Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine is offered that describes the essence of (...) defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: defensive medicine is deceptive and undermines patient autonomy; defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; defensive medicine exposes patients to harm without benefit; defensive medicine undermines trust in the profession; and defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism. (shrink)

This ambitious book by one of the most original and provocative thinkers in science studies offers a sophisticated new understanding of the nature of scientific, mathematical, and engineering practice and the production of scientific knowledge. Andrew Pickering offers a new approach to the unpredictable nature of change in science, taking into account the extraordinary number of factors—social, technological, conceptual, and natural—that interact to affect the creation of scientific knowledge. In his view, machines, instruments, facts, theories, conceptual and mathematical structures, (...) disciplined practices, and human beings are in constantly shifting relationships with one another—"mangled" together in unforeseeable ways that are shaped by the contingencies of culture, time, and place. Situating material as well as human agency in their larger cultural context, Pickering uses case studies to show how this picture of the open, changeable nature of science advances a richer understanding of scientific work both past and present. Pickering examines in detail the building of the bubble chamber in particle physics, the search for the quark, the construction of the quarternion system in mathematics, and the introduction of computer-controlled machine tools in industry. He uses these examples to address the most basic elements of scientific practice—the development of experimental apparatus, the production of facts, the development of theory, and the interrelation of machines and social organization. (shrink)

In the last few decades, philosophy of science has increasingly focused on multilevel models and causal mechanistic explanations to account for complex biological phenomena. On the one hand, biological and biomedical works make extensive use of mechanistic concepts; on the other hand, philosophers have analyzed an increasing range of examples taken from different domains in the life sciences to test—support or criticize—the adequacy of mechanistic accounts. The article highlights some challenges in the elaboration of mechanistic explanations with a focus on (...) cancer research and neuropsychiatry. It jointly considers fields, which are usually dealt with separately, and keeps a close eye on scientific practice. The article has a twofold aim. First, it shows that identification of the explananda is a key issue when looking at dynamic processes and their implications in medical research and clinical practice. Second, it discusses the relevance of organizational accounts of mechanisms, and questions whether thorough self-sustaining mechanistic explanations can actually be provided when addressing cancer and psychiatric diseases. While acknowledging the merits of the wide ongoing debate on mechanistic models, the article challenges the mechanistic approach to explanation by discussing, in particular, explanatory and conceptual terms in the light of stances from medical cases. (shrink)

Science as Practice and Culture explores one of the newest and most controversial developments within the rapidly changing field of science studies: the move toward studying scientific practice--the work of doing science--and the associated move toward studying scientific culture, understood as the field of resources that practice operates in and on. Andrew Pickering has invited leading historians, philosophers, sociologists, and anthropologists of science to prepare original essays for this volume. The essays range over the physical and biological (...) sciences and mathematics, and are divided into two parts. In part I, the contributors map out a coherent set of perspectives on scientific practice and culture, and relate their analyses to central topics in the philosophy of science such as realism, relativism, and incommensurability. The essays in part II seek to delineate the study of science as practice in arguments across its borders with the sociology of scientific knowledge, social epistemology, and reflexive ethnography. (shrink)

Jules Coleman, one of the world's leading philosophers of law, here presents his most mature work so far on substantive issues in legal theory and the appropriate methodology for legal theorizing. In doing so, he takes on the views of highly respected contemporaries such as Brian Leiter, Stephen Perry, and Ronald Dworkin.

A child of the era of decolonization, Claire Denis grew up in various regions of France’s subSaharan colonial lands, and was brought back to the ‘métropole’ as a teenager in the 1960s.She has thus had a double practice of foreignness, abroad, and in her ‘own’ country, whichshe did not know and where, in similar yet fundamentally different ways than in Africa, shefelt like an outsider again. As the daughter of a colonial administrator – a childhoodbeautifully evoked in her first (...) feature, Chocolat – she had stood as a highly visibleembodiment of the Western presence on colonial soil. On her return to France, she wouldlive through the more banal experience of becoming an invisible intruder, an exile at‘home’– a theme explored in her subsequent works. From the start, Denisthus drew on her personal knowledge of feeling rootless to explore issues that haveremained at the heart of her filmmaking: the deeply perplexing questions of identity andalienation, assimilation and rejection, desire and fear inseparable from the post-colonialmalaise that affects France with particular acuteness. (shrink)

In the 1980s, philosophical, historical and social studies of science underwent a change which later evolved into a turn to practice. Analysts of science were asked to pay attention to scientific practices in meticulous detail and along multiple dimensions, including the material, social and psychological. Following this turn, the interest in scientific practices continued to increase and had an indelible influence in the various fields of science studies. No doubt, the practice turn changed our conceptions and approaches of (...) science, but what did it really teach us? What does it mean to study scientific practices? What are the general lessons, implications, and new challenges? This volume explores questions about the practice turn using both case studies and theoretical analysis. The case studies examine empirical and mathematical sciences, including the engineering sciences. The volume promotes interactions between acknowledged experts from different, often thought of as conflicting, orientations. It presents contributions in conjunction with critical commentaries that put the theses and assumptions of the former in perspective. Overall, the book offers a unique and diverse range of perspectives on the meanings, methods, lessons, and challenges associated with the practice turn. (shrink)

If the global economy seems unfair, how should we understand what a fair global economy would be? What ideas of fairness, if any, apply, and what significance do they have for policy and law? Working within the social contract tradition, this book argues that fairness is best seen as a kind of equity in practice.

There are several important conceptual issues and questions about the practice of healthcare ethics that can, and should, inform the development of any practice standards. This paper provides a relatively short overview of seven of these issues, with the invitation for further critical reflection and examination of their relevance to and implications for practice standards. The seven issues described include: diversity (from the perspective of training and experience); moral expertise and authority/influence; being an insider or outsider; flexibility (...) and adaptability (for local contexts of practice); the relative weighting of procedural and normative aspects of ethics practice; making mistakes or errors; and conflicts of interest in practice. (shrink)

The authority of the social : a pragmatic ethos of enquiry -- Rorty and continental political thought : ontology, naturalism and history -- Theorizing after foundations : ontology, language, and heidegger -- Reconstructing naturalism : pragmatic or ontological? -- History and modernity : self-assertion and critical reflexivity -- Rorty's insights for contemporary political theory : pragmatic socio- -- Political criticism -- Pragmatic political thinking : Rorty in contemporary critical social theory -- Rorty and political theory : how pragmatism constrains and (...) enables political -- Thinking. (shrink)

The dissociation of ethics with practice -- Reconsidering approaches to moral reasoning -- Moral agency reconsidered -- Reconsidering values -- Leadership and accountability -- Reconsidering ethics management.

In this paper, we investigate how data about public preferences may be used to inform policy around the use of controversial novel technologies, using public preferences about autonomous vehicles (AVs) as a case study. We first summarize the recent ‘Moral Machine’ study, which generated preference data from millions of people regarding how they think AVs should respond to emergency situations. We argue that while such preferences cannot be used to directly inform policy, they should not be disregarded. We defend an (...) approach that we call ‘Collective Reflective Equilibrium in Practice’ (CREP). In CREP, data on public attitudes function as an input into a deliberative process that looks for coherence between attitudes, behaviours and competing ethical principles. We argue that in cases of reasonable moral disagreement, data on public attitudes should play a much greater role in shaping policies than in areas of ethical consensus. We apply CREP to some of the global preferences about AVs uncovered by the Moral Machines study. We intend this discussion both as a substantive contribution to the debate about the programming of ethical AVs, and as an illustration of how CREP works. We argue that CREP provides a principled way of using some public preferences as an input for policy, while justifiably disregarding others. (shrink)

Since its inception, phenomenological philosophy has exerted an influence on empirical science. But what is the best way to practice, use and apply phenomenology in a non‐philosophical context? How deeply rooted in phenomenological philosophy must qualitative research be in order to qualify as phenomenological? How many of the core commitments of phenomenology must it accept? In the following contribution, I will take a closer look at Max van Manen's work. I will argue that van Manen's understanding of and presentation (...) of phenomenology is quite problematic and that his book Phenomenology of Practice rather than amounting to a clear and accessible presentation of the phenomenological method that would make it do‐able to researchers who are not themselves professional philosophers is in fact both abstruse and excessively complicated. I will then turn to nursing, and by taking that as my example, outline a better way to apply and practice phenomenology. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Teachers involved in English as a foreign language (EFL) teaching play a significant role in the process of moving toward educational equity. Teacher cognition is very influential in shaping teacher practice and thus affects students’ academic performance. However, although the role of EFL teachers as equity agents has been recognized, few studies have explored EFL teachers in-depth in terms of their cognition and practice. Moreover, no review studies have given sufficient attention to the task of elucidating the interrelations (...) between EFL teachers’ cognition and practices in the context of educational equity. Therefore, to provide a novel perspective and generate fresh insights into this research field, the current study attempts to explain the connotations of these constructs, highlights the interplay between EFL teachers’ equity-oriented cognition and practice, and identifies both experiential and contextual factors that might have an effect throughout the teaching process. Finally, practical implications and directions for teachers, researchers, policy-makers, and social justice leaders who are interested in actualizing education as a means of attaining equity are also discussed. (shrink)

Mark Greenberg has suggested that there is a ‘standard picture’ of how law works, according to which the contribution that a legal text makes to the content of the law is constituted by the meaning...

This paper develops a set of 16 criteria, divided into four groupings, for responsible business practice (RBP) in Small and Medium-Sized Enterprises (SMEs) drawn from the existing SME/RBP literature. The current lack of a general set of criteria against which such activity can be judged is noted and this deficit is redressed. In order to make an initial assessment in support of the criteria so derived, an exploratory feasibility study of RBP in U.K. Fair Trade organisations was conducted. The (...) findings from this study show that most but not all of the RBP criteria seem to be applicable to U.K. Fair Trade organisations but it is recommended that the complete set of criteria continues to be used in further research until such time as there is a general consensus as to which criteria are appropriate. Implications for RBP in small businesses in general, and for Fair Trade organisations in particular, are drawn out and suggestions for further research are identified. (shrink)

We propose that institutions consider establishing a position of “Ombudsman for Research Practice”. This person would assume several roles: as asounding board to those needing confidential consultation about research issues — basic, applied or clinical; as afacilitator for those wishing to pursue a formal grievance process; and as aneducator to distribute guidelines and standards, to raise the consciousness regarding sloppy or irregular practices in order to prevent misconduct and to promote the responsible conduct of research. While there are compelling (...) features to this position, many complex issues need to be considered and resolved. We invite readers to respond to questions we raise in the text. (shrink)

In the recent philosophical literature, several counterexamples to the interpretative principle that symmetry-related models are physically equivalent have been suggested The Oxford handbook of philosophy of physics, Oxford University Press, Oxford, 2013, Noûs 52:946–981, 2018; Fletcher in Found Phys 50:228–249, 2020). Arguments based on these counterexamples can be understood as arguments from scientific practice of roughly the following form: because in scientific practice such-and-such symmetry-related models are treated as representing distinct physical situations, these models indeed represent distinct physical (...) situations. In this paper, a strategy for analysing arguments of this type is presented and applied to the examples that can be found in the literature. I argue that if we are exclusively interested in models understood as representing entire possible worlds, arguments from scientific practice should involve some additional assumptions to guarantee they are relevant for models understood in this way. However, none of the examples presented in the literature satisfy all these additional assumptions, which leads to the conclusion that arguments from scientific practice based on these examples do not undermine the interpretative principle that different symmetry-related models represent the same possible world. (shrink)

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews (...) with 28 Dutch physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

This paper suggests that a consideration of health care practice is a necessary step in gaining insight into the appropriate composition of an ethics course for students in the health care professional. Health care practice, if it responds to the needs of society, is dynamic in nature. In the current climate of change in the health service, the author sug gests that the nursing profession needs to become more proactive in analysing and attempting to determine the future shape (...) of nursing. To protect patient care the nursing profession needs to have its eyes open to the ethical dimensions of changes in role and practice. The author argues that, in attempting to ensure that the education to which nursing students are exposed is of relevance, it is necessary to introduce an element of the ideal into the ethics component of their professional education. From early on in their profes sional development students should be aware of the scope and standards of practice, and the type of role enactment to which the profession requires them to aspire. (shrink)

This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the consensus process draw these boundaries correctly. Second, we expand on the discussion in the original paper of the role and significance of the concept of (...) ‘integrating’ empirical methods and ethical argument as a standard for research practice within empirical bioethics. (shrink)

In this book the practical dimension of social justice is explained using the analysis and discussion of a variety of well-known topics. These include: the relation between theory and practice in normative political philosophy; the issue of justice under uncertainty; the question of whether we can and should unmask social injustices by means of conspiracy theories; the issues of privacy and the right to privacy; the issue of how certain psychological states may affect our moral obligations, in particular the (...) obligation to treat others fairly; and finally the concepts of morality, fairness, and self-deception. The primary goal of the book is to provide readers with an updated discussion of some important and practical social justice issues. These issues are presented from a new perspective, based on the author ́s research. It is hoped that bringing these topics together in a single book will promote the emergence of new insights and challenges for future research. Juha Räikkä is a professor at the Department of Philosophy at the University of Turku, Finland. His research focuses on ethics and political philosophy. (shrink)

Epistemic injustice is a kind of injustice that arises when one’s capacity as an epistemic subject is wrongfully denied. In recent years it has been argued that psychiatric patients are often harmed in their capacity as knowers and suffer from various forms of epistemic injustice that they encounter in psychiatric services. Acknowledging that epistemic injustice is a multifaceted problem in psychiatry calls for an adequate response. In this paper I argue that, given that psychiatric patients deserve epistemic respect and have (...) a certain epistemic privilege, healthcare professionals have a pro tanto epistemic duty to attend to and/or solicit reports of patients’ first-person experiences in order to prevent epistemic losses. I discuss the nature and scope of this epistemic duty and point to one interesting consequence. In order to prevent epistemic losses, healthcare professionals may need to provide some patients with resources and tools for expressing their experiences and first-person knowledge, such as those that have been developed within the phenomenological approach. I discuss the risk of secondary testimonial and hermeneutical injustice that the practice of relying on such external tools might pose and survey some ways to mitigate it. (shrink)

After a brief flirtation with logicism around 1917, David Hilbertproposed his own program in the foundations of mathematics in 1920 and developed it, in concert with collaborators such as Paul Bernays andWilhelm Ackermann, throughout the 1920s. The two technical pillars of the project were the development of axiomatic systems for everstronger and more comprehensive areas of mathematics, and finitisticproofs of consistency of these systems. Early advances in these areaswere made by Hilbert (and Bernays) in a series of lecture courses atthe (...) University of Göttingen between 1917 and 1923, and notably in Ackermann's dissertation of 1924. The main innovation was theinvention of the -calculus, on which Hilbert's axiom systemswere based, and the development of the -substitution methodas a basis for consistency proofs. The paper traces the developmentof the ``simultaneous development of logic and mathematics'' throughthe -notation and provides an analysis of Ackermann'sconsistency proofs for primitive recursive arithmetic and for thefirst comprehensive mathematical system, the latter using thesubstitution method. It is striking that these proofs use transfiniteinduction not dissimilar to that used in Gentzen's later consistencyproof as well as non-primitive recursive definitions, and that thesemethods were accepted as finitistic at the time. (shrink)

This text offers both a clear and thorough introduction to normative ethical theory and an extensive survey of moral issues that show how ethical theory is applied in practice. The first section presents a survey of the main methods of ethical reasoning, introducing four normative theories in four separate chapters. A case study introduces each chapter to provide a background for further explanations and to illustrate relevant features of the theory. The second section of the text presents separate chapters (...) on ten ethical issues-including such subjects as nuclear war, euthanasia, sexual ethics and capital punishment. (shrink)

In this novel account of global citizenship, Luis Cabrera argues that all individuals have a global duty to contribute directly to human rights protections and to promote rights-enhancing political integration between states. The Practice of Global Citizenship blends careful moral argument with compelling narratives from field research among unauthorized immigrants, activists seeking to protect their rights, and the 'Minuteman' activists striving to keep them out. Immigrant-rights activists, especially those conducting humanitarian patrols for border-crossers stranded in the brutal Arizona desert, (...) are shown as embodying aspects of global citizenship. Unauthorized immigrants themselves are shown to be enacting a form of global 'civil' disobedience, claiming the economic rights central to the emerging global normative charter while challenging the restrictive membership regimes that are the norm in the current global system. Cabrera also examines the European Union, seeing it as a crucial laboratory for studying the challenges inherent in expanding citizen membership. (shrink)

This article provides a theoretical critique from a particular ‘ideal type’ ethical perspective of professional codes in general and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) Code of professional conduct (reprinted on pp. 77-78) in particular. Having outlined a specific ‘ideal type’ of what ethically informed and aware practice may be, the article examines the extent to which professional codes may be likely to elicit and engender such practice. Because of their terminological inexactitudes (...) and confusions, their arbitrary values and principles, their lack of helpful ethical guidance, and their exclusion of ordinary moral experience, a number of contemporary professional codes in health and social care can be arraigned as ethically inadequate. The UKCC Code of professional conduct embodies many of these flaws, and others besides. Some of its weaknesses in this respect are anatomized before some tentative suggestions are offered for the reform of codes and the engendering of greater ethical awareness among professionals in the light of greater public ethical concerns and values. (shrink)

Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that (...) five distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient. (shrink)

In “Flourish,” Martin Seligman maintained that the elements of well-being consist of “PERMA: positive emotion, engagement, relationships, meaning, and accomplishment.” Although the question of what constitutes human flourishing or psychological well-being has remained a topic of continued debate among scholars, it has recently been argued in the literature that a paradigmatic or prototypical case of human psychological well-being would largely manifest most or all of the aforementioned PERMA factors. Further, in “A Neuroscientific Perspective on Music Therapy,” Stefan Koelsch also suggested (...) that “Music therapy can have effects that improve the psychological and physiological health of individuals,” so it seems plausible that engaging in practices of music can positively contribute to one living a more optimally flourishing life with greater psychological well-being. However, recent studies on music practice and participation have not yet been reviewed and integrated under the PERMA framework from positive psychology to further explore and explicate this possibility. This article therefore contributes to extant work by reviewing recent research on psychological well-being and music to offer support for the claim that music practice and participation can positively contribute to one living a flourishing life by positively influencing their emotions, engagement, relationships, meaning, and accomplishment. (shrink)

Diane Vaughan’s analysis of the causes of the Challenger accident suggests ways to apply science and technology studies to the teaching of engineering ethics. By sensitizing future engineers to the ongoing construction of risk during mundane engineering practice, we can better prepare them to address issues of public health, safety, and welfare before they require heroic intervention. Understanding the importance of precedents, incremental change, and fallible engineering judgment in engineering design may help them anticipate potential threats to public safety (...) arising from routine aspects of workplace culture. We suggest modifications of both detailed case studies on engineering disasters and hypothetical, ethical dilemmas employed in engineering ethics classes. Investigating the sociotechnical aspects of engineering practice can improve the initial recognition of ethical problems in real-world settings and provide an understanding of the role of workplace organization and culture in facilitating or impeding remedial action. (shrink)