Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) (...) standards. This revised report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

The ASBH Core Competencies Update Task Force (Tarzian and ASBH Core Competencies Update Task Force 2013) provides useful information for individual consultants performing case consultations. A grow...

Tarzian and ASBH Core Competencies Update Task Force (2013) say that making ethics consultation accountable means examining the abilities and qualifications of health care ethics consultants (HCECs...

In their systematic review of the work of the ASBH Core Competencies Update Task Force, Anita Tarzian and ASBH Core Competencies Update Task Force (2013) write, “The ethics facilitation approach do...

The American Society for Bioethics and Humanities is to be congratulated on its updating of competency standards for ethics consultations (Tarzian and ASBH Core Competencies Update Task Force 2013)...

The American Academy of Pediatrics Task Force on Circumcision published its policy statement and technical report on newborn circumcision in September 2012.1 ,2 Since that time, some individuals and groups have voiced objections to the work of the Task Force, while others have conveyed their support. The AAP task force is pleased that the policy statement and technical reports on circumcision have stimulated debate on this topic and welcomes respectful discussion and dialogue about the (...) scientific and ethical issues that surround neonatal circumcision. We believe this is a complex issue that does not lend itself to simplistic solutions. The Task Force encourages those of all viewpoints to contribute to a vibrant, thoughtful and respectful evidence-based dialogue. We appreciate that the free exchange of competing ideas is a necessary component of scientific discovery. We also recognise that all clinical decisions carry ethical dimensions and that a respectful and thoughtful dialogue about these issues is important. However, the Task Force also feels strongly that this debate and the academic literature are demeaned when those with an ideological agenda disseminate inaccurate information, misapply scientific principles, make accusations that are unsupported, communicate in a vitriolic tone, and attempt to discredit and mischaracterise alternative views and those who hold them. Healthy debate and …. (shrink)

The current IASP definition of pain has come under renewed criticisms recently. There is a new momentum for its revision as reflected by the fact that IASP has now a Presidential Task Force dedicated to look into whether there is enough warrant to update the definition. I critically review all the major criticisms of the current definition in detail, and raise new difficulties rarely discussed before. I show that none of the major criticisms has enough warrant to (...) force us to substantially revise the current definition. Combined with the discussion of the new difficulties, there is nonetheless a need to restate the definition using slightly different terminology that will make the original intent of the current definition clearer and more precise. A restatement of the definition is proposed and its potential is discussed in light of some empirical questions that remain. [The IASP Council has now approved a revised definition and published its rationale here: Pain 2020 Sep 1; 161(9), pp. 1976–1982. The new definition follows (most of) my recommendations.]. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Oversight of Stem Cell Research in the United States: An UpdateMary A. Majumder (bio) and Cynthia B. Cohen (bio)On 9 March 2009, President Barack Obama (2009a) signed an executive order revoking the statement issued by President George W. Bush during a televised speech in August 2001, in which the latter had sharply restricted the scope of federally funded human embryonic stem cell (hESC) research to cell (...) lines derived (without federal funding) prior to 9:00 P.M. EDT on 9 August 2001. Action by President Obama to remove the cut-off date had been expected. It came as a surprise, however, that he gave authority to determine the scope of eligible research to the Director of the National Institutes of Health (NIH), referencing only general concerns of responsibility, scientific worth, and legality.1 This contrasted not only with the approach of former President Bush, but also with that of former President Clinton, who had expressed personal opposition to the creation of embryos for research and had a distinction between hESCs derived from embryos created for research and those derived from spare embryos enshrined in NIH policy.President Obama’s remarks upon signing the executive order give some insight into the thinking behind his approach. Implicit in them are the views that earlystage human embryos outside the womb do not have full moral status and that the destruction of human embryos in the effort to care for and ease the suffering of human beings who do have full moral status does not devalue human life. The President also stressed that the decision to pursue hESC research reflected not only his opinion, but also a broad social consensus. He concluded with strong ethical commitments on two fronts:We will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.(Obama 2009b)The specific guarantee that President Obama gave against government support for the development of cloning techniques for human reproductive purposes made his silence on the use of cloning for research seem significant. Comments he had made in the course of the campaign (Obama 2008) suggested that he would affirm [End Page 195] the Clinton-era policy of limiting federal funding to hESCs derived from spare embryos. Did this silence mean that President Obama was opening the door to federal funding of research cloning when and if scientists might manage that feat?2009 NIH GuidelinesThe answer to this question and several others came on 17 April, when Raynard Kington, the acting director of NIH, released Draft NIH Guidelines for Human Stem Cell Research (NIH 2009), developed by an NIH Stem Cell Task Force, along with a request for public comment within 30 days of their publication in the Federal Register.2 The 2009 Draft Guidelines exclude from federal funding the derivation of hESCs, a restriction mandated by the reenactment of the Dickey-Wicker Amendment as part of the 2009 Omnibus Appropriations Act (Public Law 111-8, Division F, Title V, § 509). The 2009 Draft Guidelines also exclude the use of hESCs derived from embryos created for research purposes, and so represent a refusal to open the funding door as broadly as the NIH interpretation of the Dickey-Wicker Amendment might allow, at least for the time being.It appears that the drafters used as their starting point the 2000 NIH Guidelines for Research Using Human Pluripotent Stem Cells (NIH 2000) dating from the Clinton Administration, rather than more recent guidelines from the National Academy of Sciences (National Research Council 2005; 2007; 2008) and other private bodies. Both the format and content of the 2000 and 2009 NIH efforts are similar, making the departures in the latter stand out in high relief. We highlight departures related to informed consent to embryo donation, creation of human-nonhuman chimeras, and the role of an NIH task force, updating our original comment (Cohen and Majumder 2009).Informed Consent to Embryo DonationThe 2009 NIH Draft Guidelines require that certain statements... (shrink)

Clinical ethics training programs are responsible for preparing their trainees to be competent ethics consultants worthy of the trust of patients, families, surrogates, and healthcare professionals. While the American Society for Bioethics and Humanities (ASBH) offers a certification examination for healthcare ethics consultants, no tools exist for the formal evaluation of ethics trainees to assess their progress toward competency. Medical specialties accredited by the Accreditation Council for Graduate Medical Education (ACGME) use milestones to report trainees’ progress along a continuum (...) of professional development as a means of “operationalizing and implementing” medical competencies. Utilizing the Core Competencies for Healthcare Ethics Consultation and the ACGME and American Board of Pediatrics’ (ABP) Pediatric Milestones Project, we developed milestones for 17 subcompetencies in clinical ethics consultation and academic bioethics. As the field of clinical ethics becomes more standardized, such tools will be needed to promote the development of robust training programs and to certify that their graduates are competent practitioners. (shrink)

The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social–historical construction (ASBH Core Competencies for Health Care Ethics Consultation , 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011 ). Core Competencies fails to recognize that the ethics of (...) health care ethics consultants is not ethics in the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered. (shrink)

The book reconstructs the history of Western ethics. The approach chosen focuses the endless dialectic of moral codes, or different kinds of ethos, moral doctrines that are preached in order to bring about a reform of existing ethos, and ethical theories that have taken shape in the context of controversies about the ethos and moral doctrines as means of justifying or reforming moral doctrines. Such dialectic is what is meant here by the phrase ‘moral traditions’, taken as a name for (...) threads of moral discourse, made in turn of other interwoven threads, including transmission of shared codes, appeals to reform of prevailing custom, rational argument about the justification of some precept on the basis of some shared general teaching or principle, and rational argument about the ultimate basis for principles and justification of authoritative teaching. That is, the approach adopted to the reading of ethical texts depends on a firm belief in the fact that philosophers hardly created any ethical doctrine out of nothing. The main point this book tries to highlight is how different philosophical theories emerged and followed each other as a result of attempts at accounting for what was going on in the world of moral traditions. Changes were propelled by controversies between different schools, and highly abstract arguments were the unintended effects of moves made by controversialists forced to transform (and occasionally to turn upside down) their own doctrines in order to face the challenge posed by other arguments. This is the reason why the book examines not only texts that already enjoy pride of place in the history of philosophy (Aristotle, Kant, Hegel), but also other texts usually treated in the histories of religions (the Bible, the Talmud, the Quran), and others considered to be much less philosophical (Plutarchus, Pufendorf). -/- 1. Plato and a response to ethical scepticism. Two different traditions of morality in VI-V century Greece are described. The birth of philosophical questioning of traditional morality and temporal and spatial variation of custom is described within the context of the v century crisis, the demise of traditional aristocratic and tyrannical rule and the birth of democracy. Two conflicting answers to the challenge are reconstructed, namely conventionalist or immoralist theories formulated by the Sophists and the eudemonist and intellectualist Socratic theory. Plato’s own reformulation of Socrates answer to the Sophists is reconstructed. His psychological views, his classification of the four cardinal virtues and his political theory are described as parts of a unitary system, culminating in an extremely realist moral ontology identifying the idea of the good with the essence of the (moral and extra-moral) world itself. -/- 2. Aristotle and the invention of practical philosophy. Aristotle’s invention of practical philosophy as a field separated from first philosophy is shown to be an implication of his break with Plato moral ultra-realism. Aristotle’s agenda in his moral works is arguably dependent on a polemical intention, namely dismantling Socratic intellectualism. The semi-inductive or virtuously circular method of practical philosophy is illustrated, starting with the received opinions of the better and wiser individuals and trying dialectically to sift what is left of mistake and inconsistence in such opinions, finally trying to correct mistakes and make the overall practical science more consistent. The chapter illustrates then the relationship of individual ethics, or ‘monastics’, with the art and the science of the pater familias, or ‘economics’, and the science of the ruler and citizen, or politics. The nature of virtues, or better, excellences of character, is discussed, highlighting the basic role of hexis, or ‘disposition’. Prudence, or better practical wisdom, is the focus of the chapter. Its relationship with bouleusis or deliberation is examined, and its autonomous status vis-à-vis theoretical knowledge is stressed. -/- 3. Diogenes and philosophy as a way of life. The chapter provides an overview of Hellenistic ethics, which almost amounts to Hellenistic schools of philosophy, in so far as ‘philosophy’ became in these centuries primarily the name for a way of life. The typical character of the Cynical movement is highlighted, that of a school of life, not a school aimed at providing any kind of intellectual training was to be provided. -/- 4. Epicurus and ethics as self-care. The peculiar character of the Epicurean school is described, a combination of a science of well-being aiming, more than at pleasure as in the popular view, at reduction of useless suffering, of unnecessary needs, and at a balanced selection of pleasures of the best and most durable kind. -/- 5. Epictetus and ethics as therapy of the passions. The various phases of Stoicism are described, and the shifting place given to ethics in the Stoic system of idea, culminating in the paradoxical view of ethics, its impossibility in principle notwithstanding, as the only truly significant and necessary part of philosophy. Cicero is treated, showing how his own synthesis of various Hellenistic trends is as a truly philosophical enterprise, deserving serious consideration after one or two centuries when he was confined to the role of literate. Epictetus is chosen as the best example of what the Stoic tradition could yield, an art of living based on sophisticated introspection, in turn aimed at making a kind of cognitive therapy possible, dismantling obnoxious passions at their root by systematically correcting false representations. -/- 6. Philo and the reconciliation of Torah and Platonism. A reconstruction of basic ideas from a few books of the Hebrew Bible is provided, starting with the Prophetic tradition and the focus on God’s mercy as the source of motivation and standard for human behaviour. Then a comparative analysis is undertaken of a parallel tradition, namely the three codifications of the Torā (Law or, better, Instruction), highlighting how a core of moral ideas may be recognized as a basis and preamble of codification of civil law, cultural practice, and regulation of ritual purity. The importance of Leviticus is stressed as the turning point when emphasis mercy, typical of the Prophetic tradition, is combined with the legal tradition, yielding the change in sensibility of the Second Temple time. Philo of Alexandria is described as one of the three leading figures – together with Rabbi Hillel and Rabbi Yeshua – at the apex the emergence of the mentioned new sensibility, gradually including mercy as an essential part of justice and establishing the starting point of both the Rabbinic and the Christian tradition. This consists precisely in the precept of one’s neighbour’s love or of the golden rule, two eventually identical precepts whose meaning is arguably more sober and sensible than the long-lasting Christian tradition deriving from John and Augustine has made us believe and no novelty vis-à-vis so-called Ancient-Testament teachings. -/- 7. Augustine and Christianity as Neo-Platonism. The first section examines the moral doctrines of so-called 'ethical Treaties' from the Talmud, a group of treaties, among which the best known is Pirqé Avot, that were left out of the six "orders" of the canon as they did not fit in any of the six groups of issues ritual or legal on which the division was based. According to Maimonides, their peculiar theme is provided by the Deòt, 'opinions', i.e., mental dispositions, that is, the translation of the Greek term hexeis and Arab akhlak (in turn providing in this language the name for ethics as such). The three topics I reconstruct are: i) the notion of Torah: The Torah is understood as the world order itself, or as the ‘Wisdom’ that existed even before creation and was ‘the tool by which the world was built’; however, the Torah is an earthly and human entity, as it was "received" by humans, and from that very moment belongs to them; ii) the relationship between love of God and love of neighbour; the treaties require us to study and practice the Torah ‘for its own sake’, that is, require us to act out of love, not out of fear or hope of reward; iii) the idea of sanctification of daily life: having disappeared with the destruction of the Temple the possibility of any conflict between liturgical service and everyday life, the latter is assumed to be in itself divine service: to give food to the poor has the same value as sacrifices in the Temple, and as an implication, the insistence become recurrent on the goodness of created things in themselves along with a polemic against ascetic currents. The conclusions drawn are: i) the moral teachings of the Talmud and those of Yeshua are, rather than similar, virtually identical; one may safely say that the precept of love and the golden rule are central ones for all Talmudic rabbis, that mercy plays an indispensable role alongside with justice, and the latter is not a different thing from one’s neighbour’s love; ii) a peculiarity of Talmud rabbis facing Yeshua is the idea of study as worship, and knowledge as a source of justice; but this is an idea of Judaism after the Temple's destruction that cannot be attributed to the Pharisees of Yeshua’s time; iii) the relation of study and practice in the Talmud parallels that between faith and deeds in Paul's epistles, that is, respectively faith or learning are a necessary and sufficient condition to be recognized as righteous , but deeds are the inevitable effect of either faith or learning. The sayings ascribed to Yeshua are examined first, yielding the conclusion that a close equivalent may be found for every saying in Talmudic literature and yet the whole is ascribed to one rabbi, with rather consistent stress on God’s mercy and unconditional forgiving as the mark of true imitation of God. Thus, Yeshua’s teaching is pure Judaism. The third section describes briefly the galaxy of Gnostic currents and Manichaeism, trying to sketch the profile of moral teachings resulting from an encounter of Asian spiritual traditions, Hellenistic lore and sparks of teachings from apocalyptic Jewish currents. The last section summarizes the turbulent history of several encounters between Christian currents and Hellenistic philosophical schools. The first one was with late Cynicism. Recent, rather controversial, literature discovered the jargon and a few topics from the Stoic-Cynical popular philosophy in a few books from the New Testament itself. This, far from proving that Rabbi Yeshua had been influenced by cynic preachers, is a proof of the necessity felt by Christian preachers to translate the original ‘Christian’ teaching into a Greek lexicon deeply impregnated with cynic terminology. The second was with Platonism, yielding the mild and temperate moral teaching of Clemens of Alexandria, teaching the sanctity of nature and the human body, the joy of moderate fruition of ‘natural’ kinds of pleasures, and the beauty of the marital life – in short, the opposite of the standard picture of Medieval Christianity. Ambrose of Milan brings about a different kind of synthesis, namely with Middle Platonism, where Stoic themes prevail. The most shocking case is Augustine, where an early Manichean education is overcome in a former phase by a synthesis of Plotinian Neo-Platonism and Christian preaching, yielding a sustained polemic with the Manicheans and rather optimistic views on life and Creation, the body and sexuality, and Hebrew-Judaic tradition not far from Clemens of Alexandria. In a later phase, occasioned by controversy on the opposite front, with such Christian currents as the Pelagians and Donatists, Augustine comes back to heavily anti-Judaic and world-denying ascetic attitudes where is earlier Manichean upbringing seems to emerge again. The tragedy of medieval Christianity will be the later Augustine’s overwhelming influence. A final section is dedicated to the monastic tradition where a curious mixture of world-denying asceticism with an astonishingly penetrating ‘science’ of introspection emerges. -/- 8. Al Farabi and the reconciliation of Islam and Platonism. The Qurān and the qadit, that is, collections of sayings ascribed to the prophet Muhammad contain a wealth of precepts and catalogues of virtues mirroring moral contents from the Jewish and the Christian traditions, among them the basic notion of imitation of the Deity, where mercy is assumed to be its basic trait. An important tradition within Islam, namely Sufism, stressed to the utmost degree the role of mercy, turning Islam into a mystic doctrine centred on retreat from the world, abandonment to God’s will, and a peaceful and fraternal attitude to our fellow-beings. A secular literary tradition originating in the Sassanid Empire, the literature of advice to the Prince had for a time a widespread influence in the newly constituted Arabic-Islamic commonwealth. In a later phase, the legacy of Hellenic philosophy made its way into the intellectual elite of the Islamic world. The first important legacy was Platonic, and the Republic became the main text for Islamic Platonism. Al-Farabi wrote an enjoyable remake of the Platonic Republic, arguing that the citizen’s virtues were the basis on which the political building needs to rest. The secular lawgiver is enlightened by the light of reason in his everyday practice of governance, but room is made for the Prophet as the voice of revealed truth that confirms and completes the rational truth that philosophy may afford. In a second phase also Aristotelian and Stoic influence were assimilated. Miskawayh’s treatise was the masterwork at the time Arabic philosophy reached its Zenith. It is a treatment of the soul’s diseases and their remedies, combining the Aristotelian doctrine of the golden mean with the Stoic doctrine of the passions and elements of Galenic medicine. Towards the eleventh-twelve centuries a war raged among theologians and philosophers, finally won by the former with disappearance of philosophy as such. The newly established mainstream, yet, was no kind of intolerant fanaticism. It drew from the work of mystic theologian Al-Ghazālī, the best heir of Sufism, teaching a tolerant and peaceful attitude to our fellow-beings and a passive attitude to destiny as an expression of the Divine will. -/- 9. Moshe ben Maimon and the reconciliation of Torah and Aristotelian ethics. The encounter between the Talmudic tradition and Hellenic philosophy had taken place a first time in Alexandria at the time of Philo but the two traditions had parted way again. In fact, the kind of Platonic Judaism founded by Philo survived only within Christianity, in the fourth Gospel and then in writings by Clemens of Alexandria. The Talmudic literature had absorbed just less striking traits from the Hellenic Philosophy, namely an idea of ethics as care of the self and a role for the education of character as propaedeutic to theoretical knowledge. In the Arabic-Islamic world, a second round started when Jewish authors writing in Arabic undertook the task to prove the full compatibility of the tradition deriving from Torah and Platonic philosophy. The culmination of this attempt is provided by Moshe ben Maimon who tried to use Aristotelian ethics as a language into which the teaching from the Pirké Avot could be translated. -/- 10. Thomas Aquinas and the reconciliation of Christian morality and Aristotelian ethics. In the first section the fresh start is described of philosophical ethics in Latin Europe at the turn of the Millennium. In a first phase, Anselm and Peter Abelard built on a Platonic and Augustinian legacy. In this phase. remarkable innovations are introduced, including Abelard’s claim of the obliging character of erring consciousness. In a second phase, the rediscovery of Nicomachean Ethics thanks to Latin translation of Arabic versions gives birth to a new wave of ethical studies, recovering the very idea of Aristotelian practical philosophy, with the potential implication of full legitimization of natural morality, i.e. ethics without Revelation. Aquinas’s ethics is a theological ethics out of which it would be vain to try to extract a self-contained philosophical ethics. His treatment of topics in philosophical ethics, yet, does not boil down to repetition of Aristotelian arguments but is rather a creative reshaping of such arguments. For example, he introduces also in the practical philosophy a first principle parallel to the principle of non-contradiction; and he also carries out a synthesis of Aristotelianism, Stoicism, and neo-Platonism. Even though it is essentially moral theology, Aquinas’s doctrine - unlike Augustine – grants full citizenship to "natural" morality, firstly by rejecting the claim that the corruption of human nature due to the original sin is so radical as to leave "pure nature" incapable of moral goodness. The doctrine is presented in a more sophisticated formulation in a few of the Quaestiones, such as De Malo and De Veritate, in the Summa contra Gentes and in the commentaries to Aristotle than in the famous Summa Theologica, but the latter work includes the only or the largest exposition of some decisive part of the theory. Thus, the Summa Theologica should be read for what it is more than criticized for not being what it was not meant to be. It was not meant to be the brilliant synthesis of all that Reason he had been able to produce with what Revelation had added about which the Neo-Thomists used to dream, but rather a manual for the training of preachers and confessors, where theoretical claims are not too demanding and a few serious tensions are left. Besides a jump between the Prima Secundae and the Secunda Secundae, being the former an essay in virtue theory and the latter a handbook for confessors, the most serious tension is perhaps the one between the ethics of right reason presented in most of Ia-IIae and the eudemonistic ethics developed in quaestiones 1-5 of the same part; the alternative ethical theory which also may be found in Augustine, the Stoic view of a cosmic reason eventually coincident with the moral law, was believed by Anselm (followed by John Duns Scotus and William of Ockham) to be incompatible with eudemonism. It is questionable whether Thomas could reduce the tension proving that it is just an apparent tension, in so far as the right reason and bliss derived from knowledge of God tend to coincide, but this is just a conjecture. Thomas’s ethics is a virtue ethic, not a law-based one, and moral judgment focuses on the virtues, particularly charity, not on the commandments and even less on absolute prohibitions; Thomas, however, would not have considered a drastic alternative between law and the virtues such as the one which has been advanced in late twentieth-century philosophy to be justified. Nonetheless, when it discusses ‘special’ virtues, it ceases to be an ethics of virtue and becomes a disappointing and often contradictory discussion of legal and illegal acts. Such a discussion takes most of the time ‘reasonable’ middle positions on controversial issues but not the alternative approach that Aristotelianism would have made possible; even when some occasional Aristotelian claim shows up, such as money’s barrenness as a reason against usury, this seems to be made by an author who apparently ignores the Aristotelian Thomas of the Prima Secundae. It is an ethic of human autonomy which recognizes the binding character of the individual conscience and, potentially, even a duty to disobey unjust laws. It is true that what Thomas writes in his discussion of death penalty and persecution of heretics is simply disgusting, and yet we should blame Thomas the man, not Thomist ethical theory. Finally, Thomas’s ethics is not ethical ‘absolutism’, as both traditionalist Catholic theologians and secularist enemies of dogmatic morality tend to believe. It is instead an ethic of prudential judgment. Exceptions to this approach – or better results of logical fallacies – are such claims as the absolute character of negative precepts and of the existence of "intrinsically evil acts", claims that simply cease to make sense in the light of Thomas’s own distinction between human act and natural act, carrying consequences Thomas did not live long enough to draw or was not consistent enough to dare to draw. -/- 11. Francisco de Vitoria and casuistry. The first topic illustrated is the discussion about the notion of pura natura, namely the human condition after the original sin and before divine revelation. The core notion was already there in Aquinas but was later developed by Caietanus (Thomas de Vio) with a number of interesting implications: firstly a view of human nature as such much more positive than Augustine’s and his followers’ view, including both Calvinists and Jansenists; secondly, the implication that the philosopher’s morality, as opposed to the Christian’s morality, is a quite respectable kind of morality; thirdly, that theocracy and prosecution of the unfaithful lacked justification, with more far-fetching consequences than Aquinas himself had dared to draw. The second topic is casuistry, a new name for a comparatively older way of thinking, which was already there in late Stoicism and Cicero as well as in the Talmudic literature. This is an approach aimed at yielding probable enough solutions for doubtful cases even in absence of completely safe staring points. The genre developed from medieval reference books for confessors and became by the sixteenth-century a sophisticated tool-box for dealing with various fields of applied ethics. Francisco Vitoria, the main authority of Baroque Scholasticism, was a controversial figure, among the proponents of the new discipline of casuistry and a consistent proponent of more separation between the religious and the civil authority, stricter limits to the legitimacy of war, innate rights of non-Christian nations in the New World based on the notion of pura natura, providing a standard of ‘natural’ goodness, previous to revelation, on which the Indian nations were judged to live in a naturally good condition, provided with the institutions of family, justice, and religion had accordingly a right to full respect by Christian sovereigns. Bartolomé de Las Casas, arguing along similar lines, was the leader of a historical battle in defence of the rights of the Indios. -/- 12. Michel de Montaigne and the art of living. A short description of one of the Renaissance Phyrronism, one of the classical philosophies revived in the fifteenth and sixteenth century. Montaigne combines the sceptical epistemology with an understanding of ethics – indeed of philosophy as a whole – in terms of an art of living inspired by two basic ideas, sagesse, that is, practical wisdom as the only kind of rationality available after theology, science, and tradition have declared bankrupt, and an aesthetic ideal of self-transformation through the art of writing and introspection. -/- 13. Pierre Nicole and neo-Augustinianism. The chapter illustrates first the vicissitudes of Augustinianism newly born after the late medieval triumph of Thomist Aristotelianism in the alternative Protestant and Catholic versions processed by the Calvinists and the Jansenists. Then it illustrates the doctrines of Pierre Nicole, Blaise Pascal’s best disciple, on the impossibility of introspection, on the ubiquity of self-deception, on the incurably evil character of the passion of love, and on the two moralities, the one of the man of the world, the morality of honesty which is indispensable for granting peace and order but devoid of any true value for eternal salvation, since the same external behaviour may be prompted by opposite motivations, and the morality of charity, the only true one but also useless to society. The third topic is Pierre Malebranche’s view of self-deception as a ubiquitous phenomenon accounting for human action and responsibility and his reformulated theory of self-love, no less ubiquitous than for Nicole and yet not as incurably evil, given the distinction between morally indifferent and even necessary amour de soi and vicious amour proper, a distinction on which the whole of Rousseau’s moral and political theory rests. -/- 14. Samuel von Pufendorf and the new science of morality. The chapter is dedicated to the discovery of the idea of a ‘new moral science’. Hugo Grotius is discussed first highlighting the real character of his project, much closer to the Thomist idea of a natural law accessible to non-corrupted human reason when human beings are living in a state of pura natura. Then Hobbes’s combination of scepticism, voluntarism, and conventionalism is described and both the continuity with Grotius’s new science, in the search for non-revealed rational morality, and the break with him, in the adoption of voluntarism and refusal of an intellectualist view of natural law, are illustrated. Pufendorf’s work is illustrated as a synthesis of the two previous attempts and the – up to Schneewind underestimated – paradigmatic example of the new science of morality. -/- 15. Richard Cumberland and consequentialist voluntarism. The chapter gives an overview of eighteenth-century Anglican ethics, noticing how the Cambridge tradition gave special weight to natural theology as opposed to positive or revealed theology – and how two Cambridge fellows, John Gay and Thomas Brown, elaborated on Cumberland’s (and Malebranche’s, as well as Leibniz’s) strategy for finding a third way between intellectualist view and voluntarist view of the laws of nature. The result of their elaboration was a kind of a rational-choice account of the origins of natural laws, where a law-giver God chooses among a number possible sets of laws on a maximizing criterion, and God’s maximandum is happiness for his creatures. The chapter notices also how such a solution aimed at solving at once the problem of evil and that of the foundation of moral obligation by proving how God’s choice was justified as far as it was the one minimising the amount of suffering in the world. 16. Richard Price and intuitionism. The chapter describes first the doctrines of the Cambridge Platonists, an example of hyper-rationalist reaction to Calvinism. Secondly it describes the sophisticated and universally ignored – from Sidgwick to Anscombe –version of what was later labelled ‘ethical intuitionism’ – showing how it escapes familiar objections and misrepresentations of intuitionism – from Mill to Rawls – in grounding its argument on transcendental arguments while carefully avoiding recourse to introspection and psychological evidence, which has been taken as a too easy target by critics of intuitionism. Thirdly, the chapter discusses Whewell’s ‘philosophy of morality’, as opposed to ‘systematic morality’, not unlike Kant’s distinction between a pure and an empirical moral philosophy. Whewell worked out a systematization of traditional normative ethics as a first step before its rational justification; he believed that the point in the philosophy of morality is justifying a few rational truths about the structure of morality such as to rule hedonism, eudemonism, and consequentialism; yet a system of positive morality cannot be derived solely from such rational truths but requires consideration of the ongoing dialectics between idea and fact in historically given moralities. Whewell’s intuitionism turns out closer to Kantian ethics than commentators have made us believe until now, and quite different from what Sidgwick meant by intuitionism. -/- 17. Adam Smith and the morality of role-switch. The chapter describes first, Hutcheson’s attempt at basing the ‘new science’ of natural law on different bedrock than Pufendorf and the English Platonists, namely a moral sense, a faculty whose existence is assumed to be proved on an empirical basis. The second step is a reconstruction of Hume’s rejoinder in terms of a new science of man including morality on an ‘experimental’ basis, that is, a ‘Newtonian’ hypothetical-deductive approach, distinguished from Hutcheson’s allegedly uncritical descriptive approach to human nature. The third step is a reconstruction of Adam Smith theory of morality understood as emerging from a spontaneous interplay of exchanges of situations (the most basic meaning of the word ‘sympathy’ as construed by this author). -/- 18. Jeremy Bentham and utilitarianism. The bulk of the chapter is dedicated to the doctrines of Jeremy Bentham. The Enlightenment spirit that suggested the idea of a new morality, free from religion, is illustrated. The notion of utility is illustrated as well as the subsequent formulations of the principle of utility. The idea of felicific calculus is discussed, showing how its inner difficulties prompted several reformulations of the principle of utility in order to avoid undesirable implications of proposed formulations. The role of the thesis of spontaneous convergence between interest and duty is discussed, showing how it left numberless questions open, and the distinction between the virtues of prudence, justice and beneficence is described as a way out of the deadlocks of classical utilitarianism. After Bentham, Mill’s reformed utilitarianism is reconstructed, showing how it is a kind of mixed system – as closer to common sense as it gives up Bentham’s claims to consistency and simplicity – resulting as unintended consequences from the controversies in which Mill was too keen to engage. The hidden agenda of the controversy between Utilitarianism and Intuitionism, going beyond the image of the battle between Prejudice and Reason, is described, showing how both competing philosophical outlooks turn out to be more research programs than self-contained doctrinal bodies, and such programs appear to be implemented, and indeed radically transformed while in progress thanks to their enemies no less than to their supporters. -/- 19. Immanuel Kant, practical reason and judgment. The chapter argues that Kant took from Moses Mendelssohn the idea of a distinction between geometry of morals and a practical ethic. He was drastically misunderstood by his followers precisely on this point. He had learned from the sceptics and the Jansenists the lesson that men are prompted to act by deceptive ends, and he was aware that human actions are also empirical phenomena, where laws like the laws of Nature may be detected. His practical ethics made room for judgment as a holistic procedure for assessing the saliency of relevant moral qualities in one given situation; this procedure yields the same results as the geometry of morals does for abstract cases but does so immediately and without balancing conflicting duties with each other, since what makes for the salient quality of a situation is perceived from the very beginning. Kant's practical philosophy is richer than the received image, making room for an ‘empirical moral philosophy’ or moral anthropology including treatment of commerce, needs, value and price, happiness and well-being; the overall social theory and philosophy of history is less different from Adam Smith's than the received image makes believe; the paradox of happiness is central to Kant's philosophy; a distinction between happiness and well-being is clearly drawn; the distinction plays a basic role in establishing a link between the economic and the moral life. -/- 20. Georg Wilhelm Friedrich Hegel and the critique of abstract universalism. The chapter describes first the Romantic movement and the implications some of its concerns, rescuing passions, community, tradition, the individual as the bearer of a unique destiny, and the longing for organic unity between the individual, mankind and nature. Hegel’s contribution is discussed then, highlighting how, on the one hand, he shared a number of these concerns and on the other he had more rationalist leanings. The notion of morality is the pivotal point of the reconstruction, highlighting how Hegel construes this notion as a key to his own diagnosis of the malaise of modernity – the separation of individual and Gemeinschaft – and how his attack on Kant turns around this very idea. -/- 21. Friedrich Nietzsche against Christianity and the Enlightenment. The chapter illustrates first the idea of deconstruction of the back-world of values. Nietzsche claims to be legitimate heir of the French moralists, Leibniz, Kant and Hegel, in so far as he allegedly carries out to its deepest implications their discovery of what lies behind traditional naïve belief in the existence of an objective realm of values just waiting for description by the philosopher. The two exemplars form which genealogy draws inspiration are the classical philologist’s historical reconstructions of lost meanings and the chemist’s decomposition of elements. Then the genealogy of the notions of good and evil carried out in the first dissertation of Genealogy of morals is illustrated with its paradoxical conclusion that will to power is in fact the only ‘genuine’ kind of goodness. The third point illustrated is the dialectic of ascetism and self-realization with its ambiguous outcome. The suggested interpretation of such outcome is that Nietzsche’s normative ethics is a kind of virtue ethics taking an aesthetic ideal as a normative standard -/- 22. George Edward Moore and ideal utilitarianism. The chapter discusses the ideas of common sense and common-sense morality in Sidgwick. I argue that, far from aiming at overcoming common-sense morality, Sidgwick aimed purposely at grounding a consist code of morality by methods allegedly taken from the natural sciences to reach, also in ethics, the same kind of “mature” knowledge as in the natural sciences. His whole polemics with intuitionism was vitiated by the a priori assumption that the widespread ethos of the educated part of humankind, not the theories of the intuitionist philosophers, was what was worth considering as the expression of intuitionist ethics. In spite of a naïve positivist starting-point, Sidgwick was encouraged by his own approach in exploring the fruitfulness of coherentist methods for normative ethics. Thus, Sidgwick left an ambivalent legacy to twentieth-century ethics: the dogmatic idea of a “new” morality of a consequentialist kind, and the fruitful idea that we can argue rationally in normative ethics albeit without shared foundations. Then it reconstructs the background of ideas, concerns and intentions out of which Moore’s early essays, the preliminary version, and then the final version of Principia Ethica originated. I stress the role of religious concerns, as well as that of the Idealist legacy. I argue that PE is more a patchwork of rather diverging contributions than a unitary work, not to say the paradigm of a new school in Ethics. I add a comparison with Rashdall’s almost contemporary ethical work, suggesting that the latter defends the same general claims in a different way, one that manages to pave decisive objections in a more plausible way. I end by suggesting that the emergence of Analytic Ethics was a more ambiguous phenomenon than the received view would make us believe, and that the wheat (or some other gluten-free grain) of this tradition, that is, what logic can do for philosophy, should be separated from the chaff, that is, the confused and mutually incompatible legacies of Utilitarianism and Idealism. -/- 23. Edmund Husserl and the a-priori of action. The chapter illustrates first the idea of phenomenology and the Husserl’s project of a phenomenological ethic as illustrated in his 1908-1914 lectures. The key idea is dismissing psychology and trying to ground a new science of the a priori of action, within which a more restricted field of inquiry will be the science of right actions. Then the chapter illustrates the criticism of modern moral philosophy carried out in the 1920 lectures, where the main target is naturalism, understood in the Kantian meaning of primacy of common sense. The third point illustrate is Adolph Reinach’s theory of social acts as a key the grounding of norms, a view that basically sketches the very ideas ‘discovered’ later by Clarence I. Lewis, John Searle, Karl-Otto Apel and Jürgen Habermas. A final section is dedicated to Nicolai Hartman, who always refused to define himself a phenomenologist and yet developed a more articulated and detailed theory of ‘values’ – with surprising affinities with George E. Moore - than philosophers such as Max Scheler who claimed to Husserl’s legitimate heirs. -/- 24. Bertrand Russell and non-cognitivism. The chapter reconstructs first the discussion after Moore. The naturalistic-fallacy argument was widely accepted but twisted to prove instead that the intuitive character of the definition of ‘good’, its non-cognitive meaning, in a first phase identified with ‘emotive’ meaning. Alfred Julius Ayer is indicated as a typical proponent of such non-cognitivist meta-ethics. More detailed discussion is dedicated to Bertrand Russell’s ethics, a more nuanced and sophisticated doctrine, arguing that non-cognitivism does not condemn morality to arbitrariness and that the project of a rational normative ethics is still possible, heading finally to the justification of a kind of non-hedonist utilitarianism. Stevenson’s theory, another moderate version of emotivism is discussed at some length, showing how the author comes close to the discovery of the role of a pragmatic dimension of language as a basis for ethical argument. Last of all, the discussion from the Forties about Hume’s law is described, mentioning Karl Popper’s argument and Richard Hare’s early non-cognitivist but non-emotivist doctrine named prescriptivism. -/- 25. Elizabeth Anscombe and the revival of virtue ethics. The chapter discusses the three theses defended by Anscombe in 'Modern Moral Philosophy'. I argue that: a) her answer to the question "why should I be moral?" requires a solution of the problem of theodicy, and ignores any attempts to save the moral point of view without recourse to divine retribution; b) her notion of divine law is an odd one more neo-Augustinian than Biblical or Scholastic; c) her image of Kantian ethics and intuitionism is the impoverished image manufactured by consequentialist opponents for polemical purposes and that she seems strangely accept it; d) the difficulty of identifying the "relevant descriptions" of acts is not an argument in favour of an ethics of virtue and against consequentialism or Kantian ethics, and indeed the role of judgment in the latter is a response to the difficulties raised by the case of judgment concerning future action. A short look at further developments in the neo-naturalist current is given trough a reconstruction of Philippa Foot’s and Peter Geach’s critiques to the naturalist-fallacy argument and Alasdair MacIntyre’s grand reconstruction of the origins and allegedly unavoidable failure of the Enlightenment project of an autonomous ethic. -/- 26. Richard Hare and neo-Utilitarianism. The chapter addresses the issue of the complex process of self-transformation Utilitarianism underwent after Sidgwick’s and Moore’s fatal criticism and the unexpected Phoenix-like process of rebirth of a doctrine definitely refuted. A glimpse at this uproarious process is given through two examples. The first is Roy Harrod Wittgensteinian transformation of Utilitarianism in pure normative ethics depurated from hedonism as well as from whatsoever theory of the good. This results in preference utilitarianism combined with a ‘Kantian’ version of rule utilitarianism. The second is Richard Hare’s two-level preference utilitarianism where act utilitarianism plays the function of eventual rational justification of moral judgments and rule-utilitarianism that of action-guiding practical device. -/- 27. Hans-Georg Gadamer and rehabilitation of practical philosophy. The post-war rediscovery of ethics by many German thinkers and its culmination in the Sixties in the movement named ‘Rehabilitation of practical philosophy’ is described. Among the actors of such rehabilitation there were a few of Heidegger’s most brilliant disciples, and Hans-Georg Gadamer is chosen as a paradigmatic example. His reading of Aristotle’s lesson I reconstructed, starting with Heidegger’s lesson but then subtly subverting its outcome thanks to the recovery of the central role of the notion of phronesis. -/- 28. Karl-Otto Apel and the revival of Kantian ethics. Parallel to the neo-Aristotelian trend, there was in the Rehabilitation of practical philosophy a Kantian current. This started, instead than the rehabilitation of prudence, with the discovery of the pragmatic dimension of language carried out by Charles Peirce and the Oxford linguistic philosophy. On this basis, Karl-Otto Apel singled out as the decisive proponent of the linguistic and Kantian turn in German-speaking ethics, worked out the performative-contradiction argument while claiming that this was able to provide a new rational and universal basis for normative ethics. An examination of his argument is some detail is offered, followed by a more cursory reconstruction of Jürgen Habermas’s elaboration on Apel’s theory. -/- 29. John Rawls and public ethics as applied ethics. Rawls’s distinction between a “political” and a “metaphysical” approach to one central part of ethical theory, namely the theory of justice, is interpreted as a formulation of the same basic idea at the root of both the principles approach and neo-casuistry, both discussed in the following chapter, namely that it is possible to reach an agreement concerning positive moral judgments even though the discussion is still open – and in Rawls’ view never will be close – on the basic criteria for judgment. -/- 30. Beauchamp and Childress and bioethics as applied ethics. The chapter presents the revolution of applied ethics while stressing its methodological novelty, exemplified primarily by Beauchamp and Childress principles approach and then by Jonsen and Toulmin’s new casuistry. -/- . (shrink)

In “Consensus, Clinical Decision Making, and Unsettled Cases,” David M. Adams and William J. Winslade make multiple references to both editions of the American Society of Bioethics and Humanities (ASBH) Core Competencies for Healthcare Ethics Consultation in their discussion of two assumptions that are supposed to be at the heart of the facilitated consensus model’s inability to handle unsettled cases; that is, that:1. Consultants “should maintain a kind of moral impartiality or neutrality throughout the process,” “explicitly condemn[ing] (...) anything resembling a substantive ‘ethics’ recommendation,” and2. “What counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible.”Herein, I argue that neither of these assumptions is required by ASBH’s ethics facilitation approach. I then conclude by suggesting that, despite their fundamentally mistaken interpretation of the ASBH approach—perhaps even because of it—Adams and Winslade have made two important contributions to the ethics consultation literature. (shrink)

Over the past several years, the bioethics community has seen considerable attention being given in the bioethics literature and in various initiatives to the matter of standards and quality in hea...

There are many ways to avoid responsibility, for example, explaining what happens as the work of the gods, fate, society, or the system. For engineers, “technology” or “the organization” will serve this purpose quite well. We may distinguish at least nine (related) senses of “responsibility”, the most important of which are: (a) responsibility-as-causation (the storm is responsible for flooding), (b) responsibility-as-liability (he is the person responsible and will have to pay), (c) responsibility-as-competency (he’s a responsible person, that is, he’s rational), (...) (d) responsibility-as-office (he’s the responsible person, that is, the person in charge), and (e) a responsibility-as-domain-of-tasks (these are her responsibilities, that is, the things she is supposed to do). For all but the causal sense of responsibility, responsibility may be taken (in a relatively straightforward sense)—and generally is. Why then would anyone want to claim that certain technologies make it impossible to attribute responsibility to engineers (or anyone else)? In this paper, I identify seven arguments for that claim and explain why each is fallacious. The most important are: (1) the argument from “many hands”, (2) the argument from individual ignorance, and (3) the argument from blind forces. Each of these arguments makes the same fundamental mistake, the assumption that a certain factual situation, being fixed, settles responsibility, that is, that individuals, either individually or by some group decision, cannot take responsibility. I conclude by pointing out the sort of decisions (and consequences) engineers have explicitly taken responsibility for and why taking responsibility for them is rational, all things considered. There is no technological bar to such responsibility. (shrink)

Although bioethics societies are developing standards for clinical ethicists and a code of ethics, they have been castigated in this journal as “a moral, if not an ethics, disaster” for not having completed this task. Compared with the development of codes of ethics and educational standards in law and medicine, however, the pace of pro-fessionalization in bioethics appears appropriate. Assessed by this metric, none of the charges leveled against bioethics are justified. The specific charges leveled against the American Society (...) for Bioethics and Humanities and its Core Competencies report are analyzed and rejected as artifacts of an ahistoric conception of the stages by which organizations professionalize. For example, the charge that the ASBH should provide definitive criteria for what counts as “medical ethics consultation” antecedent to further progress towards professionalization is assessed by comparing it with the American Medical Association's decades-long struggle to define who can legitimately claim the title “medical doctor.” Historically, clarity about who is legitimately a doctor, a lawyer — or a “clinical ethicist”— is a byproduct of, and never antecedent to, the decades-long process by which a field professionalizes. The charges leveled against ASBH thus appear to be a function of impatient, ahistoric perfectionism. (shrink)

Upon entering the examination room, Caitlyn encounters a woman sitting alone and in distress. Caitlyn introduces herself as the hospital ethicist and tells the woman, Mrs. Dennis, that her aim is to help her reach a decision about whether to perform an autopsy on her recently deceased husband. Mrs. Dennis begins the encounter by telling the ethicist that she has to decide quickly, but that she is very torn about what to do. Mrs. Dennis adds, “My sons disagree about the (...) autopsy.” As a standardized patient, a specialized actor, the woman playing Mrs. Dennis has already delivered the same opening lines several times to different learners practicing their clinical ethics consultation skills. An SP encounter is a simulated patient encounter used for educational purposes that requires the standardization of verbal and behavioral responses. In the encounter, the simulator, or “patient,” uses a scripted medical history to enable the learner to employ a certain skill, say, the ability to perform a neurological exam. The use of standardized patients in the evaluation of clinical skills has become a staple in medical education. To tackle the challenge of teaching clinical ethics consultation skills, we have incorporated SP encounters into the curriculum of the Bioethics Program of The Union Graduate College and the Icahn School of Medicine at Mount Sinai. SP encounters are incorporated into one of our onsite classes, the Onsite Clinical Ethics Practicum, and they are part of the capstone examination, which all of our graduates must complete successfully. The inclusion of simulated encounters into the curriculum is one way in which we equip our students with the core competencies specified by the American Society for Bioethics and Humanities Task Force for clinical ethicists. (shrink)

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

As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities has published (...) core knowledge competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models—both objective and written—must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization. (shrink)

Heart rate variability (HRV) is an indicator of the regulation of the heart, see Task Force (Circulation 93(5):1043–1065, 1996). This study compares the regulation of the heart in two cases of healthy subjects within real life situations: Marathon runners and shift workers. After an update on the state of the art on HRV processing, we specify our probabilistic model: We choose modeling heartbeat series by locally stationary Gaussian process (Dahlhaus in Ann Stat 25, 1997). HRV is then (...) processed by the combination of two statistical methods: (1) Continuous wavelet transform for calculating the spectral density energy in the high frequency (HF) and low frequency (LF) bands and (2) Change point analysis to detect changes of heart regulation. Next, we plot the variations of the HF and LF energy in extreme conditions for both populations. This puts in light, that physical activities (rest, moderate sport, marathon race) can be ordered in a logical continuum. This allows to define a new index based on HF and LF energy that is log HF + log LF which appears relevant to measure HR regulation. The results obtained are pertinent but have to be completed by further studies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics Commissions: Town Meetings with a “Blue, Blue Ribbon”Susan Cartier Poland (bio)Town meetings are characteristic of New England. In theory, a quorum of registered voters in a small municipality meets annually to decide local public policy. In fact, special interests and the town bureaucracy control the meeting.Like a town meeting, a commission (or committee or council) comes into being, whether on an ad hoc or permanent basis, to direct (...) a government function. Bioethics commissions specialize in one area: the intersection of public policy with developments, either real or anticipated, in the basic and applied sciences.That specialization of commissions carries over into the selection of the members. More often than not commission members are appointed on the basis of expertise in a specific area. Although some commissions are still made up entirely of one kind of expert, usually medical, the majority of these government bodies seek breadth between the fields of law, religion, ethics, and science (including medicine and the social sciences).In the words of Mrs. Rigenbach, the law clerk to Chief Judge Carl B. Rubin of the United States District Court for the Southern District of Ohio, selection of persons “knowledgeable in the field” constitutes a “blue, blue ribbon” jury. In contrast, a “blue ribbon” jury is composed of those persons having “the greatest amount of formal education” (In re Richardson-Merrill, Inc. (Bendectin litigation), 624 Federal Supplement 1212 at 1217 (1985)). The problem with persons knowledgeable in the field is that their minds may have already been made up. For a jury, this is a disaster; for a bioethics commission, this directs and shapes the research, investigation, and discussion, or, in short, it makes for more efficient decision making.For this Scope Note, the definition of commission begins with the Bioethicsline description of its index term “advisory committees” as committees or commissions set up to advise government bodies on public policy. Furthermore, a commission [End Page 91] (or committee) receives government funding and support in exchange for its expertise in research, investigation, reporting, and recommendations.Six functions served by bioethics commissions have been clearly and succinctly described by LeRoy Walters (Commissions and Bioethics. Journal of Medicine and Philosophy 14 (4): 363–68, August 1989). The functions are: (1) to legitimize action; (2) to delay action or resolution; (3) to identify duplication; (4) to be representative; (5) to do research and find facts; and (6) to provide education and support (pp. 364–65). Since 1989, however, another government function has moved to the forefront. Instead of remaining within the legislative arena, government commissions serve the judiciary as well, in cases involving complex and technical questions. The now defunct Law Reform Commission of Canada recognized this use when it included in its annual reports a section on its “Influence on Law Reform through Judicial Decisions.”In mid-1997, the United States Supreme Court in its consolidated cases on assisted suicide used extensively the writings from a state commission, the New York State Task Force on Life and the Law, to support its rationale. Not only did the Court make use of the Task Force’s work, but in so doing the Court extended the efforts of the commission beyond its jurisdiction of New York into another jurisdiction on the opposite coast, Washington state. Furthermore, although the commission was chartered by one state, through the federal court system, its influence became national.Outside the U.S., the United Nations recently adopted its first bioethics text on the ethics of genetic research, and Canada is reworking its human research guidelines into a single set of guidelines that will apply to research in both the natural sciences and the social sciences.This Scope Note attempts to compile for the researcher and the reference librarian those commissions, existing and defunct, that have addressed bioethics issues. Only one other such attempt is known to the author, an Office of Technology Assessment [OTA] Background Paper, Biomedical Ethics in U.S. Public Policy (1993). Due to space limitations, not all publications could be listed; the selections included represent the range of topics from a particular group or the more frequently cited sources. Future updates of this compilation are planned, so please notify the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics and the Allocation of Organs for TransplantationJames F. Childress (bio)A quarter of a century ago, in my second year of teaching at the University of Virginia, I began to explore the emerging field of biomedical ethics through a seminar on “Artificial and Transplanted Organs,” which included both faculty and students from law, medicine, and the humanities. My paper for the seminar was entitled “Who Shall Live When Not (...) All Can Live?” This experience drew me into biomedical ethics, because of the complex mix of ethical, legal, and medical issues and the fruitfulness of interdisciplinary and interprofessional dialogue.Several of the major problems confronting that seminar have persisted, often in altered form. In the area of organ transplantation, two significant issues continue to require society’s attention: (1) how can the organ supply be increased, and (2) how should the available organs be allocated? I want to make a few points about ethical criteria in the allocation of donated organs, as a way to indicate some directions for organ allocation policies in the twenty-first century. I will focus on the second question because I believe that a tremendous and ever-widening gap will persist between the need for transplantable organs and the supply of human cadaveric organs.Community Ownership of Donated Organs and Public ParticipationSince the mid-1980s, the operative conception of the ownership of donated organs has shifted, with major implications for the procedures used to formulate policies for organ allocation. As vice-chair of the federal Task Force on Organ Transplantation in the mid-1980s, I did not immediately realize that debates about allocation policies often reflected different conceptions of the ownership of donated organs. More specifically, organ allocation policies largely presupposed that donated organs belonged to, or were under the dispositional authority of, transplant surgeons, with only limited public accountability. However, the Task Force (1986) held that donated organs belong to the community, and that transplant professionals are only trustees and stewards of those organs for the [End Page 397] community’s welfare. This conception of ownership implies that the public should participate in setting the criteria for organ allocation.According to Jeffrey Prottas (1994), another member of the Task Force, these shifts represent the “socialization” of organ transplantation. Although professional dominance, through knowledge and power, continues in the United Network for Organ Sharing (UNOS)—the national organ procurement and transplantation network that was established in the late 1980s—that dominance is now more circumscribed and accountable, particularly because UNOS, in developing any allocation policy, has to respond “to public criticisms with public answers.” Not only is organ allocation policy now in the public domain—and thus a matter of public ethics rather than medical ethics—the terms of the debate have changed, as Prottas further notes, so that equity must be considered along with efficiency.Balancing Several Ethical Principles or ValuesThe main ethical criteria for organ allocation express principles that are prominent in the major competing theories of justice, particularly libertarian, egalitarian, utilitarian, and communitarian theories. The principles of liberty, equality, utility, and community all play important roles, and organ allocation policies often seek to balance these competing principles, which frequently are specified or circumscribed—for instance, utility is specified as medical utility. Just or equitable policies are found in the process of balancing.UNOS (1994) attempts to develop an equitable organ allocation system in light of a “set of basic principles” and “specific measurable objectives” that have been derived from these principles. It uses the metaphor of “balance” for its efforts to relate these different principles and objectives. For instance, it holds that balancing requires that “equal consideration” be given to both medical utility and to justice, so that neither can be ranked a priori over the other. However, it may not be possible to “give equal weight to [both] medical utility and justice” (UNOS 1994, p. 123) because trade-offs appear to be unavoidable in many policies and are consistent with the metaphor of balancing.Medical Utility and EqualityMedical utility—maximizing the welfare of patients suffering from end-stage organ failure—includes, at a minimum, attention to the factors that influence both graft and patient survival, as well... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 4.1 (1997) 91-93 Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, and Psychology Articles Allen, J. F., J. Hallperin, and R. Friend. 1985. Removal and diversion tactics and the control of auditory hallucinations. Behavior Research and Therapy 23:601-605.Baker, H. D. 1995. Psychoanalysis and ideology: Bakhtin, Lacan, and Zizek. History of European Ideas 20:499-504.Bernet, R. 1994. Derrida-Husserl-Freud: The trace of transference. Southern (...) Journal of Philosophy 32 suppl.:141-158.Boden, M. A. 1996. Commentary on "Towards a design-based analysis of emotional episodes." Philosophy, Psychiatry, & Psychology 3, no. 2:135-136.Castelfranchi, C., and M. Miceli. 1996. Commentary on "Towards a design-based analysis of emotional episodes." Philosophy, Psychiatry, & Psychology, no. 2:129-133.Fowes, B. J., and F. C. Richardson. 1996. Why is multiculturalism good? American Psychologist 51, no. 6:609-621.Frith, C. 1996. Commentary on "Free will in the light of neuropsychiatry." Philosophy, Psychiatry, & Psychology 3, no. 2:91-93.Forde, R. 1996. Inclusion of psychosocial conditions in clinical practice and the problem of medicalization. Theoretical Medicine 17, no. 2:151-161.Gaylin, W., and D. Doukas. 1995. The second-hand suicide threat. Hastings Center Report 25:20-22.Gillet, G. 1995. Consciousness, thought, and neurological integrity. Journal of Mind and Behavior 16, no. 3:215-233.Haskell, R. E. 1993. Realpolitik in the addictions field: Treatment-professional, popular-culture ideology, and scientific research. Journal of Mind and Behavior 14, no. 3:257-276.Kuys, T. 1995. The tally argument again. Methodological Science 28, nos. 2-3:43-55.Lear, J. 1995. The heterogeneity of the mental: Sebastian Gardner's irrationality and the philosophy of psychoanalysis. Mind: A Quarterly Review of Psychology and Philosophy 104:863-879.Libet, B. 1996. Commentary on "Free will in the light of neuropsychiatry." Philosophy, Psychiatry, & Psychology 2, no. 3:95-96.Lloyd, D. 1996. Commentary on "Toward a design-based analysis of emotional episodes." Philosophy, Psychiatry, & Psychology 3, no. 2:127-128.Pepper-Smith, R., W. R. C. Harvey, and M. Silberfeld. 1996. Competency and practical judgment. Theoretical Medicine 17, no. 2:135-150. [End Page 91]Spence, S. A. 1996a. Free will in the light of neuropsychiatry. Philosophy, Psychiatry, & Psychology 3, no. 2:75-90.------. 1996b. Response to the commentaries. Philosophy, Psychiatry, & Psychology 3, no. 2:99-100.Stein, D. J. 1996. The philosophy of psychopathy. Perspectives in Biology and Medicine 39:569-580.Stephens, G. L. 1996. Commentary on "Free will in the light of neuropsychiatry." Philosophy, Psychiatry, & Psychology 3, no. 2:97-98.Varela, C. R. 1995. Ethnogenic theory and psychoanalysis: The unconscious as a social construction and a failed explanatory concept. Journal for the Theory of Social Behavior 25:4.Weisberger, A. M. 1995. The ethics of the broader usage of Prozac: Social choice or social bias? International Journal of Applied Philosophy 10, no. 1:69-74.Wright, I., A. Sloman, and L. Beaudoin. 1996a. Response to the commentaries. Philosophy, Psychiatry, & Psychology 3, no. 2:137.------. 1996b. Towards a design-based analysis of emotional episodes. Philosophy, Psychiatry, & Psychology 3, no. 2:101-126. Books American Psychiatric Association. Task Force on Consent to Voluntary Hospitalization. 1993. Consent to voluntary hospitalization. Washington, DC: American Psychiatric Association.Christiansen, H. D. 1972. Ethics in counseling: Problem situations. Tucson: University of Arizona Press.Clark, P., and C. Wright, eds. 1988. Mind, psychoanalysis and science. New York: Blackwell.Comerchero, V., ed. 1970. Values in conflict: Christianity, marxism, psychoanalysis, existentialism. New York: Appleton-Century-Crofts.Epstein, R. S. 1994. Keeping boundaries: Maintaining safety and integrity in the psychotherapeutic process. Washington, DC: American Psychiatric Press.Fairbairn, G. J. 1995. Contemplating suicide: The language and ethics of self harm. New York: Routledge.Grubb, A., ed. 1991. Decision-making and problems of incompetence. New York: John Wiley & Sons.Haas, L. J., and J. L. Malouf. 1995. Keeping up the good work: A practitioner's guide to mental health ethics. 2nd ed. Sarasota: Professional Resource Exchange.Hacking, I. 1995. Rewriting the soul: Multiple personality and the sciences of memory. Princeton: Princeton University... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Dewey, Implementation, and Creating a Democratic Civic UniversityIra HarkavyThinking begins in... a forked-road situation, a situation that is ambiguous, that presents a dilemma, that poses alternatives.—John Dewey (How We Think 122)The social philosopher, dwelling in the region of his concepts, “solves” problems by showing the relationship of ideas, instead of helping men solve problems in the concrete by supplying them hypotheses to be used and tested in projects of (...) reform.—John Dewey (Reconstruction in Philosophy 192)Democracy must begin at home, and its home is the neighborly community.—John Dewey (The Public and Its Problems 213)democracy, as we all know, is seriously threatened throughout the world (Fisher). In the United States, the chasm-like inequities laid bare by COVID-19, the ongoing killing of black Americans, the violent insurrection at the Capitol, and the continuing attempt to subvert the electoral process are powerful indicators of a system under severe strain (Guardian Staff; Rubin). These developments are also a sign of deep and chronic problems, including the following:1. Increasing economic, political, social, educational, and health inequalities2. Increasing racism, anti-Semitism, and xenophobia3. Increasing attacks on science, knowledge, and democracy itself4. Declining trust in nearly all major institutionsMany things, obviously, contribute to the present situation. Among them is the failure of universities to successfully do what they are supposed to do: educate students to be ethical, empathetic, engaged, democratic citizens, and [End Page 49] advance knowledge for the continuous betterment of the human condition (Benson et al., Knowledge). To use a Marxian framework, but to reject its economic determinism, universities, in my judgment, are not a part of society’s superstructure. They are, to the contrary, a core component of its base (Marx, “Preface”). What they do matters enormously, significantly determining the kind of society we have now and will have in the future.Universities, as former Harvard president Derek Bok and others have emphasized, have become the central societal institutions in the world (Bok, Universities and the Future 3). Research universities, in my judgment, are the most central. They develop new ideas and technologies, incubate businesses, serve as cultural and artistic centers, and are engines of local, national, and global economies. As anchor institutions, they often engage in partnerships with government, the private sector, and community-based organizations to revitalize local neighborhoods and schools (“Anchor Institutions Task Force”). It is the university’s role as an educational institution, however, that is most important.The schooling system increasingly functions as the core subsystem—the strategic subsystem—of modern information societies. Schooling, more than any other subsystem, as John Dewey claimed, influences the functioning of the societal system as a whole. Viewed systemically, it has on balance the greatest “multiplier” effects, direct and indirect, short-term and long-term. Restating these points somewhat differently, I strongly agree with the Chilean sociologist Eugenio Tironi that the answer to the question “What kind of education do we need?” is to be found in the answer to the question “What kind of society do we want?” (Tironi). Education and society are dynamically interactive and interdependent. If human beings hope to maintain and develop a particular type of society, they must develop and maintain the particular type of education system conducive to it. As Dewey in effect argued: No effective democratic schooling system, no democratic society.1For William Rainey Harper, who, as the first president of the University of Chicago, brought Dewey to Chicago, universities are the primary shapers of the American schooling system. In an 1899 speech at the University of California, he perceptively observed that “[t]he school system, the character of which, in spite of itself, the university determines and in a large measure controls.... [T]hrough the school system every family in this entire broad land of ours is brought into touch with the university; for from it proceed the teachers or the teachers’ teachers” (Harper 25). Agreeing with Harper, I contend that higher education institutions powerfully shape the learning, values, and aspirations of students from kindergarten through graduate school. [End Page 50]Given the university’s societal role and influence, creating and sustaining an inclusive, just democratic society requires a... (shrink)

Moral development has become an integral part in military training and the importance of moral judgment and behavior in military operations can hardly be overestimated. Many armed forces have integrated military ethics and moral decision-making interventions in their training programs. However, little is known about the effectiveness of these interventions. This study examined the effectiveness of a 1-week training program in moral decision making in the Swiss Armed Forces. The program was based on a strategy-based interactional moral dilemma approach. Results (...) of this quasi-experimental intervention study showed significant improvements in content-related (moral and instrumental awareness, quality of moral information processing, development of compensatory actions) as well as process-related (situational analysis, development and evaluation of alternative solutions, justification of decision) aspects in moral decision making. Results of a follow-up test indicated positive long-term effects with regard to moral and instrumental awareness and process-related aspects. Findings are discussed, and consequences for leadership development programs and further research are explored. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Prayer in Greek ReligionFrances Hickson–HahnSimon Pulleyn. Prayer in Greek Religion. Oxford: Clarendon Press, 1997. xvi + 245 pp. Cloth, $75.The study of prayer in ancient Greece faces rather daunting obstacles. Only four brief texts remain which scholars agree may represent authentic examples of cultic prayer: the twoword prayer of Eleusinian initiates, the Athenian [End Page 632] prayer to Zeus for rain, a prayer to Demeter for the barley (...) sheaf, and the dithyramb of Elis, for a grand total of forty words. In addition, there are three fifth–century hymns from Epidaurus, a form not universally agreed to be prayer. In the area of epigraphic evidence, the largest body of prayer–like addresses derives from curse tablets which mostly postdate the classical period and which arguably belong not to the study of religion but to that of magic. Votive inscriptions, while plentiful, are rarely in prayer form. Thus, of necessity, the scholar is largely dependent on literary evidence, most of which is poetic.Thus it is a challenging task which Simon Pulleyn took on in this revised version of his doctoral thesis: to describe and interpret the mentality of all types of prayer in archaic and classical Greece in a relatively slight volume (216 pages plus appendices, etc.). The resulting monograph, "the first book–length study of Greek prayer to appear in English" (jacket), will prove a useful introduction to the body of evidence and major lines of research on Greek prayer. His work will be especially welcome to those not competent in the ancient languages, for Pulleyn translates all of the prayers proffered as examples, as well as modern foreign–language quotations. He also includes a brief glossary of fifteen Greek words especially important in the study of prayers. While he quotes an abundance of illustrative prayers, both literary and epigraphic, and devotes considerable space to lexicographic discussions, nevertheless he produces a quite readable text.Rejecting the broader definition of prayer as any address or appeal to supernatural powers, used by Aubriot–Sevin (Prière et conceptions religieuses en Grèce ancienne, Lyon, 1992), Pulleyn defines Greek prayers as "articulate requests directed toward the gods" and proposes a four–part classification of (1) prayers based on ξενία (2) curses (), (3) entreaties (λιταί), and (4) supplications ().While there is considerable ancient evidence to support the association of prayer with petition, such a narrow description leaves in limbo other types of address to the gods, such as thanksgivings and greetings, which are too important to be left out of this or any comprehensive study of prayer. And so Pulleyn is forced to devote much space to the discussion of material which he does not technically consider prayer. In fact, he himself varies between the technical use of the term "prayer" and the more common modern definition, a practice which naturally leads to some confusion. On occasion, he resorts to the term "prayer–like" to describe nonpetitionary addresses to gods.Perhaps the reason for this emphasis on petition is the author's main thesis that is the primary characteristic of the relationship between the ancient Greeks and their gods, and thus of prayer as well. Pulleyn explains thus: "it refers to a whole nexus of related ideas that we would call reciprocity. When one gives something to a god, one is giving in the sense that the offering is pleasing; but equally one is storing up for oneself a feeling of gratitude on the part of the god, which is also The whole two–way relationship can be called one of " (4). [End Page 633]This thesis, which is prominent in the first half of the book, is most fully developed in the second chapter, where Pulleyn examines prayers of the type, known particularly from the Homeric epics. He is especially concerned with the da quia dedi(t) model, which presents an argument for fulfillment of the accompanying request based on sacrifices previously offered. Numerically, in Homer and elsewhere, this is not a common prayer type. Although it would seem to violate the typical pattern of sacrifice offered in conjunction with prayer requests, Pulleyn argues convincingly for interpretation of this prayer type within the context of reciprocity. The connection with... (shrink)

In this article, I revisit Landau and Jackendoff's () paper, “What and where in spatial language and spatial cognition,” proposing a friendly amendment and reformulation. The original paper emphasized the distinct geometries that are engaged when objects are represented as members of object kinds, versus when they are represented as figure and ground in spatial expressions. We provided empirical and theoretical arguments for the link between these distinct representations in spatial language and their accompanying nonlinguistic neural representations, emphasizing the “what” (...) and “where” systems of the visual system. In the present paper, I propose a second division of labor between two classes of spatial prepositions in English that appear to be quite distinct. One class includes prepositions such as in and on, whose core meanings engage force-dynamic, functional relationships between objects, with geometry only a marginal player. The second class includes prepositions such as above/below and right/left, whose core meanings engage geometry, with force-dynamic relationships a passing or irrelevant variable. The insight that objects’ force-dynamic relationships matter to spatial terms’ uses is not new; but thinking of these terms as a distinct set within spatial language has theoretical and empirical consequences that are new. I propose three such consequences, rooted in the fact that geometric knowledge is highly constrained and early-emerging in life, while force-dynamic knowledge of objects and their interactions is relatively unconstrained and needs to be learned piecemeal over a lengthy timeline. First, the two classes will engage different learning problems, with different developmental trajectories for both first and second language learners; second, the classes will naturally lead to different degrees of cross-linguistic variation; and third, they may be rooted in different neural representations. (shrink)

In a recent article, Arthur Applbaum contributes a new view—legitimacy as a moral power—to the debate over the concept of political legitimacy. Applbaum rejects competing views of legitimacy, in particular legitimacy as a claim-right to have the law obeyed, for mistakenly invoking substantive moral argument in the conceptual analysis, and concludes that “at the core of the concept—what legitimacy is” is only a Hohfeldian moral power. In this article, I contend that: (1) Applbaum’s view of legitimacy, when fully unfolded, (...) refers to more than a mere moral power and should therefore be rejected even by his own standards; (2) Applbaum’s rejection of competing views of legitimacy ultimately relies on a claim that he does not successfully defend, namely, the claim that moral duties are of absolute rather than prima facie force. (shrink)

The Frame Problem is the problem of how one can design a machine to use information so as to behave competently, with respect to the kinds of tasks a genuinely intelligent agent can reliably, effectively perform. I will argue that the way the Frame Problem is standardly interpreted, and so the strategies considered for attempting to solve it, must be updated. We must replace overly simplistic and reductionist assumptions with more sophisticated and plausible ones. In particular, the standard interpretation assumes (...) that mental processes are identical to certain kinds of computational processes, and so solving the Frame Problem is a matter of finding a computational architecture that can effectively represent relations of semantic relevance. Instead, we must take seriously the possibility that the way in which intelligent agents use information is inherently different. Whereas intelligent agents are plausibly genuinely causally sensitive to semantic properties as such (to what they perceive, desire, believe intend, etc.), computational systems can only be causally sensitive to the formal features that represent these properties. Indeed, it is this very substitution of formal generalizations for genuinely semantic ones that is responsible for the way current AI systems are brittle, inflexible, and highly specialized. What we need is a more sophisticated way of investigating the relationship between computational information processing and genuinely semantic information use, so that these two senses of using information are not conflated, but instead the question of how they are related to one another can be studied directly. I apply the generative methodology I have developed elsewhere for cognitive science and AI research (Miracchi, 2017, 2019a) to show how the Frame Problem can be appropriately updated. (shrink)

In a society where mobility, globalization and contact with people from other cultures have become its basic descriptors, the enhancement of plurilingualism and intercultural understanding seem to be of the utmost concern. From a Positive Psychology Perspective, agency is the human capacity to affect other people positively or negatively through their actions. This agentic vision can be related to mediation, a concept rooted in the socio-cultural learning theory where social interaction is considered a fundamental cornerstone in the development of cognition. (...) Social interactions in the language learning setting may be facilitated through musical activities due to its social bonding effect. This paper tries to offer insights on how a musical-mediated experience in language learning may develop students’ interpersonal and collaborative competences to become active members of a more inclusive society. Mediation, considered as a paradigm shift in the foreign language classroom and the different out-of-class language learning possibilities, could also provide an environment where learners maximize their emotional intelligence. Our paper focuses on this paradigm shift spearheaded by the CEFR Companion Volume and the considerable repercussions it is bound to have for foreign language didactics, as cooperative tasks become central to foreign language learning. We hypothesize that mediated language learning experiences imply a socioemotional change in learners, focusing on the others, on their needs and interests, by trying to help them understand texts, concepts or facilitating communication with their peers. An intervention with a musical-mediated language learning experience was designed and implemented in the classroom. A self assessment scale with mediation descriptors and the socioemotional expertise scale (SEE) were administered. Results show that students become more mindful of their strengths, of their capacity for collaborating and team working. This leads to more awareness of their mediation skills. Students’ mediation skills correlate significantly with their socio-emotional skills, more concretely with their expressivity. The implementation of a musical-mediated experience also promoted tolerance and enhanced learners’ intrinsic motivation for language learning at the same time as they acknowledged their diversity. (shrink)

The General Medical Council’s (GMC) Outcome for Graduates, published in 2018,1 is the latest guidance for medical schools on the GMC’s expectations of the undergraduate medical curriculum. One of its three top level outcomes—Professional Values and Behaviours—refers to medical ethics and law, professionalism and patient safety competencies. Furthermore, the recent proliferation of patient safety inquiries in the UK2–4 has elevated the emphasis on ethical medical practice5 and critical medical ethics and law competencies for future doctors. In response to (...) these developments and to ensure an up to date offering, the Institute of Medical Ethics Education Committee has updated the consensus statement on the core curriculum for medical ethics and law for doctors of tomorrow.6 This refined curriculum is the result of a national consultation process. We asked for the views of all lead teachers of medical ethics and law in all UK medical schools, the UK’s chief medical officers, the GMC, and delegates at our annual education conference in 2017 who …. (shrink)

This paper characterizes a phenomenon I call ‘binarism grammatical lacuna’ (BGL). BGL occurs when non-binary sex and gender identities are forced to choose between being he or she by the grammar of a language owing to the sex/gender binary. Although hermeneutical injustice (HI) lies at its core, given that non-binary communities come up with hermeneutical devices to overcome unintelligibility and these tools are discredited, a variety of epistemic injustices, besides HI, intertwine in BGL. I address contributory injustice, pragmatic competence (...) injustice, testimonial injustice, and testimonial smothering. Section 1 introduces the phenomenon by portraying it as an ensemble of epistemic injustices. Section 2 elucidates the variety of HI at the core of BGL by examining the case of mainstream Spanish, and section 3 reveals it as producing the primary harm of HI. Section 4 studies the relationship between grammar, ideology, and language use, calling attention to the fact that grammatical lacunae are performatively reenacted in daily speech acts. Section 5 explores the agential dimension of BGL, examining responsibilities. In addition to addressing some of the forms of epistemic injustice that might intertwine in BGL besides HI, I portray non-marginalized users of binary grammar when addressing non-binary people as hermeneutical misfirers. (shrink)

There is an increasing need for quality in ethics consultations, though there have been significant achievements in the United States and Europe. However, fundamental concerns that place the profession in jeopardy are discussed from the perspective of the U.S. in a manner that will be helpful for other countries. The descriptive component of the essay (the first two points) explains the achievements in ethics quality (illustrated by the IntegratedEthics program of the Veterans Health Administration) and the progress on standards and (...) competencies for ethics consultations (represented by the Core Competencies of the American Society for Bioethics and Humanities). Based on these achievements, the analytical component of the essay (the final three points) identifies and seeks to resolve three fundamental concerns (with increasing levels of importance) that compromise quality in ethics consultations: standards of quality; professionalism; and credentialing. The analysis argues for clearer standards of quality in ethics consultation and urges further professionalism by explaining the need for the following: interpreting the ASBH core competencies in a normative manner, developing a Code of Ethics, and clarifying the meaning of best practices. However, the most serious concern that threatens quality in ethics consultations is the lack of a credentialing process. This concern can be resolved effectively by developing an independent Ethics Consultation Accreditation Council to accredit and standardize graduate degree programs, fellowship experiences, and qualifying examinations. This credentialing process is indispensable if we are to strategically enhance quality in ethics consultations. (shrink)

Photo ID 279661800 © Sidewaypics|Dreamstime.com ABSTRACT Decolonization is complex, vast, and the subject of an ongoing academic debate. While the many efforts to decolonize or dismantle the vestiges of colonialism that remain are laudable, they can also reinforce what they seek to end. For decolonization to be impactful, it must be done with epistemic and cultural humility, requiring decolonial scholars, project leaders, and well-meaning people to be more sensitive to those impacted by colonization and not regularly included in the discourse. (...) INTRODUCTION Decolonization is complex. To successfully achieve decolonization, projects should incorporate the voices of those subjugated or silenced. Including such voices requires sincerely exploring who has been affected by colonialism or neocolonialism and how, as well as cultural sensitivity. In its basic use, decolonization refers to countries under colonial rule gaining independence or freedom from forms of subjugation. Additionally, scholars use the term to refer to efforts to dismantle neocolonialism and vestiges of colonialism. The process includes de-silencing subjugated voices.[1] I use decolonization in the latter way to refer to countries with technical independence. While arguably colonization ended formally with independence from colonizing powers, neocolonialism is the indirect, informal, and sometimes subtle control of the people, their economy, and political life despite formal independence from colonizing authorities. I conceptualize neocolonialism as a system that involves direct and involuntary control of another’s political, economic, or social life, impacting their worldview and ways of encountering the world. Decolonization may target actions, places, or systems like health care or AI to overcome the ills of colonialism and neocolonialism. It also may target knowledge and require rethinking how people develop their knowledge base. For example, if people grew up seeing an outside colonizer as superior, they would need to change their knowledge of superiority. Decolonization may target power, for example, changing who owns and distributes COVID-19 vaccines and who distributors exclude in the distribution of vaccines. Decolonization could require looking at those disempowered in the distribution process. Additionally, decolonization may target autonomy of persons by freeing people, ensuring human and individual rights, and respecting cultural traditions. Decolonization projects that try to de-silence by including the voices of those affected by colonialism and neocolonialism must examine inclusiveness in the context of the culture of the subrogated individuals. Examples of decolonization projects include making datasets inclusive of diverse peoples and places, returning to traditional food and eating practices, making sure hospitals in developing countries are led by locals and respectful of cultural traditions, returning unethically obtained artefacts or objects. Another project would be laying the groundwork for equality in formerly colonized countries to ensure that business ownership, education, and financial success will flow fairly to those previously victimized by colonization. Summarily, there are many strategies for decolonizing. However, it is worth asking whether the strategies have risks that undermine the goal of decolonization. I. Understanding Decolonization Discourses Many fields, from AI to politics, economics, health care, aviation, and academia, discuss decolonization. The content of the discourse on decolonization depends on the region and field discussing it. Rather than just reporting on decolonization, the discussions may be calls to action. For example, decolonization discourses reflect activism for cognitive justice, such as equal consideration of Indian or African knowledge systems in global health discourses.[2] In politics and political science, some scholars frame decolonization as an anti-western, anti-colonial movement by Africans to emancipate Africa/ns from subjugation or shift the continent to postcolonialism and post-neo-colonialism. This framing walls off non-African participants and may undermine their capacity to benefit the conversation.[3] There are other political scientists who actively support decolonization and see it as a field of activism in support of anyone and countries where colonization harmed people and development.[4] The point is that two ways of conceptualizing decolonization in politics and political science are discernible. One conceptualization is less inclusive since it alienates scholars and professionals from Western, high-income, or developed countries. The other is more inclusive. In humanitarian studies, including philosophy, some decolonization articles and conversations are efforts to end the destructive force of colonization. They focus on either the form, such as ecocide, genocide, and many others, or the geographic location, such as Africa, Asia, Latin America, and Oceania.[5] Finally, the feelings one brings into this conversation can adversely impact how one engages in them and who they listen to or are willing to hear from. For example, anger, rage, bitterness, and hatred are emotions that are not uncommon in spaces of decolonization conversations. Decolonization conversations that originate from a place of negativity risk deepening the psychological state of victimhood and prevent people from disrupting constructively or critically engaging in the conversation.[6] II. Understanding Decolonization Strategies Decolonization strategies mainly aim to de-silence victims of domination or subjugation. People have proposed many strategies for decolonizing. These strategies may be informed by what the target is for decolonization. Decolonization can target power relations in global health. For example, during the COVID-19 pandemic, public health organizations noted the power imbalance in vaccine distribution. Decolonization could involve de-silencing those affected by neocolonialism to bring about a more balanced distribution of power and a more fair distribution of the vaccine. By analyzing who was adversely impacted by the distribution and who ought to wield power, those engaged in decolonizing advocated for positive change and equitable power relations. Equally, when being is the target of decolonization, the language of unlearning or relearning and mental decolonization take centre stage in the decolonization discourse. For example, the quest to decolonize colonized minds aims to demythologize African inferiority and Western superiority. Demythologizing African inferiority enables those engaged in the decolonization discourse to cultivate and foster African agency.[7] Finally, when knowledge production is the target of decolonization, scholars use inclusion and cognitive justice. For example, they try to alter the knowledge that underlies global health ethics.[8] “[D]decolonizing researchers aim to respectfully understand and integrate theory from Other(ed) perspectives, while also critically examining the underlying assumptions that inform their Western research framework.”[9] One common strategy that scholars use in decolonization is inclusion. It is worth asking, does including people who have been subrogated foster decolonization? Whether that is effective depends on whether included people are more heard or whether the strategies to include them create new forms of silencing. III. Inclusion and the Quest to Decolonize Evaluating how effective inclusion is in the quest to de-silence subjugated voices is important. First, inclusive strategies are not neutral. They are epistemically situated. This situatedness constrains meaning-making in different ways: how and what questions are asked, how social roles are constructed, organized or assigned, and who is admitted to the room where these conversations occur.[10] Inclusion strategies may reinforce (unchallenged) assumptions. For example, to address prejudices and stereotypes in global health images, Arsenii Alenichev and his colleagues[11] successfully inverted “one stereotypical global health image” by prompting a generative AI to produce “an image of a traditional Indian or African healer healing a White Child.” Although there were some problems with the image of the White child, this innovation is a significant, useful effort to de-embed or strip global health images of problematic pictures that mythologize White superiority and Black inferiority. Yet it is possible that using categories like traditional Indian or African reinforces unchallenged assumptions, raising key questions regarding how language and words create new stereotypes. It is common to define traditional as non-conventional, unorthodox, and informal. Yet studies continue to reveal that non-scientifically appraised healing approaches in India or Africa are not only effective but also real, meaningful, fundamental, and primary care-seeking behaviours in many communities in these regions.[12] Suppose inclusive strategies are not un-situated. These conversations may be had within the structures, language, and spaces built by or connected to colonialism. The spaces, language, places, and structures in which these conversations occur can limit who can participate and how they participate. Importantly, some conditions are not conducive to participation as equals. The allocated time for the discussion could also constrain how individuals express themselves. It is unclear who is ultimately heard. Furthermore, epistemic situatedness of inclusion can impact decolonization conversations when participants are beneficiaries of, products of, and trained by structures and systems they seek to dismantle. To enhance the decolonization project and its goals, a pressing task is to unveil and question how the circumstances may inhibit activism. If the vestiges of colonialism continue to structure the decolonization discourse invisibly, the vestiges may undermine decolonization. For example, a public health discussion that includes white Western doctors and Western pharmaceutical executives in Africa may have many local Africans at the table but could still effectively devalue their input based on built-in assumptions and biases that are vestiges of colonialism. Second, exclusion and inclusion are also not binary. Individuals may experience exclusion, even while included (the phenomenon called internal exclusion). In other words, inclusion can fail to be substantial or become a means of enhancing optics, “a way of (un)consciously weakening the radical claims being pursued.”[13] For example, in South Africa, many institutions have made significant efforts to diversify their faculties due to the promulgation of the Employment Equity Act 55.[14] The act requires South African institutions to implement employment equity that redresses the history of harmful discrimination in the country. The act further requires transforming departments and institutional administrations. Although many recognize and support the need to transform departments in South Africa, the rhetoric of transformation departs sharply from the lived experiences.[15] This misalignment between the plan and practice is evident in the underrepresentation of black people and females in senior management teams, professorships in many universities and health departments, and positions of power in some South African institutions. Those selected in the transformation of the departments have also complained of being overworked. The burden of extra work undermines their ability to develop agency and voice in the space they now occupy or fulfil key requirements that have implications for their career trajectory.[16] This is called the minority tax. Notably, "the minority tax… is the burden of extra responsibilities [placed] on faculty of colour to achieve diversity and inclusion and contributes to attrition and impedes academic promotion."[17] One challenge for decolonializing projects will be for decolonial scholars and those selected for decolonization objectives to have the humility to decline invitations, requests, roles, and platforms for which they are either unqualified or lack the capacity to fulfil. At its heart, decolonization strategies must empower those included rather than weaken them. Finally, inclusion can lead to a phenomenon known as elite capture.[18] Elite capture occurs when socially advantaged individuals in a group monopolize or exploit activism to their own benefit at the expense of the larger, struggling group. Elite capture weakens decolonization efforts from within, revealing that those likely to benefit from global inclusive efforts are those who fulfil globally constructed standards, those “already present in the room.” There is no better strategy to weaken decolonial movements than weakening the project from within by strategically positioning individuals who share physical properties with the victims of exclusion and silencing but intellectually, behaviourally, psychologically, and emotionally share more common ground with the colonizer. Such insiders may be unaware they are furthering neocolonial conditions rather than decolonizing. In relation to decolonization, particularly in global health, elite capture reveals that those whose voices are loudest in the room are not necessarily those more impacted by colonialism. They may benefit more from reinforcing colonialism. Opportunism weakens meaningful activism from within, preventing good initiatives and strategies from having their intended impact or taking substantive root.[19] This paper cannot do justice to elite capture, but it is worth noting its negative impacts. IV. Improving the Impact of Decolonization To end neo-colonialism, it is important to understand how it manifests and what to do at each level. Beyond the academic discourse, many tangible efforts exist to decolonize through de-silencing. Examples of these efforts include the ME2 movement that seeks to centre the concerns and experiences of sexually abused or harassed victims in the public discourse. At the funding level, many grant-awarding agencies like Wellcome Trust have dedicated huge budgets to studies that help them understand how they may have perpetrated colonialism or neocolonialism and what they can do differently going forward.[20] In South Africa, promulgating the Employment Equity Act 55 was a tangible attempt to entrench decolonization concerns in a country's regulatory framework. Yet, these decolonization efforts could fail to be substantive if they do not reflect cultural sensitivity. Two key components of cultural sensitivity are worth highlighting here: epistemic and cultural humility. Epistemic humility is an intellectual virtue described as knowing one’s limitations and the limitations of the learning methods employed. At its simplest, it is the ability to admit when one is wrong. Cultural humility includes genuine attempts to learn about and embrace other cultures. Epistemic and cultural humility are signs of academic excellence and strength. Epistemic and cultural humility seriously acknowledge how the state of our knowledge, cognitive limitations, experiences, and backgrounds, while constraining us, also invite us to listen, learn, grow, and change. The limitations-owing account of epistemic and cultural humility suggests that “a person who is aware of her cognitive limitations and owns them is much better positioned to achieve such epistemic goods as true beliefs and understanding than someone who… simply has insight into the epistemic status of her beliefs.”[21] Epistemic and cultural humility may help prevent decolonization projects that unintentionally reinforce what they seek to dismantle. Epistemic humility calls on decolonizers to defer tasks for which they are not qualified to suitably qualified persons. Beyond this, humility supports brave scholarship that imagines and reimagines how featuring the same voices, faces, and perspectives possibly introduces new forms of domination or silencing. Cultural knowledge can lead to a more intentional way of seeking out the right people or a more diverse group than those frequently featured in decolonization conversations. This would give others more opportunities to navigate these spaces and should do so in ways that are familiar to them. One ought to be more sensitive to those who would ordinarily not be included in these conversations. Unless we radically and boldly reimagine these discussions, we risk alienating those most negatively impacted by neocolonialism. CONCLUSION Decolonization conversations are complex and the subject of academic debate. The strategies employed to decolonize can harm or help the victims of neo-colonialism. Inclusion of previously silenced individuals may not be enough to overcome the vestiges of colonialism, leading to a false inclusion, where those included feel excluded or contribute in ways reflecting their own biases and circumstances. Inclusion of an elite or people who do not truly represent the subjugated can lead to elite capture. For decolonization strategies to be impactful, for example, in the context of global health, project leaders and participants must engage in conversations employing epistemic and cultural humility. In many ways, epistemic and cultural humility can help us demythologize our assumptions of any cultural superiority or cognitive authority, allowing for diverse voices, cultures, and perspectives to emerge without domination. - [1] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [2] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [3] Anye-Nkwenti Nyamnjoh 2023. Is decolonisation Africanisation? The politics of belonging in the truly African university. Social Dynamics, 1-20. [4] Rianna Oelofsen 2015. Decolonisation of the African mind and intellectual landscape. Phronimon, 16, 130-146. [5] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [6] Pedro Alexis Tabensky 2008. The Postcolonial Heart of African Philosophy. South African Journal of Philosophy, 27, 285-295. [7] Nicholas M. Creary 2012. African Intellectuals and Decolonization, Ohio, Ohio University Press. [8] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [9] Vivetha Thambinathan & Elizabeth Anne Kinsella 2021. Decolonizing Methodologies in Qualitative Research: Creating Spaces for Transformative Praxis. International Journal of Qualitative Methods, 20, 16094069211014766. [10] Abimbola Seye 2023. Knowledge from the global South is in the global South. Journal of Medical Ethics, 49, 337. [11] A. Alenichev, P. Kingori & K. P. Grietens 2023. Reflections before the storm: the AI reproduction of biased imagery in global health visuals. Lancet Glob Health. [12] Jonathan K. Burns & Andrew Tomita 2015. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50, 867-877. [13] Anye-Nkwenti Nyamnjoh & Cornelius Ewuoso 2023. What type of inclusion does epistemic injustice require? Journal of Medical Ethics, jme-2023-109091. [14] 1998. Employment Equity Act. In: GOVERNMENT, S. A. (ed.) 19370. [15] Dina Zoe Belluigi & Gladman Thondhlana 2019. ‘Why mouth all the pieties?’ Black and women academics’ revelations about discourses of ‘transformation’ at an historically white South African university. Higher Education, 78, 947-963. [16] Juliet Ramohai & Khomotso Marumo 2016. Women in Senior Positions in South African Higher Education: A Reflection on Voice and Agency. 231, 135-157. [17] J. Trejo 2020. The burden of service for faculty of color to achieve diversity and inclusion: the minority tax. Mol Biol Cell, 31, 2752-2754. [18] Olufemi Taiwo 2020. Being-in-the-Room Privilege: Elite Capture and Epistemic Deference. The Philosopher, 108, 7. [19] Margarita Kurbatova & Elena Kagan 2016. Opportunism of University Lecturers As a Way to Adaptate the External Control Activities Strengthening. Journal of Institutional Studies, 8, 116-136. [20] Jeremy Farrar. 2022. An update on Wellcome's anti-racist programme. An update on Wellcome's anti-racist programme [Online]. Available from: https://wellcome.org/news/update-wellcomes-anti-racism-programme [Accessed August 10, 2022 2022]. [21] Katherine Dormandy 2018. Does Epistemic Humility Threaten Religious Beliefs? Journal of Psychology and Theology, 46, 292-304. (shrink)

This article explores the concept of cultural competence and its relevance as an organizational resource in ethical disputes. Empirically, we aim to reveal the cultural competences that a global forest industry company, StoraEnso, and a global environmental nongovernmental organization (NGO), Greenpeace, utilized in forestry conflicts during 1985–2001. Our study is based on data which were collected from corporate and NGO communication outlets and which have gone through a detailed discourse-semiotic analysis. Our reinterpretation of the discourses identified three cultural competences: (1) (...) the ability to understand changing consumer preferences and values, (2) the ability to utilize culturally determined positions of expertise, and (3) the ability to maintain trust and credibility in the community through open communicative practices. We argue that these competences are relevant in industry–NGO disputes for both parties. However, maintaining them all simultaneously is a difficult task, since various discourses which aim at upholding them can sometimes have contradictory effects. (shrink)

Introduction. The article raises the problem of eugenics as a direction of scientific thought and practice of improving the human species. The modern advances in reproductive medicine, the development of biology, the emergence of methods for editing the human genome have updated the debate around eugenics. The aim of the work is a comprehensive study of the discourse and practice of eugenics in the period of the 19th — 21st centuries. This aim involves solving a number of tasks: 1) analysis (...) of the historical context and prerequisites for the eugenics emergence; 2) the study of the institutionalization and practical implementation of its ideas in Western countries in the period until the end of World War II; 3) research on the position of eugenics after the war and the transition of discussions to the mainstream of genetics, bioethics, transhumanism; 4) study of the modern discourse of eugenics, ethical issues and the degree of government intervention in population reproduction. Methods. The author uses the historical-retrospective method, which makes it possible to comprehensively consider the context of the emergence and development of eugenics, the comparative method (when comparing the characteristic features of the «old» (authoritarian, forced) and «new» (democratic, based on personal choice) eugenics), the institutional approach ( when identifying the main institutions involved in the development, dissemination, implementation of the ideas of eugenics) and a discursive approach (to study modern discussions about the «new» eugenics and related ethical problems). Scientific novelty of the research. A comprehensive study of eugenics has been carried out, a connection has been established between the «old» and «new» eugenics, and their similarities and differences have been investigated. Results. The need to distinguish eugenics as a theory of human selection and as a practice has been proven, and the latter, depending on the political, cultural and socio-economic situation in the country, can take a variety of forms: from counseling and preventive measures to racial cleansing. It was found that population growth, urbanization, mass migration, instability in society, combined with the ideas of modernism about social order by the forces of science and technology, contributed to the spread of eugenics ideas in the late 19th - early 20th centuries. After the Nuremberg trials, the concept under study temporarily dropped out of scientific discourse. The article examines in detail the socio-economic and other preconditions that contributed to the revival of interest in eugenics in the 60s of XX century and at the present stage. It is shown that today part of the discussion has shifted to the mainstream of genetics, bioethics and transhumanism. Conclusions. It has been established that discussions about eugenics run up against the problem of breeding control, which means that they raise the question of who should perform selection, how, what are its criteria. The ethical aspects of introducing control are complicated by the fact that perceptions of the «norm» and the degree of permitted interference depend on the particular society. (shrink)

Some recent artists and critics have taken it upon themselves to demystify the notion of stylistic unity. Their task has included the historical reconception of a few “modernist” artists along “postmodern” lines, usually as precursors of current semiotic strategies.11 These artists may have used a set of incompatible styles to expose the artificiality of competing stylistic conventions, or even to challenge the myth that celebrates the authenticity of artistic expressiveness. Pablo Picasso and Marcel Duchamp, otherwise very different artists, have (...) both been seen as having “deconstructed” the concept of authenticity by problematizing basic means of artistic reference.12 But the desire to challenge conventions must not be misconstrued as an enduring element of an iconoclastic artist’s personality. Otherwise, the characterization is merely an updated version of the traditional argument for authorial unity. 11. The terms “modern” and “postmodern” are used in a variety of ways in contemporary criticism. Here, “modern” refers to nineteenth- and twentieth-century artists who embrace the notion of originality, and “postmodern” to those who would attack the notion by exposing the conventionality at its center. Although some critics who profess “modernism” do not mention “originality” by name, most subscribe to it in some form, often with the originality and self-sufficiency of the artist transposed to that of the work. This is especially true of the criticism of Clement Greenburg and Michael Fried.12. Rosalind Krauss rightly uses the semiotic complications of Picasso’s art to object to autobiographical interpretations of his work. In the course of the argument, she refers to Picasso’s semiotics as part of the “proto-history” of postmodernist art. See Krauss, “In the Name of Picasso,” The Originality of the Avant-Garde and Other Modernist Myths , pp. 38-39. Arguments for Duchamp’s protopostmodernism are much more common. For one example, see Krauss, “Notes on the Index: Part 1,” The Originality of the Avant-Garde, pp. 196-209. Margaret Olin is an assistant professor in the department of art history and criticism at the School of the Art Institute of Chicago. She is presently writing a book on the theories of Alois Riegl. (shrink)

The study of pragmatic competence has gained increasing importance within second language assessment over the last three decades. However, its study in L2 language testing is still scarce. The aim of this paper is to research the extent to which pragmatic competence as defined by the Common European Framework of Reference for Languages (CEFR) has been accommodated in the task descriptions and rating scales of two of the most popular Oral Proficiency Interviews (OPIs) at a C1 level: Cambridge’s Certificate (...) in Advanced English (CAE) and Trinity’s Integrated Skills in English (ISE) III. To carry out this research, OPI tests are first defined, highlighting their differences from L2 pragmatic tests. After pragmatic competence in the CEFR is examined, focusing on the updates in the new descriptors, CAE and ISE III formats, structure and task characteristics are compared, showing that, while the formats and some characteristics are found to differ, the structures and task types are comparable. Finally, we systematically analyse CEFR pragmatic competence in the task skills and rating scale descriptors of both OPIs. The findings show that the task descriptions incorporate mostly aspects of discourse and design competence. Additionally, we find that each OPI is seen to prioritise different aspects of pragmatic competence within their rating scale, with CAE focusing mostly on discourse competence and fluency, and ISE III on functional competence. Our study shows that the tests fail to fully accommodate all aspects of pragmatic competence in the task skills and rating scales, although the aspects they do incorporate follow the CEFR descriptors on pragmatic competence. It also reveals a mismatch between the task competences being tested and the rating scale. To conclude, some research lines are proposed. (shrink)

Writing, the exigency of writing: no longer the writing that has always (through a necessity in no way avoidable) been in the service of the speech or thought that is called idealist (that is to say, moralizing), but rather the writing that through its own slowly liberated force (the aleatory force of absence) seems to devote itself solely to itself as something that remains without identity, and little by little brings forth possibilities that are entirely other: an anonymous, (...) distracted, deferred, and dispersed way of being in relation, by which everything is brought into question – and first of all the idea of God, of the Self, of the Subject, then of Truth and the One, then finally the idea of the Book and the Work so that this writing (understood in its enigmatic rigor), far from having the Book as its goal rather signals its end: a writing that could be said to be outside discourse, outside language. – Maurice Blanchot ( The Infinite Conversation , xi) The Compendium * Beginning with the idea and practice of writing, and moving to the subject or self, then to truth and the One, and arriving at the Book and the Work, Blanchot’s words reflect the trajectory of the following work of writing. True to the embeddedness of the subject in the work of writing, the term “Compendium” has been a metonym for me over the past few years as I have thought about the concept of totality alongside its expression in figures such as the One, the Whole, or the All. In the following I aim to share some of the content of this metonym, and to enrich it by making some distinctions. 1 Here the term “Compendium” will refer to a concept of totality that is ontological (pertaining to being, and the copula) and also textual (pertaining to the symbolic, and the signifier-signified relationship). The Compendium is a figure for thinking the world as a Book, in the broadest sense—an approach to reality that is by no means new, but one that is due for renewal. 2 In partial answer to the question of the Compendium we will say that the word ‘Compendium’ stands in for expressions which seek to totalize, or concepts which seek to approach the concept of ‘everything,’ particularly when these expressions are bound up in the question of the Book (both the book as a physical object and the Book as a metaphysical figure: a way of thinking about the work in and of writing). The question of the Compendium is strongly associated with the physical and metaphysical form of the Book, like the mysterious and symbolic books which are opened in the Biblical book of Revelation, the book of life and the book of death, which together constitute an important couplet. 3 Parataxis & Hypotaxis There are two helpful distinctions that will bring us closer to an answer to the question “What is a Compendium?” The first distinction is between two figures in and for writing: parataxis and hypotaxis . Typically paired in contrast to one another as literary techniques, with parataxis indicating a side-by-side placement of textual elements and hypotaxis referring to subordinate arrangements of textual elements, the two figures can be understood as having a philosophical significance in addition to their practical function as devices for writers. For us these two terms will remain between philosophical theory and writing practice, and serve as a perspective for our writing and creation of texts. Here I take texts to refer to anything from the concrete written words in a book, to the ontological text of the world that we experience. Parataxis , as a figural way of thinking about the ontological structure of texts, refers to texts which are tightly woven and interdependent – texts within which each sentence bears the weight of the entire work. Parataxis often involves repetition, great density, and fragility. One of the best examples of this sort of text is Theodor Adorno’s posthumous magnum opus , Aesthetic Theory . In addition to the text itself, the translation history of the book may also help us to better understand parataxis and its relation to hypotaxis . The final published version of Aesthetic Theory , in German, was a text that Adorno intended to revise and rewrite, but this intention was never realized because of his untimely death. Where the German text of Aesthetic Theory certainly exemplifies the concept of parataxis , the first English edition took this densely woven text and carved Adorno’s lengthy paragraphs and lengthy sentences into manageable ‘bite-sized’ pieces of English text. The first translator took further liberty and inserted headings and new paragraph breaks where there were none in the original. Aesthetic Theory was eventually retranslated by Robert Hullot-Kentor and is now available in a form that is much more faithful to the original work. 4 The pertinent idea that this translation history points to is the distinction between parataxis and hypotaxis . Where parataxis describes texts which are repetitive, densely woven, and often fragile, hypotaxis describes texts which are hierarchical and in which the primary relation is linear – the latter of which is very similar to the first English translation of Aesthetic Theory . On the other hand, the original German text that Adorno wrote was very dense, often repetitive, and contained long sections of text unbroken by paragraphs or headings. This example of parataxis was then turned towards hypotaxis through the initial translation which took a text that was, in many ways, nonhierarchical and nonlinear, and artificially subjected it to a hierarchy that was not its own (and here I take the word of Fredric Jameson who comments on the two translations in a note at the beginning of his book Late Marxism ). 5 The point here is not about translation, but rather the distinction between parataxis and hypotaxis precisely as they are figures for discourse, written or otherwise. The concept of parataxis looks far more postmodern and rhizomic than the concept of hypotaxis which remains very modern and arborescent. This is a more figural way of talking about the distinction. However, if we wanted to take a more precise and analytical approach we could say that on the level of form parataxis involves a relationship between sentences and paragraphs in which each part bears an equally crushing responsibility to present the whole content of the text. As well, on the level of content, parataxis requires that each concept in a work take on the full conceptual weight of the total work. Continuing the analysis, we could say that parataxis describes texts in which there is no (or very little) linear or causal move from antecedent to consequent, whether in content or form. Instead, parataxis describes texts which weave together concepts via conjugations or associations. The concept of hypotaxis , on the other hand, requires that texts submit themselves to hierarchy, one example of which is logical argumentation. The contingency of the conclusion upon premises in hypotaxis is certainly distinct from the repetition, re-presentation, and conjugation of concepts in parataxis , and I think that this is evident in the difference between the writing styles prevalent in contemporary Analytic philosophy and Continental philosophy. It is not the case that the distinction between parataxis and hypotaxis absolutely corresponds with the writing styles of Continental and Analytic philosophy (respectively). There are thinkers who take exception to this pattern, such as Badiou’s more formal approach in the discourse of Continental philosophy to give one example. However, when Analytic philosophy takes its writing lessons from the sciences, and seeks to do philosophy via the clean linear move from antecedent to consequent, then I think that Analytic philosophy writes with hypotaxis in mind. On the other hand, when Continental (particularly German and French) philosophy takes its writing lessons from narrative or poetry then Continental philosophy writes with parataxis in mind. It is not fair to say that all those writing Continental philosophy are looking to narrative and poetry for stylistic direction, just as it is not the case that all those writing Analytic philosophy have mathematics and science as their writing format, however there are some striking ways in which the differing epistemologies of Continental and Analytic philosophy encourage writing with parataxis and hypotaxis in mind (respectively). For some, writing with parataxis or hypotaxis in mind is a conscious decision and a product of stylistic self-consciousness, and for others it is an unconscious discursive and epistemic requirement that must be met in order to be involved in a particular discourse. Before moving on to our second distinction, and then an examination of the question of the Book, it is important to point out that both totality and figurations like the One, the Whole, and the All, come out of very human desires to totalize or to actualize our being-towards-totality. The relationship between identity and totality then can be construed, with Heidegger in mind, as striving toward wholeness, completion, or fulfillment, each of which is a quality of compendia. 6 Compilation & Selection The first distinction between parataxis and hypotaxis pertains to both form and content, and to both the mechanics of writing and the ideas to which writing refers. The second distinction pertains to both as well. In the process of writing and in the process of perception as well, there is a tension between compilation and selection . To begin with, in the work of theory-writing there is compilation, and this is because writing theory requires a broad perspective and certain measure of totalization. On the other hand, writing theory requires that the writer select an idea or a combination of ideas to individuate out of a radical and infinite multiplicity of identities and combinations. The concern here is not primarily for the writing of a theory about a specific idea, like a secondary work or a reference text. But rather the concern is with the writing of grand theories: Marx and Marxism, Derrida and Deconstruction, Husserl and Phenomenology, Sartre and Existentialism, Saussure and Structuralism —each of which strives along a trajectory towards being all-encompassing, whether it intends to or not. Today, we could even say that Speculative Realism has embarked on this journey, and perhaps now we could say that the discourse of Speculative Realism has reached the inevitable point after which a grand theory leaves the hands of its writer or writers and becomes a possession of the collective consciousness of the academy, or (perhaps now) the mass consciousness of the blogosphere—and this is a true pharmakon , a poison and a cure, a blessing and a curse. 7 When we write theory, whether the scope is that of a grand theory or a particular theory, we write in the tension between compilation (making good on the desire to be all encompassing) and selection (being required to decide and discern and to judge what is included in the work and what is deleted or appended or abridged or given over to ellipses). Generally speaking, the work of theory-writing often comes out of a desire to totalize, that is, to develop a theory of everything that is able to apprehend new experiences and ideas while still remaining whole. I grant that this is not a universal desire, and that not everyone who sits down to write a work (or book) of theory does so because of their will-to-totality, but it remains that this drive to totalize does condition a great many writers of theory (especially those who seek to develop grand theories like those mentioned previously). At the beginning of his book of interviews, Between Existentialism and Marxism , Sartre is quoted as saying, after completing the first volume of his Critique of Dialectical Reason : “I no longer feel the need to make long digressions in my books, as if I were forever chasing after my own philosophy. It will now be deposited in little coffins, and I will feel completely emptied and at peace—as I felt after Being and Nothingness . A feeling of emptiness: a writer is fortunate if he can attain such a state. For when one has nothing to say, one can say everything .” 8 This is where our two initial distinctions come to bear on the being-towards-totality as it is expressed in the concrete practice of writing: the first being between parataxis and hypotaxis , and the second being between compilation and selection. Where this second distinction is concerned there is a certain paradox at play given that selection is inescapable, and compilation is unachievable. Selection is inescapable (with the figure of the Compendium in mind) because, even when the imperative to compile is followed to excruciating lengths, selection still has the last word. This is why the Compendium is a figure rather than some material thing that can actually be accomplished or actualized. No matter how far one goes along with the will-to-archive and the will-to-compile, it is only ever a question of minimizing selection and never eliminating it. This leads to the second point, which is that total compilation is unachievable. The closest thing to total compilation that we have before us is the ontological and textual fabric of the world. Even in the case of the world, compilation cannot be enacted in a total fashion because of the need to include both the sphere of the actual and the sphere of the possible or potential. This as another way in which compilation is always-already selection, and further evidence that total compilation is practically impossible. Discursive Figuration and Total Writing Rather than figuration referring to a figure of speech or an image, here the term points to a way in which to think about the work of writing, both the work put into writing, and the work that is the result of writing: the finished yet incomplete final piece. As figures or figurations, the Book and the Compendium are ways of thinking about the work of writing and the human desire for the wholeness, completion, and fulfillment that are made manifest in the completed form of the book (whether a published or printed or saved document put to rest by the author). These two figures bear more strongly upon works that seek to be all-encompassing, and works that strive towards expressions of totality such as the One, the Whole, or the All. Moving on to the topic of the subtitle, and on a more prescriptive note, I would say that there is more hope for theory-writing to be found in parataxis than hypotaxis . Part of the reason for this claim is the poststructuralist critique of hierarchies, and yet another part is the compelling line of thinking called “weak thought” (in theology by John D. Caputo, and in philosophy by Gianni Vattimo, among others). 9 The consequences of these two convictions are such that if one is to strongly assert the truth of a grand theory without leaving the realm of hierarchy-critique and weak thought, then one must write paradoxically with parataxis in mind, and in so doing write weakly and non-hierarchically. This does not mean avoiding a sort of topography or topology when writing theory, rather it means avoiding both subjugation and oppression in thought by pursuing a nonviolent sort of ontology. In order to do this, theory writing does not present itself as an exercise in logical analysis where one mechanically moves from a set of premises (via contingency) to the inevitable conclusion (via necessity). Instead, theory approaches the idea of a Compendium. Given that the figural Compendium places parataxis and compilation above hypotaxis and selection, then the question becomes: is placing one part of a binary term before another not just another way of selecting, or another expression of hypotaxis ? Counter to the urge to resign oneself to the reign of selection, with some qualification one can nonetheless write without deciding whether selection and hypotaxis should be subservient to compilation and parataxis (which is to say that writing-without-decision is somewhere between and beyond possibility and impossibility). This dilemma can be disarmed by stating that theory writing is not about primacy, and not about having-decided-beforehand, both stylistically and also where content is concerned. This is the paradox of writing: always striving along a trajectory ( telos ) towards totality via parataxis and compilation, but always being drawn back to finitude and making selections, and placing one idea before another with hypotaxis in mind. In light of this paradox, the question of the Compendium as a figure for discourse and a figural Book has resonance with Jacques Derrida’s essay on Edmund Jabès’ Book of Questions , found in his Writing and Difference . The Question of the Book “Little by little the book will finish me.” 10 Derrida quotes Jabès, and proceeds to outline the reflexive relationship between the author of the book and the book itself, each of which are subjected to the other through a sort of chiasmus, both ontological and textual (not that the two are entirely separable). The Book, for Derrida like Blanchot in the introductory quotation, “infinitely reflects itself” and “develops as a painful questioning of its own possibility”, and in light of this we can draw an association with the painful tension between the practical reality of selection and the ideal trajectory of compilation. 11 This tension in writing, between the will to total compilation and the necessity of abridgment, is an ontological tension between part and whole just as it is a textual tension between signifier and signified. The ontological tension in writing that Derrida expresses in his essay on Jabès is between everything and nothing – a contradiction which Derrida finds in Jabès’ Book of Questions and also in the divine, in God. When one writes between compilation and selection one writes towards totality, and here we can follow Derrida who states that the lapse in signification, presumably in the signifier-signified discrepancy, is a “ rupture with totality itself” and furthermore that this lapse cannot be rectified through deductive reason or even philosophical discourse. 12 This rupture with totality, found in the troubled relation between signifier and signified, can also tell us a lot about the Book and about writing. Given an understanding of writing as an ontological act that strives towards (but never accomplishes) totality, we can see the written book as the manifested and given body of that striving. Perhaps in other disciplines or even other schools of philosophy there is a cultural climate within which the article is prized above the book, but I am fairly confident, especially when referring to the grand theories of Continental thought, that there is a respect for the book as a uniquely meaningful object capable of apprehending totality. Derrida writes, Between the too warm flesh of the literal event and the cold skin of the concept runs meaning. This is how it enters into the book. Everything enters into, transpires in the book. This is why the book is never finite. It always remains suffering and vigilant. 13 Here the vitality of the literal event is compromised by the deadening weight of the concept, and the figure of the Book assists in this lapse of meaning. The Book is a totalizing object, much like the figure of the Compendium, and yet this totalization lacks its final object of completed totality both because the figural Book is necessarily incomplete, and because the physical book is always-already a product of selection. Instead of achieving its end of being a place where everything takes place, it suffers from the lapse of writing, the discrepancy between event and concept. Derrida continues his exposition on Jabès by bringing to light yet another reflexive relation, a reversal of the relationship between the Book and the world. Derrida writes that, for Jabès, “the book is not in the world, but the world is in the book.” 14 In addition to what was stated before, I take figuration to mean that the concepts employed, such as the Book or the Compendium, are not subject to the supposed rigor of analysis that is so prized by Enlightenment or Capitalist realisms. The figure of the Book and the figure of the Compendium cannot be held accountable to standards imported from scientific method, given an understanding that these standards require a concept to be replicable, consistent, falsifiable, measurable, and so on… This is an important point to make, especially in the present atmosphere within which theory must justify itself under conditions that are not its own. Instead of being held to these standards, figuration serves as a way in which to think about writing that leaves thought open to idealistic speculation, imperfect analogies, and most importantly the ever-present gain and loss that occur in the relationship between thought and being. By extension the figural way of addressing writing indulges in enough generalization to accommodate the excess/lack relationship between the ideal form of the Book or the Compendium, and the manifested and given body of a text (as it is practically completed and closed). Here we speak against the hostile atmosphere which would have theory submit itself to hierarchical rigor, rather than Blanchot’s “enigmatic rigor”, by being explicit about the discursive conditions and epistemic conditions under which theory operates. To write with parataxis in mind is, to a certain degree, to write with weakness as one’s methodology (with weak thought being in opposition to hypotaxis and hierarchy as much as weak thought can be in opposition to anything). Rather than asserting the strength of hierarchical theory, and rather than employing antagonistic argumentation with the goal of refutation different discursive and epistemic conditions for theory writing must be cultivated (and these are by no means new). First the critical and theoretical spirit reveals itself as being concerned with the task of complication—especially the complication and critique of binaries, dichotomies, dualities, polarities, paradoxes, parallaxes, hybridities, and especially antinomies. Second, theory positions itself as a sort of showing or revealing, rather than being ultimately focused on coming to full agreement or disagreement. This is where figuration can help theory-writing, both by placing emphasis on teleologies and trajectories (like parataxis and compilation), and by shifting focus away from pure primacy, power, or absolute origin. Figuration then, assists theory writing by placing the concern of theory outside of the concerns of the hard or soft sciences, and into the realm of thought or the idea. To speak of ‘the’ Compendium or ‘the’ Book, here, is to generalize not regarding the perfect form of the Compendium or Book, but to engage speculatively with an abstract idea which remains singular and yet complicated by multiplicity. The question of the Book that Derrida asks through Jabès is a question of everything and nothing, totality and nonbeing, and this question is a concern for writing and a concern for the figure of the Compendium so defined by the tension between compilation and selection, and parataxis and hypotaxis . On the note of nonbeing, we can look to the final page of Derrida’s first essay on Jabès in Writing and Difference and notice the introduction of his neologism, différance (with an ‘a’). Derrida writes: Life negates itself in literature only so that it may survive better. So that it may be better. It does not negate itself any more than it affirms itself: it differs from itself, defers itself, and writes itself as différance . Books are always books of life (the archetype would be the Book of Life kept by the God of the Jews) or of afterlife (the archetype would be the Books of the Dead kept by the Egyptians). 15 This introduction of différance into the equation of the Book, alongside ontological affirmation and negation, hearkens back to the discussion of the symbolic lapse earlier in his essay. Differing and deferring, the Book is always a Book of Life and a figure for the intersection of the vital (life) and the total in writing. In a way, the writer of the Book may be someone who lives life, and in another way the writer of the book-as-object may be someone who engages in the act of writing, both practically (by inscribing words on paper, or typing script on a computer) and ontologically or symbolically (by investing their existence and inexistence into a work worthy of the figural Book). In addition to the writer as writer, the writer also serves as an editor, and the editorial role alongside the idea of the Compendium shows the editor to be one who collects and compiles, while being restrained by eventual selection and decision. Beyond this the editor of works and texts, in both the Book and the world, is engaged in a process of inscribing notation—of annotating (on) the Compendium. Eternal commentary is a feature of the textual Compendium, just as open-ended totality describes the ontological Compendium. The writer as writer does not simply write texts, but rather engages in a profoundly ontological act of inscribing their existence into the world, and the writer as editor does not merely annotate or alter texts as they are, but rather comments upon the text of the world. In/Conclusion So as we create texts, and as we write and create theory, let us be and remain attentive to the figure of the Compendium and the figure of the Book. These two concurrent metonymies are essential for total writing (grand theories, etc.), and may be forgettable for those concerned with fragmentary or hierarchical writing (which are valid in their own right). From the ontological and symbolic text of the world and phenomenological experience, to concrete texts such as books or mixed media, the figure of the Compendium and the figure of the Book are important for the actualization of the human will to be all-encompassing. The figure of the Compendium teaches writers of theory that the repetition, density, and fragility of parataxis offers a strong sort of weakness which does not become yet another variety of oppressive and hegemonic thought. Rather than write with hypotaxis in mind, subjugating one thought to another via cause and effect or antecedent and consequent, I would hope that theory-writing could guiltlessly indulge in the dialectical and contradictory conjugation of ideas, and take this as a legitimate methodology. Rather than being ashamed of showing resonances or giving way to abridgment or ellipses, it is my own authorial (but not authoritative) conviction that one need not give up on totalizing and constructing grand theories because of the fact that complete totalization is impossible, and one need not give up on totalizing and constructing grand theories because of the worry of violence, for the Book and the Compendium lack their completed object and are ever incomplete trajectories. NOTES * UPDATED 7/19/13: we've updated the HTML version to reflect the (correct) PDF version. Our apologies to the author—eds. 1. I would like extend thanks to Dr. Peter Schwenger of the University of Western Ontario for his comments on this paper and his hospitality as it was presented as a Theory Session at the Centre for Theory and Criticism on October 26th 2012. I would also like to thank Andrew Weiss for conversation and critique. 2. I should clarify my use of the term ‘figure’ at the outset. Given the use of the term by Jean-Francois Lyotard in Discourse, Figure (and also Gilles Deleuze in Francis Bacon ), I should state clearly that my use of the term will not correspond to the term ‘figure’ understood as the representation of an object. Instead, my use of the term ‘figure’ and its variations (‘figural’, ‘figurative’, ‘figuration’) will refer to the illustrative or metaphorical use of the Compendium or the Book as models or ways of thinking about writing and discourse. 3. Cf. Revelations 20:12-15. 4. Theodor Adorno, Aesthetic Theory , Trans. Robert Hullot-Kentor (London & New York: Continuum Press, 1997). 5. Fredric Jameson, Late Marxism: Adorno, or the Persistence of the Dialectic (London & New York: Verso, 1990), ix-x. 6. I have written about this concept of being-towards-totality elsewhere in two pieces of writing: the first is called Notes on the Compendium (an unfinished draft) which addresses some very wide theoretical concerns, being structured as a sort of itinerary or archive, and the second is Dialectics Unbound (Punctum Books, 2013) which outlines a concept of totality without the violence of totalization. While these works are more concerned with ontological totality, here I would like to focus on the idea of the Compendium as a textual totality. 7. Cf. Louis Morelle, “Speculative Realism: After Finitude and Beyond, A vade mecum” in Speculations: Journal of Speculative Realism . Issue 3 (Brooklyn, New York: Punctum Books, 2012), 241-272. 8. Jean-Paul Sartre, Between Existentialism and Marxism . Trans. John Matthews (London & New York: Verso, 1974), 9. 9. Cf. John D. Caputo, The Weakness of God (Indiana: Indiana University Press, 2006). 10. Jacques Derrida, “Edmond Jabès and the Question of the Book” in Writing and Difference . Trans. Alan Bass (Chicago: University of Chicago Press, 1978), 65. 11. Ibid, 65. 12. Ibid, 71. 13. Ibid, 75. 14. Ibid, 76. 15. Ibid, 78. (shrink)

Today, the business world has embraced increasing uncertainty and abrupt changes. The concern for business owners is business sustainability, which is crucial for their business to remain relevant and flexible in unpredictable business environments. The process of change forces business owners to be ready for any consequences that affect their business. Due to overwhelming tasks and responsibilities, single mothers may need help to succeed in business. The present research offers a comprehensive review of business continuity from the perspective of single (...) mothers. Within the scope of this research is an exhaustive and methodical investigation of the business acumen of single mothers as entrepreneurs. A literature review was conducted, and the findings may offer a comprehensive discussion of several dimensions of entrepreneurial competency. The findings contribute new information to the existing body of knowledge regarding entrepreneurial competency, which has been a recurrent topic of discussion among earlier academics who have explored the subject matter to investigate. At the end of this paper, practising entrepreneurial competency with single-mother entrepreneurs has several implications. These findings can be applied and utilized by single-mother entrepreneurs, as well as by the government, industry, and the community. (shrink)

Background: The development of society and science, especially medical science, gives rise to new moral and ethical challenges in healthcare. Research question/objectives/hypothesis: In order to respond to the contemporary challenges that require autonomous decision-making in different work contexts, a pedagogical experiment was conducted to identify the readiness and responsiveness of current organisation of nursing higher education in Slovenia. It compared the successfulness of active learning methods online (experimental group) and in the traditional classroom (control group) and their impact on the (...) ethical competences of nursing students. The hypothesis set in the experiment, hypothesis 1 (the experimental group will be successful and will have good achievements in comprehension and application of ethical principles) was confirmed based on pre-tests and post-tests. The hypothesis tested by the questionnaire, hypothesis 2 (according to the students, the active learning methods online in the experimental group have a positive impact on the development of ethical competences) was confirmed. Research design: The pedagogical experiment was supported by a multiple-case study that enabled the in-depth analysis of the students’ attitudes towards the active learning methods in both settings. Participants and research context: The study included Slovenian first-year nursing students (N = 211) of all the enrolled students (N = 225) at the University of Ljubljana and University of Primorska in the academic year 2010/2011. Ethical considerations: Before the study ethical permission was obtained from the managements of both participating faculties. The students were given all the necessary information of the experiment before the tutorials. Findings: No significant difference was found between the two learning settings and both had a positive impact upon learning. The results of the content analysis show that the students’ active engagement with the active learning methods in the group enables the development of ethical competences and the related communicative competences, interpersonal skills, collaboration and critical thinking. Discussion: Active learning methods in the settings compared, online and the traditional classroom, enabled the development of a higher level of knowledge defined by the ability of critical thinking and reflective response, the core of ethical competences. Students develop ethical competence through active engagement in a group work, role play and discussion, and there is no difference between online or traditional learning settings. Conclusion: In the healthcare, it is crucial for providers to be capable of making autonomous decisions and managing various communication situations and contexts in which the moral attitudes and ethical sensibility are essential. (shrink)

Long‐range correlation is a general class of coordination pattern found to be common to the intrinsic dynamics of complex systems, including human behavior. Balasubramaniam, Hove, and Médé investigate intrinsic dynamics in repeated finger movements, and they find that different measures of movement dynamics yield different long‐range correlations. Results shed light on the way that coordination patterns are expressed as a function of measurement context.

To meet the specific education needs of ethics committee members (primarily full-time healthcare professionals), the Regional Ethics Department of Kaiser Permanente Northern California (KPNCAL) and Washington State University’s Elson Floyd School of Medicine have partnered to create a one-academic year Medical Ethics Certificate Program. The mission-driven nature of the KPNCAL-WSU’s Certificate Program was designed to be a low-cost, high-quality option for busy full-time practitioners who may not otherwise opt to pursue additional education. This article discusses the specific competency-focused methodologies and (...) pedagogies adopted, as well as how the Certificate Program made permanent changes in response to the global pandemic. This article also discusses in detail one of the Program’s signature features, its Practicum—an extensive simulated clinical ethics consultation placing students in the role of ethics consultant, facilitating a conflict between family members played by paid professional actors. This article concludes with survey data responses from Program alumni gathered as part of a quality study. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mencius and Xunzi between Humaneness and JusticeSungmoon Kim (bio)In his now classic Disputers of the Tao (1989), A. C. Graham aptly captured the central feature of the ancient Chinese world of thought in terms of the dispute about the Way between competing philosophical schools. But it has since long remained an intellectual challenge how to understand and evaluate the unfolding of the philosophical schools in ancient China [End Page (...) 439] coherently from a philosophical standpoint. Tao Jiang's Origins of Moral-Political Philosophy in Early China attempts to meet this long overdue challenge, and it does so admirably with philological rigor and philosophical insight.What is central to Jiang's framework is the conceptual tripod of humaneness, justice, and personal freedom, which he generally understands as "the moral norm that is agent/recipient relative" (especially, natural inclinations toward one's family/kin members), "impartial judgment on the merits of persons and states of affairs," and "the appreciation and cultivation of personal space where one can be left alone … without [being] entangled in the sociopolitical world," respectively.1 Jiang begins with Confucius by presenting him as the first major thinker in Chinese history who wrestled with the tension between humaneness and justice. According to Jiang, Confucius' seminal idea of impartial justice was critically re-appropriated by the Mohists, who advocated "impartial care" (jian ai 兼愛), while his idea of partial humaneness was later developed by Mencius, who upheld "familial virtues" as the pivot of Confucian morality and politics—although, as will be discussed shortly, this represents only one dimension of Mencius' philosophical system. Jiang understands the later development of the Laoist, the fajia ist (commonly known as "Legalist"), and the Zhuangist thoughts, largely as critical responses to the Confucian (especially the Mencian) argument for partial humaneness and the congruity between the familial and the political by naturalizing Heaven (thereby decoupling the political from the familial), developing an objective political system independent of the ruler's moral virtue, and insulating private persons from human relationality and the intervention of the state. Finally, Jiang argues that while Han Feizi's political thought presents the culmination of the early Chinese concern with impartial justice, Xunzi reformulated Confucianism by synthesizing humaneness and justice.I find Tao Jiang's overall argument, buttressed by extensive philological examinations, well-structured and penetrating, and I have no doubt that this book will make an important contribution to Chinese moral and political philosophy. Like many great books, however, Jiang's book makes numerous novel yet controversial claims, and this review aims to engage with several key questions Jiang raises with regard to Mencius and Xunzi, the two giants of classical Confucianism.The Two Strands of Mencius?In interpreting Mencius, Tao Jiang's core argument is that there is "a deep tension at the heart of the Mencian system."2 This tension, according to Jiang, rises from the two incompatible strands in Mencian thought, the "extensionist" strand and the "sacrificialist" strand: [End Page 440][W]hile the extensionist Mencius operates on the assumption, normative within Confucianism, of congruity between the personal, the familial, and the political domains, the sacrificialist Mencius recognizes a tension between the familial and the political that can be hard to reconcile or even irreconcilable under certain circumstances. Furthermore, the sacrificialist Mencius radically separates the familial from the political and ultimately prioritizes the former over the latter, by embracing the necessity for sacrifice as a way that, at times, is required to save the familial.3The extensionist Mencius presents the normative (i.e., partial humane) strand of Confucianism, which stipulates the seamless continuity between the personal, the familial, and the political, as best demonstrated in Mencius' statement that "the root of the world lies in the state; the root of the state lies in the family; the root of the family lies in oneself."4 That is, the extensionist strand of Mencius highlights the transformative force of moral self-cultivation that achieves the unity between the inner self and the outer world through the Heaven-decreed human nature, thus denying the categorial separations between ethics and politics, between moral virtue and political virtue, and between private and public. In Jiang's view, the extensionist strand captures... (shrink)

Motor learning is the process of updating motor commands in response to a trajectory error induced by a perturbation to the body or vision. The brain has a great capability to accelerate learning by increasing the sensitivity of the memory update to the perceived trajectory errors. Conventional theory suggests that the statistics of perturbations or the statistics of the experienced errors induced by the external perturbations determine the learning speeds. However, the potential effect of another type of error perception, (...) a self-generated error as a result of motor command updates, on the learning speeds has not been examined yet. In this study, we dissociated the two kinds of errors by controlling the perception of the aftereffect using a channel-force environment. One group experienced errors due to the aftereffect of the learning process, while the other did not. We found that the participants who perceived the aftereffect of the memory updates exhibited a significant decrease in error-sensitivity, whereas the participants who did not perceive the aftereffect did not show an increase or decrease in error-sensitivity. This suggests that the perception of the aftereffect of learning attenuated updating the motor commands from the perceived errors. Thus, both self-generated and externally induced errors may modulate learning speeds. (shrink)

This doctoral dissertation investigates what influence indicative conditionals have on belief updating and how learning from conditionals may be modelled in a probabilistic framework. Because the problem is related to the interpretation of conditionals, we first assess different semantics of indicative conditionals. We propose that conditionals should be taken as primary concepts. This allows us to defend a claim that learning a conditional is equivalent to learning that the relevant conditional probability is 1. This implies that learning a conditional can (...) be modelled as learning a material conditional. We then turn to a few competing approaches to the problem of learning from a conditional -- an approach that models these situations with regards to changes in the explanatory status of the antecedent, as minimising probability distances between the prior and posterior probability distributions, and, particularly, an approach based on epistemic entrenchment. It is argued that although all approaches are important for their pioneering contributions, none of them ultimately provides a fully satisfactory solution. We then formulate a proposal according to which learning a conditional may be modelled as learning a material conditional in conjunction with other contextually inferred or observed information. We show that the view has an intuitive appeal on the grounds of pragmatics and empirical research in psychology of reasoning. We also show that the proposed approach successfully resolves all standard cases from the literature. The proposal is then extended to left-nested conditionals. To do so, we first inspect some preliminary empirical data about actual reasoning with nested conditionals and then show that the proposed approach also successfully models these cases. We then investigate how the approach may be extended to the so-called imperative conditionals. We introduce a tripartite typology of imperative conditionals and argue that although imperatives cannot be probabilistically modelled in any straight-forward way, at least some general insights of the proposed method help us understand the influence that the three different types of imperative conditionals have on listeners’ beliefs. We conclude with a summary and some open questions that should be addressed in future work (e.g. the influence of counterfactuals on belief updating). (shrink)

Public health ethics began to emerge in the 1990s as a development within bioethics. Public health ethics education has been implemented in schools of public health in recent years, and specific professionalism and ethics competencies were included in the Master of Public Health (MPH) competency set developed nationally and adapted by individual schools of public health around the country. The University of Texas School of Public Health approved the present set of MPH competencies in 2005. After 4 years (...) of experience, we now report information measuring the extent to which Professionalism and Ethics competencies and subcompetencies are being met in the MPH degree program. To this end we have audited the MPH Professionalism and Ethics competency forms for FY2009 MPH graduates (n = 61). Eight courses, including required MPH core courses plus the practicum and culminating experience, were found to have substantial professionalism and ethics content. Further, 67.2% of graduates met eight or more of the 13 competencies and subcompetencies, but only 36.1% met all thirteen, indicating a need to identify topic areas to be added to, or enhanced in, the MPH curriculum. In addition, these findings will inform ongoing efforts to enhance ethics education in our health science center. Assessment of these competencies and subcompetencies is an essential step in strengthening ethics education at our institutions and in better preparing our graduates for a challenging future. We report our efforts here to demonstrate one way of carrying out programmatic assessment of ethics education in a school of public health. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Prayer in Greek ReligionFrances Hickson–HahnSimon Pulleyn. Prayer in Greek Religion. Oxford: Clarendon Press, 1997. xvi + 245 pp. Cloth, $75.The study of prayer in ancient Greece faces rather daunting obstacles. Only four brief texts remain which scholars agree may represent authentic examples of cultic prayer: the twoword prayer of Eleusinian initiates, the Athenian [End Page 632] prayer to Zeus for rain, a prayer to Demeter for the barley (...) sheaf, and the dithyramb of Elis, for a grand total of forty words. In addition, there are three fifth–century hymns from Epidaurus, a form not universally agreed to be prayer. In the area of epigraphic evidence, the largest body of prayer–like addresses derives from curse tablets which mostly postdate the classical period and which arguably belong not to the study of religion but to that of magic. Votive inscriptions, while plentiful, are rarely in prayer form. Thus, of necessity, the scholar is largely dependent on literary evidence, most of which is poetic.Thus it is a challenging task which Simon Pulleyn took on in this revised version of his doctoral thesis: to describe and interpret the mentality of all types of prayer in archaic and classical Greece in a relatively slight volume (216 pages plus appendices, etc.). The resulting monograph, "the first book–length study of Greek prayer to appear in English" (jacket), will prove a useful introduction to the body of evidence and major lines of research on Greek prayer. His work will be especially welcome to those not competent in the ancient languages, for Pulleyn translates all of the prayers proffered as examples, as well as modern foreign–language quotations. He also includes a brief glossary of fifteen Greek words especially important in the study of prayers. While he quotes an abundance of illustrative prayers, both literary and epigraphic, and devotes considerable space to lexicographic discussions, nevertheless he produces a quite readable text.Rejecting the broader definition of prayer as any address or appeal to supernatural powers, used by Aubriot–Sevin (Prière et conceptions religieuses en Grèce ancienne, Lyon, 1992), Pulleyn defines Greek prayers as "articulate requests directed toward the gods" and proposes a four–part classification of (1) prayers based on ξενία (2) curses (), (3) entreaties (λιταί), and (4) supplications ().While there is considerable ancient evidence to support the association of prayer with petition, such a narrow description leaves in limbo other types of address to the gods, such as thanksgivings and greetings, which are too important to be left out of this or any comprehensive study of prayer. And so Pulleyn is forced to devote much space to the discussion of material which he does not technically consider prayer. In fact, he himself varies between the technical use of the term "prayer" and the more common modern definition, a practice which naturally leads to some confusion. On occasion, he resorts to the term "prayer–like" to describe nonpetitionary addresses to gods.Perhaps the reason for this emphasis on petition is the author's main thesis that is the primary characteristic of the relationship between the ancient Greeks and their gods, and thus of prayer as well. Pulleyn explains thus: "it refers to a whole nexus of related ideas that we would call reciprocity. When one gives something to a god, one is giving in the sense that the offering is pleasing; but equally one is storing up for oneself a feeling of gratitude on the part of the god, which is also The whole two–way relationship can be called one of " (4). [End Page 633]This thesis, which is prominent in the first half of the book, is most fully developed in the second chapter, where Pulleyn examines prayers of the type, known particularly from the Homeric epics. He is especially concerned with the da quia dedi(t) model, which presents an argument for fulfillment of the accompanying request based on sacrifices previously offered. Numerically, in Homer and elsewhere, this is not a common prayer type. Although it would seem to violate the typical pattern of sacrifice offered in conjunction with prayer requests, Pulleyn argues convincingly for interpretation of this prayer type within the context of reciprocity. The connection with... (shrink)

Social-emotional competences are critical for positive development and significantly predict educational and occupational attainment, health, and well-being. There is however a lack of consensus about the number of core competences, and how these are defined and operationalized. This divergence in approach challenges future research as well as the scientific usefulness of the construct. In an effort to create an integrative framework, this focused review evaluates different approaches of conceptualizing and assessing social-emotional competences. Building on shared conceptions, an integrative taxonomy (...) “DOMASEC” is introduced, specifying core domains and manifestations of social-emotional competences that bridge across frameworks focusing on social and emotional learning, personality traits and self-determination theory. Core domains include intrapersonal, interpersonal and task-oriented competencies, differentiating between affective, cognitive, and behavioral manifestations of competences across these domains. It is argued that the integrative taxonomy facilitates the conceptual specification of key constructs, that it helps to better organize the multitude of terms and definitions used, and to guide the conceptualization and operationalization of social-emotional competences and their various facets. (shrink)

1. Introduction. David Malament has described a natural and satisfying resolution of the traditional problems of Newtonian cosmology—natural in the sense that it effects the escape by altering Newtonian gravitation theory in a way that leaves its observational predictions completely unaffected. I am in full agreement with his approach. There is one part of his account, however, over which Malament has been excessively modest. The resolution requires a modification to Newtonian gravitation theory. Malament presents the modification as so straightforward as (...) to be automatic. This trivializes the crucial postulate, which I shall call the “relativity of acceleration.” It is a significant physical statement in its own right and requires careful justification. Moreover the postulate proved easy to overlook for decades of discussion of the paradox. It really only becomes natural from the perspective of the newer geometric methods Malament exploits. There the postulate has become a commonplace. My purpose here is to develop the following: While Newtonian cosmology can be repaired satisfactorily, in its traditional form it remains deeply troubled. These troubles can be expressed most vividly as the paradoxical contradictions indicated below. They persist in both the integral and differential formulations of Newtonian gravitation theory. Malament's careful geometric treatment is necessarily dense. By taking some liberties with precision, his core result can be expressed in a far simpler form. Attempts to avoid the resolution Malament describes do lead to disaster. Therefore this episode can be inverted and used as the strongest extant argument for the relativity of acceleration in Newtonian gravitation theory. (shrink)