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)

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)

Berger and Miller assert that race and ethnicity based cultural competence is a failure because medicine grounds its conceptualization of cultural competence on a “flawed” understanding of r...

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)

Machiavellianism, emotional intelligence and social competence: Are Machiavellians interpersonally skilled? Machiavellians are usually associated with unusually high interpersonal skills which seem to be vital for effective manipulation of other people. However, the current research has not confirmed such an opinion. The aim of this study was to examine relations between Machiavellianism and self-report emotional intelligence, self-report social competences and recognizing emotions from facial expressions. Mach was negatively correlated with EI and SC overall result and with subscales of social competences (...) in intimate situations and in situations requiring social exposure. There was no correlation between Mach and recognizing emotions and between Mach and social competences in situations requiring assertiveness. Exploratory path analyses showed a direct negative association between Mach and EI, SC-I and SC-ES. Mach predicted indirectly SC-I, SC-ES and SC-A. (shrink)

In this paper, I present an account of group competence that is explicitly framed for cases of epistemic performances. According to it, we must consider group epistemic competence as the group agents’ capacity to produce knowledge, and not the result of the summation of its individual members’ competences to produce knowledge. Additionally, I contend that group competence must be understood in terms of group normative status. To introduce my view, I present Jesper Kallestrup’s denial that group (...) class='Hi'>competence involves anything over and beyond the aggregation of individual competences. I have divided my response into two parts. First, I compare two conceptions of competence from Ernest Sosa’s reliabilist virtue epistemology, Thinking about oneself: The place and value of reflection in philosophy and psychology, Springer, 2019) and David Löwenstein’s account of know-how. Second, I take the results from this comparison and apply them to the issue of group know-how, by the hand of Orestis Palermos and Deborah Tollefsen’s twofold approach to the topic Socially extended epistemology, Oxford University Press, 2018). Finally, I return to Kallestrup’s denial to make my point in favour of the conception of genuine group competence as the group normative status to achieve success. (shrink)

If one of the most important aims of education on military ethics is to strengthen moral competence, we argue that it is important to base ethics education on virtue ethics, the Socratic attitude and the process of ?living learning?. This article illustrates this position by means of the example of a ?train the trainer? course on military ethics for Non-Commissioned Officers (NCOs), which is developed at the Netherlands Defence Academy, and uses a number of examples both from its structure (...) and from experiences from its actual use. (shrink)

BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally (...) children of 11.2 years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (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)

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

At the centre of responsible management (RM) learning is the development of managerial competence for ethics, responsibility, and sustainability (ERS). Important contributions have been made from each: the ethics, responsibility, and sustainability disciplines. However, we are yet to integrate these disciplinary contributions into a comprehensive interdisciplinary RM competence framework that corresponds to the interdisciplinary nature of RM challenges. We address this priority in this paper and report on the findings of an integrative structured literature review of 224 management (...) competence articles across the ERS disciplines. Our thematic template analysis has produced an interdisciplinary RM competence framework of three layers of personal, behavioural, and intellectual competences and independent and interdependent competence dimensions. The resulting 3 × 2 competence matrix framework accommodates 33 interdisciplinary ERS competence themes and 90 subthemes in the six competence domains of _being_ and _becoming_, _acting_ and _interacting_, _knowing_ and _thinking_. To the RM discussion, we contribute an interdisciplinary competence framework that enables the development of responsible managers who tackle the inherently interdisciplinary issues of RM. To the competence discussion, we contribute the interdependent competence dimension and future research directions through the lens of response-ability. _JBE Section:_ Business Ethics Learning and Education. (shrink)

A form of elitism undermines much uniting on voter competence. The elitist move occurs when an author uses a self‐serving worldview as the basis for evaluating voters. Such elitism is apparent in widely cited measures of “political knowledge” and in common claims about what voters should know. The elitist move typically limits the credibility and practical relevance of the analysis by leading writers to draw unreliable conclusions about voter competence. I propose a more constructive way of thinking about (...) what voters know. Its chief virtue is its consistency with basic facts about the relationship between information and choice. (shrink)

As a study involving diabetes care demonstrates, children sometimes have a much more sophisticated capacity for taking charge of their own health care decisions than is usually recognized in bioethics. Protecting these children from their disease means involving them in their treatment as much as possible, helping them to understand it and take responsibility for it so that they can navigate the multitude of daily decisions that become part of the diabetes medical regimen.

The paper challenges William Alston’s argument against doxastic deontology, the view that we have epistemic duties concerning our beliefs. The core of the argument is that doxastic deontology requires voluntary control over our beliefs, which we do not have. The idea that doxastic deontology requires voluntary control is supposed to follow from the principle that ought implies can. The paper argues that this is wrong: in the OIC principle which regulates our doxastic duties the “can” does not stand for the (...) ability to shape our beliefs voluntarily. As an examination of everyday examples shows, it stands for cognitive competence, the reliable ability to acquire beliefs in compliance with the epistemic norms. The doxastic OIC principle asserts, in brief, that one is only obliged to believe something if one’s cognitive capacities are sufficiently strong. It is also explained why the doxastic duties do not require voluntary control as opposed to moral duties. This understanding of doxastic duties saves our everyday doxastic deontic judgments from Alston’s argument, but does not help the deontological conception of justification, which understands justification as not violating one’s epistemic duties. It actually provides another argument against the deontological conception: if the OIC regulating our doxastic duties is construed as suggested, the deontological conception of justification implies that one’s doxastic duties and, consequently, whether one’s belief is justified depend on one’s cognitive competence. Since cognitive competence varies from person to person, justification will not matter to truth and knowledge in the way epistemic justification is supposed to do. (shrink)

We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and across institutions.

Children's competence to refuse or consent to medical treatment or surgery tends to be discussed in terms of the child's ability or maturity. This paper argues that the social context also powerfully influences the child's capacity to consent. Inner attributes and external influences are discussed using an analogy of the genes and the stars.

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)

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)

This paper1 aims to develop a model of practitioner narrative competence specifically for mental health care. I begin by considering the status of narratives as a form of evidence. Following Rita Charon and Cheryl Misak, I claim that there is no distinction to be made between evidence-based medicine and narrative medicine. I then explore Charon’s model of practitioner narrative competence, and suggest that it can be fruitfully adapted for mental health care contexts, a project for which I employ (...) Jennifer Radden and John Z. Sadler’s psychiatric ethics. This project brings together two independently promising accounts to develop what I refer to as the adapted model of... (shrink)

Research in the globalization era has emphasized the importance of global competence and its integration into language teaching and learning. This article discussed the current focus of global education through the integration of global competence in English as a Second Language in Malaysia. The country’s global competence development among ESL teachers and students, along with its integration into English lessons, were identified, satisfying the need to achieve quality education. The global competence integration of ESL teachers will (...) meet the fourth United Nations Sustainable Development Goal, which strives for quality education. The global education goals form a critical starting point of this article, which articulates the connection to the targets in SDG 4. Hence, this article investigated the significance of global competence in language teaching and learning in Malaysia. Overall, the integration of global competence among ESL teachers can provide life-long learning, enhancing the quality of education. (shrink)

This paper addresses the role of social emotional competence in the emotional and behavioral problems and learning outcomes of preschool children based on their parents’ and teachers’ evaluations. In this study, we compared the perceptions of teachers and parents when evaluating the same child using the multi-informant assessment. First, the associations and differences between both the informant evaluations were investigated. Second, the correlation of the social emotional competence and emotional, and behavioral difficulties among preschool children was analyzed, separately (...) addressing their parents’ and teachers’ evaluations. Third, the role of the preschool children’s social emotional competence in their emotional and behavioral problems, and learning outcomes was investigated building the regression and mediation models. The sample consisted of 507 preschool children and their parents and teachers. Both informants completed the Strengths and Difficulties Questionnaire and Social Skills Improvement System Social-Emotional Learning Brief Scales, and teachers reported on each child’s learning outcomes. When comparing both informants’ evaluations, positive associations were found between teacher and parental evaluations of prosocial behavior and emotional, and behavioral difficulties of preschool children, as well as self-management. Parents evaluated their children higher than teachers in conduct problems, hyperactivity, prosocial behavior, and total difficulty, while teachers evaluated children higher than parents in social emotional competence. According to teachers, the social emotional competence of preschool children was negatively correlated to all difficulty scales, and positively related to the prosocial behavior scale. The demographic variables, as well as parental socioeconomic status and children’s belonging to a vulnerable group were not found to be significantly associated with the preschool children’s learning outcomes. However, social emotional competence remains a significant variable in teacher-rated learning outcomes of preschool children even if sociodemographic variables are controlled. Our findings indicate that a higher level of social emotional competence and lower levels of social, emotional, and behavioral difficulties are related to a higher preschoolers’ academic learning in their teachers’ evaluation. This suggests the importance of early facilitation of social emotional competence as a key factor for academic success and more positive behavioral outcomes. (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)

This paper describes the discourses underlying nursing teachers’ talk about their own norm‐critical competence. Norm criticism is an approach that promotes awareness and criticism of the norms and power structures that exert an excluding effect in society in general and in the healthcare encounter in particular. Given the unequal relationships that can exist in healthcare, for example relationships shaped by racism, sexism and classism, a norm‐critical approach to nursing education would help illuminate these matters. The studied empirical material consisted (...) of focus group interviews. Nursing teachers discussed their norm‐critical competence based on the university course “Norm‐Aware Caring” in which they had recently participated. Through a critical discourse analysis, three discourses were identified in their talk, all of which had the potential to disrupt traditional, normative nursing education. However, in all three discourses there was an underlying discourse of normality, clearly positioning the teachers as exemplifying the “normal.” The binary constructed between normality and otherness contradicts a basic tenet of the norm‐critical approach and may hamper the development of genuine norm‐critical competence in nursing education. (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 this paper we discuss an often-neglected topic in the literature on the ethics of voting. Our aim is to provide an account of what states are obligated to do, so that voters may fulfil their role as public decision-makers in an epistemically competent manner. We argue that the state ought to provide voters with what we call a substantive opportunity for competence. This entails that the state ought to actively foster the epistemic capabilities that are necessary to achieve (...) competent participation in political decision-making practices. (shrink)

Over the past few years, individual competencies for sustainability have received a lot of attention in the educational, sustainability and business administration literature. In this article, we explore the meaning of two rather new and unfamiliar moral competencies in the field of corporate sustainability: normative competence and action competence. Because sustainability can be seen as a highly complex or ‘wicked’ problem, it is unclear what ‘normativity’ in the normative competence and ‘responsible action’ in the action competence (...) actually mean. In this article, we raise the question how both these moral competencies have to be understood and how they are related to each other. We argue for a virtue ethics perspective on both moral competencies, because this perspective is able to take the wickedness of sustainability into account. It turns out that virtue ethics enables us to conceptualize normative competence and action competence as two aspects of one virtuous competence for sustainability. (shrink)

Emotional competence has an important influence on development in school. We hypothesized that reading and discussing children’s books with emotional content increases children’s emotional competence. To examine this assumption, we developed a literature-based intervention, named READING and FEELING, and tested it on 104 second and third graders in their after-school care center. Children who attended the same care center but did not participate in the emotion-centered literary program formed the control group ( n = 104). Our goal was (...) to promote emotional competence and to evaluate the effectiveness of the READING and FEELING program. Emotional competence variables were measured prior to the intervention and 9 weeks later, at the end of the program. Results revealed significant improvements in the emotional vocabulary, explicit emotional knowledge, and recognition of masked feelings. Regarding the treatment effect for detecting masked feelings, we found that boys benefited significantly more than girls. These findings underscore the assumption that children’s literature is an appropriate vehicle to support the development of emotional competence in middle childhood. (shrink)

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)

This is a précis of my book "Know-how as Competence. A Rylean Responsibilist Account".

About a year after the start of the Iraq War, a story broke about the abuse of Iraqi detainees by American soldiers at the Abu Ghraib prison. Editorialists and science writers noted affinities between what happened at Abu Ghraib and Philip Zimbardo’s famous 1971 Stanford Prison Experiment. Zimbardo’s experiment is part of the “situationist” literature in social psychology, which suggests that the contexts in which agents act have a larger influence on behavior, and that personality traits have a smaller influence, (...) than is ordinarily supposed. Recently, there has been increased interest among philosophers in research like Zimbardo’s and its potential for influencing ethical theories. This increase is due in part to the publication of John Doris’ Lack of Character. More recently, Doris and Dominic Murphy have argued that soldiers, including those at Abu Ghraib, often act under conditions of moral excuse because the situational pressures to which they are exposed impair their capacities for moral judgment. I argue that soldiers can be morally responsible for wartime behavior even if their moral capacities have been substantially impaired. (shrink)

The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor–patient relationship within which consent is given.

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)

Background Effective healthcare delivery in today's diverse society necessitates healthcare providers' adeptness in navigating cultural and religious nuances in patient care. However, the integration of cultural competence training into medical education remains inadequate, particularly concerning the care of Muslim patients. In response, we introduce a novel educational intervention aimed at enhancing intercultural proficiency among medical students, emphasizing care for Muslim patients. Methods The intervention comprised interactive seminars and simulated patient sessions. With a bespoke and the Cross-Cultural Competence of (...) Healthcare Professionals (CCCHP-27) questionnaire the pre- and post-course intercultural competencies of n = 31 medical students of the Medical Faculty of Jena University were assessed. Additionally, there was a control group consisting of 34 students. Statistical analyses including descriptive statistics, paired samples t-tests, Wilcoxon tests, correlation analysis, Mann–Whitney U-tests, and multiple regression analysis were employed for data analysis. Results Results of the bespoke questionnaire reveal significant improvements in intercultural knowledge (median pre 1.0 (0.6 – 1.6), median post 2.2 (2.4-2.8), p < 0.001) and in knowledge regarding Muslim patients (median pre 1.0 (0.5 – 1.5), median post 2.5 (2-3), p < 0.001) following the course. Regarding the CCCHP-27, students demonstrated a significant improvement in their skills, with pre-assessment score of 4.10 (± 0.47) and post-assessment score of 4.38 (± 0.40), p = 0.001. Female participants and those with limited prior experience demonstrated greater gains (p = 0.005 and p = 0.053). Notably, the incorporation of a session with a simulated patient garnered favorable feedback, affirming the efficacy of practical application in consolidating learning outcomes. Discussion Our study emphasizes the importance of integrating intercultural competencies training into medical education and our findings underscore the efficacy of targeted educational interventions in enhancing intercultural competencies among medical students. For the assessment of intercultural competence, our bespoke questionnaire serves as a valuable addition to the German healthcare system. Conclusion Implementation of similar interventions into medical curricula nationwide is imperative to address the needs of diverse patient populations effectively. (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)

This study examined the effect of physical exercise on the life satisfaction among college students. On the basis of the Basic Psychological Need Theory, the mediating roles of competence and relatedness needs satisfaction and their differences among college students in physical education majors and non-PE majors were explored. The sample included 1,012 college students who were selected to participate in an online survey. Major findings were as follows: The total effect of physical exercise commitment on college students’ life satisfaction (...) was marginally significant while that of physical exercise adherence was not significant; The effect of physical exercise commitment was observed exclusively through the mediating role of relatedness need satisfaction, while that of physical exercise adherence was through both competence and relatedness needs satisfaction; In terms of differences caused by major, only one mediation path, that was, physical exercise → competence need satisfaction → college students’s life satisfaction was significant among PE majors. This study thus enriched the empirical research on the benefits of physical exercise to individual mental health, highlighted the particularity of college students majoring in PE, and provided targeted and sensible suggestions for the design of physical exercise intervention programs. (shrink)

In a previous study we examined reading, spelling, and maths skills in an unselected group of 129 Italian children attending fifth grade by testing various cognitive predictors; results showed a high degree of predictors’ selectivity for each of these three behaviors. In the present study, we focused on the specificity of the predictors by performing cross-analyses on the same dataset; i.e., we predicted spelling and maths skills based on reading predictors, reading based on maths predictors and so on. Results indicated (...) that some predictors, such as the Orthographic Decision and the Arithmetic Facts tests, predicted reading, spelling and maths skills in similar ways, while others predicted different behaviors but only for a specific parameter, such as fluency but not accuracy, and still others were specific for a single behavior. To interpret these results, we propose a novel model of learning skills separately considering factors in terms of competence, performance and acquisition. Reading, spelling and calculation skills would depend on the development of discrete and different abstract competences. By contrast, overlap among behaviors would be accounted for by defective acquisition in automatized responses to individual “instances”; this latter skill is item specific but domain independent. Finally, performance factors implied in task’s characteristics may contribute to the partial association among learning skills. It is proposed that this new model may provide a useful base for interpreting the diffuse presence of comorbidities among learning disorders. (shrink)

Taking seriously the value of cultural competence in healthcare requires at least three general commitments. First, it involves accepting the view that patients' health beliefs and behaviors are influenced to a significant degree by their own social and cultural practices. Second, it requires careful attention to how health professionals typically respond to patients' different social and cultural standards at various levels of the healthcare delivery system. And third, it calls for developing interventions that are sensitive to these first two (...) issues to assure the delivery of quality healthcare for culturally diverse patients. This much is plain, insofar as we are talking about the broadest of commitments necessary to support the value of cultural competence in healthcare. But what other, more specific commitments are implied in accepting the value of cultural competence? (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)

Recent findings suggest that medical students’ moral competence decreases throughout medical school. This pilot study gives preliminary insights into the effects of two educational interventions in ethics classes on moral competence among medical students in Munich, Germany. Between 2012 and 2013, medical students were tested using Lind’s Moral Competence Test prior to and after completing different ethics classes. The experimental group participated in principle-based structured case discussions and was compared with a control group with theory-based case discussions. (...) The pre/post C-scores were compared using a Wilcoxon Test, ANOVA and effect-size calculation. The C-score improved by around 3.2 C-points in the EG, and by 0.2 C-points in the CG. The mean C-score difference was not statistically significant for the EG or between the two groups. There was no statistical significance for the teachers’ influence on C-score. In both groups, students with below-average C-scores improved and students with above-average C-scores regressed. The increase of the C-Index was greater in the EG than in the CG. The absolute effect-size of the EG compared with the CG was 3.0 C-points, indicating a relevant effect. Teaching ethics with PBSCDs did not provide a statistically significant influence on students’ moral competence, compared with TBCDs. Yet, the effect size suggests that PBSCDs may improve moral competence among medical students more effectively. Further research with larger and completely randomized samples is needed to gain definite explanations for the results. (shrink)

In a time marked by the development of innovative treatments in healthcare and the need for health professionals to deal with resulting ethical dilemmas in clinical practice, this study was developed to determine the influence of the bioethics teaching on the moral competence of medical and nursing students. The authors conduct a longitudinal study using the Moral Competence Test extended version before and after attending the ethics curricular unit, in three nursing schools and three medical schools of Portugal. (...) In this questionnaire the participant is confronted with three ethical dilemmas and asked to evaluate arguments for and against the attitude of the main character. For both nursing and medical students, C-score was lower after the attendance of the ethics curricular units, with a statistically significant decrease in the total score for nursing students and a decrease not statistically significant for medical students. A multivariate analysis did not find any association between this decrease and gender, course, or age. The phenomenon of moral segmentation was observed, with better performance in the worker and judge dilemma, than in the doctor dilemma. These results highlight the need to reflect on the curricular strategies that can be implemented for health professionals to better develop moral competence and decision-making, allowing for the provision of humanized health care. (shrink)