Is there a liberal principle of instrumental transmission?

Some of our reasons for action are grounded in the fact that the action in question is a means to something else we have reason to do. This raises the question as to which principles govern the transmission of reasons from ends to means. In this paper, we discuss the merits and demerits of a liberal transmission principle, which plays a prominent role in the current literature. The principle states that an agent has an instrumental reason to whenever -ing is a means for him to do what he has intrinsic reason to do. We start by discussing the objection that this principle implies counterintuitive reason statements. We argue that attempts to solve this “too many reasons problem” by appealing to pragmatic strategies for debunking intuitions about so-called negative reason existentials are questionable. Subsequently, we discuss three important arguments in favor of Liberal Transmission, and argue that they fail to make a convincing case for this principle. In the course of the discussion, we also provide alternative, less liberal transmission principles. We argue that these alternative principles allow us to accommodate those phenomena that seem to support Liberal Transmission while avoiding its problems

The right and the wrong kind of reasons

In a number of recent philosophical debates, it has become common to distinguish between two kinds of normative reasons, often called the right kind of reasons (henceforth: RKR) and the wrong kind of reasons (henceforth: WKR). The distinction was first introduced in discussions of the so-called buck-passing account of value, which aims to analyze value properties in terms of reasons for pro-attitudes and has been argued to face the wrong kind of reasons problem. But nowadays it also gets applied in other philosophical contexts and to reasons for other responses than pro-attitudes, for example in recent debates about evidentialism and pragmatism about reasons for belief. While there seems to be wide agreement that there is a general and uniform distinction that applies to reasons for different responses, there is little agreement about the scope, relevance and nature of this distinction. Our aim in this article is to shed some light on this issue by surveying the RKR/WKR distinction as it has been drawn with respect to different responses, and by examining how it can be understood as a uniform distinction across different contexts. We start by considering reasons for pro-attitudes and emotions in the context of the buck-passing account of value (§1). Subsequently we address the distinction that philosophers have drawn with respect to reasons for other attitudes, such as beliefs and intentions (§2), as well as with respect to reasons for action (§3). We discuss the similarities and differences between the ways in which philosophers have drawn the RKR/WKR distinction in these areas and offer different interpretations of the idea of a general, uniform distinction. The major upshot is that there is at least one interesting way of substantiating a general RKR/WKR distinction with respect to a broad range of attitudes as well as actions. We argue that this has important implications for the proper scope of buck-passing accounts and the status of the wrong kind of reasons problem (§4)

Practical conflicts as a problem for epistemic reductionism about practical reasons

According to epistemic reductionism about practical reasons, facts about practical reasons can be reduced to facts about evidence for ought-judgements. We argue that this view misconstrues practical conflicts. At least some conflicts between practical reasons put us in a position to know that an action ϕ is optional, i.e. that we neither ought to perform nor ought to refrain from performing the action. By understanding conflicts of practical reasons as conflicts of evidence about what one ought to do, epistemic reductionism fails to account for this. In conflict cases in which ϕ-ing is optional, epistemic reductionism suggests that we have equally strong evidence for and against assuming that we ought to ϕ, and thus cannot be in a position to know that it is not the case that we ought to ϕ. This is a serious flaw.Peer Reviewe

Undergraduate medical students' behavioural intentions towards medical errors and how to handle them: A qualitative vignette study

Objectives In undergraduate medical education, the topics of errors in medicine and patient safety are under-represented. The aim of this study was to explore undergraduate medical students' behavioural intentions when confronted with an error. Design A qualitative case vignette survey was conducted including one of six randomly distributed case scenarios in which a hypothetical but realistic medical error occurred. The six scenarios differed regarding (1) who caused the error, (2) the presence of witnesses and (3) the consequences of the error for the patient. Participants were asked: â € What would you do?". Answers were collected as written free texts and analysed according to qualitative content analysis. Setting Students from German medical schools participated anonymously through an online questionnaire tool. Participants Altogether, n=159 students answered a case scenario. Participants were on average 24.6 years old (SD=7.9) and 69% were female. They were undergraduate medical students in their first or second year (n=27), third, fourth or fifth year (n=107) or final year (n=21). Results During the inductive coding process, 19 categories emerged from the original data and were clustered into four themes: (1) considering communication; (2) considering reporting; (3) considering consequences; and (4) emotional responsiveness. When the student him/herself caused the error in the scenario, participants did mention communication with colleagues and taking preventive action less frequently than if someone else had caused the error. When a witness was present, participants more frequently mentioned disclosure of the error and taking actions than in the absence of a witness. When the outcome was significant to the patient, participants more often showed an emotional response than if there were no consequences. Conclusions The study highlights the importance of coping strategies for healthcare professionals to adequately deal with errors. Educators need to introduce knowledge and skills on how to deal with errors and emotional preparedness for errors into undergraduate medical education

Klinisches Denken und Handeln

Die Frage nach den Ursachen von Behandlungsfehlern und Maßnahmen, um diesen entgegenzusteuernd, sind von globalem Interesse, insbesondere seitdem das Institute for Medicine die Zusammenstellung der Studien „To Err is Human“ im Jahr 2000 herausbrachte (Kohn, Corrigan, & Donaldson, 2000). Dort wurde berichtet, dass in den USA jährlich rund 44.000 Menschen durch falsche Behandlungen sterben. In Deutschland wird davon ausgegangen, dass im Jahr 2015 rund 15.000 Behandlungsfehler vorgeworfen werden, die meisten davon in Zusammenhang mit Operationen (Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen, 2016). In rund 200 Fällen sollen Patienten an den Folgen eines Behandlungsfehlers gestorben sein. Nach derzeitigem Stand der Forschung lassen sich drei Ansätze zur Vermeidung von Fehlern unterscheiden: Der Ansatz auf Systemebene, auf Team-, und auf Individualebene (Baker, Salas, King, Battles, & Barach, 2005). Im Folgenden wird insbesondere auf die Team- und Individualebene fokussiert. Ziel des Habilitationsprojektes ist es, Patientensicherheit zu verbessern, indem Wissen über die kognitive Struktur individueller und kollektiver ärztlicher Handlungen generiert wird. Darauf aufbauend soll es möglich sein, instruktionale Interventionen zu entwerfen die (1) besser auf den persönlichen Voraussetzungen der Teilnehmer aufbauen und (2) es besser möglich machen, dass die Teilnehmer in einem fehlerfreundlichen Umfeld von ihren Fehlern lernen

Collaboration Expertise in Medicine - No Evidence for Cross-Domain Application from a Memory Retrieval Study

Background Is there evidence for expertise on collaboration and, if so, is there evidence for cross-domain application? Recall of stimuli was used to measure so-called internal collaboration scripts of novices and experts in two studies. Internal collaboration scripts refer to an individual's knowledge about how to interact with others in a social situation. Method-Study 1 Ten collaboration experts and ten novices of the content domain social science were presented with four pictures of people involved in collaborative activities. The recall texts were coded, distinguishing between superficial and collaboration script information. Results-Study 1 Experts recalled significantly more collaboration script information (M = 25.20;SD = 5.88) than did novices (M = 13.80;SD = 4.47). Differences in superficial information were not found. Study 2 Study 2 tested whether the differences found in Study 1 could be replicated. Furthermore, the cross-domain application of internal collaboration scripts was explored. Method-Study 2 Twenty collaboration experts and 20 novices of the content domain medicine were presented with four pictures and four videos of their content domain and a video and picture of another content domain. All stimuli showed collaborative activities typical for the respective content domains. Results-Study 2 As in Study 1, experts recalled significantly more collaboration script information of their content domain (M = 71.65;SD = 33.23) than did novices (M = 54.25;SD = 15.01). For the novices, no differences were found for the superficial information nor for the retrieval of collaboration script information recalled after the other content domain stimuli. Discussion There is evidence for expertise on collaboration in memory tasks. The results show that experts hold substantially more collaboration script information than did novices. Furthermore, the differences between collaboration novices and collaboration experts occurred only in their own content domain, indicating that internal collaboration scripts are not easily stored and retrieved in memory tasks other than in the own content domain

Practical Conflicts as a Problem for Epistemic Reductionism About Practical Reasons

According to epistemic reductionism about practical reasons, facts about practical reasons can be reduced to facts about evidence for ought-judgements. We argue that this view misconstrues practical conflicts. At least some conflicts between practical reasons put us in a position to know that an action F is optional, i.e. that we neither ought to perform nor ought to refrain from performing the action. By understanding conflicts of practical reasons as conflicts of evidence about what one ought to do, epistemic reductionism fails to account for this. In conflict cases in which F-ing is optional, epistemic reductionism suggests that we have equally strong evidence for and against assuming that we ought to F, and thus cannot be in a position to know that it is not the case that we ought to F. This is a serious flaw