There are several important conceptual issues and questions about the practice of healthcare ethics that can, and should, inform the development of any practice standards. This paper provides a relatively short overview of seven of these issues, with the invitation for further critical reflection and examination of their relevance to and implications for practice standards. The seven issues described include: diversity (from the perspective of training and experience); moral expertise and authority/influence; being an insider or outsider; flexibility and adaptability (for (...) local contexts of practice); the relative weighting of procedural and normative aspects of ethics practice; making mistakes or errors; and conflicts of interest in practice. (shrink)

This book challenges readers to rethink rural health ethics. Traditional approaches to health ethics are often urban-centric, making implicit assumptions about how values and norms apply in health care practice, and as such may fail to take into account the complexity, depth, richness, and diversity of the rural context. There are ethically relevant differences between rural health practice and rural health services delivery and urban practice and delivery that go beyond the stereotypes associated with rural life and rural health services. (...) This book examines key values in the rural context that have not been fully explored or taken into account when we examine health ethics issues, including the values of community and place, and a need to “revalue” relationships. It also advocates for a greater attention to meso and macro level analysis in rural health ethics as being critical to ethical analysis of rural health care. This book is essential reading for those involved in health ethics, rural health policy and governance, and for rural health providers. (shrink)

ABSTRACT When hope is discussed in bioethics’ literature, it is most often in the context of ‘false hopes’ and/or how to maintain hope while breaking bad news to patients. Little or no time is generally devoted to the description of hope that supports these analyses. In this paper, I present a detailed description of hope, one designed primarily for the healthcare context. Noting that hope is an emotional attitude, four key aspects are explored. In particular, the function of imagination in (...) hope is discussed in depth. Through an examination of the relationship between hope and vulnerability, I demonstrate how adequately describing hope can broaden the normative inquiry into the role of hope in healthcare. Three ways in which persons with hope can be vulnerable are illustrated, and the challenge of how healthcare providers can attend in moral ways to the hopes of patients is identified. (shrink)

ABSTRACT When hope is discussed in bioethics’ literature, it is most often in the context of ‘false hopes’ and/or how to maintain hope while breaking bad news to patients. Little or no time is generally devoted to the description of hope that supports these analyses. In this paper, I present a detailed description of hope, one designed primarily for the healthcare context. Noting that hope is an emotional attitude, four key aspects are explored. In particular, the function of imagination in (...) hope is discussed in depth. Through an examination of the relationship between hope and vulnerability, I demonstrate how adequately describing hope can broaden the normative inquiry into the role of hope in healthcare. Three ways in which persons with hope can be vulnerable are illustrated, and the challenge of how healthcare providers can attend in moral ways to the hopes of patients is identified. (shrink)

This paper examines the practice of covert medication administration from an organizational ethics perspective. This includes consideration of vulnerability and stigmatization, safety, and fairness in terms of the culture of health care organizations and the relevance of policies and processes in relation to covert medication administration. As much of the discussion about covert medication administration focuses on patients and health care providers, this analysis aims to help expand the analysis of this practice.

The Living Organ Donor as Patient: Theory and Practice, by Lainie Friedman Ross and J. Richard Thistlethwaite, Jr. (Oxford University Press, 2021), offers a stimulating opportunity to consider the ethics of living solid organ donation in more depth. Ross and Thistlethwaite detail a framework of five principles—respect for persons, beneficence, justice, vulnerability, and responsibility—that positions prospective living donors as patients. The authors engage readers by applying these principles across a series of examples, issues, and possibilities, the “practice.” Readers may wish (...) to reflect further on the framework's implications, including those related to vulnerability, power, and social justice (to name a few), particularly as these relate to the “theory” of this book. The book is well worth the read for clinicians, ethicists, and others involved in organ donation and transplantation. (shrink)

Early on in the development of Practicing Healthcare Ethicists Exploring Professionalization (PHEEP), the founding members recognized the need to address and meet two important goals: (1) the creation of a dynamic, rigorous process to support the exploratory work, and (2) the establishment of the means—deliberative engagement—to generate and justify the substantive content of professionalization-related products, such as practice standards and position statements. Drawing from social justice and deliberative democracy conceptions and insights (among others), the authors identify and describe the core (...) elements of the “process scaffolding” and “deliberative means” that inform PHEEP’s deliberative engagement methodology. The paper demonstrates how these process and substantive features have been meaningfully instantiated in the decision making framework established by PHEEP for its use in the development of professionalization-related products by Canadian practicing healthcare ethicists. (shrink)

Potential conflicts between the roles of physicians and researchers have been described at the theoretical level in the bioethics literature (Czoli, et al., 2011). Physicians and researchers are generally in mutually distinct roles, responsible for patients and participants respectively. With increasing emphasis on integration of research into clinical settings, however, the role divide is sometimes unclear. Consequently, physician–researchers must consider and negotiate salient ethical differences between clinical– and research–based obligations (Miller et al, 1998). This paper explores the subjective experiences and (...) perspectives of 30 physician–researchers working in three Canadian paediatric settings. Drawing on qualitative interviews, it identifies ethical challenges and strategies used by physician–researchers in managing dual roles. It considers whether competing obligations could have both positive and adverse consequences for both physician–researchers and patients. Finally, we discuss how empirical work, which explores the perspectives of those engaged in research and clinical practice, can lead the way to understanding and promoting best practice. (shrink)

BackgroundThe COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic.MethodTo inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a (...) literature review to summarize the ethical issues.ResultsThis literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates.ConclusionThis literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve. (shrink)

This article discusses clinical ethics consultation (CEC), and thereby ethics support services in the Canadian context. Commonalities and differences between the three models of ethics support and CEC shared in this article are identified, set within the broader context of the Canadian healthcare system, accreditation, and professionalization of practicing healthcare ethicists.

Physician-researchers are bound by professional obligations stemming from both the role of the physician and the role of the researcher. Currently, the dominant models for understanding the relationship between physician-researchers' clinical duties and research duties fit into three categories: the similarity position, the difference position and the middle ground. The law may be said to offer a fourth.

The verb to legitimate is often used in political discourse in a way that is prima facie perplexing. To wit, it is often said that an actor legitimates a practice which is officially prohibited in the relevant context – for example, that a worker telling sexist jokes legitimates sex discrimination in the workplace. In order to clarify the meaning of statements like this, and show how they can sometimes be true and informative, we need an explanation of how something that (...) is officially illegitimate can have a kind of ersatz legitimacy conferred on it, and how this can occur even when the actor ‘doing the legitimating’ lacks formal authority. I examine one putative explanation centred around the phenomenon of normalization, and I highlight some advantages that this account has in comparison to an alternative explanation, one that makes reference to the phenomenon of licensed authority. (shrink)

Permissivism says that for some propositions and bodies of evidence, there is more than one rationally permissible doxastic attitude that can be taken towards that proposition given the evidence. Some critics of this view argue that it condones, as rationally acceptable, sets of attitudes that manifest an untenable kind of arbitrariness. I begin by providing a new and more detailed explication of what this alleged arbitrariness consists in. I then explain why Miriam Schoenfield’s prima facie promising attempt to answer the (...) Arbitrariness Objection, by appealing to the role of epistemic standards in rational belief formation, fails to resolve the problem. Schoenfield’s strategy is, however, a useful one, and I go on to explain how an alternative form of the standards-based approach to Permissivism – one that emphasizes the significance of the relationship between people’s cognitive abilities and the epistemic standards that they employ – can respond to the arbitrariness objection. (shrink)

This paper explains how the practice of ‘no platforming’ can be reconciled with a liberal politics. While opponents say that no platforming flouts ideals of open public discourse, and defenders see it as a justifiable harm-prevention measure, both sides mistakenly treat the debate like a run-of-the-mill free speech conflict, rather than an issue of academic freedom specifically. Content-based restrictions on speech in universities are ubiquitous. And this is no affront to a liberal conception of academic freedom, whose purpose isn’t just (...) to protect the speech of academics, but also to give them the prerogative to determine which views and speakers have sufficient disciplinary credentials to receive a hearing in academic contexts. No platforming should therefore be acceptable to liberals, in principle, in cases where it is used to support a university culture that maintains rigorous disciplinary standards, by denying attention and credibility to speakers without appropriate disciplinary credentials. (shrink)

The last two decades have seen two significant trends emerging within the philosophy of science: the rapid development and focus on the philosophy of the specialised sciences, and a resurgence of Aristotelian metaphysics, much of which is concerned with the possibility of emergence, as well as the ontological status and indispensability of dispositions and powers in science. Despite these recent trends, few Aristotelian metaphysicians have engaged directly with the philosophy of the specialised sciences. Additionally, the relationship between fundamental Aristotelian concepts—such (...) as "hylomorphism", "substance", and "faculties"—and contemporary science has yet to receive a critical and systematic treatment. _Neo-Aristotelian Perspectives on Contemporary Science _aims to fill this gap in the literature by bringing together essays on the relationship between Aristotelianism and science that cut across interdisciplinary boundaries. The chapters in this volume are divided into two main sections covering the philosophy of physics and the philosophy of the life sciences. Featuring original contributions from distinguished and early-career scholars, this book will be of interest to specialists in analytical metaphysics and the philosophy of science. (shrink)

The standard view of academic freedom and free speech is that they play complementary roles in universities. Academic freedom protects academic discourse, while other public discourse in universities is protected by free speech. Here I challenge this view, broadly, on the grounds that free speech in universities sometimes undermines academic practices. One defense of the standard view, in the face of this worry, says that campus free speech actually furthers the university’s academic aims. Another says that universities have a secondary (...) democratic function, which cannot be fulfilled without free speech on campus. I identify shortcomings in both types of arguments. (shrink)

This paper examines two recent contributions to the hate speech literature – by Steven Heyman and Jeremy Waldron – which seek a justification for the legal restriction of hate speech in an account of the way that hate speech infringes against people’s dignity. These analyses look beyond the first-order hurts and disadvantages suffered by the immediate targets of hate speech, and consider the prospect of hate speech sustaining complex social structures whose wide-scale operations lower the social status of members of (...) targeted groups. In Heyman’s and Waldron’s accounts we find plausible insights into the nature of identity-based social hierarchies, and the harms that redound to subordinated people under the operations of such hierarchies. I argue, however, that both analyses are unsuccessful as justifications for the restriction of hate speech, because they do not ultimately provide reason to think that hate speech is responsible for creating or sustaining identity-based social hierarchies. (shrink)

Includes bibliographical references and index.

In disagreements about trivial matters, it often seems appropriate for disputing parties to adopt a ‘middle ground’ view about the disputed matter. But in disputes about more substantial controversies (e.g. in ethics, religion, or politics) this sort of doxastic conduct can seem viciously acquiescent. How should we distinguish between the two kinds of cases, and thereby account for our divergent intuitions about how we ought to respond to them? One possibility is to say that ceding ground in a trivial dispute (...) is appropriate because the disputing parties are usually epistemic peers within the relevant domain, whereas in a more substantial disagreement the disputing parties rarely, if ever, qualify as epistemic peers, and so ‘sticking to one’s guns’ is usually the appropriate doxastic response. My aim in this paper is to explain why this way of drawing the desired distinction is ultimately problematic, even if it seems promising at first blush. (shrink)

A distinguished critic explores the term "situatedness" - the self's position in time and place in the world and its treatment seen in legal theory, social ...

Should we implement epistemically paternalistic measures outside of the narrow range of cases, like legal trials, in which their benefits and justifiability seem clear-cut? In this chapter I draw on theories of student-led pedagogy, and Jane Friedman’s work on norms of inquiry, to argue against this prospect. The key contention in the chapter is that facts about an inquirer’s interests and temperament have a bearing on whether it is better for her to, at any given moment, pursue epistemic goods via (...) outward-facing evidence-acquisition, or in a more introspective, ratiocinative fashion. This makes problems for any non-consultative approach to assisting people in inquiry, and speaks in favor of approaches which, as with student-led pedagogy, aim to ‘tap into’ the inquirer’s interests and temperament in helping them to learn. (shrink)

Toby Handfield has advanced a subtle form of dispositionalism that purports to reconcile the concept of causal powers with broadly Humean convictions by dissolving the requirement for objectively modal relations between powers and their manifestations. He suggests we should identify manifestations with certain types of causal processes, and identify powers with properties that are parts of their structures. The modal features of causal powers can then be explained in terms of internal relations between a power and the property of being (...) a certain type of causal process, but these relations are supervenient and do not add anything to the basic ontology. In this way, causal powers may be ‘connected’ to their manifestations without admitting objectively modal relations. I disagree with this characterisation of causal powers and its identification of manifestations with types of causal processes: I question the assumption that causal processes can be isolated in quantum physics in the way Handfield requires and confront Humean dispositionalism with the problem of individuating powers in an entangled world. (shrink)

Proponents of the view which I call ‘moral antitheodicy’ call for the theistic discourse of theodicy to be abandoned, because, they claim, all theodicies involve some form of moral impropriety. Three arguments in support of this view are examined: the argument from insensitivity, the argument from detachment, and the argument from harmful consequences. After discussing the merits of each argument individually, I attempt to show that they all must presuppose what they are intended to establish, namely, that the set of (...) premises advanced in any given theodicy will be untenable. I conclude by discussing what uses there might be for the moral critique of theodicy, if it cannot be used to ground a global rejection of theodical practice. (shrink)

Philosopher Kings? The Adjudication of Conflicting Human Rights and Social Values, by George C. Christie, examines the attempts by courts to sort out conflicts involving freedom of expression, including religious expression, on the one hand, and rights to privacy and other important social values on the other. It approaches the subject from a comparative perspective, using principally cases decided by European and United States courts. A significant part of this book analyzes conflicts between freedom of expression and the right to (...) privacy. In a world in which, freedom of expression and privacy are said to be of equal value, the book explores whether it is possible to develop, through case-by-case adjudication, a legal regime which can give clear direction as to what expression is or is not permitted. Otherwise, if such a regime proves impossible, in the guise of recognizing the equal value of expression and privacy, privacy may become de facto the preferred value. (shrink)

Several recent critiques of theodicy have incorporated some form of moral objection to the theodical enterprise, in which the critic argues that one ought not to engage in the practice of theodicy. In defending theodical practice against the moral critique, Atle O. Søvik argues that the moral critique (1) begs the question against theodicy, and (2) misapprehends the implications of the claim that it is inappropriate to espouse a theodicy in certain situations. In this paper I suggest some sympathetic emendations (...) for Søvik's theodical apologetic, but I argue against Søvik's claim that the moral critique of theodicy is altogether irrelevant. (shrink)

Some authors claim that hate speech plays a key role in perpetuating unjust social hierarchy. One prima facie plausible hypothesis about how this occurs is that hate speech has a pernicious influence on the attitudes of children. Here I argue that this hypothesis has an important part to play in the formulation of an especially robust case for general legal prohibitions on hate speech. If our account of the mechanism via which hate speech effects its harms is built around claims (...) about hate speech’s influence on children, then we will be better placed to acquire evidence that demonstrates the processes posited in our account, and better placed to ascribe responsibility for these harms to individuals who engage in hate speech. I briefly suggest some policy implications that come with developing an account of the harm of hate speech along these lines. (shrink)

In this follow up to The Eudemian Ethics of Aristotle, Peter L. P. Simpson centers his attention on the basics of Aristotelian moral doctrine as found in the Great Ethics: the definition of happiness, the nature and kind of the virtues, pleasure, and friendship. This work's authenticity is disputed, but Simpson argues that all the evidence favors it. Unlike the Nicomachean and Eudemian Ethics, Aristotle wrote the Great Ethics for a popular audience. It gives us insight less into (...) Aristotle the theoretician than into Aristotle the pedagogue. For this reason, the Great Ethics has distinct advantages as an introduction to Aristotelian ethical thinking: it is simpler and clearer in its argumentation, matters such as the intellectual virtues are made suitably secondary to the practical focus, the moral virtues come through with a pleasing directness, and the work's syllogistic formalism gives it a transparency and accessibility that the other Ethics typically lack. Arius' Epitome, which relies heavily on this work, helps confirm its value and authenticity. Because the Great Ethics is generally neglected by scholars, less has been done to clear up its obscurities or to expose its structure. But to ignore it is to lose another and more instructive way of approaching and appreciating Aristotle's teaching. The translation is prefaced by an analytic outline of the whole, and the several sections of it are prefaced by brief summaries. The commentary supplies fuller descriptions and analyses, sorting out puzzles, removing misunderstandings, and resolving doubts of meaning and intention. This book is a fresh rendition of the work of the preeminent philosopher of all time. (shrink)

In free speech theory ‘speech’ has to be defined as a special term of art. I argue that much free speech discourse comes with a tacit commitment to a ‘Subtractive Approach’ to defining speech. As an initial default, all communicative acts are assumed to qualify as speech, before exceptions are made to ‘subtract’ those acts that don’t warrant the special legal protections owed to ‘speech’. I examine how different versions of the Subtractive Approach operate, and criticise them in terms of (...) their ability to yield a substantive definition of speech which covers all and only those forms of communicative action that – so our arguments for free speech indicate – really do merit special legal protection. In exploring alternative definitional approaches, I argue that what ultimately compromises definitional adequacy in this arena is a theoretical commitment to the significance of a single unified class of privileged communicative acts. I then propose an approach to free speech theory that eschews this theoretical commitment. (shrink)

Albert Camus Albert Camus was a French-Algerian journalist, playwright, novelist, philosophical essayist, and Nobel laureate. Though he was neither by advanced training nor profession a philosopher, he nevertheless made important, forceful contributions to a wide range of issues in moral philosophy in his novels, reviews, articles, essays, and speeches—from terrorism and political violence to … Continue reading Camus, Albert →.

Albert Camus Albert Camus was a French-Algerian journalist, playwright, novelist, philosophical essayist, and Nobel laureate. Though he was neither by advanced training nor profession a philosopher, he nevertheless made important, forceful contributions to a wide range of issues in moral philosophy in his novels, reviews, articles, essays, and speeches—from terrorism and political violence to … Continue reading Camus, Albert →.

Blaise Pascal (1623–1662) Blaise Pascal was a French philosopher, mathematician, scientist, inventor, and theologian. In mathematics, he was an early pioneer in the fields of game theory and probability theory. In philosophy he was an early pioneer in existentialism. As a writer on theology and religion he was a defender of Christianity. Despite chronic ill […].

In this paper we examine the ethical implications of emerging Nanotechnologically Enhanced Combat Systems (or 'NECS'). Through a combination of materials innovation and biotechnology, NECS are aimed at making combatants much less vulnerable to munitions that pose a lethal threat to soldiers protected by conventional armor. We argue that increasing technological disparities between forces armed with NECS and those without will exacerbate the ethical problems of asymmetric warfare. This will place pressure on the just war principles of jus in bello, (...) by encouraging the resort to tactics that either (i) make it more difficult to respect these principles or (ii) directly violate them, by virtue of attacking non-combatants or creating disproportionate numbers of casualties without a clear military goal. (shrink)

Shills are people who endorse products and companies for pay, while pretending that their endorsements are ingenuous. Here we argue that there is something objectionable about shilling that is not reducible to its bad consequences, the lack of epistemic conscientiousness it often relies upon, or to the shill’s insincerity. Indeed, we take it as a premise of our inquiry that shilling can sometimes be sincere, and that its wrongfulness is not mitigated by the shill’s sincerity, in cases where the shill (...) is sincere. Our proposal is that the shill’s defining characteristic is their knowingly engaging in a kind of speech that obscures a certain aspect of its social status – most commonly, by pretending to speak on their own personal behalf, while in fact speaking as an employee – and that this sort of behaviour is objectionable irrespective of any other features of the shill’s conduct. This sort of obfuscation undermines a socially beneficial communicative custom, in which we conscientiously mark the distinction between personal speech and speech-for-hire. (shrink)

The idea that human beings are intellectually self-governing plays two roles in free-speech theory. First, this idea is frequently called upon as part of the justification for free speech. Second, it plays a role in guiding the translation of free-speech principles into legal policy by underwriting the ascriptive framework through which responsibility for certain kinds of speech harms can be ascribed. After mapping out these relations, I ask what becomes of them once we acknowledge certain very general and profound limitations (...) in people's capacity for intellectual self-governance. I argue that acknowledging these limitations drastically undermines the putative justifications for free speech of the type that I identify in the first part of the paper. I then show how we can reformulate an account of intellectual and doxastic responsibility on which we may still be held responsible for what we think or believe even though we lack agent-causal capacities in our thinking and believing. Then, in light of this ascriptive account of intellectual responsibility, I show how the key ideahave minds of their owncan (and should) still play a significant role in guiding the legislative outworkings of free speech. (shrink)

The Devlin Commission Report of 1959 on the handling of the emergency in Nyasaland (Malawi) was unique in British colonial history. On no other occasion was a commission, chaired by a British judge, established to consider generally the response of a colonial government to a problem of law and order. Though now remembered mainly as an incident in decolonization, the report has a special legal significance in that it addresses the perennial problem of the relationship between respect for the rule (...) of law and the supposed need to suppress an insurrectionary movement. Documents now available make it possible to give a full account of the work of the commission, and of the processes whereby the text was modified so as to downplay Devlin's desire to publish a report which squarely faced this problem. The suppressed passages in the draft report are here published for the first time. (shrink)