An important and supposedly impactful form of clinical ethics support is moral case deliberation. Empirical evidence, however, is limited with regard to its actual impact. With this literature review, we aim to investigate the empirical evidence of MCD, thereby a) informing the practice, and b) providing a focus for further research on and development of MCD in healthcare settings. A systematic literature search was conducted in the electronic databases PubMed, CINAHL and Web of Science. Both the data collection and the (...) qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of our decisions. The qualitative analysis was supported by ATLAS.ti. Based on a qualitative analysis of 25 empirical papers, we identified four clusters of themes: 1) facilitators and barriers in the preparation and context of MCD, i.e., a safe and open atmosphere created by a facilitator, a concrete case, commitment of participants, a focus on the moral dimension, and a supportive organization; 2) changes that are brought about on a personal and inter-professional level, with regard to professional’s feelings of relief, relatedness and confidence; understanding of the perspectives of colleagues, one’s own perspective and the moral issue at stake; and awareness of the moral dimension of one’s work and awareness of the importance of reflection; 3) changes that are brought about in caring for patients and families; and 4) changes that are brought about on an organizational level. This review shows that MCD brings about changes in practice, mostly for the professional in inter-professional interactions. Most reported changes are considered positive, although challenges, frustrations and absence of change were also reported. Empirical evidence of a concrete impact on the quality of patient care is limited and is mostly based on self-reports. With patient-focused and methodologically sound qualitative research, the practice and the value of MCD in healthcare settings can be better understood, thus making a stronger case for this kind of ethics support. (shrink)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

One tradition of solving the surprise exam paradox, started by Robert Binkley and continued by Doris Olin, Roy Sorensen and Jelle Gerbrandy, construes surpriseepistemically and relies upon the oddity of propositions akin to G. E. Moore’s paradoxical ‘p and I don’t believe that p.’ Here I argue for an analysis that evolves from Olin’s. My analysis is different from hers or indeed any of those in the tradition because it explicitly recognizes that there are two distinct reductios at work in (...) the student’s paradoxical argument against the teacher. The weak reductio is easy to fault. Its invalidity determines the structure of the strong reductio, so-calledbecause it is more difficult to refute, but ultimately unsound because of reasons associated with Moore-paradoxicality. Previous commentators have not always appreciated this difference, with the result that the strong reductio is not addressed, or the response to the weak reductio is superfl uous. This is one reason why other analyses in the tradition are vulnerable to objections to which mine is not. (shrink)

Richard Taylor was born in Charlotte, Michigan on 5 November 1919. He received his A. B. from the University of illinois in 1941, his M. A. from Oberlin College in 1947, and his Ph. D. from Brown University in 1951. He has been William H. P. Faunce Professor of Philosophy at Brown University, Professor of Philosophy (Graduate Faculties) at Columbia University, and Professor of Philosophy at the University of Rochester. He is the author of about fifty articles and of five (...) philosophical books. This volume consists of essays presented to Richard Taylor on the occa sion of his sixtieth birthday. Some of the contributors have been Taylor'S students; some have been his colleagues; and all have been, and continue to be, his admirers. I have made several attempts to articulate what it is I (I would not presume to speak for anyone else) admire about Richard Taylor: (1) There is a particular 'flavor' to Taylor's philosophical writing and con versation that is wholly delightful. Like any other flavor, it can be tasted and enjoyed and remembered but never adequately described. (If there should be someone who has picked up this book who does not know what I mean, I recommend that he read the chapter on 'God' in Taylor's Metaphysics. ) (2) Taylor is a masterful dialectician. (shrink)

Monografii︠a︡ posvi︠a︡shchena tvorchestvu Petra Evgenʹevicha Astafʹeva (1846-1893), zamechatelʹnogo russkogo filosofa, psikhologa i publit︠s︡ista iz plei︠a︡dy mysliteleĭ kont︠s︡a XIX veka -- "zolotogo veka" russkoĭ kulʹtury. V knige detalʹno rassmotreny osnovnye dostizhenii︠a︡ P.E. Astafʹeva, svi︠a︡zannye s obosnovaniem spiritualisticheskogo mirovozzrenii︠a︡: ego uchenie o dukhovnoĭ lichnosti i svobode voli, paradoksalʹnai︠a︡ traktovka chuvstva li︠u︡bvi, originalʹnai︠a︡ kont︠s︡ept︠s︡ii︠a︡ "bessoznatelʹnogo", predstavlenie o vere cheloveka v sebi︠a︡ kak pochve estestvennogo bogopoznanii︠a︡ i t.d. V edinstve s filosofsko-psikhologicheskim ucheniem P.E. Astafʹeva rassmotrena ego publit︠s︡istika (vkli︠u︡chai︠a︡ novyĭ i gluboko aktualʹnyĭ variant "troĭstvennoĭ (...) formuly") i namechena vozmozhnostʹ metafizicheskogo ponimanii︠a︡ nat︠s︡ionalʹnoĭ prirody cheloveka. V prilozhenii︠a︡ k knige vkli︠u︡cheny dva ėti︠u︡da avtora, posvi︠a︡shchennye poni︠a︡tii︠a︡m narodnosti i sobornosti. (shrink)

The desire to see a sign phenomenon in different ways always has a reason to interpret it in an unbiased, panoramic way, and in some places - even allowing for contradictions in its understanding by different participants in the interpretative process. For modern humanities, this disposition is quite understandable, since it follows from its very postmodern nature, thereby defining the semantic semantic fields of the leading humanities. True, it is not so wide-spread, but instead, it is evident that Ukrainian religious (...) thinkers of the Middle Ages and Baroque have interpreted the iconic phenomena more deeply. In the story of Petro Mohyla "On the Wonderful Elder Grigory Mezhyhirsky" the metropolitan Mohyla clearly expresses the need to build before the thinking gaze of the reader his own, immanently religious-philosophical conception of the Divine, which every time would present him not just as an act of manifestation, otherwise he appears before the person, while remaining alone. The contemporary study of this issue in order to integrate its leading concepts in the religious-philosophical and general cultural discourse of the postmodern era has largely determined the relevance of the proposed article. The study of the phenomenon of "leaving" by itself in changing forms of the phenomenon of the Divine is also one of the key ones in the proposed studio, because it expresses the very meaning of the Divine as a religious, and therefore a cultural phenomenon. (shrink)

On his very first page Feldman ascribes to me a claim about the relation expressed by 'is identical with'. Feldman's way of speaking is, as Ryle might say, systematically misleading: for of course I deny that any one relation, even a relative relation, is the relation expressed by 'is identical with'. My whole thesis was that 'is identical with' expressed now one, now another, relation, according to the context of utterance.

The book pays close attention to Wittgenstein's own remarks on religious belief, arranging them against the background of his broader philosophical methodology, ...

Given a physical system, one knows that there is a logical duality between its properties and its states. In this paper, we choose its states as the undefined notions of our axiomatic construction. In fact, by means of well-motivated assumptions expressed in terms of a transition probability function defined on the set of all pure states of the system, we construct a system of elementary propositions, i.e., a complete orthomodular atomic lattice satisfying the covering law. We also study in this (...) framework the important notion of compatibility of propositions, and we define the superpositions and the mixtures of the states of the physical system. (shrink)

Artigo traduzido do original inglês " Is the Best Good Enough ?", publicado em Proceedings of the Aristotelian Society , vol. XCIII, parte 2, 1993, pp. 89-104. Todos os direitos do artigo estáo reservados aos editores de Aristotelian Society , a quem os tradutores agradecem, na pessoa de Mark Tavis, a licença para a traduçáo deste artigo. Reprinted by courtesy of the Editor of the Aristotelian Society: © [1993].