This paper proposes an ethical framework for rationing publicly financed health care. We begin by classifying alternative rationing criteria according to their ethical basis. We then examine the ethical arguments for four rationing criteria. These alternatives include rationing high technology services, non-basic services, services to patients who receive the least medical benefit, and services that are not equally available to all. We submit that a just health care system will not limit basic health care to persons unable to pay for (...) it. Furthermore, justice in health care requires limiting publicly-financed non-basic health care, striving for equality in access to basic health care, and relying on medical benefit to ration non-basic health care. (shrink)

Background: The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care “upstream”. The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Methods: Directed content analysis was used to review ethics consultation notes from an academic children’s hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues derived (...) and modified from published quality improvement protocols. Results: Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (shrink)

A caregiver from the dominant U.S. culture and a patient from a very different culture can resolve cross‐cultural disputes about treatment, not by compromising important values, but by focusing on the patient's goals.

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

Part III: Now presents solely, clinical ethics. --.

It is tempting to think that all of normativity, such as our reasons for action, what we ought to do, and the attitudes that it is fitting for us to have, derives from what is valuable. But value-first approaches to normativity have fallen out of favour as the virtues of reasons- and fittingness-first approaches to normativity have become clear. On these views, value is not explanatorily prior to reasons and fit; rather the value of things is understood in terms of (...) the pro-attitudes it is fitting to have, or that we have reasons to have, towards these things. The value-first accounts of reasons and fit that have been proposed have been direct accounts of reasons and fit. On these views, the fittingness of an attitude is explained in terms of the value of having it or the value of the object of that attitude. This chapter details and surveys these problems, explaining which are yet to be overcome, and explaining which problems direct value-first accounts can overcome. This chapter then explores the prospects of an indirect value-first account of reasons and fit. It argues that it avoids the problems that direct value-first accounts face and may be as explanatorily powerful as fittingness- and reasons-first accounts of value and normativity more generally. (shrink)

The chapter introduces and characterizes the notion of fittingness. It charts the history of the relation and its relevance to contemporary debates in normative and metanormative philosophy and proceeds to survey issues to do with fittingness covered in the volume’s chapters, including the nature and epistemology of fittingness, the relations between fittingness and reasons, the normativity of fittingness, fittingness and value theory, and the role of fittingness in theorizing about responsibility. The chapter concludes with a brief discussion of issues to (...) do with fittingness that aren’t covered extensively by the volume’s chapters in order to indicate avenues for further research. (shrink)

Interpretive Political Science is the second of two volumes featuring a selection of key writings by R.A.W. Rhodes. Volume II looks forward and explores the 'interpretive turn' and its implications for the craft of political science, especially public administration, and draws together articles from 2005 onwards on the theme of 'the interpretive turn' in political science. Part I provides a summary statement of the interpretive approach, and Part II develops the theme of blurring genres and discusses a variety of research (...) methods common in the humanities, including: ethnographic fieldwork, life history, and focus groups. Part III demonstrates how the genres of thought and presentation found in the humanities can be used in political science. It presents four examples of such blurring 'at work' with studies of: applied anthropology and civil service reform; women's studies and government departments; and storytelling and local knowledge. The book concludes with a summary of what is edifying about an interpretive approach, and why this approach matters, and revisits some of the more common criticisms before indulging in plausible conjectures about the future of interpretivism. The author seeks new and interesting ways to explore governance, high politics, public policies, and the study of public administration in general. (shrink)

On the lives and philosophy of the Prophets of Islam and Sufi Muslim saints.

Epistemic decision theorists aim to justify Bayesian norms by arguing that these norms further the goal of epistemic accuracy—having beliefs that are as close as possible to the truth. The standard defense of Probabilism appeals to accuracy dominance: for every belief state that violates the probability calculus, there is some probabilistic belief state that is more accurate, come what may. The standard defense of Conditionalization, on the other hand, appeals to expected accuracy: before the evidence is in, one should expect (...) to do better by conditionalizing than by following any other rule. We present a new argument for Conditionalization that appeals to accuracy‐dominance, rather than expected accuracy. Our argument suggests that Conditionalization is a rule of coherence: plans that conflict with Conditionalization don't just prescribe bad responses to the evidence; they also give rise to inconsistent attitudes. (shrink)

Marco Aurelio. Pensamientos.--Kant, E. Fundamentación de la metafísica de las costumbres.--Mill, J. S. De que clase de prueba es susceptible el principio de utilidad.--Lefebre, H. La moral marxista.--Dostoievski, F. Crimen y castigo.--Nietzsche, F. Más allá del bien y del mal.--Bergson, H. La obligación moral.--Camus, A. El extraño.--Hare, R. M. Etica y política.

Iranian research on anomie; enjoining good and forbidding evil.

Part of the Studies in Crime and Public Policy series, this book, written by one of the top philosophers of punishment, examines the main trends in penal theorizing over the past three decades. Duff asks what can justify criminal punishment, and then explores the legitimacy of actual practices by examining what would count as adequate justification for them. Duff argues that a "communicative conception of punishment," which he presents as a third way between consequentialist and retributive theories, offers the most (...) fruitful way of understanding punishment's meaning and justification. Duff addresses such questions as how much sentences should be constrained by proportionality requirements; what modalities of punishment best communicate their intended meaning; and what decisionmaking procedures he envisions. This book will appeal to criminologists, philosophers, and others interested in theories of punishment. (shrink)

Study on the Qurʼānic teaching for ideal society.

The human person makes great demands on the physician and calls for unique attention. Hence the doctor-patient relationship calls for the highest ideals of kindness, patience, trustworthiness, generosity and skill. The Catholic physician brings to these demands a specific meaning: ministering to the sick is to see Christ in them and to show Him to them.

After distinguishing different species of Legal Moralism I outline and defend a modest, positive Legal Moralism, according to which we have good reason to criminalize some type of conduct if it constitutes a public wrong. Some of the central elements of the argument will be: the need to remember that the criminal law is a political, not a moral practice, and therefore that in asking what kinds of conduct we have good reason to criminalize, we must begin not with the (...) entire realm of wrongdoing, but with conduct falling within the public realm of our civic life; the need to look at the different processes of criminalization, and to ask what kinds of consideration can properly figure in those processes; the need to attend to the relationship, and the essential differences, between criminal law and other modes of legal regulation. (shrink)

How can a system of criminal punishment be justified? In particular can it be justified if the moral demand that we respect each other as autonomous moral agents is taken seriously? Traditional attempts to justify punishment as a deterrent or as retribution fail, but Duff suggests that punishment can be understood as a communicative attempt to bring a wrong-doer to repent her crime. This account is supported by discussions of moral blame, of penance, of the nature of the law's demands, (...) and of the proper meaning and purpose of the criminal process of trial and verdict: it deals both with the ideals that should inform a system of criminal law and the extent to which those ideals are actualised in existing institutions and practices. The conclusion is pessimistic: punishment cannot be justified within our legal system; and this gap between the ideal and the actual presents us with serious moral dilemmas. (shrink)

Marcia Baron has offered an illuminating and fruitful discussion of extra-legal excuses. What is particularly useful, and particularly important, is her focus on our excusatory practices—on the ways and contexts in which we make, offer, accept, bestow and reject excuses: if we are to reach an adequate understanding of excuses, their implications and their grounds, we must attend to the roles that they can play in our human activities and relationships—and to the complexities and particularities of those roles. However, I (...) want to focus my comments less on the details of Baron’s discussions of excuses in extra-legal contexts than on the implications of her discussion for our understanding of excuses in the criminal law. What light (if any, a sceptic might add) can such analyses of our extra-legal concepts and practices throw on legal concepts and doctrines? (shrink)

I begin by discussing the ways in which a would-be blamer's own prior conduct towards the person he seeks to blame can undermine his standing to blame her. This provides the basis for an examination of a particular kind of 'bar to trial' in the criminal law – of ways in which a state or a polity's right to put a defendant on trial can be undermined by the prior misconduct of the state or its officials. The examination of this (...) often neglected legal phenomenon illuminates some central features of the criminal law and the criminal process, and some of the preconditions for the legitimacy of the criminal law in a liberal republic. (shrink)

A caregiver from the dominant U.S. culture and a patient from a very different culture can resolve cross‐cultural disputes about treatment, not by compromising important values, but by focusing on the patient's goals.

Some standards, such as moral and prudential standards, provide genuinely or authoritatively normative reasons for action. Other standards, such as the norms of masculinity and the mafia’s code of omerta, provide reasons but do not provide genuinely normative reasons for action. This paper first explains that there is a similar distinction amongst attitudinal standards: some attitudes (belief, desire) have standards that seem to give rise to genuine normativity; others (boredom, envy) do not. This paper gives a value-based account of which (...) attitudinal standards give rise to genuine normativity. It argues that this account has interesting implications before extending it to provide an account of which action-guiding standards are genuinely normative. It argues that this value-based account of which standards are genuinely normative is more plausible than alternatives suggested in the literature and has interesting implications for genuine normativity in law and aesthetics. (shrink)

In this article, we consider two independently appealing theories—the Growing-Block view and Humean Supervenience—and argue that at least one is false. The Growing-Block view is a theory about the nature of time. It says that past and present things exist, while future things do not, and the passage of time consists in new things coming into existence. Humean Supervenience is a theory about the nature of entities like laws, nomological possibility, counterfactuals, dispositions, causation, and chance. It says that none of (...) these entities are fundamental, since if they were, this would entail the existence of irreducible necessary connections between matters of fact. Instead, these entities supervene on a fundamental, non-nomological ‘Humean mosaic’ of property instances at spacetime points. We will further explain and motivate the Growing-Block view and Humean Supervenience in Sects. 2 and 3, but first, we turn to our master argument. (shrink)

In response to Lawrence Solum's advocacy of a ‘virtue–centred theory of judging’, I argue that there is indeed important work to be done in identifying and characterising those qualities of character that constitute judicial virtues – those qualities that a person needs if she is to judge well (though I criticise Solum's account of one of the five pairs of judicial vices and virtues that he identifies – avarice and temperance). However, Solum's more ambitious claims – that a judge's vice (...) necessarily corrupts her decisions, and that in at least some contexts we must define a legally correct decision as one that would be reached by a virtuous judge – should be rejected: we can undermine the former by attending to the requirements of due process, and the latter by attending to the ways in which a judge would try to justify her decision. (shrink)