Cognitive science, at least as done by many philosophers, seeks to develop what one might call a content-based theory of cognition. These theorists generally seek to predict/explain cognition by employing generalizations between contentful states like beliefs and desires. In his book, From Folk Psychology To Cognitive Science, Stephen Stich argues that cognitive science should not attempt to employ content-based theories in its explanations of human (and other) behavior. For the most part Stich directs his arguments towards belief/desire psychology. Some of (...) his arguments, however, are directed at content-based theories in general. In this paper, I will be concerned with one of these more general arguments—the principle of autonomy argument.The conclusion of the principle of autonomy argument is that the predictions and explanations generated by content-based theories, in so far as they are possible, do not fall within the domain of prediction and explanation in cognitive science. (shrink)

When we start with the wrong question, no matter how good an answer we get, it won’t give us the results we want. Rather than joining the throngs who are asking, When will this economic crisis be over? Jim Wallis says the right question to ask is How will this crisis change us? The worst thing we can do now, Wallis tells us, is to go back to normal. Normal is what got us into this situation. We need (...) a new normal, and this economic crisis is an invitation to discover what that means. Some of the principles Wallis unpacks for our new normal are . . . • Spending money we don’t have for things we don’t need is a bad foundation for an economy or a family. • It’s time to stop keeping up with the Joneses and start making sure the Joneses are okay. • The values of commercials and billboards are not the things we want to teach our children. • Care for the poor is not just a moral duty but is critical for the common good. • A healthy society is a balanced society in which markets, the government, and our communities all play a role. • The operating principle of God’s economy says that there is enough if we share it. • And much, much more . . . In the pages of this book, Wallis provides us with a moral compass for this new economy—one that will guide us on Wall Street, Main Street, and Your Street. Embracing a New Economy Getting back to "the way things were" is not an option. It is time we take our economic uncertainty and use it to find some moral clarity. Too often we have been ruled by the maxims that greed is good, it’s all about me, and I want it now. Those can be challenged only with some of our oldest and best values—enough is enough, we are in it together, and thinking not just for tomorrow but for future generations. Jim Wallis shows that the solution to our problems will be found only as individuals, families, friends, churches, mosques, synagogues, and entire communities wrestle with the question of values together. (shrink)

In this paper, I build on Wittgenstein’s metaphor of a toolbox to introduce the metaphor of ‘tool confusion’ – how differing conceptual constructs may be applied, or misapplied, to one another and the effect that such applications have on the advancement of management theory. Moving beyond metaphor, I investigate a theory of management through two specific philosophical lenses (Popper and Lyotard). This analysis tests both the theory and the philosophies with regard to how each philosophy may be applied as a (...) tool to advance theory towards more effective application. Preliminary conclusions confirm that the application of partial philosophies is not as useful as the application of complete philosophies. Deeper contemplation, however, suggests that there is no upper limit to the completeness of philosophies. Thus, the problem of completeness is inescapable. In place of completeness, I explore the use of perceptual tools that are more specific, foundational and concise. Engaging in a second investigation, I use structures of logic (circular, linear, branching and co-causal) to investigate the subject theory. This investigation suggests at least two important insights relating to the structure of theory and the fuzziness of theory. Combined, these investigations and related conversations suggest rigorous methods for advancing theories and a more normative role for the philosophy of management that will support the accelerated advancement of management theory and practice. (shrink)

Purpose – The purpose of this paper is to investigate the internal structure of Gandhi's ethics as a way to determine opportunities for improving that system's ability to influence behavior. In this paper, the author aims to work under the idea that a system of ethics is a guide for social responsibility. -/- Design/methodology/approach – The data source is Gandhi's set of ethics as described by Naess. These simple (primarily quantitative) studies compare the concepts within the code of ethics, and (...) their relationships to one another. -/- Findings – Gandhi's ethics are robust at the 0.25 level (the scale is zero to one – zero is lowest). This is consistent with theories of the social sciences (that do not work well in practice). Gandhi's success might be ascribed to his leadership ability. -/- Research limitations/implications – Some suggest this approach is reductionist because of its superficial similarity to approaches of physical science. The implications for research are profound. First, this approach provides an objective method for comparing (and so, advancing) systems of ethics. Second, this paper suggests the opportunity to compare the internal structure of ethics with “external” aspects – the implementation of ethical systems. -/- Practical implications – By itself, Gandhi's system of ethics cannot be reliably applied in practice - it cannot be expected to change behavior more than any other system of ethics. This raises concerns about other ethical codes as well. The practical implications of the form of analysis presented in this paper are immense because it provides a way for practitioners to objectively compare two codes of ethics and determine which one will be more effective. -/- Originality/value – The approach documented in the paper has never been applied to the field of ethics. It is unique in that it addresses the “internal” structure of a system of ethics (compared to the “external”, or application, of ethical systems). (shrink)

What are we to make of Western Buddhism? Glenn Wallis argues that in aligning their tradition with the contemporary self-help industry, Western Buddhists evade the consequences of Buddhist thought. This book shows that with concepts such as vanishing, nihility, extinction, contingency, and no-self, Buddhism, like all potent systems of thought, articulates a notion of the "real." Raw, unflinching acceptance of this real is held by Buddhism to be at the very core of human "awakening." Yet these preeminent human truths (...) are universally shored up against in contemporary Buddhist practice, which contradicts the very heart of Buddhism. The author's critique of Western Buddhism is threefold. It is immanent, in emerging out of Buddhist thought but taking it beyond what it itself publicly concedes; negative, in employing the "democratizing" deconstructive methods of François Laruelle's non-philosophy; and re-descriptive, in applying Laruelle's concept of philofiction. Through applying resources of Continental philosophy to Western Buddhism, A Critique of Western Buddhism suggests a possible practice for our time, an "anthropotechnic", or religion transposed from its seductive, but misguiding, idealist haven. (shrink)

As reproductive genetic technologies advance, families have more options to choose what sort of child they want to have. Using preimplantation genetic diagnosis (PGD), for example, allows parents to evaluate several existing embryos before selecting which to implant via in vitro fertilization (IVF). One of the traits PGD can identify is genetic deafness, and hearing embryos are now preferentially selected around the globe using this method. Importantly, some Deaf families desire a deaf child, and PGD–IVF is also an option for (...) them. Selection for genetic deafness, however, encounters widespread disapproval in the hearing community, including mainstream philosophy and bioethics. In this paper I apply Elizabeth Barnes’ value-neutral model of disability as mere-difference to the case of selecting for deafness. I draw on evidence from Deaf Studies and Disability Studies to build an understanding of deafness, the Deaf community, and the circumstances relevant to reproductive choices that may obtain for some Deaf families. Selection for deafness, with deafness understood as mere-difference and valued for its cultural identity, need not necessitate impermissible moral harms. I thus advocate that it is sometimes morally permissible to select for deafness in one’s child. (shrink)

In evaluating a metatheory, it is possible and desirable to use methods found in critical metatheory. In this post, I use such tools to rigorously analyze and quantify the internal logical structure of Wilber's metatheory. The results show that Wilber's metatheory is unlikely to be of much use in practical application and that it has much room for growth and improvement.

In this paper I criticize the most significant recent examples of the practical knowledge analysis of knowledge-how in the philosophical literature: David Carr [1979, Mind, 88, 394–409; 1981a, American Philosophical Quarterly, 18, 53–61; 1981b, Journal of Philosophy of Education, 15(1), 87–96] and Stanley & Williamson [2001, Journal of Philosophy, 98(8), 411–444]. I stress the importance of know-how in our contemporary understanding of the mind, and offer the beginnings of a treatment of know-how capable of providing insight in to the use (...) of know-how in contemporary cognitive science. Specifically, I claim that Carr’s necessary conditions for know-how fail to capture the distinction he himself draws between ability and knowing-how. Moreover, Carr ties knowing-how to conscious intent, and to an explicit knowledge of procedural rules. I argue that both moves are mistakes, which together render Carr’s theory an inadequate account both of common ascriptions of knowledge-how and of widely accepted ascriptions of knowledge-how within explanations in cognitive science. Finally, I note that Carr’s conditions fail to capture intuitions (heshares) regarding the ascription of know-how to persons lacking ability. I then consider the position advocated by Stanley & Williamson (2001), which seems avoid Carr’s commitments to conscious intent and explicit knowledge while still maintaining that “knowledge-how is simply a species of knowledge-that" (Stanley & Williamson, 2001, p. 411). I argue that Stanley and Williamson’s attempt to frame a reductionist view that avoids consciously occurrent beliefs during exercises of knowledge-how and explicit knowledge of procedural rules is both empirically implausible and explanatorily vacuous. In criticizing these theories I challenge the presuppositions of the most pervasive response to Ryle in the philosophic literature, what might be described as “the received view." I also establish several facts about knowing-how. First, neither conscious intent nor explicit representation (much less conscious representation) of procedural rules are necessary for knowing-how given the theory of cognition current in cognitive science. I argue that the discussed analyses fail to capture the necessary conditions for knowledge-how because know-how requires the instantiation of an ability and of the capacities necessary for exploiting an ability—not conscious awareness of purpose or explicit knowledge of rules. Second, one must understand knowledge-how as task-specific, i.e., as presupposing certain underlying conditions. Conceiving of know-how as task-specific allows one to understand ascriptions of know-how in the absence of ability as counterfactual ascriptions based upon underlying competence. (shrink)

In this article, I consider a set of contextual questions related to the social and economic influences on the construction and use of Capernaum’s great limestone synagogue, and ask what these influences might tell us about Jewish–Christian relations in this village during the fifth and sixth centuries CE. After a survey of current scholarship, I address issues of method and engage in the interpretation of the relevant primary sources, some of which have only very recently been discov­ered, while others have (...) been overlooked in discussion of the question, or are deserving of reinterpret­ation. Building upon previous proposals, and in places revising them, I argue that we should see a dynamic interplay at work between local and non-local sources of funding for the synagogue and an intensely interactive and relational setting for the town’s Jews and Christians. (shrink)

I argue that Fodor's analysis of ceteris paribus laws fails to underwrite his appeal to such laws in his sufficient conditions for representation. It also renders his appeal to ceteris paribus laws impotent against the major problem for his theory of representation. Finally, Fodor's analysis fails to provide useful solutions to the traditional problems associated with a thoroughgoing understanding of ceteris paribus clauses. The analysis, therefore, fails to bolster Fodor's position that special science laws are of necessity ceteris paribus laws (...) and that one must recognize them as scientifically legitimate. (shrink)

Background: International developments suggest that providing clinical ethics services to help clinicians negotiate ethical issues that arise in clinical practice is beneficial and reflects best practice in promoting high ethical standards and patient-centered care. The aim of this study was to explore the needs and experiences of clinical staff members to inform the development of future clinical ethics support. Methods: Health professionals at a large regional health service completed an online survey containing questions about the frequency of ethical and legal (...) issues encountered in clinical practice, the type of situations that gave rise to the ethical and/or legal uncertainty or concern, how clinicians currently address these issues, and what support would be welcome. Results: The survey was completed by 369 staff members, including 61% with more than 10 years in the profession and 51% in nursing/midwifery. Two-thirds (66%) indicated they often considered ethical implications of their clinical decisions, and half (49%) often considered the legal implications. More than half (58%) were often/occasionally concerned about the ethically right thing to do. Patient requests for borderline treatment (47%), staff disagreements about patient care (48%), and patients declining recommended treatment (54%) were the most frequent reasons given for ethical or legal uncertainty. Sixty-nine percent of respondents indicated that the way their department addressed ethical issues could be improved and 85% agreed that there is a need for more discussion on ethical issues. The majority (82%) of respondents had encountered ethically challenging clinical situations where additional support would have helped. Common approaches to issues were discussion with colleagues/supervisor (91.1%), discussion at handover/group forums (50.8%), and consultation with guidelines/protocols (60.9%). Conclusions: A majority of clinical staff members surveyed have encountered ethically/legally challenging cases daily for which they have often sought additional advice. This study indicates that many clinical staff members would welcome some form of additional clinical ethics support including advice and education. (shrink)

Sustainability is an important topic for understanding and developing our society. For scholars who want their academic contributions to have an impact, sustainability is important for our conceptual systems. Because our conceptual systems share similarities with our social systems, we may investigate their characteristics to gain insight into how both may be achieved or at least understood. Theories of the humanities as well as the social/behavioral sciences are changing very rapidly. They are fragile and few seem to have any longevity. (...) At the same time, the theoretical base does not seem to be “advancing.” They are not supporting highly effective results in the real world, so we continue to have seemingly insolvable problems such as crime, war, and poverty. This may be because academia has become inward-focused or, in Luhmann’s terminology, autonomous from the outside world. In seeking to understand how to develop more sustainable theories we found that the concept of sustainability is contested. And, in the process of comparing the sustainability of social systems to the sustainability of theories, we came to realize that neither perspective is viable. Drawing on Luhmann’s insights on the interdependence of theories and society, we came to realize that the two exist in a coevolutionary relationship. Importantly, we present an approach for measuring that evolution and suggest directions for accelerating the coevolutionary advance of society and science. (shrink)

In this paper, I build on Wittgenstein’s metaphor of a toolbox to introduce the metaphor of ‘tool confusion’ – how differing conceptual constructs may be applied, or misapplied, to one another and the effect that such applications have on the advancement of management theory. Moving beyond metaphor, I investigate a theory of management through two specific philosophical lenses (Popper and Lyotard). This analysis tests both the theory and the philosophies with regard to how each philosophy may be applied as a (...) tool to advance theory towards more effective application. Preliminary conclusions confirm that the application of partial philosophies is not as useful as the application of complete philosophies. Deeper contemplation, however, suggests that there is no upper limit to the completeness of philosophies. Thus, the problem of completeness is inescapable. In place of completeness, I explore the use of perceptual tools that are more specific, foundational and concise. Engaging in a second investigation, I use structures of logic (circular, linear, branching and co-causal) to investigate the subject theory. This investigation suggests at least two important insights relating to the structure of theory and the fuzziness of theory. Combined, these investigations and related conversations suggest rigorous methods for advancing theories and a more normative role for the philosophy of management that will support the accelerated advancement of management theory and practice. (shrink)

In this paper, I delineate two major problems facing reliabilist approaches in epistemology. I argue that Alvin Goodman's (1986) position fails to solve either problem. I then suggest an alternative reliabilist approach that ties truth-ratio assessments to particular, well-specified cognitive tasks. I claim that a well-specified cognitive task is an empirical hypothesis about a system that involves the specification of input and output types and nomic correlations (including statistical correlations) that underlie the system's performance. On my approach, one characterizes processes (...) by reference to the system's dispositions across the situations consistent with the task. Characterization is best understood as revealing a strategy or a set of strategies for generating outputs from inputs relying on certain nomic correlations associated with the task. (shrink)

This descriptive and cross-sectional study aims to evaluate academic dishonesty among university nursing students in Turkey. The study’s sample included 196 students. Two instruments were used for gathering data. The first instrument, a questionnaire, which included some socio-demographic variables (age, class, gender, education, family structure, parents’ attitude and educators’ attitude) formed the first part. The second part included the Academic Dishonesty Tendency Scale developed by Eminoğlu and Nartgün. The data were analyzed using descriptive statistics and Kruskall Wallis, One-way Anova, (...) t- test and Mann-Whitney U test. It was found that academic dishonesty was at medium-level (2.60—3.39) in nursing students. (shrink)

This paper examines the nomic covariationist strategy of using idealization to define representation. While the literature has focused upon the possibility of defining ideal conditions for perception, I argue that nomic covariationist appeals to idealization are pseudoscientific and contrary to a foundational and empirically well-supported methodological presupposition in cognitive science. Moreover, one major figure in this camp fails to come to grips with its role and its problems in mainstream science. Thus he forwards a false dichotomy of the sciences and (...) treats idealization as a blank check written by scientists on an unknown bank. Finally, I consider and reject alternative formulations of the nomic covariationist's idealization strategy. (shrink)

Sustainability is an important topic for understanding and developing our society. For scholars who want their academic contributions to have an impact, sustainability is important for our conceptual systems. Because our conceptual systems share similarities with our social systems, we may investigate their characteristics to gain insight into how both may be achieved or at least understood. Theories of the humanities as well as the social/behavioral sciences are changing very rapidly. They are fragile and few seem to have any longevity. (...) At the same time, the theoretical base does not seem to be “advancing.” They are not supporting highly effective results in the real world, so we continue to have seemingly insolvable problems such as crime, war, and poverty. This may be because academia has become inward-focused or, in Luhmann’s terminology, autonomous from the outside world. In seeking to understand how to develop more sustainable theories we found that the concept of sustainability is contested. And, in the process of comparing the sustainability of social systems to the sustainability of theories, we came to realize that neither perspective is viable. Drawing on Luhmann’s insights on the interdependence of theories and society, we came to realize that the two exist in a coevolutionary relationship. Importantly, we present an approach for measuring that evolution and suggest directions for accelerating the coevolutionary advance of society and science. (shrink)

This book takes readers on a fascinating journey to the very heart of Tantra: its key teachings, foundational lineages, and transformative practices. Since the West's discovery of Tantra 100 years ago, there has been considerable fascination, speculation, and more than a little misinformation about this spiritual movement. Now, for the first time in the English language, Tantra Illuminated presents an accessible introduction to this sacred tradition that began 1,500 years ago, in the far north of India. The book uses translations (...) from primary Sanskrit sources, offers a profound look at spiritual practice, and reveals Tantra's rich history and powerful teachings. (shrink)

A rapidly growing body of scholarship shows that we can gain new insights into theories and policies by understanding and increasing their systemic structure. This paper will present an overview of this expanding field and discuss how concepts of structure are being applied in a variety of contexts to support collaboration, decision making, learning, prediction, and results. Next, it will delve into the underlying structures of logic that may be found within those theories and policies. Here, we will go beyond (...) Toulmin’s logics of claim and proof that have not proven useful for advancing the social sciences and focus on five structures of “causal logic.” The results suggest a useful and more comprehensive approach to developing deeper understanding of our conceptual systems such as theory and policy. (shrink)

Thomas Hornsby was a hard-working, scientifically ambitious and significant man of vision during the second half of the eighteenth century. He was a notable astronomical observer, founder of the Radcliffe Observatory at Oxford, a successful lecturer, a Commissioner of Longitude at a critical time, and editor of James Bradley's Astronomical Observations. This paper presents some long-neglected facts; in assembling scattered fragments into a coherent account, it raises new speculations.

Summary Edward Cocker was a well-known writing master and engraver during his lifetime, but is chiefly remembered for his posthumous arithmetic textbook, immortalized in the saying ?According to Cocker?. The book proved popular, being right for its time, and it remained in use for a century. It unexpectedly became the subject of controversy when Augustus De Morgan pronounced it to be the produce of its editor, John Hawkins. Research now shows that there is little doubt that it was really Cocker's (...) work. (shrink)

ArgumentApprenticeship was probably the largest mode of organized learning in early modern European societies, and artisan practitioners commonly began as apprentices. Yet little is known about how youths actually gained skills. I develop a model of vocational pedagogy that accounts for the characteristics of apprenticeship and use a range of legal and autobiographical sources to examine the contribution of different forms of training in England. Apprenticeship emerges as a relatively narrow channel, in which the master’s contribution to training was weakly (...) defined and executed conservatively. The creation of complementary channels of formal instruction was constrained by cost and coordination problems. When we consider a range of British youths who obtained advanced skills as artisan practitioners (and engaged in invention or pursued natural philosophical interests), we see the importance of individual agency over institutional structures. For these youths, training could involve rejecting apprenticeship, engaging in periods of advanced study, including time in multiple workshops after the end of apprenticeship, and parallel campaigns to access scarce books and communities of scholarship. (shrink)

The present article is a contribution to a particularly urgent issue that is unfolding in Buddhist circles in North America andEurope. Although this issue is framed in various ways, it revolves around a single question; namely, what form will contemporary reconfigurations of Buddhism take in the twenty-first century West? The most influential groups in this discussion to date are those that style themselves secular-, progressive-, atheist-, agnostic-, liberal-, and post-traditional Buddhist. As these groups gain adherents in the West, traditional organizations, (...) such as the various Zens, Tibetans, Vipassanas, etc., are stating their claim to “Buddhism” with increasingly vehement proprietorship. The present article, however, is not yet another attempt to reformulate or reform (in any sense of the term) “Buddhism.” Neither is it concerned with ameliorating traditional Buddhism's relationship with contemporary western secular values. In performing its first task, however, my emerging theory, called “speculative non-buddhism,” can contribute to the current debate in a decisive way by showing that all forms of Buddhism are identical. What makes them so is that they are all governed by what I call “buddhistic decision:” the syntactical structure that constitutes all things, discourse, and people, “Buddhist.” Decision thus constitutes both the ideological nature, and the ideological constant, of “Buddhism.”. (shrink)

The object of this article is not to criticize Professor Watson's psychology, still less his physiology; neither do I wish to attempt a fundamental metaphysical criticism, such as that contained in Professor Lloyd Morgan's article in the April number of the Journal, but it appears to me that a purely logical criticism, admitting Professor Watson's facts and observations, and assuming his mechanistic point of view, may be a useful preliminary to such wider and more fundamental inquiry.

The object of this article is not to criticize Professor Watson's psychology, still less his physiology; neither do I wish to attempt a fundamental metaphysical criticism, such as that contained in Professor Lloyd Morgan's article in the April number of the Journal, but it appears to me that a purely logical criticism, admitting Professor Watson's facts and observations, and assuming his mechanistic point of view, may be a useful preliminary to such wider and more fundamental inquiry.

euroscience of Rule-Guided Behavior brings together, for the first time, the experiments and theories that have created the new science of rules. Rules are central to human behavior, but until now the field of neuroscience lacked a synthetic approach to understanding them. How are rules learned, retrieved from memory, maintained in consciousness and implemented? How are they used to solve problems and select among actions and activities? How are the various levels of rules represented in the brain, ranging from simple (...) conditional ones if a traffic light turns red, then stop to rules and strategies of such sophistication that they defy description? And how do brain regions interact to produce rule-guided behavior? These are among the most fundamental questions facing neuroscience, but until recently there was relatively little progress in answering them. It was difficult to probe brain mechanisms in humans, and expert opinion held that animals lacked the capacity for such high-level behavior. However, rapid progress in neuroimaging technology has allowed investigators to explore brain mechanisms in humans, while increasingly sophisticated behavioral methods have revealed that animals can and do use high-level rules to control their behavior. The resulting explosion of information has led to a new science of rules, but it has also produced a plethora of overlapping ideas and terminology and a field sorely in need of synthesis. In this book, Silvia Bunge and Jonathan Wallis bring together the worlds leading cognitive and systems neuroscientists to explain the most recent research on rule-guided behavior. Their work covers a wide range of disciplines and methods, including neuropsychology, functional magnetic resonance imaging, neurophysiology, electroencephalography, neuropharmacology, near-infrared spectroscopy, and transcranial magnetic stimulation. This unprecedented synthesis is a must-read for anyone interested in how complex behavior is controlled and organized by the brain. (shrink)

Originally published in 1944, this book was originally intended as a continuation of the 1943 publication Nautical Mathematics, which is also reissued in this series. In it, the principles set out in Nautical Mathematics are given practical applications, and the text is supplied with exercises to test and clarify the lessons. This book will be of value to anyone with an interest in the history of education in the forces during WWII.

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)