Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

Currently living people cannot be said to be wronged because of the wrongless emissons of greenhouse gases by past people. According to the usual subjunctive-historical understanding of harm, currently living people cannot be said to be harmed by the impact of greenhouse emissions on their well-being. By relying on a subjunctive-threshold notion of harm we can justify conclusions about both the present generation’s duties not to violate the rights of future generations, and the present generation’s duties to compensate currently living (...) people for the harms inflicted upon them through the lasting impact of wrongless past harms. This interpretation supports a forward-looking understanding of the grounds of our relating to wrongless past harms. The significance of past harms lies in their consequences for the well-being of currently living and future people. The subjunctive-threshold notion of harm lends support to a standard of minimal, general, and universal justice. Those actors who are in a position to fulfill its requirements are under a duty to do so. Especially the rich and powerful countries ought to counteract the harmful impact of past greenhouse emissions. (shrink)

Quentin Smith has argued (Philosophical Studies, 1987, pp. 371-392) that the token-reflexive and the date versions of the new tenseless theory of time are open to insurmountable difficulties. I argue that Smith's central arguments are irrelevant since they rest upon methodological assumptions accepted by the old tenseless theory, but rejected by the new tenseless theory.

It is shown that the paradoxes of confirmation are closely linked to the paradoxes of material implication and that they can be avoided by formulating natural laws in terms of a genuine if-Connective rather than the material conditional. However, Natural laws so expressed are not confirmed by simple conjunctions. The question then is whether the common assumption that simple conjunctions do confirm universal generalizations is correct. The answer given is that it is not. In particular, A confirming proposition of the (...) form 'this is a black raven' is not equivalent to 'this is a raven and this is black'. (shrink)

It sometimes happens that a philosopher will develop a view on some topic and then later come to reject it. J. L. Austin was perhaps unique in that he not only rejected a philosophical view of which he himself was the author, he patiently developed the view and then showed it to be ultimately unsatisfactory within the compass of the same work. And he did this not once but three times, in material intended for publication. I am thinking, of course, (...) of his notion of performative utterances: the view that there is a class of utterance, the members of which would on standard grammatical grounds be classed as statements, yet whose proper business is not to state anything but to perform some act. For example, to say ‘I promise to be there’ is to promise to be there, and not to state that one promises nor even to state that one will be there. (shrink)

In a recent article in this journal, Heidi Giannini (2017) has argued that the Christian doctrines of love and of hope require Christians to endorse universal, unconditional forgiveness, understood in terms of the renunciation of “negative reactive attitudes.” She also addresses criticisms of this interpretation. It is argued that Giannini has failed to provide a Christian justification for universal, unconditional forgiveness. Part of the problem is that she espouses a definition of forgiveness and an understanding of the nature of forgiveness (...) that, as a result of neglecting the teaching of the New Testament, exhibits a number of incoherencies and theological weaknesses. Her account is also vulnerable to philosophical and moral criticisms of a serious nature. (shrink)

Jerry L. Walls, the author of books on hell and heaven, completes his tour of the afterlife with a philosophical and theological exploration and defense of purgatory, the traditional teaching that most Christians require a period of postmortem cleansing and purging of their sinful dispositions and imperfections before they will be fully made ready for heaven. He examines Protestant objections to the doctrine and shows that the doctrine of purgatory has been construed in different ways, some of which are fully (...) compatible with Protestant theology. In particular, while purgatory has often been understood as matter of punishment in order to make satisfaction for sins that have not been fully remitted, it can also be seen as the completion of the sanctification process, an account of the doctrine that is fully consistent with the Protestant doctrine of justification by faith. Purgatory assumes not only continuity of personal identity but also gradual moral and spiritual growth between death and resurrection. Different theories of personal identity are examined and assessed in light of these assumptions. Walls also shows that the traditional doctrine of purgatory is not understood as a second chance for salvation, but goes on to argue that it should be modified to allow for postmortem repentance. He concludes with an examination of C.S. Lewis's writings on purgatory, and suggests that Lewis can be a model for evangelicals and other Protestants to engage the doctrine of purgatory in a way that is true to their theology. (shrink)

Health care services increasingly face patient populations with high levels of ethnic and cultural diversity. Cultures are associated with distinctive ways of life; concepts of personhood; value systems; and visions of the good that affect illness experience, help seeking, and clinical decision-making. Cultural differences may impede access to health care, accurate diagnosis, and effective treatment. The clinical encounter, therefore, must recognize relevant cultural differences, negotiate common ground in terms of problem definition and potential solutions, accommodate differences that are associated with (...) good clinical outcomes, and manage irresolvable differences. Clinical attention to and respect for cultural difference (a) can provide experiences of recognition that increase trust in and commitment to the institutions of the larger society, (b) can help sustain a cultural community through recognition of its distinct language, knowledge, values, and healing practices, and (c) to the extent that it is institutionalized, can contribute to building a pluralistic civil society. (shrink)

This paper describes the change of emphasis that occurred in the teaching of ethics to small groups of clinical students. Although the original focus of the course was on the analysis of ethical dilemmas associated with individual patients known to the students, it soon became evident that there were, for the students themselves, more fundamental ethical dilemmas in their new role as clinical students. These included worries about how to respond when patients asked questions which their consultants had previously deceived (...) them about, worries about inflicting pain on patients, as with intravenous cannulation, and the role of the medical student in the clinical team. We emphasise the need to explore student experiences as part of the process of ethics teaching. (shrink)

A student considering a career as a financial advisor is confronted by a common industry practice that some consider misleading and unethical. The case fosters financial literacy by allowing students to connect theory to practice through the analysis of a highly realistic brokerage statement using Microsoft Excel. It permits an instructor to seamlessly inject an ethical component into an accounting or finance course while simultaneously sharpening students' understanding of key financial concepts such as bond valuation and yield to maturity.

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS Metaphysics as a Guide to Morals. By IRIS MURDOCH. Harmondsworth: Allen Lane; New York: Viking, 1992. $35.00. Dame Iris Murdoch is familiar to most people as a witty and en· gaging novelist whose twenty-four hooks of fiction can he read on a variety of levels. They are wonderful stories, hut the philosophically acute reader will also enjoy Murdoch's judgments, polemics, and inhouse jokes about philosophers and philosophical (...) views. Comparatively few people are aware of Murdoch's previous scholarly studies: Sartre, Romantic Rationalist, The Sovereignty of the Good, The Fire and the Sun; and Acastos. Even so, those familiar with these hooks will recognize the profound impact she has had on debates within moral philosophy. She has been at the forefront of the move· ment that has rehabilitated the central importance of such notions as goodness, the Good, virtue, and the moral life as a journey. So it is not surprising that Murdoch has returned to the genre of philosophical argument to advance her views on the relationship between metaphysics and morals. But it is surprising that her argument exhibits neither the clarity of thought characteristic of the analytic philosophy in which she was trained nor the dramatic narrative of her novels. Indeed the hook reads like a collage of lecture notes, complete with extensive quotations from other people's thoughts with minimal com· mentary. Further, the chapter titles (e.g., " Fact and Value," " Schopenhauer," " Consciousness and Thought-I," " Derrida and Struc· turalism," " Consciousness and Thought-II," "Notes on Will and Duty," " Axioms, Duties, Eros," " Void ") shed little light on the overall structure or argument of the hook. One cannot help hut have the impression that Murdoch spent less time crafting the argument of this hook than she does in crafting the story line and characters of her novels. This is not to say, of course, that there is not much to he learned from Murdoch's perspective. She is remarkably erudite, and her discussion of various themes, figures, and issues often yields fascinating insights. But the whole is considerably less than the sum of its often interesting parts. I have already suggested that this is partly because of the structure and style in which the hook is written. But the hook 687 688 BOOK REVIEWS is also disappointing, and perhaps more determinatively, because of the overall perspective she seeks to deploy and defend. Readers of Murdoch's work have heretofore often wondered about the relationship between her avowed Platonism and her interest in Christianity. Metaphysics as a Guide to Morals has the virtue of clarifying that relationship, hut the result is unpersuasive. At the heart of Murdoch's Platonism is her recasting of the allegory of the cave from The Republic. The moral life is an arduous struggle to ascend from the cave (represented, as in her earlier works, by " the fat, relentless ego ") by a dispossession of the self so that we can apprehend a little less imperfectly the perfect form of the Good. As Murdoch puts it, Plato assumes the internal relation of value, truth, cogmtion. Virtue (as compassion, humility, courage) involves a desire for and achievement of truth instead of falsehood, reality instead of appearance. Goodness involves truth.seeking knowledge and ipso facto a discipline of desire. ' Getting things right ', as in meticulous grammar or mathematics, is truth-seeking as virtue. Learning anything properly demands (virtuous ) attention. Here the idea of truth plays a crucial role (as it does also in Kant) and reality emerges as the object of truthful vision, and virtuous action as the product of such vision. This is a picture of the omnipresence of morality and evaluation in human life (p. 39). Such a depiction ought to resonate quite deeply with Christians, something not lost on Murdoch when she writes a few pages earlier: "There are innumerable points at which we have to detach ourselves, to change our orientation, to redirect our desire and refresh and purify our energy, to keep on looking in the right direction: to attend upon the grace that comes through faith " (p. 25). But Murdoch's "grace" and her "truth-seeking as virtue," among other themes, involve something quite different from what Christians... (shrink)