Instituciones como el Consejo de Europa o el Instituto Cervantes y expertos como Byram o Deardorff han desarrollado modelos y bases educativas que dan luz a los docentes para ejecutar programas para el desarrollo de una ciudadanía pluricultural, que se comunica y está inmersa en la diversidad.Este estudio analiza si dichos modelos permiten establecer unos descriptores que definan la competencia intercultural desde una perspectiva procedimental. De esta manera, se pretende establecer un análisis de las bases teóricas y prácticas de (...) la competencia intercultural, tanto en el nivel del marco teórico como en el nivel de actuación del alumnado. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted (...) by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Some of the most significant policy responses to cases of fraudulent and questionable conduct by scientists have been to strengthen professionalism among scientists, whether by codes of conduct, integrity boards, or mandatory research integrity training programs. Yet there has been little systematic discussion about what professionalism in scientific research should mean. In this paper I draw on the sociology of the professions and on data comparing codes of conduct in science to those in the professions, in order to examine what (...) precisely the model of professionalism implies for scientific research. I argue that professionalism, more than any other single organizational logic, is appropriate for scientific research, and that codes of conduct for scientists should strengthen statements concerning scientific autonomy and competence, as well as the scientific service ideal. (shrink)

This study proposed a novel construct – green core competence – to explore its positive effects on green innovation and green images of firms. The results showed that green core competences of firms were positively correlated to their green innovation performance and green images. In addition, this research also verified two types of green innovation performance had partial mediation effects between green core competences and green images of firms. Therefore, investment in the development of green core competence was (...) helpful to businesses for the enhancement of their green innovation and green images. Furthermore, this study found that green core competence, two types of green innovation performance, and green images of medium & small enterprises (SMEs) were all significantly less than those of large enterprises in the information and electronics industry in Taiwan. Therefore, there was the advantage of firm size for the green core competence in this industry, and it was imperative for SMEs to develop and create their green core competences to strengthen their green innovation performance, and green images. (shrink)

Deep brain stimulation is a well-accepted treatment for movement disorders and is currently explored as a treatment option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence mental states critical to personality to such an extent that it affects an individual’s personal identity, i.e. the experience of psychological continuity, of persisting through time as the same person. Without questioning the usefulness of DBS as a treatment option for various serious and treatment refractory (...) conditions, the potential of disruptions of psychological continuity raises a number of ethical and legal questions. An important question is that of legal responsibility if DBS induced changes in a patient’s personality result in damage caused by undesirable or even deviant behavior. Disruptions in psychological continuity can in some cases also have an effect on an individual’s mental competence. This capacity is necessary in order to obtain informed consent to start, continue or stop treatment, and it is therefore not only important from an ethical point of view but also has legal consequences. Taking the existing literature and the Dutch legal system as a starting point, the present paper discusses the implications of DBS induced disruptions in psychological continuity for a patient’s responsibility for action and competence of decision and raises a number of questions that need further research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ought We to Require Emotional Capacity as Part of Decisional Competence?Paul S. Appelbaum* (bio)AbstractThe preceding commentary by Louis Charland suggests that traditional cognitive views of decision-making competence err in not taking into account patients’ emotional capacities. Examined closely, however, Charland’s argument fails to escape the cognitive bias that he condemns. However, there may be stronger arguments for broadening the focus of competence assessment to include emotional (...) capacities, centering on the ways in which emotions aid humans in processing information. Before emotional capacities are added to the list of functions essential for decisional competence, though, the feasibility and utility of such a reorientation must be demonstrated.To what extent ought persons’ capacities to experience emotion be taken into account when determining whether they should be deemed competent to make their own decisions? In the previous article, Louis Charland (1998) argues that traditional models of decision-making competence—of which the MacArthur Competence Treatment Study is a typical example—are mistaken in focusing narrowly on persons’ cognitive abilities to the neglect of emotional factors. In contrast, he suggests, constructs of competence ought explicitly to require a capacity to experience emotions, which he believes is central to meaningful decision making, before deeming persons competent.Charland, as he acknowledges, is not the first to suggest that the presence of some degree of emotional capacity is a necessary element of competence, but his argument is among the most elaborate to date and is certainly worth closer examination. Looked at carefully, however, Charland’s argument does not make quite the case for the determination of emotional capacity in competence assessment that he claims for it. Indeed, as I demonstrate below, Charland may share the same “pernicious [End Page 377] cognitive bias” that he ascribes to more traditional approaches. However, despite what I identify as the problems in Charland’s argument, others have raised more disturbing questions about the lack of attention to emotional issues in competence assessment. Thus, I am not ready to reject entirely the possibility that determinations of decisional competence ought to consider emotional factors. I conclude by outlining the questions that remain to be answered to identify more clearly the potential benefits of such an approach.The Construct of Decision-Making CompetenceSome preliminary comments about the nature of the dominant construct of decision-making competence may provide a useful frame for my response to Charland’s paper. Contemporary ideas of competence are tied inextricably to the ideal of self-determination in modern Western societies. Such societies are committed to respect for individual choice, both as a good in its own right and on the grounds that each person knows best what choices will maximize his or her own welfare. In general, therefore, states will not intervene to prevent persons from acting on their decisions, even when the choices they make—like the decision to smoke or to refuse potentially life-saving medical care—may objectively be thought to be detrimental to them.In some cases, however, the presumption that people will act in their own interests, as well as the notion that there is something intrinsically valuable in respecting their choices, fails (Buchanan and Brock 1989). When people’s minds are so disordered that they cannot be said to be making meaningful choices, other values come into play. Such people are called “incompetent.” When persons reach that point, the state’s interest in protecting its citizens becomes primary and someone else must make decisions on their behalf. Note that the size of this group must be sharply limited, lest a liberal society’s commitment to self-determination be undermined: There is no more profound infringement of the rights of citizens than the determination that they are incompetent. Thus, the criteria for incompetence must be selected in a deliberately narrow fashion—alternately, one might say that the standards for competence are made intentionally broad—so that all but a tiny percentage of citizens will be permitted to make decisions on their own.In the Anglo-American world, the process of formulating criteria of competence by and large has been left to the common law courts. Over the course of centuries they have identified the capacities that are, in... (shrink)

Increased work complexity and financial strain in the health care sector have led to higher demands on staff to handle ethical issues. These demands can elicit stress reactions, that is, moral distress. One way to support professionals in handling ethical dilemmas is education and training in ethics. This article reports on a controlled prospective study evaluating a structured education and training program in ethics concerning its effects on moral distress. The results show that the participants were positive about the training (...) program. Moral distress did not change significantly. This could be interpreted as competence development, with no effects on moral distress. Alternatively, the result could be attributed to shortcomings of the training program, or that it was too short, or it could be due to the evaluation instrument used. Organizational factors such as management involvement are also crucial. There is a need to design and evaluate ethics competence programs concerning their efficacy. (shrink)

Business students early on should be offered a course presenting and analyzing ethical dilemmas they will face as human beings both in the business world and in society. However, such a course should use literature, plays, and novels to illustrate ethical norms and values in the intertwined relationships of human activities. Better than business case studies, literature offers portraits of characters as leaders, employees, consultants, and other professionals, as ordinary human beings with conflicting desires, drives, and ambitions. Literary texts offer (...) excellent descriptions of the circumstances or the organizational settings in which people find themselves. I believe this is the best way to sensitize students without business experience when they are still open to such a formative learning process. At the same time, this pedagogical method linking ethics and literature may help to critically expose some of the weak or missing aspects of various management theories students encounter in their business curriculum and make them more observant and critical. (shrink)

According to what we propose to call “the competence model,” competence is a necessary condition for valid informed consent. If a person is not competent to make a treatment decision, the decision must be made by a substitute decision-maker on her behalf. Recent reports of various United Nations human rights bodies claim that article 12 of the Convention on the Rights of Persons with Disabilities involves a wholesale rejection of this model, regardless of whether the model is based (...) on a status, outcome, or functional approach to competence. The alleged rationale of this rejection is that denying persons the right to make their own treatment decisions based on an assessment of competence necessarily discriminates against persons with mental disorders. Based on a philosophical account of the nature of discrimination, we argue that a version of the competence model that combines supported decision-making with a functional approach to competence does not discriminate against persons with mental disorders. Furthermore, we argue that status- and outcome-based versions of the competence model are discriminatory. (shrink)

Business students early on should be offered a course presenting and analyzing ethical dilemmas they will face as human beings both in the business world and in society. However, such a course should use literature, plays, and novels to illustrate ethical norms and values in the intertwined relationships of human activities. Better than business case studies, literature offers portraits of characters as leaders, employees, consultants, and other professionals, as ordinary human beings with conflicting desires, drives, and ambitions. Literary texts offer (...) excellent descriptions of the circumstances or the organizational settings in which people find themselves. I believe this is the best way to sensitize students without business experience when they are still open to such a formative learning process. At the same time, this pedagogical method linking ethics and literature may help to critically expose some of the weak or missing aspects of various management theories students encounter in their business curriculum and make them more observant and critical. (shrink)

Elitist scepticism of democracy has a venerable history. This paper responds to the latest round of such scepticism—the ‘competence objection’, articulated in recent work by Jason Brennan. Brennan’s charge is that democracy is unjust because it allows uninformed, irrational, and morally unreasonable voters to exercise power over high-stakes political decisions, thus imposing undue risk upon the citizenry. I show that Brennan’s objection admits of two interpretations, and argue that neither can be sustained on close examination. Along the way, I (...) consider the merits of Brennan’s preferred ‘epistocratic’ alternative to democracy, and argue that it is likely to lead to lower-quality outcomes. (shrink)

In view of the numerous accounting and corporate scandals associated with various forms of moral misconduct and the recent financial crisis, economics and business programs are often accused of actively contributing to the amoral decision making of their graduates. It is argued that theories and ideas taught at universities engender moral misbehavior among some managers, as these theories mainly focus on the primacy of profit-maximization and typically neglect the ethical and moral dimensions of decision making. To investigate this criticism, two (...) overlapping effects must be disentangled: the self-selection effect and the treatment effect. Drawing on the concept of moral judgment competence, we empirically examine this question with a sample of 1773 bachelor’s and 501 master’s students. Our results reveal that there is neither a self-selection nor a treatment effect for economics and business studies. Moreover, our results indicate that—regardless of the course of studies—university education in general does not seem to foster students’ moral development. (shrink)

Robot ethics encompasses ethical questions about how humans should design, deploy, and treat robots; machine morality encompasses questions about what moral capacities a robot should have and how these capacities could be computationally implemented. Publications on both of these topics have doubled twice in the past 10 years but have often remained separate from one another. In an attempt to better integrate the two, I offer a framework for what a morally competent robot would look like and discuss a number (...) of ethical questions about the design, use, and treatment of such moral robots in society. Instead of searching for a fixed set of criteria of a robot’s moral competence I identify the multiple elements that make up human moral competence and probe the possibility of designing robots that have one or more of these human elements, which include: moral vocabulary; a system of norms; moral cognition and affect; moral decision making and action; moral communication. Juxtaposing empirical research, philosophical debates, and computational challenges, this article adopts an optimistic perspective: if robotic design truly commits to building morally competent robots, then those robots could be trustworthy and productive partners, caretakers, educators, and members of the human community. Moral competence does not resolve all ethical concerns over robots in society, but it may be a prerequisite to resolve at least some of them. (shrink)

Entrepreneurship plays a significant role in promoting the social and economic development of a country. At present, entrepreneurship education is widely carried out in universities and colleges in order to improve students’ entrepreneurial ability, and then to provide support for the formation of a comprehensive entrepreneurial situation. As entrepreneurship education has gradually become a hot topic of teaching for innovation and entrepreneurship education of international students, studies on the influencing mechanism of entrepreneurship education of international students in relation to their (...) entrepreneurial behavior are conducive to providing theoretical basis and empirical evidence for international students’ entrepreneurship education, so as to pertinently guide international students’ innovation and entrepreneurship practice. This study aims to explore the influence of entrepreneurship education, government support for entrepreneurship, global competence, entrepreneurial self-efficacy, and entrepreneurial intention on the entrepreneurial behavior of international students in the Republic of Korea. It summarized and drew on the results of the existing literature research. According to the contents and points of research, this study takes the international students studying in Korea as the sample and uses statistical analysis software, SPSS 22.0 and AMOS 24.0, to establish a structural equation model to conduct empirical study on the influencing mechanism of entrepreneurial behavior of international students in Korea, so as to better understand the influence of entrepreneurship education in Korean universities and colleges on entrepreneurial behavior of international students in Korea. Based on the analysis results, this study puts forward the theoretical basis for the policies related to effective management of entrepreneurship, which will help alleviate the unemployment of young people studying in Korea and the tight labor market supply and demand. (shrink)

Moral development has become an integral part in military training and the importance of moral judgment and behavior in military operations can hardly be overestimated. Many armed forces have integrated military ethics and moral decision-making interventions in their training programs. However, little is known about the effectiveness of these interventions. This study examined the effectiveness of a 1-week training program in moral decision making in the Swiss Armed Forces. The program was based on a strategy-based interactional moral dilemma approach. Results (...) of this quasi-experimental intervention study showed significant improvements in content-related (moral and instrumental awareness, quality of moral information processing, development of compensatory actions) as well as process-related (situational analysis, development and evaluation of alternative solutions, justification of decision) aspects in moral decision making. Results of a follow-up test indicated positive long-term effects with regard to moral and instrumental awareness and process-related aspects. Findings are discussed, and consequences for leadership development programs and further research are explored. (shrink)

Cognitive archaeologists attempt to infer the cognitive and cultural features of past hominins and their societies from the material record. This task faces the problem of _minimum necessary competence_: as the most sophisticated thinking of ancient hominins may have been in domains that leave no archaeological signature, it is safest to assume that tool production and use reflects only the lower boundary of cognitive capacities. Cognitive archaeology involves selecting a model from the cognitive sciences and then assessing some aspect of (...) the material record through that lens. We give examples to show that background theoretical commitments in cognitive science that inform those models lead to different minimum necessary competence results. This raises an important question: what principles should guide us in selecting a model from the cognitive sciences? We outline two complementary responses to this question. The first involves using _independent_ lines of evidence to converge on a particular capacity. This can then influence model choice. The second is a broader suggestion. Theoretical diversity is a good thing in science, but is only beneficial over a limited amount of time. According to recent modelling work, one way of limiting diversity is to introduce extreme priors. We argue that having a broad spectrum of views in the philosophy of cognitive science may actually help cognitive archaeologists address the problem of minimum necessary competence. (shrink)

Background and purpose Educators’ ethical competence is of crucial importance for developing students’ ethical thinking. Previous studies describe educators’ ethical codes and principles. This article aims to widen the understanding of health- and social care educators’ ethical competence in relation to core values and ethos. Theoretical background and key concepts The study is based on the didactics of caring science and theoretically links the concepts ethos and competence. Methods Data material was collected from nine educational units for (...) healthcare and social service in Finland. In total 16 semi-structured focus group interviews with 48 participants were conducted. The interviews were analysed with a thematic analysis according to Braun and Clarke. Ethical considerations The study is approved by the Declaration of Helsinki, the legislation regarding personal data and the General Data Protection Regulation. The study received ethical permission from the University of Jyväskylä. Informed consent was obtained from all the educational units and participants in the study. Findings The findings are presented based on three general patterns, an ethical basic motive, an ethical bearing and ethical actions. Subthemes are Humane view of students as unique individuals with individual learning, Bearing of tactfulness and firmness, Bearing of perceptiveness and accessibility, Bearing of satisfaction and joy over student learning, Valuing bearing towards each oneself and colleagues, Ability to interact and flexibility, Collegiality and a supportive work community and Educators as role models and inspirators. Conclusion Educators’ personal and professional ethos is crucial to student learning, personal growth and ethical reasoning. Therefore, it is important to further develop educators’ training regarding ethical competence. (shrink)

This important handbook provides a comprehensive, authoritative review of achievement motivation and establishes the concept of competence as an organizing ...

Most behavioral decision research takes place in carefully controlled laboratory settings, and examination of relationships between performance and specific real-world decision outcomes is rare. One prior study shows that people who perform better on hypothetical decision tasks, assessed using the Adult Decision-Making Competence (A-DMC) measure, also tend to experience better real-world decision outcomes, as reported on the Decision Outcomes Inventory (DOI). The DOI score reflects avoidance of outcomes that could result from poor decisions, ranging from serious (e.g., bankruptcy) to (...) minor (e.g., blisters from sunburn). The present analyses go beyond the initial work, which focused on the overall DOI score, by analyzing the relationships between specific decision outcomes and A-DMC performance. Most outcomes are significantly more likely among people with lower A-DMC scores, even after taking into account two variables expected to produce worse real-world decision outcomes: younger age and lower socio-economic status. We discuss the usefulness of DOI as a measure of successful real-world decision making. (shrink)

While thinkers of the material turn offer new conceptual resources for talking about non-human ontologies, interaction researchers are trying to reassemble the social situation fragmented by telecommunication. Conversation analysts tend to see technical objects in their situation-constitutive role, but they can also disrupt the current projects of the participants whilst remaining "unseen and unnoticed" (e.g. Zoom delays). We propose a conceptualization of the relationship between the participant and the interaction environment as a source of agency, which makes it possible to (...) preserve an emic perspective. We illustrate our thesis by analyzing a case study of interaction between a Deaf and a hearing participant in VRChat. In this case, virtual pencils that leave durable inscriptions in the air are used by participants for communication. We analyze a simple question-and-answer sequence and demonstrate that: the participants treat the inscriptions as material; the hearing participant is less capable of communicating in this space than the Deaf person; the answer to the question is produced jointly due to the instructional work of the Deaf participant. The results allow us to draw the following conclusions about the nature of materiality, agency and communicative competence: 1) the materiality of the environment is not a purely analytical category, but is constructed by the participants in the interaction; 2) the agency of the participants depends on the environment and at the same time has a distributed character; 3) communicative competence is not directly related to the "internal" characteristics of the agent, such as atypicality. (shrink)

Supervised injectable opioid assisted treament prescribes injectable opioids to individuals for whom other forms of addiction treatment have been ineffective. In this article, we examine arguments that opioid-dependent people should be assumed incompetent to voluntarily consent to clinical research on siOAT unless proven otherwise. We agree that concerns about competence and voluntary consent deserve careful attention in this context. But we oppose framing the issue solely as a matter of the competence of opioid-dependent people and emphasize that it (...) should be considered in the context of inequities in access to siOAT as a medical treatment. Consequently, we suggest that bioethics literature on nonexploitation, which focuses on clinical research in low-income countries, is helpful due to locating ethical issues within systemic social conditions. Finally, we consider the implications of our argument for the ethics of clinical research on siOAT. (shrink)

This study investigates the effectiveness of pedagogical practices used to teach business ethics. The business community has greatly increased its demands for better ethics education in business programs. Educators have generally agreed that the ethical principles of business people have declined. It is important, then, to examine how common methods of instruction used in business ethics could contribute to the development of higher levels of moral judgment competence for students. To determine the effectiveness of these methods, moral judgment (...) class='Hi'>competence levels for undergraduate and graduate students from three institutions were measured and compared based upon the pedagogical method used in a business class. Significant differences were found for moral reasoning and moral competence scores depending on the method used for ethics instruction. Students in classes with more highly integrated ethics coverage scored higher in moral reasoning and moral competence. (shrink)

Norms conferring public or private powers, i.e., the competence to issue other norms, play a very important rôle in law. But there is no agreement among legal philosophers about the nature of such norms. There are two main groups of theories, those that regard them as a kind of norms of conduct (either commands or permissions) and those that regard them as non-reducible to other types of norms. I try to show that reductionist theories are not quite acceptable; neither (...) the command-variety (Kelsen, Alf Ross inOn Law and Justice), nor the permission-variety (von Wright, Kanger, Lindahl) provide a satisfactory account of competence norms.Among the authors who maintain that competence norms are different from (and hence not reducible to) norms of conduct are Hart, Ross inDirectives and Norms, and Searle. Ross and Searle distinguish between regulative and constitutive rules as two radically different kinds of rules and classify competence norms among constitutive rules. This distinction runs parallel to von Wright's distinction between rules that are prescriptions and determinative rules. While the first regulate actions (by commanding, prohibiting, or permitting them), determinative rules define certain concepts. To view competence norms as (partial) definitions of certain legal concepts (like those of legislator, judge, etc.) seems to open interesting perspectives and to shed light on at least one aspect of these elusive norms. (shrink)

Georges Rey; XV*—Semantic Externalism and Conceptual Competence, Proceedings of the Aristotelian Society, Volume 92, Issue 1, 1 June 1992, Pages 315–334, https.

Culturally Responsive Teaching (CRT) weaves together rigor and relevance while it improves student achievement and engagement. The Philippine Department of Education implemented Indigenous People’s education to respond to the demands for culturally responsive teaching. Teacher education graduates are expected to articulate the rootedness of education in sociocultural contexts in creating a learning environment that recognizes respect, connectedness, choice, personal relevance, challenges, engagement, authenticity, and effectiveness. Practice teachers need relevant exposure and immersion to fully develop their competence in CRT. This (...) scenario necessitates attention to assessing the competence of 191 practice teachers in CRT, correlating their competence across dimensions, and verifying the role of gender and degree programs in competence development. This investigation provides evidence on the role of gender in competence development toward culturally responsive teaching. Such competence is vital in practice teachers, especially because they are exposed to learners with diverse backgrounds during their teaching internship. This evidence informs supervising instructors in molding practice teachers. (shrink)

Background The ethical competence of head nurses plays a pivotal role in nursing ethics. Ethical climate is a prerequisite for ethical competence, and moral resilience can positively influence an individual’s ethical competence. However, few studies have focused on the relationship between ethical climate, moral resilience, and ethical competence among them. Objectives To investigate the relationship between ethical climate, moral resilience, and ethical competence, and examine the mediating role of moral resilience between ethical climate and ethical (...) competence among head nurses. Design A quantitative, cross-sectional study. Methods A total of 309 Chinese head nurses completed an online survey, including ethical climate questionnaire, Rushton moral resilience scale, and ethical competence questionnaire. Inferential statistical analysis includes Pearson’s correlation and a structural equation model. Ethical considerations This study received ethical approval from the Institutional Review Board of Xiangya Nursing School of Central South University (No. E2023146). Results Head nurses’ ethical climate score positively impacted ethical competence (r = 0.208, p <.001), and ethical climate could affect ethical competence through the mediating role of moral resilience. Conclusion This study emphasized the value of ethical climate in moral resilience of head nurses, ultimately leading to an enhancement in their ethical competence. (shrink)

Dr Baumgarten analyses three possible justifications for doctors to decide that a patient is 'incompetent' to make or participate in medical decisions affecting him, and points out the difficulties of each. He argues that the degree to which a patient relinquishes control over decision-making which affects him will vary in different circumstances and should be explicitly agreed in the initial doctor-patient contract, rather as it often is when a client employs a professional to invest money on his behalf.

Many clinical ethics support services do not involve patients. This is surprising because of the broad commitment to provide patient-centered healthcare. Clinical ethics support services are a component of the healthcare system and have an influence on patient care, and should therefore align with the regulatory and ethical requirements of patient-centered care, just process and cultural competence. First, in order to achieve good patient care, it is essential to involve patients in making their own healthcare decisions. Second, just ethical (...) deliberation requires that the deliberating parties have access to complete, accurate and unbiased information – this is best achieved through direct patient input. These arguments are especially compelling in the case of non-dominant cultural and ethnic groups. Here, we argue that when a clinician refers a case to a clinical ethics support services for consideration, and that case involves a conflict between the views or values of the clinician and the patient, the patient is entitled to, at a minimum: (a) be informed of the referral; (b) have the opportunity to speak directly to the clinical ethics support services prior to deliberation; (c) be provided with any opinion directly from the clinical ethics support services; and (d) have the opportunity to speak to a clinical ethics support services member after the deliberation. We use New Zealand as a case study to support and extrapolate the ethical principles and the minimum patient involvement requirements. We draw on our empirical research with senior doctors at a tertiary New Zealand hospital. Clinicians in our study indicated that they would feel bound by clinical ethics support service advice and that the clinical ethics support service has a significant impact on patient care in the case it reviews. (shrink)

Tyler Burge first introduced his distinction between epistemic entitlement and epistemic justification in ‘Content Preservation’ in 1993. He has since deployed the distinction in over twenty papers, changing his formulation around 2009. His distinction and its basis, however, is not well understood in the literature. This chapter distinguishes two uses of ‘entitlement’ in Burge, and then focuses on his distinction between justification and entitlement, two forms of warrant, where warrants consists in the exercise of a reliable belief-forming competence. Since (...) he draws the distinction in terms of reasons, this chapter brings his account of reasons altogether in one place. The chapter introduces a decision-procedure for classifying warrants as justifications or entitlements. The distinction between justification and entitlement is not the same as the inferential vs. non-inferential distinction. The chapter distinguishes inference from processing, thinking, reasoning, and critically reasoning. Burge’s new formulation of the distinction was driven by the recognition of non-accessible modular reasons. Three kinds of access are distinguished. (shrink)

I very much enjoyed reading the interesting and original article by Steel and colleagues (2017). But I found myself strongly disagreeing with its conclusion once the real point of the argument became clear to me. At the same time, I believe that the authors are correct to draw attention to the importance of context and inequities in framing discussions of the ethics of voluntary consent in heroin prescription research. I begin with a brief summary of the authors’ conclusion, quoting directly (...) and adding my own emphases, since there are major philosophical points I wish to make that hinge on nuances in wording... (shrink)

Most theories of semantic competence in natural language implicitly assume the Language of Thought Hypothesis. According to this hypothesis, all human cognition consists in the deployment of a language of thought. This language of thought is supposed to be independent of natural language, yet at the same time, it is supposed to be semantically isomorphic with natural language. Given this assumption, it is easy to answer basic questions regarding semantic competence in natural language. What are semantic properties of (...) natural language, and how did they originate? Natural language inherits the semantic properties of the language of thought it is used to express. What does semantic competence consist in? It consists in knowing how to translate items in one's language of thought into a public medium. ;The starting point of this dissertation is the rejection, by some prominent paradigms in cognitive science, of the view that human cognition consists in the deployment of a language of thought that is, at the same time, independent of natural language, yet semantically isomorphic with it. The dissertation constitutes a fledgling attempt to explore an alternative approach to explaining semantic competence in natural language, an approach that is compatible with this rejection of the Language of Thought Hypothesis. ;Rather than conceive of natural language as a tool for expressing items in a pre-existing, semantically isomorphic, language of thought, I urge that language be conceived of as a norm-governed social practice. On this view, the semantic properties of natural language are determined by the inferential norms governing linguistic performances. In order to explain the origin of its semantic properties, one must explain the origin of the inferential norms that govern language. In order to explain what semantic competence consists in, one must explain how individuals learn to abide by these inferential norms. The bulk of the dissertation is devoted to showing that neither of these explanatory projects requires endorsing the Language of Thought Hypothesis. I do this by sketching the form that such explanations might take, and showing that they are consistent with much current research in ethology, comparative psychology, developmental psychology, and evolutionary biology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Anorexia and the MacCAT-T Test for Mental Competence:Validity, Value, and EmotionLouis C. Charland (bio)Keywordsmental competence, decisional capacity, anorexia, value, emotionValidity of the MacCAT-THow does one scientifically verify a psychometric instrument designed to assess the mental competence of medical patients who are asked to consent to medical treatment? Aside from satisfying technical requirements like statistical reliability, results yielded by such a test must conform to at least (...) some accepted pretheoretical desiderata; for example, determinations of competence, as measured by the test, must capture a minimal core of accepted basic intuitions about what competence means and what a theory of competence is supposed to do. The concepts of "face validity" and "content validity" are both important here. Face validity "indicates that an instrument appears to test what it is supposed to and that it is a plausible method for doing so" (Portney and Watkins 2000, 82). Content validity "means that the test contains all the elements that reflect the variable being studied" (Portney and Watkins 2000, 83). An adequate instrument for measuring mental competence must at minimum satisfy both of these requirements.What Tan and her colleagues (2006) have shown is that the MacArthur Competence Assessment Tool—Treatment (MacCAT-T) test for mental competence may not be an empirically valid measure of mental competence for some cases of anorexia. The data they report show that "competence," as measured by the MacCAT-T, does not conform sufficiently well with what is wanted of a clinical medical theory of competence. More specifically, the MacCAT-T is deficient in both face and content validity. This result is extremely significant; previous challenges to the validity of the MacCAT-T have often been largely theoretical in nature. My own objection that the MacCAT is inadequate because it omits the influence of emotion is based on a combination of empirical theory (Charland 1998a) and philosophical argument (Charland 1998b). However, it is entirely theoretical in nature. So is my argument that in ignoring emotion the MacCAT misses a crucial contributing ingredient in competence, namely, value (Charland 2001, see especially 136 note 2). Tan's study provides valuable empirical evidence for the second of these challenges, which deals more specifically with value. On the one hand, the study clearly demonstrates that patients sometimes do [End Page 283] base their treatment decisions on reasons derived from values. And on the other hand, it also nicely illustrates the centrality of values—"utilities" or "preferences"—in the decision-making process generally; a basic assumption of standard decision theory for which, paradoxically, there appears to be no satisfactory counterpart in the MacCAT-T model of reasoning and decision making.Thus, values figure among the reasons that patients actually use in reasoning when they weigh the risks and benefits of proposed treatment options. The MacCAT-T must be amended to incorporate this fact if it is to be a satisfactory clinical medical tool. Without such a correction, the concept of mental competence it measures is empirically invalid. At the root of the problem is a clash of intuitions. Tan's data provide convincing evidence that some of the patients who are deemed to be mentally competent by MacCAT-T standards should not in fact be considered competent. Note that the language in which this clash is expressed—"should not in fact"—involves a combination of descriptive and prescriptive elements, reminding us that the concept of competence is dual in nature: it is both prescriptive and descriptive (Freedman 1981). These problems underscore the need for greater clarity about what pretheoretically we want a clinical theory and test of competence to capture. It is of course reasonable to say that such a test must be consistent with major tenets of the relevant case law (Appelbaum 1998). But a legally valid concept of competence of this sort is too thin and arbitrary a foundation on which to build a clinical medical theory of competence. An empirically valid theory and test of the latter sort must incorporate the role of values if it is be truly helpful in medical practice.Value and the MacCAT-TI agree with Tan and her colleagues that some notion of "pathological value" needs to be... (shrink)

In response to rapid technological changes in our society, there are calls by governments and industry for increased training of the workforce. But training alone is not sufficient to ensure success, even if talent, discipline and good fortune are all amply provided. When “training” goals require creativity, or decision making, or moral judgment, then adequate preparation must also include “education” in John Dewey’s sense—that is, imparting abilities to solve new problems and grasp novel meanings. Concluding this small monograph is a (...) proposed research agenda, which includes exploring the crucial role of “intuition” and related processes in abilities to generate hypotheses and solve problems. In its elaboration on the nature and limits of training, compared to education, the discussion includes a Thought Experiment, based on Bernard Suits’ exploration of rules and success in playing games. (shrink)

This discussion paper addresses Ian Wilks’ defence of the risk‐related standard of competence that appears in Bioethics 11. Wilks there argues that the puzzle posed by Mark Wicclair in Bioethics 5 against Dan Brock's argument in favour of a risk‐related standard of competence — namely that Brock’s argument allows for situations of asymmetrical competence — is not a genuine problem for a risk‐related standard of competence. To show this, Wilks presents what he believes to be two (...) examples of real situations in which asymmetrical competence arises. I argue that insofar as Wilks equivocates two senses of competence in his examples — namely, competence to perform a task and competence in performing a task — Wilks is unable to illustrate the existence of real situations of asymmetrical competence. By examining the way in which Wilks equivocates two senses of competence in his examples, and by applying the results of this examination to the problem of patient competency within the medical field, I argue that not only does Wilks fail to show that situations of asymmetrical competence exist, but he is also unable to provide a foundation for understating how the risk‐related standard of competence can strike a balance between an individual’s autonomy and benevolent intervention. I thus conclude that insofar as Wilks fails to answer the objections raised by Wicclair and others against the risk‐related standard of competence, the risk‐related standard of competence continues to be undermined by the problem of asymmetrical competence. (shrink)

This article examines the discourse competence of high-functioning children with autistic spectrum disorders to participate in narrative introduction sequences with family members. The analysis illuminates the children’s own efforts to launch narratives, as well as their ability to build upon the contributions of others. Ethnographic, discourse analytic methodology is integrated with the theory of discourse organization and the weak central coherence account of autism. Introductions of both personal experience narratives as well as fictional narratives are examined. The children were (...) especially competent in the use of stable introductory practices when launching fictional narratives, pre-organized by the media of expression. Their challenge was not in the introduction, but in the narrative co-telling, which often was not globally organized over an extended course of propositions. The heterogeneity of the ASD children’s discourse competence and its implications for discourse analysis are discussed. (shrink)

Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency (...) medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values. (shrink)