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)

The purpose of this paper is to provide further clarity to the technical and policy difficulties associated with mitigating greenhouse gas emissions from agriculture by identifying and distilling the core tensions which propagate and animate them. We argue that these complexities exist across four critical dimensions: the epistemological, the ethical, the political, and the practical. Adequately confronting the challenge of agricultural emissions will require improved transparency in emissions measurement, increased science communication, enhanced public participatory mechanisms, and the integration of ethical (...) deliberation in scientific and policy discussions. (shrink)

This is the first of two companion articles drawn from a larger project, provisionally entitled Undisciplining Moral Epistemology. The overall goal is to understand how moral claims may be rationally justified in a world characterized by cultural diversity and social inequality. To show why a new approach to moral justification is needed, it is argued that several currently influential philosophical accounts of moral justification lend themselves to rationalizing the moral claims of those with more social power. The present article explains (...) how discourse ethics is flawed just in this way. The article begins by identifying several conditions of adequacy for assessing reasoning practices designed to achieve moral justification and shows that, when used in contexts of cultural diversity and social inequality, discourse ethics fails these conditions. It goes on to argue that the failure of discourse ethics is rooted in its reliance on a broader conception of moral epistemology that is invidiously idealized. It concludes by pointing to the need to rethink both the mission and the method of moral epistemology. (shrink)

The centenary of the birth of Ludwig Wittgenstein (1889-1951) provided an opportunity for recovering some of the great Wittgensteinian subjects, for re-examining them and for discussing their implications and relevance. This volume is the result of the interchange that took place in Girona (Spain) among well-known scholars of Wittgenstein's work in different countries. The eleven contributions are organized into three main subjects: on Wittgenstein's method (B. McGuinness, E. Tugendhat and J.M. Terricabras), on knowledge and meaning (G.E.M. Anscombe, R. Bambrough, N. (...) Malcolm, and P.T. Geach), on language and use (D. Pears, E.v. Savigny, J. Bouveresse and J. Ferrater Mora). This volume is not only the result of the different and mature reflexions of its authors, but in two cases (Malcolm and Ferrater Mora) it has also unfortunately become their last contribution to the subject. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could further (...) improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

Romanian born E.M. Cioran, who lived in Paris until his death in 1995, writes of politics, of history, and of the utopian dream. "Cioran has a claim to be regarded as among the handful of original minds... writing today".--NEW YORK TIMES.

In this article, I examine the moral dimensions of gender affirmation. I argue that the moral value of gender affirmation is rooted in what Iris Murdoch called loving attention. Loving attention is central to the moral value of gender affirmation because such affirmation is otherwise too fragile or insincere to have such value. Moral reasons to engage in acts that gender affirm derive from the commitment to give and express loving attention to trans people as a way of challenging their (...) marginalization. In the latter part of the paper, I will discuss how my arguments bear on recent arguments by Robin Dembroff and Daniel Wodak (2018) on the use of gender-neutral language. They argue that we have a duty not to use gender-specific pronouns for anyone. Their conclusion turns, in part, on a rejection of gender affirmation as a moral duty. The value of gender affirmation, rooted in our moral perception of trans people, should make us skeptical of this conclusion, in favor of a more nuanced and pluralistic approach to the ethics of gendering. (shrink)

_Zettel, _ an en face bilingual edition, collects fragments from Wittgenstein's work between 1929 and 1948 on issues of the mind, mathematics, and language.

En las tres últimas décadas del siglo XX, muchos filósofos analíticos han abordado cuestiones de ética práctica, ampliando radicalmente el campo de la filosofía moral más allá de los temas metaéticos que habían sido su foco principal durante la mayor parte del siglo. Sin embargo, abordar este tipo de controversias prácticas rápidamente hizo surgir la cuestión de cómo justificar las afirmaciones morales normativas. Muchos filósofos analíticos se basaron en el intuicionismo, que tiene un linaje muy antiguo dentro de la filosofía (...) moral anglófona. Este artículo evalúa tres formas en las que los filósofos analíticos del siglo XX recurrieron a las intuiciones para apoyar o rebatir las afirmaciones morales. Argumentamos que esos métodos fracasaron en su objetivo de promover un conocimiento moral digno de confianza porque se basaron en supuestos que, cuando se presumen en contextos de injusticia epistémica estructural, son sistemáticamente engañosos. A pesar de que las intuiciones se encuentran entre las fuentes de conocimiento en las que los agentes morales deben confiar, la epistemología moral debe prestar especial atención a los procesos sociales a través de los cuales se recogen, refinan y evalúan las intuiciones y otras formas de evidencia. Producir un conocimiento moral digno de confianza requiere procesos de razonamiento democráticos que sean sensibles a la omnipresencia de la injusticia epistémica y la dominación, así como desarrollar estrategias para contrarrestarlas. (shrink)

In 2005 St Andrews Studies published a volume of essays by Anscombe entitled Human Life, Action and Ethics, followed in 2008 by a second with the title Faith in a Hard Ground. Both books were highly praised. This third volume brings essays on the thought of historical philosophers in which Anscombe engages directly with their ideas and arguments. Many are published here for the first time and the collection provides further testimony to Anscombe's insight and intellectual imagination.

The appearance of Nan Dunbar's important commentary onBirdsis to be welcomed. Inevitably, however, such a volume requiresaddenda et corrigenda; and already the author must be collecting material for a second edition. Here is somepabulum. On the passage cited, Dunbar comments, ‘The difficulties of this sentence stem from uncertainty over (a) the form and sense of the main verb … and (b) the point of χαραδρι⋯ν μιμο⋯μενος and its connection with what precedes …’.

The present article allows to explore, analyze and reflect on the consequences and problems posed by biobanks and attempts to prove the need of social and humanitarian support in establishing and functioning of biobanks as a new type of scientific institutions. The basis of the article is the latest publications devoted to social and humanitarian aspects of biobanking and Russian experience of the initial formation of this subject domain. The article marks and classifies different aspects of biobanking that objectively demands (...) the participation of specialists in ethics and social sciences. The cases of biobanking development and risks are estimated; the objective need of applied ethics and social sciences specialists’ participation in biobanking is proved. (shrink)

MORALITY is an area of culture that is highly susceptible to philosophical skepticism. This has been so at least since the time of the Greek Sophists. But modern Western civilization seems to be especially prone to philosophical doubts about the moral enterprise because of widely shared assumptions and views in the modern age about the knowledge-yielding powers of the human mind. This particular trouble spot in the culture has received extensive philosophical attention ever since the seventeenth century, but activity in (...) moral philosophy has never been greater than in our own time. (shrink)