Background: The field of clinical ethics is examining ways of determining competency. The Assessing Clinical Ethics Skills (ACES) tool offers a new approach that identifies a range of skills necessary in the conduct of clinical ethics consultation and provides a consistent framework for evaluating these skills. Through a training website, users learn to apply the ACES tool to clinical ethics consultants (CECs) in simulated ethics consultation videos. The aim is to recognize competent and incompetent clinical ethics consultation skills by (...) watching and evaluating a videotaped CEC performance. We report how we set a criterion cut score (i.e., minimally acceptable score) for judging the ability of users of the ACES tool to evaluate simulated CEC performances.Methods: A modified Angoff standard-setting procedure was used to establish the cut score for an end-of-life case included on the ACES training website. The standard-setting committee viewed the Futility Case and estimated the probability that a minimally competent CEC would correctly answer each item on the ACES tool. The committee further adjusted these estimates by reviewing data from 31 pilot users of the Futility Case before determining the cut score.Results: Averaging over all 31 items, the proposed proportion correct score for minimal competency was 80%, corresponding to a cut score that is between 24 and 25 points out of 31 possible points. The standard-setting committee subsequently set the minimal competency cut score to 24 points.Conclusions: The cut score for the ACES tool identifies the number of correct responses a user of the ACES tool training website must attain to “pass” and reach minimal competency in recognizing competent and incompetent skills of the CECs in the simulated ethics consultation videos. The application of the cut score to live training of CECs and other areas of practice requires further investigation. (shrink)

Clinical Ethics Consultation (CEC) has grown significantly in the last decade, and efforts are being made to professionalize the practice. The American Society for Bioethics and Humanities (ASBH) has been instrumental in this process, having published the _Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants_ and founded and endorsed the creation of the _Healthcare Ethics Consultant Certified (HCEC) Certification Commission._ The ASBH also published “core competencies” for healthcare ethics consultants and has delineated a clear identity and role of (...) such consultants distinct from that other healthcare professionals. In addition, more enter the field armed with advanced degrees (MA and PhD) or certification in clinical ethics consultation. While some have questioned the trend toward professionalization, the momentum is clearly in its favor. This paper explores three questions: Does the professionalization of healthcare ethics consultation expose those engaged in the field to the types of liability claims faced by professionals in other fields? What specific liabilities could affect a healthcare ethics consultant? And finally, what should healthcare ethics consultants do to protect themselves against liability claims? We conclude that while the risk of liability remains low, those engaged in the field should accept that risk just as part of their status as professionals and, like those in allied professions, seek appropriate protection in the form of liability insurance. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. (...) ObjectiveThe primary objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

Standardizing consultation processes is increasingly important as clinical ethics consultation becomes more utilized in and vital to medical practice. Solid organ transplant represents a relatively nascent field replete with complex ethical issues that, while explored, have not been systematically classified. In this paper, we offer a proposed taxonomy that divides issues of resource allocation from viable solutions to the issue of organ shortage in transplant and then further distinguishes between policy and bedside level issues. We then identify all transplant (...) related ethics consults performed at the Cleveland Clinic between 2008 and 2013 in order to identify how consultants conceptually framed their consultations by the domains they ascribe to the case. We code the CC domains to those in the Core Competencies for Healthcare Consultation Ethics in order to initiate a broader conversation regarding best practices in these highly complex cases. A discussion of the ethical issues underlying living donor and recipient related consults ensues. Finally, we suggest that the ethical domains prescribed in the Core Competencies provide a strong starting ground for a common intra-disciplinary language in the realm of formal CEC. (shrink)

The Quality Attestation Presidential Task Force has made a thoughtful and thorough contribution to the establishment of clinical ethics consultation as a professional field. As Eric Kodish, Joseph J. Fins, and colleagues indicate, quality attestation is another step in bringing greater accountability and transparency to CEC. To complete this process, however, the work of the QAPTF must be situated within a larger project. As the field further develops, there will be a move toward restricting CEC to those who (...) have demonstrated, by means of this version of the quality attestation or an eventual iteration of it, that they are capable of conducting an ethics consultation with the skill, knowledge, and rigor necessary. This raises the question of how potential consultants will gain the experience required to produce a portfolio of cases when only those who are qualified are permitted to perform CECs, either by their institution or by some external evaluator, such as The Joint Commission. Now may be the time to begin thinking about further developments in the field that will complement both current academic training programs and the quality attestation process. For this, we might look to the Association for Clinical Pastoral Education for its model for certifying educators of chaplains who wish to become professionals. (shrink)

Several approaches to clinical ethics consultation (CEC) exist in medical practice and are widely discussed in the clinical ethics literature; different models of CECs are classified according to their methods, goals, and consultant’s attitude. Although the “facilitation” model has been endorsed by the American Society for Bioethics and Humanities (ASBH) and is described in an influential manual, alternative approaches, such as advocacy, moral expertise, mediation, and engagement are practiced and defended in the clinical ethics field. Our Clinical Ethics Center (...) in Paris was founded in 2002 in the wake of the Patients’ Rights Act, and to date it is the largest center that provides consultation services in France. In this article we shall describe and defend our own approach to clinical ethics consultation, which we call the “Commitment Model,” in comparison with other existing models. Indeed commitment implies, among other meanings, continuity through time, a series of coherent actions, and the realization of important social goals. By drawing on a recent consultation case, we shall describe the main steps of our consultation procedure: interviews with major stakeholders, including patients and proxies; case conferences; and follow up. We shall show why we have chosen the term “commitment” to represent our approach at three different but interrelated levels: commitment towards patients, within the case conference group, and towards society as a whole. (shrink)

In the zeal to find a workable credentialing process for clinical ethics consultants (CECs), the current motto in the field seems to be “something is better than nothing.” Although the field has be...

In the article “An Argument for Standardized Ethical Directives for Secular Healthcare Services,” Abram L. Brummett and Jamie C. Watson argue that, parallel to the directives of the Roman Catholic Church, secular healthcare ethics consultants (HECs) need substantive standardized ethical guidelines (what they call SEGs) that would constitute a best practice across all HECs in the U.S. Brummett and Watson believe that the absence of such directives constitutes an important deficit in clinical ethics consultation (CEC) that needs to be rectified (...) in order for consultation to achieve the professionalism and universality necessary for legitimacy. This is a bold argument worthy of consideration, perhaps most because it challenges the field to engage in a self-assessment about its current and future directions against the backdrop of both the concerning data on national CEC and the current intense values polarization in the U.S. As part of assessment, I will argue in this essay that such a consensus document is not only impossible in our current national climate, but undesirable given the way that it would impose lib- Values Imposition and Ethical Pluralism: An Argument Against Standardized Ethical Directives for Healthcare Ethics Consultants Autumn Fiester eral clinical ethics values on an extremely values-pluralistic populace and exacerbate the deep divisions that many of us fear could be our national undoing. (shrink)

Recently, Matt King and Peter Carruthers have argued that the Real Self accounts of moral responsibility or autonomy are under pressure because they rely on a questionable conception of self-knowledge of propositional attitudes, such as beliefs and desires. In fact, they defend, as a plausible assumption, the claim that transparent self-knowledge of propositional attitudes is incompatible with mounting evidence in the cognitive sciences. In this chapter, we respond to this line of argument. We describe the types of self-knowledge that might (...) plausibly be involved, as psychological prerequisites, in the processes of identification and integration that lead to the constitution of the real self of an agent. We argue that these forms of self- knowledge do not require the type of transparent knowledge of propositional attitudes that, according to King and Carruthers, is incompatible with the results of contemporary cognitive science. (shrink)

Recently some have argued that psychopaths might suffer generalised cognitive impairments that affect their capacity for mental time travel. In relation to the past, mental time travel is the capacity to have memories of past episodes in which the agent was personally involved. In relation to the future, mental time travel involves prospection, the capacity to imagine future situations where the agent might be involved. The authors argue that certain studies on the instrumental learning of psychopaths show that, in relation (...) to certain specific situations, these subjects might be impaired in certain capacities for mental time travel. Following Harry Frankfurt, they maintain that moral responsibility requires a capacity to identify with certain desires. This process of identification involves accepting desires in virtue of an evaluation that is sensitive to commitments that stem from previously formed mental states. Therefore, identification relies on some basic capacities of mental time travel. The authors argue that a process of “detachment” from current operative desires is of central importance in the process of identification. They claim that certain experiments concerning the instrumental learning in psychopaths show that, in certain cases, they are incapable to register changes in their situation that determine a lack of detachment from certain current operative motivational states. However, other experiments show that psychopaths, in other circumstances, are capable of “detaching” from certain of their motivational states. These empirical findings allow the authors to argue that the process of identification in psychopathic offenders in certain specific circumstances might be impaired. (shrink)

The paper presents a kind of normative anti-realist view of epistemology, in the same ballpark as recent versions of expressivism. But the primary focus of the paper is less on this meta-epistemological view itself than on how it should affect ground-level issues in epistemology: for instance, how it should deal with certain forms of skepticism, and how it allows for fundamental revision in epistemic practices. It is hoped that these methodological consequences will seem attractive independent of the normative anti-realism. Indeed, (...) some normative realists seem to embrace the view on skepticism, but it is argued that their position is unstable: the realism undermines the methodology. The general theme of the paper is that the issue of normative realism is deeply entwined with issues of methodology, in strong contrast to the common claim that meta-epistemological views in the tradition of expressivism have no first order impact. (shrink)

James articulates and defends a Spinozist view of the interplay between poetry and philosophy: philosophy has an ineliminably poetic content, and poetry is an aid and support to philosophy. In this piece, I juxtapose James’s Spinozist schema with another schema available within Spinoza’s historical milieu. In Ibn Tufayl’s view, rather than poetry being an aid to philosophy, poetry opens to a world of experience that even the best philosophy cannot grasp. For flat-footed philosophers who think that philosophy can in principle (...) have the last word on everything, poetics might give an approximate indication of a kind of experience that lies beyond it. (shrink)

The book concludes by examining how we might bring such transformation about.Written by two of the leading experts in the fields of early childhood and ...

Fielding discusses how Michel Foucault and Maurice Merleau-Ponty view spatial and temporal bodies. Foucault dismisses the understanding of an inside soul surrounded by a body.

An interpretation of Berkeley’s theory of meaning must account for operative utility as well as Berkeley’s commitment to the truth of Christian scriptures. I argue that formalist and use-theoretic...

Sandra Field, Jeffrey Flynn, Stephen Macedo, Longxi Zhang, and Martin Powers discussed Powers’ book China and England: The Preindustrial Struggle for Social Justice in Word and Image at the American Philosophical Association’s 2020 Eastern Division meeting in Philadelphia. The panel was sponsored by the APA’s “Committee on Asian and Asian-American Philosophers and Philosophies” and organized by Brian Bruya.

Science Without Numbers caused a stir in 1980, with its bold nominalist approach to the philosophy of mathematics and science. It has been unavailable for twenty years and is now reissued in a revised edition with a substantial new preface presenting the author's current views and responses to the issues raised in subsequent debate.

Argues that there are two reasons for ascribing to mental states, structures more fine-grained than the sets of possible world they represent: first, fine-grained structure enters naturally into the explanation of behaviour; second, fine-grained structure is needed in a theory of how those states represent the sets of possible worlds they represent. In connection with the first point, it is argued that Stalnaker’s attempt to use metalinguistic content to obviate the need of fine-grained structure cannot work. In connection with the (...) second point, it is argued that the systematicity in the assignment of content to mental states can be accommodated only by postulating a fine-grained structure for mental states. Also contains some discussion of doing without representational content, understood in the non-deflationary sense that Stalnaker assumes. (shrink)

The common practice of advancing arguments based on current physics in support of metaphysical conclusions has been criticized on the grounds that current physics may well be wrong. A further criticism is leveled here: current physics itself depends on metaphysical assumptions, so arguing from current physics is in fact arguing from yet more metaphysics. It is shown that the metaphysical assumptions underlying current physics are often deeply embedded in the formalism in which theories are presented, and hence impossible to dismiss (...) as mere motivational or interpretative speculation. It is then shown that such assumptions, when made explicit, can wreck havoc on otherwise-sensible philosophical arguments. It is argued in conclusion that this situation is both unlikely to be reparable just by being more careful, and unlikely to go away as further, presumably more subtle physical theories are developed. (shrink)

This paper is concerned with the debate between substantival and relational theories of space-time, and discusses two difficulties that beset the relationalist: a difficulty posed by field theories, and another difficulty called the problem of quantities. A main purpose of the paper is to argue that possibility can not always be used as a surrogate of ontology, and that in particular that there is no hope of using possibility to solve the problem of quantities.

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Sanity and Irresponsibility”Lloyd Fields (bio)AbstractI make two criticisms of Wilson’s proposal to dispense with a loaded axiological criterion of sanity. First, Edwards’s axiological criterion of sanity, which Wilson accepts, involves the requirement of impartiality, which at least excludes some standards of right and wrong. Second, value pluralism applies only to morally acceptable forms of life and thus presupposes a standard of right and wrong. I conclude by (...) noting that mental illnesses are not sufficiently characterised by extreme and persistent deviance from practical rationality, as conceived by Edwards and Wilson.KeywordsSanity, responsibility, mental illness, value pluralismWilson’s paper is set in an important tradition of which Susan Wolf is a notable exemplar. He tackles the crucially important issue of how practical rationality is related to mental health and of how certain forms of irrationality are connected with mental illness. This issue must be taken into account in order to avoid infecting the criteria of sanity with “idiosyncratic or culturally biased norms.” Like Wolf (1989, 137–151), Wilson holds that sanity is a necessary condition of responsibility. But Wilson rejects the second of Wolf’s two criteria of sanity on the grounds that it invokes a definite normative theory of right and wrong. He proposes instead that whether an agent is sane should be decided on the basis of whether s/he displays practical rationality, as defined by Edwards’s list of seven items. Following Edwards, Wilson implicitly equates “sanity” with “mental health” and “insanity” with “mental illness.” By rejecting an axiological criterion of sanity that depends on a normative theory of right and wrong, Wilson is able to ensure that individuals like JoJo are not judged to be insane and hence not morally responsible for their actions. Wilson is right to stress the importance of our not applying notions such as “mental illness” or “insanity” too widely, especially in such a way as to allow blameworthy persons to escape blame and punishment.But are Wilson’s own criteria of sanity free from dependence on a normative theory, or a normative standard, of right and wrong? First, let us note that Wilson states Edwards’s seventh condition of practical rationality as follows: “holding values that are or would be adopted under the conditions of (negative) freedom.” Edwards’s own formulation of this condition is the following: “having values which have been (or would be) adopted under conditions of freedom, enlightenment and impartiality” (1982, 315). Wilson explains “freedom” as the absence of coercion. It is uncertain what “enlightenment” means in this context. Impartiality would seem to include being impartial between oneself and others and between one’s own tribe, nation or race and that of others. Although this requirement is perhaps too general to be regarded as a sufficient standard [End Page 303] of right and wrong, it is at least part of such normative theories as utilitarianism and Kant’s moral theory, while it is inconsistent with ethical egoism, i.e., the view that an action is right or wrong depending on whether it serves or frustrates the agent’s overall best interests. One could dispute Wilson’s claim, therefore, that Edwards’s seventh item is not a “loaded” axiological criterion.Second, Wilson maintains that we can avoid assuming a loaded axiological criterion for sanity by adopting the position of value pluralism. Wolf’s axiological criterion for sanity is that the agent should be capable of knowing the difference between right and wrong. Wilson holds that this criterion, as presented, invokes a normative theory of right and wrong. The criterion would not do so if it were applied in accordance with value pluralism, which, Wilson says, “rejects the notion that there is one monolithic theory of right and wrong without denying that an actor may behave virtuously or viciously.” Wilson appears to assume that an “unloaded” version of Wolf’s axiological criterion would be more or less equivalent to Edwards’s seventh condition of practical rationality.Value pluralism maintains that there are incompatible forms of life that display distinct virtues. “Whichever form of life one is pursuing there are virtues which elude one because they are available only to people pursuing alternative and... (shrink)

Helen Fielding considers how the repetition of the same can be phenomenally shifted. Considering the phenomenon of death by suicide in response to cyberbullying, she asks how cyberspace as a system can be opened up and become more responsive to the living affect of young women subjected to abuse. At the heart of this problem is the breakdown of personal time into objective time, whereby the inexhaustible potentiality of the living world is collapsed into the indifferent infinity of the possible (...) that, unconnected to living existence, is ultimately a closed system. (shrink)

Michael Fielding; Against Competition, Journal of Philosophy of Education, Volume 10, Issue 1, 30 May 2006, Pages 124–146, https://doi.org/10.1111/j.1467-9752.1.

A selective background -- Broadly classical approaches -- Paracompleteness -- More on paracomplete solutions -- Paraconsistent dialetheism.

Binz et al. propose a general framework for meta-learning and contrast it with built-by-hand Bayesian models. We comment on some architectural assumptions of the approach, its relation to the active inference framework, its potential applicability to living systems in general, and the advantages of the latter in addressing the explanation problem.

Shows how children can be responsible, from brushing teeth to putting toys away.

Serious re-examination of participatory traditions of democracy is long overdue. Iconically central to such traditions of democratic education is the practice of whole School Meetings. More usually associated with radical work within the private sector, School Meetings are here explored in detail through two examples from publicly funded education, Epping House School, a mixed residential primary/elementary school for students with severe emotional, social and behavioural difficulties and secondary/high schools within the Just Community School movement in the USA. In addition to (...) providing richly textured accounts of the multiple realities and challenges of pioneering overtly democratic practices such as School Meetings within the publicly funded sector of education substantial attention is paid to analytic engagement with the kind of organisational structures, practices and cultures that seem to play an important role in their successful operation and development. The different phenomenological and theoretical strands weaving their way through the texture of Meeting practices also raise a number of key issues within the fields of social and political philosophy, in particular, whether School Meetings are best understood as predominantly political or communal phenomena. In gesturing towards the philosophical groundwork of a satisfactory answer I argue for the importance of the undeservedly neglected notion of democratic fellowship within the lexicon of democratic polity and aspiration. (shrink)

In May 2021, Alan Bechaz, Racher Du, Will Cailes and Thomas Spiteri interviewed Sandra Leonie Field for UPJA’s Conversations from the Region. A series of discussions that invites philosophers from or based in Australasia to share their student and academic experiences. The segment looks into what inspires people to study philosophy, how they pursue their philosophical interests, and gives our audiences a better idea of philosophy as an undergraduate.

In lieu of an abstract, here is a brief excerpt of the content:Psychopathy, Other-Regarding Moral Beliefs, and ResponsibilityLloyd Fields (bio)AbstractIn this paper I seek to show that at least one kind of psychopath is incapable of forming other-regarding moral beliefs; hence that they cannot act for other-regarding moral reasons; and hence that they are not appropriate subjects for the assessment of either moral or legal responsibility. Various attempts to characterize psychopaths are considered and rejected, in particular the widely held view (...) that psychopaths are, in general, incapable of understanding moral concepts. The particular disability proposed here, the incapacity to form other-regarding moral beliefs, is then derived from an analysis of what is required for someone to be a responsible agent. This is illustrated with a detailed case history. A defect of this kind is shown to vitiate moral responsibility, because it renders the psychopath irresponsive to the social pressures which normally ensure respect for moral norms. It is also shown that the psychopath is not a suitable subject for the assessment of legal responsibility, because he lacks the capacity to act from common prudence to avoid sanctions. I conclude that the attempt to characterize particular defects from among the heterogeneity of psychopathic subjects, could lead to better targeted, and hence to more effective, management of particular cases.KeywordsCriminality, mental illness, personality disorder, blame, liability, moral beliefs, guilt, social moralityIntroductionThe term “psychopath” has been used with a wide variety of different meanings and, no doubt, covers a heterogeneous group of subjects (Criminal behaviour and mental health 1992). My aim in this paper is to argue that at least a subgroup of those subjects are characterized by an inability to form other-regarding moral beliefs—and hence, for this particular reason, are not morally responsible agents—and that they also lack the capacity for prudence, and hence are not legally responsible agents.I begin by distinguishing the particular sense in which I will be using the term “psychopathy.” I then consider some suggestions in the literature regarding the defect by which psychopaths might be characterized—that they are mentally ill, or incapable of understanding moral concepts. In rejecting these, I come to the suggestion that the relevant defect is an inability to form other-regarding moral beliefs, a defect which is graphically illustrated by a case report from the literature. I explore the implication of this kind of defect for [End Page 261] moral responsibility as a socially-embedded notion, and the implication of the psychopath’s inability to exercise prudence in relation to legal liability.Nothing in this paper should be taken to suggest that psychopaths are irredeemable. On the contrary, as I argue in an endnote, correctly characterizing the defect from which they suffer leads directly to forms of treatment whose effectiveness has acquired a measure of empirical support.The Nature of PsychopathyPsychopathy is not a homogeneous concept; there are different types of psychopaths. For example, Henderson identified a type of psychopath who he classified as “Predominantly Creative,” exemplified by such figures as T. E. Lawrence and Joan of Arc. In people of this type genius is associated with heightened sensitivity, psychosexual immaturity and emotional instability (Henderson 1939, 108–20; Henderson and Gillespie 1969, 317). Predominantly creative psychopaths do not come within my purview.By “psychopathy” I shall mean the specific form of personality disorder described by Cleckley in his book, The Mask of Sanity (Cleckley 1964). Cleckley’s description forms the basis of Hare’s Revised (20-item) Psychopathy Checklist. The Checklist includes the following personality traits and deviant behaviors:1. Glibness/superficial charm.2. Grandiose sense of self-worth.3. Need for stimulation/proneness to boredom.4. Pathological lying.5. Conning/manipulative.6. Lack of remorse or guilt.7. Shallow affect.8. Callous/lack of empathy.9. Parasitic lifestyle.10. Poor behavioral controls.11. Promiscuous sexual behavior.12. Early behavior problems.13. Lack of realistic, long-term plans.14. Impulsivity.15. Irresponsibility.16. Failure to accept responsibility for own actions.17. Many short-term marital relationships.18. Juvenile delinquency.19. Revocation of conditional release.20. Criminal versatility (Hare 1986, 18). 1This conceptualization resembles in many respects the category of Antisocial Personality Disorder as described in the American Psychiatric... (shrink)