This chapter contains sections titled: Introduction Competency Aesthetic Practices Inter‐Subjective Validity Project Conclusion Notes.

We think we know how to appreciate wine—trained connoisseurs take dainty sips in sterile rooms and provide ratings based on objective knowledge and technical expertise. In Epistenology, Nicola Perullo vigorously challenges this approach, arguing that it is the enjoyment of drinking wine as an active and participatory experience that matters. Perullo argues that wine comes to life not in the abstract space of the professional tasting but in the real world of shared experiences; wines can change in these encounters, and (...) drinkers along with them. Just as a winemaker is not simply a producer but a nurturer, a wine is fully known only through an encounter among a group of drinkers in a specific place and time. Wine is not an object to analyze but an experience to make, creatively opening up new perceptual possibilities for settings, cuisines, and companions. The result of more than twenty years of research and practical engagement, Epistenology presents a new paradigm for the enjoyment of wine and through it a philosophy based on participatory and relational knowledge. This model suggests a profound shift—not knowledge about but with wine. Interweaving philosophical arguments with personal reflections and literary examples, this book is a journey with wine that shows how it makes life more creative and free. (shrink)

The practice of unrestricted universal suffrage is unjust. Citizens have a right that any political power held over them should be exercised by competent people in a competent way. Universal suffrage violates this right. To satisfy this right, universal suffrage in most cases must be replaced by a moderate epistocracy, in which suffrage is restricted to citizens of sufficient political competence. Epistocracy itself seems to fall foul of the qualified acceptability requirement, that political power must be distributed in ways against (...) which there are no qualified objections. However, it is less intrinsically unjust than democracy with universal suffrage, and probably produces more just outcomes. Thus epistocracy is more just than democracy, even if not perfectly just. (shrink)

BackgroundValue sensitivity – the ability to recognize value-related issues when they arise in practice – is an indispensable competence for medical practitioners to enter decision-making processes related to ethical questions. However, the psychological competence of value sensitivity is seldom an explicit subject in the training of medical professionals. In this contribution, we outline the traditional concept of moral sensitivity in medicine and its revised form conceptualized as value sensitivity and we propose an instrument that measures value (...) sensitivity.MethodsWe developed an instrument for assessing the sensitivity for three value groups in a four step procedure: 1) value identification ; 2) value representation ; 3) vignette construction and quality evaluation ; and 4) instrument validation by comparing nursing professionals with hospital managers.ResultsWe find that nursing professionals recognize and ascribe importance to principle-related issues more than professionals from hospital management. The latter are more likely to recognize and ascribe importance to strategy-related issues.ConclusionsThese hypothesis-driven results demonstrate the discriminatory power of our newly developed instrument, which makes it useful not only for health care professionals in practice but for students and people working in the clinical context as well. (shrink)

The purpose of the article is to shed light on how experiences of sensory perceptions in the domains of vision, smell, taste, and touch are recast into text and discourse in the genre of wine reviews. Because of the alleged paucity of sensory vocabularies, in particular in the olfactory domain, it is of particular interest to investigate what resources language has to offer in order to describe those experiences. We show that the main resources are, on the one (...) hand, words evoking properties that are applicable cross-modally and properties of objects that range over more than one domain, and on the other, vivid imagery that compares the characteristics of the wine with people, buildings, animals, and the hustle and bustle of market places and other events. The second goal is to account for the construals of the meanings of the expressions used in the recontextualization into written discourse in the light of their apparent flexibility across the descriptions of the sensory experiences. In contrast to a large body of the literature on sensory meanings in language, we argue that the descriptors of properties such as sharp, soft, lemon, and cherry used to describe a wine's qualities across the sensory domains are not polysemous synesthetic metaphors, but monosemous synesthetic metonymizations, more precisely zone activations. With regard to the imagery used, the construals represented cover both similes, metaphorizations and metonymizations proper. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Practice of SurgeryKaren DevonThere’s no one on the snowy road driving beside me. It’s Christmas Eve, the night the newest attending surgeon on staff gets to be on call. Tonight feels like an anniversary of sorts. The first time I performed an appendectomy “alone” was on Christmas Eve. I can’t recall if it was snowing back then since I hadn’t left the hospital in days. I had assumed (...) that while I was operating on that 26–year–old woman with new abdominal pain that moved towards the left lower quadrant, my attending staff on call was sleeping soundly. I didn’t even know where he lived, or how long it would take if something catastrophic were to happen. I phoned the white–haired man to get his blessing just before midnight. “Have you done this operation before?” he asked. “Yes, several, but not completely alone” I confessed. “Go for it and call me when you are done. Oh, and be safe!” Click. Gulp.As I drive in tonight, again past midnight, I reflect upon that night. Was it practice? A right of passage? The most appropriate treatment for the patient? Perhaps it was even safer this way since my attending really had never done this operation the way it is now done—laparoscopically—by residents. I clearly recall telling the patient and her mother, “We do this all the time! The staff surgeon on call will come in if I need him, but the chief residents always do this operation and I feel comfortable taking care of you.” Sign on the dotted line and make sure you read the part where you are told this is a teaching hospital. Not only was independence an expectation, but I was also supposed to teach the more junior house staff how to emulate what I was so expertly performing.That night I took out the rotting appendix without incident and called the grey haired surgeon in the wee hours. “Merry Christmas Doctor. Sorry to bother you. I just wanted to let you know that the patient is awake and doing well.” “Yes I know. Good work” he replied. “I was in my office. Just in case.”As a resident, I was often torn between the need to gain independence in order to learn and grow as a surgeon, and the idea that I was practicing. As most budding surgeons do, I wanted to be the person doing the surgery. Working on my technical skills was clearly an important part of expertise. Surgery is inherently different than other types of medicine. It seemed slightly more difficult for someone to stop my cutting, than to catch the error in a prescription, before some damage is done. Perhaps a little more like driving a car, than learning to use a calculator. Recently a more modern surgical education is evolving, whereby students practice by simulations on machines. Yet educators know that ultimately many “firsts” need to occur with real patients. That proficiency and expertise are more than a diagnosis, a steady hand, or even the two combined. If the experience of operating as the primary surgeon without immediate supervision, on a patient with acute appendicitis never occurred until we passed licensing exams wouldn’t that be more harmful? I may have been the least legally responsible for outcomes, that night of my own first, when the grey–haired surgeon took the [End Page E1] responsibility of trusting me. But in fact, the obligation I felt was enormous. We cannot simulate the weight of responsibility that comes when responsible for another human being, who you have met and who provides their trust in you. Furthermore, as the teachers of this art and science, we need to balance our obligations to each individual patient with our obligation to society to train competent and caring future surgeons. Surgery would have no history if the “practice” of surgery had nothing to do with practice, defined in its simplest form, yet how do we cover all of this during the late night conversation that is called informed consent. Interestingly since that December evening and for the next 200 laparoscopic appendectomies before my graduation in to... (shrink)

Moral dissensus is a distinct feature of our time. This is not only true of our post-modern culture in general, but also of business culture specifically. In this paper I start by explaining how modernist rationality has produced moral dissensus without offering any hope of bringing an end to it in the foreseeable future. Opting for a form of post-modernist rationality as the only viable way of dealing with moral dissensus, I then make an analysis of a number of ways (...) proposed by both specialists in the field of business ethics, as well as philosophers to deal with moral decision-making in this situation of moral dissensus. The conclusion reached is that none of these attempts succeeds in coming to terms with moral dissensus. I then formulate an alternative approach to moral decision-making which I call: Rational interaction for moral sensitivity. After explaining this approach, I defend it against some of the most obvious objections that might be raised against it in a business environment. When you''re talking birth control, what blocks it and freezes it out is that it''s not a matter of more or fewer babies being argued. That''s just on the surface. What''s underneath is a conflict of faith, of faith in empirical social planning versus faith in the authority of God as revealed by the teachings of the Catholic Church. You can prove the practicality of planned parenthood till you get tired of listening to yourself and it''s going to get nowhere because your antagonist isn''t buying the assumption that anything socially practical is good per se. Goodness for him has other sources which he values as much as or more than social practicality. (Robert M. Pirsig, Zen and the Art of Motorcycle Maintenance.). (shrink)

This study reports the results of a study of Swedish psychiatrists’ responses to moral statements related to decision making in the psychiatric context. Use was made of the Moral Sensitivity Questionnaire, a modified instrument previously constructed from a theory of moral sensitivity. This Likert-type scale contains 30 items constructed from the following categories: interpersonal orientation, structuring moral meaning, benevolence, modifying autonomy, experiencing moral conflict, and trust in medical knowledge and principles of care. The purpose was to identify possible (...) differences in responses rather than to evaluate right or wrong responses. The analysis is based on 754 completed questionnaires. The results of the study showed some significant differences in the item and category levels; for example, male psychiatrists experienced more conflicts than female psychiatrists and agreed to a greater extent that medical knowledge was most important in deciding what was best for the patient. The results also showed that more female than male psychiatrists thought that the relationship with the patient was most important in psychiatric practice. (shrink)

Modern societies are characterized by a division of epistemic labor between laypeople and epistemic authorities. Authorities are often far more competent than laypeople and can thus, ideally, inform their beliefs. But how should laypeople rationally respond to an authority’s beliefs if they already have beliefs and reasons of their own concerning some subject matter? According to the standard view, the beliefs of epistemic authorities are just further, albeit weighty, pieces of evidence. In contrast, the Preemption View claims (...) that, when one discovers what an authority believes, it is not permissible to rely on any of one’s own reasons concerning the subject matter. The original version of this view, as proposed by Linda Zagzebski, has recently been severely criticized for recommending blind trust and for abandoning even minimal standards for critical thinking. In our paper, we defend a new version of the Preemption View—Defeatist Preemptionism—in a way that differs radically from Zagzebski’s. We argue that our view can be derived from certain widely accepted general epistemic principles. In particular, we claim that preemption can be identified as a special case of source sensitive defeat. Moreover, we argue that Defeatist Preemptionism does not lead to the undesirable consequences that critics ascribe to the Preemption View. The paper thus articulates the foundations and refinements of the Preemption View, such that it adequately captures the phenomenon of epistemic authority and the rational requirements related to it. (shrink)

continent. 2.1 (2012): 40–43. Lance Olsen is a professor of Writing and Literature at the University of Utah, Chair of the FC2 Board of directors, and, most importantly, author or editor of over twenty books of and about innovative literature. He is one of the true champions of prose as a viable contemporary art form. He has just published Architectures of Possibility (written with Trevor Dodge), a book that—as Olsen's works often do—exceeds the usual boundaries of its genre as (...) it explores his interests in narrative theory and pedagogy. The book is a kind of “anti-textbook;” a performative polemic against the stale, conservative and monolithic conception of the literary that so often dominates institutional discourse around creative writing. The following interview takes the occasion of AoP's publication as a chance to speak with Olsen about the book itself as well as to engage with larger, unanswerable, questions about the futures and intersections of literature and education. —Ben Segal INTERVIEW: 1) First, I want to start before the beginning, with the title. I’m really fascinated by the concept it conjures. Can you say something about innovative/experimental/(choose your adjective) literature in relation to both ideas around architecture and possibility? Innovative or experimental are tremendously fraught adjectives, needless to say. But for the purposes of my book, they modify a fiction concerned with the questions: What is fiction? What can it do, and how, and why? Now, of course, what looks “innovative” or “experimental” to one at 17 may not be what looks “innovative” or “experimental” to one at 27 or 57, and what looks “innovative” or “experimental” in 1812 may not be what looks “innovative” or “experimental” in 2012. A certain existential and historical perspectivism is always at work. But I think it’s fair to say that innovative and experimental usually refer to a narrativity that includes a self-reflective awareness of and engagement with theoretical inquiry, concerns, and obsessions, as well as a sense of being in conversation with fiction across space and time. One can't create challenging writing in a vacuum; it has to challenge in relation to something. So contemporary writers interested in the subject are not only in pursuit of the innovative, but are also always-already writing subsequent to it—writing, that is, in its long wake. Architectures of Possibility conceives of creativity as a possibility space, a locale just outside our comfort zones where we can and should take multiple chances in order to imagine in new ways, explore fresh strategies for finding and cultivating ideas, re-view what it is we’re doing and why, better understand what Samuel Beckett meant when he wrote: “Try again. Fail again. Fail better.” It reminds us that there are other ways of narrating our worlds and ourselves than those we have inherited from the entertainment industry, the government, academia, previous writing, and so on. 2) AoP seems to be directed at several audiences (and purposes) simultaneously. What I mean is that it seems at times a polemic in favor of innovative literature, at other times a creative writing textbook, and still other times a guide to the network of publishers, journals, and programs that make up the current world of non-mainstream literary art in the U.S. In my mind, Architectures is a theorized anti-textbook about writing. Most textbooks on the subject (think of Janet Burroway’s Writing Fiction: A Guide to Narrative Craft , taught in most creative-writing classroom across the country) orchestrate how to construct conventional stories. They instruct from a place of power how to generate familiar stories that are repeated so often that many of us begin to take them as the primary model for narrativity, if not unconsciously as a kind of truth. The result, as Brian Kiteley points out in 3 A.M. Epiphany (one of the only other alternative textbooks about innovative writing around, by the way, and a tremendous repository of exercises), is merely competent texts. Architectures problematizes that gesture by outlining what conventional narrativity looks like, urging writers to think about its ideology of form as well as content, and invites them to imagine writing, not as a set of relatively stable conventions, but, rather, as a possibility space where everything can and should be thought, tried, challenged. It thereby rhymes with Roland Barthes’s definition of literature: the question minus the answer—which is to say Architectures poses complications to the act of writing rather than solutions. 3) One of the most notable things about the book is the use of interviews. This is also one of the reasons that I think the book works so well for a variety of audiences—that anyone with even a passing interest in the state and future of literature will have an interest in your conversation with people like Ben Marcus, Samuel Delany, and Lydia Davis. I was hoping you could just talk a little about how you chose these subjects to interview, how you edited the interview material, and which answers you received struck you the most. Experimentalism , like realism , wants to appear in the plural. The idea of gathering more than forty interviews (with the help of my awesome collaborator, Trevor Dodge, himself a fine innovative author) represents an attempt to suggest that: the wide, rich, exciting opportunities inherent in the term. There are interviews with younger writers, elder statesmen in the field, publishers, editors, hypermedia artists, comic book makers, and so on: Joe Wenderoth, Carole Maso, Scott McCloud, Nick Montfort, Kathy Acker, et al. Trevor and I decided to do flash interviews: short, concentrated Q&As, each focusing on a particular troubling of writing. We only lightly edited the results to match the manuscript’s overall style, and every interview arrived as a surprise housing several unexpected insights. Three brief examples: Michael Mejia, when asked about what he dreads when setting about writing: “Dread is an interesting word here. I associate it less with loathing or aversion, I suppose, than with a kind of productive fear. Do I dread a project’s failure? Sure, who doesn’t? Who wants to waste time on something that comes to nothing, or is unreadable? But then, what do these terms mean, and who or what defines a work as a ‘failure,’ as ‘waste,’ as ‘unreadable’? Should a work actually try to interrogate and exceed these conceptual limitations? My tendency is to write into dread in order to reveal to myself, as much as to any reader that may come after, the varied complacencies that make other, mostly more conventional writings, readable. It’s at the frontier between readability (security) and unreadability (terror) that I want to live creatively.” Carole Maso, when asked what she’d like a sentence to accomplish: “I think a sentence can if allowed carry emotional and intellectual states as they flee, as they come and go, an escaping essence difficult to hold in other ways. In this way I think the sentence can work as a phrase of music does, sounding something large and elusive in us. Alternatively it can provide sometimes a stability, an essence, a moment of being. Unlike music the sentence also of course carries language with all its potential for meaning making and memory traces and association with it as well. I probably love the accretion of sentences most—those patterns, that shimmer, that resonance.” Shelley Jackson, when asked what is innovative about the innovative: “The purpose of the innovative is, I think, to wake us up. We are not quite alive, most of the time; we occupy a sort of cartoon version of our lives, its lines made smooth by repetition. Writing can open the seams in that world, reintroduce us to the real lives that we have forgotten. Maybe all good writing is innovative in some sense, in that it shows or tells or makes you feel something you never felt before—something for which you have no cartoon ready.” 4) You talk a little about N. Katherine Hayles’s concept of Media Specific Analysis and propose the supplemental notion of Medium Specific Generation—basically taking Hayles and applying her thought from the perspective of the writer. I’ve been trying to develop somewhat related theoretical frameworks, so I was really excited to come upon this section of the book. I’m wondering if you can talk a little more about this idea and, in general, about the potentials that you see as being opened up by writers engaging with and exploiting different media as literary platforms? “Lulled into somnolence by five hundred years of print,” Hayles urges in her (at least for me) transformative 2004 essay, “Print is Flat, Code is Deep,” “literary analysis should awaken to the importance of media-specific analysis, a mode of critical attention which recognizes that all texts are instantiated and that the nature of the medium in which they are instantiated matters.” She goes on to argue critics should learn to become more attuned to the materiality of the medium under investigation—which is to say a story isn’t a story isn’t a story. Rather, the “same” story remediated through film is intrinsically different from that story remediated through conventionally printed books is intrinsically different from that story remediated through hypermedia. “Materiality,” Hayles goes on, “is reconceptualized as the interplay between a text’s physical characteristics and its signifying strategies, a move that entwines instantiation and signification at the outset.” My point in Architectures is simply to emphasize Media Specific Generation: the idea that when writing you should be cognizant, not only of the thematics of the text you are working on, and, as it were, the internal components of its narrativity (character, language, plot, etc.), but also of the material embodiment those components take, and, perhaps more important, the material embodiment those components can take. The idea that the way texts matter matters isn’t something usually addressed in any significant way in creative-writing classrooms and textbooks. It may almost go without saying such experimentation with typography, layout, and white space has a long tradition—certainly one that tracks back at least as far as Guillaume Apollinaire’s early twentieth-century Calligrammes , Laurence Sterne’s textually ribald eighteenth-century Tristram Shandy , although one could arguably plot a hypothetical trajectory that reaches to ancient Greek romances like Achilles Tatius’ second-century Leucippe and Clitophon . Experiments into atomic materiality and digital immateriality bracket the definition of “book” at the same time they highlight Michael Martone’s prediction of its present future as increasingly viral, collaborative, and ephemeral. Or, as Matthew Battles points out: the future of the “book” has already arrived, and it is “ethereal and networked” rather than “an immutable brick.”While conventional writing and reading practices are conceptualized as private, individual, relatively fixed experiences, many of the new forms indicate that writing and reading—from production through dissemination—are rapidly becoming public, collective, incrementally unfixed experiences. That strikes me as an astonishing set of opportunities for a writer to investigate. 5) Another concept you elaborate in AoP is that of limit texts, basically texts that, once you read them, change what you imagine as the shape/horizon/potential of literature. You provide a fantastic reading list of limit texts at the end of AoP. I was hoping you could talk about a few of them in terms of how they specifically operate as limit texts for you—how they expand your understanding of what literature could be or do. Karl Jaspers coined the word Grenzsituationen (border/limit situations) to describe existential moments accompanied by anxiety in which the human mind is forced to confront the restrictions of its existing forms—moments that make us abandon, fleetingly, the securities of our limitedness and enter new realms of self-consciousness. Death, for example. Limit texts are a variety of disturbance that carries various elements of narrativity to their brink so the reader can never quite imagine them in the same terms again. Once you’ve taken one down from the shelf, you’ll never be able to put it back up again. They won’t leave you alone. They will continue to work on your imagination long after you’ve read them. Simply by being in the world, they ask us to embrace difficulty, freedom, radical skepticism. One of the most important for me is Samuel Beckett’s The Unnamable . Instead of establishing conventional setting and building traditional character, from its first words it unsettles both: “Where now? Who now? When now?” That first trio of question marks broadcasts the thematics of the writing (“novel” may be too strong a word) that will follow: it is all about a voice (or, perhaps, voices, about the grammatical mistake of the first-person pronoun), a consciousness (maybe, again, too strong a word), often genderless, removed from place and chronology and socioeconomic reality, hovering in a state of perpetual aporia. All it knows is what it doesn’t know, and its not-knowing is blackly, sardonically comic. The Unnamable is the embodiment of an unreliable narrator—a subject position that can’t trust itself, let alone be trusted by a reader. It contradicts, takes back, digresses, undoes what it just did, forgets, lies, hallucinates gloriously. The language is abstract, disembodied, devoid of sensory data, grayish rather than painterly in texture. Without knowing this passage is from a novel, a reader might well conclude s/he were reading a patch of (anti-)Cartesian philosophy. It might be helpful to conceive of what Beckett is doing as post-genre writing, then, or perhaps what Raymond Federman referred to as critifiction—a mode that blurs conventional distinctions between theory and narrative. In completely different register, and much more recently, Anne Carson’s Nox blew me away. It takes the form of an elegy for her older brother, whom she didn’t know well and who died unexpectedly while on the run from the law in Europe. The thing itself arrives in a box that simulates a thick book, as well as the brother’s textual coffin. Open it, and inside you discover, not a codex, but an accordioned series of “pages” that folds out into an arrangement that suggests an ancient scroll (Carson is, perhaps illuminatingly, a professor of classics) made up of shards of her brother’s letters, old photographs, tickets, Carson’s observations, Catullus’ poem 101 (the one addressed to the Roman poet’s dead brother, a doubling of Carson’s situation), and extensive dictionary entries on all the words that compose that poem. The aggregate produces a collage about the impossibilities of aggregates, the impossibilities of understanding fully, of capturing absences in language. At times Nox feels less an example of what most readers consider a book than something closer to a three-dimensional work of assemblage art. It’s a beautiful mechanism for contemplating Media Specific Analysis, for urging us all to be more extreme. 6) Finally, I want to talk a little about pedagogy and institutions. I’m less interested in questions like “Are MFA programs good for writers?” than in questions about how your role as teacher informs your understanding of literature and your writing practice. I’m also very curious about your take on how commercially marginal literary art is largely patronized by large state institutions and at the same time often imagines itself as a critical and even possibly revolutionary practice. How have your own positions within universities and university-affiliated organizations shaped your thinking about them and about innovative literature? I can imagine in many ways it might make you even more critical. And (I know, another ‘and’...) how does AoP (especially given its relation to Rebel Yell , your previous text on creative writing) reflect your personal history and experience as a teacher and member of communities that are largely defined by institutions? In the classroom, I try to generate the pedagogical field I would have liked to have inhabited as a student, but didn’t. Roland Barthes has a lovely line about this: “We need to substitute for the magisterial [classroom] space of the past (the word delivered by the master from the pulpit above with the audience below, the flock, the sheep, the herd)—a less upright, less Euclidean space where no one, neither teacher nor students, would ever be in his final place.” Easier said than done, of course, but an important life project for all who think of themselves as educators. My own classroom, my own writing, and Architectures of Possibility itself attempt to create the sort of possibility space where, as I mentioned at the outset of our interview, everything should be thought, tried, challenged; where everything rhymes with Roland Barthes’s definition of literature: the question minus the answer. I’m not sure I could write what I’m writing now without the conversations I have almost daily with my students, the conversations they have with each other, the conversations we all have with the texts we study. Especially in light of the paradigm shift over the last, say, quarter century from academia as intellectual exploration to academia as McDonaldized trade school, the irony isn’t lost on me concerning the discrepancy between the safe harbor innovative authors find there and the cultural critiques those authors launch through their writing and pedagogical work. In 2001, I quit my full professorship at one institution precisely because of my disappointment over what had happened to the learning environment there. I had no intentions of reentering the field. In 2007, however, the University of Utah approached me, and I found myself in an environment much more hospitable to the sort of work I want to do—teaching experimental narrative theory and practice. It isn’t by any means a simple irony. One could easily argue innovative writing and pedagogy represents the trace of the paradigm Barthes suggests, and that trace is tremendously productive in all kinds of ways. Innovative writing has never and will never change the world in any large, macrocosmic way. But we’ve all had our lives changed, one by one, by an encounter with a difficult, rich, resonant piece of prose, poetry, music, art, you name it. We’ve all had our lives changed at the ahistorical, microcosmic moment by a class we’ve taken, a teacher we’ve studied with, to such an extent that we became, quite literally, different people. I just came across a stunning set of sentences from Derrida on the topic: “What is education? The death of the parents.” That’s what we’re all up to in the innovative, be it in written texts or the texts we call our classrooms or the texts we call our politics: trying to disrupt what both can and can’t be disrupted, trying to undo what both can and can’t be undone, continuously. (shrink)

This paper examines definitions and uses of reflective and creative writing in health care education classrooms and professional development settings. A review of articles related to writing in health care reveals that when teaching narrative competence is the goal, creative writing may produce the best outcomes. Ultimately, the paper describes the importance of defining literary creative writing as a distinct form of writing and recommends scholars interested in using literary creative writing to teach narrative competence study pedagogy of the field.

This paper contributes to a debate that has arisen in the recent self-knowledge literature between agentialists and empiricists. According to agentialists, in order for one to know what one believes, desires, and intends, rational agency needs to be exercised in centrally significant cases. Empiricists disagree: while they acknowledge the importance of rationality in general, they maintain that when it comes to self- knowledge, empirical justification, or warrant, is always sufficient. In what follows, I defend agentialism. I argue that if we (...) could only come to know our judgement-sensitive attitudes in the way described by empiricism, then we would be self-estranged from them when we acquire knowledge of them. We would relate to our own attitudes as if we were watching the movies of our inner lives unfold. Given that this is not the position we typically inhabit, with respect to our judgement-sensitive attitudes, I conclude that empiricism fails. This is the self-estrangement argument against empiricism. I then consider a response that Brie Gertler, an empiricist, offers to the objection that empiricism fatally portrays us ‘mere observers of a passing cognitive show’ (2016, p. 1). I argue that her response is unsuccessful. Hence, we should endorse agentialism. (shrink)

ObjectivesTo identify and analyse ethical considerations raised when individuals with body dysmorphic disorder consult for non-surgical cosmetic procedures.MethodsEthical analysis was conducted addressing the issues of best interests and capacity to consent for non-surgical cosmetic procedures in individuals with BDD. Analysis was informed by the findings of semistructured interviews with non-surgical cosmetic practitioners and mental health professionals.FindingsNon-surgical cosmetic interventions were viewed not to be in the best interests of individuals with BDD, as they fail to address core psychological issues, result in (...) dissatisfaction post-procedure, and risk harm. Referral to mental health services was advocated, however numerous obstacles to this were perceived. The issue of capacity to consent to non-surgical cosmetic procedures raised questions regarding whether standard capacity assessment is sensitive to the manner in which BDD may influence decision-making processes. In addition, concerns were voiced that decisions made by individuals with BDD in this context may be judged foolish, and thus wrongly equated with lack of capacity.Discussion/conclusionsEthical analysis, informed by the available evidence base, suggests that it is generally not in the best interests of individuals with BDD to undergo non-surgical cosmetic intervention, and referral to mental health services is indicated. Analysis of capacity draws parallels between BDD and anorexia nervosa, as decision-making capacity in both conditions can be impaired by pathological values derived from the disorder. Means of differentiating clinical assessment of pathological values from inappropriate value judgements are advocated, in order to safeguard against the latter encroaching into capacity assessment. (shrink)

Many of us think that we just aren't enough. Not good enough, not pretty enough, not rich enough, and not happy enough. But just because we think something doesn't mean it's true. You are more than you think you are teaches you how to revise your belief system, fulfill your deepest dreams and desires, and create an epic, successful, and inspiring life. Unlocking your True Self is the key to new levels of joy, beauty, and peace. (...) But what is the True Self, and how can you realize its infinite potential? In this easy-to-read book, Kimberly Snyder answers these questions and shows you how to tap into this unstoppable force to transform every aspect of your life for the better. Drawing inspiration from the teachings of the great guru Paramahansa Yogananda along with personal stories and the latest scientific research, Kimberly offers simple exercises, potent ancient practices, and in-depth meditations to help you overcome negative beliefs and see yourself as you truly are--a goddess, a warrior, a lover, and a creator of your extraordinary destiny" -- Back cover. (shrink)

Background: Ethics, being a fundamental component of nursing practice, must be integrated in the nursing education curriculum. Even though different bodies are promoting ethics and nursing researchers have already carried out work as regards this concept, it still remains difficult to clearly identify the components of this competence. Objective: This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice. Method: An integrative review was carried out, for the 2009–2014 period, (...) in the CINAHL, MEDLINE, and EMBASE databases and in the journal Nursing Ethics. The keywords nursing ethics or ethical competence were used in order to make sure to widely encompass the concept of “ethical competence” in the case of a university curriculum in nursing. In the end, 89 articles were selected. Ethical consideration: We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review. Results: Ethical sensitivity, Ethical knowledge, Ethical reflection, Ethical decision-making, Ethical action, and Ethical behavior are the most frequently used terms with regard to ethical competence in nursing. They were then defined so as to better ascertain the possible components of ethical competence in nursing. Conclusion: Even though ethical competence represents a sine qua non competence in nursing practice, no consensus can be found in literature with respect to its definition. The identification of its components and their relationships resulting from this integrative review adds to the clarification of its definition. It paves the way for other studies that will contribute to a better understanding of its development, especially among nursing students and practicing nurses, as well as the factors that may exert an influence. More adapted education strategies can thus be put forward to support its development. (shrink)

BackgroundChildren’s sensory processing patterns are linked with their eating habits; children with increased sensory sensitivity are often picky eaters. Research suggests that children’s eating habits are also partially influenced by attention to food and beverage advertising. However, the extent to which sensory processing influences children’s attention to food cues remains unknown. Therefore, we examined the attentional bias patterns to food vs. non-food logos among children 4–12 years with and without increased oral sensory sensitivity.DesignChildren were (...) categorized into high vs. typical oral sensory sensitivity by the Sensory Profile-2. We used eye-tracking to examine orientation and attentional bias to food vs. non-food logos among children with high vs. typical oral sensory sensitivity. We used a mixed model regression to test the influence of oral sensory sensitivity to attentional biases to food vs. non-food logos among children.ResultsResults showed that children with high oral sensory sensitivity showed attentional biases toward non-food logos; specifically, children with high oral sensory sensitivity oriented more quickly to non-food logos as compared to food logos, as well as spent more time looking at non-food logos as compared to food logos. Findings were in the opposite direction for children with typical oral sensory sensitivity.ConclusionSensory sensitivity may be an individual characteristic that serves as a protective mechanism against susceptibility to food and beverage advertising in young children. (shrink)

This book represents the first full-length study of the aesthetics of the appreciation of wine. It introduces and argues for the validity and significance of several new concepts: competency, project, and aesthetic practices. Using these concepts -- together with analyses borrowed from cognitive science, sensory science, Husserlian phenomenology and hermeneutics -- the case is made that wine can be a proper and indeed significant object of aesthetic attention. The implications of this are pursued in three ways: First, within the (...) culture of wine, with a sustained treatment of important concepts such as terroir; second, within philosophical aesthetics. The latter results in a position termed 'contextual aesthetics' that sees aesthetic acts as always situated within cultural practices, and given meaning thereby. The third implication is for the cultural and aesthetic value accorded to the various senses, and the kinds of underlying issues that might have led to, and might now lead away from, these values. (shrink)

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent (...) with the research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills. (shrink)

In this article, we explore the potential contribution of care ethics to the field of media ethics. In the first part of this article, we discuss the theoretical and philosophical background of the ethics of care. In the second part, we suggest some specific avenues for theoretical, critical, and practical applications of care ethics to the field of journalism and media ethics.

Although taste and smell seem hard to imagine, some people nevertheless report vivid imagery in these sensory modalities. We investigate whether experts are better able to imagine smells and tastes because they have learned the ability, or whether they are better imaginers in the first place, and so become experts. To test this, we first compared a group of wine experts to yoked novices using a battery of questionnaires. We show for the first time that experts report greater vividness (...) of wine imagery, with no difference in vividness across sensory modalities. In contrast, novices had more vivid color imagery than taste or odor imagery for wines. Experts and novices did not differ on other vividness of imagery measures, suggesting a domain‐specific effect of expertise. Critically, in a second study, we followed a group of students commencing a wine course and a group of matched control participants. Students and controls did not differ before the course, but after the wine course students reported more vivid wine imagery. We provide evidence that expertise improves imagery, exemplifying the extent of plasticity of cognition underlying the chemical senses. (shrink)

International companies expanding and competing in an increasingly global context are currently discovering the necessity of sharing knowledge across geographical and disciplinary borders. Yet, especially in such contexts, sharing knowledge is inherently complex and problematic in practice. Inspired by recent contributions in science studies, this paper argues that knowledge sharing in a global context must take into account the heterogeneous and locally embedded nature of knowledge. In this perspective, knowledge cannot easily be received through advanced information technologies, but must always (...) be achieved in practice. Empirically, this paper draws from two contrasting initiatives in a major international oil and gas company for improving its current ways of sharing knowledge between geographically distributed sites and disciplines involved in well planning and drilling. The contrasting cases reveal that while a shared database system failed to improve knowledge sharing across contexts, a flexible arrangement supporting collaboration and use of different representation of knowledge was surprisingly successful. Based on these findings the paper underscores and conceptualizes various triangulating practices conducted in order to achieve knowledge across borders. More accurately these practices are central for individuals’ and communities’ abilities to: (i) negotiate ambiguous information, (ii) filter, combine, and integrate various heterogeneous sources of information, and (iii) judge the trustworthiness of information. Concerning the design and use of information technologies this implies that new designs need to facilitate triangulating practices of users rather than just providing advanced platforms (“digital junkyards”) for sharing information. (shrink)

Plausibly, how much is at stake in some salient practical task can affect how generously people ascribe knowledge of task-relevant facts. There is a metaphysical puzzle about this phenomenon, and an empirical puzzle. Metaphysically: there are competing theories about when and how practical stakes affect whether it is correct to ascribe knowledge. Which of these theories is the right one? Empirically: experimental philosophy has struggled to find a stakes-effect on people’s knowledge ascriptions. Is the alleged phenomenon just (...) a philosopher’s fantasy? I propose a new psychological account of when and why people’s knowledge ascriptions are sensitive to stakes. My hypothesis is motivated by empirical research on how people’s judgements are sensitive to their social context. Specifically, people’s evaluations are sensitive to their ‘psychological distance’ from the scenarios they are considering. When using ‘fixed-evidence probes’, experimental philosophy has found that what’s at stake for a fictional character in a made-up scenario has little or no effect on how participants ascribe knowledge to them. My hypothesis predicts this finding: the scenarios are too ‘psychologically distant’ to participants. Our empirical puzzle is resolved: the stakes-effect often present in the wild won’t be present in vignette studies. (This illustrates a widespread problem with X-phi vignette studies: if people might judge differently in other social contexts, we can’t generalize from the results of these experiments. That is, vignette studies are of doubtful ‘external validity’.) The hypothesis also resolves our metaphysical puzzle. It predicts that people do not ascribe knowledge in a way deemed correct by any of the standard philosophical views, namely classical invariantism, interest-relative invariantism, and contextualism. Our knowledge ascriptions shift around in the way that’s most useful for social beings like us, and this pattern in our judgements can only be endorsed by a genuinely relativist metaphysics for knowledge. (shrink)

There is something attractive about combining the values of equality and responsibility, even though the view most commonly associated with doing so, of luck egalitarianism, is beset with objections. This article hence proposes an alternative approach to being a responsibility-sensitive egalitarian: one grounded on our valuable social practices of responsibility, rather than on a desire to mitigate the influence of luck on people's prospects. First, I argue that this practice-based approach better captures the very reasons that responsibility is significant (...) for justice than does the prevalent approach among luck egalitarians: namely, the values of fairness, choice and respect. Second, I show that the remaining motivation of the luck egalitarian approach, of being ‘anti-luck’, is impoverished. I conclude by suggesting that this practice-based approach is better motivated and more palatable than existing forms of luck egalitarianism, even for those relational egalitarians who standardly criticise making egalitarianism responsibility-sensitive. (shrink)

Regardless of unpredictable and contingent geopolitical events such as last year’s surprising rejection of the European Constitution in France and the Netherlands, this coming year will certainly witness a large surge in patriotism. The Winter Olympics in February, and the World Cup in the summer, both promise to whip national sentiments into a fever pitch. One other thing is certain, though: journals of philosophy and ethics will continue to debate the virtues of cosmopolitanism, as this number of Ethical Perspectives does (...) through its contributions below.Why is this? Why do philosophers and academics hold on to this idea of cosmopolitanism, an idea utterly lacking in the convictions of the general public? Is it perhaps because the first cosmopolitans were in fact philosophers? The first to identify himself as a cosmopolitan was Diogenes the Cynic, and Plato’s dialogues paint many of the Sophists in cosmopolitan hues. Although people generally support the idea of internationalism as far as it promotes trade, travel, and football tournaments, once it begins to meddle in internal affairs, as it does with outsourcing and transnational constitutions, they tend to fall back upon the patria. They killed Socrates for corrupting the youth of Athens, not the youth of the world.Whether it is the service and manufacturing industries of Asia and India ‘stealing’ American jobs, or widespread fears of Brussels’ legendary bureaucrats, the non-academic public consistently turns from its tepid embrace of cosmopolitanism to patriotism whenever threatened. Are we too quick to label this as self-interest or even selfishness? Or is there something else at work in the debate between cosmopolitanism and patriotism? Some approaches to cosmopolitanism are certainly guilty of an absolute removal of difference, of wishing away the nation state, of replacing it with an international body based on purely universal principles, and of wiping away the competencies of nations on many levels. The call for the world state can come across as an appeal for an anodyne and internationalist homogeneity based on a clinical morality that, for all its sensitivity, runs roughshod over the well-engrained cultural, legal, and social beliefs of many peoples.Clearly, this is what many Europeans fear, and to a large degree, Americans as well in their dislike for the International Court of Justice. Even the economic hegemony of outsourcing removes national power, and replaces it with pure economic rationality.Our contributors below do not advocate these reductions, although some may point to them. Key to each contribution below is sensitivity to the world as it is, to its need for difference even in the face of an ever-increasing globalisation that sometimes is connected with cosmopolitanism. Yet, every proponent of cosmopolitanism must sketch how it is possible in practice. Of course, an obvious problem is how to dwell consequently as a cosmopolitan. Not many contemporary cosmopolitans would be prepared to follow Diogenes’ commitment to rootlessness: living in exile after having been included in a forgery conviction aimed at his father, the ascetic Diogenes called a barrel his home. Such was his drive to live a levelled life that he cast away his only bowl upon seeing a poor peasant boy drinking from cupped hands. Today’s cosmopolitan leads a much more prosaic life, and hence the problem with cosmopolitanism begins as something mundane. Does not a cosmopolitan still pay national taxes? Does not a cosmopolitan still need a national passport and second country visas? But, the questions quickly turn ontological: how can one shed oneself of one’s nationality, of one’s belonging, as if it is just an accident of one’s own constitution, instead of as an important property of one’s own constitution? In other words, belonging is important: a citizen of the world still values citizenship. Clearly, the absolute cosmopolitan reduction is an absurdity: one is always rooted, in some sense. Even cosmopolitanism is rooted in a specific Western mindset, and is no self-evident preference of human existence.As Rudi Visker’s contribution so clearly shows through an investigation of the narcissism of minor differences, these questions revolve around the question of confrontation with alterity. What I am, in no small way plays off what I am not. I cannot be everything, if I am something. Freud’s analysis of minor differences reveals that members of a group identify with that group on the basis these minor differences. What is self-evident to a particular culture marks that culture off from another culture, a culture that by definition does not share the same set of the self-evident. To be a foreigner, as any ex-patriot can attest, is to stand outside of the self-evident, whether this means interpreting gestures, understanding commercial practices, or, as Freud would have it, staying on the correct side of national taboos. There is thus a dialectic of inner and outer, a dialectic which refuses a reduction of one to the other. As Visker puts it, recognising the stranger within oneself is quite different than recognising the stranger outside of oneself, and to confuse these as being the same is not only to misunderstand the very issue at stake, it is also a dangerous trivialisation of difference.But clearly, there is something viable and laudable in the idea of cosmopolitanism, since it stresses the universal moral community of humanity. Cosmopolitanism is an attempt to see all human subjects as subject to the same moral law. Indeed, the sort of federation to which cosmopolitanism leads, at least in a modified Kantian expression as Bert van Roermund tells us, even gives us good grounds to recognise the legitimacy and moral equivalence of states. Importantly, the international legal order does not draw its power from any supranational force, but from the choice of independent national actors to recognise it. Hence, this cosmopolitan order depends on nationhood, and good standing within this order depends on the degree to which a country decides to participate. Again, the universal here depends on well-rooted particularity, a particularity able to choose for the universal.What do we do, then, with outlaw nations, those nations that are hostile to the choice for the universal? Through a clear reading of Hegel, Paul Cobben proposes that the metric for a state’s legality is the measure to which it permits the moral freedom of its citizens to bloom. A free person requires a free legal order; only in such can a person obtain the full measure of human rights due. States that do not permit this blooming are illegitimate; they contradict the nature of the human person, and citizens dwelling under the yoke of these have the right to ask for outside assistance in removing this illegitimate power above them. However, for this plea to be met, two conditions must obtain: the oppressed people must have the wherewithal to form a political order after the removal of the illegitimate state, and the action must be grounded in the principles and support of a legal community, which in essence would be a world federation of states. In fact, it is morally incumbent upon all legal states to aim at such a world federation, upon pain of contradiction.Our duty to others does not end with the politically oppressed; the economically oppressed also lay a moral claim upon us. So, as Toon Vandevelde asks in his contribution, what about the global poor? The poor are hungry and in need of shelter and a future, but to address these issues at the level of rights is in a way heartless: what good does it do to legislate that everyone has the right to food, when this right can never be called upon, or enforced, in any meaningful sense? Moreover, approaches that demand non-prioritised generosity not only ignore the fundamental economic fact of scarcity, they also run the risk of creating the moral hazard of dependence on charity. The true cosmopolitan approach is the recognition of our common humanity and of our concomitant duty to help others as far as this help does not endanger us. This duty is compounded by the marginalisation of the poor through globalisation, a globalisation that they did not ask for. The extent of our help is indeterminate, but its direction is clear: it must aim to integrate those poor who wish it within our international systems, and so to ease their own transitions from poverty.Both Gil Anidjar and Maria Bonnafous-Boucher continue this theme of economy, but each from a highly specific viewpoint. Indeed, their contributions are perhaps somewhat darker, delving into an aspect of the unspoken underneath the choice for the universal. Anidjar begins with the relation between religion and economy within the interplay of Judaism and Christianity, whereas Bonnafous-Boucher focuses on the development of political economy through a Foucaultian lens. Although highly distinct contributions, both share the insight that the economy is now the central theme of our power structures, and that economy, isolated from questions of morality or justice, must likewise play a decisive role within the structure of cosmopolitanism, or, at minimum, the political unity of peoples. For, national government long ago ceded to a promiscuous mix of governance, and religion to economy. This nexus enthrones governance as an economic rationale stripped of all other trappings, and inscribes any possible cosmopolitanism within a framework of an aggressive capitalism, a kind of economic theology, a kind of hegemony in which state boundaries are essentially liquefied. Capital, after all, knows no boundaries. (shrink)

The context of economic globalization has contributed to the emergence of a new form of social action which has spread into the economic sphere in the form of the new social economic movements. The emblematic figure of this new generation of social movements is fair trade, which influences the economy towards political or social ends. Having emerged from multiple alternative trade practices, fair trade has gradually become institutionalized since the professionalization of World Shops, the arrival of fair trade products in (...) the food industry, and the establishment of an official "fair trade" label. With the strength that this institutionalization has generated, fair trade can now be considered a real trade system that questions, as much as it renews, the traditional economic system. In parallel, this transformation has exacerbated the tensions within the movement, which can be characterized as a clash between a "radical, militant" pole and a "softer, more commercial" one. However, it is not the actual institutionalization of fair trade which is being debated among fair trade actors on either side of the fence, but rather the challenges inherent in finding an economic institutionalization acceptable to social economic movements. Therefore the institutionalization process of fair trade should not be seen as mere degradation of social action, but rather as typical of the institutionalization process of new social economic movements. If we need to worry about the highjacking and alteration of the fair trade movement by the dominant economic system, the opposite is no less likely, as new social economic movements contribute to an ethical restructuring of markets. (shrink)

The theme of this issue of Ethical Perspectives is the French tradition in liberal thought, and the unique contribution that this tradition can make to debates in contemporary liberalism. It is inspired by a colloquium held at the Katholieke Universiteit Leuven in December of 2008 entitled “In Search of a Lost Liberalism: Constant, Tocqueville, and the singularity of French Liberalism.” This colloquium was held in conjunction with the retirement of Leuven professor and former Dean of the Institute of Philosophy, André (...) Van de Putte, who found much inspiration in this tradition. A revised version of his valedictory lecture from the conference serves as the final contribution to this issue. Much contemporary liberal political philosophy is currently done in conversation with a line of liberal thinkers starting with John Locke, running through Immanuel Kant and John Stuart Mill, and culminating in the work of John Rawls and his followers. The reasons for the enormous appeal of this philosophical tradition are, among other things, the combination of the central role of the intuitively appealing value of individual liberty with a strong rationalistic, universalistic, and normative character. The thread running through most of these liberal theories is a commitment to what the French liberal Benjamin Constant referred to as “the liberty of the moderns,” that is, liberty in a negative sense, as a lack of interference in one’s activity from others and from government. This focus has expanded over time to include a richer body of civil, political, social, economic and cultural rights, for instance, in the work of liberal thinkers who have tried to integrate the insights of communitarian thought and discourse ethics in their work. However, the emphasis on individual liberty in the negative sense continues to be the normative and theoretical touchstone and default position for many contemporary liberal theories. The limitation of the canon of liberal thought to the aforementioned authors and themes deprives the contemporary debate of a rich source of ideas: the French liberal tradition. Montesquieu, considered to be the father of this tradition, provides a good example of how it can enrich current debates in liberal theory. Montesquieu’s work evinces a keen eye for the dynamics of power relations and the limitations of the power of the better rational argument. His insight that power can sometimes only be checked by an equal and opposing power, so that a system of separation and balance of powers is necessary in order to preserve liberty, is reflected in the foundations of most modern democracies. Montesquieu also argues that contingent environmental, historical, social and economic conditions play a dramatic role in determining what kind of government is appropriate for a particular society. On his view, ignoring these facts when framing a government can inadvertently end in despotism. Montesquieu’s observations challenge us to reexamine some of contemporary liberalism’s universalist and rationalist claims. Benjamin Constant is most famous for his distinction between two kinds of liberty: the liberty of the ancients and the liberty of the moderns. The ancient form of liberty manifested itself in the active political participation of citizens in the ancient republic. While this form of government and decision-making was suitable for small, homogeneous city-states, Constant argues that it is impracticable for large modern nation-states. Hence, the concept of modern liberty shifts to an emphasis on the rule of law and the non-interference of the state in private matters. This form of liberty is familiar to us from contemporary liberalism – and Constant cherishes this form of freedom as much as any liberal does today. However, his position is complex: he also argues that the liberty of the ancients should not be neglected. Active political participation is needed to ensure that the government is executing its duty of preserving the modern form of liberty by publicly pointing out violations. The contemporary relevance of Constant’s work is clear when we consider the alleged “democratic deficit” that plagues the EU and international institutions such as the UN, the IMF, and the World Bank. Not only does this democratic deficit threaten the modern form of liberty by placing decision-making processes out of sight of the people, it also threatens citizens’ sense of self-respect derived from self-governance. Constant’s argument for the necessity of combining the liberty of the ancients with that of the moderns provides a fruitful resource for confronting these contemporary issues. Tocqueville’s work on liberalism benefits from his opportunity to observe a society founded on liberal democratic principles – the United States of America – in action. In his Democracy in America, he examines the social consequences, both intended and unintended, of building a society on ‘the equality of conditions’, as he defines ‘democracy’. Tocqueville sees a tension between the democratic value of equality and the aristocratic value of the rule of the best. He observes that democratic societies do not necessarily choose the best leaders and instead promote mediocrity instead of virtue, talent, and excellence. Democracy also confronts citizens with the threat of ‘soft despotism’, where a government that preserves the outer signs of the liberty of the moderns nevertheless controls the behavior of its citizens in minute detail through a system of detailed rules ostensibly aimed at their welfare. This paternalism is an even more insidious threat to liberal values than the hard variety of despotism, since it is so difficult to detect and done in the name of liberal values themselves. Taking Tocqueville’s observations seriously would add complexity to attempts to theorize about the modern social-democratic welfare state. The contributions to this issue supplement and critique mainstream liberal thought and its relation to contemporary issues through a serious engagement with the French liberal tradition. Annelien De Dijn’s contribution discusses Bertrand de Jouvenel, a lesser-known 20th Century representative of the French political tradition she terms ‘aristocratic liberalism’. This tradition has its roots in the work of Montesquieu, and emphasizes the importance of intermediary bodies, most importantly the aristocracy, in providing a check to the top-down power of despotic state authorities and the bottom-up power of revolutionary leveling tendencies, both of which threaten liberty. De Dijn situates Jouvenel in this tradition, but then indicates an important difference between his thought and that of his predecessors: his most significant work, On Power, is not only on French history, but on European history. Pointing to the enthusiastic reception of this work in the Anglophone world, she suggests that the rise of totalitarianism in Europe gave the anti-totalitarian features of aristocratic liberalism a broader appeal. Valentino Lumowa’s paper concerns Constant’s classic text, The Liberty of the Ancients Compared with that of the Moderns. Lumowa argues that in order to understand Constant’s piece, we must be aware that its two parts were written under different historical circumstances and decipher the argumentative thrust inherent in the text. Following Stephen Holmes, he argues that to understand the shift Constant made in the second part of the text, we should read it within the context of the increasing influence of the ultra-Royalists in the legislature during the Bourbon Restoration. However, in contrast to Holmes, he contends that the spirit of both civic and individual freedom, which enlivens representative system, is the backbone of the text in its unity. Demin Duan’s essay investigates an apparent ambivalence between liberal and imperialist tendencies in the work of Alexis de Tocqueville, which has already drawn some attention from Tocquevillian scholars. These interpretations of Tocqueville and his writings on empire generally agree that Tocqueville stands in a recognized tradition of liberalism, which is characterized by respect for human rights, individual freedom and a sense of universal humanism. On this standard view, Tocqueville’s support of imperialism represents nothing but an unfortunate breach of his own otherwise consistent liberal thinking. Duan’s article questions this standard position. By questioning the assumption of Tocqueville’s liberalism in the first place, he tries to gauge the influence of both the old republican tradition and the new liberal perspective on his thinking. In conclusion, he argues that Tocqueville’s overall thought, especially his notion of freedom, is very much informed by an old republican tradition. His support of French imperialism could be better understood from this perspective rather than be rendered simply as a deviation from liberal norms. Pawel Marczewski’s contribution is an attempt to show that Tocqueville’s conception of liberty transcends the divisions between negative and positive aspects of freedom. He begins by juxtaposing this conception with the opposition drawn by Constant between liberty of the ancients and liberty of the moderns. While Tocqueville and Constant shared a concern for the preservation of individual rights, Tocqueville was much more reluctant to accept the modern loss of the communal dimension of liberty. He did not accept the view that jouissances privées, private pleasures, are the main compensation that the modern world has to offer for the lost ancient treasure of political participation. The essay then looks into the relevance of Tocqueville’s standpoint for current debates between liberal defenders of negative freedom and republican advocates of freedom as non-domination. Participants on both sides of the debate seem to be so devoted to showing that their particular approach provides the best guarantees against actual and possible threats to liberty that they overlook the fact that their definitions of freedom remain significantly similar. By arguing that ‘to be free is to be guided by one’s own will’, contemporary republicans, as well as their liberal counterparts, move along the lines drawn by Constant towards private pleasures. By questioning the inevitability of this turn, Tocqueville provides us with a valuable contribution to these discussions in contemporary political philosophy. Finally, André Van de Putte’s contribution, an adaptation of his emeritus speech that closed the conference on French Liberalism, appeals to Tocqueville in order to draw attention to the importance of intermediary, dialogical bodies in mitigating the implicit despotic tendencies of the democratic drive to equality. In Tocqueville’s view, the transition from the feudal corporate inequality to democratic individual equality was not a clean break. Rather, this transition is a continual process of democratization that is driven by a desire for equality, or egalité des conditions. This dissolution of distinctions of estate, class and status has the unintended consequence of concentrating the diffuse power of these entities into a centralized state, which is responsible for ensuring the equality of all under the law. This process leaves increasingly isolated and atomized individuals to face the power of a monolithic state in defense of their freedom, and moves toward a soft, paternalistic despotism. Constant’s freedom of the moderns is not sufficient to protect individuals from this centralized power. Democracy also requires the political freedom of the ancients. Van de Putte argues for a system in which atomized individuals organize themselves into intermediary bodies that, in a Montesquieuian balance of powers, can enter into dialogue with each other and the state on more equitable terms. Van de Putte’s contribution closes with a plea for a conception of democracy as a regime of dialogue. (shrink)

Diagnostic errors are more frequently a result of the clinician's failure to combine medical knowledge adequately than of data inaccuracy. Diagnostic reasoning studies are valuable to understand and improve diagnostic reasoning. However, most diagnostic reasoning studies are characterized by some limitations which make these studies seem more simple than diagnostic reasoning in real life situations actually is. These limitations are connected both to the failure to acknowledge components of knowledge used in clinical practice as well as (...) to acknowledge the physician-patient relationship's influence on clinical knowledge and on the reasoning process itself. In addition the modes of reasoning described in these studies frequently is oversimplified. In this paper three simplistic and competing models of diagnostic reasoning are analyzed and criticized, followed by an evaluation of two alternative models proposing a combined view. (shrink)

The digitalisation of healthcare is transforming nursing practice, presenting unique opportunities and challenges that demand more than technical competence from nursing professionals. Despite the growing integration of digital tools, nursing remains in the ‘foothills of digital transformation’, with significant gaps in the critical and theoretical frameworks required to navigate this shift effectively. This article explores how Paulo Freire's critical pedagogy may address these gaps by fostering critical digital skills in nursing students. Drawing on Freire's concepts of problem‐posing education, (...) conscientization, dialogue and praxis, the article proposes a pedagogical model that encourages students to critically examine the socio‐political and ethical implications of digital tools within their practice. By aligning Freirean principles with contemporary nursing challenges, the article argues for a shift away from solely competency‐based frameworks toward educational approaches that promote reflective, dialogical, and ethically informed engagement with technology. The limitations of Freirean pedagogy, including its difficulty in evidencing direct outcomes, are discussed alongside its potential to cultivate a philosophically engaged nursing workforce capable of navigating the complexities of a digital healthcare environment and its associated impact on the profession. This approach underscores the importance of preserving nursing's core ethical and relational values while embracing the transformative potential of digital technologies. (shrink)

In order to maximize human performance, defence forces continue to explore, develop, and apply human performance enhancement (HPE) methods, ranging from pharmaceuticals to (bio)technological enhancement. This raises ethical, legal, and societal concerns and requires organizing a careful reflection and deliberation process, with relevant stakeholders. We discuss a range of ethical, legal, and societal aspects (ELSA), which people involved in the development and deployment of HPE can use for such reflection and deliberation. A realistic military scenario with proposed HPE application can (...) serve as a starting point for such an iterative and participatory process. Stakeholders can discuss this application, modify its features, and design appropriate processes around it – for instance, procedures for informed consent. We propose that organizing aspects into these three categories – ethical, legal, and societal – can help involve appropriate interlocutors at different moments: legal aspects with people in strategy or management roles, from the start of a project; ethical aspects with people in operations and medical roles, during development; and societal aspects with people in communication and personnel roles, during deployment. Notably, we developed and discussed this framework and the three aspects in close collaboration with personnel from the military. (shrink)

Recent increases in the rates of parental refusal of routine childhood vaccination have eroded many countries’ “herd immunity” to communicable diseases. Some parents who refuse routine childhood vaccines do so because they deny the mainstream medical consensus that vaccines are safe and effective. I argue that one reason these vaccine denialists disagree with vaccine proponents about the reasons in favor of vaccination is because they also disagree about the sorts of practices that are conducive to good reasoning about healthcare choices. (...) Vaccine denialists allocate epistemic authority more democratically than do mainstream medical professionals. They also sometimes make truth ascriptions for nonepistemic reasons, fail to recognize legitimate differences in expertiseand competence, and seek uncritical affirmation of their existing beliefs. By focusing on the different epistemic values and practices of vaccine denialists and mainstream medical professionals, I locate my discussion of vaccine denialism within broader debates about rationality. Furthermore, I argue that gender inequality and gendered conceptions of reason are important parts of the explanation of vaccine denialism. Accordingly, I draw upon feminist work—primarily feminist social epistemology—to help explain and evaluate this form of vaccine refusal. (shrink)

This article examines the ‘integrated conception of competence’ as conceived by Paul Hager and David Beckett and suggests that its characterization in terms intended to distance it from behaviouristic and reductionist notions of competence is not sufficient to differentiate it from other models. Taking up Hager and Beckett’s idea that competence must be inferred from behaviour, it is suggested that this indicates how the integrated conception is more properly distinguished by virtue of the method used rather than what (...) it is that is assessed. Drawing on the work of Wittgenstein and Donald Davidson, it is argued that it is possible to discern two logically distinct methodological approaches to competence assessment, allowing a clear distinction to be made between the integrated conception and the kind of approach which predominates in the UK’s framework of vocational qualifications. While the latter is shown to be rightly criticized for its deficiencies, in contrast the integrated conception is seen to suggest a methodological approach that is capable of acknowledging the full richness of occupational practice. (shrink)

This project evaluates the impact of the National Science Foundation's policy to promote education in the responsible conduct of research. To determine whether this policy resulted in meaningful RCR educational experiences, our study examined the instructional plans developed by individual universities in response to the mandate. Using a sample of 108 U.S. institutions classified as Carnegie “very high research activity”, we analyzed all publicly available NSF RCR training plans in light of the consensus best practices in RCR education that were (...) known at the time the policy was implemented. We found that fewer than half of universities developed plans that incorporated at least some of the best practices. More specifically, only 31% of universities had content and requirements that differed by career stage, only 1% of universities had content and requirements that differed by discipline; and only 18% of universities required some face-to-face engagement from all classes of trainees. Indeed, some schools simply provided hand-outs to their undergraduate students. Most universities had plans that could be satisfied with online programs such as the Collaborative Institutional Training Initiative's RCR modules. The NSF policy requires universities to develop RCR training plans, but provides no guidelines or requirements for the format, scope, content, duration, or frequency of the training, and does not hold universities accountable for their training plans. Our study shows that this vaguely worded policy, and lack of accountability, has not produced meaningful educational experiences for most of the undergraduate students, graduate students, and post-doctoral trainees funded by the NSF. (shrink)

-/- Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. -/- Research objectives: The purpose of this inquiry was to explore nurses’ moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social–moral space of nurses’ work in order to capture (...) how competencies may reflect an adaptation to a less than ideal work environment. -/- Research design: A critical qualitative approach was used. -/- Participants: Fifteen graduate nursing students from various practice areas participated. -/- Ethical considerations: After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed. -/- Findings: One overarching theme ‘Mediating the tension between providing false hope and destroying hope within biomedicine’ along with three subthemes, including ‘Reimagining hopeful possibilities’, ‘Exercising caution within the social–moral space of nursing’ and ‘Maintaining nurses’ own hope’, was identified, which represents specific aspects of this moral competency. -/- Discussion: This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope. -/- Conclusion: The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 21.1 (2001) 33-36 [Access article in PDF] How I, a Christian, Have Learned from Buddhist Practice, or "The Frog Sat on the Lily Pad... Not Waiting" Frances S. Adeney Louisville Presbyterian Theological Seminary As a Christian, I have practiced various forms of silent meditation. I remember sitting under the grand piano as a child of three, watching the sun flit through white curtains during our one-hour home (...) communion service of the Plymouth Brethren. Most of the hour was spent in communal silence, gathered around a small table upon which was placed wine and bread. My memories of these meetings are filled with a sense of awe and presence.I practiced a different kind of silent meditation as a young adult when I spent six weeks living on a beach in Greece. I saw few people apart from my two companions and the shepherdess who brought her flock to the meadow each day. I spent hours watching the waves or studying the grains of sand at my feet. I never missed a sunset.At certain times of my life, there were more intentional, prayer-filled kinds of silent meditation. Wordless yearnings and grievings were brought to those meditations as I sought understanding and peace during times of illness, loss, and confusion. I wouldn't call any of those experiences Buddhist meditation. They were intentionally focused on either worshiping Christ or experiencing nature. There was no attempt to leave behind desires, no longing for emptiness, no intentional focus on being in the present moment, qualities that I associate with Buddhist meditation.The first time I joined a group of people practicing Buddhist sitting was in 1997. Yet I felt like I had been doing this kind of silent meditating for years. Here is how that convergence came about.During the early 1990s, while living in Indonesia, I frequently visited a Trappist monastery in central Java. The nuns there didn't practice Buddhism, but my spiritual director, a German priest who lived down the mountain, said to me, "Come and see." Father Hamma introduced me to sitting in a gentle non-technique-oriented way. He called it "contemplative prayer." I took up this practice daily during a difficult time of loss in my life. Spiritual retreats at the monastery up the mountain helped me learn to let go of what I could not hold onto in life. It was there that I began to experience the delight and calm that comes from a practice of meditative silence. [End Page 33]This silent meditation differed from other practices of silence that I had known in significant ways: (1) It was not focused on an interchange between God and myself. I was not listening for God's voice. I was not bringing my concerns to God. I was simply entering a place of silence. (2) It was not predicated on specific ideas about God or thoughts from writings in the Bible. I did not need to frame this time of silence with religious meanings. (3) It was not focused on an outcome. I neither expected nor did I ask for any changes in myself or the world.Yet there were ways in which this practice of meditative silence was framed by my Christian faith. In taking up this practice, I felt I was intentionally entering God's presence. While not looking for spiritual experiences, I was somehow seeking life, and I did believe that God met me in those silent moments. More than once I had experiences that were "sightings" if not meetings with the Divine. During the seven years that I have practiced entering silence, the space that I enter has grown larger, and the conviction that I am entering and becoming part of God's presence deepens. The frog sat on the lily pad not waiting. This Haiku poem resulted from one such experience. I had taken the bus out from the city. It dropped me at the foot of one of hundreds of small mountains in Java covered by... (shrink)

Philosophers of logic are particularly interested in understanding the aims, epistemology, and methodology of logic. This raises the question of how the philosophy of logic should go about these enquires. According to the practice-based approach, the most reliable method we have to investigate the methodology and epistemology of a research field is by considering in detail the activities of its practitioners. This holds just as true for logic as it does for the recognised empirical and abstract sciences. If we (...) wish to systematically understand the aims and epistemology of logic, we are best placed achieving this by looking at what logicians do, rather than reflecting upon the nature of logic itself. In this entry, we outline the motivations for a practice-based approach towards the philosophy of logic and highlight its advantages over more “top-down” approaches, which attempt to infer conclusions about the nature of logic and its methodology on the basis of traditional assumptions about knowledge, metaphysics, or logic itself. We end by addressing several prominent concerns raised against the practice-based approach. (shrink)

Decisions based on algorithmic, machine learning models can be unfair, reproducing biases in historical data used to train them. While computational techniques are emerging to address aspects of these concerns through communities such as discrimination-aware data mining and fairness, accountability and transparency machine learning, their practical implementation faces real-world challenges. For legal, institutional or commercial reasons, organisations might not hold the data on sensitive attributes such as gender, ethnicity, sexuality or disability needed to diagnose and mitigate emergent indirect discrimination-by-proxy, (...) such as redlining. Such organisations might also lack the knowledge and capacity to identify and manage fairness issues that are emergent properties of complex sociotechnical systems. This paper presents and discusses three potential approaches to deal with such knowledge and information deficits in the context of fairer machine learning. Trusted third parties could selectively store data necessary for performing discrimination discovery and incorporating fairness constraints into model-building in a privacy-preserving manner. Collaborative online platforms would allow diverse organisations to record, share and access contextual and experiential knowledge to promote fairness in machine learning systems. Finally, unsupervised learning and pedagogically interpretable algorithms might allow fairness hypotheses to be built for further selective testing and exploration. Real-world fairness challenges in machine learning are not abstract, constrained optimisation problems, but are institutionally and contextually grounded. Computational fairness tools are useful, but must be researched and developed in and with the messy contexts that will shape their deployment, rather than just for imagined situations. Not doing so risks real, near-term algorithmic harm. (shrink)

‘Computational thinking’ (CT) is highlighted in research literature, societal debates, and educational policies alike as being of prime significance in the 21st century. It is currently being introduced into K–12 (primary and secondary education) curricula around the world. However, there is no consensus on what exactly CT consists of, which skills it involves, and how it relates to programming. This article pinpoints four competing claims as to what constitutes the defining traits of CT. For each of the four claims, inherent (...) philosophical presuppositions are identified concerning the nature of thinking, problem-solving, and human–computer relationships. It is argued that most of these philosophical presuppositions are very similar to ones that Hubert Dreyfus and Donald Schön addressed forty to fifty years ago. Therefore, claims about the power of CT raise old discussions in a new disguise. Dreyfus and Schön argued that the presuppositions were wrong. Do their arguments hold and thus defeat contemporary claims about CT? Alternatively, has the technological development since the time of their writings proven them wrong? This article argues that it is necessary to heed the arguments of Dreyfus, Schön, and—later—Bent Flyvbjerg to ensure that CT curricula are built in accord with the value-rational nature of human practice, rather than on misconceived rationalizations of problem-solving, computer use, and computational aspects in the world. However, the pervasive integration of information technology in today's world raises new issues concerning human–machine collaborations that sidetrack the arguments of Dreyfus and Schön. A revised view of CT is required which focusses on articulating how humans can design for, partake in, and critically appraise human–machine collaborations. (shrink)

The term "social science" promises more than its practitioners can deliver: it promises knowledge. This knowledge is to consist of statements of empirical regularities of such quality as will enhance predictive power and inform public and private policy. Boundaries of Competence illuminates obstacles to this aspiration. Chapter 1 grounds knowledge in perception. Chapter 2 challenges the assumption that ordinary language necessarily describes reality and reveals the mischief words can do. Chapter 3 proposes a continuum of perceiving-conceiving involved in (...) different ways of "knowing" worlds. Chapter 4 lays out requirements of measurement, arguing that assigning numbers to dubious observations gives false assurance that mathematical manipulations necessarily rep- resent events. Chapter 5 shows how choice of unit affects the correlations we find in our search for causes. Chapter 6 holds that, given deficiencies in knowledge and perhaps because of the way Nature works, we assess probabilities rather than seek certainties. Chapter 7 notes difficulties in counting events that consist of "social facts," which "depend on us," and those that refer to "brute facts," that exist independently of us. Chapter 8 criticizes the practice of employing proxies for observations of what we're talking about. In particular, it demonstrates the error produced by relying on what people say as measure of what they do. Chapter 9 criticizes ways of explaining conduct by characterizing actors and their acts, and by "understanding" them through empathy. Chapter 10 discusses the important and never-ending quarrel about causation. Chapters 11 and 12 argue that in social affairs, decision is regularly torn between doing what is effective (rational) and doing what is right (moral). Nettler's writing is crisp, and his argument balanced. He employs research from several disciplines to challenge ideologically driven descriptions of our condition and explanations of our conduct. Gwynne Nettler is professor emeritus at the University of Alberta in Edmonton, Canada, where he taught psychology, sociology, and criminology. His previous books include Explanations, Social Concerns, and Explaining Crime. (shrink)

There are three main metaphysical positions on race. Anti-realists do not believe there are any races. Natural kind approaches find sub-groups of homo sapiens that have scientific importance and label those groups races, generally taking them to be biological categories. This book argues that anti-realism is false, and the groups natural kind theorists point to, if real, are not the groups we care about in ordinary discussions of race. This book defends, instead, a social kind view, which considers races to (...) exist because of contingent social practices. I argue for a social kind view that recognizes that biological features we use to classify people racially do not make races natural kinds. Racial groups could theoretically exist independently of any social constructions, since they are just groups of people, but social constructions single out certain groups of people as races, give them social importance, and allow us to name them as races. This book also identifies several kinds of context-sensitivity in our racial classification and sees that context-sensitivity as central to how racial categorization works. In terms of our moral response to these metaphysical realities, we need racial categories to identify problems in how our racial constructions are formed, including addressing harmful effects, rather than seeking to eliminate the categories in any direct way, but we should also make efforts to change the conditions that generate those problematic elements, with a goal of retaining only the unproblematic aspects. (shrink)

Opinions about cognitive enhancement (CE) are context-dependent. Prior research has demonstrated that factors like peer pressure, the influence of authority figures, competition, moral relevance, familiarity with enhancement devices, expertise, and the domain of CE to be enhanced can influence opinions. The variability and malleability of patient, expert, and public attitudes toward CE is important to describe and predict because these attitudes can influence at-home, clinical, research, and regulatory decisions. If individual preferences vary, they could influence opinions about practices and regulations (...) due to disagreements about the desirable levels of risks and benefits. The study of attitudes about CE would benefit from psychological theories that explain judgments. In particular, we suggest that variability in risk and benefit sensitivity could psychologically mediate judgments about CE in many contexts. Drawing from prospect theory, which originated in behavioral economics, it is likely that framing effects, shifted reference points, and the tendency to weigh losses (risks) more heavily than gains (benefits) predict decisions about CE. We suggest that public policy could benefit from a shared conceptual framework, such as prospect theory, that allows us to describe and predict real-world decisions about CE by patients, experts, and the public. (shrink)

We present a method for assessing the sensitivity of the true causal effect to unmeasured confounding. The method requires the analyst to set two intuitive parameters. Otherwise, the method is assumption free. The method returns an interval that contains the true causal effect and whose bounds are arbitrarily sharp, i.e., practically attainable. We show experimentally that our bounds can be tighter than those obtained by the method of Ding and VanderWeele, which, moreover, requires to set one more (...) parameter than our method. Finally, we extend our method to bound the natural direct and indirect effects when there are measured mediators and unmeasured exposure–outcome confounding. (shrink)

What happens when the scientific tradition of openness clashes with potential societal risks? The work of American toxic-exposure epidemiologists can attract media coverage and lead the public to change health practices, initiate lawsuits, or take other steps a study’s authors might consider unwarranted. This paper, reporting data from 61 semi-structured interviews with U.S. toxic-exposure epidemiologists, examines whether such possibilities shaped epidemiologists’ selection of journals for potentially sensitive papers. Respondents manifested strong support for the norm of scientific openness, but a significant (...) minority had or would/might, given the right circumstances, publish sensitive data in less visible journals, so as to prevent unwanted media or public attention. Often, even those advocating such limited “burial” upheld openness, claiming that less visible publication allowed them to avoid totally withholding the data from publication. However, 15% of the sample had or would, for the most sensitive types of data, withhold publication altogether. Rather than respondents explaining their actions in terms of an expected split between “pure science” and “social advocacy” models, even those publishing in the more visible journals often described their actions in terms of their “responsibility”. Several practical limitations (particularly involving broader access to scientific literature via the Internet) of the strategy of burial are discussed, and some recommendations are offered for scientists, the media, and the public. (shrink)

Background: In the midst of the Covid-19 pandemic, healthcare workers increasingly encounter serious ethical issues that negatively affect their professionalism. Purpose: The study aims to examine the ethical sensitivity levels of physicians and nurses working in surgical units during the Covid-19 pandemic and the associating factors. Method: The sample of this cross-sectional online questionnaire–based study consists of 161 healthcare workers working at the surgical units in Turkish hospitals. The data were collected using the “Nurse Descriptive Information Form” developed by (...) the researchers and the “Ethical Sensitivity Questionnaire.” Ethical considerations: Approval was granted by the ethics committee. Verbal and written consent was received from the healthcare workers. Results: Ethical sensitivity in the dimension of conflict was found to be higher in healthcare workers who had ethical issues during the Covid-19 pandemic, who were married, who were nurses, who worked more than 45 h, and who had a work experience of 7–10 years (p < 0.05). Healthcare workers with a family member diagnosed with Covid-19 had high ethical sensitivity in the dimension of conflict (p = 0.008), while those who reported being fully competent and ready (p = 0.038) about Covid-19 were found to have low ethical sensitivity. Besides, those who experienced inadequate supplies (p = 0.045), long working hours (p = 0.038), and problems in asepsis–sterilization (p = 0.046) during the Covid-19 pandemic were found to have low sensitivity in the holistic approach dimension. Conclusion: The study revealed that ethical issues during the Covid-19 pandemic, sociodemographic characteristics, knowledge-skills about Covid-19, and the problems encountered in the work environment during the pandemic affect the ethical sensitivity of healthcare workers in the dimensions of conflict and holistic approach. Therefore, it is recommended that governments and all healthcare workers, and stakeholders in the health system in our country and other countries take action to promote ethical sensitivity in response to the rapidly increasing epidemic by considering the factors that adversely affect ethical sensitivity. (shrink)

Investigating the causal relationship between exposure and time-to-event outcome is an important topic in biomedical research. Previous literature has discussed the potential issues of using hazard ratio (HR) as the marginal causal effect measure due to noncollapsibility. In this article, we advocate using restricted mean survival time (RMST) difference as a marginal causal effect measure, which is collapsible and has a simple interpretation as the difference of area under survival curves over a certain time horizon. To address both measured and (...) unmeasured confounding, a matched design with sensitivity analysis is proposed. Matching is used to pair similar treated and untreated subjects together, which is generally more robust than outcome modeling due to potential misspecifications. Our propensity score matched RMST difference estimator is shown to be asymptotically unbiased, and the corresponding variance estimator is calculated by accounting for the correlation due to matching. Simulation studies also demonstrate that our method has adequate empirical performance and outperforms several competing methods used in practice. To assess the impact of unmeasured confounding, we develop a sensitivity analysis strategy by adapting the E-value approach to matched data. We apply the proposed method to the Atherosclerosis Risk in Communities Study (ARIC) to examine the causal effect of smoking on stroke-free survival. (shrink)

Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as (...) emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values. (shrink)

The intensive care unit, with its structural complexity and the exposure of critically ill patients to various disparities, presents a significant setting for health disparities. This critical ethnographic study sought to uncover cultural knowledge and ethical practices for reducing health disparities in providing care services within the intensive care unit. The focus was on understanding how ethical considerations and cultural competence can address and mitigate these disparities effectively. This critical ethnographic study was conducted in 2022–2023 at intensive care units in (...) western Iran. Three interrelated phases were used to collect and analyze the data. More than 300 h of observation were done during the first phase. A horizon analysis was carried out in the next phase. To further enhance the dataset, 18 informants participated in semi-structured interviews and informal conversations. Following that, the analysis procedure was conducted to identify a culture of health disparities and factors that reduce it, as it had been in the prior stage. Trustworthiness data collection methods were implemented to ensure the validity and reliability of the study. Two key themes emerged from the study: (A) Improved cultural competence, which encompassed empathy towards patients and their families, effective communication, prioritization of continuous learning, appropriate knowledge and awareness, sensitivity to cultural and religious beliefs, staff attitude and personality, and the delivery of customized care tailored to each patient’s needs. (B) Supporting role and compensating for disparities involved recommendations for upholding ethical standards, compensatory actions, maintaining professional behavior despite external factors, addressing gaps and deficiencies, and actively defending and supporting patients. The findings indicate that staff with high cultural competence can ethically mitigate health disparities through their supportive roles. Managers and health policymakers should create barriers to health disparity by improving staff cultural competence and knowledge about health disparities. (shrink)

According to evidentialist views, credence in a proposition p should be proportional to the degree of evidential support that one has in favor of p. However, empirical evidence suggests that our credences are systematically sensitive to practical factors. In this article, I provide a cost–benefit analysis of credences' practical sensitivity. The upshot of this analysis is that credences sensitive to practical factors fare better than practically insensitive ones along several dimensions. All things considered, our credences (...) should be sensitive to practical factors. (shrink)

A number of philosophers have claimed that we should take not just empirical uncertainty but also fundamental moral uncertainty into account in our decision-making, and that, despite widespread moral disagreement, doing so would allow us to draw robust lessons for some issues in practical ethics. In this article, I argue that, so far, the implications for practical ethics have been drawn too simplistically. First, the implications of moral uncertainty for normative ethics are far more wide-ranging (...) class='Hi'>than has been noted so far. Second, one can't straightforwardly argue from moral uncertainty to particular conclusions in practical ethics, both because of ‘interaction’ effects between moral issues, and because of the variety of different possible intertheoretic comparisons that one can reasonably endorse. (shrink)

I demonstrate that the two major ethical traditions agree that there are given desires which provide extra-rational practical reasons. Empiricist theories ground ethics in such desires, but the extra-rationality of this foundation appears to lead to stultifying subjectivism. Rationalist theories justify the appeal to an independent Kantian Reason as necessary to gain control over such desires. But the status of these desires as providing motivating reasons guarantees that such independent Reason can never be more than one among (...) competing sources of practical rational motivation. ;I then argue that the generalization and extension of the epistemological argument against the given provides compelling evidence that there can be no such given desires. This argument demonstrates that episodes which can provide reasons cannot be extra-rational, indeed must be constituted through rational endorsement. This critical argument is applied to the work of Dennis Stampe and Thomas Hobbes , and extended from desires to preferences . ;In order to provide rational warrant, a desire must itself be rationally endorsed in a context of other endorsed episodes within which its own warrant is secured. There are no given desires, no extra-rational practical reasons in which the crude empiricist can ground practical reasoning. But there is also no need to postulate Reason independent of desire to gain rational control over such desires. I close by suggesting that this critical argument provides a framework for the construction of a middle ground between the two traditions which incorporates their central insights while avoiding their chronic failings. (shrink)

Representationalists have routinely expressed skepticism about the idea that inflexible responses to stimuli are to be explained in representational terms. Representations are supposed to be more than just causal mediators in the chain of events stretching from stimulus to response, and it is difficult to see how the sensory states driving reflexes are doing more than playing the role of causal intermediaries. One popular strategy for distinguishing representations from mere causal mediators is to require (...) that representations are decoupled from specific stimulus conditions. I believe this requirement on representation is mistaken and at odds with explanatory practices in sensory ecology. Even when sensory states have the job of coordinating a specific output with a specific input, we can still find them doing the work of representations, carrying information needed for organisms to respond successfully to environmental conditions. We can uncover information at work by intervening specifically on the information conveyed by sensory states, leaving their causal role undisturbed. (shrink)