How do we teach medical students to protect patients? My initial reaction to the question posed by Taylor and Goodwin was like first glimpsing ‘Jaws’: we’re going to need a bigger boat. The authors’ answer makes two important claims: first, that safety should be ethically sourced by better integration between teaching of safety and ethics; second, that teaching should encourage students to think about organisational failure rather than focusing on individual blame and personal responsibility to whistleblow.1 On the first, they (...) highlight how ethics teaching often sits apart from that on safety. For the second, they use the concept normalisation of deviance, with its contained idea of structural secrecy, to depict organisational failure that is argued as largely immune to whistleblowing. Why wouldn’t these challenges warrant a bigger boat? On their first claim: it is not just for safety, but throughout the curriculum that ethics teaching needs to be integral. Given coming challenges, it should become the cake rather than the icing. Consider, for example, that artificial intelligence stands to transform many knowledge-based professions, medicine among them. Tomorrow’s doctors will have a surfeit of data and automated decision aids at their fingertips. So, as far as they remain necessary, doctors will …. (shrink)

Kindness and its kindred concepts, compassion and empathy, are strongly valued in healthcare. But at the same time, health systems all too often treat people unfairly and cause harm. Is it possible that kindness actually contributes to these unkind outcomes? Here, I argue that, despite its attractive qualities, kindness can pose and perpetuate systemic problems in healthcare. By being discretionary, it can interfere with justice and non-maleficence. It can be problematic for autonomy too. Using the principalist lens allows us to (...) visualise kindness more clearly and to dissect out its key qualities. Ideally, kindness should be not just beneficent but also respectful of the person, fair and non-maleficent. I use examples to illustrate the adverse impacts when kindness runs short on each. Finally, I propose that we can improve on this, by diversifying our approach to inclusion. Outgroups should be more included, as a way to mitigate discrimination wrought by discretionary kindness. But we can do better. Ingroup health professionals too often sit ‘above the fray’. They should also be more included, but now as research subjects, so we can understand together how they benefit from discretionary kindness and deftly make it work for them and theirs. (shrink)

Nietzche claimed that once we know why to live, we’ll suffer almost any how.1 Artificial intelligence (AI) is used widely for the how, but Ferrario et al now advocate using AI for the why.2 Here, I offer my doubts on practical grounds but foremost on ethical ones. Practically, individuals already vacillate over the why, wavering with time and circumstance. That AI could provide prosthetics (or orthotics) for human agency feels unrealistic here, not least because ‘answers’ would be largely unverifiable. Ethically, (...) the concern is that AI stands to frack our humanity. We form a fragile ecosystem of ethical subjects, our responsiveness to others’ suffering, enabled by our own. To deliberate together for incapacitated others is among those solemn privileges that verify our humanity. Having AI mine these delicate pain-forests risks treating our suffering as the new oil—to be extracted and exploited, but beyond our vision and at our cost. Let’s briefly develop each idea, starting with the how/why distinction. This is palpable, even for more prosaic questions like how or why to drive. The former admits of increasingly sophisticated technological fixes and nudge; the latter often remains very particular and personal. How much greater then, the difference between …. (shrink)

Video recording is widely available in modern operating rooms. Here, I argue that, if patient consent and suitable technology are in place, video recording of surgery is an ethical duty. I develop this as aduty to protect,arguing for professional and institutional duties, as distinguished forduties of rescue.A professional duty to protect is described in mental healthcare. Practitioners have to take reasonable steps to prevent serious, foreseeable harm to their clients and others, even if that entails a non-consensual breach of confidentiality. (...) I argue surgeons have a similar duty to patients which means that, provided the patient consents, surgery should be routinely videoed. This avoids non-consensual breaches of patient confidentiality and is aligned with stated professional obligations.An institutional duty to protect means institutions have to take reasonable steps to prevent serious, foreseeable harm at the hands of their surgeons. Rulli and Millum highlighted how institutions can meet their duty using a more consequentialist approach that balances wider interests.To test the force and scope of such duties, I examine potential impacts of routine videoing on aspects of autonomy, justice, beneficence and non-maleficence. I find routine videoing can benefit areas including safety, candour, consent and fairness in access (to surgical careers and expertise). Countervailing claims, for example, on liability, confidentiality and privacy can be resisted—such that where consent and the technology are in place, routine videoing meets aduty of easy protection. In other words, its use should be standard of care. (shrink)

This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the ‘AP‐physician‐family‐relationship’ and the dominant role Chinese families play in medical decision‐making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from (...) Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives ‘weak’ family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re‐interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its ‘parens patriae’ power to defend the defenseless in society and the integrity of the medical profession. (shrink)

Since its inception, experimental social psychology has arguably been of two minds about the nature and role of theory. Contemporary social psychology's experimental approach has been strongly informed by the “nomological-deductive” approach of Carl Hempel in tandem with the “hypothetico-deducive” approach of Karl Popper. Social psychology's commitment to this hybrid model of science has produced at least two serious obstacles to more fruitful theorizing about human experience: the problem of situational specificity, and the manifest impossibility of formulating meaningful general laws (...) of human social behavior. It is argued that a social psychology based on the search for this kind of lawfulness, under the auspices of either a strict or loose interpretation of the largely Hempelian model, is ultimately unworkable. An alternative approach to social psychology that is attentive both to the need for understanding individual situations and behaviors and to the need for generalized understanding of actual human behaviors is offered. This approach is grounded in the hermeneutic tradition. (shrink)

My thesis is simple. The right of informational privacy, the great modern achievement often attributed to the classic Samuel Warren and Louis Brandeis article, “The Right to Privacy” , asserts an individual's right not to have private personal information circulated. Warren and Brandeis claimed that individual dignity in a modern society requires that people be able to keep their private lives to themselves and proposed that the common law should be understood to protect this dignity by making dissemination of private (...) information a tort. As broadly stated, this right not to have private information distributed directly conflicts with a broadly conceived freedom of speech and of the press. My claim is that, in cases of conflict, the law should reject the Warren and Brandeis innovation. Speech and press freedom should prevail; the privacy tort should be ignored. This conclusion requires a normative argument concerning the appropriate basis and status of speech freedom that this essay will not really provide but for which I have argued elsewhere. Here, instead, I will describe that theory of speech freedom, explore its implications for informational privacy, and finally suggest some reasons to think that rejection of the privacy tort should not be so troubling and is, in fact, pragmatically desirable. (shrink)

This is a literature review study, of unemployment which is widespread in today's societies, where individuals with work capacity, find themselves without employment activity due to a lack of opportunities or simply because they cannot find a job. The research aims to learn and understand the causes of unemployment and underemployment in Ecuador, particularly in the Province of Chimborazo during the years 2021-2022. To achieve this we have relied on the collection of statistical data and its subsequent analysis, interpretation, judgment, (...) and prospection, which provides a base tool for decision-making, as well as for academic and business deepening. (shrink)

In this article, I want to draw attention to one strand ofthe complex web of processes that are involved when people group others, including themselves, into social categories. I will focus on the tendency to treat members of one's own group more favorably than nonmembers, a tendency that has been called ingroup favoritism. The structure of the article has three parts. First I will offer anevolutionary argument as to why ingroup favoritism, or something very much like it, is required by (...) theories of the evolution of altruism. I will then review some of the basic social psychological research findings dealing with social categorization generally, and ingroup favoritism specifically. Finally, I will examine two problems in business ethics from the point of view of ingroup favoritism to suggest ways in which social psychological principles and findings may be mobilized to help solve problems of racial or gender discrimination in business contexts. (shrink)

In this paper I examine five essential themes in Brand Blanshard's coherence theory of truth. Blanshard defines truth in terms of the rational or the interdependence of concepts, where concepts determine objects of experience rather than merely conform to them. On this view, truth is contextual and is the approximation of thought to reality or the systemization of the two ends - the immanent and transcendent. I raise some worries for this account of truth, foremost of which is the worry (...) that it commits us to a deep-seated skepticism, both theoretical and practical. In order to be able to tell when the immanent end is achieved and if it is making progress towards the transcendent end (i.e., when the ultimate systematization is realized), we require an omniscient standpoint of cosmic order or overarching system of beliefs. While this seems possible in principle it is not so in practice. (shrink)

If “on what matters” captures Parfit’s search for objective moral truths (Parfit 2011), perhaps “on who matters (and why)” might be a working title for Shepherd’s enquiry into the moral status of n...

How could we better use public inquiries to stem the recurrence of healthcare failures? The question seems ever relevant, prompted this time by the inquiry into how former nurse Letby was able to murder newborns under National Health Service care. While criminality, like Letby’s, can be readily condemned, other factors like poor leadership and culture seem more often regretted than reformed. I would argue this is where inquiries struggle, in the space between ethics and law—with what is awful but lawful. (...) In response, we should learn from progress with informed consent. Inquiries and civil litigation have seen uninformed ‘consent’ shift from being undesirable to unlawful. If better leadership and culture were sole drivers here, we would likely be doing far better in many other areas of healthcare too. Instead, one could argue that progress on consent has been made by reducing _epistemic injustice_—by naming and addressing _epistemic_ issues in ways that enhance _social power_ for patients. If this is an ingredient that transforms clinician–patient working, might it also shift conduct within other key relationships, by showing up what else should become unlawful and why? Naming _medical paternalism_ may have helped with consent reform, so I continue this approach, first naming two areas of epistemic injustice: _management feudalism_ and _legal chokeholds_. Remedies are then considered, including the democratisation of management and reforms to legal ethics, legislation and litigation. In brief, public inquiries may improve if they also target epistemic injustices that should become unlawful. Focus on informed consent and epistemic relationships has improved the medical profession. Likewise, it could help healthcare leaders shift from fiat towards consent, and their lawyers from a stifling professional secrecy towards the kind of candour a prudent public expects. (shrink)

When the clinician and patient are unable to reconcile differences over treatment, does this mean the latter lacks capacity to decide in such matters? Wellesleyet alanalyse the legal judgements in the case of Ms Sudiksha Thirumalesh where, on the particulars, the Court of Protection answered yes, only for the Court of Appeal to disagree. The authors highlight concerns about using isolated false belief as an indicator of incapacity and advise that such matters may be better resolved by greater discussion of (...) the benefits and burdens of treatment, alongside consideration of their costs. Here, I suggest that a disability perspective is also helpful to such cases, recognising that this was a disagreement from which the patient couldn't walk away. Disability means that particular care is required when considering the burdens and benefits of treatment as these may vary widely in the eye of the beholder. Second, the costs of litigation are particularly high when a disabled person, with life-limiting illness, is left feeling they are using precious time and energy arguing for their existence. Third, any such legal judgments ought to make clear what reasonable adjustments have been offered to include the disabled person in proceedings. Fourth, and relatedly, such disputes should be attentive to the significant risk of epistemic injustice, where disabled patients find themselves less believed, in part because the ‘able-bodied’ have not shared their experiences. Together, these considerations (i) add to the call made by Wellesleyet alfor better discussions and (ii) suggest that early involvement of Rehabilitation Medicine, with expertise in disability and related ethics, could offer an important means to reduce the need for such litigation in the future. (shrink)

Dieser Sammelband vereint Schriften, Artikel und Essays von Brigadier Mag. Dr. Edwin Rudiger Micewski. Die Kompilation wurdigt sein Wirken als Offizier und Philosoph und stellt einem an militarphilosophischen Fragen und humanistischen Aspekten der militarischen Lebenswelt interessierten Leserkreis eine zusammenfassende Gesamtschau deutscher wie englischer Veroffentlichungen des Autors zur Verfugung. Die philosophisch und grundwissenschaftlich orientierten Beitrage behandeln Grundfragen von Sicherheitspolitik und Militarphilosophie und sind aufgrund ihres zeitlosen Charakters auch fur aktuelle Herausforderungen von Relevanz. Infolge der thematischen Bezuge des publizistischen OEvres des (...) Autors gliedert sich die Arbeit in drei Kapitel, die den philosophischen und ethischen Schriften, den Beitragen zur Sicherheitspolitik und politisch-militarischen Beziehungen sowie den Fragen von Fuhrung, Bildung und militarischem Professionalismus gewidmet sind. Ein einleitender Abschnitt beinhaltet Reflexionen zu Person, Werk und Wirken von Edwin Rudiger Micewski, die von vier herausragenden Personlichkeiten des internationalen akademisch-sicherheitspolitischen Diskurses verfasst wurden.". (shrink)

Collaboration on the First Edition of Spacetime Physics began in the mid-1960s when Edwin Taylor took a junior faculty sabbatical at Princeton University where John Wheeler was a professor. The resulting text emphasized the unity of spacetime and those quantities (such as proper time, proper distance, mass) that are invariant, the same for all observers, rather than those quantities (such as space and time separations) that are relative, different for different observers. The book has become a standard introduction to (...) relativity. The Second Edition of Spacetime Physics embodies what the authors have learned during an additional quarter century of teaching and research. They have updated the text to reflect the immense strides in physics during the same period and modernized and increased the number of exercises, for which the First Edition was famous. Enrichment boxes provide expanded coverage of intriguing topics. An enlarged final chapter on general relativity includes new material on gravity waves, black holes, and cosmology. The Second Edition of Spacetime Physics provides a new generation of readers with a deep and simple overview of the principles of relativity. (shrink)

Hutchins examines a set of phenomena that have fallen between the established disciplines of psychology and anthropology, bringing to light a new set of relationships between culture and cognition.

Everybody knows that humans are cultural animals. Although this fact is universally acknowledged, many opportunities to exploit it are overlooked. In this article, I propose shifting our attention from local examples of extended mind to the cultural-cognitive ecosystems within which human cognition is embedded. I conclude by offering a set of conjectures about the features of cultural-cognitive ecosystems.

THE CONCEPT OF CONSCIOUSNESS CHAPTER I THE RENAISSANCE OF LOGIC WITHIN the last two decades the scholarly world has witnessed a revival of interest in logic ...