Decision-making Capacity matters to whether a patient’s decision should determine her treatment. But why it matters in this way isn’t clear. The standard story is that dmc matters because autonomy matters. And this is thought to justify dmc as a gatekeeper for autonomy – whereby autonomy concerns arise if but only if a patient has dmc. But appeals to autonomy invoke two distinct concerns: concern for authenticity – concern that a choice is consistent with an individual’s commitments; and concern for (...) sovereignty – concern that an individual exercises control over that which is hers to control. Here, I argue, neither concern can alone explain why dmc matters. Instead, dmc matters because it indicates a harmony between the two concerns – the demands of each concern are more likely to agree if a patient has dmc. This vindicates the standard story, but also makes clear that dmc is an inappropriate gatekeeper for autonomy. (shrink)

It is natural to think that there is a tight connection between whether someone is responsible for some outcome and whether it is appropriate to hold her accountable for that outcome. And this natural thought naturally extends to health: if someone is responsible for her health, then, all else being equal, she is accountable for it. Given this, some have thought that responsibility for health has an important role to play in distributing the benefits and burdens of healthcare. But there (...) is a reason for caution. That health is influenced by social, economic, and environmental factors is a matter of consensus. And some have argued that in light of these social determinants of health, individuals are not typically responsible for their health, rendering inappropriate policies that employ a responsibility‐for‐health criterion. This debate implicates a number of overlapping concepts and questions that are often difficult to pull apart. And I worry that those who maintain that social determinants undermine responsibility for health have latched on to the wrong target. The social determinants of health are relevant to such policies, but, I argue, not by globally undermining responsibility. Rather, social determinants are sometimes responsibility‐undermining, sometimes responsibility‐preserving, and often relevant to whether we should hold individuals accountable for their health regardless of their responsibility. This calls for a more nuanced appraisal of the ways in which the social determinants of health are relevant to such policies. And here I attempt to provide one. (shrink)

There are cases of ineffable learning — i. e., cases where an agent learns something, but becomes certain of nothing that she can express — where it is rational to update by Jeffrey conditionalization. But there are likewise cases of ineffable learning where updating by Jeffrey conditionalization is irrational. In this paper, we first characterize a novel class of cases where it is irrational to update by Jeffrey conditionalization. Then we use the d-separation criterion to develop a causal understanding of (...) when and when not to Jeffrey conditionalize that bars updating by Jeffrey conditionalization in these cases. Finally, we reflect on how the possibility of so-called “unfaithful” causal systems bears on the normative force of the causal updating norm that we advocate. (shrink)

The role and importance of empathy in clinical practice has been widely discussed. This paper focuses on the ideal of clinical empathy, as involving both cognitive understanding and affective resonance. I argue that this account is subject to a number of objections. Affective resonance may serve more as a liability than as a benefit in clinical settings, and utilizing this capacity is not clearly supported by the relevant empirical literature. Instead, I argue that the ideal account of empathy in medicine (...) remains cognitive, though there is a central role for expressing empathic concern toward patients. (shrink)

One natural way to argue for the existence of some subjective constraint on agents’ obligations is to maintain that without that particular constraint, agents will sometimes be obligated to do that which they lack the ability to do. In this paper, I maintain that while such a strategy appears promising, it is fraught with pitfalls. Specifically, I argue that because the truth of an ability ascription depends on an (almost always implicit) characterization of the relevant possibility space, different metaethical accounts (...) take obligation to be constrained by different senses of ability. As a result, what initially looks to be a point of consensus—that ability constrains obligation—turns out to be a point of contention, and arguments with this at the foundation are much more likely to obscure, rather than resolve, metaethical disputes. Despite this, appeals to ability in metaethics aren’t doomed to be fruitless. On the contrary, if we can independently establish a particular sense of ability as the normatively relevant one, then we have good grounds for ruling out metaethical accounts that are inconsistent with it. In the final section, I make just such an argument. What seems right about the thought that ability constrains obligation is that an agent cannot be obligated to do that which her circumstances prevent her from doing. I argue that only a sense of ability that is both epistemically and motivationally restricted adequately respects the limits of agential control. (shrink)

The question of how to treat an incapacitated patient is vexed, both normatively and practically—normatively, because it is not obvious what the relevant objectives are; practically, because even once the relevant objectives are set, it is often difficult to determine which treatment option is best given those objectives. But despite these complications, here is one consideration that is clearly relevant: what a patient prefers. And so any device that could reliably identify a patient’s preferences would be a promising tool for (...) guiding the treatment of incapacitated patients. The patient preference predictor is just such a tool—an algorithm that takes as inputs a patient’s sociodemographic characteristics, and outputs a reliable prediction about that patient’s treatment preferences.1 But some have worried that the use of such a tool would violate or fail to appropriately respect patients’ autonomy. There are, I think, two ways to understand this kind of criticism. First, globally—as a worry that any systematic implementation of the PPP would be problematic on the grounds that it would result in significant or pervasive autonomy violations. Second, locally—as a worry that in some important range of cases, certain uses of the PPP would be problematic on autonomy grounds. Jardas et al, as I read them, address global autonomy-based criticisms, arguing—convincingly, in my view—that there’s no reason to suspect the autonomy concerns raised by the PPP would be so significant and pervasive as to render any implementation of it generally problematic.1 But even with the global criticisms rebuffed, there remains work to be done. Any ethically acceptable implementation of the PPP must be sensitive to the more local autonomy-based criticisms, with restrictions and safeguards in place to ensure respect for autonomy in the kinds of cases in which the use of the PPP might otherwise threaten …. (shrink)

Affective empathy has been variously characterized. First, I argue that we have reasons to prefer a narrower account of affective empathy, which requires the cognitive mechanisms of perspective-taking. Second, I mount a challenge to the standard account of affective matching thought to be required for affective empathy. On one widely held view, affective empathy requires an actual affective match between the subject and the target of empathy. I reject this view. While empathy often involves an actual match, we also count (...) as empathizing with the target if we share the fitting state in their situation. This wider account better captures a number of plausible cases of empathy, and it also better explains why we care about affective empathy. (shrink)

A Patient Preference Predictor (PPP)—an algorithm capable of predicting, on the basis of demographic or more personalized data, what an incapacitated patient would prefer were they capacitated—is a...

Marshall et al. (2024) persuasively argue that some patients with opiate use disorder (OUD), who refuse observation after naloxone resuscitation in the emergency department (ED), “may be making non...

This paper addresses the issue of narrative influence on knowledge acquisition in science education. Special characteristics of narratives and of narrative processing are compared to characteristics and processing of traditional expository educational materials. This paper goes beyond the existing literature on processing of media presentations that combine narrative and educational contents. Effects of four distinctive narrative features – dramatization, emotionalization, personalization, and fictionalization – are discussed with regard to their influence on single steps in knowledge acquisition to explain the superiority (...) of narratives over expository material found in some studies. The need for a model describing the complex relationships between the effects of the single narrative characteristics on knowledge acquisition is proposed. (shrink)

Zum I. Kapitel 1 Diesen hier nur skizzierten Strukturzusammenhang von Fragehinsichten und Sachbezügen, innerhalb dessen die Politische Philosophie ihren Ort gewinnt, hat der Verf des näheren darzulegen versucht in einem Aufsatz Die Staatsphilosophie im Verhältnis zur Politik als Wissenschaft, in: Dieter Oberndörfer (Hrsg.), Wissenschaftliche Politik. Eine Einführung in Grundfragen ihrer Tradition und Theorie. Freiburg i. Br. 1962, S. 153-195. Vgl. dazu insbesondere auch Arnold Bergslraesser, Politik in Wissenschaft und Bildung. Schriften und Reden. Freiburg i. Br. 1961, S. 17-29 (Die Stellung (...) der Politik unter den Wissen schaften); Dieter Oberndärfer, Politik als praktische Wissenschaft, in dem oben angeführten Band, S. 9-58, bes. S. 37ff. ; Olto Heinrich von der GablenlZ, Politische Wissenschaft und Philosophie, in: Politische Vierteljahresschrift 1, 1960/61, S. 4-11; H.R.G. Greaves, Grundlagen der Politischen Theorie. Neuwied-Berlin 1960 sowie die Arbeiten von Hans Barlh, Helmut Kuhn, Max Müller (vgl. Anm. 6, Nr. 7), Joachim Ritter (zu Aristoteles) und Leo Slrauss, die zu den wenigen gehören, die heute noch von der Philosophie selbst aus den Problembereich der Praktischen und Politischen Philosophie in einem unserem Ver ständnis verwandten Sinne zu erörtern und grundzulegen suchen (s. Lit.-Verz.). Es sei auch auf die unter diesem Betracht in Frage kommenden Publikationen Hannah Arendts hingewiesen. Siehe außerdem unsere Angaben unter Anm. 4 und 5.-In ein analoges Ver hältnis setzt Helmut Schelsky (Ortsbestimmung der deutschen Soziologie. Düsseldorf Köln 1959) Soziologie, philosophische Theorie der Gesellschaft und allgemeine Philosophie zueinander. (shrink)

This article discusses John Stuart Mill's voluntary slavery argument in On Liberty. The author shows that standard interpretations of the argument rely on the assumption that part of Mill's objection to voluntary slavery is the permanent nature of the decision. However, in correspondence, Mill also objects to voluntary ‘coolie’ labour contracts, which he regards as a form of slavery. This produces difficulties for standard interpretations of the voluntary slavery argument. Finally, the author provides a revised interpretation of Mill's argument to (...) solve this problem. (shrink)

This article addresses ethical concerns with the use of electronic health records (EHRs) by physicians in clinical practice. It presents arguments for two claims. First, requiring physicians to maintain patient EHRs for medically unnecessary tasks is likely contributing to increased burnout, decreased quality of care, and potential risks to patient safety. Second, medical institutions have ethical reasons to employ medical scribes to maintain patient EHRs. Finally, this article reviews central objections to employing medical scribes and provides responses to each.

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts about (...) who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

Current national and international guidelines for the ethical design and development of artificial intelligence (AI) and robotics emphasize ethical theory. Various governing and advisory bodies have generated sets of broad ethical principles, which institutional decisionmakers are encouraged to apply to particular practical decisions. Although much of this literature examines the ethics of designing and developing AI and robotics, medical institutions typically must make purchase and deployment decisions about technologies that have already been designed and developed. The primary problem facing medical (...) institutions is not one of ethical design but of ethical deployment. The purpose of this paper is to develop a practical model by which medical institutions may make ethical deployment decisions about ready-made advanced technologies. Our slogan is “more process, less principles.” Ethically sound decisionmaking requires that the process by which medical institutions make such decisions include participatory, deliberative, and conservative elements. We argue that our model preserves the strengths of existing frameworks, avoids their shortcomings, and delivers its own moral, practical, and epistemic advantages. (shrink)

As costs decline and technology inevitably improves, current trends suggest that artificial intelligence (AI) and a variety of "carebots" will increasingly be adopted in medical care. Medical ethicists have long expressed concerns that such technologies remove the human element from medicine, resulting in dehumanization and depersonalized care. However, we argue that where shame presents a barrier to medical care, it is sometimes ethically permissible and even desirable to deploy AI/carebots because (i) dehumanization in medicine is not always morally wrong, and (...) (ii) dehumanization can sometimes better promote and protect important medical values. Shame is often a consequence of the human-to-human element of medical care and can prevent patients from seeking treatment and from disclosing important information to their healthcare provider. Conditions and treatments that are shame-inducing offer opportunities for introducing AI/carebots in a manner that removes the human element of medicine but does so ethically. We outline numerous examples of shame-inducing interactions and how they are overcome by implementing existing and expected developments of AI/carebot technology that remove the human element from care. (shrink)

Navin, Brummett, and Wasserman (2022) argue—successfully, we think—that the standard “comparative” account of decision-making capacity (DMC) fails to capture an important range of cases in which a...

In this paper, we raise and discuss a puzzle about the relationships among goods, reasons, and deontic status. Suppose you have it within your power to give someone something they would enjoy. The following claims seem platitudinous: you can use this power to reward whatever kind of option you want, thereby making that option better and generating a reason for that person to perform it; this reason is then weighed alongside and against the other reasons at play; and altogether, the (...) reasons determine the deontic statuses of that person’s options. We show, however, that in a certain class of cases at least one of these apparent platitudes must be false. In particular, we show that in a certain kind of case wrongfulness cannot be rewarded. In some cases, if one tries to reward wrongfulness, something surprising must go awry: either what you attempt to give as a reward would not, in fact, be good, or it would not generate a reason, or it would have a surprising effect on the deontic status of the relevant options. The upshot is that the relationships among goods, reasons, and deontic status are complicated in ways that have not previously been remarked. (shrink)

Pickering, Newton-Howes, and Young argue for externalism about competence—the view that “welfare judgments are part of judgments about competence” and posit an “explanatory connection” betwe...

The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive ‘high tech’ medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource (...) allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals. (shrink)

Visiting historical places can give important impulses regarding education of history, society, and politics. While there does exist extensive research on visitors' experiences at memorial sites, little is known about the impact of everyday places holding dark history. Two experimental studies took place in a research institute, a former women's clinic, where in the time of National Socialist dictatorship in Germany hundreds of forced sterilizations took place. Historical awareness was manipulated via systematic variation of prior information. We found partial evidence (...) that historical awareness had a negative effect on personal mood. Awareness of the site's NS history had a negative effect on the perceived valence of related photos but did not influence their qualitative description. Also, there was partial evidence that the site itself was perceived less positively and evoked more arousal when participants were aware of its NS history. Possible reasons are discussed. (shrink)

The failure of many patients with chronic conditions to correctly follow medical advice that they hope or intend to follow is a major concern, especially as effective long‐term therapies for chronic conditions materialize. Some US healthcare providers have responded with strategies that involve implementing contracts with their patients, including provisions that may deny future treatments after continued nonadherence. This is among the first articles to explicitly discuss the ethics of patient contracts.

This study aimed to investigate whether a range of tasks that have been generally classed as requiring insight form an empirically separable group of tasks distinct from tasks generally classed as non-insight. In this study, 24 insight tasks, 10 non-insight tasks, and tests of individual differences in cognitive abilities and working memory were administered to 60 participants. Cluster analysis of the problem-solving tasks indicated that the presumed insight problems did tend to cluster with other presumed insight problems, and similarly the (...) presumed non-insight problems tended to cluster with other presumed non-insight tasks. Performance on presumed insight problems was particularly linked to measures of ideational flexibility with a different pattern of results for the non-insight tasks. Spatial insight problems were linked to spatial flexibility and verbal insight tasks were linked to vocabulary scores. The results are discussed in relation to recent developments of dual process theories of thinking. (shrink)

Since Erich Lindemann's seminal work on 'the symptomatology and management of acute grief' from 1944, it has been common to define grief through its particular emotional structure and dynamics. According to this perspective, grief announces itself in socalled 'pangs of grief' in which the bereaved is occasionally flooded by waves of emotions. This picture has become so ingrained in our understanding of grief that it has defined both public discourse on grief and contemporary clinical constructs. In this paper, I propose (...) that underneath grief's fluctuating emotivity, there is a deeper feeling of grief. This deeper feeling reflects an altered mode of being in the world in which the bereaved experiences herself as 'at a distance' from the worldly. I will refer to this state as world-distancing and emphasize it as a protective affective state that shields the bereaved from a limit situation in which the world has become overwhelming in the absence of the deceased. It is experienced as being in a bubble or as if enclosed in a kind of membrane that shields the bereaved from the intrusiveness and penetrating character of the world. Worlddistancing, however, comes with significant perils if the bereaved are unable to reattach to the world. I outline this danger as a state of existential loneliness that follows from what Eugené Minkowski termed a felt lack of vital contact with the world. (shrink)

Although science supplies medicine's “gold standard,” knowledge exercised in the care of patients is, like moral knowing, a matter of narrative, practical reason. Physicians draw on case narrative to store experience and to apply and qualify the general rules of medical science. Literature aids in this activity by stimulating moral imagination and by requiring its readers to engage in the retrospective construction of a situated, subjective account of events. Narrative truths are provisional, uncertain, derived from narrators whose standpoints are always (...) situated, particular, and uncertain, but open to comparison and reinterpretation. Reading is thus a model for knowing in both morality and clinical medicine. While principles remain essential to bioethics and science must always inform good clinical practice, the tendency to collapse morality into principles and medicine into science impoverishes both practices. Moral knowing is not separable from clinical judgment. While ethics must be open to discussion and interpretation by patients, families, and society, it is nevertheless substantively and epistemologically an inextricable part of a physician's clinical practice. (shrink)

This essay discusses an alternative interpretation of the term “Dasein” as Heidegger uses it in Being and Time and, in particular, the possibility that Dasein is meant to contain an inherent form of intersubjectivity to which we must “return” in order to achieve authenticity. In doing so, I build on the work of John Haugeland and his interpretation of Dasein as a mass term, while exploring the implications such an interpretation has on Heidegger’s conception of “authenticity”. Ultimately, this paper aims (...) to take seriously Heidegger’s claim to be moving past the isolated Cartesian subject and towards a view of authentic human existence that is cognizant of the way our identities are always formed within a pre-existing community. In addition, since many interpretations of Heidegger have argued that “the Anyone” is representative of all possible forms of community, I consider how this alternative understanding of Dasein as intersubjective can shed new light on critical remarks Heidegger makes about “the Anyone”. Thus, I argue that by reinterpreting Dasein as community, we can find more coherence between Heidegger’s otherwise conflicting conceptions of authenticity and “the Anyone”. (shrink)

It is only when mixing two or more pure substances along a reversible path that the entropy of the mixing can be made physically manifest. It is not, in this case, a mere mathematical artifact. This mixing requires a process of successive stages. In any finite number of stages, the external manifestation of the entropy change, as a definite and measurable quantity of heat, isa fully continuous function of the relevant variables. It is only at an infinite and unattainable limit (...) thata non-uniform convergence occurs. And this occurs when considered in terms of the number of stages together with a distinguishability parameter appropriate to the particular device which is used to achieve reversibility. These considerations, which are of technological interest to chemical engineers, resolve a paradox derived in chemical theory called Gibbs'' Paradox. (shrink)