BackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most common ethical (...) arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.ConclusionsWe argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs. (shrink)

Bernadette M Tobin; Development in Virtues, Journal of Philosophy of Education, Volume 20, Issue 2, 30 May 2006, Pages 201–214, https://doi.org/10.1111/j.1467-9.

Bernadette M Tobin; Development in Virtues, Journal of Philosophy of Education, Volume 20, Issue 2, 30 May 2006, Pages 201–214, https://doi.org/10.1111/j.1467-9.

Bernadette M Tobin; An Aristotelian Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 2, 30 May 2006, Pages 195–211, https://doi.

Bernadette M Tobin; Richard Peters's Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 1, 30 May 2006, Pages 15–27, https://doi.

Bernadette M Tobin; Richard Peters's Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 1, 30 May 2006, Pages 15–27, https://doi.

Bernadette M Tobin; An Aristotelian Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 2, 30 May 2006, Pages 195–211, https://doi.

It is in its Consequentialist mood that Australian philosophizing most clearly displays the 'no-nonsense' quality that we are tempted to think of as a national virtue: I hope this volume goes some way to showing the dangers of our being tempted by such flattering but ultimately shallow (and indeed morally coarse) national myths.

Two years ago, a group of philosophers and bioethicists published what they called a 'Consensus Statement on Conscientious Objection in Healthcare'. The statement, called the Brocher Statement because the group met at a foundation of that name in Geneva, sets out ten points that should 'inform, at the level of legislations and institutional policies, the way that conscientious objections in healthcare is regulated'. The statement proposes a very low threshold for compelling the performance of a practice in violation of conscience, (...) whether of an individual or of an institution, in healthcare. In so doing, it reflects the position advanced ten years earlier by the influential Australian philosopher, Julian Savulescu. Himself one of the group who proposed this 'Consensus Statement', Savulescu had claimed that '[a] doctor's conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources, which requires a reasonable conception of the patient's good and the patient's informed desires. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors'. Such a policy would, I submit, fail to accommodate the legitimate scope for conscientious decision-making, which is at the heart of medical professionalism. (shrink)

The success of assisted reproductive technologies (ARTs) worldwide has led to an accumulation of frozen embryos that are surplus to the reproductive needs of those for whom they were created. In these situations, couples must decide whether to discard them or donate them for scientific research or for use by other infertile couples. While legislation and regulation may limit the decisions that couples make, their decisions are often shaped by their religious beliefs. Unfortunately, health professionals, scientists and policy-makers are often (...) unaware of the way in which faith traditions view ART and decisions concerning the ‘fate’ of surplus embryos. In this paper scholars representing six major religious traditions provide a commentary on a hypothetical case concerning the donation or destruction of excess ART embryos. These commentaries provide a rich account of religious perspectives on the status of the human embryo and an insight into the relevance of faith to health and policy decisions, particularly in reproductive medicine, ART and embryo research. (shrink)

Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...) correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients. (shrink)

Les événements culturels internationaux constituent-ils un système symbolique indépendant des médias? Le propos de cet article s'inscrit dans une théorie générale de la trivialité, c'est-à-dire de la circulation des concepts entre la sphère de la production culturelle et celle des médias. Sans remettre en cause l'apport fondamental de Davidson à la théorie de l'événement - à savoir qu'un événement existe indépendamment de toute reconstruction ultérieure notamment par les médias - et, au contraire, en soulignant les apports d'une sémantique de l'histoire (...) pour comprendre une production culturelle, il cherche à mettre en évidence les interactions entre ces deux sphères, notamment les rôles du dispositif et du répertoire d'actions dans la pré-construction de l'information et l'incorporation de certains éléments du débat mené dans les médias par la sphère culturelle. S'il ne peut pas proposer une définition arrêtée de l'événement culturel international, en revanche, le chercheur peut observer le travail permanent de reconfiguration que couvre la catégorisation de ces événements.The international cultural events they are a symbolic system independent media? The purpose of this article is part of a general theory of triviality, that is to say, the circulation of concepts between the sphere of cultural production and the media. Without jeopardizing the fundamental contribution of Davidson's theory of the event - ie an event exists independently of any subsequent reconstruction by the media - and, instead, highlighting the contributions of the semantics history to understand cultural production, it seeks to highlight the interactions between these two spheres, including the roles of the device and directory actions in the pre-construction information and the incorporation of some elements of the debate conducted in the media by the cultural sphere. If they can not provide a conclusive definition of the international cultural event, however, the researcher can observe the work of permanent reconfiguration covers the categorization of these events. (shrink)

Medical Officers serving with their national contingents in peacekeeping operations are faced with difficult ethical decisions in regard to their obligations to the local civilian population. Such populations may be under-resourced in regard to medical care, and vulnerable to abuse and exploitation. Though the medical officer may support the local medical services, he/she should never undermine these resources. Adopting a human rights approach and observing the requirements of ethical medicine, aids the doctor in prioritising his/her duties. At times there may (...) be conflict with one’s own military superiors. It is wise to discuss potential difficulties prior to setting out on the mission. Human rights abuses cannot be ignored. The medical officer has a duty to do his/her best to report their observations so as to prevent abuse or to bring it to an end. (shrink)

Most work on reflexivity has focused on individuals exercising their reflexivity through discourse. However, agents have three major aspects (intentionality, causal efficacy and embodiment) and they are fundamentally social. This article examines the possibility of collective reflexivity conducted not just by saying, but also by doing—that is, through their embodiment. By expanding the concept of ‘performatives’ to encompass not just speech acts but also acts that speak (i.e. embodied activities as socially meaningful) and applying the work of Charles S. Peirce (...) in order to develop an ontology of embodied reflexivity, it becomes possible to determine several criteria defining embodied collective reflexivity. Assessing possibilities such as legislative debate, political demonstrations, religious ritual and dramatic performance reveals that a certain set of practices does in fact meet those criteria and discloses additional aspects of what constitutes embodied collective reflexivity. (shrink)

Family members do not have an official position in the practice of euthanasia and physician assisted suicide in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point (...) for further empirical and ethical inquiry. A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making. (shrink)

This article draws from cultural studies, political theory, international relations, art history and museum studies in order to consider `China Design Now' — the blockbuster exhibition, recently held at the V&A. It argues that, despite the inclusion of a number of interesting exhibits, the attempt to frame contemporary Chinese design independently of political contextualization has led to an exhibition which is largely unsatisfying. The approach taken by the V&A is further shown to have produced several ironic outcomes. First, by attempting (...) to avoid `contentious' political issues, the museum has, in fact, forced the `political' to the fore. Second, by taking such an approach, the V&A demonstrates that it has failed to understand the essentially political nature of the design problem. Third, it has produced an exhibition which appears to advocate a neoliberal agenda — one which insists on an inexorable drive towards greater global economic integration. Finally, it has failed to mention its own embeddedness within larger strategies of `cultural diplomacy' and the significance of such strategies for international relations and for cultural production. As well as drawing on a range of relevant literature, the article makes direct reference to exhibition wall texts, exhibit labels and quotations from the catalogue in order to support its argument. (shrink)

This paper is an exploration of the state of ‘clinical unease’ experienced by clinicians in contexts where professional judgement—grounded in clinical knowledge, critical reflection and a sound grasp of the law—indicates that there is more than one ethically defensible way to proceed. The question posed is whether the courts can be viewed as an appropriate vehicle to settle clinical unease by providing a ruling that clarifies the legal and ethical issues arising in the case, even in situations where there is (...) no dispute between the patient (or her proxies) and the healthcare team.The concept of ‘clinical unease’ is framed with reference to the broader experience of clinical decision-making, and distinguished from other widely discussed phenomena in the healthcare literature like moral distress and conscientious objection. A number of reported cases are briefly examined where the courts were invited to rule in circumstances of apparent ‘unease’. The respective responsibilities of clinicians and courts are discussed: in particular, their capability and readiness to respond to matters of ethical concern.Four imagined clinical scenarios are outlined where a clinical team might welcome a court adjudication, under current rules. Consideration is given to the likelihood of such cases being heard, and to whether there may be better remedies than the courts. There are final reflections on what clinicians may actually wish for in seeking court involvement, and on whether a willingness to engage with the experience of clinical unease may lead to greater sensitivity towards the value perspectives of others. (shrink)

Even though sign-systems are a crucial part of society, critical realism, as developed by Roy Bhaskar, does not yet have an adequate theory of signs and semiosis. The few suggestions that Bhaskar offers can be advanced through the semiotics of C.S. Peirce. In doing so, however, it becomes necessary to reconsider Bhaskar's ontological domains of the real, the actual, and the subjective, and expand the last domain into one of semiosis. This new understanding of ontological domains, incorporating Peirceian semiotics, provides (...) the basis for rethinking the ontology of society: the customary dyad structures/agents becomes the triad structures/agents/discourses, each of which possesses material, sociological, and meaningful aspects. (shrink)

Approaches to business ethics can be roughly divided into two streams: ‹codes of behavior’ and ‹forms of subjectification’, with code-oriented approaches clearly dominating the field. Through an elaboration of poststructuralist approaches to moral philosophy, this paper questions the emphasis on codes of behaviour and, thus, the conceptions of the moral and responsible subject that are inherent in rule-based approaches. As a consequence of this critique, the concept of a practice-based ‹ethics of responsiveness’ in which ethics is never final but rather (...) always ‹to come’, is investigated. In such an approach the ethical self is understood as being continuously constituted within power/knowledge relations. Following this line, we ask how one can become a responsible subject while also acknowledging certain limits of full responsibility. We thereby explore responsibility as a considered but unconditional openness in response to the other. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 25.2 (2001) 347-350 [Access article in PDF] Book Review The Sin of Knowledge: Ancient Themes and Modern Variations, The Sin of Knowledge: Ancient Themes and Modern Variations, by Theodore Ziolkowski; xvi & 222 pp. Princeton: Princeton University Press, $29.95. After thirty-five years of teaching and administrating at Princeton University, dozens of books, and innumerable articles, the eminent Germanist Theodore Ziolkowski has turned his attention to a (...) theme appropriate for someone so immersed in the intellectual life: the sorrow and grief that accompany human knowledge. Although Ziolkowski has made great contributions in standard studies of genre (notably the elegy and the twentieth-century novel) and authors (Mann, Hesse, and Broch), he became especially well known for his theorization and implementation of thematic studies, ranging from the sublime--fictionalizations of the life of Jesus--to the humorous--talking animals in literature. The figures whom Ziolkowski has selected for analysis of the sin of knowledge are Adam, Prometheus, and Faust, each of whom he views through both an ancient and a modern lens.All three of these mythic heroes violate "divine prohibitions against the new knowledge" (p. 69). Less heroically, all of these myths treat women misogynistically. Generally, Ziolkowski sees each of these stories as having emerged in a time of crisis, when new opportunities presented humanity with knowledge both alluring and disruptive. Because these are highly elastic myths, able to provide meaning in a variety of contexts, they have all mutated in modern times. Adam's Fall comes to represent the human transition from innocence to consciousness, Prometheus becomes a symbol for socialism's promise, and Faust turns into a representative of the American way of life.Looking at the ancient legend of Adam, Ziolkowski notes that sexuality and wisdom are linked in many of the oldest texts in humanity's recorded history. The emphasis on knowledge, however, is especially strong in the Hebrew myth. While many Near Eastern traditions have stories with similarities to the Biblical account of Adam and Eve, only Hebrew mythology has the Tree of Knowledge. For Ziolkowski, the fact that this story was probably set down during the reign of King Solomon explains this emphasis on knowledge. Because the Age of Solomon was a time of unparalleled wealth and power for the Hebrews, [End Page 347] Ziolkowski argues that the tale of Adam and Eve is the kind of myth "produced by cultures that have reached a certain level of sophistication... and look back with a degree of nostalgia at an imagined simpler, happier existence" (p. 23). According to Ziolkowski, knowledge becomes a sin for the Hebrews as they come to terms with the limitations of everything that their knowledge has brought them even at the height of their power and glory.In the modern era, Ziolkowski continues, the story of Adam has become secularized, representing the transition of humanity from a state of innocence to one of consciousness. He finds references to the Fall in Voltaire's Candide, Kleist's The Broken Pitcher, E. T. A. Hoffmann's The Golden Pot, Melville's Billy Budd, and Hesse's Demian. The overall trend of these representations of the rise of consciousness has been increasingly negative, culminating in sentiments like those expressed by the East German author Günter Kunter, who argues that "our whole present misery and all the problems of industrial civilization" can be linked to "the moment when man used the first firestone as a tool, the Fall" (p. 107). As Ziolkowski concludes: "Two centuries of secularization have brought the modern Adam to a depressing end" (p. 108).Citing Nietzsche, who compared Prometheus to Adam (and Pandora to Eve), Ziolkowski looks first at Hesiod's depiction of Prometheus as a trickster and then to Aeschylus' hero. Unlike the authors of the story of Adam and Eve, though, Aeschylus depicts Prometheus' claim to divine knowledge in a positive light: "Rather than a humankind declining from a glorious golden age to the present deplorable iron age, Aeschylus sees humanity progressing by means of knowledge--the crafts, arts, and sciences--from blindness and ignorance... (shrink)

In many countries grappling with the politics of equal recognition, the experiences, beliefs and reasons for action of people who identify as non-binary are starting to be seen as valid and intelligible.1 And, despite some gender clinics still responding cautiously to requests for non-standard medical interventions, their treatment needs are now recognised in major clinical guidelines. This is the current social context in which Notini and colleagues outline the case of ‘Phoenix’, an 18-year-old birth-assigned woman, who has requested the indefinite (...) continuation of puberty suppression, a treatment that was initiated when the client was 11 years old to mitigate their intense distress at the onset of puberty. Drawing on a conception of health as overall well-being, the authors conclude that OPS is ‘consistent with the proper goals of medicine’, and that there are ‘equity-based reasons’ for offering OPS to adults as a group. They concede that the physical risks are greater for OPS than for hormonal interventions generally provided to people with a binary gender identity. They also acknowledge the need for ‘a fine-grained ethical evaluation of Phoenix’s particular situation’ to assess whether the potential benefits of OPS outweigh the potential harms for this individual. Here I respectfully raise three points to amplify the authors’ discussion. First, there seem to be significant ethical issues of a general, not a particular, kind arising from the type of individual evaluation they call for. Following initial screening for significant mental distress and other major vulnerabilities, the key undertaking …. (shrink)

Summary With regard to the dynamics of human experience and behavior, Gestalt theoretical psychotherapy (GTP) relies mainly on Kurt Lewin’s dynamic field theory of personality. GTP is carried out by including a re-interpretation of Lewin’s theory in some aspects of psychotherapeutic practice in relation to critical realism. Human experience and behavior are understood to be functions of the person and the environment (including the other individuals therein) in a psychic field (life space), which encompasses both of these mutually dependent factors. (...) The anthropological model of this approach is, therefore, not mono-personal but, a priori, structural and relational in nature. It does not one-sidedly focus on the “inner components” of a person, but on the interrelation of the individual and a given environment, which affects experience and behavior. After a brief introduction of these basic concepts, this lecture will focus especially on Lewin’s concept of tension-systems, which may be considered as the Gestalt theoretical counterpart of Freud’s drive theory. Further, we define the basic assumptions which underlie GTP and explain how the person moves through her/his life experience in terms of Gestalt psychology. (shrink)

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners (...) have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care. (shrink)

All articles in May 2019’s special issue of Bioethics offer profound insights into the issue of “being a burden to others” in relation to wishes to die, which are highly relevant for ethical debates about end‐of‐life care and physician‐assisted dying. In this reply, we wish to stress the importance of acknowledging and analyzing the sociopolitical context of the phenomenon “being a burden” in relation to wishes to die and we will show how this analysis could benefit from a care ethical (...) approach. As discussions in care ethics have made clear, caring practices are both social and political practices. An empirical and ethical analysis of “being a burden” therefore needs to take institutional and societal norms and structures into account, in addition to first‐person experiences and concepts such as caring needs, relational autonomy, and interdependency. Besides the relevance of the sociopolitical context for the phenomenon “being a burden” as such, the sociopolitical context also seems relevant for the investigation of the phenomenon, which we will illustrate by reflecting on “being a burden” in relation to the practice of physician‐assisted dying in the Netherlands. (shrink)

Dans un territoire de la République de plus en plus fragmenté, l’appréciation du bon ordre est de plus en plus difficile pour l’autorité civile de police municipale, maire ou préfet. L’occupation de l’espace et les conflits qui en résultent sont mal anticipés par la planification de l’urbanisme comme l’illustrent les grands rassemblements d’hommes, le désarroi des campagnes et les quartiers sensibles. L’ordre public doit s’exercer dans la proximité mais sous bonne régulation zonale.

The primacy of practice in the development of knowledge is one of materialism’s fundamental tenets. Most arguments supporting it have been strictly philosophical. However, over the past thirty years cognitive science has provided mounting evidence supporting the primacy of practice. Particularly striking is its finding that thought is fundamentally metaphoric—that images emerging from everyday embodied activities not only make ordinary experiences intelligible, but also underpin our more abstract engagements with the world, elaborated in disciplines such as ethics and science. Cognitive (...) science’s implications must now be absorbed into critical realism. Cognitive science bolsters critical realism by providing a scientifically-grounded analysis of the passage from body to mind and the fundamental unity between them, while sustaining their distinctiveness. Its implications for critical realism ripple out in four waves: first, critical realism’s understanding of the mind/body relationship; second, its concepts of the process that connects theory and practice, and what that means for critical realism’s view of intellectual production, the place of metaphor in scientific theorization, and cultural development; its view of culture as a complexwhole; and finally, its theory of human agency as embodied and intentional. (shrink)

The primacy of practice in the development of knowledge is one of materialism's fundamental tenets. Most arguments supporting it have been strictly philosophical. However, over the past thirty years cognitive science has provided mounting evidence supporting the primacy of practice. Particularly striking is its finding that thought is fundamentally metaphoric—that images emerging from everyday embodied activities not only make ordinary experiences intelligible, but also underpin our more abstract engagements with the world, elaborated in disciplines such as ethics and science. Cognitive (...) science's implications must now be absorbed into critical realism. Cognitive science bolsters critical realism by providing a scientifically-grounded analysis of the passage from body to mind and the fundamental unity between them, while sustaining their distinctiveness. Its implications for critical realism ripple out in four waves: first, critical realism's understanding of the mind/body relationship; second, its concepts of the process that connects theory and practice, and what that means for critical realism's view of intellectual production, the place of metaphor in scientific theorization, and cultural development; its view of culture as a complex whole; and finally, its theory of human agency as embodied and intentional. (shrink)