ObjectivesThe end of life is an ethically challenging time requiring complex decision-making. This study describes ethical frameworks among physician trainees, explores how these frameworks manifest and relates these frameworks to experiences delivering end-of-life care.DesignWe conducted semistructured in-depth exploratory qualitative interviews with physician trainees about experiences of end-of-life care and moral distress. We analysed the interviews using thematic analysis.SettingAcademic teaching hospitals in the United States and United Kingdom.ParticipantsWe interviewed 30 physician trainees. We purposefully sampled across three domains we expected to be (...) associated with individual ethics in order to elicit a diversity of ethical and experiential perspectives.ResultsSome trainees subscribed to a best interest ethical framework, characterised by offering recommendations consistent with the patient’s goals and values, presenting only medically appropriate choices and supporting shared decision-making between the patient/family and medical team. Others endorsed an autonomy framework, characterised by presenting all technologically feasible choices, refraining from offering recommendations and prioritising the voice of patient/family as the decision-maker.ConclusionsThis study describes how physician trainees conceptualise their roles as being rooted in an autonomy or best interest framework. Physician trainees have limited clinical experience and decision-making autonomy and may have ethical frameworks that are dynamic and potentially highly influenced by experiences providing end-of-life care. A better understanding of how individual physicians’ ethical frameworks influences the care they give provides opportunities to improve patient communication and advance the role of shared decision-making to ensure goal-aligned end-of-life care. (shrink)

:Empirical work has shown that patients and physicians have markedly divergent understandings of treatability statements in the context of serious illness. Patients often understand treatability statements as conveying good news for prognosis and quality of life. In contrast, physicians often do not intend treatability statements to convey improvement in prognosis or quality of life, but merely that a treatment is available. Similarly, patients often understand treatability statements as conveying encouragement to hope and pursue further treatment, though this may not be (...) intended by physicians. This radical divergence in understandings may lead to severe miscommunication. This paper seeks to better understand this divergence through linguistic theory—in particular, H.P. Grice’s notion of conversational implicature. This theoretical approach reveals three levels of meaning of treatability statements: the literal meaning, the physician’s intended meaning, and the patient’s received meaning. The divergence between the physician’s intended meaning and the patient’s received meaning can be understood to arise from the lack of shared experience between physicians and patients, and the differing assumptions that each party makes about conversations. This divergence in meaning raises new and largely unidentified challenges to informed consent and shared decision making in the context of serious illness, which indicates a need for further empirical research in this area. (shrink)

Some patients who are dependent on extracorporeal membrane oxygenation (ECMO) are alert and retain capacity to participate in decision-making, including decisions regarding whether to continue life...

The current issue of the American Journal of Bioethics illustrates the scope of disagreement among professionals about normothermic regional perfusion (NRP). A similar range of opinions has been de...

This chapter shows how The Daily Show targets those political and religious leaders who claim to receive clear revelations from the divine, either by their own particular religious experiences and practices or through sacred texts. It considers some of the ways Stewart calls into question their apparently unquestionable grasp of the mind of God. Philosophers like the famous English thinker John Locke have made their living by carefully examining not only the nature of the world around us, but also the (...) more puzzling aspects of human behavior. For instance, Locke describes and critiques the sort of “enthusiasm” by recognizing that such religiously convicted individuals: “persuade themselves that they are under the peculiar guidance of heaven in their actions and opinions, especially in those of them which they cannot account for by the ordinary methods of knowledge and principles of reason. (shrink)

Perhaps the central focus of American bioethics has been to push against medical paternalism on the grounds that it impedes the autonomy of patients—that is, their ability to make choices of their...

A key source of support for the view that challenging people’s beliefs about free will may undermine moral behavior is two classic studies by Vohs and Schooler (2008). These authors reported that exposure to certain prompts suggesting that free will is an illusion increased cheating behavior. In the present paper, we report several attempts to replicate this influential and widely cited work. Over a series of five studies (sample sizes of N = 162, N = 283, N = 268, N (...) = 804, N = 982) (four preregistered) we tested the relationship between (1) anti-free-will prompts and free will beliefs and (2) free will beliefs and immoral behavior. Our primary task was to closely replicate the findings from Vohs and Schooler (2008) using the same or highly similar manipulations and measurements as the ones used in their original studies. Our efforts were largely unsuccessful. We suggest that manipulating free will beliefs in a robust way is more difficult than has been implied by prior work, and that the proposed link with immoral behavior may not be as consistent as previous work suggests. (shrink)

The opinion of Mr. Justice Francis of the English High Court which denied the parents of Charlie Gard, who had been born with an extremely rare mutation of a genetic disease, the right to take their child to the United States for a proposed experimental treatment occasioned world wide attention including that of the Pope, President Trump, and the US Congress. The case raise anew a debate as old as the foundation of Western medicine on who should decide and on (...) what standard when there is a conflict between a family and the treating physicians over a possible treatment. This paper will explore the different approaches of the British and American courts on the issue and the various proposals from that of John Rawls in his A Theory of Justice to a processed-based approach for resolving such disputes. As carefully crafted as the opinion of Mr Justice Nicholas Francis in the Gard case proved to be, it left commentators unsatisfied. A widespread criticism, captured in an article by Michael Dougherty in The National Review was for the state to ‘get out of the way of the parents trying to act in the best interests of the child’.1 Although he conceded the parents could be adding to the suffering of the child by taking Charlie to America for an experimental therapy and agreed that such a choice ‘may be the wrong decision,’ in Dougherty’s view, it should still be ‘their decision’. Dougherty’s stand was the popular response to the question of ‘Who should decide?’ It fails, however, to propose any rationale for the decision. It provided no norms, no standards and no guidelines for the parents. Their motive could equally well be indifference to the suffering of the child as concern for his well-being. Furthermore, even good, loving parents may make …. (shrink)

In their target article, Nielsen Busch and Mjaaland (2023) address a longstanding debate within the bioethics and organ transplantation community regarding whether controlled donation after circula...

In their target article, Millum and Bromwich situate their article against a backdrop of well-documented empirical research demonstrating that many participants have variable and often poor...

We examined participants' reading and recall of informed consent documents presented via paper or computer. Within each presentation medium, we presented the document as a continuous or paginated document to simulate common computer and paper presentation formats. Participants took slightly longer to read paginated and computer informed consent documents and recalled slightly more information from the paginated documents. We concluded that obtaining informed consent online is not substantially different than obtaining it via paper presentation. We also provide suggestions for improving (...) informed consent-in both face-to-face and online experiments. (shrink)

There is a puzzle about why self-deception, a process that obscures the truth, is so pervasive in human behavior given that tracking the truth seems important for our survival and reproduction. William von Hippel and Robert Trivers argue that, despite appearances, there is good reason to think that self-deception is an adaptation by arguing: self-deception leads to a positive self-perception and a positive self-perception increases an individual’s fitness. D.S. Neil Van Leeuwen, however, gives persuasive arguments against both steps. In (...) response, we will defend both propositions, thereby supporting the conclusion that self-deception indeed has adaptive value. The first premise will be bolstered by a survey of the philosophical literature and empirical work on self-deception, whereas the second will be strengthened by empirical research on a behavioral phenomenon known as the winner effect. (shrink)

in Neil Jacobs (ed.), Open Access: Key strategic, technical and economic aspects, Chandos Publishing, 2006.

While The Daily Show with Jon Stewart is certainly entertaining, it can also deliver a deeper analysis of our contemporary media environment. Stewart's analysis echoes that of the celebrated New York University media theorist Neil Postman, whose discerning insights seem to ground some of The Daily Show's sharpest comic bits. Much of The Daily Show's sharpest comedy requires its audience to grasp a Postman‐like criticism of television news. In addition, Stewart himself seems to offer a more general critique of (...) today's televised public discourse that is reminiscent of Postman's in several significant ways. This isn't to say, however, that Postman and Stewart are in perfect agreement. For one thing, Postman argues that the transformation of serious discussion into entertainment is all but inevitable when this discussion takes place on television. Stewart, on the other hand, seems to believe that television can do better. (shrink)

In this paper we examine the relationship between diligence and ethics and the connection between procrastination and ethical misconduct for lawyers. From there we ask the question of whether legal education does enough to teach law students good habits of time management that might minimize the kind of procrastination that so often goes hand in hand with lawyer malfeasance. Far from concluding that legal education addresses these issues adequately we advance the claim that legal education actually teaches procrastination. Drawing on (...) the work of Neil Fiore and his book: The Now Habit: A Strategic Program for Overcoming Procrastination and Enjoying Guilt-Free Play we argue that law students are often susceptible to the psychological factors that lead to procrastination: fear of failure, fear of success and resentment of authority. From there we outline aspects of legal education that feed into rather than combating these vulnerabilities. Finally we outline recommendations for how legal education could begin to take more seriously the relationship between time management and legal ethics and to model and inculcate good time management skills. (shrink)

Essays devoted to the work of the late Neil Wilson, Canadian philosopher and contributor to the field of semantic analysis that emerged from the fusion of logic, pragmatism, and ontology. Many of the essays in this volume take their initial inspiration from Wilson's seminal work Substances Without Substrata.

Our purpose in this article is to identify and suggest resolution for two core problematics of grounded theory. First, while grounded theory provides transparency to one part of the conceptualization process, where codes emerge directly from the data, it provides no such systematic or transparent way for gaining insight into the conceptual relationships between discovered codes. Producing a grounded theory depends not only on the definition of conceptual pieces, but the delineation of a relationship between at least two of those (...) pieces. Second, the conceptualization process of grounded theory is done in hierarchical fashion, where individual codes emerge from the data but then are used to generate insight into more general concepts and thematic statements. But various works on grounded theory have failed to provide any systematic way of using data specific levels of scale (the codes) to gain insight into more macro levels of scale (concepts and themes). We offer fractal concept analysis as a means of resolving both of these issues. By using a logic structure generator, fractal concept analysis delineates self-similar conceptual frameworks at various levels of abstraction, yielding a method for linking concepts together within and between levels of scale encountered in the grounded theory coding and categorization process. We conclude that this fractal analytic technique can bolster the aims of grounded theory as a formalized and systematic process for generating theory from empirical data. (shrink)

This article reviews the seven “visions” of evolution proposed by Depew and Weber , concluding that each posited relationship between natural selection and self-organization has suited different aims and approaches. In the second section of the article, we show that these seven viewpoints may be collapsed into three fundamentally different ones: natural selection drives evolution; self-organization drives evolution; and natural selection and self-organization are complementary aspects of the evolutionary process. We then argue that these three approaches are not mutually exclusive, (...) since each may apply to different stages of development of different systems. What emerges from our discussion is a more encompassing view: that self-organization proposes what natural selection disposes. (shrink)

Awarding rights to rivers, forests, and other environmental entities (EEs) is a new and increasingly popular approach to environmental protection. The distinctive feature of such rights of nature (RoN) legislation is that direct duties are owed to the EEs. This paper presents a novel rebuttal of the strongest argument against RoN: the no interest argument. The crux of this argument is that because EEs are not sentient, they cannot possess the kinds of interests necessary to ground direct duties. Therefore, they (...) cannot be legitimate rights-bearers. After considering and rejecting standard responses to this argument, the paper challenges its fundamental assumption: that rights-correlative duties must be grounded in the interests of the rights-bearer. The paper then presents the RoN critic with a dilemma. The critic must either accept that EEs are legitimate rights-bearers, or delegitimise many well-established rights-bearers along with EEs. Either way, the no interest argument loses its force. (shrink)

Jason Stanley's "Knowledge and Practical Interests" is a brilliant book, combining insights about knowledge with a careful examination of how recent views in epistemology fit with the best of recent linguistic semantics. Although I am largely convinced by Stanley's objections to epistemic contextualism, I will try in what follows to formulate a version that might have some prospect of escaping his powerful critique.

This book is the first systematic treatment of 'responsibilist' or character-based virtue epistemology, an approach to epistemology that focuses on intellectual ...

One of the major contributions which Christopher Hookway has made to pragmatist epistemology is a critical exploration of the role that affective dispositions play in inquiry. According to Hookway, a well-functioning rational inquirer must rely upon a set of pre-reflective and affective dispositions which are not themselves fully available to rational evaluation. Despite their pre-reflective nature, on the pragmatist account these affective dispositions provide us with judgments and evaluations which are in many cases more reliable than those provided by explicit (...) rational reflection. -/- This chapter presents and defends Hookway’s account of the epistemic importance of our affective dispositions. The first section presents three roles which affective dispositions play within inquiry. The second section considers the concern that affective dispositions should be considered impositions upon our epistemic agency. In response, Hookway suggests that we must identify with our affective dispositions, and two interpretations of this claim are offered. The third section considers the possibility that the confidence we have in our affective dispositions might be appropriately shaken if we recognize that they are not shared by other inquirers. The chapter concludes by suggesting that Hookway’s position can overcome this worry by developing his notion of critical self-trust in three distinct ways. (shrink)

Given the tremendous proliferation of student plagiarism involving the Internet, the purpose of this study is to determine which theory of ethical reasoning students invoke when defending their transgressions: deontology, utilitarianism, rational self-interest, Machiavellianism, cultural relativism, or situational ethics. Understanding which theory of ethical reasoning students employ is critical, as preemptive steps can be taken by faculty to counteract this reasoning and prevent plagiarism. Additionally, it has been demonstrated that unethical behavior in school can lead to unethical behavior in business; (...) therefore, correcting unethical behavior in school can have a positive impact on organizational ethics. To meet this objective, a content analysis was conducted on the written records of students formally charged with plagiarizing at a large West Coast university. Each case was classified according to the primary ethical reasoning that the student used to justify plagiarism. Results indicate that students predominately invoke deontology, situational ethics, and Machiavellianism. Based on these findings, specific recommendations are offered to curb plagiarism. (shrink)

Neil E. Williams develops a systematic metaphysics centred on the idea of powers, as a rival to neo-Humeanism, the dominant systematic metaphysics in philosophy today. Williams takes powers to be inherently causal properties and uses them as the foundation of his explanations of causation, persistence, laws, and modality.

This Element explores what it means for two theories in physics to be equivalent, and what lessons can be drawn about their structure as a result. It does so through a twofold approach. On the one hand, it provides a synoptic overview of the logical tools that have been employed in recent philosophy of physics to explore these topics: definition, translation, Ramsey sentences, and category theory. On the other, it provides a detailed case study of how these ideas may be (...) applied to understand the dynamical and spatiotemporal structure of Newtonian mechanics - in particular, in light of the symmetries of Newtonian theory. In so doing, it brings together a great deal of exciting recent work in the literature, and is sure to be a valuable companion for all those interested in these topics. (shrink)

On his death in 2007, Richard Rorty was heralded by the New York Times as “one of the world’s most influential contemporary thinkers.” Controversial on the left and the right for his critiques of objectivity and political radicalism, Rorty experienced a renown denied to all but a handful of living philosophers. In this masterly biography, Neil Gross explores the path of Rorty’s thought over the decades in order to trace the intellectual and professional journey that led him to that (...) prominence. The child of a pair of leftist writers who worried that their precocious son “wasn’t rebellious enough,” Rorty enrolled at the University of Chicago at the age of fifteen. There he came under the tutelage of polymath Richard McKeon, whose catholic approach to philosophical systems would profoundly influence Rorty’s own thought. Doctoral work at Yale led to Rorty’s landing a job at Princeton, where his colleagues were primarily analytic philosophers. With a series of publications in the 1960s, Rorty quickly established himself as a strong thinker in that tradition—but by the late 1970s Rorty had eschewed the idea of objective truth altogether, urging philosophers to take a “relaxed attitude” toward the question of logical rigor. Drawing on the pragmatism of John Dewey, he argued that philosophers should instead open themselves up to multiple methods of thought and sources of knowledge—an approach that would culminate in the publication of Philosophy and the Mirror of Nature , one of the most seminal and controversial philosophical works of our time. In clear and compelling fashion, Gross sets that surprising shift in Rorty’s thought in the context of his life and social experiences, revealing the many disparate influences that contribute to the making of knowledge. As much a book about the growth of ideas as it is a biography of a philosopher, Richard Rorty will provide readers with a fresh understanding of both the man and the course of twentieth-century thought. (shrink)

This essay presents an ideal for modern Western romantic love.The basic ideas are the following: people want to form a distinctive sort of plural subject with another, what Nozick has called a "We", they want to be loved for properties of certain kinds, and they want this love to establish and sustain a special sort of commitment to them over time.

Unspecific evidence calls for imprecise credence. My aim is to vindicate this thought. First, I will pin down what it is that makes one's imprecise credences more or less epistemically valuable. Then I will use this account of epistemic value to delineate a class of reasonable epistemic scoring rules for imprecise credences. Finally, I will show that if we plump for one of these scoring rules as our measure of epistemic value or utility, then a popular family of decision rules (...) recommends imprecise credences. In particular, a range of Hurwicz criteria, which generalise the Maximin decision rule, recommend imprecise credences. If correct, the moral is this: an agent who adopts precise credences, rather than imprecise ones, in the face of unspecific and incomplete evidence, goes wrong by gambling with the epistemic utility of her doxastic state in too risky a fashion. Precise credences represent an overly risky epistemic bet, according to the Hurwicz criteria. (shrink)

Introduction HLA Hart: A biographical sketch Jurisprudence is the theoretical study of a practical subject. Its object is to achieve a systematic and ...

Retroduction -- Contextualized self-interpretations -- Causal mechanisms -- Ontology -- Logics -- Articulation.

According to accuracy-first epistemology, accuracy is the fundamental epistemic good. Epistemic norms — Probabilism, Conditionalization, the Principal Principle, etc. — have their binding force in virtue of helping to secure this good. To make this idea precise, accuracy-firsters invoke Epistemic Decision Theory (EpDT) to determine which epistemic policies are the best means toward the end of accuracy. Hilary Greaves and others have recently challenged the tenability of this programme. Their arguments purport to show that EpDT encourages obviously epistemically irrational behavior. (...) We develop firmer conceptual foundations for EpDT. First, we detail a theory of praxic and epistemic good. Then we show that, in light of their very different good-making features, EpDT will evaluate epistemic states and epistemic acts according to different criteria. So, in general, rational preference over states and acts won’t agree. Finally, we argue that based on direction-of-fit considerations, it’s preferences over the former that matter for normative epistemology, and that EpDT, properly spelt out, arrives at the correct verdicts in a range of putative problem cases. (shrink)

This article draws attention to a pattern of development within science and other intellectual research communities that has received virtually no mention. We propose that subsequent dominance of a research community by a figure responsible for significant innovation often delays progress in the field. During the period in which the revolutionary continues to influence research in a community, far too frequently the effect is to freeze progress within the limited directions which the revolutionary sanctions.

Induced by intake of the psychedelic substances LSD, psilocybin, DMT and mescaline, psychedelic experiences have been extensively described by subjects as entailing a most unusual increase in the scope and quality of their consciousness. Accordingly, psychedelic experiences have been widely characterised as an “expansion of consciousness.” This article poses the following question, as yet unaddressed in contemporary philosophy and the tradition of phenomenology: to what exactly does “expansion of consciousness” refer as a general characterisation of psychedelic experiences, and what role (...) might attention play therein? On the basis of Aron Gurwitsch’s phenomenology of attention, the following thesis is presented: (a) “expansion of consciousness” refers to a particular restructuration of consciousness in psychedelic experiences. (b) This occurs by means of certain extreme transformations in direction, scope, mode and degree of attention. In order to explicate this thesis, the characteristic features of psychedelic experiences that pertain to expansion of consciousness and attention are first systematically identified from a survey of subject reports. Second, it is demonstrated that the few previous attempts to understand expansion of consciousness in terms of attention as a filter/reducing-valve, spotlight or zoom-lens each fail to explain how consciousness is structured in psychedelic experiences. Third, it is argued that psychedelic expansion of consciousness is a general restructuration of consciousness by means of extreme attentional transformations. In conclusion, brief consideration is given to the question of whether psychedelic expansion of consciousness can have epistemic and ethical value for life. (shrink)

In De interpretatione 9, Aristotle argues against the fatalist view that if statements about future contingent singular events (e.g. ‘There will be a sea battle tomorrow,’ ‘There will not be a sea battle tomorrow’) are already true or false, then the events to which those statements refer will necessarily occur or necessarily not occur. Scholars have generally held that, to refute this argument, Aristotle allows that future contingent statements are exempt from either the principle of bivalence, or the law of (...) excluded middle. This paper offers a new interpretation of Aristotle’s refutation of fatalism. According to this interpretation, each member of a pair of contradictory future contingent statements, in virtue of expressing modal necessity, is simply false. (shrink)

In this paper, we make the case that a person who is considering or has already made a decision that appears seriously harmful to that person should in some cases be judged incapable of making that...

Philosophers have long been tempted by the idea that objects and properties are abstractions from the facts. But how is this abstraction supposed to go? If the objects and properties aren't 'already' there, how do the facts give rise to them? Jason Turner develops and defends a novel answer to this question: The facts are arranged in a quasi-geometric 'logical space', and objects and properties arise from different quasi-geometric structures in this space.

Philosophers from Hart to Lewis, Johnston and Bennett have expressed various degrees of reservation concerning the doctrine of double effect. A common concern is that, with regard to many activities that double effect is traditionally thought to prohibit, what might at first look to be a directly intended bad effect is really, on closer examination, a directly intended neutral effect that is closely connected to a foreseen bad effect. This essay examines the extent to which the commonsense concept of intention (...) supports a reasonably consistent and coherent application of double effect. Two important conclusions are these: (1) a number of traditionally proscribed activities involve a kind of “targeting” of innocents that can be taken to exhibit a direct intention to harm them; (2) a direct intention to harm need not involve a desire to harm in any ordinary sense of the latter expression. (shrink)