This volume presents a selection of Hubert Dreyfus's pioneering work in bringing phenomenology and existentialism to bear on the philosophical and scientific study of the mind. Each of the thirteen essays interprets, develops, and extends the insights of his predecessors working in the European philosophical tradition. One of Dreyfus' central contributions to reading the historical canon of philosophy comes from his recognition that great philosophers help us to understand the -background practices- of a culture - the practices (...) that shape and embody our most basic understanding of ourselves and the things and situations we encounter in our world. Background practices are all too often overlooked completely, or else their importance is misunderstood. Each chapter in this volume shows in one way or another how a broad range of philosophical topics can only be properly understood when we recognize how they are grounded in the background practices that shape our lives and give meaning to our activities, our tasks, our normative commitments, our aims and our goals. (shrink)

Dutch developments on euthanasia have drawn much attention over the years. Defenders and opponents have been telling very different stories about the practice of euthanasia and the frequency of cases, and the Dutch government has been struggling with the legal and moral problems involved. Concern about the procedures followed by physicians as well as questions on the “real” figures led the government to decide to organize an epidemiological study on the extent and the decision making. The results of the study (...) were published in November 1991. Interpretation of the data may lead to a final settlement of the debate on euthanasia and has inevitably led to a revival of the moral debate of the 1970s. For the moment it has been decided that euthanasia will remain officially illegal under the Penal Code. However, in cases where euthanasia does occur, Attorneys General will continue to check the procedures followed by physicians to ensure no abuses have occurred and to safeguard physicians against prosecution. In this contribution, we discuss the development and intertwinement of legal, medical, and moral aspects of euthanasia in The Netherlands and the effects of the empirical studies of 1991, both on definitions and procedures for medical decisions at the end of life. (shrink)

In order to maximize human performance, defence forces continue to explore, develop, and apply human performance enhancement (HPE) methods, ranging from pharmaceuticals to (bio)technological enhancement. This raises ethical, legal, and societal concerns and requires organizing a careful reflection and deliberation process, with relevant stakeholders. We discuss a range of ethical, legal, and societal aspects (ELSA), which people involved in the development and deployment of HPE can use for such reflection and deliberation. A realistic military scenario with proposed HPE application can (...) serve as a starting point for such an iterative and participatory process. Stakeholders can discuss this application, modify its features, and design appropriate processes around it – for instance, procedures for informed consent. We propose that organizing aspects into these three categories – ethical, legal, and societal – can help involve appropriate interlocutors at different moments: legal aspects with people in strategy or management roles, from the start of a project; ethical aspects with people in operations and medical roles, during development; and societal aspects with people in communication and personnel roles, during deployment. Notably, we developed and discussed this framework and the three aspects in close collaboration with personnel from the military. (shrink)

This volume presents a collection of refereed papers reflecting the state of the art in the area of over-constrained systems. Besides 11 revised full papers, selected from the 24 submissions to the OCS workshop held in conjunction with the First International Conference on Principles and Practice of Constraint Programming, CP '95, held in Marseilles in September 1995, the book includes three comprehensive background papers of central importance for the workshop papers and the whole field. Also included is an introduction (...) by one of the volume editors together with a bibliography listing 243 entries. All in all this is a very useful reference book relevant for all researchers and practitioners interested in hierarchical, partial, and over-constrained systems. (shrink)

The COVID-19 pandemic marked a before and after for the global economy, and one of the most affected sectors was the health sector, where rising costs in medical care, protective equipment and infrastructure, coupled with a decrease in income from other regular services, led a large part of health centers such as public and private hospitals to resort to unethical accounting practices for the manipulation of their financial information (creative accounting). These events of financial depression and relaxation of controls (...) during the health emergency allowed the creation of a "favorable" environment to distort financial statements through techniques such as premature recording of income, undervaluation of expenses, among others, to evade taxes and take advantage of the benefits imposed by governments to promote humanitarian aid and prioritize health care. The purpose of this article is to highlight the most common creative accounting practices that were applied in the health sector in Latin America during the COVID-19 pandemic and the consequent effects it had on the economy and on the governmental control of the countries in the region for the detection of these practices. (shrink)

The Practices of Global Ethics takes a unique look at global ethics: not as mere written statements but as a set of practices undertaken by thousands of organisations and hundreds of thousands of people to shape the normative trajectory of human affairs. It looks at statements of global ethical principles including The Universal Declaration of Human Rights, the Earth Charter and the Rio Documents and positions them as the outcomes and expression of ongoing practices. Offering innovative, critical (...) and thoughtful analyses of ethical practices since World War II, the book examines efforts to promote human rights; foster ecological responsibility; end genocide; reduce global poverty; encourage responsible and sustainable international business practices; cultivate understanding and collaboration amongst the world's religions among other worldwide endeavours. (shrink)

Normative reasons for action are considerations that count in favor of actions. They are the considerations that determine what an agent should do in a given situation. If the agent acts on these considerations, they justify her action. This paper concerns accounts of normative reasons that separate the explanation of why a particular reason counts in favor of an agent’s performing some action from the content of that reason. Elements of this explanation of why the reason is a reason are (...) “background conditions” on that reason, rather than part of the reason itself. (shrink)

This study is based on the background of how artificial intelligence technology is applied to the field of creativity and design education to improve the design vision, teaching methods, and actual design productivity of practitioners. The purpose of the research is to compare traditional design education and new design education methods combined with AI technology. Taking the Technological Pedagogical Content Knowledge technology integration model as the starting point, a comprehensive evaluation is selected for different types of research to explore (...) the animation design professional courses in design education, the content of students’ perception preferences, and the evaluation of ease of learning so as to conduct research and analyze AI technology. Design new education strategies and practice methods under the background. In the research, a comparative experimental study was conducted on 40 first-year students majoring in animation design. The results show that through online design studio project practice, with personalized project learning guidance, the learning needs of students to show a better trend, and customized learning and project practice content can enhance the learning experience and performance of students. In the future, we can further expand the scope of analysis, include more case studies, and conduct more comprehensive research, including how to deal with the expansion of the platform for students’ learning of design in situations similar to coronavirus disease 2019 that profoundly affects our lives, and how the project is applied in practice. (shrink)

Background: Practical wisdom, understood as knowing how to be or act in any present situation with clients, is believed to be an essential part of the knowledge needed to be a professional mental health worker. Exploring processes of adapting, extending knowledge and refining tacit knowledge grounded in mental health workers’ experiences with being in practice may bring awareness of how mental health workers reflect, learn and practice professional ‘artistry’. Research question: The aim of the article was to explore mental (...) health workers’ processes of development and learning as they appeared in focus groups intended to develop practical wisdom. The main research question was ‘How might the processes of development and learning contribute to developing practical wisdom in the individual as well as in the practice culture?’ Research design: The design was multi-stage focus groups, and the same participants met four times. A phenomenological hermeneutical method for researching lived experience guided the analysis. Participants and context: Eight experienced mental health workers representing four Norwegian municipalities participated. The research context was community-based mental health services. Ethical considerations: The study was reported to Norwegian Social Data Services, and procedures for informed consent were followed. Findings: Two examples of processes of re-evaluation of experience (Association, Integration, Validation, Appropriation and Outcomes and action) were explored. The health workers had developed knowledge in previous encounters with clients. In sharing practice experiences, this knowledge was expressed and developed, and also tested and validated against the aims of practice. Discussions led to adapted and extended knowledge, and as tacit knowledge was expressed it could be used actively. Discussion: Learning to reflect, being ready to be provoked and learning to endure indecisiveness may be foundational in developing practical wisdom. Openness is demanding, and changing habits of mind is difficult. Conclusion: Reflection on, and confrontation with, set practices are essential to building practice cultures in line with the aims of mental health services. (shrink)

It is hard to imagine our life without questions. They facilitate orientation in our environment, enable interpersonal communication and make the acquisition of knowledge possible. Questions direct scientific research, are used as research tools and are an important medium of transferring knowledge in teaching. The book is intended as a par excellence philosophical monograph of the theory of questions, presenting the most important erotetic problems, their general background and selected practical applications. It is prepared in all fairness to results (...) acquired in the framework of the logical theories of questions but goes beyond this framework. (shrink)

While the story of Stanislav Petrov – the Soviet Lieutenant Colonel who likely saved the world from nuclear holocaust in 1983 – is often trotted out to advocate for the view that human beings ought to be kept “in the loop” of automated weapons’ responses, I argue that the episode in fact belies this reading. By attending more closely to the features of this event – to Petrov’s professional background, to his familiarity with the warning system, and to his (...) decisions to defy his protocol – it becomes clear that Petrov was not seamlessly working “in his loop,” but reassessing it entirely. I claim that this exhibits a paradox intrinsic to all automated loops: namely, that their optimum function in fact rests on unforeseen human interventions that cannot be reliably codified ex ante, that is, that good judgment cannot simply be “programmed into” their protocols. This dependence, moreover, reveals automation’s ineluctable need for virtue ethics – not in the usual sense (whereby ethics deliberates about, say, possible damages and loss of life), but in the sense that ethical judgment, rightly understood, entails the reassessment of all of the conditions surrounding a decision, including whether a protocol should be followed at all. (shrink)

This article is a continuation of a line of investigation I began in ‘Literal Meaning’. Its aim is to explore some of the relations between the meaning of words and sentences and the context of their utterance. The view I shall be challenging is sometimes put by saying that the meaning of a sentence is the meaning that it has independently of any context whatever — the meaning it has in the so-called „null context“. The view I shall be espousing (...) is that in general the meaning of a sentence only has application (it only, for example, determines a set of truth conditions) against a background of assumptions and practices that are not representable as a part of the meaning. (shrink)

Kant did not initially intend to write the Critique of Practical Reason, let alone three Critiques. It was primarily the reactions to the Critique of Pure Reason and the Groundwork of the Metaphysics of Morals that encouraged Kant to develop his moral philosophy in the second Critique. This volume presents both new and first-time English translations of texts written by Kant’s predecessors and contemporaries that he read and responded to in the Critique of Practical Reason. It also includes several subsequent (...) reactions to the second Critique. Together, the translations in this volume present the Critique of Practical Reason in its full historical context, offering scholars and students new insight into Kant’s moral philosophy. The detailed editorial material appended to each of the eleven chapters helps introduce readers to the life and works of the authors, outlines the texts translated, and points to relevant passages across Kant’s works. (shrink)

Polish medical law does not explicitly regulate the possibility of off-label use of medicines. Such procedures therefore raise doubts in medical practice, where medicines are often prescribed beyond the Characteristic of Medicinal Product. This phenomenon particularly affects the treatment of children, as there is a lack of registered medicines in this age group, but they are registered for use in adults. Since such treatment goes beyond the scope of registration, a dilemma arises as to whether it is permissible and, if (...) so, under what conditions and whether sanctions are imposed on the medical professional using the off-label medicine. These issues are addressed in an article by Dr Maria Gutowska-Ibbs, entitled 'Off label - practical consequences of unclear legislation". The present study complements these considerations and is in part an ad vocem statement. The article attempts to differentiate between the use of off-label medicines and medical experiments, following the criterion of the purpose for which a given medical action is performed. The limits of admissibility of such actions under criminal law are also discussed in more detail. Off-label treatment is considered through the prism of the required precautionary rules, compliance with which is the antithesis of inadvertence. It is assumed that if the drug was administered in accordance with current medical knowledge and the treatment is adequate to the patient's condition, there is no violation of these rules, which excludes the imputation of inadvertence. An extensive section of the study is devoted to the issue of the patient's consent to treatment outside the indications. Above all, it emphasises the need to explain in detail to the patient the circumstances of prescribing such a drug and, on this basis, to obtain informed consent. It also stresses the importance of the written form of consent, which can have a significant evidentiary impact in potential litigation. (shrink)

In this paper I take up John Searle's account of ?Background capacities? to render intelligible the presupposed and hidden aspects of the background conditions that enable the performance of skilled movement. The paper begins with a review of Searle's initial account of Background capacities and how this picture can be applied to account for skilled movement in sport. Then an objection to this picture is addressed, claiming that Searle's initial picture might ?overrepresentationalise? background conditions. Moreover, this (...) objection prompts how Searle has modified his initial picture of background conditions in accordance with his more recent ?connection principle?. Searle's recent account of background conditions is then elaborated and discussed in the second half of the paper. The discussion emphasises three distinct levels of analysis in Searle's framework necessary to a full understanding of his background conditions: (i) the neurophysiological level; (ii) the descriptive higher-order practical skill level; and (iii) the logical level of integration. It is argued that Searle's logical framework is found plausible, but that more work is needed to better understand the background conditions of skilled movement in terms of neurophysiological capacities and practical skills from both scientific and philosophical perspectives. (shrink)

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers (...) may be as important as that of the students. (shrink)

Background: The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves. Objectives: This study describes operating theatre nurses’ experiences of ethical value conflicts in perioperative practice. Research design: Qualitative design, narratives from 15 operating theatre nurses and hermeneutic text (...) interpretation. Ethical consideration: The study followed ethical principles in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee. Findings: The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient’s care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient’s best. This occurred when operating theatre nurses’ competence was not taken seriously and was ignored in patient care. Conclusion: Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Background Theory of Delusion and Existential PhenomenologyRichard G. T. Gipps (bio) and John Rhodes (bio)KeywordsPhenomenology, psychological explanation, epistemology, schizophreniaSituating and Clarifying the PaperThe commentaries of Nassir Ghaemi and Giovanni Stanghellini help to sketch out the intellectual landscape of philosophical perspectives in psychiatry, and situate our paper within it. A happy convergence between the analytical philosophy perspective from which we were writing, and the existential–phenomenological paradigm described by (...) both authors, is the result. Stanghellini in particular carefully describes three main theories of existential deformations, tracing delusion formation back to either (i) a disturbance of meaning synthesis conceived as a dysfunction of a Husserlian consciousness, (ii) a disturbance of pre-reflective self-consciousness resulting in a kind of paralyzing hyperreflexivity, and (iii) (Stanghellini’s preferred model) a disturbance of embodiment. This final account views delusion as springing from a failure in the subject’s corporeal and praxical being-in-the-world. As the subject’s practical, pre-reflective grip on the world is loosened, so their minds become unconstrained by that understanding and practical rationality immanent within that grip, and thought, now unconstrained, starts to travel through delusional worlds. Stanghellini accordingly views our model as an example of a disembodiment theory, which allows it to overcome the disadvantages of the first two models, which may both, in their own ways, overvalue the rôle of (disturbances of) reflective consciousness in the formation (and delusional deformation) of everyday understanding.Being situated within a preexisting landscape has both its benefits and its disbenefits, the principle example of the latter being the potential assimilation of anything new to what has already been said. Thus, although we are grateful to our commentators for placing us on the larger historical and conceptual map, it may be helpful to briefly rehearse our motivations for drawing on the philosophical ideas of the Bedrock and Background in our theory of delusion. Our paper was primarily motivated by a concern that current, psychologically mainstream, cognitive models of delusion, although helpfully drawing our attention to common reasoning and perceptual deficits in the person with psychosis, fail to adequately account for what is delusional about delusions. It was, in [End Page 321] particular, to account for the certainty with which the deluded person clings to often quite extraordinary beliefs that we drew on the epistemological notion of the background. And although this epistemological notion fits quite neatly with ontological concerns regarding the embodied and praxical character of human existence, it is the particular epistemic rôle that it played in our theory—to do with the extraratiocinative constraint on judgement provided by the Background—that we wish to stress here.We return to this shortly, but first wish to comment briefly on two specific considerations raised by the commentaries. The first concerns Stanghellini’s claim that, for us, “when studying delusions, the focus should be on providing an adequate framework for understanding, rather than providing empirical hypotheses to be tested” (2008, 311–314). It seems to us, however, that both are equally important. What we wished to stress, however, was that empirical hypothesis testing may be led astray if it is not informed by an adequate framework for understanding. For example, most cognitive psychological experiments on delusions concern themselves with the individual’s ability to make appropriate guesses (e.g., regarding the color of beads in a bag), and their tendency to jump to conclusions; they do not concern themselves with the kinds of extraordinary conviction and certainty met with in delusion. The risk run by empirical researchers of cognitive factors in delusion is that a lack of a prior adequate theorization of delusion makes for accounts that are ultimately only of the formation, not of delusion in particular but rather of false or unusual beliefs more generally. An analytical approach, however, can help to explicate the ways in which the psychiatric concept of delusion fails to be adequately characterized by the quite general ‘external criteria’ of delusion (as Jaspers [1963] called them: falsity, stubbornness, uncommon), and aids in the construction of empirical hypotheses this time constrained by an understanding of the true ‘internal criteria’ of psychotic belief. Such an approach helps to spell out the... (shrink)

Gender inequity is a persistent problem in the United States. While the high school social studies classroom should be an important space for addressing gender inequity, there is significant underrepresentation of women in the curriculum. Thus, it is crucial that we understand how self-described feminist social studies teachers present women and gender-equity in their classrooms. In this mixed-methods study, the researchers examined the beliefs and practices of six feminist-identifying teachers. The results reveal commonalities across teachers related to classroom discourses, (...) curricular modifications, and professional practice, yet there were compelling differences based on whether or not the teacher subscribed to a critical feminist perspective or a liberal feminist perspective. While all the teachers in the study saw themselves as change agents, teachers who operated from a critical feminist lens focused more on structural gender inequity as a means to eliminate sexism, whereas teachers who operated from a liberal lens focused more on individual acts of sexism and greater inclusion of women—often individual women—in the curriculum. This study contributes to the scarce research on feminism in social studies and provides tools for practitioners who want practices that are more inclusive. (shrink)

Normative pictures are in use in various fields of legal practice. A background knowledge enables the understanding of this sort of pictures and affects both the morphology of the normative picture and its practical use. This paper is divided into two parts. The first part will focus on the morphology of normative pictures. The second part of the paper focuses on the different uses of normative pictures. Normative pictures with the same morphology can play very different roles because their (...) relationship with the rules can vary. (shrink)

In recent years, many disciplines have become interested in the scientific study of morality. However, a conceptual framework for this work is still lacking. In The Moral Background, Gabriel Abend develops just such a framework and uses it to investigate the history of business ethics in the United States from the 1850s to the 1930s. According to Abend, morality consists of three levels: moral and immoral behavior, or the behavioral level; moral understandings and norms, or the normative level; and (...) the moral background, which includes what moral concepts exist in a society, what moral methods can be used, what reasons can be given, and what objects can be morally evaluated at all. This background underlies the behavioral and normative levels; it supports, facilitates, and enables them. Through this perspective, Abend historically examines the work of numerous business ethicists and organizations--such as Protestant ministers, business associations, and business schools--and identifies two types of moral background. "Standards of Practice" is characterized by its scientific worldview, moral relativism, and emphasis on individuals' actions and decisions. The "Christian Merchant" type is characterized by its Christian worldview, moral objectivism, and conception of a person's life as a unity. The Moral Background offers both an original account of the history of business ethics and a novel framework for understanding and investigating morality in general. (shrink)

The experimental revolution in the social sciences is one of the most significant methodological shifts undergone by the field since the ‘quantitative revolution’ in the nineteenth century. One of the often valued features of social science experimentation is precisely the fact that there are clear methodological rules regarding hypothesis testing that come from the methods of the natural sciences and from the methodology of RCTs in the biomedical sciences, and that allow for the adjudication among contentious causal claims. We examine (...) critically this claim and argue that some current understandings of the practices that surround social science experimentation overestimate the degree to which experiments can actually fulfil this role as “objective” adjudicators, by neglecting the importance of shared background knowledge or assumptions and of consensus regarding the validity of the constructs involved in an experiment. We take issue with the way the distinction between internal and external validity is often used to comment on the inferential import of experiments, used both among practitioners and among philosophers of science. We describe the ways in which the more common use of the internal/external distinction differs from Cook and Campbell’s original methodological project, in which construct validity and the four-fold validity typology were all important in assessing the inferential import of experiments. We argue that the current uses of the labels internal and external, as applied to experimental validity, help to encroach a simplistic view on the inferential import of experiments that, in turn, misrepresents their capacity to provide objective knowledge about the causal relations between variables. (shrink)

The commodification of silence responding to a disturbing environment is integrated in the growing attention economy. This paper suggests that the idea of silence embedded in these products preclude fruitful understandings of—and interventions in—theproblematics they address, and it proposes Cage’s silence as a more efficacious model for understanding our problems with a disturbing environment, and a better practice for intervening in it. Informed by Yves Citton’s ecology of attention the paper argues that Cage’s silence centers the interplay of attention, subjectivity (...) and intentionality, as it takes play between us and the background, which to some extent produces us. And finally, it suggests that the Cagean practice of paying attention to this background is what Citton calls a “micropolitics of attention”, because it reveals the background as a battleground. (shrink)

The spiritual experience is, somehow, closer to what is proper to the contemporary scientific experiment: both are ways of tryout. A follower of such path needs to meet the requirements comparable with those of scientific experiment : rules and criteria of verification. Yet the result of this spiritual quest is on another level, because it grants access to a reality beyond our common-sense perception. To express the contents of this experience is extremely difficult, and the normal usage of words is (...) inadequate. And, with any generation in history, expressing the specificity of this experience becomes always a question of novelty. This is due to a different cultural and social background, of a different “field of experience”. I consider that nowadays we can better understand the rigor of a spiritual path as well as its concreteness, tracking the significance of spiritual practice for a more complex understanding of reality. But at the same time, new spiritual experiences, made in the actual contexts, can offer new solutions and new answers to the contemporary social and cultural challenges. Spirituality, understood as a practice following a particular religious tradition and aiming personal and community’s betterment, has the ability to provide empathy for the other, because somebody having a spiritual practice can recognize a similar need of any other human. “To reconcile” can have many meanings, from reconciling individuals to reconciling neighborhoods, communities, entire countries, to which the reconciliation with self gathers. (shrink)

The concept of human gene therapy came on the heels of fundamental discoveries on the nature and working of the gene. However, realistic prospects to correct the underlying cause of recessive genetic disorders through the transfer of wild‐type alleles of defective genes had to wait for the arrival of recombinant DNA technology. These techniques permitted the isolation and insertion of genes into the first recombinant delivery systems. The realization that viruses are natural gene carriers provided inspiration for gene therapy and, (...) as engineered vectors, viruses became prominent gene delivery vehicles. Nonetheless, when put in the context of human and non‐human primate studies, all vectors fell short of success regardless of their viral or non‐viral origin. Recognition of issues such as inefficient gene transfer and short‐lived or scant expression in the relevant cell type(s) prompted researchers to refine and develop several gene delivery systems, in particular those based on retroviruses, adeno‐associated viruses and adenoviruses. Concomitantly, available technology was deployed to tackle disorders that require few genetically corrected cells to attain therapy. BioEssays 27: 506–517, 2005. © 2005 Wiley periodicals, Inc. (shrink)

Combating homophobia, racism, sexism, and other forms of discrimination and violence in our society requires more than just focusing on the overt acts of prejudiced and abusive individuals. The very intelligibility of such acts, in fact, depends upon a background of shared beliefs, attitudes, and behaviors that together form the context of social practices in which these acts come to have the meaning they do. This book, inspired by Wittgenstein as well as feminist and critical race theory, shines (...) a critical light on this background in order to show that we all share more responsibility for the persistence of oppressive social practices than we commonly suppose—or than traditional moral theories that connect responsibility just with the actions, rights, and liberties of individuals would lead us to believe. First sketching a nonessentialist view of rationality, and emphasizing the role of power relations, Peg O’Connor then examines in subsequent chapters the relationship between a variety of "foreground" actions and "background" practices: burnings of African American churches, hate speech, child sexual abuse, coming out as a gay or lesbian teenager, and racial integration of public and private spaces. These examples serve to illuminate when our "language games" reinforce oppression and when they allow possibilities for resistance. Attending to the background, O’Connor argues, can give us insight into ways of transforming the nature and meaning of foreground actions. (shrink)

This article aims to introduce the recent movements regarding philosophical practice in Japan. In order to understand them in a better way, the historical development and background of philosophical practice shall be shown briefly in the first part. In the second part, three cases of relatively popular philosophical practices in Japan, that is, philosophy cafe, philosophy for/with children and philosophical consulting in the business settings are described as successful practices.

Background: The ability to consent promotes children’s access to health services. Healthcare providers should assess and arrive at a clinical judgement about the child’s maturity and mental capacity to obtain valid consent. Research objective: The objective of the study was to determine practices employed by South African healthcare providers to obtain consent for treatment from children. Research design: A qualitative, explorative, descriptive research design was used and the study was contextual. Participants and research context: In all, 24 healthcare (...) providers (professional nurses and medical practitioners) were purposively sampled from a hospital and primary health clinics. Semi-structured interviews were used. Ethical consideration: Ethical approval was obtained from the Institutional Review Board and gatekeepers. Written informed consent was obtained from each participant. Findings: Healthcare providers’ current practices in obtaining consent from children revealed inconsistency in implementation as well as the yardstick used to determine children’s mental capacity. Building trust with children, sharing information and assessment were interlinked in obtaining consent. Discussion: The inconsistent practice has implications for children’s access to healthcare services. Conclusion: Inconsistent practices in the implementation of consent laws have the potential to violate children’s rights to bodily and psychological integrity, access to health services and having their opinions heard and be taken into consideration. Through uncovering the current perceptions and practices and a literature review, guidelines intended for use by the Department of Health could be developed. (shrink)

Background Defensive medicine is physicians’ deviation from standard medical care which is primarily intended either to reduce or avoid medico legal litigation. Although the Federal Ethics Committee review in Ethiopia has shown that applications for medical/surgical error investigation claims are increasing at an alarming rate, there is no study to date done to estimate the degree of defensive practice done by the physicians with an intention of avoiding this increasing legal claim. This study assessed the practice of defensive medicine (...) among highly litigious disciplines (surgery) and described factors associated with its practice. Methods Cross sectional quantitative study using online survey questionnaires was conducted to assess the degree of defensive practice and six factors (age, years of experience, specialty, monthly income, place of practice and previous medico legal history) associated with its practice were assessed among surgeons working in Ethiopia. Results A total of 430 surgeons directly received an online survey questionnaire and 236 of them successfully completed the questionnaire making the response rate 51.2%. Nearly half of the study participants (51.7%) were aware of the concept of defensive medicine and 174 (74%) reported performing one form of defensive practice. Twenty-nine (12.3%) of the participants have legal dispute history, though only 1.3% of them ended up in penalty. Avoiding high risk procedures was the commonest defensive act performed by 60% of the participants, followed by ordering tests unnecessarily (52.1%). Multinomial logistic regression model showed that there was no association between age of the participant, place of practice, year of experience and defensive practice. This model also showed that cardiothoracic and vascular surgeons perform less defensively than surgeons with other specialty with P value of 0.02. Conclusion The practice of defensive medicine is widespread among surveyed Ethiopian surgeons and further studies are required to objectively estimate the effect of defensive practice on the health care system of the country. Policy makers need to develop strategy towards decreasing this high rate of defensive practice. (shrink)

Background: The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery. Aim: To present (a) the arguments for and against conscientious (...) objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice. Design: Discussion paper. Ethical considerations: Ethical guidelines has been followed at each stage of this study. Findings: Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient’s rights. Discussion and conclusion: Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice. (shrink)

Background There is a need for clearer guidance for pharmacists regarding their responsibilities when selling complementary medicines. A recently published ethical framework provides guidance regarding the specific responsibilities that pharmacists need to meet in order to fulfil their professional obligations and make a positive contribution to health outcomes when selling complementary medicines. Objective Evaluate the acceptability and feasibility of a new ethical framework for the sale of complementary medicines in community pharmacy. Methods Australian community pharmacists were invited to participate (...) in online focus groups and interviews. Participants were recruited via multiple methods, including social media and the professional networks of pharmacy groups. Participants were provided the ethical framework prior to the discussion. Discussions were transcribed verbatim and analysed using thematic analysis. Results Seventeen community pharmacists participated in the study. There was good representation among participants in terms of gender, years of practice, pharmacy location and script volume. Participants differed in how proactive they were in relation to selling and providing advice on complementary medicines, how they interpreted evidence in relation to complementary medicines, and how they navigated their practice within the retail environment of community pharmacy. The majority of participants found the framework was acceptable for practice and was feasible for implementation with targeted support. Participants identified two important areas for targeted support in implementing the framework: improved access to evidence-based information resources on complementary medicines and independent evidence-based education and training on complementary medicine for pharmacists and pharmacy support staff. Conclusion The ethical framework addresses an important gap in providing specific professional guidance to pharmacists when selling complementary medicines. The results of the study suggest that the framework may be acceptable to community pharmacists and be feasible to implement with targeted support. (shrink)

Examines Searle's theory of intentionality. The author argues that the three reasons given by Searle in support of his hypothesis of a background, which underlies our intentional states, are inconclusive at best.

Background People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. Method This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk (...) of suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. Results The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. Conclusion There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them. Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area. (shrink)

Background The twenty first- century marked the exponential growth in the use of intelligent robots and artificial intelligent in nursing compared to the previous decades. To the best of our knowledge, this article is first in responding to question, “Can nurses in clinical practice ascribe responsibility to intelligent robots and artificial intelligence when they commit errors?”. Purpose The objective of this article is to present two worldviews (anthropocentrism and biocentrism) in responding to the question at hand chosen based on (...) the roles of the entities involved in the use of intelligent robots and artificial intelligence in nursing. Methods The development of this article was motivated by the immense discoveries, the current landscape, and nurses’ role in relation to advanced technologies in healthcare. The paper begins the discussion by situating the use of intelligent robots and artificial intelligence in nursing and healthcare and presenting its ethical and moral implications. Then, we presented the two worldviews: anthropocentrism and biocentrism which are used to respond to the task at hand. Results Anthropocentrism puts humans in the center in terms of moral standing and thus responsibility rests on them alone. Biocentrism declares that all creations deserve moral consideration and thus responsibility is equally allocated to all entities. Within these two worldviews, consensus development was offered to resolve these issues. Consensus provides clarity and democracy between and among the societies. Conclusions The findings of this article can be basis in (1) instituting mechanisms of robust peer review and a rigorous series of simulation before adopting or implementing intelligent robots and artificial intelligence in clinical practice; (2) education and training of highly specialized nurse practitioners who can be focal persons in responding to ethical and moral issues with regard to these advanced technologies; and (3) harmonization of robotics research, manufacturing, and clinical practice. (shrink)

Background: This study was developed as a result of a court case involving conflicts between midwives’ professional practice and their faith when caring for women undergoing abortions in Scotland. Research questions: What are practising Roman Catholics’ perspectives of potential conflicts between midwives’ professional practice in Scotland with regard to involvement in abortions and their faith? How relevant is the ‘conscience clause’ to midwifery practice today? and What are participants’ understandings of Canon 1398 in relation to midwifery practice? Research design: (...) The theoretical underpinning of this study was Gadamer’s hermeneutic out of which the method developed by Fleming et al. involving a five-stage approach was utilised. Participants and research context: The research was conducted in the south of Scotland. A purposive sampling method was used. Eight participants who were practising Roman Catholics familiar with the subject of conscientious objection who were either midwives, lawyers (civil, canon or both) or priests contributed. Ethical considerations: The major ethical issues related to respect for autonomy, maintaining confidentiality and obtaining voluntary informed consent. Parish priests agreed to act as gatekeepers to prospective participants. All legal requirements were addressed regarding data collection and storage. Approval was given by the ethics committee of the university with which one of the researchers were associated. Findings: Three key themes provide an understanding of the situation in which midwives find themselves when considering the care for a woman admitted for an abortion: competing legal systems, competing views of conscience and limits of participation. Conclusion: Clear guidelines for practice should be developed by a multi-professional and consumer group based on an update of the abortion law to reflect the change from a surgical to medical procedure. Clarification of Canon 1398 in relation to what is and is not participation in the procurement of abortion would be of benefit to midwives with a conscientious objection. (shrink)

Scientific risk evaluations are constructed by specific evidence, value judgements and biological background assumptions. The latter are the framework-setting suppositions we apply in order to understand some new phenomenon. That background assumptions co-determine choice of methodology, data interpretation, and choice of relevant evidence is an uncontroversial claim in modern basic science. Furthermore, it is commonly accepted that, unless explicated, disagreements in background assumptions can lead to misunderstanding as well as miscommunication. Here, we extend the discussion on (...) class='Hi'>background assumptions from basic science to the debate over genetically modified (GM) plants risk assessment. In this realm, while the different political, social and economic values are often mentioned, the identity and role of background assumptions at play are rarely examined. We use an example from the debate over risk assessment of stacked genetically modified plants (GM stacks), obtained by applying conventional breeding techniques to GM plants. There are two main regulatory practices of GM stacks: (i) regulate as conventional hybrids and (ii) regulate as new GM plants. We analyzed eight papers representative of these positions and found that, in all cases, additional premises are needed to reach the stated conclusions. We suggest that these premises play the role of biological background assumptions and argue that the most effective way toward a unified framework for risk analysis and regulation of GM stacks is by explicating and examining the biological background assumptions of each position. Once explicated, it is possible to either evaluate which background assumptions best reflect contemporary biological knowledge, or to apply Douglas' 'inductive risk' argument. (shrink)

Background: Doctors should disclose the diagnosis to patients according to the principle of autonomy. However, not disclosing the diagnosis and prognosis to cancer patients remains common in mainland China. Objective: The study explored the experiences and attitudes of patients with cancer, family members, and the medical staff in truth-telling. Research design: A quantitative survey with three closed-ended questionnaires was conducted. Participants: In all, 137 patients with cancer, 134 family members caring for cancer cases, and 54 medical staff were surveyed. (...) Descriptive statistics were used to summarize all characteristics, and the chi-square test was performed to analyze group differences in attitudes toward cancer disclosure. Ethical considerations: This study was approved by the Committee on Ethics of Biomedicine Research, at the Second Military Medical University (HJEC-2018-YF-001). Informed consent was obtained from all participants prior to study commencement. Findings: A total of 59.8% of patients were informed about their diagnosis within 1 week, and 19.7% inferred theirs. The medical staff preferred to prioritize family members in informing about patient diagnosis while 77.4% of patients preferred to be told the whole truth at the time of initial diagnosis. More patients than family members and medical staff wanted the patients to be informed about the diagnosis ( p < 0.001). A significant difference was found between the patients and family members regarding who should tell the patients. Discussion: The willingness of patients in knowing the truth was underestimated by their family members as well as the medical staff. Guessing the truth indirectly may exert negative effects on the patients, and not telling the truth is inappropriate in patients who want to be informed. Conclusion: Disclosure of a cancer diagnosis is a complex process involving medical practice, as well as a range of cultural, ethical, and legal factors. The medical staff should first assess each patient’s willingness in truth-telling and inform about disease diagnosis with respect. Emotional support and comfort from family members are encouraged. Anyone in the patient’s care team, especially nurses, could be integrated in the process of truth-telling. (shrink)

Background Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Method Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The (...) findings revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one’s interests unjustly considered. Results Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient’s needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. Conclusion Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient’s interests and the care provided, despite existing compensation systems. (shrink)

Virtue, as a tendency toward goodness, has an interrelated structure made up of a stable disposition of intentions and emotions on the one hand and the ability to make rational analysis and obtain moral knowledge on the other. All these elements of knowing, feeling, and willing in the structure of virtue cannot be fully understood merely from a psychological perspective. Emotion, will, and rationality in virtue always have certain moral content. Virtue, as a structure with good disposition, constitutes a moral (...) agent and consequently an intrinsic foundation for moral practice. Of course, virtue is not a priori. On the contrary, its development is closely associated with an individual’s social and historical background. Because of virtue, an agent goes beyond the rational compulsion and intended efforts into a realm of nature. (shrink)

Background: The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. Objectives: This study explored nurses’ care practices at (...) the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. Findings: A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Discussion: Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Conclusion: Despite the avoidance of death talk and nurses’ lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values. (shrink)