Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

Medical advances in transplantation techniques have driven an exponential increase in the demand for transplantable organs. Unfortunately, policy efforts to bolster the organ supply have been less than effective, failing to provide a stopgap for ever-increasing numbers of patients who await organ transplantation. The number of registrations on waiting lists exceeded 65,245 in early 1999, a 325% increase over the 20,000 that existed 11 years earlier in 1988. Regrettably, more than 4,000 patients die each year while awaiting transplantation.

The Treatment Escalation Plan (TEP) was introduced into our trust in an attempt to improve patient involvement and experience of their treatment in hospital and to embrace and clarify a wider remit of treatment options than the Do Not Resuscitate (DNR) order currently offers. Our experience suggests that the patient and family are rarely engaged in DNR discussions. This is acutely relevant considering that the Mental Capacity Act (MCA) now obliges these discussions to take place. The TEP is a form (...) that the doctor completes, ideally with the competent patient or close relative, documenting what treatment options would be appropriate if that patient were to become acutely unwell. Ventilation of the lungs, cardiac resuscitation, renal replacement therapy, intravenous fluids and antibiotics are all discussed. The study evaluated patient and relative experiences with the TEP. 55 patients or their relatives were interviewed regarding their experience of the TEP and thoughts regarding the process. 96% of patients and relatives evaluated thought that the TEP was a good idea. Free text comments were all positive and only 34% of patients claimed to feel anxious when completing the form. Following this study, the TEP has been expanded hospital wide and into the community within our trust. Discussions are currently taking place in hospitals within our region to introduce the TEP form into other local trusts. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

Weak psychological egoism is the doctrine that anything an agent does intentionally, that agent does at least expecting thereby to realize one of her self-regarding ends. (Strong psychological egoism, by contrast, is the doctrine that agents act always intending thereby to realize a self-regarding end.) Though weak psychological egoism is a doctrine ultimately answerable to empirical evidence, we presently have excellent a priori reasons for accepting it and attempting to construct psychological theories that include it as an organizing principle. These (...) reasons have mainly to do with the idea that to understand the motivation behind an action, we need to understand the force of the consideration that motivates the agent, and the way to do this is to find a self-regarding end associated in the agent''s mind with acting on that consideration. (shrink)

Donald Davidson holds that metaphors have no linguistic meaning in addition to their literal meaning. Max Black and Frank B. Farrell each contends that Davidson’s view is inconsistent with the fact that metaphors are appropriate objects of explication and evaluation. However, as I show, Davidson’s view actually is entirely consistent with this fact. I also argue that Black’s and Farrell’s own accounts of metaphor imply that sometimes the linguistic meaning of a sentence is other than a product of the meanings (...) of its words and its logical form, and I give a reason why accounts of metaphor with this implication are best rejected. E.M. Zemach, for his part, agrees with Davidson about what metaphors mean, but contends that, on Davidson’s recent account of language and interpretation, all metaphors turn out to be true; metaphors express novel or impractical but nonetheless literally true comparisons or categorizations. Zemach, however, I argue, has neglected the distinction between how speakers actually apply their words to things and their standards of correct application. (shrink)

I will present what I think is the best argument for the version of psychological egoism under consideration here, and explain why I think even that argument fails to go much distance toward establishing it. It turns out, though, I will caution, that defeating that argument means only that we are right to reject psychological egoism as extremely implausible; it does not entitle us to claim to have shown the thesis itself to be either confused and senseless or false. However, (...) my main goal in this paper is neither to refute nor to defend psychological egoism, but rather to show how it, even in a very strong form, manages to survive a number of common objections both to itself and to arguments meant to support it. (shrink)

To believe a proposition wishfully is to believe it because one wants to believe it, and not because one has evidence or reason that it is true. Is it wise to be open to believing wishfully? After criticising one popular argument that we ought be closed to believing wishfully, I develop an argument that being closed to believing wishfully is to labour under a debilitating prejudice. As a rule, then, we ought to be open to believing wishfully. I find one (...) and only one exception to this rule. People who value understanding things as they are, and value this more than anything else they value, are wise to be closed to believing wishfully. (shrink)

The dissertation is an exploration of the possibility and nature of interpretation. Its thesis is that coming to know what someone believes or desires, or what their words mean, or what they are doing, is not to be distinguished from coming to know something about the world. This thesis is defended, on the one hand, by distancing it from empiricist readings, and, on the other hand, by arguing against idealist or realtivist reasons for rejecting it. ;The dissertation is in two (...) parts. Part I, "Philosophy of Mind," takes up the question whether the thesis stated above implies that agents are mere objects and knowledge of minds is just knowledge of brains. There is, it is true, a sense in which explanations of events under physical descriptions are better as explanations than are explanations of the same events under psychological descriptions; nonetheless, it is argued, psychological descriptions and explanations are neither reducible to nor eliminable in favour of purely physicalistic ones. Part I established that coming to know what someone believes or means is coming to know something about the world--something about the world, that is, under a psychological description. ;Part II, "Philosophy of Language," takes up the question whether there is some difference in kind between knowledge of things conceived as psychological or meaningful and knowledge of things conceived as physical, a difference in addition to that of subject matter. It emerged in Part I that the notion of rationality is central to psychological description and explanation, whereas it plays no role in physical description: is this a difference that makes a difference? It is concluded that interpretation is possible not because speaker and interpreter share a tradition, or a conceptual scheme, or countless basic beliefs, or even because most of their beliefs are true. Rather, the possibility of interpretive knowledge rests on nothing more than that interpreter and speaker are in causal contact with a common environment. Thus in no important respect is interpretive understanding unlike knowledge of physical things. (shrink)

The authors argue that while meaning holism makes massive error possible, it does not, as Donald Davidson fears, threaten interpretability. Thus they hold, in opposition to Davidson, that meaning holism need not be constrained by an account of meaning according to which in the methodologically most basic cases the content of a belief is given by the cause of that belief. What ensures interpretability, they maintain, is not that speakers' beliefs are in the main true, but rather that beliefs have (...) the contents they do because of events others can in principle identify and describe. (shrink)