Empirical studies on people's moral attitudes regarding ethically challenging topics contribute greatly to research in medical ethics. However, it is not always clear in which ways this research adds to medical ethics as a normative discipline. In this article, we aim to provide a systematic account of the different ways in which attitudinal research can be used for normative reflection. In the first part, we discuss whether ethical judgements can be based on empirical work alone and we develop a sceptical (...) position regarding this point, taking into account theoretical, methodological and pragmatic considerations. As empirical data should not be taken as a direct source for normative justification, we then delineate different ways in which attitudes research can be combined with theoretical accounts of normative justification in the second part of the article. Firstly, the combination of attitudes research with normative-ethical theories is analysed with respect to three different aspects: The extent of empirical data which is needed, the question of which kind of data is required and the ways in which the empirical data are processed within the framework of an ethical theory. Secondly, two further functions of attitudes research are displayed which lie outside the traditional focus of ethical theories: the exploratory function of detecting and characterising new ethical problems, and the field of ‘moral pragmatics’. The article concludes with a methodological outlook and suggestions for the concrete practice of attitudinal research in medical ethics. (shrink)

Theories of practical reason must meet a psychological requirement: they must explain how normative practical reasons can be motivationally efficacious. It would be pointless to claim that we are subject to normative demands of reason, if we were in fact unable to meet those demands. Concerning this requirement to account for the possibility of rational motivation, internalist approaches are distinguished from externalist ones. I defend internalism, whilst rejecting both ways in which the belief‐desire model can be instantiated. Both the Humean (...) and the Kantian instantiation of that model fail to account for the internal connection between normative and motivating reasons required by internalism. The two classes of reasons rather come to be seen as mutually exclusive. Opposing the belief‐desire model, I argue that rational motivation can only be established by reference to emotion. Emotions are affective perceptions. They have motivational force so that they can contribute to the explanation of action. At the same time they can rationalise actions because they have an intentional content which resembles the content of sensory perception in being representational. Because of this, the emotions can noninferentially justify judgements, which in turn can justify actions. I conclude by outlining the Aristotelian account of practical reason and ethics that emerges from integrating the emotions into practical reasoning. Doing the right thing is much more a matter of seeing things right than of drawing the right inferences. Seeing things right, in its turn, is not only to justify an action: it necessarily implies to be motivated to act accordingly. (shrink)

Almost all contemporary philosophers on the subject agree that emotions play an indispensable role in the justification (as opposed to the mere causation) of other mental states and actions. However, how this role is to be understood is still an open question. At the core of the debate is the phenomenon of conflict without contradiction: why is it that an emotion need not be revised in the light of better judgment and knowledge? Conflict without contradiction has been explained either by (...) difference in content between emotion and judgment, or by a difference in the respective attitude towards content. I argue that conflict without contradiction is due to both differences, where difference in content is prior to difference in attitude. (shrink)

This paper discusses the issue of legitimacy and, in particular the processes of building, losing, and repairing environmental legitimacy in the context of the Deepwater Horizon case. Following the Deepwater Horizon catastrophe in 2010, BP plc. was accused of having set new records in the degree of divergence between its actual operations and what it had been communicating with regard to corporate responsibility. Its legitimacy crisis is here to be appraised as a case study in the discrepancy between symbolic and (...) substantive strategies in corporate greening and its communication. A narrative analysis of BP’s “beyond petroleum”-rebranding and the “making this right”-campaign issued in response to the Gulf of Mexico disaster discusses their respective implications for corporate change. Further, the question is addressed why BP’s green image endeavors were so widely accepted at first, only to find themselves dismissed as corporate greenwashing now. The study concludes that where a corporation’s “green narrative” consistently evokes established narratives, its legitimacy will be judged against narrative, rather than empirical truth. Thus, the narrative will be more willingly accepted as speaking for the issuing company’s legitimacy, irrespective of whether it reflects substantive greening or not. (shrink)

This book opens up a new route to the study of knowledge dynamics and the sociology of knowledge. The focus is on the role of metaphors as powerful catalysts and the book dissects their role in the construction of theories of knowledge and will therefore be of vital interest to social and cognitive scientists alike.

I discuss two ways in which emotions explain actions: in the first, the explanation is expressive; in the second, the action is not only explained but also rationalized by the emotion's intentional content. The belief-desire model cannot satisfactorily account for either of these cases. My main purpose is to show that the emotions constitute an irreducible category in the explanation of action, to be understood by analogy with perception. Emotions are affective perceptions. Their affect gives them motivational force, and they (...) can rationalize actions because, like perception, they have a representational intentional content. Because of this, an emotion can non-inferentially justify a belief which in its turn justifies or rationalizes an action; so emotions may constitute a source of moral knowledge. (shrink)

Umberto Eco's Baudolino (2000) never achieved the success of his first novel, The Name of the Rose (1980), although both are historical fictions that provide literary clothing for philosophical ideas. In Baudolino, Eco again dramatizes the disagreement between rationalists and empiricists regarding the sources of our concepts and knowledge, ideas that came to the fore during the medieval period and which continue to be pertinent questions in epistemology. Propositions of either sense experience or logic and reasoning being the basis for (...) knowledge, offer Eco an opportunity for playing what he calls "a game of ambiguity about truth and lies."1 Historical uncertainties, the holes in the fabric of our knowledge about .. (shrink)

Within the ethical debate on Machine Learning-driven decision support systems (ML_CDSS), notions such as “human in the loop” or “meaningful human control” are often cited as being necessary for ethical legitimacy. In addition, ethical principles usually serve as the major point of reference in ethical guidance documents, stating that conflicts between principles need to be weighed and balanced against each other. Starting from a neo-Kantian viewpoint inspired by Onora O'Neill, this article makes a concrete suggestion of how to interpret the (...) role of the “human in the loop” and to overcome the perspective of rivaling ethical principles in the evaluation of AI in health care. We argue that patients should be perceived as “fellow workers” and epistemic partners in the interpretation of ML_CDSS outputs. We further highlight that a meaningful process of integrating (rather than weighing and balancing) ethical principles is most appropriate in the evaluation of medical AI. (shrink)

‘Scientific advice to politics’, the ‘nature of expertise’, and the ‘relation between experts, policy makers, and the public’ are variations of a topic that currently attracts the attention of social scientists, philosophers of science as well as practitioners in the public sphere and the media. This renewed interest in a persistent theme is initiated by the call for a democratization of expertise that has become the order of the day in the legitimation of research funding. The new significance of ‘participation’ (...) and ‘accountability’ has motivated scholars to take a new look at the science – politics interface and to probe questions such as "What is new in the arrangement of scientific expertise and political decision-making?", "How can reliable knowledge be made useful for politics and society at large, and how can epistemically and ethically sound decisions be achieved without losing democratic legitimacy?", "How can the objective of democratization of expertise be achieved without compromising the quality and reliability of knowledge?" Scientific knowledge and the ‘experts’ that represent it no longer command the unquestioned authority and public trust that was once bestowed upon them, and yet, policy makers are more dependent on them than ever before. This collection of essays explores the relations between science and politics with the instruments of the social studies of science, thereby providing new insights into their re-alignment under a new régime of governance. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Using the example of architecture, this article defends the thesis that designing should not be regarded as a kind of experimenting. This is in contrast to a widespread methodological claim that design processes are equivalent to experimentation processes. The contrary thesis can be proven by focusing on actual practices, techniques and design strategies. Closely connected with the thesis is an even more important epistemological claim, which contends that designing serves not only to develop artefacts but is also a means of (...) acquiring genuine knowledge. When the epistemic relevance of said practices, techniques and strategies is reassessed, designing emerges clearly as an independent epistemic praxis. To defend the thesis, the present article draws on and analyses empirical material from an ethnographic field study in order to back up the conceptual analysis. (shrink)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in (...) analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

_BMC Medical Ethics_ is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies. _BMC __Medical Ethics _is part of the _BMC_ series which publishes subject-specific journals focused on the needs of individual research communities across all areas of biology and medicine. We do not make editorial decisions on the basis of the interest of a study or (...) its likely impact. Studies must be scientifically valid; for research articles this includes a scientifically sound research question, the use of suitable methods and analysis, and following community-agreed standards relevant to the research field. Specific criteria for other article types can be found in the submission guidelines. _BMC series - open, inclusive and trusted_. (shrink)

BackgroundMachine learning-based clinical decision support systems (ML_CDSS) are increasingly employed in various sectors of health care aiming at supporting clinicians’ practice by matching the characteristics of individual patients with a computerised clinical knowledge base. Some studies even indicate that ML_CDSS may surpass physicians’ competencies regarding specific isolated tasks. From an ethical perspective, however, the usage of ML_CDSS in medical practice touches on a range of fundamental normative issues. This article aims to add to the ethical discussion by using professionalisation theory (...) as an analytical lens for investigating how medical action at the micro level and the physician–patient relationship might be affected by the employment of ML_CDSS.Main textProfessionalisation theory, as a distinct sociological framework, provides an elaborated account of what constitutes client-related professional action, such as medical action, at its core and why it is more than pure expertise-based action. Professionalisation theory is introduced by presenting five general structural features of professionalised medical practice: (i) the patient has a concern; (ii) the physician deals with the patient’s concern; (iii) s/he gives assistance without patronising; (iv) s/he regards the patient in a holistic manner without building up a private relationship; and (v) s/he applies her/his general expertise to the particularities of the individual case. Each of these five key aspects are then analysed regarding the usage of ML_CDSS, thereby integrating the perspectives of professionalisation theory and medical ethics.ConclusionsUsing ML_CDSS in medical practice requires the physician to pay special attention to those facts of the individual case that cannot be comprehensively considered by ML_CDSS, for example, the patient’s personality, life situation or cultural background. Moreover, the more routinized the use of ML_CDSS becomes in clinical practice, the more that physicians need to focus on the patient’s concern and strengthen patient autonomy, for instance, by adequately integrating digital decision support in shared decision-making. (shrink)

Experiences of contact with nature in school education might be beneficial for promoting ecological lifestyles and the wellbeing of children, families, and teachers. Many theories and empirical evidence on restorative environments, as well as on the foundations of classical pedagogical approaches, recognize the value of the direct experience with natural elements, and the related psychological and educational outcomes. In this work we present two studies focusing on the contact with nature in outdoor education interventions with primary and secondary school students (...) in Italy. A questionnaire measuring connectedness to nature, psycho-physical wellbeing, pro-environmental attitudes, students’ life satisfaction, pro-social behavior, empathy and anxiety was completed before and after the education program by the participants to the intervention group and by students of a control group. The students in the intervention groups participated in environmental education programs consisting in guided activities in contact with the nature during four visits in one of two natural protected areas. The students in the control groups attended the same schools as the intervention group but they were not involved in the environmental education program. The students in both the groups completed the questionnaire in the same weeks of the year. Findings show that taking part to the outdoor education program has positive outcomes on psycho-physical wellbeing, on connectedness to nature and on pro-social behavior of students in the intervention group, compared to the control group. The implications related to the effectiveness of outdoor education interventions and future directions of research and practice in environmental psychology and education are discussed. (shrink)

BackgroundHealthcare providers have to make ethically complex clinical decisions which may be a source of stress. Researchers have recently introduced Artificial Intelligence (AI)-based applications to assist in clinical ethical decision-making. However, the use of such tools is controversial. This review aims to provide a comprehensive overview of the reasons given in the academic literature for and against their use.MethodsPubMed, Web of Science, Philpapers.org and Google Scholar were searched for all relevant publications. The resulting set of publications was title and abstract (...) screened according to defined inclusion and exclusion criteria, resulting in 44 papers whose full texts were analysed using the Kuckartz method of qualitative text analysis.ResultsArtificial Intelligence might increase patient autonomy by improving the accuracy of predictions and allowing patients to receive their preferred treatment. It is thought to increase beneficence by providing reliable information, thereby, supporting surrogate decision-making. Some authors fear that reducing ethical decision-making to statistical correlations may limit autonomy. Others argue that AI may not be able to replicate the process of ethical deliberation because it lacks human characteristics. Concerns have been raised about issues of justice, as AI may replicate existing biases in the decision-making process.ConclusionsThe prospective benefits of using AI in clinical ethical decision-making are manifold, but its development and use should be undertaken carefully to avoid ethical pitfalls. Several issues that are central to the discussion of Clinical Decision Support Systems, such as justice, explicability or human–machine interaction, have been neglected in the debate on AI for clinical ethics so far.Trial registrationThis review is registered at Open Science Framework (https://osf.io/wvcs9). (shrink)

We critically analyze the rationale of arguments from finetuning and naturalness in particle physics and cosmology, notably the small values of the mass of the Higgs-boson and the cosmological constant. We identify several new reasons why these arguments are not scientifically relevant. Besides laying out why the necessity to define a probability distribution renders arguments from naturalness internally contradictory, it is also explained why it is conceptually questionable to single out assumptions about dimensionless parameters from among a host of other (...) assumptions. Some other numerological coincidences and their problems are also discussed. (shrink)

Due to increasing consumer skepticism towards promotional messages, companies are looking for new ways to communicate with their target audiences in a less obtrusive way than traditional advertising. Sponsored content disseminated on the online portals of newspapers (i. e., online advertorials) is regarded as a promising way to promote products and brands. Regulations require communicators to inform consumers about the commercial nature of this ‘masked’ persuasion attempt by including an explicit sponsorship disclosure (i. e., a ‘Sponsored’ label). This study demonstrates (...) that such an explicit advertising cue may not be enough to alert recipients. Furthermore, this study investigates the effects of promotional messages by means of a 2 (no disclosure vs. disclosure) x 2 (no forewarning vs. forewarning) experiment. Results show that both (i) foregoing instructions aimed at activating consumers’ persuasion knowledge (i. e., an additional forewarning message) and (ii) recipients’ prior media literacy can foster the effect of sponsorship disclosures in triggering situational distrust towards brand-related content, and in turn, increasing consumers’ reactance. (shrink)

We all know what a voluntary action is - we all think we know when an action is voluntary, and when it is not. Yet, performing and action and defining it are different matters. What counts as an action? When does it begin? Does the conscious desire to perform an action always precede the act? If not, is it really a voluntary action? This is a debate that crosses the boundaries of Philosophy, Neuroscience, Psychology, and Social Science. This book brings (...) together some to the leading thinkers from these disciplines to consider this deep and often puzzling topic. The result is a fascinating and stimulating debate that will challenge our fundamental assumptions about our sense of free-will. (shrink)

ABSTRACTThis article develops and advances a liberal ideal of equality for evaluating the lawful scope of employer control over employees. It argues that, in addition to attending to discrimination and bargaining power asymmetries, we should ensure that our laws treat workers as the moral equals of their bosses more broadly—as people with equally weighty claims to exercising agency over their own values and lives. To illustrate, the article explains that employer control over workplace expression can preclude colleagues from communicating with (...) each other as moral equals and can compromise employees’ abilities to exercise agency over their own characters. It then discusses how our agential interests in workplace expression can guide legal reform. (shrink)

I argue that, in experiencing a recalcitrant emotion, one does not violate a rational requirement of any sort. Rational requirements, as the expression has come to be used, are requirements of coherence. Accordingly, my argument is that there is nothing incoherent in any way about experiencing a recalcitrant emotion. One becomes incoherent only if one allows the emotion to influence one's reasoning and/or action, in which case one violates the ‘consistency principle’ and/or the ‘enkratic principle’. From the standpoint of rationality, (...) it would even be counterproductive to put subjects under the obligation that their emotional experiences and their evaluative judgements must always fit together. When we nevertheless intuitively sense that the subject is irrational in experiencing a recalcitrant emotion this is in cases in which the emotion challenges the subject's agential identity. However, emotions can, but need not, challenge one's agential identity, and, furthermore, perceptions can do so as well. In any case, challenges of this kind do not involve the violation of a rational requirement. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Name der Zeitschrift: Klio Jahrgang: 97 Heft: 1 Seiten: 329-332.

Alvin Plantinga verdedigt een externalistische kentheorie ten aanzien van religieus geloof. In dit artikel beargumenteer ik dat een internalistische benadering meer recht doet aan de manier waarop veel mensen hun relatie ten aanzien van geloven ervaren: geloven gaat vaak gepaard met twijfel, en iemand moet in zijn of haar geloof vaak afwegingen maken tussen argumenten voor en tegen het bestaan van God. In Plantinga’s theorie wordt er aan het metafysische probleem of er al dan niet een God bestaat te weinig (...) recht gedaan, waardoor er tevens te weinig ruimte wordt geboden voor wederzijds respect tussen gelovigen en niet gelovigen. (shrink)

Although leaders in the field of ethics have for many years pointed to the crucial role that organizations play in shaping healthcare ethics, organizational ethics remains a relatively undeveloped area of ethics activity. Clinical ethics committees are an important source of potential expertise, but new skills will be required. Clinical ethics committees seeking to extend their purview to organizational issues will have to respond to three challenges—how to gain sanction and support for addressing controversial and sensitive issues, how to develop (...) an acceptable process, and how to make a difference on the ground. The article presents practical suggestions for how clinical ethics committees meet these challenges. (shrink)