This book takes a new approach to ethics by focusing on the kinds of dilemmas that confront people almost daily on the job.

Recent experiments have shown that when individuals with a substance use disorder are confronted with drug-related cues, they exhibit an automatically activated tendency to approach these cues. The strength of the drug approach bias has been associated with clinically relevant measures, such as increased drug craving and relapse, and activations in brain reward areas. Retraining the approach bias by means of cognitive bias modification has been demonstrated to decrease relapse rates in patients with an alcohol use disorder and to reduce (...) alcohol cue-evoked limbic activity. Here, we review empirical and theoretical literature on the drug approach bias and explore two distinct models of how the drug approach bias may be embodied. First, we consider the “biological meaning” hypothesis, which grounds the automatic approach bias in the natural meaning of the body. Second, we consider the “sensorimotor hypothesis,” which appeals to the specific sensorimotor loops involved in the instantiation of addictive behaviors as the basis of the automatic approach bias. In order to differentiate between the adequacies of these competing explanations, we present specific, predictions that each model should make. (shrink)

Over the past two decades, the competency movement has been gathering momentum internationally within the ranks of professional nursing. It can be argued that this momentum is in response to government initiatives aimed at improving consistency in workforce training and accreditation, and fostering national and international portability of qualifications. At the same time, the competency movement has provided the opportunity for regulators, service providers and government to develop mechanisms to reconstitute competent nurses as accountable, self‐regulating subjects and to monitor this (...) transformation in particular ways. The ways in which competencies have been taken up to do this transforming work in Canada are unique and deserving of some detailed description and analysis.We argue that Canadian nursing regulatory authorities have chosen to view competence as the rehearsal of ethical attributes consonant with the professional role,as opposed to the enactment of skilled conduct. As a result, reflective practices rather than skill and knowledge have become the cornerstone of nursing competency formulation and review. We argue that this distinctly Canadian approach to competency serves three ends. First, it privileges the ‘attribute’ element of the nursing competency model and side steps the ever‐problematic ‘nursing knowledge’ issue; second, self‐surveillance by nurses shifts the onus for professional development from industry to the individual; and third, it concedes responsibility for skill assessment by the regulatory authorities to industry control, leaving employers free to determine skill base and skill mix requirements for practice. Finally, we argue that the reflective component of the regulatory framework for Canadian nurses radically fails as a tool for auditing quality and assessing competency. Rather, it functions as a governmental practice that furthers the deregulatory and economic rationalist aims of the Canadian health reform agenda. (shrink)

The promises of precision medicine are often heralded in the medical and lay literature, but routine integration of genomics in clinical practice is still limited. While the “last mile” infrastructure to bring genomics to the bedside has been demonstrated in some healthcare settings, a number of challenges remain — both in the receptivity of today's health system and in its technical and educational readiness to respond to this evolution in care. To improve the impact of genomics on health and disease (...) management, we will need to integrate both new knowledge and new care processes into existing workflows. This change will be onerous and time-consuming, but hopefully valuable to the provision of high quality, economically feasible care worldwide. (shrink)

Courses in the history of philosophy which exclude contributions made by women cannot legitimately claim to teach this history. This is true, not merely because those histories are incomplete, but rather because they give a biased account. I sketch the difficulties thus posed for the profession, and offer suggestions for developing a less biased, more accurate understanding of the history of philosophy.

Although beef and dairy production in Alberta, Canada, enjoys strong public support, there are enduring public concerns, including farm animal welfare. Evolving codes of practice and animal care councils prescribe changes and improvements to many areas of farm management, and may be seen by farmers as an appropriate response to public animal welfare concerns. However, codes of practice do not address every animal welfare concern, and new concerns can arise over time. Drawing on social practice theory and in-depth field research (...) with 36 cattle and dairy farmers, this paper explores the materials, competencies, and meanings of four animal husbandry practices: branding, dehorning, weaning, and on-farm handling and moving. Findings show that branding and dehorning are evolving slowly with attention to pain management, but remain firmly rooted in ranching tradition and communities of practice. Weaning and animal handling practices are evolving more quickly with attention to changing materials, attitudes, and values that are more prevalent within producer communities. (shrink)

During the fall of 2001 (October 22–25), The Norwegian Radiation Protection Authority (NRPA) and the Agricultural University of Norway arranged a consensus conference on the protection of the environment against ionising radiation. The motive for the conference was the need to study the ethical and philosophical basis for protection of nature in its own right. The conference was funded by Nordic Nuclear Safety Research (NKS), in cooperation with the International Union of Radioecology (IUR). The National Committee for Research Ethics in (...) Science and Technology (NENT) was hired as facilitators for the consensus process. This paper will give a brief outline of the aims and method of the conference, distinguishing these from other kinds of consensus conferences. The paper ends with some general reflections on the appropriateness of seeking consensus on ethics-related issues among experts. (shrink)

Ellen Meiksins Wood is a leading contemporary political theorist who has elaborated an innovative approach to the history of political thought, the social history of political theory .

Ethical dilemmas are often not discussed in the dissemination of educational research. While the ethical guidelines for research seem clear at first glance, a closer look at the intimate nature of qualitative research reveals that there are many ambiguities or ‘grey’ areas where researchers must rely on their personal value systems. This article discusses the challenges faced by an experienced educator, although novice researcher, in considering the ethical parameters of her own research with adolescents with hearing loss. In particular, the (...) grey ethical areas identified by the researcher include: (a) vulnerable population; (b) researcher role confusion; (c) consent; (d) privacy, confidentiality, and anonymity; as well as (e) the nature of risk. Based on the author’s own reflections on beginning the research process, the article presents possible pitfalls and ways of overcoming the possibility of becoming immobilized by the ethical enigmas of research. (shrink)

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

When reflecting on the nature of skilled action, it is easy to fall into familiar dichotomies such that one construes the flexibility and intelligence of skill at the level of intentional states while characterizing the automatic motor processes that constitute motor skill execution as learned but fixed, invariant, bottom-up, brute-causal responses. In this essay, I will argue that this picture of skilled, automatic, motor processes is overly simplistic. Specifically, I will argue that an adequate account of the learned motor routines (...) that constitute embodied skills cannot be given in a purely bottom-up, brute-causal fashion. Rather, motor control is intelligent all the way down. To establish this, I will first review two recent accounts of skill, Stanley and Krakauer and Papineau, which characterize the automatic motor control responsible for the fine-grained movements constitutive of motor skill as brute, low-level phenomena. I will then isolate five key features that should apply to skilled motor control, if these accounts are correct. Together, the accounts posit that motor control is: ballistic, invariant, independent of general action trajectories, Insensitive to semantic content, and independent of personal-level intentions. In the final section of this paper, I will appeal to optimal control theory for empirical evidence to challenge the commitment to skilled action as qualified by the above features. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, these (...) variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity. (shrink)

One of the hallmarks of virtue is reliably acting well. Such reliable success presupposes that an agent is able to recognize the morally salient features of a situation, and the appropriate response to those features and is motivated to act on this knowledge without internal conflict. Furthermore, it is often claimed that the virtuous person can do this in a spontaneous or intuitive manner. While these claims represent an ideal of what it is to have a virtue, it is less (...) clear how to make good on them. That is, how is it actually possible to spontaneously and reliably act well? In this paper, we will lay out a framework for understanding how it is that one could reliably act well in an intuitive manner. We will do this by developing the concept of an action schema, which draws on the philosophical and psychological literature on skill acquisition and self-regulation. In short, we will give an account of how self-regulation, grounded in skillful structures, can allow for the accurate intuitions and flexible expertise required for virtue. While our primary goal in this paper is to provide a positive theory of how virtuous intuitions might be accounted for, we also take ourselves to be raising the bar for what counts as an explanation of reliable and intuitive action in general. (shrink)

This paper provides an account of the strategic control involved in skilled action. When I discuss strategic control, I have in mind the practical goals, plans, and strategies that skilled agents use in order to specify, structure, and organize their skilled actions, which they have learned through practice. The idea is that skilled agents are better than novices not only at implementing the intentions that they have but also at forming the right intentions. More specifically, skilled agents are able formulate (...) and modify, adjust and adapt their practical intentions in ways that are appropriate, effective, and flexible given their overall goals. Further, to specify the kind of action plans that are involved in strategic control, I’ll rely on empirical evidence concerning mental practice and mental imagery from sports psychology as well as evidence highlighting the systematic differences in the cognitive representations of skills between experts and non-experts. I’ll claim that, together, this evidence suggests that the intentions that structure skilled actions are practical and not theoretical, that is, that they are perceptual and motor and not abstract, amodal, or linguistic. Importantly, despite their grounded nature, these plans are still personal-level, deliberate, rational states. That is, the practical intentions used to specify and structure skilled actions are best conceived of as higher-order, motor-modal structures, which can be manipulated and used by the agent for the purpose of reasoning, deliberation, decision-making and, of course, the actual online structuring and organizing of action. (shrink)

Philosophical questions surrounding skill and expertise can be traced back as far as Ancient Greece, China, and India. In the twentieth century skilled action was an important factor in the work of phenomenologists such as Heidegger and Merleau-Ponty and analytic philosophers including Gilbert Ryle. However, as a subject in its own right it has, until now, remained largely in the background. The Routledge Handbook of Philosophy of Skill and Expertise is an outstanding reference source and the first major collection of (...) its kind, reflecting the explosion of interest in the topic recent years. Comprising thirty-nine chapters written by leading international contributors, the Handbook is organised into six clear parts: Skill in the History of Philosophy Skill in Epistemology Skill, intelligence, and agency Skill in Perception, Imagination, and Emotion Skill, Language, and, Social Cognition Skill and Expertise in Normative Philosophy. Essential reading for students and researchers in philosophy of mind and psychology, epistemology and ethics, The Routledge Handbook of Philosophy of Skill and Expertise is also suitable for those in related disciplines such as social psychology and cognitive science. It is also relevant to those who are interested in conceptual issues underlying skill and expertise in fields such as sport, the performing arts, and medicine. (shrink)

Purity has been recognized as an ideal of proof. In this paper, I consider whether purity continues to have value in contemporary mathematics. The topics (e.g., algebraic topology, algebraic geometry, category theory) and methods of contemporary mathematics often favor unification and generality, values that are more often associated with impurity rather than purity. I will demonstrate this by discussing several examples of methods and proofs that highlight the epistemic significance of unification and generality. First, I discuss the examples of algebraic (...) invariants and of considering a mathematical object from several different perspectives to illustrate that the methods used in contemporary mathematics favor impurity. Then I consider an example from category theory which demonstrates how unification and generality are related to impurity and that impure solutions can be explanatory. In light of this discussion, we see that purity only has marginal value within contemporary mathematics which instead prioritizes the epistemic values associated with impurity. (shrink)

I identify and characterize the kind of personal-level control-structure that is most relevant for skilled action control, namely, what I call, “practical intention”. I differentiate between practical intentions and general intentions not in terms of their function or timing but in terms of their content. I also highlight a distinction between practical intentions and other control mechanisms that are required to explain skilled action. I’ll maintain that all intentions, general and practical, have the function specifying, sustaining, and structuring action but (...) that several functions that have been attributed to proximal intentions are actually implemented by other control mechanisms that are not themselves best identified as intentions. Specifically, I will claim that practical intentions do not initiate, monitor, specify or guide the fine-grained, online, kinematic aspects of action. Finally, I suggest that the way in which practical and general intentions should be differentiated is in terms of their content, where general intentions specify the overall goal, outcome, or end of an action as it is conceived of by the agent at a time, and practical intentions determine the means to that end. I conclude by providing empirical evidence to support this way of characterizing the intentions that “interface” with the mechanisms of motor control. Though this discussion has repercussions for action in general, I will limit my discussion to cases of skill. (shrink)

Although affective facial pictures are widely used in emotion research, standardised affective stimuli sets are rather scarce, and the existing sets have several limitations. We therefore conducted a validation study of 490 pictures of human facial expressions from the Karolinska Directed Emotional Faces database (KDEF). Pictures were evaluated on emotional content and were rated on an intensity and arousal scale. Results indicate that the database contains a valid set of affective facial pictures. Hit rates, intensity, and arousal of the 20 (...) best KDEF pictures for each basic emotion are provided in an appendix. (shrink)

In recent years, a debate concerning the nature of knowing-how has emerged between intellectualists who claim that knowledge-how is reducible to knowledge-that and anti-intellectualists who claim that knowledge-how comprises a unique and irreducible knowledge category. The arguments between these two camps have clustered largely around two issues: intellectualists object to Gilbert Ryle's assertion that knowing-how is a kind of ability, and anti-intellectualists take issue with Jason Stanley and Timothy Williamson's positive, intellectualist account of knowing-how. Like most anti-intellectualists, in this paper (...) I will raise objections to Stanley and Williamson's account of knowing-how and also defend the claim that ability is necessary for knowing-how attributions. Unlike most discussions of knowing-how, however, I will return to more Rylean considerations in order to illustrate that any intellectualist account of knowing-how, not simply Stanley and Williamson's preferred variety, will fail because it will be unable to account for fundamental differences in the knowledge required to instantiate an ability and the knowledge involved in propositional thought. (shrink)

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on (...) the following key issues: § 1.Providing information about research integrity § 2.Providing education, training and mentoring § 3.Strengthening a research integrity culture § 4.Facilitating open dialogue § 5.Wise incentive management § 6.Implementing quality assurance procedures § 7.Improving the work environment and work satisfaction § 8.Increasing transparency of misconduct cases § 9.Opening up research § 10.Implementing safe and effective whistle-blowing channels § 11.Protecting the alleged perpetrators § 12.Establishing a research integrity committee and appointing an ombudsperson § 13.Making explicit the applicable standards for research integrity. (shrink)

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

All Christians read the Bible differently, pray differently, value their traditions differently, and give different weight to individual and corporate judgment. These differences are the basis of conflict. The question Christian ethics must answer, then, is, "What does the good life look like in the context of conflict?" In this new introductory text, Ellen Ott Marshall uses the inevitable reality of difference to center and organize her exploration of the system of Christian morality. What can we learn from Jesus' (...) creative use of conflict in situations that were especially attuned to questions of power? What does the image of God look like when we are trying to recognize the divine image within those with whom we are in conflict? How can we better explore and understand the complicated work of reconciliation and justice? This innovative approach to Christian ethics will benefit a new generation of students who wish to engage the perennial questions of what constitutes a faithful Christian life and a just society. (shrink)

Darwin’s classic ‘Origin of Species’ (Darwin 1859) described forces of selection acting upon individuals, but there remains a great deal of controversy about what exactly the status and definition of a biological individual is. Recently some authors have argued that the individual is dispensable – that an inability to pin it down is not problematic because little rests on it anyway. The aim of this paper is to show that there is a real problem of biological individuality, and an urgent (...) need to arbitrate over the current plethora of solutions to it. (shrink)

There is strong theoretical support for a relationship between various characteristics of religiousness and attitudes towards business ethics. This paper examines three frequently- studied dimensions of religiousness (fundamentalism, conservatism, and intrinsic religiousness) and their ability to predict students' willingness to behave unethically. Because prior research indicated a possible relationship between the religious affiliation of an institution and its members' ethical orientation, we studied students at universities with three different types of religious affiliation: evangelical, Catholic, and none.Results of the study lend (...) support to a negative relationship between the above-mentioned dimensions of religiousness and willingness to behave unethically. In addition, students at the Evangelical university were far less willing to engage in unethical behavior than were students at either the Catholic or the unaffiliated institutions. (shrink)

To address the current lack of knowledge about clinical ethics fellowship programs (CEFPs), we surveyed all 36 programs in the U.S. and Canada. The number of CEFPs has grown exponentially over the last 40 years and far exceeds previous estimates. Commonalities among CEFPs include: 88.8% require an advanced degree or rarely accept applicants without one; 91.7% of programs do not restrict applicants to a specific background such as medicine or philosophy; and 88.9% of programs compensate fellows. CEFPs vary widely on (...) numbers of fellows trained in the last 3 years (1–111), numbers of consultations performed by each fellow (0–450), and salaries paid ($0-$95,000). Less than half of programs meet CEFP standards established by ABPD. Nonpaying programs and larger programs tend to have lower admission standards and lower expectations for fellows. We hope these data will help inform CEFP standards that promote quality and consistency without stifling desirable diversity and innovation. (shrink)

In this paper, I argue that there are cases of explanatory induction in mathematics. To do so, I first introduce the notion of explanatory definition in the context of mathematical explanation. A large part of the paper is dedicated to introducing and analyzing this notion of explanatory definition and the role it plays in mathematics. After doing so, I discuss a particular inductive definition in advanced mathematics—CW\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${ CW}$$\end{document}-complexes—and argue that it is (...) explanatory. With this, we see that there are cases of explanatory induction. (shrink)

Traditional Chinese culture, Confucianism, in particular, has a non-individualist conception of what it is to be human. It conceives of people fundamentally as members of social groups—specifically, the family, the clan, the political community and the state—not as atomic individuals as perceived in modern society. The communist ideology since the middle of the last century also emphasizes the significance of ‘the common good’ of the state which describes a specific ‘good’ that is shared and beneficial for all (or most) members (...) of a given community. Nevertheless, marketization and decentralization in China today have significantly challenged the notion of a state-oriented community that directly impacts China's healthcare system, beginning with the dismantling of the rural collectives and state-owned enterprises as part of the reform and opening process. This article will address healthcare challenges in China today, examining the conceptual/ethical issues raised by public healthcare, and contending that public health concerns should go beyond the dichotomy between individualism and collectivism. The article will argue that the family-oriented model of Confucianism offers an alternative way to look at what constitute a community and common goods. The Confucian approach to ethics is relevant to healthcare today. For example, it will be much easier to find a shared idea of common good in terms of complicated issues like healthcare; it would make sense to give a larger role to families via family savings accounts, and not have everything determined by the government. (shrink)

The connection between understanding and explanation has recently been of interest to philosophers. Inglis and Mejía-Ramos (Synthese, 2019) propose that within mathematics, we should accept a functional account of explanation that characterizes explanations as those things that produce understanding. In this paper, I start with the assumption that this view of mathematical explanation is correct and consider what we can consequently learn about mathematical explanation. I argue that this view of explanation suggests that we should shift the question of explanation (...) away from why-questions and towards a “what’s going on here” question. Additionally, I argue that when we recognize the connection between understanding and explanation we naturally see how more than just proof can be explanatory. I expand this point by detailing how definitions and diagrams can be explanatory. In all, we see that when we take seriously the connection between understanding and explanation, we get a better sense of how explanation arises within mathematics. (shrink)

Hysterectomy (or hysterectomy with oophorectomy) is the most frequently performed major surgery in the United States, affecting approximately 700,000 women each year (Easterday, 1983). There has long been interest in the psychological effects of these surgeries. However, apart from the concern that some hysterectomies may be unnecessary (Pearse, 1976), there has been little attention to bioethical issues relating to hysterectomy. Physicians and nurses are ethically obligated to respect the woman who may have a hysterectomy by treating her as an autonomous (...) agent. Informed consent within the context of a decision for hysterectomy should include balanced information and supportive exploration of the woman's values, goals, and life plan. Care of the patient should assist her adjustment, thereby also promoting her autonomy. Physician attitudes toward hysterectomy and the hysterectomy patient can have a major influence on patient self-determination. (shrink)

This paper has two sections. In the first, I shall deal with the parts of the ontological principle; in the second, with the question of whether to accept or reject its third part.