Promoting Cognitive Conflict in Health Care Ethics: Moral Reasoning with Boundary Cases

As many college students are at a time of tremendous personal and academic growth, introductory philosophy courses have the potential to equip students with practical critical reasoning skills. Despite this, many introductory courses in this domain emphasize students’ learning about pre-existing dialectics in the abstract, rather than over self-reflection and development of personal philosophical perspectives. In doing so, we may be failing to support the needs of pre-professional students looking to prepare themselves for their careers ahead. In this practitioner paper, we report our efforts as a practicing philosophy instructor (Bursten) and a learning scientist (Finkelstein) to iterate on the design of a student-centered instrument for moral reasoning in medical contexts within an introductory Health Care Ethics course. We identified the positive role that providing boundary cases played in helping students’ experience productive cognitive conflict, and, in turn, how these experiences improved critical self-reflection and moral reasoning

The top trumps of time:Factors motivating the resolution of temporal ambiguity

What factors motivate our understanding of metaphoric statements about time? English exhibits two deictic space–time metaphors: the Moving Ego metaphor conceptualizes the ego as moving forward through time, while the Moving Time metaphor conceptualizes time as moving forward towards the ego (Clark, 1973). In addition to earlier research investigating spatial influences on temporal reasoning (e.g., Boroditsky & Ramscar, 2002), recent lines of research have provided evidence that a complex of factors, such as personality differences, event valence, lifestyle, and emotional experiences, may also influence people’s perspectives on the movement of events in time – providing new insights on metaphor and its ability to reflect thought and feeling (e.g., Duffy & Feist, 2014; Duffy, Feist, & McCarthy, 2014; Margolies & Crawford, 2008; Richmond, Wilson, & Zinken, 2012). Probing these findings further, two studies were conducted to investigate whether the interpretation of a temporally ambiguous question may arise from an interaction between the valence of the event and aspects of the personality (Experiment 1) and lifestyle (Experiment 2) of the comprehender. The findings we report on shed further light on the complex nature of temporal reasoning. While this involves conceptual metaphor, it also invokes more complex temporal frames of reference (t-FoRs) (Evans, 2013), which are only partially subserved by space-to-time conceptual metaphors

“It’s hard to tell”. The challenges of scoring patients on standardised outcome measures by multidisciplinary teams: a case study of Neurorehabilitation

Background Interest is increasing in the application of standardised outcome measures in clinical practice. Measures designed for use in research may not be sufficiently precise to be used in monitoring individual patients. However, little is known about how clinicians and in particular, multidisciplinary teams, score patients using these measures. This paper explores the challenges faced by multidisciplinary teams in allocating scores on standardised outcome measures in clinical practice. Methods Qualitative case study of an inpatient neurorehabilitation team who routinely collected standardised outcome measures on their patients. Data were collected using non participant observation, fieldnotes and tape recordings of 16 multidisciplinary team meetings during which the measures were recited and scored. Eleven clinicians from a range of different professions were also interviewed. Data were analysed used grounded theory techniques. Results We identified a number of instances where scoring the patient was 'problematic'. In 'problematic' scoring, the scores were uncertain and subject to revision and adjustment. They sometimes required negotiation to agree on a shared understanding of concepts to be measured and the guidelines for scoring. Several factors gave rise to this problematic scoring. Team members' knowledge about patients' problems changed over time so that initial scores had to be revised or dismissed, creating an impression of deterioration when none had occurred. Patients had complex problems which could not easily be distinguished from each other and patients themselves varied in their ability to perform tasks over time and across different settings. Team members from different professions worked with patients in different ways and had different perspectives on patients' problems. This was particularly an issue in the scoring of concepts such as anxiety, depression, orientation, social integration and cognitive problems. Conclusion From a psychometric perspective these problems would raise questions about the validity, reliability and responsiveness of the scores. However, from a clinical perspective, such characteristics are an inherent part of clinical judgement and reasoning. It is important to highlight the challenges faced by multidisciplinary teams in scoring patients on standardised outcome measures but it would be unwarranted to conclude that such challenges imply that these measures should not be used in clinical practice for decision making about individual patients. However, our findings do raise some concerns about the use of such measures for performance management

Heated debates and cool analysis: thinking well about financial ethics

Not for the first time, the banks and other financial institutions have got themselves – and the rest of us – into a mess, this time on an unprecedented financial and geographical scale. It is no surprise that opinions about causes, consequences and cures abound with ethical issues, as well as technical and economic concerns, a focus of attention. It is to be hoped that useful lessons for the future will be learned. In this chapter, however, we step back from a direct engagement with the stated ills of the financial system itself, whether actual or perceived, chronic or acute. Our starting point is that crisis in the financial system not only makes us stop and think; but it might also, particularly under conditions of moral panic, prevent us from thinking well. Our contention is that a further impediment to thinking well about financial crises is the lack of a substantial body of academic knowledge that might be termed ‘financial ethics’ – a corpus of well developed conceptual insights and appropriate empirical evidence. We identify some of the reasons for this situation and proffer some suggestions regarding what might be done to remedy it – including the development of knowledge that is as relevant to everyday practices during periods of normality as it is to providing perspectives on crisis. The chapter is structured as follows: the next section provides a perspective on debate during times of crisis; the middle section seeks to explain why academic financial ethics is not a significant constituent element of debate on the financial crisis post-2007; and the final two main sections explore ways in which an academic agenda for financial ethics might be constructed. In a curious way this chapter echoes some of the themes and especially the conclusion of David Bevan’s chapter in this work (chapter18) although the reasoning to the conclusion that finance ethics is an empty set follows a rather different Badiou-inspired path in chapter 18

Interrogating copyright history

An understanding of the past – how we got to where we are today – informs the approach of much recent scholarship about copyright. The EIPR is no exception: in an article published in 2003, one co-author of this article (Ronan Deazley) argued that the interpretation of aspects of eighteenth century copyright history – the ruling of the House of Lords in Donaldson v Becket in 1774 – had implications for twenty-first century policy-making and judicial reasoning. This interest in the past has been traced to a ‘historical turn’ in scholarship in the late 1990s, which marked a move away from the more forward-looking approach of the earlier twentieth century, when lawyers had little time for historical perspectives. The climate of renewed scholarly interest in copyright history in recent decades, amongst other things, has seen the launch in 2008 of the AHRC funded digital archive of Primary Sources on Copyright History (hosted at www.copyrighthistory.org), now expanded to cover seven jurisdictions (Italy, UK, USA, Germany, France, Spain, the Netherlands), as well as the founding of the International Society for the History and Theory of IP (or ‘ISHTIP’) which will see its 8th annual workshop in July 2016. That both initiatives are linked to CREATe (and so to both co-authors ), the RCUK-funded centre for research into copyright, the creative economy, and the future of creative production in the digital age, illustrates well a current perception that a study of the past is of value to those researching the present

Stakeholder narratives on trypanosomiasis, their effect on policy and the scope for One Health

Background This paper explores the framings of trypanosomiasis, a widespread and potentially fatal zoonotic disease transmitted by tsetse flies (Glossina species) affecting both humans and livestock. This is a country case study focusing on the political economy of knowledge in Zambia. It is a pertinent time to examine this issue as human population growth and other factors have led to migration into tsetse-inhabited areas with little historical influence from livestock. Disease transmission in new human-wildlife interfaces such as these is a greater risk, and opinions on the best way to manage this are deeply divided. Methods A qualitative case study method was used to examine the narratives on trypanosomiasis in the Zambian policy context through a series of key informant interviews. Interviewees included key actors from international organisations, research organisations and local activists from a variety of perspectives acknowledging the need to explore the relationships between the human, animal and environmental sectors. Principal Findings Diverse framings are held by key actors looking from, variously, the perspectives of wildlife and environmental protection, agricultural development, poverty alleviation, and veterinary and public health. From these viewpoints, four narratives about trypanosomiasis policy were identified, focused around four different beliefs: that trypanosomiasis is protecting the environment, is causing poverty, is not a major problem, and finally, that it is a Zambian rather than international issue to contend with. Within these narratives there are also conflicting views on the best control methods to use and different reasoning behind the pathways of response. These are based on apparently incompatible priorities of people, land, animals, the economy and the environment. The extent to which a One Health approach has been embraced and the potential usefulness of this as a way of reconciling the aims of these framings and narratives is considered throughout the paper. Conclusions/Significance While there has historically been a lack of One Health working in this context, the complex, interacting factors that impact the disease show the need for cross-sector, interdisciplinary decision making to stop rival narratives leading to competing actions. Additional recommendations include implementing: surveillance to assess under-reporting of disease and consequential under-estimation of disease risk; evidence-based decision making; increased and structurally managed funding across countries; and focus on interactions between disease drivers, disease incidence at the community level, and poverty and equity impacts

How Society’s Philosophy Has Shaped Occupational Therapy Practice for the Past 100 Years

The Anne Cronin Mosey lecture seeks to stimulate provocative thinking about issues important to occupational therapy. The speaker is asked to raise a controversial issue and provide a perspective that may challenge many in the audience. In this paper, I examine occupational therapy practice in the context of the dominant philosophical movement of American society. The first part presents the influence of America’s dominant philosophical movements on the profession: pragmatism (1917), modernism (1940), and, currently, postmodernism. I propose that occupational therapy’s acceptance of modernism has resulted in two major opposing viewpoints, prompting polarization and fragmentation in the profession. I argue that it is time for the profession to be guided by a pluralistic postmodern philosophy that embraces the profession’s diversity. In the second part, I argue that practitioners should use postmodern pluralistic clinical reasoning, which emphasizes ethical concerns, practitioners’ competence and surrounding circumstances, and clients’ unique situations, while considering empirical evidence and theoretical perspectives. Postmodern pluralistic clinical reasoning does not argue for one conceptual model or theoretical approach. Instead, practitioners know that there are multiple possible interventions to address clients’ needs. The challenge is to select the best guideline for intervention or frame of reference given the clients’ and practitioners’ circumstances

Perspective Reasoning and the Solution to the Sleeping Beauty Problem

This paper proposes a new explanation for the paradoxes related to anthropic reasoning. Solutions to the Sleeping Beauty Problem and the Doomsday argument are discussed in detail. The main argument can be summarized as follows: Our thoughts, reasonings and narratives inherently comes from a certain perspective. With each perspective there is a center, or using the term broadly, a self. The natural first-person perspective is most primitive. However we can also think and express from others’ perspectives with a theory of mind. A perspective’s center could be unrelated to the topic of discussion so its de se thoughts need not to be considered, e.g. the perspective of an outside observer. Let’s call these the third-person perspective. First-person reasoning allows primitive self identification as I am inherently unique as the center of the perspective. Whereas from third-person perspective I am not fundamentally special comparing to others so a reference class of observers including me can be defined. It is my contention that reasonings from different perspectives should not mix. Otherwise it could lead to paradoxes even independent of anthropic reasoning. The paradoxes surrounding anthropic reasoning are caused by the aforementioned perspective mix. Regarding the sleeping beauty problem the correct answer should be double halving. Lewisian halving and thirding uses unique reasonings from both first and third-person perspectives. Indexical probabilities such as “the probability that this is the first awakening” or “the probability of me being one of the first 100 billion human beings” also mixes first- and third-person reasonings. Therefore invalid. Readers against perspectivism may disagree with point 1 and suggest we could reason in objective terms without the limit of perspectives. My argument is compatible with this belief. Objective reasoning would be analytically identical to the third-person perspective. My argument would become that objective reasoning and perspective reasonings should not mix. In the following I would continue to use “third-person perspective” but readers can switch that to “objective reasoning” if they wish so

Analytic frameworks for assessing dialogic argumentation in online learning environments

Over the last decade, researchers have developed sophisticated online learning environments to support students engaging in argumentation. This review first considers the range of functionalities incorporated within these online environments. The review then presents five categories of analytic frameworks focusing on (1) formal argumentation structure, (2) normative quality, (3) nature and function of contributions within the dialog, (4) epistemic nature of reasoning, and (5) patterns and trajectories of participant interaction. Example analytic frameworks from each category are presented in detail rich enough to illustrate their nature and structure. This rich detail is intended to facilitate researchers’ identification of possible frameworks to draw upon in developing or adopting analytic methods for their own work. Each framework is applied to a shared segment of student dialog to facilitate this illustration and comparison process. Synthetic discussions of each category consider the frameworks in light of the underlying theoretical perspectives on argumentation, pedagogical goals, and online environmental structures. Ultimately the review underscores the diversity of perspectives represented in this research, the importance of clearly specifying theoretical and environmental commitments throughout the process of developing or adopting an analytic framework, and the role of analytic frameworks in the future development of online learning environments for argumentation