BackgroundClinical ethics support aims to support health care professionals in dealing with ethical issues in clinical practice. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization. In this paper we present a specific way of organizing CES, which we have called integrative CES, and argue that this approach meets some of the challenges regarding implementation and organization.MethodsThis integrative approach was developed in an iterative process, combining actual experiences in a case study (...) in which we offered CES to a team that provides transgender health care and reflecting on the theoretical underpinnings of our work stemming from pragmatism, hermeneutics and organizational and educational sciences.ResultsIn this paper we describe five key characteristics of an integrative approach to CES; 1. Positioning CES more within care practices, 2. Involving new perspectives, 3. Creating co-ownership of CES, 4. Paying attention to follow up, and 5. Developing innovative CES activities through an emerging design.ConclusionsIn the discussion we compare this approach to the integrated approach to CES developed in the US and the hub and spokes strategy developed in Canada. Furthermore, we reflect on how an integrative approach to CES can help to handle some of the challenges of current CES. (shrink)

Externalist representationalism is touted as a superior rival to naïve realism, and yet a careful analysis of the externalist representationalist's analysis of our ordinary perceptual experiences shows the view to be far closer to naïve realism than we might have expected. One of the central advertised benefits of representationalist views in general is that they are compatible with the idea that ordinary, illusory and hallucinatory perceptual experiences are of the same fundamental kind. Naïve realists are forced to deny the ‘common (...) fundamental kind claim’ and adopt disjunctivism. However, I argue that externalist representationalism is also a version of disjunctivism. Consequently, one of the main rivals to naïve realism turns out not to be a rival at all. (shrink)

In recent years, business ethics and economic scholars have been paying greater attention to the development of commons organizing. The latter refers to the processes by which communities of people work in common in the pursuit of the common good. In turn, this promotes commons organizational designs based on collective forms of common goods production, distribution, management and ownership. In this paper, we build on two main literature streams: the ethical approach based on the theory of the common good of (...) the firm in virtue ethics and the economic approach based on the theory of institutions for collective action developed by Ostrom’s research on common-pool resources to avert the tragedy of the commons. The latter expands to include the novel concepts of new commons, “commoning” and polycentric governance. Drawing on the analysis of what is new in these forms of organizing, we propose a comprehensive model, highlighting the integration of two sets of organizing principles—common good and collective action – and five problem-solving processes to explain the main dimensions of commons organizing. We contribute to business ethics literature by exploring the convergence between the ethical and economic approaches in the development of a commons organizing view. (shrink)

Doxastic involuntarism—the thesis that we lack direct voluntary control (in response to non-evidential reasons) over our belief states—is often touted as philosophical orthodoxy. I here offer a novel defense of doxastic voluntarism, centered around three key moves. First, I point out that belief has two central functional roles, but that discussions of voluntarism have largely ignored questions of control over belief's guidance function. Second, I propose that we can learn much about doxastic control by looking to cognitive scientific research on (...) control over other relevantly similar mental states. I draw on a mechanistic account of control of the guidance function for “emotion-type states,” and argue that these same cognitive control mechanisms can used to block doxastic guidance. This gives us an account of “back-end” doxastic control which can be deployed for reasons which are not the right kinds of reasons to support “front-end” belief formation—i.e., non-evidential reasons. Third, I argue that comprehensive, self-directed exercises of this kind of control can amount to an underappreciated kind of voluntarism. This form of voluntarism is available to any account of belief that takes guidance-instantiation to be at least partly constitutive of believing. Finally, I discuss objections to, and upshots of, the view. (shrink)

While committed to the view that Buddhist Reductionism offers the best account of the Abhidharma distinction of the two truths, Siderits (2009) argues that Buddhist Reductionism has the surprising consequence of making itself inexpressible. This inexpressibility follows from the semantic insulation between conventional and ultimate discourses that Siderits argues is required in order to preserve classical logic for both types of discourse, avoiding contradiction and bivalence failure. I argue that inexpressibility is a problematic consequence that threatens to constitute a reductio (...) of Buddhist Reductionism. (shrink)

One of Mark Textor’s main aims in Brentano’s Mind is to refute Brentano’s claim that intentionality – the capacity our mental acts have for being of, about, or directed on something – is the mark of the mental. I defend the view that Brentano analysed intentionality in terms of intentional inexistence (and so wasn’t an intentionality primitivist as Textor suggests). And I argue that we can regard intentionality as being the mark of the mental, but only if we give a (...) non-relational analysis of the idea of intentional inexistence. Textor objects to an analysis of intentionality in terms of intentional inexistence for failing to account for the relationship between the object our mental act is directed on, and the ‘immanent’ or ‘inexistent’ object which all mental acts contain. I claim that this problem doesn’t arise if the object our mental act is directed on just is the immanent/ inexistent object. I argue that Brentano (at least sometimes) seems to identify the two. I then offer my own view of intentionality according to which our mental acts are directed on immanent/ inexistent objects, and that ‘directedness’ should be understood non-relationally. (shrink)

ABSTRACTThis article studies multi-stakeholder initiatives as spaces for both deliberation and contestation between constituencies with competing discourses and disputed values, beliefs, and preferences. We review different theoretical perspectives on MSIs, which see them mainly as spaces to find solutions to market problems, as spaces of conflict and bargaining, or as spaces of consensus. In contrast, we build on a contestatory deliberative perspective, which gives equal value to both contestation and consensus. We identify four types of internal contestation which can be (...) present in MSIs—procedural, inclusiveness, epistemic, and ultimate-goal—and argue that embracing contestation and engaging in ongoing revision of provisional agreements, criteria, and goals can enhance the democratic quality of MSIs. Finally, we explore the implications of this perspective for theorizing about the democratic quality in MSIs and about the role of corporations in transnational governance. (shrink)

In this paper we report on empirical research which investigates social capital of Small and Medium Sized Enterprises (SMEs). Bringing an international perspective to the work, we make a comparison between 30 firms located in West London and Munich in the sectors of food manufacturing/production, marketing services and garages. Here we present 6 case studies, which we use to illustrate the early findings from this pilot project. We identify differences in approach to associational membership in Germany and the U.K., with (...) a greater propensity to "belong" to an official group in Germany. We distinguish clear sectoral similarities across the countries, and indications that certain personality types will seek out engagement and find time beyond busy work life schedules, often merging work/home/leisure life and friends. Some of our cases illustrate that formal institutions, networks and mutual relationships can develop social capital for the SME, although we should take care not to assume a universal win-win situation for those who are engaged and contribute to the common good. Some of the obstacles to cooperation and civic engagement are outlined. (shrink)

I argue that our expectations for particular evil events, conditional on theism, ought to be informed by our empirical knowledge of history—that is, the history of what God, if God exists, has already allowed to happen. This point is under-appreciated in the literature. And yet if I’m right, this entails that most particular evil events are not evidence against theism. This is a limited but interesting consequence in debates over the evidential impact of evil.

Anti-individualists claim that concepts are individuated with an eye to purely external facts about a subject's environment about which she may be ignorant or mistaken. This paper offers a novel reason for thinking that anti-individualistic concepts are an ineliminable part of commonsense psychology. Our commitment to anti-individualism, I argue, is ultimately grounded in a rational epistemic agent's commitment to refining her own representational practices in the light of new and surprising information about her environment. Since anti-individualism is an implicit part (...) of responsible epistemic practices, we cannot abandon it without compromising our own epistemic agency. The story I tell about the regulation of one's own representational practices yields a new account of the identity conditions for anti-individualistic concepts. (shrink)

Locke's political theory centres on juridical matters of law, right, consent and legitimacy. Despite his concern to differentiate politics from family and posit a free and equal post-familial individual as political subject, this apparently abstract political theory is itself conveyed through a narrative of family. Locke rejects patriarchal absolutism that casts the king as a patriarchal father by thinking politics through alternative conceptions of father, sons and brothers. As such, Locke did not in fact help muster liberalism by instantiating a (...) vivid public-private divide that insulated the political imagination from ideas of family. (shrink)

: Although "brain death" and the dead donor rule—i.e., patients must not be killed by organ retrieval—have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents ≥18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD telephone survey (...) was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: "brain dead," in a coma, or in a persistent vegetative state (PVS). Respondents provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. More than 98 percent of respondents had heard of the term "brain death," but only one-third (33.7%) believed that someone who was "brain dead" was legally dead. The majority of respondents (86.2%) identified the "brain-dead" patient in the first scenario as dead, 57.2 percent identified the patient in a coma as dead (Scenario 2), and 34.1 percent identified the patient in a PVS as dead (Scenario 3). Nearly one-third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed, or held beliefs that were not congruent with current definitions of "brain death." This study highlights the need for more public dialogue and education about "brain death" and organ donation. (shrink)

Do not chew with your mouth open! Take your hat off when you enter a church! Do not skip the queue! Pay your taxes! Do not cross on a red light! These are familiar imperatives, and their immediate source are ‘socially constructed norms’: norms that exist as a matter of social fact. These range from informal etiquette and politeness norms to the complex norms making up our legal systems. While we often feel bound by these norms, we are also aware (...) that they can be pernicious: the product of injustice and vehicles for its perpetuation. The question thus arises: when and why, if ever, does the fact that a socially constructed norm requires us to perform a certain action place us under a genuine moral obligation to comply? In Morality and Socially Constructed Norms, I answer that such an obligation, when it exists, is grounded in a broader, familiar duty, namely the duty to respect people’s permissible and authentic exercises of agency. This is what I call the ‘Agency-Respect View.’ The first part of the book outlines and defends the view, the second part considers relevant applications. (shrink)

This paper explores the rise of agential materialism in humanities and science and its influence on technological progress, proposing ‘softness’ as a paradigm for designing increasingly ‘agentised’ technologies. Soft technologies – defined by plastic embodiments, self-organisation, and multi-scalar material design – challenge hegemonic visions of machines as rigid, unfeeling, and subordinate to human control. Case studies in soft and biohybrid robotics, wetware computing, and nanotechnology demonstrate how emerging soft technologies embody unprecedented forms of artificial agency and outline future possibilities for (...) embodied intelligence. A paradigm shift towards softness fosters ‘micro-sustainability’, embedding self-contained, regenerative energy and resource management at the material scale. By complicating the separation of nature and artifact and the hierarchical relationship of humans and technologies, the paradigm of softness contributes to a broader ‘ecology of technology’, offering pathways for sustainable innovation in the face of global ecological challenges. (shrink)

Listening to music can be an intensely moving experience. Many people love music in part because of its power to alter or amplify their moods, and turn to music for inspiration, comfort, or therapy. It is a puzzle, then, why many of us spend so much time listening to sad music. If music can influence our moods, and assuming that most people would prefer to be happy not sad, why would we choose to listen to sad music? I revisit the (...) question of why we like sad music, drawing from work in both the philosophy and psychology of music, as well as work in the philosophy and science of affect. I argue to shift the focus of the question to music-induced moods, not emotions. This reframes the debate but does not dissolve the paradox. To understand what is appealing about the affective experience of listening to sad music I suggest we take into account the unique features of music-induced sad mood. I argue that sad mood and a certain sort of focused music listening are mutually reinforcing in ways that differ from other mood/music interactions. Sad mood and sad music are, in a sense, made for each other. (shrink)

Resumo Este artigo tem o objetivo de mostrar as semelhanças entre o espírito livre de Nietzsche e o gênio de Schopenhauer. Em primeiro lugar, ambos compartilham de uma abordagem mística do conhecimento: perdem sua individualidade e identificam-se aos objetos do conhecimento com o intuito de obter conhecimento do mundo. Em segundo lugar, ambas as figuras encontram-se associadas à loucura. Em terceiro lugar, o espírito livre e o gênio são indivíduos excepcionais que, diferentemente do que se passa com a maior parte (...) dos indivíduos, já não se encontram atrelados a questões mundanas. Conduzem-se na vida pacificamente, pairando sobre os valores em que as pessoas mais acreditam, cientes de sua falsidade.This article aims to show the similarities between Nietzsche’s free spirit and Schopenhauer’s genius. First of all, both share a mystical approach to knowledge: they lose their individuality and identify themselves with the objects of knowledge in order to obtain knowledge of the world. Secondly, both figures are associated with madness. Thirdly, the free spirit and the genius are exceptional individuals who unlike the majority of people are no longer attached to worldly matters. They conduct their lives peacefully, hovering over the values in which most people believe, aware of their falsehood. (shrink)

Although it is now commonplace to take emotions to be the sort of phenomena for which there are reasons, the question of how to cash out the reason-responsiveness of emotions remains to a large extent unanswered. I highlight two main ways of thinking about reason-responsiveness, one that takes agential capacities to engage in norm-guided deliberation to underlie reason-responsiveness, and another which instead takes there to be a basic reason-relation between facts and attitudes. I argue that the latter approach should be (...) preferred. Not only does a reasons-basic approach promise to fare better in accounting for cases that its opponent struggles to accommodate, but it promises also to uncover a sui generis relation between emotions and their reasons which is at best obscured and at worst denied by its opponent. (shrink)

Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory and (...) presumptive vaccination. It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner. Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics. (shrink)

From the earliest application of modern randomized controlled trials in medical research, scientists and observers have deliberated the ethics of randomly allocating study participants to trial control arms. Adaptive RCT designs have been promoted as ethically advantageous over conventional RCTs because they reduce the allocation of subjects to what appear to be inferior treatments. Critical assessment of this claim is important, as adaptive designs are changing medical research, with the potential to significantly shift how clinical trials are conducted. Policy-makers are (...) swiftly moving to encourage greater use of adaptive designs. In 2016, the newly enacted 21st Century Cures Act instructed the Food and Drug Administration to help product sponsors incorporate adaptive methods into proposed clinical trial protocols and applications for investigational drugs and also biological products. In this article, we review the ethical justifications commonly offered for adaptive designs, explore these arguments in the context of actual trials, and contend that clinical equipoise is a useful standard for adaptive-trial ethics. We distinguish between theoretical and clinical equipoise and explain why ethical arguments related to adaptive trials tend to focus on the former. Yet we contend that theoretical equipoise can be an unreliable standard for adaptive ethics. While we contend that clinical equipoise is the most critical principle for the primary ethical concerns posed by adaptive trials, we suggest ethical approaches to deal with some additional concerns unique to adaptive designs. (shrink)

Petrus Ramus (Pierre de la Ramée, 1515-1572) fue profesor Real de Elocuencia y Filosofía en el Collège Royal (París). Movido por su vocación pedagógica redefinió el ámbito de las artes liberales, despojando a la retórica de su contenido tradicional. Para Ramus la retórica consiste solo en la elocuti..

The New Social Disease is about how we personalize our computers and associated technologies while depersonalizing others and ourselves.

We investigated family members’ lived experience of Parkinson’s disease aiming to investigate opportunities for well-being. A lifeworld-led approach to healthcare was adopted. Interpretative phenomenological analysis was used to explore in-depth interviews with people living with PD and their partners. The analysis generated four themes: It’s more than just an illness revealed the existential challenge of diagnosis; Like a bird with a broken wing emphasizing the need to adapt to increasing immobility through embodied agency; Being together with PD exploring the kinship (...) within couples and belonging experienced through support groups; and Carpe diem! illuminated the significance of time and fractured future orientation created by diagnosis. Findings were interpreted using an existential-phenomenological theory of well-being. We highlighted how partners shared the impact of PD in their own ontological challenges. Further research with different types of families and in different situations is required to identify services required to facilitate the process of learning to live with PD. Care and support for the family unit needs to provide emotional support to manage threats to identity and agency alongside problem-solving for bodily changes. Adopting a lifeworld-led healthcare approach would increase opportunities for well-being within the PD illness journey. (shrink)

Comparative philosophy is gaining traction in professional academic philosophy, with specialist journals, organizations, books, and public campaigns. These inroads have been made in canonical areas of philosophy, including epistemology, metaphysics, logic, and value theory. Yet comparative philosophy still plays little role in practical applied ethics, an interdisciplinary research area in which work with practice and policy implications are dominated by the anglophone world. In this article, I explain why comparative work might be especially difficult in this type of applied ethics, (...) and I suggest how comparative philosophers might overcome these challenges to connect their theoretical work with contemporary practical issues. (shrink)

In this paper, I focus on the concept of embeddedness as the background against which eros is a force and a power in and through interactions. To go beyond an internalist account of eros, I engage in a dialogue with some philosophical accounts of desire from an enactive perspective.This enables me to shed light on the location of the embodied tension as “in-between” lovers and “all-around” them. Crucial to this tensional account of embedded eros is the intertwining between self and (...) others’ becomings in processes of participatory sense-making. Through participatory sense-making lovers make their worlds, creating new ways of being and knowing in the ensemble. I advance some steps towards an enactive ethics of eros where, I claim, the cultivation of the space in-between and all-around lovers is the key to avoid the traps of a degenerated form of eros. (shrink)

Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat psychiatric conditions. For depression therapy, PEIs include both approved treatment modalities, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), and experimental neurotechnologies, such as deep brain stimulation (DBS) and adaptive brain implants (ABIs). We present results from a survey-based experiment in which members of four relevant stakeholder groups (psychiatrists, patients with depression, caregivers of adults with depression, and the general public) assessed whether treatment with one of (...) four PEIs (ECT, rTMS, DBS, or ABIs) was better or worse than living with treatment-resistant depression (TRD) and then provided a narrative explanation for their assessment. Overall, the prevalence of many narrative themes differed substantially by stakeholder group—with psychiatrists typically offering different reasons for their assessment than non-clinicians—but much less so by PEI modality. A large majority of all participants viewed their assigned PEI as better than living with TRD, with their reasons being a mix of positive views about the treatment and negative views about TRD. The minority of all participants who viewed their assigned PEI as worse than living with TRD tended to express negative affect toward it as well as emphasize its riskiness, negative side effects, and, to a lesser extent, its invasiveness. The richness of these narrative explanations enabled us to put in context and add depth to key patterns seen in recent survey-based research on PEIs. (shrink)