BackgroundCritical Incident Reporting Systems (CIRS) provide a well-proven method to identify clinical risks in hospitals. All professions can report critical incidents anonymously, low-threshold, and without sanctions. Reported cases are processed to preventive measures that improve patient and staff safety. Clinical ethics consultations offer support for ethical conflicts but are dependent on the interaction with staff and management to be effective. The aim of this study was to investigate the rationale of integrating an ethical focus into CIRS.MethodsA six-step approach combined the (...) analysis of CIRS databases, potential cases, literature on clinical and organizational ethics, cases from ethics consultations, and experts’ experience to construct a framework for CIRS cases with ethical relevance and map the categories with principles of biomedical ethics.ResultsFour main categories of critical incidents with ethical relevance were derived: (1) patient-related communication; (2) consent, autonomy, and patient interest; (3) conflicting economic and medical interests; (4) staff communication and corporate culture. Each category was refined with different subcategories and mapped with case examples and exemplary related ethical principles to demonstrate ethical relevance.ConclusionThe developed framework for CIRS cases with its ethical dimensions demonstrates the relevance of integrating ethics into the concept of risk-, quality-, and organizational management. It may also support clinical ethics consultations’ presence and effectiveness. The proposed enhancement could contribute to hospitals’ ethical infrastructure and may increase ethical behavior, patient safety, and employee satisfaction. (shrink)

Background Recent publications reveal shortcomings in evidence review and summarization methods for patient decision aids. In the large-scale "Share to Care (S2C)" Shared Decision Making (SDM) project at the University Hospital Kiel, Germany, one of 4 SDM interventions was to develop up to 80 decision aids for patients. Best available evidence on the treatments' impact on patient-relevant outcomes was systematically appraised to feed this information into the decision aids. Aims of this paper were to (1) describe how PtDAs are developed (...) and how S2C evidence reviews for each PtDA are conducted, (2) appraise the quality of the best available evidence identified and (3) identify challenges associated with identified evidence. Methods The quality of the identified evidence was assessed based on GRADE quality criteria and categorized into high-, moderate-, low-, very low-quality evidence. Evidence appraisal was conducted across all outcomes assessed in an evidence review and for specific groups of outcomes, namely mortality, morbidity, quality of life, and treatment harms. Challenges in evidence interpretation and summarization resulting from the characteristics of decision aids and the type and quality of evidence are identified and discussed. Conclusions Evidence reviews in this project were carefully conducted and summarized. However, the evidence identified for our decision aids was indeed a "scattered landscape" and often poor quality. Facing a high prevalence of low-quality, non-directly comparative evidence for treatment alternatives doesn't mean it is not necessary to choose an evidence-based approach to inform patients. While there is an urgent need for high quality comparative trials, best available evidence nevertheless has to be appraised and transparently communicated to patients. (shrink)

Political science is divided between methodological individualists, who seek to explain political phenomena by reference to individuals and their interactions, and holists (or nonreductionists), who consider some higher-level social entities or properties such as states, institutions, or cultures ontologically or causally significant. We propose a reconciliation between these two perspectives, building on related work in philosophy. After laying out a taxonomy of different variants of each view, we observe that (i) although political phenomena result from underlying individual attitudes and behavior, (...) individual-level descriptions do not always capture all explanatorily salient properties, and (ii) nonreductionistic explanations are mandated when social regularities are robust to changes in their individual-level realization. We characterize the dividing line between phenomena requiring nonreductionistic explanation and phenomena permitting individualistic explanation and give examples from the study of ethnic conflicts, social-network theory, and international-relations theory. (shrink)

Solidarity is supposed to facilitate collective action. We argue that it can also help overcome false consciousness. Groups practice if they pool information about what is in their true interest and how to vote accordingly. The more numerous can in this way overcome the but only if they are minimally confident with whom they share the same interests and only if they are better-than-random in voting for the alternative that promotes their interests. Being more cohesive and more competent than the (...) Masses, the Elites can employ the same strategy perhaps all the more effectively. But so long as the Masses practice epistemic solidarity they will almost always win, whether or not the Elites do. By enriching the traditional framework of the Condorcet Jury Theorem with group-specific standards of correctness, we investigate how groups can organize to support the alternatives truly in their interests. (shrink)

The morphological marking that distinguishes conditionals that are called “counterfactual” from those that are not, can also be found in other modal constructions, such as in the expression of wishes and oughts. We propose to call it “X-marking”. In this article, we lay out desiderata for a successful theory of X-marking and make some initial informal observations. Much remains to be done.

In this paper we develop a new methodology for normative theorising, which we call Directed Reflective Equilibrium. Directed Reflective Equilibrium is based on a taxonomy that distinguishes between a number of different functions of hypothetical cases, including two dimensions that we call representation and elicitation. Like its predecessor, Directed Reflective Equilibrium accepts that neither intuitions nor basic principles are immune to revision and that our commitments on various levels of philosophical enquiry should be brought into equilibrium. However, it also offers (...) guidance about how different types of cases ought to be sequenced to achieve this result. We argue that this ‘directional’ approach improves, in various ways, upon the non-directional approach of traditional Reflective Equilibrium. (shrink)

Offering a collection of fifteen essays that deal with issues at the intersection of phenomenology, logic, and the philosophy of mathematics, this 2005 book is divided into three parts. Part I contains a general essay on Husserl's conception of science and logic, an essay of mathematics and transcendental phenomenology, and an essay on phenomenology and modern pure geometry. Part II is focused on Kurt Godel's interest in phenomenology. It explores Godel's ideas and also some work of Quine, Penelope Maddy and (...) Roger Penrose. Part III deals with elementary, constructive areas of mathematics. These are areas of mathematics that are closer to their origins in simple cognitive activities and in everyday experience. This part of the book contains essays on intuitionism, Hermann Weyl, the notion of constructive proof, Poincaré and Frege. (shrink)

Keith DeRose defends contextualism: the view that the truth-conditions of knowledge ascriptions vary with the context of the ascriber. Mark Richard has criticised contextualism for being unable to vindicate intuitions about disagreement. To account for these intuitions, DeRose has proposed truth-conditions for “knows” called the Gap view. According to this view, knowledge ascriptions are true iff the epistemic standards of each conversational participant are met, false iff each participant's standards aren't met, and truth-valueless otherwise. An implication of the Gap view (...) is that people with divergent standards can enter conversations and thereby render knowledge claims gappy. We characterise this as a form of trolling. We argue that trolling results in unacceptably counterintuitive implications and that this constitutes a reductio against the Gap view. We also briefly explore the implications of trolling for other contextualist views about “knows,” as well as a broader class of context sensitive expressions. (shrink)

What is time? Is time real, or a mere illusion? We seem to feel the passage of time in our consciousness but are doomed to encounter great difficulty when trying to get a deeper grip on the nature of time. As Augustine famously remarked, "if no one asks me about what time is, I know what it is, but if I wish to explain it to him who asks, I do not know". The present essay does not aim so much (...) at giving a complete answer to this intricate and difficult question as to focus on Zhuangzi to excavate the idea of time inherent in his philosophical writings. A second aim is to show how it relates to some of the contemporary concerns about time. More specifically, our concern is not about... (shrink)

The Federalist, justifying the Electoral College to elect the president, claimed that a small group of more informed individuals would make a better decision than the general mass. But the Condorcet Jury Theorem tells us that the more independent, better-than-random voters there are, the more likely it will be that the majority among them will be correct. The question thus arises as to how much better, on average, members of the smaller group would have to be to compensate for the (...) epistemic costs of making decisions on the basis of that many fewer votes. This question is explored in the contexts of referendum democracy, delegate-style representative democracy, and trustee-style representative democracy. (shrink)

BackgroundRecent advancements in neuroscientific techniques have allowed us to make huge progress in our understanding of memories, and in turn has paved the way for new memory modification technologies that can modulate memories with a degree of precision, which was not previously possible. With advancements in such techniques, new and critical ethical questions have emerged. Understanding and framing these ethical questions within the current philosophical theories is crucial in order to systematically examine them as we translate these techniques to the (...) clinic.Main bodyIn this paper, we discuss the ethical implications of modern neuroscience techniques that aim to disrupt or enhance memories. We attempt to frame the MMTs in the context of existing ethical philosophical theories to provide a cohesive analysis of the myriad of ethical quagmires that might emerge from such technologies. We argue the application of Aristotle’s Golden Mean and multiple accounts of authenticity are useful in approaching the ethical questions surrounding MMTs. We then propose a framework in which ethical considerations can be systematically examined. Lastly, we provide caveats and considerations for the use of this framework. Overall, we provide a practical approach for the ethical use of MMTs depending on the situation.ConclusionWhile at face value, our model appears to put severe limitations on the application of MMTs, we are not completely opposed to their use, but rather our framework guides the agent to consider the implications before making any decisions. Most importantly, we argue that the use of MMTs does not reduce the responsibility of the initial decision, and the agent must accept the post-MMT self as the new “true self” regardless of the outcome. As the developmental trajectory of MMTs suggests we are getting closer to practical clinical applications, ethical concerns across a wide range of disciplines need to be addressed to develop best strategies and policies when dealing with MMTs. If this can be achieved, we believe the ethical use of MMTs is not only possible but would also be of tremendous benefit to many people suffering from memory-related mental disorders. (shrink)

Posing the question ‘How diverse is philosophy of education in the West?’ this paper responds to two recent defences of African philosophy of education which endorse its communitarianism and oppose individualism in Western philosophy of education. After outlining Thaddeus Metz's argument that Western philosophy of education should become more African by being more communitarian, and Yusef Waghid's defence of communitarianism in African philosophy of education, we develop a qualified defence of aspects of individualism in education. Our reservations about some aspects (...) of communitarianism lead us to argue for a role for some forms of individualism in African as well as Western education. Finally, reflecting on what is at stake in this kind of comparative philosophy of education, we argue that an over-emphasis on cultural differences can distract philosophers of education from the attention they should pay to the common dangers posed across continents by the influence of global capitalism on education. (shrink)

Maxwell et al. [Maxwell, J. P., Masters, R. S. W., Kerr, E., & Weedon, E. . The implicit benefit of learning without errors. The Quarterly Journal of Experimental Psychology, 54A, 1049–1068. The implicit benefit of learning without errors. The Quarterly Journal of Experimental Psychology, 54A, 1049–1068] suggested that, following unsuccessful movements, the learner forms hypotheses about the probable causes of the error and the required movement adjustments necessary for its elimination. Hypothesis testing is an explicit process that places demands on (...) cognitive resources. Demands on cognitive resources can be identified by measuring probe reaction times and movement times. Lengthened PRT and movement times reflects increased cognitive demands. Thus, PRT and movement times should be longer following errors, relative to successful, movements. This hypothesis was tested using a motor skill . Furthermore, the association between error processing and the preparation and execution phases of movement was examined. The data confirmed that cognitive demand is greater for trials following an error, relative to trials without an error. This effect was apparent throughout learning and in both the preparatory and execution phases of the movement. Cognitive effort also appeared to be higher during movement preparation, relative to movement execution. (shrink)

When people interact with social robots, they treat them as real social agents. How people depict robots is fun to consider, but when people are confronted with embodied entities that move and talk – whether humans or robots – they interact with them as authentic social agents with minds, and not as mere representations.

The compositional analysis of sentences like “Tony has been happy since he’s been taking Prozac” becomes feasible through a combination of a maximal informativeness semantics for definite descriptions and an elided second “since” inside the “since”-clause.

This book deals with the thorny issue of human rights in different cultures and religions, especially in the light of bioethical issues. In this book, experts from Christianity, Judaism, Islam, Buddhism, Daoism, Hinduism and Confucianism discuss the tension between their religious traditions and the claim of universality of human rights. The East-West contrast is particularly evident with regards to human rights. Some writers find the human rights language too individualistic and it is foreign to major religions where the self does (...) not exist in isolation, but is normally immersed in a web of relations and duties towards family, friends, religion community, and society. Is the human rights discourse a predominantly Western liberal ideal, which in bioethics is translated to mean autonomy and free choice? In today's democratic societies, laws have been drafted to protect individuals and communities against slavery, discrimination, torture or genocide. Yet, it appears unclear at what moment universal rights supersede respect for cultural diversity and pluralism. This collection of articles demonstrates a rich spectrum of positions among different religions, as they confront the ever more pressing issues of bioethics and human rights in the modern world. This book is intended for those interested in the contemporary debates on religious ethics, human rights, bioethics, cultural diversity and multiculturalism. (shrink)

ZusammenfassungPatientenmobilität und grenzüberschreitende Gesundheitsversorgung sind alltägliche Phänomene in der Europäischen Union. Im Jahr 2011 hat die EU eine Richtlinie erlassen, um in diesem Kontext Rechtssicherheit herzustellen. Bisher gibt es keine umfassenden systematischen Studien über ethische Aspekte grenzübergreifender Gesundheitsversorgung. In dieser Arbeit werden die rechtlichen Entwicklungen der grenzübergreifenden Gesundheitsversorgung dargestellt und die in der Literatur vereinzelt erwähnten ethisch relevanten Aspekte heuristisch und auf Patiententypologien aufbauend systematisch inventarisiert und diskutiert. Es zeigt sich, dass die Möglichkeit der Patientenmobilität und die damit vor allem (...) verbundenen Finanzierungsregelungen die Autonomie einiger Patienten sicherlich verbessern kann. Allerdings können wohl nicht alle Patienten Versorgungsverbesserungen erwarten. Im Gegenteil können sogar negative Konsequenzen für einige Patienten folgen, was vor allem aus gerechtigkeitstheoretischen Überlegungen kritisch zu sehen ist. (shrink)

The American Journal of Bioethics, Volume 12, Issue 9, Page 26-28, September 2012.

Autophagy promotes both health and disease, depending on tissue types and genetic contexts, yet the regulatory mechanism remain incompletely understood. Our recent publication has uncovered a coherent FOXO‐SNAI feed‐forward loop in autophagy, which is evolutionarily conserved from Drosophila to human. In addition, it's revealed that DNA binding plays a critical role in intracellular localization of nucleocytoplasmic shuttling proteins. Based on these findings, herein we further integrate mechanistic insights of FOXO‐SNAI regulatory interplay in autophagy and unravel the potential link of FOXO‐induced (...) autophagy with SNAI in diseases. Besides, the generality of DNA‐retention mechanism on transcription factor nuclear localization is illustrated with wide‐ranging discussion, and more functions potentially regulated by FOXO‐SNAI feedforward loop are provided. Elucidation of these unsolved paradigms will expand the understanding of FOXO‐SNAI interplay and facilitate the development of new therapeutics targeting FOXO‐SNAI axis in diseases. (shrink)

I thought the paper by Kai-yee Wong and Chris Fraser was fascinating and insightful. Two things I especially appreciated are the clarity with which they summarize my views. I think they are quite fair and accurate. Second, I appreciate their suggestion that the way to deal with the practical problem of weakness of will has much to do with the role of the Background in shaping our actions. I think they are especially on the right track when they say that (...) the improvement of Background skills may actually narrow the range of real options for action, (p. 21) nonetheless, they do not decrease freedom. As they say, “It is a process of strengthening the self, and the agent is likely to experience the concomitant restriction of ‘live’ options not as a limitation but as strength of character.” (p. 21). That seems to me very much on the right track. What they are suggesting, and it is a powerful addition to my own writings, is that we should not just think of the Background as facilitating languages, games and social practices generally, but for morality as well (p. 23). (shrink)

In 1997, after long social debates, the Japanese government enacted a law on organ transplantation from brain-dead bodies. Since 1993, on gene therapy, administrative agencies have issued a series of guidelines. This study seeks to elucidate when people became aware of the issues and when they formed their opinions on organ transplant and gene therapy. At the same time, it aims to examine at which point in time experts, those in university ethical committees and in academic societies, consider these technologies (...) became accepted among the public. A self-administered questionnaire was sent by mail to a stratified random sampling of 3000 people nationwide in Japan. Another questionnaire was sent both to the member societies of the Japanese Association of Medical Sciences and to the ethical committees of all the medical schools in Japan. Results of the surveys indicated that many of the public remained undecided on the desirability of organ transplant or gene therapy at the time of enactment of official guidelines. A substantial part of them formed their opinions in subsequent periods, especially around the time of first implementation and thereafter. Experts of the academic societies and of the university ethical committees regarded the time of implementation as an important factor in the acceptance of the technologies in society. Since many people formed their opinion during the period of technological implementation, communications efforts to facilitate public understanding of science and technology, as well as to advance practical discussion on policy alternatives in this period can play a key role in determining the fate of technological innovation and ethical debates in medicine. (shrink)

Kai Nielsen is one of Canada's most distinguished political philosophers. In a career spanning over 40 years, he has published more than 400 papers in political philosophy, ethics, meta-philosophy, and philosophy of religion. Pessimism of the Intellect presents a thoughtful collection of Nielsen's essays complemented by an extended reflective interview with Nielsen. This collection allows the reader to grasp the systematic scope of his thought and methodology.

In einer qualitativen Interviewstudie zur Situation und zu Veränderungen in deutschen Krankenhäusern berichteten GeschäftsführerInnen und ÄrztInnen übereinstimmend von hohem und zunehmendem Druck, mittels der medizinisch-pflegerischen Leistungen Gewinne machen zu müssen. Während die GeschäftsführerInnen dabei jedoch bei patientenbezogenen ärztlichen Entscheidungen keine ethischen Konflikte sahen, berichteten ÄrztInnen von erheblichen Verletzungen des ärztlichen Ethos. Während die GeschäftsführerInnen erklärten, sie würden von den ÄrztInnen „ethisch korrektes Entscheiden“ erwarten, berichteten ÄrztInnen, dass die Rahmenbedingungen ihrer Arbeit die Unabhängigkeit ärztlicher Entscheidungen untergrüben, indem betriebswirtschaftliche Interessen die Medizin (...) korrumpierten. Entscheidungen zur stationären Aufnahme, zur Wahl der Behandlungsprozesse und zur Entlassung der PatientInnen seien in zunehmendem Maße an wirtschaftlichen Interessen des Hauses und damit nicht allein an den medizinischen Bedarfen der PatientInnen orientiert. GeschäftsführerInnen bewerteten die Unabhängigkeit ärztlicher Entscheidungen hoch, während ÄrztInnen diese als deutlich eingeschränkt bezeichneten. Die Ergebnisse verweisen auf ungelöste Konflikte zwischen Medizinethik und „Ökonomie“. Organisationsethik ist zur Vermittlung auf der Ebene der Krankenhäuser und des Gesundheitswesens insgesamt gefordert. Sie muss sich darüber hinaus mit der Wissensproduktion im Feld der Versorgungs- und Qualitätsforschung kritisch auseinandersetzen. (shrink)

The starting point of this chapter is the uncontroversial assumption that the right to defend the innocent against unjust aggression is limited to the infliction of necessary harm and is further limited to the infliction of proportionate harm. The aim of the chapter is to shed light on the nature and location of those limits. The chapter is divided into three sections. In the first section it is argued that both unnecessary and disproportionate defense infringe upon the rights of an (...) unjust aggressor. The final two sections address, respectively, the questions of where the boundary between necessary and unnecessary defense is located and of where the boundary between proportionate and disproportionate defense is located. Those questions turn out to be more complicated than is often noticed, and the answers reached in these sections are novel ones. (shrink)

Even outside Europe, human beings have long contemplated philosophical questions. This book explores Neo-Confucianism and its most important representative: Zhu Xi (1130-1200). In Medieval China, Indian Buddhism was widely received; many endorsed the idea that the self and the world are illusionary (i.e. "empty") but that "emptiness" (sunyata) can be known in meditation. Although Neo-Confucian thinkers in the 11th and 12th centuries also practiced meditation, Buddhist ideas otherwise represented a nuisance for them. In his careful reconstruction, Kai Marchal examines which (...) concepts, ways of speaking, and practices these Neo-Confucians developed to achieve a realistic worldview grounded in ordinary life. "Emptiness" was transformed into the unity of all things. Moreover, Marchal comes to the surprising conclusion that Zhu Xi's thought continues Buddhism in one crucial respect: in the conception of a reflective self-relation located in the world, which is not intended to strengthen the human tendency to egocentricity, but rather to weaken it. (shrink)

Metaphilosophy is itself philosophy about philosophy. It is not something before or independent of philosophy. Both Kai Nielsen and Richard Rorty are deeply concerned (someone might say obsessively preoccupied) with metaphilosophy. They both are thoroughly historicist and contextualist resolutely rejecting any form of a transcendental or metaphysical turn. They argue against claims to absolute validity (as well as against absolutism in any form) and a natural order of reasons: some 'Reason' to which any rational agent must be committed. They both (...) see philosophy as a transitional genre first (historically speaking) from religion then metaphysics and more latterly from scientistic conceptions of the world. But they differ about what philosophy is transitional to. For Rorty it is historical narrative and utopian proposals; for Nielsen it is critical theory. Rorty claims this, Nielsen's intentions to the contrary notwithstanding, commits him to enlightenment rationalism. Nielsen replies that his form of critical theory is deeply historicist and contextual without being resolutely atheoretical. This plays out in political orientation to Nielsen's being a socialist while Rorty is a social democrat. (shrink)

Drawing on insights of thinkers in the natural rights tradition, Draper analyzes numerous hypothetical cases including those involving a runaway trolley, then seeks to determine if killing civilians in war is ever justified. In his consideration of this issue he avoids appealing to the principle of double effect. Having considered hypothetical cases at length, he leaves it to others to decide if any option to go to war is justifiable. In this regard he himself is sceptical.

This festschrift includes a dozen essays on issues that have been at the focus of Kai Nielsen's research, mainly issues in ethics and political philosophy. Among these are four essays on socialism and Marxism. There are also essays on philosophy of religion, epistemology, and meta-philosophy.

We investigate whether ordinary quantification over objects is an extensional phenomenon, or rather creates non-extensional contexts; each claim having been propounded by prominent philosophers. It turns out that the question only makes sense relative to a background theory of syntax and semantics (here called a grammar) that goes well beyond the inductive definition of formulas and the recursive definition of satisfaction. Two schemas for building quantificational grammars are developed, one that invariably constructs extensional grammars (in which quantification, in particular, thus (...) behaves extensionally) and another that only generates non-extensional grammars (and in which quantification is responsible for the failure of extensionality). We then ask whether there are reasons to favor one of these grammar schemas over the other, and examine an argument according to which the proper formalization of deictic utterances requires adoption of non-extensional grammars. (shrink)

- uneducated in the field authors who defend a consensus they are being TOLD when they enter offices of Ed-Sci, teaching and writing works on learning-theory - but never checked the facts, PART I and PART II.

Currently, the repetition of a critical way of speaking results in a stagnating tendency in educational debates. This had led to the endeavour of developing a ‘post-critical pedagogy’. This paper employs Rortyan and Latourian language in order to tackle the question of how such a post-critical pedagogy should deal with critique. It argues that if one takes critique as what Latour calls a debunking activity, then post-critical pedagogy should leave critique behind. If however critique means simply to say how something (...) should not be, then post-critical pedagogy should remain critical. In addition, however, there is a need for enriching the critical vocabulary with more affirmative language. For accomplishing this need, in contrast to recent suggestions to go back to ontology, the paper suggests that new propositions developed by literary theorists like Sedgwick and Felski are more promising. All these arguments are framed by Rorty’s notion of philosophy as cultural politics. (shrink)

Psychedelic ethics is at a crossroads. Confronted with the undeniable harm wrought by a widespread embrace of exceptionalism, many are approaching psychedelics not only in the context of urgent men...

Ludwig Wittgenstein acknowledges that the Augustinian picture also informed his earlier conception of language. The Augustinian identification of the meaning of a word with the word's referent is accepted only with a further restriction. In the Tractatus, Wittgenstein distinguishes between simple objects and the thereof composed complex objects. This chapter provides a systematic reconstruction of Wittgenstein's sometimes opaque remarks on ostensive definitions and his critique of the Augustinian picture of language. It then addresses the doctrines about names and naming endorsed (...) in the Tractatus. According to the later Wittgenstein the simple ostensive definition of a word, consisting in the utterance of the word accompanied by a pointing gesture, does not unambiguously determine the use of the word. Wittgenstein's arguments can be complemented by the observation that having the same sample is not necessary for two terms to be equivalent either. (shrink)