Medical Research Council, Capetown, South Africa Nasheen Naidoo Medical Research Council, Capetown, South Africa Shamagonam James Medical Research Council, Durban, South Africa Priscilla Reddy Medical Research Council, Capetown, South Africa * Corresponding author: 306 Arnold House, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA 01003, USA. Tel.: (413) 545 1005; Email: Buchanan{at}schoolph.umass.edu ' + u + '@' + d + ' '//--> . Abstract The analysis presented here lays out the ethical warrants for requiring community oversight (...) of health research conducted in international settings. It reviews the inadequacies with the current standards of individual informed consent and research ethics committee review, and then, shows how a broader population-based public health perspective raises new demands on justice involving due consideration of the rights, harms and benefits to the community as a whole. As developed here, an ethical standard that requires community oversight of health research is justified on three principled grounds: respect for community autonomy and their right to self-determination; due consideration of the consequences of the research for the community as a whole; and, a more complete understanding of human autonomy. The paper concludes with practical recommendations regarding the composition of Community Advisory Boards to ensure that they have legitimate decision-making authority in diverse socio-cultural contexts. CiteULike Connotea Del.icio.us What's this? (shrink)

The familiar issue of corporate social responsibility takes on a new topic. Added to the list of concerns from affirmative action and environmental integrity is their growing contributions to education. At first glance, the efforts may appear to be ordinary gestures of communal good will in terms of providing computers, sponsoring book covers, and interactive materials provided by Scholastic Magazine. A closer view reveals a targeted market of student life who are vulnerable to commercials placed in these formats. Among the (...) most effective corporate intervention is Channel One News. It offers a newsworthy show but with mandatory commercial viewing. This increasing trend of corporations intervening to assist schools that need more money and/or equipment is disingenuous.In this essay, I present the background of this commercialization of education and demonstrate the violations against student autonomy and integrity. Although there may be utilitarian merits to some interventions, I argue that these infringe upon the moral value of personhood. Advertising in schools in its current practice is immoral on deontological grounds. (shrink)

In Western countries a considerable number of older people move to a residential home when their health declines. Institutionalization often results in increased dependence, inactivity and loss of identity or self-worth (dignity). This raises the moral question as to how older, institutionalized people can remain autonomous as far as continuing to live in line with their own values is concerned. Following Walker's meta-ethical framework on the assignment of responsibilities, we suggest that instead of directing all older people towards more autonomy (...) in terms of independence, professional caregivers should listen to the life narrative of older people and attempt to find out how their personal identity, relations and values in life can be continued in the new setting. If mutual normative expectations between caregivers and older people are not carefully negotiated, it creates tension. This tension is illustrated by the narrative of Mr Powell, a retired successful public servant now living in a residential home. The narrative describes his current life, his need for help, his independent frame of mind, and his encounters with institutional and professional policies. Mr Powell sees himself as a man who has always cared for himself and others, and who still feels that he has to fulfil certain duties in life. Mr Powell's story shows that he is not always understood well by caregivers who respond from a one-sided view of autonomy as independence. This leads to misunderstanding and an underestimation of his need to be noticed and involved in the residential community. (shrink)

Two dogmas of liberalism in the therapeutic setting are challenged: (1) that patients have a ready-made ability to act autonomously; and (2) that non-intervention by physicians is the best strategy for protecting the autonomy of patients. Recognition of the impact of illness upon autonomous behavior forms the basis of this challenge. It is suggested that autonomy is better conceived as a process of personal growth by which patients become better able to overcome the disruptive effects of illness. The physician is (...) assigned an active role in the achievement of this therapeutic goal. The implications of this new liberal theory are illustrated by reference to the informed consent issue. (shrink)

Shared views regarding the moral respect which is owed to children in family life are used as a guide in determining the moral permissibility of nontherapeutic clinical research procedures involving children. The comparison suggests that it is not appropriate to seek assent from the preadolescent child. The analogy with interventions used in family life is similarly employed to specify the permissible limit of risk to which children may be exposed in nontherapeutic research procedures. The analysis indicates that recent writers misconceive (...) how certain moral principles, such as respect for personal autonomy, require us to act toward children. The results are also used to assess proposed federal regulations on research with children. (shrink)

The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analyzed in this perceptive work. The book defends the concept of autonomy, but argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long term care. The treatment of actual autonomy stresses the developmental and social nature of human persons and the priority of identification over autonomous choice. The work balances analysis of the ethical concepts (...) associated with autonomy with discussion of the implications of the ethical analysis for long term care. A central chapter involves a phenomenological analysis of four general features of everyday experience (space, time, communication, and affectivity) and explores their practical implications for long term care. This work concludes with a discussion of the advantages associated with a phenomenologically-inspired treatment of actual autonomy for the ethics of long-term care. (shrink)

In this paper I analyze the alleged conflict between economic incentives to efficiently utilize health care resources and the obligation to provide patients with the best possible medical care. My analysis is developed in four stages. First, I discuss briefly the nature of prospective payment systems and economic incentives as well as the issue of professional autonomy. Second, I disscuss the notion of an incentive for action both as an economic incentive and as a concept of moral psychology. Third, I (...) analyze several definitions of the physician's professional obligation and discuss four conditions that morally qualify the obligation. And fourth, I explore why the views of economists and physicians differ so strikingly on the question of economic incentives. In the process of this analysis, I argue that criticisms of prospective payment systems which are premised primarily on the conflict between economic incentives to contain cost and the professional obligation of beneficence are probably as much a matter of rhetoric as serious argumentation. Keywords: autonomy, beneficence, cost containment, economic incentives, moral obligation, prospective payment CiteULike Connotea Del.icio.us What's this? (shrink)

Central to much medical ethical analysis is the concept of the role of the physician. While this concept plays an important role in medical ethics, its function is largely tacit. The present paper attempts to bring the concept of a social role to prominence by focusing on an historically recent and rather richly contextured role, namely, that of consultation liaison psychiatry. Since my intention is primarily theoretical, I largely ignore the empirical studies which purport to develop the detailed functioning of (...) the role. My limited intent is to draw attention to the theoretical complexity of the consultation liaison role as an example of the general relevance of role concepts to medical ethics. For this reason, consultation liaison psychiatry will function as an illustration of fundamental concepts of medical ethics rather than as a subject of analysis in its own right. Similarly, the concept of the social role will be developed only as is necessary to explore the general relationship between the consultation liaison role and ethical analysis. Keywords: medical ethics, consultation liaison psychiatry, social role, autonomy, institution CiteULike Connotea Del.icio.us What's this? (shrink)

Over fifty years ago, H.M. was treated for chronic epilepsy by a bilateral hippocampectomy. Among the lasting side effects of this treatment was that H.M. could no longer form certain types of long term memories, although he could form others. One of the many morals philosophers and psychologists have sometimes drawn from this sad case (and others) is that information about the brain can be used to guide theorizing about the mind. More specifically, it has been claimed that differences in (...) the way in which psychological properties are realized in the brain can be used in the delimitation of distinct psychological properties. In this paper, we build on the Dimensioned theory of realization and a companion theory of multiple realization to argue that the discovery of differences in neurobiological realization do not by themselves lead to the splitting of psychological properties. Such differences in realizers could constitute unique realizations of distinct psychological types or multiple realizations of one psychological type. Whether one has unique realizations or multiple realizations—whether psychological properties are split or not—is not determined by the neuroscience alone, but by the psychological theory under examination. Thus, one might say that, in the splitting or non-splitting of properties, psychology enjoys a kind of autonomy from neuroscience. (shrink)

Background There have been different ethical approaches to the issues in the history of philosophy. Two American philosophers Beachump and Childress formulated some ethical principles namely 'respect to autonomy', 'justice', 'beneficence' and 'non-maleficence'. These 'Four Principles' were presented by the authors as universal and applicable to any culture and society. Mawlana, a great figure in Sufi tradition, had written many books which not only guide people how to worship God to be close to Him, but also advise people how to (...) lead a good life to enrich their personality, as well as to create a harmonious society and a peaceful world. Methods In this study we examined the major works of Mawlana to find out which of these 'Four Principles of Bioethics' exist in Mawlana's ethical understanding. Results We have found in our study that all these principles exist in Mawlana's writings and philosophy in one form or another. Conclusions We have concluded that, further to Beachump and Childress' claim that these principles are universal and applicable to any culture and society, these principles have always existed in different moral traditions in different ways, of which Mawlana's teaching might be presented as a good example. (shrink)

The scientific community has debated the importance of “return” activities after ethnobiological studies. This issue has provoked debate because it touches on the ethics of research and the relationships with the people involved in these studies. This case study aimed to investigate community perception of an ethnobotany research project that was carried out in the semi-arid region of northeastern Brazil. Furthermore, we reported how the residents of this rural community felt about participating in the activities of “return” that arose from (...) the projects. Our findings demonstrate that “return” activities should be planned from the design phase of the research until its closure as a lifelong process that allows the communities involved to gradually take ownership of the information and actions that are being generated. Similarly, we argue that such activities must be negotiated with the people of the community so that they have decision-making power and autonomy to decide what is most relevant to their lives. (shrink)

The paper describes the refusal of the liberal community to assert the right of persons accused of mental illness to be free of coercive psychiatric intrusion. It suggests that the penchant for benevolent governmental intrusion into other social problems may be at fault and recommends that intervention be abandoned in favor of a return to human autonomy as a basis of the concept of freedom.

Ethicists don't discuss etiquette very much, in part because it has always seemed too close to the surface of social interaction and too ephemeral or conventional for theory. But I suspect that most people, even philosophers, would agree that social etiquette often reinforces and complements our ethical intuitions. For example, in social etiquette we draw a line between reasonable and normal questions to ask others and questions which pry, invade privacy, or otherwise embarrass them. A natural justification of this practice (...) is that it conserves personal autonomy by helping people control information about themselves and decide for themselves how and when to disclose information. Many of the practices of "polite culture" serve similar, if less profound, purposes. (shrink)

Introduction : the politics of our selves -- Foucault, subjectivity, and the enlightenment : a critical reappraisal -- The impurity of practical reason : power and autonomy in Foucault -- Dependency, subordination, and recognition : Butler on subjection -- Empowering the lifeworld? autonomy and power in Habermas -- Contextualizing critical theory -- Engendering critical theory.

Is there any reason not to spy on other people as necessary to get the facts straight, especially if you can put the facts you uncover to good use? To “spy” is secretly to monitor or investigate another's beliefs, intentions, actions, omissions, or capacities, especially as revealed in otherwise concealed or confidential conduct, communications and documents. By definition, spying involves secret, covert activity, though not necessarily lies, fraud or dishonesty. Nor does spying necessarily involve the use of special equipment, such (...) as a tape recorder or high-powered binoculars. Use of a third party agent, such as a “private eye” or Central Intelligence Agency operative is not necessary for surveillance to count as spying. Spying is morally troublesome both because it violates privacy norms and because it relies on secrecy and, perhaps, nefarious deception. Contemporary technologies of data collection make secret, privacy-invading surveillance easy and nearly irresistible. For every technology of confidential personal communication - telephone, mobile phone, computer email - there are one or more counter-technologies of eavesdropping. But covert surveillance conducted by amateur and professional spies still includes old-fashioned techniques of stealth, trickery and deception known a half century ago: shadowing by car, peeking at letters and diaries, donning disguises, breaking and entering, taking photographs, and tape recording conversations. The ethical examination of spying cannot be reduced to a conversation about reigning in the mischief potential of twenty-first century technology. We do need to concern ourselves with what tomorrow's spies will do with nanotechnology, but plenty of spying is possible with the time-tested techniques of the Baby Boomers, or even, for that matter, the Victorians. The philosophical problem I wish to consider here is the ethical limits of spying on others, when the reasons for spying are good. I explore the plausibility of three interrelated ideas. The first idea is one I will call the anti-spying principle: spying on other adults is prima facie unethical. The second idea is an exception to the anti-spying principle: spying on others is ethically permissible, even mandatory, in certain situations, where the ends are good. The third and final idea is a constraint on exceptions to the anti-spying principle: where spying is ethically permitted or required, there are ethical limits on the methods of spying. The virtuous spy will violate privacy and transparency norms, of course; but he or she will, to the extent possible, continue to act with respect for the moral autonomy and for the moral and legal interests of the investigative target. (shrink)

This paper presents the principal findings from a three-year research project funded by the US National Science Foundation (NSF) on ethics of human enhancement technologies. To help untangle this ongoing debate, we have organized the discussion as a list of questions and answers, starting with background issues and moving to specific concerns, including: freedom & autonomy, health & safety, fairness & equity, societal disruption, and human dignity. Each question-and answer pair is largely self-contained, allowing the reader to skip to those (...) issues of interest without affecting continuity. (shrink)

It is argued in this paper that the latest UK government white paper on public health, Choosing Health, is vulnerable to a charge of paternalism. For some years libertarians have levelled this charge at public health policies. The white paper tries to avoid it by constant reference to informed choice and choice related terms. The implication is that the government aims only to inform the public of health issues; how they respond is up to them. It is argued here, however, (...) that underlying the notion of informed choice is a Kantian, ‘‘inner citadel’’ view of autonomy. According to this view, each of us acts autonomously only when we act in accord with reason. On such a view it is possible to justify coercing, cajoling, and conning people on the basis that their current behaviour is not autonomous because it is subject to forces that cause irrational choice, such as addiction. ‘‘Informed choice’’ in this sense is compatible with paternalism. This paternalism can be seen in public health policies such as deceptive advertising and the treatment of ‘‘bad habits’’ as addictions. Libertarians are bound to object to this. In the concluding section, however, it is suggested that public health can, nonetheless, find ethical succour from alternative approaches. (shrink)

The proliferation of biometric identification technology raises difficult issues in the matter of security, privacy and identity. Though biometric "images" are not images per se, they are both unique representations of an individual in themsevles and a means of access to other identifying information. I compare biometric imaging with other kinds of identifying representations and find that there are issues specific to biometric ID's. Because they represent information that is written into the body they are directly related to one's sense (...) of autonomy and self-esteem. Releasing biometric ID's into the public sphere therefore involves a tangible loss of control and privacy. This does not mean that to do so is never a reasonable act, but rather that it should be carefully weighed, and should never be mandatory in order to receive any fundamental rights or benefits. (shrink)

Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary (...) goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs. (shrink)

Recently, the ‘right to die’ became a major social issue. Few agree suicide is a right tout court . Even those who believe suicide (‘regular’, passive, or physician-assisted) is sometimes morally permissible usually require that a suicide be ‘rational suicide’: instrumentally rational, autonomous, due to stable goals, not due to mental illness, etc. We argue that there are some perfectly ‘rational suicides’ that are, nevertheless, bad mistakes. The concentration on the rationality of the suicide instead of on whether it is (...) a mistake may lead to permitting suicides that should be forbidden. (shrink)

The importance of a healthy mentoring relationship, and how to go about achieving one, has been explored in several disciplines, including psychology. However, little of this work has focused specifically on unique ethical issues that may arise while mentoring undergraduate students. The authors provide a definition of mentoring in the context of undergraduate education that takes into account undergraduates' status as emerging adults. We delineate both similarities and differences between mentoring undergraduate students and graduate students. Ethical issues that may arise (...) while mentoring undergraduates, especially around themes of vocation, autonomy and influence, boundaries, power, the priority of the protg's needs, the mentor's motives, and accessibility, are spotlighted. We argue that although there is considerable overlap between mentoring graduate students and mentoring undergraduates, there are issues and concerns unique to working with undergraduates that require explication so that they can be appropriately addressed to the benefit of both protg and mentor. (shrink)

I begin with the assumption that a philosophically significant tension exists today in feminist philosophy of religion between those subjects who seek to become divine and those who seek their identity in mutual recognition. My critical engagement with the ambiguous assertions of Luce Irigaray seeks to demonstrate, on the one hand, that a woman needs to recognize her own identity but, on the other hand, that each subject whether male or female must struggle in relation to the other in order (...) to maintain realism about life and death. No one can avoid the recognition that we are each given life but each of us also dies. In addition, I raise a more general, philosophical problem for analytic philosophers who attempt to read Continental philosophy of religion: how should philosophers interpret deliberately ambiguous assertions? For example, what does Irigaray mean in asserting, 'Divinity is what we need to become free, autonomous, sovereign'? To find an answer, I turn to the distinctively French readings of the Hegelian struggle for recognition which have preoccupied Continental philosophers especially since the first half of the last century. I explore the struggle for mutual recognition between women and men who must face the reality of life and death in order to avoid the projection of their fear of mortality onto the other sex. This includes a critical look at Irigaray's account of subjectivity and divinity. I turn to the French philosopher Michèle Le Doeuff in order to shift the focus from divinity to intersubjectivity. I conclude that taking seriously the struggle for mutual recognition between subjects forces contemporary philosophers of religion to be realist in their living and dying. With this in mind, the lesson from the Continent for philosophy of religion is that we must not stop yearning for recognition. Indeed, we must even risk our autonomy/divinity in seeking to recognize intersubjectivity. (shrink)

The combined use of computers and telecommunications and the latest evolution in the field of Artificial Intelligence brought along new ways of contracting and of expressing will and declarations. The question is, how far we can go in considering computer intelligence and autonomy, how can we legally deal with a new form of electronic behaviour capable of autonomous action? In the field of contracting, through Intelligent Electronic Agents, there is an imperious need of analysing the question of expression of consent, (...) and two main possibilities have been proposed: considering electronic devices as mere machines or tools, or considering electronic devices as legal persons. Another possibility that has been frequently mentioned consists in the application of the rules of agency to electronic transactions. Meanwhile, the question remains: would it possible, under a Civil Law framework, to apply the notions of “legal personhood” and “representation” to electronic agents? It is obvious that existing legal norms are not fit for such an endeavouring challenge. Yet, the virtual world exists and it requires a new but realistic legal approach on software agents, in order to enhance the use of electronic commerce in a global world. (shrink)

Government-sponsored enterprises (GSEs) and quasi-autonomous non-governmental organizations (quangos) comprise a powerful organizational sector that has been criticized for its lack of accountability to governments and their citizens. These organizations are established to serve the public as a whole by targeting the needs of particular groups or fulfilling specific functions. Often they use practices adopted from the business sector, and sometimes they enter the marketplace as profit-making enterprises. In light of the contribution of GSE Fannie Mae to the 2008 world economic (...) crisis, the impact of this sector on effective democratic government bears further examination. In this article, I present a systems model that suggests how researchers might comprehensively assess the accountability of organizations in this sector, here termed the “gray sector,” with respect to their government missions. I focus on four systems dimensions: mission, organizational design, organizational outcomes, and the information feedback process. Organizational design and the nature of the sector population are cited as emerging issues of particular importance. (shrink)

The aim of this article is to explore the impact of commercial marketing on personal autonomy. Several philosophers argue that marketing conflicts with ideals of autonomy or, at best, is neutral to these ideals. After qualifying our concept of marketing and introducing the distinctions between (i) divergent and convergent marketing and (ii) being autonomous and acting autonomously, we demonstrate the heretofore unnoticed positive impact of marketing on autonomy. Specifically, we argue that (i) convergent marketing has a significant potential to reinforce (...) autonomous action and (ii) divergent marketing has a significant potential to reinforce the state of being autonomous. (shrink)

Informed consent to therapy is the legal doctrine which imposes on a physician the duty to explain the nature and risks of a proposed treatment so the patient can make an informed decision whether to undergo the treatment. The doctrine has spawned tremendous controversy in the legal and medical professions.In this paper I examine the doctrine of informed consent as developed by the courts. The thrust of my criticism is that as the doctrine has been developed, it significantly undercuts individual (...) autonomy. Several modifications are suggested which would provide more support for autonomy interests. (shrink)

The use of antibiotics by one person can profoundly affect the welfare of other people. I will argue that efforts to combat antimicrobial resistance generate a global collective action problem that only a well-designed international treaty can overcome. I begin by describing the problem of resistance and outlining some market-friendly policy tools that participants in a global treaty could use to control the problem. I then defend the claim that these policies can achieve their aim while protecting individual liberty and (...) state autonomy. Finally, I offer some suggestions for a treaty, drawing lessons from the failure of the Kyoto Protocol on climate change and the success of the Montreal Protocol on ozone depletion. (shrink)

Professional philosophers are members of bioethical committees and regulatory bodies in areas of interest to bioethicists. This suggests they possess moral expertise even if they do not exercise it directly and without constraint. Moral expertise is defined, and four arguments given in support of scepticism about their possession of such expertise are considered and rejected: the existence of extreme disagreement between moral philosophers about moral matters; the lack of a means clearly to identify moral experts; that expertise cannot be claimed (...) in that which lacks objectivity; and that ordinary people do not follow the advice of moral experts.I offer a better reason for scepticism grounded in the relation between moral philosophy and common-sense morality: namely that modern moral philosophy views even a developed moral theory as ultimately anchored in common-sense morality, that set of basic moral precepts which ordinary individuals have command of and use to regulate their own lives.Even if moral philosophers do nevertheless have a limited moral expertise, in that they alone can fully develop a set of moral judgments, I sketch reasons – grounded in the values of autonomy and of democracy – why moral philosophers should not wish non-philosophers to defer to their putative expertise. (shrink)

In the face of differences about how sex should be taught to young persons, and consistent with a liberal principle of neutrality, educationalists can adopt one of two strategies. The ‘retreat to basics’ consists in teaching only a basic agreed code of sexual conduct, or a set of agreed principles of sexual morality. The ‘conjunctive–disjunctive’ strategy consists in teaching the facts of sexual activity together with the various possible evaluations of these facts. Both strategies are beset with significant and insuperable (...) difficulties. Perhaps one should presume only to teach sex in a way that maximises the foundational liberal ideal of autonomy. (shrink)

I criticise the ‘liberal’view of the proper relationship between the family and State, namely that, although the interests of the child should be paramount, parents are entitled to rights of both privacy and autonomy which should be abrogated only when the child suffers a specifiable harm. I argue that the right to bear children is not absolute, and that it only grounds a right to rear upon an objectionable proprietarian picture of the child as owned by its producer. If natural (...) parents have any rights to rear they derive from duties to bring their children into rational maturity where they can exercise rights for themselves. The presumption that natural parents are best suited to rear their own children should be discounted, as should the assumption that alternatives to natural parenting are unacceptably bad. I reject the suggestion that parents should be ‘licensed’but argue for a much closer monitoring of the family. Familial privacy, which such monitoring breaches, is shown to have a culturally specific and, given the facts of abuse, dubious value. In conclusion, I briefly specify the forms of monitoring I approve. (shrink)

Using the example of an unconsented mouth swab I criticise the view that an action of this kind taken in itself is wrongful in respect of its being a violation of autonomy. This is so much inasmuch as autonomy merits respect only with regard to ‘critical life choices’. I consider the view that such an action is nevertheless harmful or risks serious harm. I also respond to two possible suggestions: that the action is of a kind that violates autonomy; and, (...) that the class of such actions violates autonomy. I suggest that the action is wrongful in as much as it is a bodily trespass. I consider, and criticise, two ways of understanding how morally I stand to my own body: as owner and as sovereign. In respect of the latter I consider Arthur Ripstein's recent defence of a sovereignty principle. Finally I criticise an attempt by Joel Feinberg to explain bodily trespass in terms of personal autonomy. (shrink)

Has the diversity of corporate boards of directors improved? Should it? What role does diversity play in reducing corporate wrongdoing? Will diversity result in a more focused board of directors or more board autonomy? Examining the state of Tennessee as a case study, the authors collected data on the board composition of publicly traded corporations and compared those data to an original study conducted in 1995. Data indicate only a modest improvement in board diversity. This article discusses reasons for the (...) scarcity of women on boards and concludes that, to enhance strategic decisions, board membership should reflect the corporation''s consumer population. Thus, women are a critical but overlooked resource. Areas for future research are also considered. (shrink)

Our economic system, the market economy, is a part of a broader system or society. We frequently study the operation of the market economy as if it were autonomous, even though there are many complex and mutual relationships between society, the economic system and the other systems – political, cultural, religious, legal, etc. – that form part of society. In a market economy we may identify several components: a frame or background in which the economic activity takes place, a set (...) of ideas and theories, the values shared by this society, the set of institutions, norms and rules that control the economic behavior of people, and the incentives or motivations of the economic agents. The play of these elements defines the operation of a market economy. Is ethics an institution, or does it belong to the set of values and ideas? In this paper I will discuss the role of institutions, norms and rules in society, with special reference to the economic system, in order to gain insight into the relationship between institutions and ethics. I study first the concept and features of social institutions and norms; second, institutional change, and third, the relationship between ethics and institutions. (shrink)

When Caja de Pensiones para la Vejez y de Ahorros , “ la Caixa ,” was created in 1905, it was not only the transient response to a serious social, political, and economical problem, but also provided a permanent solution by creating a long-lasting social welfare institution. In addition, its founder understood the responsibility of social welfare institutions not as an isolated responsibility for each institution, but as part of a harmonious whole that is a real moral entity with a (...) socio-economic character, with autonomy and unity of nature, purpose, and form. The purpose of this article is to show how the corporate social responsibility conception of Francesc Moragas, the founder of “ la Caixa ,” informed the activities of the new institution in a variety of dimensions, including its service to the customers, its economic strengths, the social work, and its participation in the creation of the public system of social security in Spain. (shrink)

Some theorists who accept the existence of global justice duties to alleviate the condition of distant needy strangers hold that these duties are significantly constrained by special ties to fellow countrymen. The patriotic priority thesis holds that morality requires the members of each nation-state to give priority to helping needy fellow compatriots over more needy distant strangers. Three arguments for constraint and patriotic priority are examined in this essay: an argument from fair play, one from coercion, another from coercion and (...) autonomy. Under scrutiny, none of these arguments qualifies as successful. (shrink)

Advertisers often have been accused of using techniques which manipulate and control the behavior of consumers and hence violate their autonomy. Some of these techniques are puffery, subliminal advertising, and indirect information transfer. After examining both criticisms and defenses of such practices, this paper presents an analysis of four of the concepts involved in the debate — the concepts of autonomous desire, rational desire, free choice, and control. Applying the results to the case of advertising, it is shown that advertising (...) cannot be found guilty of intrinsically or frequently violating the consumer's autonomy in any of the relevant senses of this notion. (shrink)

In this paper three models of teaching and learning medical ethics are discussed critically, the traditional and revised vocational models, and the patient-centred model. The autonomy-oriented patient-centred ethics of Beauchamp and Childress is rejected in favour of a hermeneutic practical ethics. A performative conception of ethics teaching is recommended as the most appropriate model for use in the theory and practice of ethics pedagogy.

In some medical cases there is a moral distinction between killing and letting die, but in others there is not. In this paper I present an original and principled account of the moral distinction between killing and letting die. The account provides both an explanation of the moral distinction and an explanation for why the distinction does not always hold. If these explanations are correct, the moral distinction between killing and letting die must be taken seriously in medical contexts. Defeasibly, (...) when an agent kills she takes responsibility, but when an agent lets die she does not take responsibility. Therein lies the moral distinction between killing and letting die. The distinction, however, is defeated when an agent is already responsible for the surrounding situation. In such cases, killing does not involve taking any further responsibility and letting die does not avoid taking any responsibility. Medical examples are frequently complicated because patients' autonomous choices impact upon medical practitioners' surrounding responsibility. (shrink)

Respect for autonomy is problematic in relation to public health programmes such as vaccination, as the success of such programmes depends on widespread compliance. European countries have different policies for dealing with objectors to vaccination programmes. In some countries compliance is compulsory, while in others objectors are exempted or allowed to enter the programme under specific conditions. In this paper I argue that the objectors should not be treated as a homogenous group as is done in the above-mentioned policies. Objectors (...) have different arguments for not participating in vaccination programmes. Considering the value of respect for autonomy, some but not all of these arguments need to be accommodated by authorities. The concept of 'narrative autonomy' provides criteria to distinguish between tenable and untenable claims to the right to refuse vaccination. Narrative autonomy understands autonomy as essentially linked to identity, as this provides the moral framework with which we assess our first-order preferences. The above-mentioned concept of autonomy is derived from the concept of narrative identity as described by Marya Schechtman. She suggests that the application of the Articulation Constraint and the Reality Constraint enables us to establish the validity of personal narratives. Additionally, form and content features of identity, as proposed by Anthony Laden, will be used as criteria to establish the compatibility of the defectors' arguments with shared scientific and political values. Such compatibility is essential to accommodate respect for autonomy in the context of public health. (shrink)

Several nation states have reasons to halt the import of genetically modified organisms. The current international trend towards a regime of free trade makes such bans problematic. Whether a nation state is deemed justified in banning a certain product is strongly connected to discussions about what are acceptable criteria for proof of risk. The determination of these criteria hinges upon considerations of individual and national autonomy. This paper compares two different points of view in the debate: the WTO opposed to (...) the UN. A distinction between internal and external autonomy explains the differences in approach between the UN and the WTO. The conclusion is reached that adequate respect for autonomy requires a certain amount of flexibility in the criteria for proof of risk. (shrink)

Technological developments often bring about new risks. Informed consent has been proposed as a means to legitimize the imposition of technological risks. This principle was first introduced in medical practice to assure the autonomy of the patient.The introduction of IC in the field of technological practice raises questions about the comparability of the type of informed consent. To what extent are thepossibilities to include laypeople in making decisions regarding risks similar in the technological field to giving informed consent in the (...) medical field and whatdoes this imply for the design and implementation of IC in the technological field? Medical and the technological practice are clearly alike in that both fieldsare characterized by highly specialized, technical knowledge which can be quite inaccessible to the average layperson. However, a fundamental difference ariseswith regard to the aim, knowledge of risks and exclusiveness of the practices in each field. The differences in aim imply that the necessity for each practice isperceived differently by laypeople, thus leading them to assess the respective risks differently. The differences in knowledge of risks arise from the variabilityin the ways that can be used to describe a given risk. Definition of risk in medical practice is more homogenous in this respect than the risk definition intechnological fields. Futhermore, medical practice tends to be more exclusive, leading laypeople immersed in that practice to necessarily embrace most of thefundamental underlying that practice. These differences result in divergent recommendations for the implementation of informed consent in the technological field, basically: there is a need for more extensive procedure and for less decisive authority for the individual. (shrink)

In this paper I present a moral account of the legal notion of deceptive advertising. I argue that no harmful consequences to the consumer need follow from a deceptive advertisement as such, and I suggest instead that one should focus on the consequences of permitting the practise of deceptive advertising on society as a whole. After a brief account of deceptive advertising, I move to discuss the role of the reasonable person standard in its definition. One interpretation of this standard (...) is empirical, aiming to objectify the quality of misleadingness in the advertisement. I offer an alternative normative interpretation which aims to draw the line between the advertiser's responsibility and that of the consumer, between misleading and miscomprehension. I then examine and reject several possible moral grounds for condemning and prohibiting deceptive advertising. These include: harm, in the sense of welfare, to the misled consumer; harm to competitors; and a violation or a reduction of the consumer's autonomy. Finally, I explain how the effect of the practise of deceptive advertising on society as a whole should inform our normative line-drawing between misleading and miscomprehension, and how it provides the basis for the moral evaluation of deceptive advertising. (shrink)

My theory of biocentric consequentialism is first shown not to be significantly inegalitarian, despite not advocating treating all creatures equally. I then respond to Carter's objections concerning population, species extinctions, the supposed minimax implication, endangered interests, autonomy and thought-experiments. Biocentric consequentialism is capable of supporting a sustainable human population at a level compatible with preserving most non-human species, as opposed to catastrophic population increases or catastrophic decimation. Nor is it undermined by the mere conceivable possibility of counter-intuitive implications. While Carter (...) shows that value-pluralism need not be riddled with contradictions, his version still introduces some, and faces further problems. Thus consequentialist theories may be needed to sift our values, at least if our values are commensurable. Carter's apparent suggestion that monistic theories such as biocentric consequentialism can never be harnessed to rich theories of value and must each myopically give undue prominence to a single value is questioned. (shrink)

Possible environmental and related impacts of human activity are shown to include the extinction of humanity and other sentient species, excessive human numbers, and a deteriorating quality of life (I). I proceed to argue that neither future rights, nor Kantian respect for future people's autonomy, nor a contract between the generations supplies a plausible basis of obligations with regard to future generations. Obligations concern rather promoting the well-being of the members of future generations, whoever they may be, as well as (...) of current generations. Future benefits and costs should only be discounted where there are special reasons for doing do so (e.g. relevant opportunity costs) (II). A sustainable economy is held to be necessary for intergenerational equity. This granted, principles of equity are introduced concerning: compensation for long-term risks and for resource depletion; conserving the stock of resources, resource diversity, and assimilative capacity; equal options and opportunities for each generation; and remedying past failures to conserve environmental quality. Rules and policies considered include: an efficient, diversified, and ecologically sustainable economy; no increase of risk of irreversible environmental change; and action despite uncertainty to avert serious future outcomes (the Precautionary Principle). These policies are argued to require rectification of current injustices within and between current generations (III). Finally, the recently resuscitated metaphysical model of society as a partnership between generations is held to imply the view of each generation as trustees rather than owners of the planet. This trusteeship view is independently credible, and supportive of the principles and policies earlier introduced; and its adoption by successive generations could turn the partnership model into a reality (IV). (shrink)

This paper reviews Constructivism and the sources of its influence overIsraeli educational discourse. Then, it describes examples ofConstructivists projects in the teaching of sciences and technology inIsrael (Sela, Media Plus), as well as a project that is based on theConstructivist approach to teaching (Together), and several Constructivistexperimental schools, followed by a summary of the obstacles to theimplementation of such projects. Next, it stresses two basic flaws in theConstructivist view and introduces a post-constructivist educationalparadigm, the Autonomy Oriented Education (AOE), which uses (...) `reflectionon experiments in living' as its major tool and aims to enable thedevelopment of autonomous, belonging and moral individuals. (shrink)

As health care costs continue to escalate, cost control measures will likely become unavoidable and painful. One approach is to engage external forces to allocate resources - for example, through managed care or outright rationing. Another approach is to engage consumers to make their own allocation decisions, through "self-rationing," wherein they are given greater awareness, control, and hence responsibility for their health care spending. Steadily gaining popularity in this context is the concept of "consumer directed health care" (CDHC), which is (...) envisioned to both control cost and enhance choice, by combining financial incentives with information to help consumers make more informed health care decisions and to appreciate the economic trade-offs of those decisions. While CDHC is gaining attention in the popular press, business publications, and academic journals, it is not without controversy about its relative merits and demerits. CDHC raises questions regarding the ethical limits of consumer responsibility for their choices. While the emphasis on consumer choice implies that autonomy is the ruling ethical principle in CDHC, it must be tempered by justice and beneficence. Justice must temper autonomy to protect disadvantaged populations from further widening disparities in health care access and outcomes that could arise from health care reform efforts. Beneficence must temper autonomy to protect consumers from unintended consequences of uninformed decisions. Thoughtful paternalism suggests that CDHC plans offer choices that are comprehensible to lay consumers, limited in their range of options, and carefully structured with default rules that minimize potential error costs. (shrink)

Abstract As a result of a questionnaire administered to Heads and pupils in secondary schools in Lincolnshire, certain differences of perception emerge between heads and pupils concerning areas of school life which implicitly relate to moral education. Heads tend to see their schools as strict, yet claim to have few rules. Pupils want more freedom over uniform, assembly, RE, and games, and more involvement in making rules and appointing prefects. Heads are happy about staff??pupil relationships and the pastoral system, but (...) pupils are dissatisfied. The role of House Tutor needs careful definition and evaluation. Community service, voluntary interest groups and co?operative group work seem to fall short of potential as instruments of moral education. There are very marked differences of attitude to compulsory attendance at assembly and RE between heads and pupils; compulsion may be counter?productive in terms of the development of individual moral autonomy. 1 This paper is based on a dissertation accepted in partial fulfilment of the M.Ed. degree requirements at Nottingham University. (shrink)

This paper uses the controversy over the denial of care on futility grounds as a window into the broader issue of the role of cost in decisions about treatment near the end of life. The focus is on a topic that has not received the attention it deserves: the difference between refusing medical treatment and demanding it. The author discusses health care reform and the ethics of cost control, arguing that we cannot achieve universal access to quality care at affordable (...) care without better public understanding of the moral legitimacy of taking cost into account in health care decisions, even decisions at the end of life. (shrink)

Abstract. The American dream of the “self-made man” is as central to the functioning of our capitalist society as Wall Street and as familiar as the Statue of Liberty. According to this dream, the tired masses have a shot at making it on their own if they have the will power, stamina, and intestinal fortitude to survive and compete. What do we do now that we are faced with scientific evidence that this very strategy is driving society into disconnection, despair, (...) and even poor health? Relational-cultural theory states that growth happens through and toward relationships not toward increased separation and autonomy. Relational-cultural theory describes empathy and mutuality as key components to healthy relationships. This essay will focus on the latest research in the neuroscience of relationships—the development of the capacity to connect within relationships, the systems that help us read and empathize with others, the adaptability and plasticity of the central nervous system, and the destructive nature of isolation. (shrink)

A participatory democracy necessarily minimizes legal restraints on its citizens, substituting, for the common good, moral obligations to contribute with their activities. This article argues that a democratic society is endangered unless both media and citizens accept reciprocal moral obligations related to the distribution and use of information. Journalists are expected to facilitate distribution of information and engage citizens usefully in the knowledge process, fueling the participatory engine that drives a democracy. Citizens, in return, have a reciprocal obligation to expose (...) themselves to useful information, respond publicly, tolerate (and even encourage) diversity, and protect media autonomy. (shrink)

This paper explores the value of respect for personal autonomy in relation to clearly immoral and irrational acts committed freely and intentionally by competent people. Following Berlin's distinction between two kinds of liberty and Darwall's two kinds of respect, it is argued that coercive suppression of nonautonomous, irrational, and self-harming acts of competent persons is offensive to their human dignity, but not disrespectful of personal autonomy. Irrational and immoral choices made by competent people may claim only the negative liberty to (...) be left alone. Lives disposed to autonomy are worthy of solidarity and active support in addition to the right of free choice and action. Autonomous premeditated desires (distinguished from mere consent) may embody transcendental choices, which transcend consideration of physical and psychological well-being. Choices made by incompetent persons (e.g., children and the mentally disabled) are not related to autonomy, but to self-directedness. The value of human dignity confers protection to self-directedness, but not at the expense of other vital interests. (shrink)

The article calls for a departure from the common concept of autonomy in two significant ways: it argues for the supremacy of semantic understanding over procedure, and claims that clinicians are morally obliged to make a strong effort to persuade patients to accept medical advice. We interpret the value of autonomy as derived from the right persons have to respect, as agents who can argue, persuade and be persuaded in matters of utmost personal significance such as decisions about medical care. (...) Hence, autonomy should and could be respected only after such an attempt has been made. Understanding suffering to a significant degree is a prerequisite to sincere efforts of persuasion. It is claimed that a modified and pragmatic form of discourse is the necessary framework for understanding suffering and for compassionately interacting with the frail. (shrink)

Given the increasing need for solid organ and tissue transplants and the decreasing supply of suitable allographic organs and tissue to meet this need, it is understandable that the hope for successful xenotransplantation has resurfaced in recent years. The biomedical obstacles to xenotransplantation encountered in previous attempts could be mitigated or overcome by developments in immunosuppression and especially by genetic manipulation of organ source animals. In this essay we consider the history of xenotransplantation, discuss the biomedical obstacles to success, explore (...) recent developments in transgenic sourcing of organs and tissues, and analyze the problem of infectious disease resulting from xenotransplantation (xenosis). We then apply a model of risk analysis to these risks. The conclusions of this risk analysis are used in an ethical evaluation of informed consent in xenotransplantation, with an ethical foundation in Kantian autonomy and Levinasian heteronomic alterity. Our conclusion is that individual and collective informed consent to the infectious disease risks of xenotransplantation requires an open, participatory and dialogical public policy process not yet seen in the United States and Europe. Until that process is created, we propose caution in xenotransplantation in general and a postponement of solid organ xenotransplants in particular. (shrink)

In the 4th edition of this best-selling textbook, the authors introduce students to the business of philosophizing, thereby inducting them into the art of reasoning and analyzing key concepts in education. This introductory text, continuously in print for more than thirty years, is a classic in its field. It shows, first and foremost, the importance of philosophy in educational debate and as a background to any practical activity such as teaching. What is involved in the idea of educating a person (...) or the idea of educational success? What, if anything, can be known and how should we organize what we know for curriculum purposes? What are the criteria for establishing the optimum balance between formal and informal teaching techniques? How trustworthy is educational research? In addition to these questions, which strike to the heart of the rationale for the educative process as a whole, the authors explore such concepts as culture, creativity, autonomy, indoctrination, needs, interests and learning by discovery. In this new updated edition, the authors draw on the latest research in genetics to argue that education is uniquely human and is essentially what develops us as humans. Resisting modern tendencies to equate knowledge with opinion, and value judgments with taste, this book leads the reader into the business of philosophizing and champions the cause of reason in education. (shrink)

Engineering ethics is usually focused on engineers’ ethics, engineers acting as individuals. Certainly, these professionals play a central role in the matter, but engineers are not a singularity inside engineering; they exist and operate as a part of a complex network of mutual relationships between many other people, organizations and groups. When engineering ethics and engineers’ ethics are taken as one and the same thing the paradigm of the ethical engineer which prevails is that of the heroic engineer, a certain (...) model of the ideal engineer: someone both quite individualistic and strong enough to deal with all the moral challenges that could arise. We argue that this is not the best approach, at least today in our interrelated world. We have achieved a high degree of independence from nature by means of technology. In exchange for this autonomy we have become increasingly tied up with very complex systems to which we constantly delegate new tasks and powers. Concerns about safety keep growing everywhere due to the fact that now we have a sensitive awareness of the huge amount of power we are both consuming and deploying, thus, new forms of dialogue and consensus have to be incorporated at different levels, in different forums and at different times. Within these democratic channels of participation not just the needs and interests, but also the responsibilities and mutual commitments of all parties should be taken into account. (shrink)

Despite its virtues, lay decision-making in medicine shares with professional decision-making a disturbing common feature, reflected both in formal policies prohibiting high-risk research and in informal policies favoring treatment decisions made when a crisis or change of status occurs, often late in a downhill course. By discouraging patient decision-making but requiring dedication to the patient's interests by those who make decisions on the patient's behalf, such practices tend to preclude altruistic choice on the part of the patient. This eclipse is (...) to be regretted not just because widescale altruism has the capacity to provide important social goods and correct injustices in distribution, but for intrinsic reasons as well. It is argued that preserving the possibility of altruism obliges patients – and future patients – to make decisions about dying and other medical matters in advance, thus avoiding that displacement of decision-making onto lay and professional second parties which results in altruism's eclipse. Keywords: altruism, medical decision-making, patient's interest, self-interest, autonomy, death and dying decisions, refusal of treatment, prolongation of life, allowing to die, high-risk research CiteULike Connotea Del.icio.us What's this? (shrink)

oise Baylis, 1234 Le Marchant Street, Halifax, Nova Scotia, Canada B3H 3P7. Tel.: (902)-494–2873; Fax: (902)-494-2924; Email: francoise.baylis{at}dal.ca ' + u + '@' + d + ' '//--> . Abstract Recently, there has been a growing interest in public health and public health ethics. Much of this interest has been tied to efforts to draw up national and international plans to deal with a global pandemic. It is common for these plans to state the importance of drawing upon a well-developed (...) ethics framework and we argue that this framework should reflect the values and insights of feminist relational theory. More specifically, we argue that pandemic planning must be squarely situated in the larger realm of public health and that an ethics framework for public health will be one that recognizes the need to pay particular attention to the vulnerability of subpopulations lacking in social and economic power. We propose an ethics framework for public health that builds on the notions of relational personhood (including relational autonomy and social justice) and relational solidarity. In this way, we aim for a public health ethics that, as appropriate, promotes the public interest and the common good. CiteULike Connotea Del.icio.us What's this? (shrink)

On the basis of the characterization of autonomy set out by Beauchamp and Childress in Principles of Biomedical Ethics, we first explore some of the parameters along which autonomy may vary in degree through a series of hypothetical examples drawn from various settings; and, second and in more detail, we examine how the range of autonomy is affected through informed consent to various medical diagnostic tests. Our conclusions are (1) that there are significant implications for patient autonomy inherent in new (...) and forthcoming diagnostic modalities, and (2) that attention should be paid to these implications in formulating policies for both clinical practice and research. We close with (a) some specific policy recommendations for clinical practice and research, and (b) some metaphysical speculations raised by our explorations. (shrink)

Should a growing market for genetic self-tests be welcomed or feared? From the point of view of personal autonomy the increasing availability of predictive health information seems promising. Yet it is frequently pointed out that genetic information about future health may cause anxiety, distress and even loss of life-hopes. In this article the argument that genetic self-tests undermine personal autonomy is assessed and criticized. I contend that opportunities for autonomous choice are not reduced by genetic information but by misperceptions and (...) misunderstandings of the results of genetic tests. Since the interpretation of genetic information is sometimes distorted by the information provided about the genetic products, more attention should be given to deceitful marketing that overblows the utility of genetic products. Yet personal autonomy is reduced neither by genetic tests nor by genetic information and there is consequently no compelling case for the conclusion that genetic self-tests should be prohibited. (shrink)

This article critically examines, from the perspective of a Roman Catholic Healthcare ethicist, the second edition of the Core Competencies for Healthcare Ethics Consultation report recently published by the American Society for Humanities and Bioethics. The question is posed: can the competencies identified in the report serve as the core competencies for Roman Catholic ethical consultants and consultation services? I answer in the negative. This incongruence stems from divergent concepts of what it means to do ethics consultation, a divergence that (...) is rooted in each perspective's very different visions of autonomy. Furthermore, because of the constitutive elements of Catholic ethics consultation, such as the Ethical and Religious Directives for Health Care Services, the tradition needed to apply those directives, and the Catholic facility’s membership in the institutional Church, the competencies needed for its practice differ in kind from those identified by the report. While there are many practical points of convergence, the competencies identified by the report should not be adopted uncritically by Catholic healthcare institutions as core competencies for ethical consultation services. (shrink)

Abortion is the central issue in the conscientious objection debate. In this article I demonstrate why this is so for two philosophical viewpoints prominent in American culture. One, represented by Patrick Lee and Robert P. George, holds that the fundamental moral value of being human can be found in bare life and the other, represented by Tom Beauchamp and James Childress, holds that this fundamental value is found in the life that can choose and determine itself. First, I articulate Lee (...) and George’s philosophical theory and demonstrate how the fundamental moral value of their theory, personhood, is represented in the issue of abortion. Second, I examine Beauchamp and Childress’ theoretical vision and demonstrate how their fundamental moral value, the right to autonomous self-determination, is represented in abortion. Third, I sketch the theoretical and practical dynamics of the conscientious objection debate as well as each author’s understanding of conscience. Fourth, I demonstrate how abortion, which represents their respective fundamental value, shapes each perspectives’ approach to the conscientious objection debate. I conclude that because each theory finds its fundamental value represented in the issue of abortion, each perspective is bound to engage the conscientious objection debate in a way that centers on the issue of abortion. (shrink)

Do bioethicists need yet another theoretical approach with which to frame their disagreements? Many pragmatists contend that pragmatism, unlike its liberal and utilitarian counterparts, is uniquely commendable in (a) beginning from our lived experiences and (b) locating those experiences amid our social relations. In place of an " principlism," pragmatism offers a practical "bedside-bioethic"; in lieu of "autonomy run amuk," pragmatism proposes an ethic rooted in our communal resources. To date, however, efforts to develop such a bioethic have been stymied (...) by pragmatists' own abstract theoretical commitments, commitments that prevent them, most directly, from beginning with the lived experiences and communal resources of those who hold theological commitments. This self-imposed methodological constraint, I argue, has needlessly thwarted pragmatism's most striking methodological promise: its potential to cultivate productive debates among secular and theologically-informed participants. (shrink)

The purpose of this article is threefold: (a) to describe the relevant ethical and legal issues associated with decisional capacity among minors and to discuss the importance of these concepts for children and adolescents living with HIV, (b) to provide a framework for assessing the decisional capacity of children and adolescents with HIV, and (c) to present a model for thinking about how to use this assessment data to guide action along the protection-autonomy continuum.

Written by a nurse and a philosopher, Ethics in Nursing blends the concrete detail of recurring problems in nursing practice with the perspectives, methods, and resources of philosophical ethics. It stresses the aspects of the nurses role and relations with others -- physicians, patients, administrators, other nurses -- that give ethical problems in nursing their special focus. Among the issues addressed are deception, parentalism, confidentiality, conscientious refusal, nurse autonomy, compromise, and personal responsibility for institutional and public policy. The third edition (...) has been enlarged with new cases and case discussions related to AIDS and an additional chapter on the expanding scope of nursing ethics as it addresses issues related to scarce resources, cost containment, justice, and the possibilities of health care rationing. (shrink)

In my response to Golash I distinguish between two steps in my original argument. The first relates to the special value of conjugal (two-person) love relationships. I defend this step against criticisms, arguing that the two-person relationship provides a form of recognition that is of special importance to us and cannot be found in other sorts of relationship. The two-person relationship is one that, at least as private individuals, we have special reason to pursue. The second step concerns the claim (...) that the special value of such relationships tends to promote the autonomy of those who have them. It is this second step that is important for the argument that a liberal state – one, at any rate, that takes itself to be in the business of safeguarding the pre-conditions of autonomy – could have reason to favour marriage or some form of civic partnership over other forms of intimate adult tie. However, I admit that Golash puts forward plausible – if anecdotal – arguments against this second step. I therefore agree that I need to be more tentative about this step than I was in the original paper. (shrink)

This paper argues that a liberal state is justified in promoting relationships of conjugal love – the form of relationship that is the basis of the institution of marriage – on the grounds that they are essential to the development and maintenance of autonomy. A deep human need is that the detail of our lives be recognized (accepted, affirmed, granted importance) by others (or by an other). Autonomy can be compromised when this need is not met. So a state concerned (...) with autonomy ought to be concerned with relationships in which people can be given recognition. This argument justifies support for friendship as well as conjugal love; why is the latter particularly special? The answer is that in conjugal love partners value each other exclusively (i.e., in a way they do not value anyone else). Conjugal relations therefore recognise the uniqueness and individual value of a person's life in away that friendship does not. (shrink)

Stephen J. Schulhofer, Unwanted Sex: The Culture of Intimidation and the Failure of Law Cambridge, MA: Harvard University Press, 1998, xii + 284 pp.