Recent advancements in therapeutic and diagnostic medicine, along with the creation of large biobanks and methods for monitoring health technologies, have improved the prospects for preventing, treating, and curing illness. These same advancements, however, give rise to a plethora of ethical questions concerning good decision-making and best action. These ethical questions engage policymakers, practitioners, scientists, and researchers from a variety of fields in different ways. Collaborations between professionals in the medical and health sciences and the social sciences and humanities often (...) take an asymmetrical form, as when social scientists use ethnographic approaches to study the moral issues and practices of physicians. The ethics laboratory described in this article is a cross-sectoral and inter-disciplinary forum for collaborative investigation on important moral topics. It offers an experimental way of unpacking implied assumptions, underlying values, and comparable notions from different professional healthcare fields. The aim of this article is to present the ethics laboratory’s methodology. The article offers a model and a hermeneutical framework that rests on a dialogical approach to ethical questions. The model and the framework derive from a Danish research project, _Personalized Medicine in the Welfare State_. This article uses personalized medicine as a point of reference, though it offers an argument for the applicability of the model more broadly. (shrink)

The attention for Moral case deliberation has increased over the past years. Previous research on MCD is often written from the perspective of MCD experts or MCD participants and we lack a more distant view to the role of MCD in Dutch health care institutions in general. The purpose of this paper is to provide an overview of the state of the art concerning MCD in the Netherlands. As part of a larger national study on clinical ethics support in the (...) Netherlands, we will focus on the prevalence and characteristics of MCD in Dutch health. A mixed methods design was used in which we combined two survey questionnaires, two focus groups and 17 individual interviews with top managers or ethics support staff. The findings demonstrate that the prevalence of MCD is relatively high in Dutch health care, especially in mental health care. Institutions with MCD differ from institutions without MCD concerning size, kind of problems and importance of ideological background. Characteristic of MCD is that it often exists for 3 years or more, has a high participation of health professionals and middle managers and is both organized scheduled as unscheduled. As well integration in existing policy as key persons emerge as important issues in relation to the positioning of MCD. We conclude that MCD is a part of an integrated ethics policy and serves as a catalyst for such an integrated ethics policy. (shrink)

Scheinerman (2023) proposes that at the Human Genome Editing Initiative international summit (held in March 2023) there should have been a parallel, separate Citizens’ Jury, and that the Human Geno...

David Wiggins; XV*—Weakness of Will Commensurability, and the Objects of Deliberation and Desire, Proceedings of the Aristotelian Society, Volume 79, Issue 1, 1.

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals (...) bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

Ethics designates a structured process by which important human values and meanings of life are understood and tackled. Therein, the ability to discuss openly and reflect on (aka deliberation) understandings of moral problems, on solutions to these problems, and to explore what a meaningful resolution could amount to is highly valued. However, the indicators of what constitutes a high-quality ethical deliberation remain vague and unclear. This article proposes and develops a pragmatist approach to evaluate the quality of deliberation. Deliberation features (...) three important moments: (1) broadening and deepening the understanding of the situation, (2) envisioning action scenarios, (3) coming to a judgment based on the comparative evaluation of scenarios. In this paper, we propose seven criteria to evaluate ethical deliberations: (1) collaborative diversity, (2) experiential literacy, (3) organization of experiences, (4) reflective capacity to instrumentalize the experiences of others, (5) interactional creativity, (6) openness of agents, (7) quality of the reformulation of scenarios. These criteria are explained and applied to the three moments of deliberation. Based on these criteria, three kinds of outcomes for deliberations are identified and discussed: good ethical deliberations, partial ethical deliberations, bad ethical deliberations. Our proposal will guide researchers and practitioners interested in the evaluation of the quality of ethical deliberations. It provides a reference tool that allows them to identify the possible limitations of a deliberation and to implement actions aimed at correcting these limitations in order to achieve the desired qualitative objectives. (shrink)

Trust in the practice of rational deliberation is widespread and largely unquestioned. This paper uses recent work from business contexts to challenge the view that rational deliberation in a group improves decisions. Pressure to reach consensus can, in fact, lead to phenomena such as groupthink and to suppression of relevant data. Aggregation of individual decisions, rather than deliberation to a consensus, surprisingly, can produce better decisions than those of either group deliberation or individual expert judgment. I argue that dissent is (...) epistemically valuable, not because of the discussion it can provoke (Mill's and Longino's view about the benefit of dissent), but because dissenting positions often are associated with particular data or insights that would be lost in consensus formation. Social epistemologists can usefully pay attention to various methods of aggregation of individual opinion for their effectiveness at realizing epistemic goals. (shrink)

Volume 20, Issue 6, June 2020, Page 70-72.

A case study of an ethical dilemma concerning twin nine-year-old sisters in a persistent vegetative state is presented. This is illustrated by the use of a systematic ethical framework to examine the case and the resolution, which was ultimately obtained with nurse—parent interrelations, using the human becoming nursing theory.

I defend a deontological social contract justification of punishment for philosophers who deny free will and moral responsibility (FW/MR). Even if nobody has FW/MR, a criminal justice system is fair to the people it targets if we would consent to it in a version of original position deliberation where we assumed that we would be targeted by the justice system when the veil is raised. Even if we assumed we would be convicted of a crime, we would consent to the (...) imprisonment of violent criminals if prison conditions were better than the state of nature but deterring enough to prevent the state of nature. (shrink)

Ethics support staff help others to deal with moral challenges. However, they themselves can also experience moral challenges such as issues regarding (breaching) confidentiality when practicing ethics support. Currently there is no insight in these confidentiality issues and also no professional guidance for dealing with them. To gain insight into moral challenges related to Moral Case Deliberation (MCD), we studied a) beliefs and experiences of MCD facilitators regarding breaching confidentiality, b) considerations for (not) breaching confidentiality, and c) needs for an (...) ethics support tool. Data collection consisted of qualitative research methods: six semi-structured interviews; analyses of a) two recorded MCD sessions, and b) a focus group with MCD facilitators. Findings: MCD facilitators mention different conceptions and interpretations of confidentiality and various moral challenges. Questions concerning confidentiality ultimately cause reflections on roles and responsibilities of facilitators. Needs for ethics support vary from seeking advice to procedural and sometimes normative guidance for MCD facilitators. Education for MCD facilitators should focus on developing a concrete tool that stimulates awareness and reflection(skills). (shrink)

Volume 24, Issue 12, December 2024, Page 62-64.

In this essay, first the pragma-dialectical theory of strategic maneuvering is explained. Then the focus is on the conventionalization of communicative practices in communicative activity types and the institutional constraints it imposes on strategic maneuvering. Thus, an adequate background is created for discussing, on the basis of several recent projects, pragma-dialectical research of argumentative discourse in the political domain.

Contemporary Anglo-American political thought is witnessing a revival of theories of deliberative democracy. The principle of public argumentation, according to which the legitimation of a general norm is predicated upon a rational and open dialog among all those affected by this norm, constitutes their common underlying assumption. This assumption is itself grounded in the metatheoretical claim that arguing is the defining activity of a demos of free and equal members. Habermas' well-known formulation of communicative or discursive democracy represents one of (...) the earliest, most discussed, and indeed most emblematic versions of the existing models of deliberative democracy. It is here, I believe, that Castoriadis' political theory can prove exceptionally important as it provides a starting point and a solid ground for articulating one of the most incisive and convincing critiques of the limits and flaws of communicative democracy. Although Castoriadis himself never directly discussed deliberative democracy as such, we can try to approximate from various parts of his work what he might have thought about, especially when it comes to Habermas' model. (shrink)

Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the CARE model provides a (...) substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings. (shrink)

Two intuitions lie at the heart of our conception of free will. One intuition locates free will in our ability to deliberate effectively and control our actions accordingly: the ‘Deliberation and Control’ (DC) condition. The other intuition is that free will requires the existence of alternative possibilities for choice: the AP condition. These intuitions seem to conflict when, for instance, we deliberate well to decide what to do, and we do not want it to be possible to act in some (...) other way. I suggest that intuitions about the AP condition arise when we face ‘close calls,’ situations in which, after deliberating, we still do not know what we really want to do. Indeed, several incompatibilists suggest such close calls are necessary for free will. I challenge this suggestion by describing a ‘confident agent’ who, after deliberating, always feels confident about what to do (and can then control her actions accordingly). Because she maximally satisfies the DC condition, she does not face close calls, and the intuition that the AP condition is essential for free will does not seem to apply to her. I conclude that intuitions about the importance of the AP condition rest on our experiences of close calls and arise precisely to the extent that our deliberations fail to arrive at a clear decision. I then raise and respond to several objections to this thought experiment and its relevance to the free will debate. (shrink)

A traditional concern for determinists is that the epistemic conditions an agent must satisfy to deliberate about which of a number of distinct actions to perform threaten to conflict with a belief in determinism and its evident consequences. I develop an account of the sort that specifies two epistemic requirements, an epistemic openness condition and a belief in the efficacy of deliberation, whose upshot is that someone who believes in determinism and its evident consequences can deliberate without inconsistent beliefs. I (...) argue that conditions of both types are indispensable, and that they can be formulated so as to withstand the relevant objections. (shrink)

This is an inquiry into the economic psychology of trust: that is, what model of the political economy of complex liberal democracies is conducive to attitudes that allow difference to be perceived in the terms of ‘significant other’, rather than as a menacing or an irrelevant stranger. As a test case of prevailing perceptions of otherness in European societies, I examine attitudes towards Turkey’s accession to the European Union.

This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with a clear justification of why it is important to take best standards, norms, and physician judgment seriously and a clear (...) justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. (shrink)

In New Essays on Human Understanding, book II, chapter xxi Leibniz presents an interesting picture of the human mind as not only populated by perceptions, volitions and appetitions, but also by endeavours. The endeavours in question can be divided to entelechy and effort; Leibniz calls entelechy as primitive active forces and efforts as derivative forces. The entelechy, understood as primitive active force is to be equated with a substantial form, as Leibniz says: “When an entelechy – i.e. a primary or (...) substantial endeavour – is accompanied by perception, it is a soul” (NE II, xxi, §1; RB, 170). What about efforts, then? One is certainly the will. In NE, II, xxi, §5 Leibniz argues that volition is the effort (conatus) to move towards what one finds good and away from what one finds bad and that this endeavor arises from the perceptions we are aware of. As an endeavour results in action unless it is prevented, from will (which is always directed to the good) and power together follows action. However, this is not so simple. Leibniz argues that there is also a second class of efforts: “There are other efforts, arising from insensible perceptions, which we are not aware of; I prefer to call these ‘appetitions’ rather than volitions” (NE II, xxi, §5; RB, 173). Although there are appetitions of which one can be aware, usually these appetitions arise from the insensible petite perceptions and are consequently affecting us subconsciously. Now, although all minute perceptions are confused perceptions, they are always related to pleasure and displeasure and also to perfection and imperfection. From this follows that there can be different efforts present in the soul at the same time: the will which is directed to apperceived good and several separate appetitions which lead to different goals, both to those which bring about perfection and pleasure of the mind (joy) and those which bring about displeasure and imperfection (sorrow). These efforts are not only in conflict with each other but may also be in conflict with entelechy. A typical case is perceiving a sensual pleasure. Our entelechy which is always directed to final causes (perfection) may be in conflict with several different appetitions which are related in different ways to the sensual pleasure in question. If our understanding is developed enough, our will resists the temptation posed by the pleasure (agreeing with entelechy), but if the temptation is too strong, the appetitions outweigh the will and the resulting action bring about imperfection and sorrow as it is related to imperfection. In this paper I will argue that deliberation in the human soul is a battle of different endeavors described above: the entelechy in the soul strives according to its law-of-the-series towards its telos (perfection) and the will accompanies it by being automatically directed to the good. This thrust towards the apparent good is aided or hindered by the appetitions which can be thought as derivative forces in the Leibnizian dynamics. Depending on whether the predominant appetitions are related to good or bad desires, the deliberation succeeds or fails in achieving the real good which is the goal of human deliberation. The successs can be facilitated beforehand by developing our understanding so that we are less easily swept away by the derivative forces (NE II, xxi, §19). A central role in this task is played by strong willing. As Martha Bolton has noted in her recent paper, an essential feature of the basic, standing endeavors is that they are continuous – although the power balance in the soul changes from moment to moment, something lingers from our previous volitions. That is why Leibniz argues that we pave way for the future deliberations by our previous voluntary actions (NE II, xxi, §23). In contrast, the appetitions are temporary, fliegende Gedanken as Leibniz says in NE II, xxi, §12. Therefore there is a constant, always changing power balance between two kinds of endeavors in the soul: primitive active force versus derivative forces. I will argue that the behavior of the forces in the soul can be understood with a vectorial model which is related to Leibniz’s early ideas of calculus of variations and which was anticipated by Arnauld and Nicole’s Port-Royal Logic. The central idea in the model is that the options are in tension towards each other and the ratio between them at each moment determines the consequent outcome. The proper relationship between the endeavors is not a simple balance, two options which exhaust each other, but a case where different efforts complement each other: “Since the final result is determined by how things weigh against one another, I should think it could happen that he most pressing disquiet did not prevail; for even If it prevailed over each of the contrary endeavours taken singly, it may be outweighed by all of them together.” Leibniz continues : “Everything which then impinges on us weighs in the balance and contributes to determining a resultant direction, almost as in mechanics” (NE II, xxi, §40; RB, 193). The different endeavors can be understood as vectors leading to different directions and the end result is a certain direction that deliberation takes. The dynamical tension between the different endeavors presents a situation where everything affects everything and the following direction, the resulting volition follows more or less automatically. In Theodicy, §325 Leibniz describes the deliberation as follows: “One might, instead of the balance, compare the soul with a force that puts forth an effort on various sides simultaneously, but which acts only at the spot where action is easiest or there is least resistance” (Huggard, 322) This kind of dynamical tension can be understood in terms of the calculus of variations where there are several possible variations available but where the dynamics of the situation results in the decision taking the “easiest” route which is more or less objectively good depending on the level of the deliberator’s understanding. In his comments to Bayle’s note L of “Rorarius” Leibniz says: “The soul, even though it has no parts, has within it, because of the multitude of representations of external things, or rather because of the representation of the universe lodged within it by the creator, a great number, or rather an infinite number, of variations (Woolhouse & Francks (ed.), ‘New System’ and Associated Texts, 101). This kind of deliberation is comparable to God’s choice of the best world with the difference that God’s understanding is infinite which again results in the fact that the choice is the best possible. Whereas in nature the easiest route taken is always optimal as nature is God’s creation, in men the goodness or badness of men’s actions is dependent on their state of wisdom, that is, how developed their understanding is. The more wise men are, the more metaphysical goodness or perfection follows from their actions. (shrink)

This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden (...) rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels. Keywords: cost containment, democratic deliberation, fairness, justice, rationing CiteULike Connotea Del.icio.us What's this? (shrink)

By deliberation we understand practical reasoning with an end in view of choosing some course of action. Integral to it is the agent's sense of alternative possibilities, that is, of two or more courses of action he presumes are open for him to undertake or not. Such acts may not actually be open in the sense that the deliberator would do them were he to so intend, but it is evident that he assumes each to be so. One deliberates only (...) by taking it for granted that both performing and refraining from any of the acts under consideration are possible for one, and that which is to be selected is something entirely up to oneself. What is it for a course of action to be presumed as open, or for several courses of action to present themselves as a range of open alternatives? Answering these questions is essential for an understanding of deliberation and choice and, indeed, for the entire issue of free will and responsibility. According to one common view, a deliberator takes the considered options to be open only by assuming he is free to undertake any of them and, consequently, that whichever he does undertake is, as yet, a wholly undetermined matter. Built into the structure of deliberation, on this theory, is an indeterministic bias relative to which any deliberator with deterministic beliefs is either inconsistent or condemned to a fatalistic limbo. An unmistakable challenge is thereby posed: is there an alternative conception of the presuppositions underlying deliberation more congenial to a deterministic perspective yet adequate to the data? Convinced that there is, I develop a partial account of deliberation that, though highly similar to the aforementioned view, diverges at a critical juncture. (shrink)

Contrary to the popular belief, I argue that a more inclusive polity does not necessarily conflict with the goal of improving the epistemic capacities of deliberation. My argument examines one property of democracy that is usually thought of in non-epistemic terms, inclusion. Inclusion is not only valuable for moral reasons, but it also has epistemic virtues. I consider two epistemic benefits of inclusive deliberation: inclusive deliberation helps to create a more complete picture of the world that everyone dwells together; and (...) inclusive deliberation can be helpful in reducing biases and errors endemic to a society. Having advanced two epistemic arguments for inclusive deliberation, I argue that the Deweyan model best captures the knowledge-pooling function of deliberation. (shrink)

Volume 20, Issue 3, March 2020, Page 42-44.

At the third episode of Sophocles’ Electra, the heroine, believing that her brother Orestes is dead, invites her sister Chrisothemis to a plan to kill Aegisthus, in a speech that recalls fifth century Athenian’s public honors to the tyrannicide couple, Harmodius and Aristogiton, and thus presents the two sisters as a kind of democratic champions (v. 947-989). This paper compares the treatment given by contemporary Commentaries to Sophocles’ Electrato this speech with recent gender-oriented studies of Athenian citizenship, in order to (...) argue that the idea of the ancient polisas a “man’s club” depends much more on a modern stereotype about Athenian politics than on the ancient evidence available to us –a stereotype that projects XIX century European conceptions of politics on the ancient context, and perpetuates backwards a supposedly universal masculine domination. In this light, Electra’s attitude, surely exceptional because of her equally exceptional situation, far from strikingly transgressing ancient gender-roles, points to the importance of female citizenship in democratic Athens. (shrink)

Jehovah's Witnesses' (JWs) refusal of blood transfusions has recently gained support in the medical community because of the growing popularity of "no-blood" treatment. Many physicians, particularly so-called "sympathetic doctors", are establishing a close relationship with this religious organization. On the other hand, it is little known that this blood doctrine is being strongly criticized by reform-minded current and former JWs who have expressed conscientious dissent from the organization. Their arguments reveal religious practices that conflict with many physicians' moral standards. They (...) also suggest that a certain segment of "regular" or orthodox JWs may have different attitudes towards the blood doctrine. The author considers these viewpoints and argues that there are ethical flaws in the blood doctrine, and that the medical community should reconsider its supportive position. The usual physician assumption that JWs are acting autonomously and uniformly in refusing blood is seriously questioned. (shrink)

The article examines the new discourse on medical professionalism and responsibility through the prism of conflicts among moral values, especially with regard to truth-telling. The discussion is anchored in the renaissance of English-language writing on medical ethics in the 18th century, which paralleled the rise of humanitarianism and the advent of the word “responsibility”. Following an analysis of the meanings of the value of responsibility in general and in medical practice in particular, it is argued that, similarly to the Aristotelian (...) notion of equity, responsibility of care is a second-order value, which corrects virtues, laws and norms in exceptional circumstances. Virtues and practices of the second order, such as responsibility and deliberation, bear especially on professional doctoring, which includes a commitment to give priority to the good of the patient over one’s own good. It is argued that, in situations of conflict, and particularly conflicts between personal moral identity and the good of patients, the fundamental professional commitment is to critical and rational deliberation and to the cultivation of psycho-moral flexibility. This leads indirectly to moral growth and strengthening of professional character. (shrink)

Part 1 What Do Teachers Need to Know? Part 2 What Makes a Good Teacher? Part 3 Being a Teacher?

To introduce an archival protocol of a ‘Debate about methods in the social sciences, especially the conception of social science method represented by the Institute’, held on 17 January 1941 at the Institute of Social Research in New York, the article focuses on certain conflicts in substance and terms of discourse among members of the Institute, with special emphasis on Franz Neumann’s distinctive approaches, notwithstanding his professed loyalty to Max Horkheimer’s theory. These are seen to arise not only from Neumann’s (...) assignment as bargaining agent for the Institute and his distinctive relations with American colleagues, but also from their different orientations to the conflicted legacies of Weimar. (shrink)

Many philosophers claim that ‘ought’ implies ‘can’. In light of recent empirical evidence, however, some skeptics conclude that philosophers should stop assuming the principle unconditionally. Streumer, however, does not simply assume the principle’s truth; he provides arguments for it. In this article, we argue that his arguments fail to support the claim that ‘ought’ implies ‘can’.

The concern for the role of emotion in argumentative encounters has rested upon the concept of emotion as arguments, emotions to obtain the adherence of the audience and reflect the virtues of a good arguer. In this paper, we focus on understanding emotion and argumentation based on cognitive approaches that identify the relationship between the two elements, to propose the use of emotion regulation strategies in deliberative dialogue. Bearing in mind that the intensity of emotional responses may, in some cases, (...) hamper one’s capacity to solve problems during a practical argument, we suggest that the use of emotion regulation strategies may favor deliberative dialogue, leading to more adaptive emotional responses and, in turn, better argumentative encounters, rendering decision-making more efficient. This article conceptualizes argumentation, revealing the historical path of emotion in studies on argumentation. It presents the concepts of emotion and emotion regulation, followed by the function of emotion regulation in argumentative encounters, illustrating this in two different situations. We conclude with the contribution made by the use of strategies for emotion regulation during deliberative dialogue. (shrink)

In this article, I consider the extent to which heteronomous people can be positive contributors to political deliberation. I examine the normative potential of heteronomous people as participants in public debate, and address the overall effects that inclusion of heteronomous people can provide for group deliberations. I subsequently consider empirical findings that bear upon the case I develop, and conclude that liberals ought to reconsider the importance of heteronomous people in healthy liberal democracy. This philosophical recognition lays groundwork for a (...) more morally and politically compelling version of liberalism, one that outstrips comprehensive schemes that vaunt personal autonomy as liberalism's primary normative commitment. (shrink)