The traditional liberal view on conflicts between care for wellbeing and respect for choice and desire is that we should look to degrees of competence and voluntariness to determine which moral imperative should take priority. This view has likely influenced the common view that children’s choices should be considered only to the extent that this promotes their future autonomy and helps us determine their best interests. I reject both the general traditional liberal view and its application (...) to children. Competence and voluntariness, as well as maturity, are at best proxies for what really matters, which is wellbeing, choice and desire. We typically have reason to respect children’s choices, irrespective of any further positive consequences. If we should more often make children do what they do not want to do, this is mainly because, though we should care about respecting their choices, we should care even more about their wellbeing and future autonomy. (shrink)

In the continuing debate about the role of the Clinical Ethics Consultant in performing clinical ethics consultations, it is often assumed that consultants should operate within ethical and legal standards. Recent scholarship has focused primarily on clarifying the consultant's role with respect to the ethical standards that serve as parameters of consulting. In the following, however, I wish to address the question of how the ethics consultant should weigh legal standards and, more broadly, how consultants might weigh authoritative directives, (...) whether legal, institutional, or professional, against other normative considerations. I argue that consultants should reject the view that authoritative directives carry exclusionary reason for actions and, further, ethicists should interpret directives as lacking any moral weight qua authoritative directive. I then identify both implications and limitations of this view with respect to the evolving role of the ethics consultant in an institutional setting, and in doing so propose the kinds of considerations the ethicist should weigh when presented with an authoritative directive. (shrink)

In the formation of the acquis of the science of fiqh, many scientific figures have been associated with the methods of the Imams of the sect and their views, which are passed on to the next generations. In the history of the Ḥanafī mad̲h̲hab, there are many scholars whose works, views or just their names have survived. The views of the scholars who are at the forefront of this work can be accessed through their works. The opinions of some scholars (...) who did not have works, or whose works have not survived, can be found in the jurisprudential corpus of other scholars. Unfortunately, there are many scholars whose works and opinions have not survived, and only their names are mentioned. This study focuses on the Ḥanafī jurist al-Baqqālī (d. 452/1060), whose scholarly personality, position in jurisprudence and works have not survived to the present day, although his name is mentioned in fiqh literature. The article analyses various sources and evidence for the identification of al-Baqqālī. The main argument of the article was clarified by examining fiqh books, which are among the authoritative sources of the Ḥanafī fiqh corpus, rather than works of ṭabaḳat, and by scanning digital resources. The determination and presentation of the scholarly personality of al-Baqqālī and his jurisprudential views are the distinctive feature of this article. Baqqālī was recognised as an influential jurist within the Ḥanafī fiqh tradition and was considered one of the mashāʼịḵẖ (eminent jurists). However, detailed information about him could not be found. However, considering the available evidence, it is proven that al-Baqqālī, who stands out with the attribution of al-Baqqālī, is not al-Baqqālī whose views are consulted in the Ḥanafī mad̲h̲hab and among the possibilities that arise, the views that predominate in the identification of al-Baqqālī's identity are given. For this reason, it is emphasised that Baqqālī is a figure that requires further research and study. It is emphasised that this article can contribute to the understanding of the Ḥanafī fiqh tradition. Baqqālī's jurisprudential views on some matters of worship and transaction reflect important debates. Although al-Baqqālī adhered to the basic principles of the Ḥanafī mad̲h̲hab, he occasionally developed original ijtihād against the general views of the imams or the mad̲h̲hab. Baqqālī's original jurisprudence and jurisprudential views occupy an important place in the sect's literature. He was particularly influential in matters of fatwa and left his views to later jurists. Such a study aims to solve a scholarly problem in the fields of the history of science and the history of fiqh. Clarifying the identities and specialisms of those involved can help to ensure historical and scientific clarity. The purpose of this article is to contribute to the accumulation of historical and scientific knowledge by seeking to learn more about this issue and to reduce uncertainties. (shrink)

The theoretical prediction of Higgs boson was arguably one of the most important contributions in particle physics in the 20th century, with significant implications for modern cosmology. Its reported discovery in 2012 was celebrated as one of the most significant scientific achievements of all times. The fierce public discourse that followed was at large ignited by the media-hyped nickname “God particle” attributed to Higgs boson. The debate regarding the science-religion relation reinvigorated once again and plenty theologically informed views were expressed. (...) In this paper, I take into consideration the authoritative views expressed by the Catholic Church and the Greek-Orthodox Church and I discuss them in comparison with each other, as well as in juxtaposition with other views expressed in the public discussion on the issue, in an attempt to draw philosophically interesting inferences. (shrink)

This piece discusses perhaps the most agonizing ethical decision ethics consultants and other providers encounter. This is the extent to which providers should defer decisions to patients or to their proxy decision makers as opposed to imposing their own views as to what they think is ethically right. It discusses the most difficult issues these providers may encounter, especially when they wish to depart from authoritative bodies’ standards or guidelines, and it presents initial steps providers may take to help (...) patients and their families work together to resolve these dilemmas more harmoniously. It highlights how providers may inadvertently impose flawed biases on patients and families. Finally, it discusses how providers should take initiative with both parties to offer to help appeal when these avenues already exist and seek to establish the appellate procedures when they are absent. (shrink)

This article provides a philosophical analysis of a putative right of the child to have their expressed views considered in matters that affect them. Article 12 of the United Nations Convention on the Rights of the Child 1989 is an influential and interesting statement of that right. The article shows that the child’s ‘right to a voice’ is complex. Its complexity lies in the problem of contrasting an adult’s normative power of choice with a child’s weighted views, in the various (...) senses in which we might consider the child’s views, and in the questions of how to weight those views and how their weighting makes a practical difference in coming to a decision. In so doing we criticise other accounts that simply regard a child’s views as having consultative value. We also make better sense of how we might weight a child’s views. The philosophical issues addressed in the article carry implications for how we might understand Article 12 that are not satisfactorily identified and addressed in the voluminous literature on Article 12 within childhood studies. These issues also have implications for how we might understand the distinction between adults and children in respect of powers of personal choice. We conclude by emphasising the importance and value of the right that Article 12 seeks to formally identify. (shrink)

In aiming to frame plagiarism as an academic literacy issue, this paper focuses on the strategies used by firsts years Portuguese university students, when writing from sources, along with the relationship between these strategies and the way students view themselves as readers, writers and users of sources. The study was based on 44 short summary essays written by students as well as their responses to a questionnaire and checklist on citation rules. The evaluation of the essays revealed that students (...) often use copying and patchwriting. In addition, we found that much of the time students changed the meaning of the content expressed in the source. In relation to the way students evaluated themselves, generally their view was they used appropriate strategies. The study did not reveal a relationship between perceptions of using appropriate strategies and the use of those same strategies. Nonetheless, we found an association between performance and perceptions of using copying. Perceived use of a ‘think-then-do’ strategy was also related to changing the meaning when writing from sources. Concerning school achievement, stronger students evaluated themselves as using more appropriate strategies, and those who had not previously failed school year also displayed a better knowledge of citation rules. However, we failed to find any relationship between school achievement and the use of strategies for writing from sources. The main findings of the current research point to the existence of issues concerning how to address academic literacy, findings that go beyond plagiarism and, consequently, indicate the need for pedagogical responses. (shrink)

The Clinical ethics centre in Paris offers its services equally to doctors and patients/proxies. Its primary goal is to re-equilibrate doctor–patient roles through giving greater voice to patients individually in medical decisions. Patients are present at virtually all levels, initiating consults, providing their point of view and receiving feedback. The implications of patients' involvement are threefold. At an operational level, decision-making is facilitated by repositioning the debate on ethical grounds and introducing a dynamic of decisional partnership, although contact with (...) patients can make it difficult to deny their demands and set the limits of our role. Ethically, it reinforces patients' autonomy and grants them a place of veritable ethics ‘actors’, with the danger that this may become excessively autonomy oriented. Finally, at a collective level, the programme fulfils its political purpose in promoting patients' rights and the ideal of démocratie sanitaire, but complicates balancing individual demands with collective values. (shrink)

One hundred inpatients on an acute hospital elderly care unit and 43 of their relatives were interviewed shortly before hospital discharge. Eighty per cent of elderly patients and their relatives were aware of cardiopulmonary resuscitation (CPR). Television drama was their main source of information. Patients and relatives overestimated the effectiveness of CPR. Eighty-six per cent of patients were willing to be routinely consulted by doctors about their own CPR status, but relatives were less enthusiastic about routine consultation. Patients' and relatives' (...) views about the appropriateness of CPR did not differ significantly. Seventeen percent of patients did not desire CPR. However, 64 per cent of patients were ultimately willing to follow their doctor's advice about the appropriateness of CPR. The conclusion reached is that mentally competent, elderly patients but not their relatives should be routinely consulted about their own desire for CPR in order to avoid resuscitating patients against their wishes. Further research is required to find out how patients would feel about resuscitation if they were terminally ill or chronically confused, and how carers would feel about resuscitating such patients. (shrink)

Background: Despite the expansion of ethics consultation services, questions remain about the aims of clinical ethics consultation, its methods and the expertise of those who provide such services.Objective: To describe physicians’ expectations regarding the training and skills necessary for ethics consultants to contribute effectively to the care of patients in intensive care unit .Design: Mailed survey.Participants: Physicians responsible for the care of at least 10 patients in ICU over a 6-month period at a 921-bed private teaching hospital with an established (...) ethics consultation service. 69 of 92 eligible physicians responded.Measurements: Importance of specialised knowledge and skills for ethics consultants contributing to the care of patients in ICU; need for advanced disciplinary training; expectations regarding formal-training programmes for ethics consultants.Results: Expertise in ethics was described most often as important for ethics consultants taking part in the care of patients in ICU, compared with expertise in law , religious traditions , medicine and conflict-mediation techniques . When asked about the formal training consultants should possess, however, physicians involved in the care of patients in ICU most often identified advanced medical training as important.Conclusions: Although many physicians caring for patients in ICU believe ethics consultants must possess non-medical expertise in ethics and law if they are to contribute effectively to patient care, these physicians place a very high value on medical training as well, suggesting a “medicine plus one” view of the training of an ideal ethics consultant. As ethics consultation services expand, clear expectations regarding the training of ethics consultants should be established. (shrink)

Objectives: To collect information on the involvement, legal understanding and ethical views of preregistration house officers regarding end-of-life decision making in clinical practice.Design: Structured telephone interviews.Participants: 104 PRHO who responded.Main outcome measures: Information on the frequency and quality of involvement of PRHO in end-of-life decision making, their legal understanding and ethical views on do-not-resuscitate order and withdrawal of treatment.Results: Most PRHO participated in team discussions on the withdrawal of treatment or a DNR order . Of them, 46 participants had themselves (...) discussed the DNR order with patients. In all, it was agreed by 84 respondents that it would be unethical to make a DNR order on any patient who is competent without consulting her or him. With one exception, it was indicated by the participants that patients who are competent may refuse tube feeding and 101 participants thought that patients may refuse intravenous nutrition. The withdrawal of artificial ventilation in incompetent patients with serious and permanent brain damage was considered to be morally appropriate by 95 and 97 thought so about the withdrawal of antibiotics. The withdrawal of intravenous hydration was considered by 67 to be morally appropriate in this case.Conclusions: PRHO are often involved with end-of-life decision making. The results on ethical and legal understanding about the limitations of treatment may be interpreted as a positive outcome of the extensive undergraduate teaching on this subject. Future empirical studies, by a qualitative method, may provide valuable information about the arguments underlying the ethical views of doctors on the limitations of different types of medical treatment. (shrink)

In current practice, decisions regarding whether or not to resuscitate infants born at the limits of viability are generally made with expectant parents during a prenatal consultation with a neonatologist. This article reviews the current practice of prenatal consultation and describes three areas in which current practice is ethically problematic: (1) risks to competence, (2) risks to information, and (3) risks to trust. It then reviews solutions that have been suggested in the literature, and the drawbacks to each. Finally, it (...) suggests that the model of prenatal consultation be altered in three ways: (1) that the prenatal consultation be viewed as a process over time, rather than a onetime event; (2) that decision making in the prenatal consultation be framed as a choice between nonresuscitation and a trial of neonatal intensive care, rather than a choice between “doing nothing” and “doing everything”; and (3) that the prenatal consultation process devote serious attention to both the transfer of information and the non-informational needs of families, rather than focus on the transfer of information alone. (shrink)

Society has historically not taken a benign view of genetic disease. The laws permitting sterilization of the mentally re tarded~ and those proscribing consanguineous marriages are but two examples. Indeed as far back as the 5th-10th centuries, B.C.E., consanguineous unions were outlawed (Leviticus XVIII, 6). Case law has traditionally tended toward the conservative. It is reactive rather than directive, exerting its influence only after an individual or group has sustained injury and brought suit. In contrast, state legislatures have not (...) been inhibited in enacting statutes. Many of their products can be characterized as hasty, unnecessary, ill-conceived, and based on the heart rather than the head. Moreover the lack of expert consultation sought has also been remarkable. One state legislature, for example, has advocated immunization for sickle cell anemia! Many others have enacted laws for the screening of inborn errors of metabolism, e.g., phenylketon uria, but have poorly defined the lines of responsibility to secure compliance. A spate of specific disease-related bills has emerged in the u.S. Congress, each seeking recognition and appropriations. Sickle cell anemia, hemophilia, Cooley's anemia and Tay-Sachs disease have been among the front-runners for support. Finally, in 1975, Congress has begun to examine an omnibus bill concerning all forms of genetic disease. The bill, termed the National Genetic Diseases Act is, however, still far from being enacted. (shrink)

Externalism in the philosophy of mind has been thought by many to pose a serious threat to the claim that subjects are in general authoritative with regard to certain of their own intentional states.¹ In a series of papers, Tyler Burge (1985_a_, 1985_b_, 1988, 1996) has argued that the distinctive entitlement or right that subjects have to self- knowledge in certain cases is compatible with externalism, since that entitlement is environmentally neutral, neutral with respect to the issue of the (...) individuation dependence of subjects' intentional states on factors beyond their bodies. His reason is that whereas externalism—the view that certain intentional states of persons are individuation-dependent on objects and/or phenomena external to their bodies—is a metaphysical thesis, authoritative self-knowledge is an epistemological matter. This being so, there is no reason to suppose that the two need conflict with one another. (shrink)

The combination of money and intimacy, particularly in the context of paid caring, can be difficult, given the tendency to view them as belonging to separate spheres. This research studied paid caring within the context of breastfeeding and labor support, using 72 interviews with lactation consultants, doulas, clients, and health care professionals, as well as 150 hours of ethnographic observation. Building upon the work of Viviana Zelizer, I examined the relational work of lactation consultants, doulas, and their clients, finding (...) that this process is highly influenced by the way gender is mapped onto the separate spheres dichotomy. Lactation consultants, doulas, and their clients drew boundaries around their social relations to construct them as different from family care in order to legitimate the combination of money and intimacy. Lactation consultants and doulas both experienced tension in determining appropriate transactions and media for their care work, which illustrates how the separate spheres ideology can perpetuate the relative low pay of care work. (shrink)

The language of ethics expertise has become particularly important in bioethics in light of efforts to establish the value of the clinical ethics consultation, to specify who is qualified to function as a clinical ethics consultant, and to characterize how one should evaluate whether or not a person is so qualified. Supporters and skeptics about the possibility of ethics expertise use the language of ethics expertise in ways that reflect competing views about what ethics expertise entails. We argue for clarity (...) in understanding the nature of expertise and ethics expertise. To be an ethics expert, we argue, is to be an expert in knowing what ought to be done. Any attempt to articulate expertise with respect to knowing what ought to be done must include an account of ethics that specifies the nature of moral truth and the means by which we access this truth or a theoretical account of ethics such that expertise in another domain is linked to knowing or being better at judging what ought to be done and the standards by which this “knowing” or “being better at judging” is determined. We conclude with a discussion of the implications of our analysis for the literature on ethics expertise in CEC. We do think that there are clear domains in which a clinical ethics consultant might be expert but we are skeptical about the possibility that this includes ethics expertise. Clinical ethics consultants should not be referred to as ethics experts. (shrink)

In the realm of Philosophical Practice, there remains a lack of clarity surrounding the essential characteristics that define a practice as “philosophical”. This paper aims to establish seven minimal criteria that must be met by a philosophical consultancy in order to be considered genuinely “philosophical”. Additionally, it explores the question of how one can assess the quality of such a philosophical consultancy. I provide a (non-exhaustive) answer from an Aristotelian point of view, according to which goodness is a matter (...) of balance. In the context of philosophical consultancy, the consultant should find this balance in two respects: first, between their concern for the topic and their concern for the individual seeking counsel, and, secondly, between a hermeneutical and a critical attitude in dialogue. Finally, I present a visual representation of my findings that can serve as a tool for evaluating whether a consultancy is philosophical and whether it is balanced. __ En el ámbito de la práctica filosófica, sigue habiendo una falta de claridad en torno a las características esenciales que definen una práctica como "filosófica". Este artículo pretende establecer siete criterios mínimos que debe cumplir una consultoría filosófica para ser considerada genuinamente "filosófica". Además, explora la cuestión de cómo se puede evaluar la calidad de dicha consultoría filosófica. Aporto una respuesta (no exhaustiva) desde un punto de vista aristotélico, según el cual la bondad es una cuestión de equilibrio. En el contexto de la consultoría filosófica, el consultor debe encontrar este equilibrio en dos aspectos: en primer lugar, entre su preocupación por el tema y su preocupación por el individuo que busca consejo, y, en segundo lugar, entre una actitud hermenéutica y una actitud crítica en el diálogo. Por último, presento una representación visual de mis conclusiones que puede servir de herramienta para evaluar si una consultoría es filosófica y si está equilibrada. (shrink)

In “Deception and the Clinical Ethicist,” Christopher Meyers defends that view that deception practiced by clinical ethicists is legitimate if it satisfies a series of justifying conditions (Meyers...

BackgroundClinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital.MethodsSemi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May 31, 2020. (...) All documents were analysed by two researchers independently.ResultsTwenty-four CECCs were requested within the study period, of which most (n = 22; 92%) had been initiated by physicians of the department. The patients were an average of 79 years old (R: 43–96), and 14 (58%) patients were female. The median length of stay prior to request was 12.5 days (R: 1–65 days). The most frequent diagnoses (several diagnoses possible) were cardiology-related (n = 29), followed by sepsis (n = 11) and cancer (n = 6). Twenty patients lacked decisional capacity. The main reason for a CECC request was uncertainty about the balancing of potential benefit and harm related to the medically indicated treatment (n = 18). Further reasons included differing views regarding the best individual treatment option between health professionals and patients (n = 3) or between different team members (n = 3). Consensus between participants could be reached in 18 (75%) consultations. The implementation of a disease specific treatment intervention was recommended in five cases. Palliative care and limitation of further disease specific interventions was recommended in 12 cases.ConclusionsTo the best of our knowledge, this is the first in-depth evaluation of a CECC service set up for an academic department of cardiology and intensive medical care. Patient characteristics and the issues deliberated during CECC provide a starting point for the development and testing of more tailored clinical ethics support services and research on CECC outcomes. (shrink)

BackgroundPatient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients’ trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects of patient-centred care (...) among doctors in the Chinese public hospitals.MethodsA quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China.ResultsIn total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes.ConclusionThe study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals. (shrink)

Pragmatic presupposition is analyzed in this paper as grounded on an implicit reasoning process based on a set of presumptions, which can define cultural differences. The basic condition for making a presupposition can be represented as a reasoning criterion, namely reasonableness. Presuppositions, on this view, need to be reasonable, namely as the conclusion of an underlying presumptive reasoning that does not or may not contain contradictions with other presumptions, including the ordering of the hierarchy of presumptions. Presumptions are in (...) turn analyzed considering their nature and their hierarchy, namely their object and their possible contextual backing, which eliminates some of their possible defaults. This analysis of presupposition brings to light the relationship between communicative infelicities or misunderstandings deriving from presuppositional failures and the underlying system of presumptions and presumptive reasoning. This approach can be applied to the investigation of communicative problems within the medical context, and more precisely the communication in diabetes cases. (shrink)

In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God’s-eye perspective. In this paper, I focus on the implications of Engelhardt’s views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt’s views for this question. Finally, (...) I discuss some of Engelhardt’s foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation. (shrink)

International health research in malaria-endemic settings may include screening for sickle cell disease, given the relationship between this important genetic condition and resistance to malaria, generating questions about whether and how findings should be disclosed. The literature on disclosing genetic findings in the context of research highlights the role of community consultation in understanding and balancing ethically important issues from participants’ perspectives, including social forms of benefit and harm, and the influence of access to care. To inform research practice locally, (...) and contribute to policy more widely, this study aimed to explore the views of local residents in Kilifi County in coastal Kenya on how researchers should manage study-generated information on sickle cell disease and carrier status. (shrink)

Clinical ethics consultations are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, (...) lingering sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient “closure” for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as “bioethics mediation.”. (shrink)

This essay explores Confucian views on war as seen in the Spring and Autumn Annals . The interpretation is based mainly on the Gongyang Zhuan , supplemented by other authoritative sources in the Gongyang tradition, such as D ong Zhongshu (179-104 BCE) and H e Xiu (129-182). The Spring and Autumn Annals contains three components: facts, words, and principles. This essay explicates the principles for going to war and the principles for conducting a war. The Confucian perspective sheds light (...) on war against enemies of civilization, conditions for waging a preemptive war, punitive expedition, as well as the use of weapons of mass destruction. The Confucian views as presented here are realistic and pragmatic in nature but are also compatible with the humanistic concern of Confucianism. This essay ends with a summary of the salient and sophisticated features of the Confucian views on war. (shrink)

By reading a novel by George Eliot alongside a novel by her Indian contemporary Fakir Mohan Senapati, this essay offers a cross-cultural comparison of fictional realisms. In The Mill on the Floss , Eliot used a learned narrator and extended forms of free indirect discourse to examine humble life with unprecedented sympathy and complexity, but the formal dissonance between the authoritative narrative voice and class-marked forms of represented speech construct a view of the lower classes from “above”—that is, (...) from the vantage point of the educated middle-class readers whom Eliot implicitly constructs as the agents of history. By contrast, Senapati’s Six Acres and a Third , written in the demotic Indian language of Oriya, achieves a view from “below” through an ironic narrator who parodies the very type of learned discourse that Eliot deploys as the instrument of liberal humanism. By thus evacuating a discursive cultural authority, Senapati produces a dialogic interplay of voices that brings the reader into the lives of his impoverished villagers without sentimentality or condescension—an achievement that in some ways resembles later European modernism as much as the realism of Eliot. (shrink)

Background: Bioethics consultations are conducted in varied settings, including hospitals, universities, and other research institutions, but there is sparse information about bioethics consultations conducted in corporate settings such as pharmaceutical companies. The purpose of this article is to describe a bioethics consultation service at a pharmaceutical company, to report characteristics of consultations completed by the service over a 6-year period, and to share results of a consultation feedback survey. Methods: Data on the descriptive characteristics of bioethics consultations were collected from (...) 2008 to 2013 and analyzed in Excel 2007. Categorical data were analyzed via the pivot table function, and time-based variables were analyzed via formulas. The feedback survey was administered to consultation requesters from 2009 to 2012 and also analyzed in Excel 2007. Results: Over the 6-year period, 189 bioethics consultations were conducted. The number of consultations increased from five per year in 2008 to approximately one per week in 2013. During this time, the format of the consultation service was changed from a committee-only approach to a tiered approach (tailored to the needs of the case). The five most frequent topics were informed consent, early termination of a clinical trial, benefits and risks, human biological samples, and patient rights. The feedback survey results suggest the consultation service is well regarded overall and viewed as approachable, helpful, and responsive. Conclusions: Pharmaceutical bioethics consultation is a unique category of bioethics consultation that primarily focuses on pharmaceutical research and development but also touches on aspects of clinical ethics, business ethics, and organizational ethics. Results indicate there is a demand for a tiered bioethics consultation service within this pharmaceutical company and that advice was valued. This company's experience indicates that a bioethics consultation service raises awareness about bioethics, empowers employees to raise bioethical concerns, and helps them reason through challenging issues. (shrink)

This chapter offers an analysis of the authoritatively normative concept PRACTICAL OUGHT that appeals to the constitutive norms for the activity of non-arbitrary selection. It argues that this analysis permits an attractive and substantive explanation of what the distinctive normative authority of this concept amounts to, while also explaining why a clear statement of what such authority amounts to has been so elusive in the recent literature. The account given is contrasted with more familiar constitutivist theories, and briefly shows how (...) it answers “schmagency”-style objections to constitutivist explanations of normativity. Finally, the chapter explains how the account offered here can help realists, error theorist, and fictionalists address central challenges to their views. (shrink)

The philosophical method is critical to ethics consulting. To be truly effective, ethicists need grounding in ethics theory, abstract reasoning and conceptual analysis. A Practical Guide to Clinical Ethics Consulting allows ethicists to understand problems from practitioners' points-of-view, and allows for a genuine appreciation of the working life of practitioners.

The French bioethics laws of 1994 contain the principles of the anonymity and non commodification of all donations of body parts and products including gametes in medically assisted reproduction. The two revisions of the law, in 2004 and 2011 have upheld the rule. In view of the latest revision process, the French government organized a large public consultation in 2009. Within the event a “consensus conference” was held in Rennes about different aspects of assisted reproduction. In what follows we (...) shall first describe the anonymity clause for gamete donations in the French law and the debates surrounding it. We shall then analyse the procedure used for the 2009 public consultation and the related consensus conference, as well as its upshot concerning the anonymity doctrine. In this respect we shall compare the citizens’ own recommendations on the gamete anonymity issue and its translation in the consultation’s final report drafted by a philosopher mandated by the organizing committee. Whereas the final report cited some fundamental ethical arguments as reason for upholding the provisions of the law—most notably the refusal of the ‘all biological’ approach to reproductive issues—citizens were more careful and tentative in their position although they also concluded that for pragmatic reasons the anonymity rule should continue to hold. We shall argue that the conservative upshot of the public consultation is due to some main underlying presuppositions concerning the citizens’ role and expertise as well as to the specific design of the consensus conference. Our conclusion will be that public consultations and consensus conferences can only serve as an empirical support for devising suitable bioethics norms by using second-order normative assumptions. (shrink)

Assisted dying is a divisive and controversial topic and it is therefore desirable that a broad range of interests inform any proposed policy changes. The purpose of this study is to collect and synthesize the views of an important stakeholder group—namely people with disabilities —as expressed by disability rights organisations in Great Britain. Parliamentary consultations were reviewed, together with an examination of the contemporary positions of a wide range of DROs. Our analysis revealed that the vast majority do not have (...) a clear public stance; those that do exhibit a significant diversity of opinion. DROs opposing legislation on assisted dying have argued that it would be premature, misguided, inequitable and culturally undesirable. Some specify conditions that would have to be satisfied before they could support legalisation, such as radical improvements in health and social care services and the elimination of discrimination against PwD. DROs supporting assisted dying maintain that a change in the law would promote autonomy, end intense suffering, can be delivered safely and is supported by the DRO’s membership. The discussion considers the reasons why several DROs adopt a neutral stance and the argument is made that, whatever their overarching stance on the issue, DROs need to be involved in the policy debate so that the crucial perspectives of PwD are heard and addressed. This is an important message for countries around the world that permit, or are considering legalising, assisted dying. (shrink)

It is widely accepted that knowledge of certain of one’s own mental states is authoritative in being epistemically more secure than knowledge of the mental states of others, and theories of self-knowledge have largely appealed to one or the other of two sources to explain this special epistemic status. The first, ‘detectivist’, position, appeals to an inner perception-like basis, whereas the second, ‘constitutivist’, one, appeals to the view that the special security awarded to certain self-knowledge is a conceptual (...) matter. I argue that there is a fundamental class of cases of authoritative self-knowledge, ones in which subjects are consciously thinking about their current, conscious intentional states, that is best accounted for in terms of a theory that is, broadly speaking, introspectionist and detectivist. The position developed has an intuitive plausibility that has inspired many who work in the Cartesian tradition, and the potential to yield a single treatment of the basis of authoritative self-knowledge for both intentional states and sensation states. (shrink)

In Values and the Reflective Point of View (2006), Robert Dunn defends a certain expressivist view about evaluative beliefs from which some implications about self-knowledge are explicitly derived. He thus distinguishes between an observational and a deliberative attitude towards oneself, so that the latter involves a purely first-person point of view that gives rise to an especially authoritative, but wholly non-observational, kind of self-knowledge. Even though I sympathize with many aspects of Dunn's approach to evaluative beliefs (...) and also with his stress on the practical significance of self-knowledge, I argue that his proposal seriously misinterprets the role of observation and evidence within the first-person point of view and, derivatively, in the formation of evaluative beliefs. (shrink)

This paper offers an analysis of the authoritatively normative concept PRACTICAL OUGHT that appeals to the constitutive norms for the activity of non-arbitrary selection. I argue that this analysis permits an attractive and substantive explanation of what the distinctive normative authority of this concept amounts to. I contrast my account with more familiar constitutivist theories, and briefly show how it answers ‘schmagency’-style objections to constitutivist explanations of normativity. Finally, I explain how the account offered here can be used to help (...) realists, error theorist, and fictionalists address central challenges to their views. (shrink)

This paper defends a qualified observational model of authoritative self‐knowledge, which centres on two features of ordinarily observable characteristics that help explain a subject's direct awareness of them. The first is that they are basic, in that one does not have to know of any underlying fact in virtue of which they apply when they do; and the second is that it is generally necessary and sufficient for the application of such a characteristic that it seems to a normal (...) observer, in normal circumstances, that it does apply. The view is defended against two well‐known misgivings about modelling such knowledge on observation: first, that there is a telling structural disanalogy, since observation normally involves three components, namely, the item perceived, an intermediary, non‐conceptual sensation state, and a judgement grounded in that sensation state, whereas self‐knowledge of an intentional state apparently involves analogues of the first and third components only, namely, a first‐order content‐bearing state and the second‐order state that it validates; and second that, whereas the relations between a perceptual state and the item perceived are causal and contingent, those between first‐ and corresponding second‐order intentional states are in general non‐contingent, and so not merely causal. (shrink)

BackgroundThe purpose of this study is to make a philosophical argument against the phenomenological critique of standardization in clinical ethics. We used the context of clinical ethics in Saudi Arabia to demonstrate the importance of credentialing clinical ethicists.MethodsPhilosophical methods of argumentation and conceptual analysis were used.ResultsWe found the phenomenological critique of standardization to be flawed because it relies on a series of false dichotomies.ConclusionsWe concluded that the phenomenological framing of the credentialing debate relies upon two extreme views to be navigated (...) between, not chosen among, in the credentialing of clinical ethicists. (shrink)

BackgroundAdherence to widely accepted practice standards is a frequently used measure of healthcare quality. In the U.S., the most widely recognized authoritative source of practice standards for ethics consultation (EC) is the second edition of the American Society for Bioethics and Humanities’ Core Competencies for Healthcare Ethics Consultation report.MethodsTo determine the extent to which EC practices in U.S. hospitals adhere to these practice standards, we developed and analyzed 12 evaluative measures from a national survey.ResultsOnly three of the 12 standards (...) achieved over 75% adherence with reported EC practices: allowing anyone involved in a case to request an EC (100%), not requiring an attending physician’s permission to conduct an EC (97.6%), and having at least one person on the ethics consultation service (ECS) with advanced level EC proficiency (79.3%).ConclusionsImplications are discussed for achieving consensus on EC standards as they continue to evolve. (shrink)

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

With the rapid development of genetic research and applications in health care there is some agreement among funding and regulatory bodies that the public need to be equipped to deal with the choices that the new technologies will offer them, although this does not necessarily include a role for the public in influencing their development and regulation. This paper considers the methods and purpose of public consultations in the area of genetics including large-scale surveys of opinion, consensus conferences and focus (...) groups. Consultation has been undertaken to enable the researchers/policy makers to see what the public do not know and plan more public education to make up the deficiency, to check on areas of concern so that public education can be used to address them or to gain a public mandate for a planned policy. An alternative and more recent approach is to find out what the public do know and understand and to see how experts can learn from them in order to get a fuller view of technology in use. (shrink)

BackgroundThe theory and practice of ethics consultations (ECs) in health care are still characterized by many controversies, including, for example, the practice of giving recommendations. These controversies are complicated by an astonishing lack of evidence in the whole field. It is not clear how often a recommendation is issued in ethics consultations and when and why this step is taken. Especially in a facilitation model in which giving recommendations is optional, more data would be helpful to evaluate daily practice, ensure (...) that this practice is in line with the overarching goals of this approach and support the development of standards.MethodsWe analyzed all consultations requested from an EC service working under a facilitation approach at a maximum-care university hospital in Germany over a period of more than 10 years. Our aim was to better understand why—and under what circumstances—some consultation requests result in a recommendation, whereas others can be sufficiently addressed solely by facilitated meetings. We especially wanted to know when and why clients felt the need for clear advice from the EC service while in other cases they did not. We compared ethics consultations in terms of the differences between cases with and without recommendations issued by the ethics consultants using χ2 difference tests and Welch’s t-test.ResultsA total of 243 ECs were carried out between September 2008 and December 2019. In approximately half of the cases, a recommendation was given. All recommendations were issued upon the request of clients. When physicians asked for an EC, the consultation was significantly more likely to result in a recommendation than when the EC was requested by any other party. ECs in cases on wards with ethics rounds resulted in comparably fewer recommendations than those in wards without ethics rounds. When interpersonal conflicts were part of the problem or relatives were present in the meeting, clients less frequently asked for a recommendation.ConclusionFrom the client’s point of view, there does not seem to be only one “right” way to provide ethics consultations, but rather several. While facilitated meetings are obviously appreciated by clients, there also seem to be situations in which a recommendation is desired (especially by physicians). Further empirical and theoretical research is needed to validate our single-center results and re-evaluate the role of recommendations in ethics consultations. (shrink)

Many recent discussions of self-consciousness and self-knowledge assume that there are only two kinds of accounts available to be taken on the relation between the so-called first-order (conscious) states and subjects' awareness or knowledge of them: a same-order, or reflexive view, on the one hand, or a higher-order one, on the other. I maintain that there is a third kind of view that is distinctively different from these two options. The view is important because it can accommodate (...) and make intelligible certain cases of authoritative self-knowledge that cannot easily be made intelligible, if at all, by these other two types of accounts. My aim in this paper is to defend this view against those who maintain that a same-order view is sufficient to account for authoritative self-knowledge. (shrink)

With the rapid development of genetic research and applications in health care there is some agreement among funding and regulatory bodies that the public(s) need to be equipped to deal with the choices that the new technologies will offer them, although this does not necessarily include a role for the public in influencing their development and regulation. This paper considers the methods and purpose of public consultations in the area of genetics including large-scale surveys of opinion, consensus conferences and focus (...) groups. Consultation has been undertaken to enable the researchers/policy makers to see what the public do not know and plan more public education to make up the deficiency, to check on areas of concern so that public education can be used to address them or to gain a public mandate for a planned policy. An alternative and more recent approach is to find out what the public(s) do know and understand and to see how experts can learn from them in order to get a fuller view of technology in use. (shrink)

BackgroundContemporary medical practice is complicated by many dilemmas requiring ethical sensitivity and moral reasoning.ObjectiveTo investigate physicians’ experience in ethical decision-making and their attitude towards ethics consultation.MethodsIn a cross-sectional survey 126 physicians representing the main clinics of Pleven University hospital were investigated by a self-administered questionnaire. The following variables were measured: occurrence, nature and ways of resolving ethical problems; physicians’ attitudes towards ethics consultation; physicians’ opinions on qualities and skills of an ethics consultant, and socio-demographic characteristics. Data analysis included descriptive statistics, (...) χ2 and t-test.ResultsResponse rate was 88.9% (n = 112). Men and women were equally represented (48.2%–51.8%). The sample consisted of experienced physicians: 42.9% had 11–20 years experience, and 33% had 21–30 years. According to 84.8% of respondents, ethical problems have been discussed in their specialty. Predominant dilemmas included relationships with patients and relatives (76.8%) and team work (67.6%). Over ¾ of physicians needed an advice in solving ethical problems. Ninety six percent responded positively to ethics consultation. They would mainly request it for resolving conflicts (72.5%), and in case of concern for the rightness of their decisions (52.7%). The image of an ethics consultant was built of clinical competence (70.9%), ability to deal with conflicts (59.1%), communication skills (58.2%), tolerance for different views (55.4%), and a special qualification in ethics (52.7%).ConclusionsThe study underlined that Pleven University hospital physicians face similar ethical dilemmas as their colleagues in other countries do. The expressed positive attitudes to ethics consultation should serve as a basis for further research and development of ethics consultation services. (shrink)

Epistemology and Biblical Theology pursues a coherent theory of knowledge as described across the Pentateuch and Mark's Gospel. As a work from the emerging field of philosophical criticism, this volume explores in each biblical text both narrative and paraenesis to assess what theory of knowledge might be presumed or advocated and the coherence of that structure across texts. In the Pentateuch and Mark, primacy is placed on heeding an authenticated and authoritative prophet, and then enacting the guidance given in (...) order to see what is being shown--in order to know. Erroneous knowing follows the same boundaries: failure to attend to the proper authoritative voice or failure to enact guidance creates mistaken understanding. With a working construct of proper knowing in hand, points of contact with and difficulties for contemporary philosophical epistemologies are suggested. In the end, Michael Polanyi's scientific epistemology emerges as the most commensurable view with knowing as it appears in these foundational biblical texts. Therefore, this book will be of interest to scholars working across the fields of Biblical studies and philosophy. (shrink)

Background: There is general consensus internationally that unfair distribution of the benefits of research is exploitative and should be avoided or reduced. However, what constitutes fair benefits, and the exact nature of the benefits and their mode of provision can be strongly contested. Empirical studies have the potential to contribute viewpoints and experiences to debates and guidelines, but few have been conducted. We conducted a study to support the development of guidelines on benefits and payments for studies conducted by the (...) KEMRI-Wellcome Trust programme in Kilifi, Kenya. Methods: Following an initial broad based survey of cash, health services and other items being offered during research by all programme studies (n = 38 studies), interviews were held with research managers (n = 9), and with research staff involved in 8 purposively selected case studies (n = 30 interviewees). Interviews explored how these ‘benefits’ were selected and communicated, experiences with their administration, and recommendations for future guidelines. Data fed into a consultative workshop attended by 48 research staff and health managers, which was facilitated by an external ethicist.FindingsThe most commonly provided benefits were medical care (for example free care, and strengthened quality of care), and lunch or snacks. Most cash given to participants was reimbursement of transport costs (for example to meet appointments or facilitate use of services when unexpectedly sick), but these payments were often described by research participants as benefits. Challenges included: tensions within households and communities resulting from lack of clarity and agreement on who is eligible for benefits; suspicion regarding motivation for their provision; and confusion caused by differences between studies in types and levels of benefits. Conclusions: Research staff differed in their views on how benefits should be approached. Echoing elements of international benefit sharing and ancillary care debates, some research staff saw research as based on goodwill and partnership, and aimed to avoid costs to participants and a commercial relationship; while others sought to maximise participant benefits given the relative wealth of the institution and the multiple community needs. An emerging middle position was to strengthen collateral or indirect medical benefits to communities through collaborations with the Ministry of Health to support sustainability. (shrink)

The bulk of the present book has not been published previously though Chapters II and IV are based in part on two earlier papers of mine: "The Influence of Harald H!1lffding's Philosophy on Niels Bohr's Interpretation of Quantum Mechanics", which appeared in Danish Yearbook of Philosophy, 1979, and "The Bohr-H!1lffding Relationship Reconsidered", published in Studies in History and Philosophy of Science, 1988. These two papers comple ment each other, and in order to give the whole issue a more extended treatment (...) I have sought, in the present volume by drawing on relevant historical material, to substantiate the claim that H!1lffding was Bohr's mentor. Besides containing a detailed account of Bohr's philosophy, the book, at the same time, serves the purpose of making H!1lffding' s ideas and historical significance better known to a non-Danish readership. During my work on this book I have consulted the Royal Danish Library; the National Archive of Denmark and the Niels Bohr Archive, Copenhagen, in search of relevant material. I am grateful for permission to use and quote material from these sources. Likewise, I am indebted to colleagues and friends for commenting upon the manuscript: I am especially grateful to Professor Henry Folse for our many discussions during my visit to New Orleans in November-December 1988 and again here in Elsinore in July 1990. (shrink)

Clinical ethics consultants often confront the most difficult clinical encounters, typically in the setting of chronically critically ill patients and surrogate decision makers. These encounters require not only analytical skills but interpersonal skills as well. In this article, I focus on an interpersonal skill absent from the American Society for Bioethics and the Humanities Task Force’s Core Competencies for Healthcare Ethics Consultation. I introduce the psychoanalytic concept of transference and argue that knowledge and use of transference phenomena are sometimes indispensable (...) for ethics consultation with surrogate decision makers. For solicitation of moral views, disclosure of relevant beliefs and values, and identification of the central ethical question—essential to assessment and analysis—cannot at times begin without recognition and working through of transference. (shrink)

Background: International developments suggest that providing clinical ethics services to help clinicians negotiate ethical issues that arise in clinical practice is beneficial and reflects best practice in promoting high ethical standards and patient-centered care. The aim of this study was to explore the needs and experiences of clinical staff members to inform the development of future clinical ethics support. Methods: Health professionals at a large regional health service completed an online survey containing questions about the frequency of ethical and legal (...) issues encountered in clinical practice, the type of situations that gave rise to the ethical and/or legal uncertainty or concern, how clinicians currently address these issues, and what support would be welcome. Results: The survey was completed by 369 staff members, including 61% with more than 10 years in the profession and 51% in nursing/midwifery. Two-thirds (66%) indicated they often considered ethical implications of their clinical decisions, and half (49%) often considered the legal implications. More than half (58%) were often/occasionally concerned about the ethically right thing to do. Patient requests for borderline treatment (47%), staff disagreements about patient care (48%), and patients declining recommended treatment (54%) were the most frequent reasons given for ethical or legal uncertainty. Sixty-nine percent of respondents indicated that the way their department addressed ethical issues could be improved and 85% agreed that there is a need for more discussion on ethical issues. The majority (82%) of respondents had encountered ethically challenging clinical situations where additional support would have helped. Common approaches to issues were discussion with colleagues/supervisor (91.1%), discussion at handover/group forums (50.8%), and consultation with guidelines/protocols (60.9%). Conclusions: A majority of clinical staff members surveyed have encountered ethically/legally challenging cases daily for which they have often sought additional advice. This study indicates that many clinical staff members would welcome some form of additional clinical ethics support including advice and education. (shrink)

From the beginning, a code of ethics for bioethicists has been conceived of as part of a movement to professionalise the field. In advocating for such a code, Baker repeatedly identifies ‘having a code of ethics’ with ‘professionalization’. The American Society of Bioethics and Humanities (ASBH) echoes this view in their code of ethics for healthcare ethics consultants (HCECs)1 and the subsequent publication in the American Journal of Bioethics.2 Taking for granted that a code of ethics could be a (...) valuable asset for HCECs, this essay has two aims. First, there are good reasons to doubt that the label ‘profession’ has significant meaning for HCECs. Attempts to accurately conceive of a profession fall into two broad camps: substantive and formal. Substantive conceptions should be rejected. Specifically, substantive conceptions beg the question about what it means to be a profession, which produces devastating problems for practical application. Formal conceptions of profession (eg, Davis’ conception3) avoid begging the question, but do so at the cost of identifying the responsibilities of a profession. Using the term ‘professional responsibilities’, then, requires additional explication and classifying HCECs as professionals requires the identification of their role-specific responsibilities.i Second, this essay will critique the ASBH code of ethics for HCECs as a first articulation of these responsibilities. As written, this code of ethics has limited value for HCECs because most of the responsibilities identified in this code do not identify HCEC-specific responsibilities. In closing, some important strategies to improve upon this initial attempt to define the responsibilities of HCECs are identified. For at least the last decade, Baker has encouraged bioethicists to adopt a code of ethics. Throughout this effort, Baker intertwines having a code of ethics with becoming a profession: ‘Is it time for bioethics to assert its integrity by developing …. (shrink)