Reflection in medical education is becoming more widespread. Drawing on our Jesuit Catholic heritage, the Loyola University Chicago Stritch School of Medicine incorporates reflection in its formal curriculum and co–curricular programs. The aim of this type of reflection is to help students in their formation as they learn to step back and analyze their experiences in medical education and their impact on the student. Although reflection is incorporated through all four years of our undergraduate medical curriculum, this essay will focus (...) on three areas where bioethics faculty and medical educators have purposefully integrated reflection in the medical school, specifically within our bioethics education and professional development efforts: 1) in our three–year longitudinal clinical skills course Patient Centered Medicine (PCM), 2) in our co–curricular Bioethics and Professionalism Honors Program, and 3) in our newly created Physician’s Vocation Program (PVP). (shrink)

First published in 1984, this is a study of categorization practices: how people categorize each other and their actions; how they describe, infer, and judge. The book presents a sociological analysis and description of practical activities and makes a cogent contribution to the study of how the moral order actually works in practical communicative contexts. Among the issues dealt with are: collectivity categorizations, the organization of lists and descriptions, moral attribution and inferences, and the relationship between standards of morality and (...) standards of rationality. (shrink)

We conducted two eye-tracking experiments investigating the processing of the Mandarin reflexive ziji in order to tease apart structurally constrained accounts from standard cue-based accounts of memory retrieval. In both experiments, we tested whether structurally inaccessible distractors that fulfill the animacy requirement of ziji influence processing times at the reflexive. In Experiment 1, we manipulated animacy of the antecedent and a structurally inaccessible distractor intervening between the antecedent and the reflexive. In conditions where the accessible antecedent mismatched the animacy cue, (...) we found inhibitory interference whereas in antecedent-match conditions, no effect of the distractor was observed. In Experiment 2, we tested only antecedent-match configurations and manipulated locality of the reflexive-antecedent binding (Mandarin allows non-local binding). Participants were asked to hold three distractors (animate vs. inanimate nouns) in memory while reading the target sentence. We found slower reading times when animate distractors were held in memory (inhibitory interference). Moreover, we replicated the locality effect reported in previous studies. These results are incompatible with structure-based accounts. However, the cue-based ACT-R model of Lewis and Vasishth ( 2005 ) cannot explain the observed pattern either. We therefore extend the original ACT-R model and show how this model not only explains the data presented in this article, but is also able to account for previously unexplained patterns in the literature on reflexive processing. (shrink)

In this final response, the author reflects on the recent European elections that favored Euro-skeptic right-wing parties all over Europe. Their Far-Right views blame ‘immigrants’ for the current problems in Europe and challenge institutionalized solidarity. The response, firstly, attacks the dominating discourses in the media which obscure that 75 % of the voters embrace the status quo of free movement and regional citizenship within the EU. Secondly, this final reply connects the move to Far-Right views to general feelings of insecurity (...) that increased in the aftermath of the 2008 financial crisis. Current scape-goat policies regarding immigrants can be traced to strategies of neighborliness, which in turn reflect deeper social and economic anxieties caused by the withdrawal of state services and the logic of neo-liberal capitalism. (shrink)

I argue along the following lines: For Wollstonecraft, liberty is independence in two different spheres, one presupposing the other. On the one hand, liberty is independence in relation to others, in the sense of not being vulnerable to their whim or arbitrary will. Call this social, or political, liberty. For liberty understood in this way, infringements do not require individual instances of interfering. Liberty is lost in unequal relationships, through dependence on the goodwill of a master. In addition, liberty is (...) independence of mind, a state I am in when I trust my own reasoned judgement above any other authority. Call this moral liberty. Moral liberty needs social liberty. In other words, to the extent I am subject to the whim of others, I am not in a position to be guided by my own judgement. Moral liberty is one of two aspects of virtue: a disposition to independent deliberation according to reason. As such, virtue is a habit of mind. The second aspect of virtue is universal benevolence as its action guiding principle. This is how liberty, equality, and virtue fit together. Social liberty, understood as independence in relation to others, necessarily coexist with equality, and is necessary for moral liberty, the habit of mind that makes up one aspect of virtue, as well as for universal benevolence as virtue’s action guiding principle. This triad explains her views on property, on sex equality, and also on legitimate government. My second line of argument is that according to Wollstonecraft, we have a duty to be virtuous. Virtue is the main object of human life. But since virtue, in both its aspects, needs social liberty and since liberty is the birthright of man, the duty is conditioned on the right. The foundation for the triad of liberty, equality, and virtue is a theory of rights. The basis for the discussion of virtue is the right to the conditions necessary for its realization. The duty is conditioned on the right to liberty. (shrink)

Cities and local governments loom large on the sustainability agenda. Networks such as Fair Trade Towns International (FTT) and the Organic Cities Network aim to bring about global policy change from below. Given the new enthusiasm for local approaches, it seems relevant to ask to what extent local groups exercise power and in what form. City networks present their members as “ethical places” exercising _power with_, rather than _power over_ others. The article provides an empirical analysis of the power of (...) FTT and Organic Cities in Germany. In both cases, we found cities that are eager to emphasize their inclusive potential. Their willingness to compromise is demonstrated most illustratively by the fact that several cities are members of both networks: While the FTT campaign aims to address problems of international trade but does not abandon it, Organic Cities advocate for a new localism based on food supply from farmers in the same region. In both cases, city networks use their purchasing power to increase the share of certified products. By doing so, the city networks reproduce privileged positions of consumers benefitting from the global capitalist order (_power over_). However, our analysis revealed that networks also make citizens reflect upon agri-food challenges and allow developing alternatives for more sustainable systems (_power with_). (shrink)

This article is a critical analysis of Ingrid Robeyns’ “economic limitarianism” (2017, 2019, 2022), the suggestion that there is a moral case against allowing people to be richer than they need to be in order to achieve full flourishing. Wealth above a certain “riches line” lacks value and should be capped at that level. Robeyns claims that limitarianism is justified as a partial theory of economic justice, since vast wealth is a threat to political equality and the revenue raised from (...) taxing wealth can be used to meet urgent needs. She also claims that limitarianism is problem-driven philosophy and should be judged by its capacity to address problems in the world as it is. The argument in this article is that limitarianism fails on its own premises, both as partial theory of justice and as guide to decision-making. The arguments invoked in its favour as theory does not provide reasons to support it over other redistributive schemes. As guide to practical action, it runs counter to what empirical research reveals about how attitudes to economic inequality works in that people’s acceptance of inequality adjusts: the more unequal a society is, the more inequality is accepted as fair. By disregarding inequalities below the riches-line as well as the economic system that produces them, limitarianism has no tools for countering this adjustment and risks legitimating a politics of inequality. Anyone who shares Robeyns’ concerns about economic inequality have reason to be wary of limitarianism. (shrink)

What kinds of norms constrain mechanistic discovery and explanation? In the mechanistic literature, the norms for good explanations are directly derived from answers to the metaphysical question of what explanations are. Prominent mechanistic accounts thus emphasize either ontic or epistemic norms. Still, mechanistic philosophers on both sides agree that there is no sharp distinction between the processes of discovery and explanation. Thus, it seems reasonable to expect that ontic and epistemic accounts of explanation will be accompanied by ontic and epistemic (...) accounts of discovery, respectively. As we will show here, however, recent discovery accounts implicitly rely on both ontic and epistemic norms to characterize the discovery process. In this paper, we develop an account that makes explicit that, and how, ontic and epistemic norms work together throughout the discovery process. By describing mechanism discovery as a process of pattern recognition we demonstrate that scientists have to develop epistemic activities to distinguish a pattern from its background. Furthermore, they have to determine which epistemic activities successfully describe how the pattern is implemented by identifying the pattern’s components. Our approach reveals that ontic and epistemic norms are equally important in mechanism discovery. (shrink)

Featuring contributions from the world’s leading experts on the subject and based partly on several detailed case studies, this volume is the first comprehensive analysis of the scientific notion of robustness as well as of the general ...

Two classes of account have been proposed to explain the memory processes subserving the processing of reflexive-antecedent dependencies. Structure-based accounts assume that the retrieval of the antecedent is guided by syntactic tree-configurational information without considering other kinds of information such as gender marking in the case of English reflexives. By contrast, unconstrained cue-based retrieval assumes that all available information is used for retrieving the antecedent. Similarity-based interference effects from structurally illicit distractors which match a non-structural retrieval cue have been interpreted (...) as evidence favoring the unconstrained cue-based retrieval account since cue-based retrieval interference from structurally illicit distractors is incompatible with the structure-based account. However, it has been argued that the observed effects do not necessarily reflect interference occurring at the moment of retrieval but might equally well be accounted for by interference occurring already at the stage of encoding or maintaining the antecedent in memory, in which case they cannot be taken as evidence against the structure-based account. We present three experiments (self-paced reading and eye-tracking) on German reflexives and Swedish reflexive and pronominal possessives in which we pit the predictions of encoding interference and cue-based retrieval interference against each other. We could not find any indication that encoding interference affects the processing ease of the reflexive-antecedent dependency formation. Thus, there is no evidence that encoding interference might be the explanation for the interference effects observed in previous work. We therefore conclude that invoking encoding interference may not be a plausible way to reconcile interference effects with a structure-based account of reflexive processing. (shrink)

How do cognitive neuroscientists explain phenomena like memory or language processing? This book examines the different kinds of experiments and manipulative research strategies involved in understanding and eventually explaining such phenomena. Against this background, it evaluates contemporary accounts of scientific explanation, specifically the mechanistic and interventionist accounts, and finds them to be crucially incomplete. Besides, mechanisms and interventions cannot actually be combined in the way usually done in the literature. This book offers solutions to both these problems based on insights (...) from experimental practice. It defends a new reading of the interventionist account, highlights the importance of non-interventionist studies for scientific inquiry, and supplies a taxonomy of experiments that makes it easy to see how the gaps in contemporary accounts of scientific explanation can be filled. The book concludes that a truly empirically adequate philosophy of science must take into account a much wider range of experimental research than has been done to date. With the taxonomy provided, this book serves a stepping-stone leading into a new era of philosophy of science—for cognitive neuroscience and beyond. (shrink)

Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis (...) was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context. (shrink)

Against influential strands of feminist theory, I argue that there is nothing essentialist or homogenising about the category ‘women’. I show that both intersectional claims that it is impossible to separate out the ‘woman part’ of women, and deconstructionist contentions that the category ‘women’ is a fiction, rest on untenable meta-theoretical assumptions. I posit that a more fruitful way of approaching this disputed category is to treat it as an abstraction. Drawing on the philosophical framework of critical realism I elucidate (...) the nature of the vital and inevitable process of abstraction, as a means of finding a way out of the theoretical and methodological impasse that the ‘ban’ on the category ‘women’ has caused. Contrary to many contemporary feminist theorists, I contend that, although the category ‘women’ does not reflect the whole reality of concrete and particular women, it nevertheless refers to something real, namely the structural position as woman. (shrink)

Background: It is of importance to understand and communicate caring ethics as a ground for qualitative caring environments. Research is needed on nursing attributes that are visible in nursing leadership since it may give bases for reflections related to the patterns of specific contexts. Aim: The aim of this study was to illuminate the meaning of crucial attributes in nursing leadership toward an ethical care of patients in psychiatric in-patient settings. Research design: The design of the study was descriptive and (...) qualitative with a phenomenological hermeneutical approach. Participants and research context: The study comprised focus group interviews with nurses working in indoor psychiatric care who participated after giving informed consent. Ethical considerations: Since the topic and informants are not labeled as sensitive and subject to ethical approval, it is not covered by the ethics committee’s aim and purpose according to Swedish law. However, careful procedures have been followed according to ethics expressed in the Declaration of Helsinki. Findings: When identifying the thematic structures, analysis resulted in three major themes: To supply, including the following aspects: to supply evidence, to supply common space, and to supply good structures; To support, including the following aspects: to be a role model, to show appreciation and care, and to harbor; To shield, including the following aspects: to advocate, to emit non-tolerance of unethical behavior, and to reprove. Discussion: Leadership is challenging for nurses and plays an important role in ethical qualitative care. These findings should not be understood as a description about nurse manager’s role, which probably has different attributes and more focus on an organizational level. Conclusion: Making the understanding about crucial attributes explicit, the nurse may receive confirmation and recognition of crucial attributes for ethical care in order to move toward an ethical care. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

It is my contention here that Quentin Skinner’s conception of neo-roman liberty as it is articulated in Liberty Before Liberalism serves to establish two normative premises for human rights philosophy. Those premises are, first, that human rights should offer the strongest protection for those persons who are most vulnerable and liable to social and political discrimination and marginalisation. Second, the objects of human rights should be conceptualised in terms of open-ended goals of justice, predicated on a commitment to structural equality. (...) I will have reason to refer to a reflection that Skinner makes on utopianism and how the “classic liberal case” of liberty can be associated with a critique of utopianism in political theory. By utopianism Skinner means – with reference to William Paley – a political theory that incorporates into its concepts demands that cannot be met without a fundamental change of practice and which moves beyond what it is at present reasonable for most people to expect of life. On this understanding, Skinner points out, John Rawls’s A Theory of Justice is a utopian treatise: it does not adapt to whatever is politically feasible but sets a challenging standard of justice for political institutions. I would qualify this by saying that the challenging nature of Rawls’s theory of justice is connected to the fact that it is systemic rather than utopian. A fear of the charge of utopianism is one of the recurrent features of human rights philosophy as we know it today. This is manifest in an incongruous tendency to join a moral philosophy of the good life with a political theory of basic provisions and life at the subsistence level. I hope to show that there is a consistent neo-roman case to be made for a more politically challenging human rights philosophy. (shrink)

A large number of legal rules create an obligation to prevent, repair or otherwise mitigate damage to human health or the environment. Many of these rules require that a legally relevant causal relation between human behaviour and the damage at issue is established, and in the establishment of causal relations of this kind scientific information is often pressed into service. This thesis examines this specifically legal use of scientific information. It shows that many legally relevant causal relations cannot be established (...) in this way. It also shows that the legal strategy for dealing with epistemic difficulties by relaxing the standard of proof is of limited value in tackling this problem. Consequently, the legal rules focused upon are less efficient tools for combating damage to human health and the environment than their appearances suggest. Other legal means to achieve this aim should therefore be considered. The thesis begins by presenting a framework which can be used to solve some important problems with communication and the division of labour that arise when scientific information is used to answer legal questions. This framework recognizes both epistemological and ontological differences between law and science. The latter are differences between the kinds of entity which are relevant in distinct theoretical contexts; the former, by contrast, are differences between applicable standards of proof. In subsequent parts of the thesis this framework shapes the discussion of the question: To what extent can legally relevant causal relations, involving legally significant entities, be established through the application of scientific information about other, scientifically relevant entities and legal standards of proof. The thesis concludes with a discussion of some of the ways in which the legal regulation could, potentially, be adapted, so as to counteract damage to human health and the environment more efficiently. (shrink)

Definition of the problemAdvance directives involve evaluative assumptions about the further course of one’s life that can be more or less appropriate and thus call for ethical reflection. This contribution focuses on the basis and criteria of such assumptions. We argue that considerations regarding the temporal structure of a good life constitute a particularly relevant perspective in this context.ArgumentsEmpirical studies on the individual composition of advance directives point to the important role of personal values and life plans that can change (...) over time. Therefore, we first contextualize advance directives from the perspective of an ethics of the good life and then discuss their implications with regard to different levels of temporality, comprising fundamental parameters of human existence in time, cultural models of the life course, as well as narratives of the individual trajectory of life.ConclusionConceptions of a good life and its temporal structure represent an important perspective for drafting and interpreting advance directives. Their consideration provides a more nuanced understanding of the evaluative implications of advance care planning. This can benefit individual patients, service providers, as well as policy makers. (shrink)

In the 1980s, philosophical, historical and social studies of science underwent a change which later evolved into a turn to practice. Analysts of science were asked to pay attention to scientific practices in meticulous detail and along multiple dimensions, including the material, social and psychological. Following this turn, the interest in scientific practices continued to increase and had an indelible influence in the various fields of science studies. No doubt, the practice turn changed our conceptions and approaches of science, but (...) what did it really teach us? What does it mean to study scientific practices? What are the general lessons, implications, and new challenges? This volume explores questions about the practice turn using both case studies and theoretical analysis. The case studies examine empirical and mathematical sciences, including the engineering sciences. The volume promotes interactions between acknowledged experts from different, often thought of as conflicting, orientations. It presents contributions in conjunction with critical commentaries that put the theses and assumptions of the former in perspective. Overall, the book offers a unique and diverse range of perspectives on the meanings, methods, lessons, and challenges associated with the practice turn. (shrink)

In this article I will do three things: I will argue that solidarity is not necessary for political legitimacy, that non-domination is a strong candidate for legitimacy criterion, and, finally, that non-domination can legitimate the egalitarian welfare state.

In this paper, a logic for reasoning about coalitional power is developed which explicitly represents agents’ preferences and the actions by which the agents can achieve certain results. A complete axiomatization is given and its satisfiability problem is shown to be decidable and EXPTIME -hard.

This article examines the recent transformations of the Italian welfare state from a familist welfare model to what I term transnational market familism. In this model, families buy in care labour, commonly provided by migrant workers. There is now a growing literature exploring both the transformations of the Italian welfare model and the experiences of migrant workers providing care in Italy. However, what has been overlooked in the current literature is the ethical aspect of this model of welfare provision, which (...) is part of the transnational political economy of care. The article analyses the ethical implications of the migrant-in-the-family model, which transforms the care relationship between the caregiver and care receiver into a complex relationship between the family member organising care, the migrant caregiver and the dependent care receiver. The context of such welfare provision is transnational. Examining this care triangle, I draw on care ethics and individualization perspective for an analysis of how social policies safeguard, or overlook, human interaction and care relationships in the context of global hierarchies. The article draws on ethnographic data gathered in Naples, Italy, during 2004–2005, including interviews with Neapolitan employers and elderly care-receivers, interviews with migrant workers, as well as participant observations. (shrink)

Background In Swedish intensive care units, nine percent of patients do not survive despite receiving advanced life-sustaining treatments. As these patients transition to end-of-life care, ethical considerations may become paramount. Aim To explore the ethical challenges that critical care nurses encounter when caring for patients at the end of life in an intensive care context. Research design The study used a qualitative approach with an interpretive descriptive design. Research context and participants Twenty critical care nurses from eight intensive care units (...) in an urban region in Sweden were interviewed, predominately women with a median age of fifty-one years. Ethical considerations This study was approved by The Swedish Ethics Review Authority. Findings Critical care nurses described encountering ethical challenges when life-sustaining treatments persisted to patients with minimal survival prospects and when administering pain-relieving medications that could inadvertently hasten patients’ deaths. Challenges also arose when patients expressed a desire to withdraw life-sustaining treatments despite the possibility of recovery, or when family members wanted to shield patients from information about a poor prognosis; these wishes occasionally conflicted with healthcare guidelines. The critical care nurses also encountered ethical challenges when caring for potential organ donors, highlighting the balance between organ preservation and maintaining patient dignity. Conclusion Critical care nurses encountered ethical challenges when caring for patients at the end of life. They described issues ranging from life-sustaining treatments and administration of pain-relief, to patient preferences and organ donation considerations. Addressing these ethical challenges is essential for delivering compassionate person-centered care, and supporting family members during end-of-life care in an intensive care context. (shrink)