Introduction. Rest and motion. Stability and progress.--The meaning of justice. The science of values.--The equilibration of interests. Cause and effect. The individual and society. Liberty and government.--Liberty and government. Conclusion.

Current evolutionary and cognitive theories of religion posit that supernatural agent concepts emerge from cognitive systems such as theory of mind and social cognition. Some argue that these concepts evolved to maintain social order by minimizing antisocial behavior. If these theories are correct, then people should process information about supernatural agents’ socially strategic knowledge more quickly than non-strategic knowledge. Furthermore, agents’ knowledge of immoral and uncooperative social behaviors should be especially accessible to people. To examine these hypotheses, we measured response-times (...) to questions about the knowledge attributed to four different agents—God, Santa Claus, a fictional surveillance government, and omniscient but non-interfering aliens—that vary in their omniscience, moral concern, ability to punish, and how supernatural they are. As anticipated, participants respond more quickly to questions about agents’ socially strategic knowledge than non-strategic knowledge, but only when agents are able to punish. (shrink)

Over the past century, six studies – the most recent data from 2000 – and one review have comprehensively examined the content of medical oaths and oath-taking practices, all focusing on North Amer...

Anarchism is by far the least broadly understood ideology and the least studied academically. Though highly influential, both historically and in terms of recent social movements, anarchism is regularly dismissed. Anarchism: A Conceptual Approach is a welcome addition to this growing field, which is widely debated but poorly understood. Occupying a distinctive position in the study of anarchist ideology, this volume, authored by a handpicked group of established and rising scholars, investigates how anarchists often seek to sharpen their message and (...) struggle to determine what ideas and actions are central to their identity. Moving beyond defining anarchism as simply an ideology or political theory, this book examines the meanings of its key concepts, which have been divided into three categories: Core, Adjacent, and Peripheral concepts. Each chapter focuses on one important concept, shows how anarchists have understood the concept, and highlights its relationships to other concepts. Although anarchism is often thought of as a political topic, the interdisciplinary nature of Anarchism: A Conceptual Approach makes it of interest to students and scholars across the social sciences, liberal arts, and the humanities. (shrink)

Finding ways to foster intellectual humility (IH)—the willingness to own one’s limitations—is an important goal for facilitating effective learning. We report the results of a longitudinal, quasi-experimental study, conducted across six undergraduate, culturally diverse (58% racial/ethnic minority) introductory philosophy courses, that evaluates how social perceptions and cross-cultural reasoning change following a course on epistemology and social ethics. Critically, we manipulated whether each class received a standardized lesson in IH at the start of the course or not. Participants provided self-ratings of (...) IH, gave round-robin judgments of their classmates, and completed a wise-reasoning writing exercise focusing on a cultural conflict at both the beginning and end of the summer course session. Results revealed no change in self-reported IH, but an increase in perceived peer IH and conscientiousness within classes where IH was taught. Moreover, an analysis of the participants’ writing suggested greater levels of compromise-seeking when dealing with a cultural conflict among the students taught about IH, relative to those in the control classes. This study provides initial insights regarding the relationship between IH and cultural humility, as well as the efficacy of facilitating the development of IH among undergraduate students. (shrink)

Collected and edited by Noah Levin -/- Table of Contents: -/- UNIT ONE: INTRODUCTION TO CONTEMPORARY ETHICS: TECHNOLOGY, AFFIRMATIVE ACTION, AND IMMIGRATION 1 The “Trolley Problem” and Self-Driving Cars: Your Car’s Moral Settings (Noah Levin) 2 What is Ethics and What Makes Something a Problem for Morality? (David Svolba) 3 Letter from the Birmingham City Jail (Martin Luther King, Jr) 4 A Defense of Affirmative Action (Noah Levin) 5 The Moral Issues of Immigration (B.M. Wooldridge) 6 The Ethics of our (...) Digital Selves (Noah Levin) -/- UNIT TWO: TORTURE, DEATH, AND THE “GREATER GOOD” 7 The Ethics of Torture (Martine Berenpas) 8 What Moral Obligations do we have (or not have) to Impoverished Peoples? (B.M. Wooldridge) 9 Euthanasia, or Mercy Killing (Nathan Nobis) 10 An Argument Against Capital Punishment (Noah Levin) 11 Common Arguments about Abortion (Nathan Nobis & Kristina Grob) 12 Better (Philosophical) Arguments about Abortion (Nathan Nobis & Kristina Grob) -/- UNIT THREE: PERSONS, AUTONOMY, THE ENVIRONMENT, AND RIGHTS 13 Animal Rights (Eduardo Salazar) 14 John Rawls and the “Veil of Ignorance” (Ben Davies) 15 Environmental Ethics: Climate Change (Jonathan Spelman) 16 Rape, Date Rape, and the “Affirmative Consent” Law in California (Noah Levin) 17 The Ethics of Pornography: Deliberating on a Modern Harm (Eduardo Salazar) 18 The Social Contract (Thomas Hobbes) -/- UNIT FOUR: HAPPINESS 19 Is Pleasure all that Matters? Thoughts on the “Experience Machine” (Prabhpal Singh) 20 Utilitarianism (J.S. Mill) 21 Utilitarianism: Pros and Cons (B.M. Wooldridge) 22 Existentialism, Genetic Engineering, and the Meaning of Life: The Fifths (Noah Levin) 23 The Solitude of the Self (Elizabeth Cady Stanton) 24 Game Theory, the Nash Equilibrium, and the Prisoner’s Dilemma (Douglas E. Hill) -/- UNIT FIVE: RELIGION, LAW, AND ABSOLUTE MORALITY 25 The Myth of Gyges and The Crito (Plato) 26 God, Morality, and Religion (Kristin Seemuth Whaley) 27 The Categorical Imperative (Immanuel Kant) 28 The Virtues (Aristotle) 29 Beyond Good and Evil (Friedrich Nietzsche) 30 Other Moral Theories: Subjectivism, Relativism, Emotivism, Intuitionism, etc. (Jan F. Jacko). (shrink)

This essay examines the concept of criticism in the early works of Walter Benjamin. Critique is for Benjamin an attitude toward objectivity that treats it as a medium of reflection, and embodies a politics of ‘sobriety.’ This critical posture provides the early Benjamin with an original method of critiquing capitalism as a form of religion. Capitalist religion is characterized by the proliferation of ‘debt’ that robs the subject of the capacity for critical experience. Art critique and the (...) critique of capitalism are two valences of the concept of critique: positive critique, and negative critique. (shrink)

Ao tratar da beleza artística no §46 da Critica da faculdade do juízo, Kant afirma ser característico do artista o talento de genialidade. Segundo o autor, tal talento seria algo que lhe é natural e através do qual o artista seria capaz de fazer de suas obras a exposição daquilo que ele irá chamar posteriormente no §49 de Ideias estéticas. Estas ideias tendo como característica principal a possibilidade de não serem completamente incluídas em um conceito, conferindo assim à obra uma (...) pluralidade de significados. Por sua vez, em sua tese de doutorado intitulada O conceito de crítica de arte no romantismo alemão, Walter Benjamin propõe-se a analisar o conceito de crítica presente nos românticos, sustentando como tese principal que a verdadeira crítica para tais autores consiste em desdobrar as potencialidades inerentes às obras. Desta forma, a proposta do presente trabalho consiste em mostrar que as características principais que uma "verdadeira" obra de arte possui no pensamento kantiano enquanto exposição de Ideias estéticas, são profundamente análogas àquelas que Benjamin vê nos românticos através do conceito de crítica de arte. (shrink)

This book provides a study of Walter Benjamin's first philosophy in two senses: it focuses on his early philosophy as a source of insight into his later works, and it explores his thinking about the nature of truth, method, experience, the relation of body and mind, and the limits of human knowledge. While most attention is paid to Benjamin's later works, his writings from roughly 1914-1925 explore philosophical themes and develop a critical method. This book argues that this (...) early work founds a series of original and lasting questions and insights. Benjamin understands experience as a broken continuum of diverse forms of spiritual expression, each of which is ephemeral. This leads Benjamin to a series of thought figures: the notion of language as a medium of experience; a philosophy of perception based in the natural history of the human body; an emphasis on mimesis as a faculty of creative assimilation; and a discovery of memory as a power for excavation of meaning in past experience. This book demonstrates that the need for a new understanding of the metaphysical structure of experience, as well as a new conception of truth, play a special role in shaping Benjamin's subsequent work. Walter Benjamin's First Philosophy will be of interest to scholars and advanced students working on the thought of Walter Benjamin, 20th-century Continental philosophy, comparative literature, and modern German thought. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

This essay argues for the philosophical standing of Walter Benjamin’s early work and posits a deeper continuity between this early work as a philosopher and the subsequent development of his work as a writer. When these fragments are read in proper relation to each other, they reveal for the first time many of the key innovations of Benjamin as a philosopher, as well as his points of influence on Horkheimer and Adorno. His early ‘Program’ critiques the Enlightenment conception (...) of experience as a means for gaining empirical knowledge, and announces the need for a new concept of experience. Benjamin follows through on this program with a method of philosophical enquiry that is by turns fragmentary and constellational, developing a series of provisional notions of experience, which form a constellation with one another: perception, mimesis, language as a medium of experience, observation and memory. (shrink)

This edited collection of original essays explores the irreducible role of aesthetic forms of experience and activity in the philosophies of Walter Benjamin and Theodor W. Adorno.

In the nineteenth century, Benjamin Jowett spent over thirty years translating Plato’s Republic. That is an extreme example of perfectionism, but it helps us appreciate the magnitude (and the hubris) of the goal Boethius set for himself in the Introduction to his translation of Aristotle’s De Interpretatione: translating, analyzing, and reconciling the complete opera of Plato and Aristotle.1 As “incomparably the greatest scholar and intellect of his day,”2 Boethius may have had the ability and the energy his ambition required. (...) But we will never know how much Boethius would have achieved as a philosopher if he had not suffered a premature death. In 523, less than a year after being named Magister Officiorum3 by King Theodoric, Boethius was charged with treason, hastily and possibly illegally tried, and executed in 526.4 Since the contemporary sources of information about the affair are vague and fragmented, the passage of nearly 1500 years has brought no consensus in explaining Boethius’ tragic fall from a brilliant intellectual and political career. (shrink)

This collection features original essays that examine Walter Benjamin¿s and Theodor Adorno¿s essays and correspondence on literature. Taken together, the essays present the view that these two monumental figures of 20th-century philosophy were not simply philosophers who wrote about literature, but that they developed their philosophies in and through their encounters with literature. Benjamin, Adorno, and the Experience of Literature is divided into three thematic sections. The first section contains essays that directly demonstrate the ways in which literature (...) enriched the thinking of Benjamin and Adorno. It explores themes that are recognized to be central to their thinking¿mimesis, the critique of historical progress, and the loss and recovery of experience¿through their readings of literary authors such as Baudelaire, Beckett, and Proust. The second section continues the trajectory of the first by bringing together four essays on Benjamin¿s and Adorno¿s reading of Kafka, whose work helped them develop a distinctive critique of and response to capitalism. The third and final section focuses more intently on the question of what it means to gain authentically critical insight into a literary work. The essays examine Benjamin¿s response to specific figures, including Georg B¿chner, Robert Walser, and Julien Green, whose work he sees as neglected, undigested, or misunderstood. This book offers a unique examination of two pivotal 20th-century philosophers through the lens of their shared experiences with literature. It will appeal to a wide range of scholars across philosophy, literature, and German studies. (shrink)

This article maps the emergent field of Islamophobia Studies through a discussion of recently published monographs, representing the broad spectrum of theoretical and analytical approaches to the phenomenon. Strengths and deficiencies in recent works of Nathan Lean, Deepa Kumar, Chris Allen, David Tyrer and Anne Norton are discussed. I argue that in different ways, a more thorough engagement with critical and Marxist theories of racism could contribute to a more accurate understanding of the phenomenon. This, however, is predicated on recognising (...) and theorising Islamophobia as racism – albeit one ‘without races’ – and a discussion about its differences from and similarities to other kinds of racism. (shrink)

Sarah McGrath (2008; 2011) argues that, when it comes to our controversial moral views, we have no reason to think we are less likely to be in error than those who disagree with us. I refer to this position as the Moral Peer View (MPV). Under pressure from Nathan King (2011a; 2011b), McGrath admits that the Moral Peer View need not always have been true, though she maintains it is true now. Although King seems to think there should be current (...) counterexamples to the Moral Peer View, he holds back from actually proposing any. I argue that those of us who favor marriage equality and gender equality are currently in a position to reject the Moral Peer View with regard to these issues, and I propose conditions under which people can reasonably take their moral beliefs to be epistemically advantaged. King and McGrath agree that opponents of slavery like William Wilberforce could reasonably believe they enjoyed an epistemic advantage over proponents of slavery, and I suggest that proponents of marriage equality and gender equality might make similar claims. I propose that we can make additional claims to epistemic advantages if we believe that (1) almost everyone that considers the matter admits they are advantages, (2) those who disagree with use would admit they are advantages, and (3) we can give a plausible explanation as to why those that we think are epistemically disadvantaged have not noticed that they are disadvantaged. Finally, I argue that it reasonable to think our controversial beliefs are justified if we can find reasons to think our opponents are mistaken, and do not see similar reasons to think ourselves mistaken. This is a better policy than supposing we are just as prone to make mistakes as our opponents, as the latter is both less defensible in theory, and more likely to stifle intellectual progress. (shrink)

The study of anarchism as a philosophical, political, and social movement has burgeoned both in the academy and in the global activist community in recent years. Taking advantage of this boom in anarchist scholarship, Nathan J. Jun and Shane Wahl have compiled twenty-six cutting-edge essays on this timely topic in New Perspectives on Anarchism.

In Virtual Worlds, Benjamin Woolley examines the reality of virtual reality.

Mental Imagery, whereby we experience aspect of a perceptual scene or perceptual object in the absence of direct sensory stimulation is ubiquitous. Often the existence of mental imagery is demonstrated by asking one’s reader to volitionally generate a visual object, such as closing ones eyes and imagining an apple. However, mental imagery also arises in auditory, tactile, interoceptive, and olfactory cases. A number of influential philosophical theories have attempted to explain mental imagery in terms of belief-based forms of representation using (...) the Dependence Thesis, dependence upon means of access, such as enactivism, or in terms of the similarity of content with perceptual processing. The focus of this paper concerns the later approach and in particular assessing if Nanay’s promissory note that his theory is applicable to modalities other than vision, such as smell, seems likely to be of theoretical tender. The thesis argued for in this paper is that olfactory imagery exists and is best accounted for by considering it as a type of perceptual processing with a unique representational format relative to the olfactory perceptual modality. The paper concludes by summarizing the applicability of Nanay’s theory of mental imagery for olfaction and suggests some further issues that arise when transitioning to multi-modal mental imagery. (shrink)

The first philosophers of the Frankfurt School famously turned to the psychoanalytic theories of Sigmund Freud to supplement their Marxist analyses of ideological subjectification. Since the collapse of their proposed "marriage of Marx and Freud," psychology and social theory have grown apart to the impoverishment of both. Returning to this union, Benjamin Y. Fong reconstructs the psychoanalytic "foundation stone" of critical theory in an effort to once again think together the possibility of psychic and social transformation. Drawing on the (...) work of Hans Loewald and Jacques Lacan, Fong complicates the famous antagonism between Eros and the death drive in reference to a third term: the woefully undertheorized drive to mastery. Rejuvenating Freudian metapsychology through the lens of this pivotal concept, he then provides fresh perspective on Theodor Adorno, Max Horkheimer, and Herbert Marcuse's critiques of psychic life under the influence of modern cultural and technological change. The result is a novel vision of critical theory that rearticulates the nature of subjection in late capitalism and renews an old project of resistance. (shrink)

During the 2020 COVID-19 pandemic, open science has become central to experimental, public health, and clinical responses across the globe. Open science is described as an open commons, in which a right to science renders all possible scientific data for everyone to access and use. In this common space, capitalist platforms now provide many essential services and are taking the lead in public health activities. These neoliberal businesses, however, have a problematic role in the capture of public goods. This paper (...) argues that the open commons is a community of rights, consisting of people and institutions whose interests mutually support the public good. If OS is a cornerstone of public health, then reaffirming the public good is its overriding purpose, and unethical platforms ought to be excluded from the commons and its benefits. (shrink)

ld English manors have their ghosts. And though I would not want to call analytic philosophy a ‘manor’, nor exactly ‘old’, it certainly is of some decent English origin, and it left adolescence a while ago. No wonder then, that it is not exempt from haunting terrors. One particular spectre has been haunting it for decades; it already gave some analytic pioneers the creeps, and we still now and then find people terrified by it: the ghost of old Bradley has (...) not yet found its rest and keeps on threatening people with his notorious regress. The present essay is a lecture in exorcism; much of the fear old Bradley spread, so I will argue, peters out once we dare to look it in the eye. However, this essay is not primarily exegetical, and especially not an attempt in interpreting Bradley. I find Bradley’s writings, to say the least, not particularly accessible. Discussions of isolated passages from his longer treatises will probably be less fruitful than a careful study of the positions within the whole argumentative structure, supplied by the examination of Bradley’s intellectual upcoming. His treatments on relations and properties, in which he develops the famous regress argument, are motivated by a radical goal: a vindication of some form of monism. To reach this goal, he tries to deconstruct the most basic categories of our ordinary conceptual framework. Thus, he holds that.. (shrink)

People implicitly associate different emotions with different locations in left-right space. Which aspects of emotion do they spatialize, and why? Across many studies people spatialize emotional valence, mapping positive emotions onto their dominant side of space and negative emotions onto their non-dominant side, consistent with theories of metaphorical mental representation. Yet other results suggest a conflicting mapping of emotional intensity (a.k.a., emotional magnitude), according to which people associate more intense emotions with the right and less intense emotions with the left (...) — regardless of their valence; this pattern has been interpreted as support for a domain-general system for representing magnitudes. To resolve the apparent contradiction between these mappings, we first tested whether people implicitly map either valence or intensity onto left-right space, depending on which dimension of emotion they attend to (Experiments 1a, b). When asked to judge emotional valence, participants showed the predicted valence mapping. However, when asked to judge emotional intensity, participants showed no systematic intensity mapping. We then tested an alternative explanation of findings previously interpreted as evidence for an intensity mapping (Experiments 2a, b). These results suggest that previous findings may reflect a left-right mapping of spatial magnitude (i.e., the size of a salient feature of the stimuli) rather than emotion. People implicitly spatialize emotional valence, but, at present, there is no clear evidence for an implicit lateral mapping of emotional intensity. These findings support metaphor theory and challenge the proposal that mental magnitudes are represented by a domain-general metric that extends to the domain of emotion. (shrink)

Souvent délaissée, la pensée politique de l’international chez Hobbes et Bentham recèle plus de points communs qu’on ne pourrait le penser. Pour reconstruire philosophiquement cette pensée, en s’attachant plus spécifiquement au rapport entre économie et politique, on explique d’abord leur commune opposition aux colonies et aux politiques étrangères bellicistes. On montre ensuite comment ils comprennent le commerce international, l’économie et le marché en relation avec l’État, et enfin qu’on ne saurait constituer une théorie politique internationale assurant la sécurité, la paix (...) et la prospérité qui soit autonome et séparée de la théorie de l’État. (shrink)

In response to the racial disparities that plague the American criminal justice system, the Movement for Black Lives calls for an end to policing and punishment “as we know it.” But refusing to punish violent offenses leaves unprotected those most vulnerable to crime, and outright abolition thus appears to undermine black rights and liberties. I call this the decarceration dilemma. After discussing Tommie Shelby and Christopher Lewis’s attempts to resolve the dilemma, I offer my own, which employs a procedural rather (...) than a substantive solution. I lean on the principle of expanded asymmetry (EA), which holds that it is better to underpunish than overpunish. After defending EA, I note that it obtains only under conditions of uncertainty. I then show that because virtually all trials of black offenders meet the uncertainty condition, sentencing authorities are obliged to treat black offenders leniently. I conclude by noting the advantages of my proceduralist approach. (shrink)

Wilson et al. focus on one class of AGL tasks: the cognitively demanding task of detecting non‐adjacent dependencies (NADs) among items. They provide a typology of the different types of NADs in natural languages and in AGL tasks. A range of cues affect NAD learning, ranging from the variability and number of intervening elements to the presence of shared prosodic cues between the dependent items. These cues, important for humans to discover non‐adjacent dependencies, are also found to facilitate NAD learning (...) in several nonhuman animal species. (shrink)

While the proliferation of diversity, equity, and inclusion (DEI) initiatives among medical schools and residency training programs has provided important benefits of demographic and experiential diversity among medical trainees, there has not been a similar emphasis upon the importance of moral diversity in medical training. Enhanced attention to the importance of moral diversity and the centrality of conscience to medical practice might allow trainees to better interface with the morally diverse patients they serve, learn important virtues like humility, patience, and (...) tolerance, and deepen their understanding of and appreciation for alternative moral viewpoints among their fellow practitioners. (shrink)

This article critically assesses the moral arguments that speak in favour of three consumer options: buying local food, buying global (non‐local) food, and buying global food while also purchasing carbon offsets to mitigate the environmental impact of food transportation. We argue that because the offsetting option allows one to provide economic benefits to the poorest food workers while also mitigating the environmental impact of food transportation it is morally superior to the alternatives.

What recourse do democrats have if a present generation uses democratic legal procedures to abrogate constitutional essentials, dissolving past commitments and denying future generations the fundamental freedoms and equalities it currently enjoys? In Sovereignty across Generations, Alessandro Ferrara responds to this issue by re-examining key concepts related to democracy, including sovereignty, constituent power, liberalism and constitutionalism. This review analyses Ferrara’s theory of ‘sequential sovereignty’, which reconceives ‘the people’ as a body spanning generations and grounds it in the ideal of vertical (...) reciprocity. Ferrara provides a sound normative framework for understanding transgenerational obligations and the unamendability of constitutional essentials. However, this review also identifies some limits to Ferrara’s approach: his focus on implied unamendability risks creating a dissonance between legality and legitimacy, and his reluctance to fully engage with ‘containment’ creates a blind spot in democracy’s self-defence. The review concludes that explicit unamendability and containment are consistent with Ferrara’s theory of sequential sovereignty and provide a better safeguard for democracy across generations. (shrink)

Imaginez un homme ou une femme du futur, étudiant(e) en philosophie et assistant à ses premiers cours de philosophie morale et politique. Imaginez ce cours donné par un(e) professeur(e), les remarques des étudiant(e)s à propos de telle thèse, tel argument. Imaginez leurs sourires, leurs réactions de stupéfaction ou de scandale, leurs blagues… Imaginez à présent que ces réactions expriment aussi le fait qu’ils étudient ceux-là même qui ont ruiné leur monde, c’est-à-dire ceux qui ont causé un c..

Taking a cue from Teilhard de Chardin's Christologically inflected speculation, the key question in this issue is whether the project of transhumanism is compatible with Christianity and the Incarnation of Christ. Two articles focus on theological anthropology and the limits, if any, of human perfection in light of Christ's perfection. Another article examines the ontological claims about human nature in transhumanism and its incompatibility with a Christian ontology. The last two turn from more abstract concerns to consider how the use (...) of technology can inhibit or help human moral and spiritual development. (shrink)

In 1952, two well-known characters called ‘A’ and ‘B’ met for the first time to argue about the Identity of Indiscernibles (Black, 1952). A argued that the principle is true, and B that it is false. By all accounts A took a bit of a beating and came out worst-off. Forty-three years later John O’Leary-Hawthorne offered a response on behalf of A that looked as if it would work so long as A was willing to accept the universal-bundle theory of (...) substance (Hawthorne, 1995). In 1997, A and B met again (Zimmerman, 1997). A took Hawthorne’s advice and revealed himself as a universal-bundle theorist. But B was well-prepared, and once more A took a beating. Since then Gonzalo Rodriguez-Pereyra (2004) has put the boot in, offering further criticism of A’s position. In recent years A has been rather quiet, leaving B to reign as the undisputed champion. However, it turns out that A is down, but not out. And now it’s time for A’s revenge. (shrink)

Eight focus groups were conducted in four public hospitals in Madrid to explore healthcare professionals’ perceptions of advance directives in order to improve the understanding of their lack of success among physicians and patients. A purposive sample of sixty healthcare professionals discussed ADs and reasons for their infrequent use. Three main themes were identified: perceptions about their meaning, appraisals of their use in clinical practice, and decision-making about them. Healthcare professionals perceived a lack of clarity about their definition and implementation. (...) There is insufficient awareness of their efficacy in improving the quality of clinical relationships and decision-making, and they are often perceived only as a bureaucratic procedure. Advance directives are not integrated in the clinical practice of Madrid’s healthcare specialist services because their application is exceedingly complex, because of insufficient education about them, and because of lack of procedural clarity. Consequently, healthcare professionals are not aware of how ADs could improve clinical decision-making, of when and for whom their use is appropriate, and of who has responsibility for providing ADs-related information to patients. These circumstances contribute to patients’ lack of interest in completing these documents and to physicians’ sceptical views about their usefulness. (shrink)