional groups, and when it does, it runs a strong risk of becoming oppressive and illiberal. Moreover, she holds that there is no need for a single shared identity among citizens of the liberal state. Her conception of people tied together by a shared fate is to this extent compatible with Burtt’s attempt to make liberalism’s commitment to autonomy more hospitable to groups of individuals encumbered by unchosen attachments, but her notion of citizenship as shared fate also goes further than that, and possibly stands in some tension with, Burtt’s view, since it allows and even encourages people to develop primary affiliation to all kind of groups – traditional as well as global. (shrink)
We present an argument for revising the theory of alternatives for Scalar Implicatures and for Association with Focus. We argue that in both cases the alternatives are determined in the same way, as a contextual restriction of the focus value of the sentence, which, in turn, is defined in structure-sensitive terms. We provide evidence that contextual restriction is subject to a constraint that prevents it from discriminating between alternatives when they stand in a particular logical relationship with the assertion or (...) the prejacent, a relationship that we refer to as symmetry. Due to this constraint on contextual restriction, discriminating between alternatives in cases of symmetry becomes the task of focus values. This conclusion is incompatible with standard type-theoretic definitions of focus values, motivating our structure-sensitive definition instead. (shrink)
In Finite and Infinite Goods, Adams develops a sophisticated and richly detailed Platonic-theistic framework for ethics. The view is Platonic in virtue of being Good-centered; it is theistic both in identifying God with the Good and, more distinctively, in including a divine command theory of moral obligation. Readers familiar with Adams’s earlier divine command theory will recall that in response to the worry that God might command something evil, Adams introduced an independent value constraint, claiming that only the commands of (...) a loving God were fit to constitute moral obligations. In Finite and Infinite Goods he develops this notion of a loving and good God in what is now a fundamentally Good-centered ethical framework with a subordinate divine command theory of moral obligation. There is much of worth here, especially for theists wishing to think through the merits of a good-based theistic ethics, but also for those nontheists like myself who have a general interest in the nature of value and obligation. (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)
Globalization generates new structures of human interdependence and vulnerability while also posing challenges for models of democracy rooted in territorially bounded states. The diverse phenomena of globalization have stimulated two relatively new branches of political theory: theoretical accounts of the possibilities of democracy beyond the state; and comparative political theory, which aims at bringing non-Western political thought into conversation with the Western traditions that remain dominant in the political theory academy. This article links these two theoretical responses to globalization by (...) showing how comparative political theory can contribute to the emergence of new global “publics” around the common fates that globalization forges across borders. Building on the pragmatist foundations of deliberative democratic theory, it makes a democratic case for comparative political theory as an architecture of translation that helps deliberative publics grow across boundaries of culture. (shrink)
I propose a unified solution to two puzzles: Ross's puzzle and free choice permission. I begin with a pair of cases from the decision theory literature illustrating the phenomenon of act dependence, where what an agent ought to do depends on what she does. The notion of permissibility distilled from these cases forms the basis for my analysis of 'may' and 'ought'. This framework is then combined with a generalization of the classical semantics for disjunction — equivalent to Boolean disjunction (...) on the diagonal, but with a different two-dimensional character — that explains the puzzling facts in terms of semantic consequence. (shrink)
In this paper, I argue that brain death is death because, despite the appearance of genuine integration, the brain-dead body does not in fact possess the unity that is proper to a human organism. A brain-dead body is not a single entity, but a multitude of organs and tissues functioning in a coordinated manner with the help of artificial life support. In order to support this claim, I first lay out Hoffmann and Rosenkrantz’s ontological account of the requirements for organismal (...) unity and summarize an earlier paper in which I apply this account to the brain death debate. I then further support this ontological argument by developing an analogy between the requirements for the unity of an organism and the requirements for the unity of an orchestra. To do so, I begin by examining the role that a conductor plays in unifying a traditional orchestra, and then go on to show that the human organism functions like a traditional orchestra that relies upon a conductor for its unity. Next, I consider the conditions required to achieve orchestral unity in conductorless orchestras and show that, in contrast to simpler organisms like plants, the postnatal human organism lacks those conditions. I argue, in other words, that although conductorless orchestras do exist, the human organism is not one of them. Like a traditional orchestra without a conductor, the brain-dead body is not a unified whole. (shrink)
This article explains the problems with Alan Shewmon’s critique of brain death as a valid sign of human death, beginning with a critical examination of his analogy between brain death and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper metaphysical analysis, I offer a revised (...) rationale for the validity of the neurological criterion of human death. (shrink)
Competition among scientists for funding, positions and prestige, among other things, is often seen as a salutary driving force in U.S. science. Its effects on scientists, their work and their relationships are seldom considered. Focus-group discussions with 51 mid- and early-career scientists, on which this study is based, reveal a dark side of competition in science. According to these scientists, competition contributes to strategic game-playing in science, a decline in free and open sharing of information and methods, sabotage of others’ (...) ability to use one’s work, interference with peer-review processes, deformation of relationships, and careless or questionable research conduct. When competition is pervasive, such effects may jeopardize the progress, efficiency and integrity of science. (shrink)
Rory Fox challenges the traditional understanding that Thomas Aquinas believed that God exists totally outside of time. His study investigates the work of several mid-thirteenth-century writers, and thus provides access to a wealth of material on medieval concepts of time and eternity.
This paper will be concerned with the conjunctive interpretation of a family of disjunctive constructions. The relevant conjunctive interpretation, sometimes referred to as a “free choice effect,” (FC) is attested when a disjunctive sentence is embedded under an existential modal operator. I will provide evidence that the relevant generalization extends (with some caveats) to all constructions in which a disjunctive sentence appears under the scope of an existential quantifier, as well as to seemingly unrelated constructions in which conjunction appears under (...) the scope of negation and a universal quantifier. (shrink)
In the Doctrine of Virtue Kant stipulates that ‘Love is a matter of feeling, not of willing . . . so a duty to love is an absurdity.’ Nonetheless, in the same work Kant claims that we have duties of love to other human beings. According to Kant, the kind of love which is commanded by duty is practical love. This paper defends the view that the duty of practical love articulated in the Doctrine of Virtue is distinct from the (...) duty of beneficence and best understood as a duty of self-transformation, which agents observe by cultivating a benevolent disposition and practical beneficent desires. (shrink)
In this essay, I outline fundamental anthropological and moral principles related to human sexuality and gender identity and then apply these principles to analyze and evaluate the views of several authors who attempt to carve out a “middle way” between liberal and traditionalist approaches to these issues. In doing so, I engage especially with the claim that gender dysphoria, rather than being a psychological issue, is a type of biological intersex condition in which one’s “brain sex” is out of line (...) with one’s genital and chromosomal sex. I argue that understanding the human person as a unity of body and soul and recognizing human sexuality as ordered toward the human good of marriage understood as inseparably unitive and procreative reveals the flaws in this position and helps to show why hormonal or surgical gender reassignment therapy is not a medically or ethically appropriate response to gender dysphoria. I also offer an alternative characterization of gender dysphoria and suggestions for responding with true compassion to those who suffer from it. (shrink)
In 1986, philosopher-bioethicist Samuel Gorovitz published an essay entitled “Baiting Bioethics,” in which he reported on various criticisms of bioethics that were “in print, or voiced in and around … the field” at that time, and set forth his assessment of their legitimacy. He gave detailed attention to what he judged to be the particularly fierce and “irresponsible attacks” on “the moral integrity” and soundness of bioethics contained in two papers: “Getting Ethics” by philosopher William Bennett and “Medical Morality Is (...) Not Bioethics,” coauthored by us. Gorovitz attributed some of the criticisms that bioethics was eliciting to the fact that this new, rapidly rising, and increasingly visible field had brought “scholars and practitioners together who otherwise would have little exposure to one another's disciplines. Their interactions are mutually enriching at times,” he declared, “but mutually baffling and even infuriating at other times.” In this latter regard, he suggested that “perhaps” Fox and Swazey's characterization of bioethics in the article he dissected “reflects a general revulsion at endeavors they see as inadequately like the social sciences or insufficiently respectful of them.” He went on to say that despite his objections to our “complaints” about bioethics—especially to our claim that “autonomy [had] been an unduly emphasized value” in the field—he had “a lingering sense” that there might be “a grain of truth” in them. Gorovitz ended his essay with an affirmation about the “benefit” that bioethics can derive from “responsible” and even from “irresponsible” criticism. “The unexamined discipline invites the philosopher's critical scrutiny no less than the unexamined life,” he aphoristically concluded. a. (shrink)
Scholars exploring the logic of Rousseau's voting rules have typically turned to the connection between Rousseau and the Marquis de Condorcet. Though Condorcet could not have had a direct influence on Rousseau's arguments about the choice of decision rules in "Social Contract," the possibility of a connection has encouraged the view that Rousseau's selection of voting rules was based on epistemic reasons. By turning to alternative sources of influence on Rousseau--the work of Hugo Grotius and particularly that of Samuel Pufendorf--a (...) moral, and not purely epistemic, logic of rules governing collective decision making emerges. For Rousseau, as for Pufendorf, the proper choice of voting rule can elicit the appropriate attitude of an individual with respect to the decision of the whole, and can support the morally significant activity of acknowledging error upon discovering that one has voted against the general will. (shrink)
My project is to reconsider the Kantian conception of practical reason. Some Kantians think that practical reasoning must be more active than theoretical reasoning, on the putative grounds that such reasoning need not contend with what is there anyway, independently of its exercise. Behind that claim stands the thesis that practical reason is essentially efficacious. I accept the efficacy principle, but deny that it underwrites this inference about practical reason. My inquiry takes place against the background of recent Kantian metaethical (...) debate — each side of which, I argue, correctly points to issues that need to be jointly accommodated in the Kantian account of practical reason. The constructivist points to the essential efficacy of practical reason, while the realist claims that any genuinely cognitive exercise of practical reason owes allegiance to what is there anyway, independently of its exercise. I argue that a Kantian account of respect for persons (“recognition respect”) suggests how the two claims might be jointly accommodated. The result is an empirical moral realism that is itself neutral on the received Kantian metaethical debate. (shrink)
The coming of bioethics -- The coming of bioethicists -- "Choices on our conscience": the inauguration of the Kennedy Institute of Education -- "Hello, Dolly": bioethics in the media -- Celebrating bioethics and bioethicists -- Thinking socially and culturally in bioethics -- Reminiscences of observing participants -- Bioethics circles the globe -- Bioethics in France -- The development of bioethics in the Islamic Republic of Pakistan -- The coming of the culture wars to American bioethics.
For Kant, ‘reflection’ is a technical term with a range of senses. I focus here on the senses of reflection that come to light in Kant's account of logic, and then bring the results to bear on the distinction between ‘logical’ and ‘transcendental’ reflection that surfaces in the Amphiboly chapter of the Critique of Pure Reason. Although recent commentary has followed similar cues, I suggest that it labours under a blind spot, as it neglects Kant's distinction between ‘pure’ and ‘applied’ (...) general logic. The foundational text of existing interpretations is a passage in Logik Jäsche that appears to attribute to Kant the view that reflection is a mental operation involved in the generation of concepts from non-conceptual materials. I argue against the received view by attending to Kant's division between ‘pure’ and ‘applied’ general logic, identifying senses of reflection proper to each, and showing that none accords well with the received view. Finally, to take account of Kant's notio.. (shrink)
The notion of measurement plays a central role in human cognition. We measure people’s height, the weight of physical objects, the length of stretches of time, or the size of various collections of individuals. Measurements of height, weight, and the like are commonly thought of as mappings between objects and dense scales, while measurements of collections of individuals, as implemented for instance in counting, are assumed to involve discrete scales. It is also commonly assumed that natural language makes use of (...) both types of scales and subsequently distinguishes between two types of measurements. This paper argues against the latter assumption. It argues that natural language semantics treats all measurements uniformly as mappings from objects (individuals or collections of individuals) to dense scales, hence the Universal Density of Measurement (UDM). If the arguments are successful, there are a variety of consequences for semantics and pragmatics, and more generally for the place of the linguistic system within an overall architecture of cognition. (shrink)
As is clear in the 2008 report of the President's Council on Bioethics, the brain death debate is plagued by ambiguity in the use of such key terms as ‘integration’ and ‘wholeness’. Addressing this problem, I offer a plausible ontological account of organismal unity drawing on the work of Hoffman and Rosenkrantz, and then apply that account to the case of brain death, concluding that a brain dead body lacks the unity proper to a human organism, and has therefore undergone (...) a substantial change. I also show how my view can explain hard cases better than one in which biological integration is taken to imply ontological wholeness or unity. (shrink)
Can ordinary citizens in a democracy evaluate the claims of scientific experts? While a definitive answer must be case by case, some scholars have offered sharply opposed general answers: a skeptical versus an optimistic. The article addresses this basic conflict, arguing that a satisfactory answer requires a first-order engagement in judging the claims of experts which both skeptics and optimists rule out in taking the issue to be one of second-order assessments only. Having argued that such first-order judgments are necessary, (...) it then considers how they are possible, outlining a range of practices and virtues that can inform their success and likelihood, and drawing throughout on ancient Greek insights as well as contemporary social psychology and sociology of knowledge. In conclusion the ethics of democratic judgment so developed is applied to the dramatic conviction of the members of an Italian scientific risk commission in L'Aquila. (shrink)