In moral epistemology, the method of reflective equilibrium is often characterized in terms of intuitions or understood as a method for justifying intuitions. An analysis of reflective equilibrium and current theories of moral intuitions reveals that this picture is problematic. Reflective equilibrium cannot be adequately characterized in terms of intuitions. Although the method presupposes that we have initially credible commitments, it does not presuppose that they are intuitions. Nonetheless, intuitions can enter the process of developing a reflective equilibrium and, if (...) the process is successful, be justified. Since the method of reflective equilibrium does not essentially involve intuitions, it does not constitute a form of intuitionism in any substantial sense. It may be classified as intuitionist only in the minimal sense of not reducing justification to a matter of inference relations alone. (shrink)

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. (...) This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist. (shrink)

Arriving at a moral judgment is not a straightforward or linear process in which ethical theories are simply applied to cases. Instead it is a process in which the formulation of the moral problem, the formulation of possible “solutions”, and the ethical judging of these solutions go hand in hand. This messy character of moral problems, however, does not rule out a systematic approach. In this article, we describe a systematic approach to problem solving that does justice to the complex (...) nature of moral problems and ethical judgment: the ethical cycle. Our goal is to provide a structured and disciplined method of addressing moral problems, which helps to guide a sound analysis of these problems. We will illustrate the usefulness of this cycle with an example. Further, we will discuss two general issues in applied ethics in relation to the proposed ethical cycle: the role of ethical theories and the place of individual judgment versus collective deliberation. (shrink)

The aim of this article is to review the recent popularity of casuistry as a model of moral inquiry. I argue that proponents of casuistry do not endorse the particularist epistemology that seems to be implied by their position, and that this is why casuistry does not seem to present something really new in comparison to 'top-down' generalist approaches. I contend that casuistry should develop itself as a (moderately) particularist position and that the challenge for the defender of casuistry is (...) to come up with ideas that strengthen the ('intuitionist') model of rationality that underlies most forms of particularism. (shrink)

How are we to appraise new technological developments that may bring revolutionary social changes? Currently this is often done by trying to predict or anticipate social consequences and to use these as a basis for moral and regulatory appraisal. Such an approach can, however, not deal with the uncertainties and unknowns that are inherent in social changes induced by technological development. An alternative approach is proposed that conceives of the introduction of new technologies into society as a social experiment. An (...) ethical framework for the acceptability of such experiments is developed based on the bioethical principles for experiments with human subjects: non-maleficence, beneficence, respect for autonomy, and justice. This provides a handle for the moral and regulatory assessment of new technologies and their impact on society. (shrink)

This paper takes up the question of the role of philosophical moral theory in our attempts to resolve the ethical problems that arise in health care, with particular reference to the contention that we need theory to be determinative of our choice of actions. Moral theorizing is distinguished from moral theories and the prospects for determinacy from the latter are examined through a consideration of the most promising candidates: utilitarianism, deontology and the procedures involved in reflective equilibrium. It is argued (...) that the current lack of any generally accepted method of solving moral problems, together with the extreme improbability of philosophy achieving a plausibly determinate theory, should encourage us to approach the problems in a spirit of agnosticism regarding the way in which theoretical material might be of relevance. The practical test for both moral theorizing and moral theories is thus not determinacy but the degree to which they increase our understanding of moral problems by serving, as they do in philosophy, as a means of inquiry into their nature. (shrink)

Various theories have been put forward in an attempt to explain what makes moral judgments justifiable. One of the main theories currently advocated in bioethics is a form of coherentism known as wide reflective equilibrium. In this paper, I argue that wide reflective equilibrium is not a satisfactory approach for justifying moral beliefs and propositions. A long-standing theoretical problem for reflective equilibrium has not been adequately resolved, and, as a result, the main arguments for wide reflective equilibrium are unsuccessful. Moreover, (...) practical problems that arise in using the method of wide reflective equilibrium undermine the idea that it is a viable approach for justifying moral judgments about cases and policies. Given that wide reflective equilibrium is the most prominent version of coherentism, these considerations call into question the coherentist approach to justification in bioethics. (shrink)

In a recent paper, Peter Singer suggests that some interesting new findings in experimental moral psychology support what he has contended all along—namely that intuitions should play little or no role in adequate justifications of normative ethical positions. Not only this but, according to Singer, these findings point to a central flaw in the method (or epistemological theory) of reflective equilibrium used by many contemporary moral philosophers. In this paper, we try to defend reflective equilibrium from Singer’s attack and, in (...) part, we do this by discussing Singer’s own favoured moral methodology as outlined in his Practical Ethics . Although basing ethics solely on (certain kinds of) intuitions certainly is problematic, we argue, basing it solely on ‘reason’ gives rise to similar problems. The best solution would arguably be one which could strike a balance between the two—but, we suggest, this is precisely what reflective equilibrium is all about. (shrink)

Empirical studies on people's moral attitudes regarding ethically challenging topics contribute greatly to research in medical ethics. However, it is not always clear in which ways this research adds to medical ethics as a normative discipline. In this article, we aim to provide a systematic account of the different ways in which attitudinal research can be used for normative reflection. In the first part, we discuss whether ethical judgements can be based on empirical work alone and we develop a sceptical (...) position regarding this point, taking into account theoretical, methodological and pragmatic considerations. As empirical data should not be taken as a direct source for normative justification, we then delineate different ways in which attitudes research can be combined with theoretical accounts of normative justification in the second part of the article. Firstly, the combination of attitudes research with normative-ethical theories is analysed with respect to three different aspects: The extent of empirical data which is needed, the question of which kind of data is required and the ways in which the empirical data are processed within the framework of an ethical theory. Secondly, two further functions of attitudes research are displayed which lie outside the traditional focus of ethical theories: the exploratory function of detecting and characterising new ethical problems, and the field of ‘moral pragmatics’. The article concludes with a methodological outlook and suggestions for the concrete practice of attitudinal research in medical ethics. (shrink)

In this paper, I argue that health plays a special role in the promotion of well-being within the capabilities approach framework. I do this by first presenting a scenario involving two individuals, both of whom lack access to only one capability. The first cannot secure the capability of bodily health due to an unhealthy lifestyle, whilst the second lacks access to bodily integrity due to a life of celibacy. Second, I explore these scenarios by assessing the nature of disadvantage suffered (...) in both instances. I suggest that corrosive disadvantage (or the type of disadvantage that adversely impacts one’s ability to secure other valuable things) is what leads us to conclude that health is of special moral importance in the promotion of justice and the endorsing of well-being. (shrink)

Interactive technology assessment is a novel approach to evaluating (health) technology, which philosophically draws from the works of Rawls and Habermas. That is, it seeks to organise a practical setting for discursive ethics in order to find a legitimate basis for policy to be pursued when the technology under scrutiny features a moral controversy. Interactive technology assessment involves a cycle of interviews with all stakeholders, who are explicitly asked to respond (anonymously) to the concerns and issues raised by other participants. (...) This cycle is completed repeatedly, so that a process of vicarious learning develops. This process aims at identifying issues agreed and disagreed upon, on the basis of which widely endorsed policy recommendations can be formulated. This chapter involves an interactive technology assessment of paediatric cochlear implantation. The rationale, the design, and the results are explained, as well as the main ethical aspects of the procedure. (shrink)

This paper develops and defends a coherentist account of reasons. I develop three core ideas for this defense: a distinction between basic reasons and noninferential justification, the plausibility of the neglected argument against first philosophy, and an emergent account of reasons. These three ideas form the backbone for a credible coherentist view of reasons. I work toward this account by formulating and explaining the basic reasons dilemma. This dilemma reveals a wavering attitude that coherentists have had toward basic reasons. More (...) importantly, the basic reasons dilemma focuses our attention on the central problems that afflict coherentist views of basic beliefs. By reflecting on the basic reasons dilemma, I formulate three desiderata that any viable coherentist account of basic beliefs must satisfy. I argue that the account on offer satisfies these desiderata. (shrink)

Arriving at a moral judgment is not a straightforward or linear process in which ethical theories are simply applied to cases. Instead it is a process in which the formulation of the moral problem, the formulation of possible "solutions", and the ethical judging of these solutions go hand in hand. This messy character of moral problems, however, does not rule out a systematic approach. In this article, we describe a systematic approach to problem solving that does justice to the complex (...) nature of moral problems and ethical judgment: the ethical cycle. Our goal is to provide a structured and disciplined method of addressing moral problems, which helps to guide a sound analysis of these problems. We will illustrate the usefulness of this cycle with an example. Further, we will discuss two general issues in applied ethics in relation to the proposed ethical cycle: the role of ethical theories and the place of individual judgment versus collective deliberation. (shrink)

So-called 'realists' have argued that political philosophers should engage with real politics, but that mainstream 'non-realist' political philosophers fail to do so. Perhaps surprisingly, many of the discussions between realists and their critics have not drawn much on debates in metaethics. In this paper, I argue that this is an oversight. There are important connections between the realism/non-realism debate and certain controversies in metaethics. Both realism and non-realism come with metaethical baggage. By considering several arguments that could be made for (...) and against both positions, each of which rests on contested views about the metaphysics and epistemology of value, I outline exactly which metaethical claims realists and nonrealists must defend in order to make their position tenable. (shrink)

The realities of human agency and decision making pose serious challenges for research ethics. This article explores six major challenges that require more attention in the ethics education of students and scientists and in the research on ethical conduct in science. The first of them is the routinization of action, which makes the detection of ethical issues difficult. The social governance of action creates ethical problems related to power. The heuristic nature of human decision making implies the risk of ethical (...) bias. The moral disengagement mechanisms represent a human tendency to evade personal responsibility. The greatest challenge of all might be the situational variation in people’s ethical behaviour. Even minor situational factors have a surprisingly strong influence on our actions. Furthermore, finally, the nature of ethics itself also causes problems: instead of clear answers, we receive a multitude of theories and intuitions that may sometimes be contradictory. All these features of action and ethics represent significant risks for ethical conduct in science. I claim that they have to be managed within the everyday practices of science and addressed explicitly in research ethics education. I analyse them and suggest some ways in which their risks can be alleviated. (shrink)

Philosophical theorizing is often, either tacitly or explicitly, guided by intuitions about cases. Theories that accord with our intuitions are generally considered to be prima facie better than those that do not. However, recent empirical work has suggested that philosophically significant intuitions are variable and unstable in a number of ways. This variability of intuitions has led naturalistically inclined philosophers to disparage the practice of relying on intuitions for doing philosophy in general (e.g. Stich & Weinberg 2001) and for doing (...) moral philosophy in particular (Appiah 2008; Doris & Stich 2005; Horowitz 1998; Nadelhoffer & Feltz 2008; Sinnott Armstrong 2008). In this paper, we will draw on naturalistic considerations to offer some solace to philosophers who rely on intuitions. We wouldn’t call this a defense of intuitions, exactly, since we are sympathetic with much of the naturalists’ critique. But we want to introduce into the debate some neglected naturalistic reasons to be optimistic about intuitions, focusing especially on ethical intuitions. (shrink)

This article begins with a detailed analysis of how the choice situation of a social contract for international business ethics can be constructed and justified. A choice situation is developed by analyzing conceptions of the multinational firm and the domain of international business. The result is a hypothetical negotiation between two fictional characters, J. Duncan Grey and Elizabeth Redd, who respectively represent the interests of businesses and communities seeking to engage in international trade. The negotiators agree on ethical principles governing (...) wages, the environment, and compliance social and cultural norms. These principles are then shown to rest in wide reflective equilibrium with considered moral judgments on international business ethics, which are drawn from international agreements, such as the UN Declaration on Human Rights, and voluntary business initiatives, such as the Global Sullivan Principles and the UN Global Compact. (shrink)

Rationale, aims and objectives: Bioethics and professionalism are standard subjects in medical training programmes, and these curricula reflect particular representations of meaning and practice. It is important that these curricula cohere with the actual concerns of practicing clinicians so that students are prepared for real-world practice. We aimed to identify ethical and professional concerns that do not appear to be adequately addressed in standard curricula by comparing ethics curricula with themes that emerged from a qualitative study of medical practitioners. Method: (...) Curriculum analysis: Thirty-two prominent ethics and professionalism curricula were identified through a database search and were analysed thematically. Qualitative study: In-depth, semi-structured interviews were conducted with 20 medical practitioners. Participants were invited to reflect upon their perceptions of the ways in which values matter in their practices and their educational experiences. The themes emerging from the two studies were compared and contrasted. Results: While representations of meaning and value in ethics and professionalism curricula overlap with the preoccupations of practicing clinicians, there are significant aspects of ‘real-world’ clinical practice that are largely ignored. These fell into two broad domains: ‘sociological’ concerns about enculturation, bureaucracy, intra-professional relationships, and public perceptions of medicine; and epistemic concerns about making good decisions, balancing different kinds of knowledge, and practising within the bounds of professional protocols. Conclusions: Our findings support the view that philosophy and sociology should be included in medical school and specialty training curricula. Curricula should be reframed to introduce students to habits of thought that recognize the need for critical reflection on the social processes in which they are embedded, and on the philosophical assumptions that underpin their practice. (shrink)

Most management researchers pause at the threshold of objective right and wrong. Their hesitation is understandable. Values imply a “subjective,” personal dimension, one that can invite religious and moral interference in research. The dominant epistemological camps of positivism and subjectivism in management stumble over the notion of moral objectivity. Empirical research can study values in human behavior, but hard-headed scientists should not assume that one value can be objectively better than another. In this article, we invite management researchers to rethink (...) this presumption. We show how accepting at least a limited form of moral objectivity, namely, an epistemic orientation that seeks objective moral reasons, can benefit management research by 1. guiding research practice; 2. using patterns of moral objectivity as clues for formulating empirical hypotheses for psychological explanations; and 3. adding prescriptive power to empirical theories. (shrink)

A Moorean fact, in the words of the late David Lewis, is ‘one of those things that we know better than we know the premises of any philosophical argument to the contrary’. Lewis opens his seminal paper ‘Elusive Knowledge’ with the following declaration.

Rule consequentialism (RC) holds that the rightness and wrongness of actions is determined by an ideal moral code, i.e., the set of rules whose internalization would have the best consequences. But just how many moral codes are there supposed to be? Absolute RC holds that there is a single morally ideal code for everyone, while Relative RC holds that there are different codes for different groups or individuals. I argue that Relative RC better meets the test of reflective equilibrium than (...) Absolute RC. In particular, I contend that Relative RC is superior because it accommodates our convictions about costless benefits. Some have charged that Relative RC threatens our convictions about the generality of moral codes and that it leads inevitably to what Brad Hooker calls “runaway relativism.” I argue that Relative RC has principled reasons for stopping this imagined slide down the slippery slope. (shrink)

Jeff McMahan appeals to what he calls the “Time-relative Interest Account of the Wrongness of Killing ” to explain the wrongness of killing individuals who are conscious but not autonomous. On this account, the wrongness of such killing depends on the victim’s interest in his or her future, and this interest, in turn, depends on two things: the goods that would have accrued to the victim in the future; and the strength of the prudential relations obtaining between the victim at (...) the time of the killing and at the times these goods would have accrued to him or her. More precisely, when assessing this interest, future goods should be discounted to reflect reductions in the strength of such relations. Against McMahan’s account I argue that it relies on an implausible “actualist” view of the moral importance of interests according to which satisfactions of future interests only have moral significance if they are satisfactions of actual interests. More precisely, I aim to show that the Time-relative Interest Account does not have the implications for the morality of killing that McMahan takes it to have, and implies, implausibly, that certain interest satisfactions which seem to be morally significant are morally insignificant because they are not satisfactions of actual interests. (shrink)

In this paper it is argued that functional role semantics can be saved from criticisms, such as those raised by Putnam and Fodor and Lepore, by indicating which beliefs and inferences are more constitutive in determining mental content. The Scylla is not to use vague expressions; the Charybdis is not to endorse the analytic/synthetic distinction. The core idea is to use reflective equilibrium as a strategy to pinpoint which are the beliefs and the inferences that constitute the content of a (...) mental state. The beliefs and the inferences that are constitutive are those that are in reflective equilibrium in the process of attributing mental states to others. (shrink)

Imagine that an anthropologist returns from her study of a group of people and reports the following:They refuse to kill one person even to avert the death of all involved—including that one person;They won’t directly push someone to his death to save the lives of five others, but they will push a lever to kill him to save five others;They punish transgressors because it feels right, even when they expect the punishment to cause far more harm than good—and even when (...) the harm done by the punishment exceeds the harm done by the transgression being punished.The anthropologist’s report might lead us to conclude that these people are at least confused, and perhaps even dangerous.Here’s some bad news. Those people are us. Or so suggests recent research in experimental psychology and the neurosciences. This research indicates that our moral intuitions have a vaguely deontological character and they prompt us to make any number of judgments that appear arbitrary or otherwise unjustified, such ... -/- I contend that Greene partly misunderstands the practical implications of his own principles. If our ordinary moral judgments are to do the strategic work Greene wants them to do, he needs to endorse fullfledged Sidgwickian self-effacement for at least some areas of micro-level decision making. By the lights of some of Greene’s own arguments, people must accept the correctness—and not simply the usefulness—of the relevant intuitions in their personal conduct to satisfy utilitarian standards. I argue that removing utilitarian reasoning from micro-level decision making is consistent with Greene’s preferred strategy of using utilitarianism as a Bcommon currency^ for resolving moral conflict at the institutional level. To clarify upfront: the aim of this paper is to offer an internal criticism rather than to defend (e.g.,) the relevant empirical research, utilitarianism, self-effacement, and so on. I’m making an argument about where Greene’s own psychological and philosophical commitments should take him. (shrink)

Liberal societies are characterized by respect for a fundamental value pluralism; i.e., respect for individuals’ rights to live by their own conception of the good. Still, the state must make decisions that privilege some values at the cost of others. When public ethics committees give substantial ethical advice on policy related issues, it is therefore important that this advice is well justified. The use of explicit tools for ethical assessment can contribute to justifying advice. In this article, I will discuss (...) one approach to ethical assessment, the ethical matrix method. This method is a variant of intuitionist balancing. Intuitionism is characterized by stressing the existence of several (at least two) fundamental prima facie moral principles, between which there is no given rank order. For some intuitionist approaches, coherentism has been proposed as a model of justification. This article will discuss justification of ethical advice and evaluate the appropriateness of coherentism as a justificatory approach to intuitionist tools. (shrink)

The anti-counterfeiting trade agreement was originally meant to harmonise and enforce intellectual property rights provisions in existing trade agreements within a wider group of countries. This was commendable in itself, so ACTA’s failure was all the more disappointing. In this article, I wish to contribute to the post-ACTA debate by proposing a specific analysis of the ethical reasons why ACTA failed, and what we can learn from them. I argue that five kinds of objections—namely, secret negotiations, lack of consultation, vagueness (...) of formulation, negotiations outside any international body, and the creation of a new governing body outside already existing forums—had only indirect ethical implications. This takes nothing away from their seriousness but it does make them less compelling, because agreements should be evaluated, ethically, for what they are, rather than for the alleged reasons why they are being proposed. I then argue that ACTA would have caused three ethical problems: an excessive and misplaced kind of responsibility, a radical decrease in freedom of expression, and a severe reduction in information privacy. I conclude by indicating three lessons that can help us in shaping a potential ACTA 2.0. First, we should acknowledge the increasingly vital importance of the framework of implicit expectations, attitudes, and practices that can facilitate and promote morally good decisions and actions. ACTA failed to perceive that it would have undermined the very framework that it was supposed to foster, namely one promoting some of the best and most successful aspects of our information society. Second, we should realise that, in advanced information societies, any regulation affecting how people deal with information is now bound to influence the whole ‘onlife’ habitat within which they live. So enforcing IPR becomes an environmental problem. Third, since legal documents, such as ACTA, emerge from within the infosphere that they affect, we should apply to the process itself, which one day may lead to a post-ACTA treaty, the very framework and ethical values that we would like to see promoted by it. (shrink)

The phenomenon of distributed knowledge is well-known in epistemic logic. In this paper, a similar phenomenon in ethics, somewhat neglected so far, is investigated, namely distributed morality. The article explains the nature of distributed morality, as a feature of moral agency, and explores the implications of its occurrence in advanced information societies. In the course of the analysis, the concept of infraethics is introduced, in order to refer to the ensemble of moral enablers, which, although morally neutral per se, can (...) significantly facilitate or hinder both positive and negative moral behaviours. (shrink)

In A Theory of Justice (1971), John Rawls introduces the concept of “reflective equilibrium.” Although there are innumerable references to and discussions of this concept in the literature, there is, to the present author's knowledge, no discussion of the most important question: Why reflective equilibrium? In particular, the question arises: Is the method of reflective equilibrium applicable to the choice of this method itself? Rawls's drawing of parallels between Kant's moral theory and his own suggests that his concept of “reflective (...) equilibrium” is on a par with Kant's concept of “transcendental deduction.” Treating these two approaches to justification as paradigmatic, I consider their respective merits in meeting the reflexive challenge, i.e., in offering a justification for choice of mode of justification. My enquiry into this topic comprises three parts. In this first part, I raise the issue of the reflexivity of justification and question whether the reflexive challenge can be met within the framework of A Theory of Justice. (shrink)

In A Theory of Justice (1971), John Rawls introduces the concept of “reflective equilibrium.” Although there are innumerable references to and discussions of this concept in the literature, there is, to the present author's knowledge, no discussion of the most important question: Why reflective equilibrium? In particular, the question arises: Is the method of reflective equilibrium applicable to the choice of this method itself? Rawls's drawing of parallels between Kant's moral theory and his own suggests that his concept of “reflective (...) equilibrium” is on a par with Kant's concept of “transcendental deduction.” Treating these two approaches to justification as paradigmatic, I consider their respective merits in meeting the reflexive challenge, i.e., in offering a justification for choice of mode of justification. In the first part of this enquiry (Eng 2014a), I raised the issue of the reflexivity of justification and questioned whether the reflexive challenge can be met within the framework of A Theory of Justice. In the second part (Eng 2014b), I outlined a Kantian approach that represents a paradigmatic alternative to Rawls. In this third and final part, I shall argue that Rawls's reflective equilibrium cannot justify the choice of itself and that in the broader perspective thus necessitated, we cannot escape the metaphysical issues integral to the Kantian approach. (shrink)

This paper is concerned with the practical importance of different forms of paternalism for educational theory and practice. Contrary to the traditional treatment of paternalism as a sometimes necessary and rather messy aspect of educational practices, I demonstrate that paternalism is to be regarded as an “indigenous concept” of educational theory and as the ‘indigenous model of justification’ that underlies the structure of educational practices. Based on an analysis of the intricate nexus between autonomy-oriented forms of paternalism and educational forms (...) of autonomy-based perfectionism I furthermore argue that a perfectionistically structured conception of autonomy provides a more adequate evaluative framework for justifying autonomy as an educational aim than alternative educational regimes of autonomy can deliver. Finally, I discuss some major theoretical problems of bridging the gap between general ethical principles and their application in practical fields. (shrink)

Soft regulatory measures are often promoted as an alternative for existing regulatory regimes for nanotechnologies. The call for new regulatory approaches stems from several challenges that traditional approaches have difficulties dealing with. These challenges relate to general problems of governability, tensions between public interests, but also (and maybe particularly) to almost complete lack of certainty about the implications of nanotechnologies. At the same time, the field of nanotechnology can be characterized by a high level of diversity. In this paper, we (...) discuss and compare two models for framing public policy in relation to technology regulation: the first is a deliberative model based on foresight knowledge and the second the wide reflective equilibrium model, developed by political philosopher John Rawls. In both models, the aim is to find consensus on (a framework for) policy measures and regulation. On the basis of a critical discussion of the strengths and weaknesses of both models, some tentative conclusions are drawn for effective policy making and implementation based on soft law. (shrink)

In professional settings, people often have diverse and competing conceptions of responsibility and of when it is fair to hold someone responsible. This may lead to undesirable gaps in the distribution of responsibilities. In this paper, a procedural model is developed for alleviating the tension between diverging responsibility conceptions. The model is based on the Rawlsian approach of wide reflective equilibrium and overlapping consensus. The model is applied to a technological project, which concerned the development of an in-house monitoring system (...) based on ambient technology. The development of this innovative technology raised questions among the technological researchers about its social acceptance and the way issues related to privacy and security should be addressed. The case is analyzed in terms of two procedural norms (reflective learning and inclusiveness), which are based on literature on policy and innovation networks. Analysis of the case shows that, in a pluralist setting, a procedural approach can be useful for encouraging discussion on the legitimacy of different responsibility conceptions and the question what a fair responsibility distribution amounts to. (shrink)

Due to their non-hierarchical structure, socio-technical networks are prone to the occurrence of the problem of many hands. In the present paper an approach is introduced in which people’s opinions on responsibility are empirically traced. The approach is based on the Rawlsian concept of Wide Reflective Equilibrium (WRE) in which people’s considered judgments on a case are reflectively weighed against moral principles and background theories, ideally leading to a state of equilibrium. Application of the method to a hypothetical case with (...) an artificially constructed network showed that it is possible to uncover the relevant data to assess a consensus amongst people in terms of their individual WRE. It appeared that the moral background theories people endorse are not predictive for their actual distribution of responsibilities but that they indicate ways of reasoning and justifying outcomes. Two ways of ascribing responsibilities were discerned, corresponding to two requirements of a desirable responsibility distribution: fairness and completeness. Applying the method triggered learning effects, both with regard to conceptual clarification and moral considerations, and in the sense that it led to some convergence of opinions. It is recommended to apply the method to a real engineering case in order to see whether this approach leads to an overlapping consensus on a responsibility distribution which is justifiable to all and in which no responsibilities are left unfulfilled, therewith trying to contribute to the solution of the problem of many hands. (shrink)

The ArgumentSome have claimed that negative genetic interventions are morally permissible while positive ones are not, but the distinction cannot be used to draw this moral boundary. Underlying the negative/positive distinction is a distinction between treatment and enhancement. The treatment/enhancement distinction at best provides an imperfect guide to which health care services we are obliged to provide and which we are not. It offers only some “warning flags” to help us think about what is permissible or not.

The arguments advanced in this paper are the following. Firstly, that just as Trevarthen’s three subjective/intersubjective levels, primary, secondary, and tertiary, mapped out different modes of access, so too response is similarly structured, from direct primordial responsiveness, to that informed by shared pragmatic concerns and narrative contexts, to that which demands the distantiation afforded by representation. Secondly, I propose that empathy is an essential mode of intentionality, integral to the primary level of subjectivity/intersubjectivity, which is crucial to our survival as (...) individuals and as a species. Further to this last point, I argue that empathy is not derived on the basis of intersubjectivity, nor does it merely disclose intersubjectivity, rather it is constitutive of intersubjectivity at the primary level. Empathy is a direct, irreducible intentionality separable in thought from the other primary intentional modes of perception, rationality, memory and imagination, but co-arising with these. In regard to the inter-personal level, the concrete relations with others, primary empathy is both the ground for the possibility of the secondary manifestations—pity, sympathy, perspective taking, etc., and motivates them. Thirdly, it is the movement in the core of subjectivity initially generated by shifting attention between the ‘I’ and ‘we’ perspectives and later ‘solidified’ through affect to become shifting identification, which opens up the intersubjective domain. So we can affirm that we are not only born into sociality but our sociality goes to the roots of our being as Husserl, Heidegger and Merleau-Ponty have claimed. (shrink)

This paper is about the moral status of those human beings with profound intellectual disabilities (PIDs). We hold the common sense view that they have equal status to ‘normal’ human beings, and a higher status than any non-human animal. We start with an admission, however: we don’t know how to give a fully satisfying theoretical account of the grounds of moral status that explains this view. And in fact, not only do we not know how to give such an account, (...) but the most satisfying account of moral status that we know (which we call ‘the standard account’) entails that our view is false. It entails that those with PIDs have a lower status than ordinary human beings and an equal status to non-human animals. Now, in this paper, we do absolutely nothing to try to show where the standard account goes wrong, and we do absolutely nothing to resolve the difficulties we see in developing an alternative account that supports our view. Indeed, we do not give any argument against the standard account or in favour of our own view. Instead, we raise the following question: in order to be justified in continuing to hold our view, are we obliged to give such an account? Our answer will be that we are not. (shrink)

Abstract: In this article the author develops the view, held by some, that political constructivism is best interpreted as a pragmatic enterprise aiming to solve political problems. He argues that this interpretation's structure of justification is best conceived in terms of two separate investigations—one develops a normative solution to a particular political problem by working up into a coherent whole certain moral conceptions of persons and society; and the other is an empirically based analysis of the political problem. The author (...) argues that the empirically based analysis can generate criteria for assessing whether the normative theory successfully works out a solution, thereby developing a functionalist structure of justification. He further argues that this interpretation overcomes a longstanding criticism of constructivism, namely, that the use of substantive moral concepts in the hypothetical choice procedure biases the defense of principles in a particular direction and therefore begs important philosophical questions. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

Some philosophers, such as Kai Nielsen, view Rawls's rejection of metaphysical claims, encapsulated in his method of avoidance, as being compatible with the "anti-philosophical" stance, the view that metaphysical debates are sterile and should be abandoned to be replaced by practically viable forms of thinking. This paper shows that this reading of the method of avoidance is incorrect and argues that the method of avoidance is in fact comparable to Carnap's higher-order standpoint of neutrality with regards to different frameworks. This (...) sheds new light on Rawlsian theory and situates it within the empiricist tradition. (shrink)

Some empirical findings seem to show that people value health benefits differently depending on the age of the beneficiary. Health economists and philosophers have offered justifications for these preferences on grounds of both efficiency and equity. In this paper, I examine the most prominent examples of both sorts of justification: the defence of age-weighting in the WHO's global burden of disease studies and the fair innings argument. I argue that neither sort of justification has been worked out in satisfactory form: (...) age should not be taken into account in the framework of the burden of disease measure, and on the most promising formulations of the fair innings argument, it turns out to be merely an indicator of some other factor. I conclude by describing the role of age in theories of justice of healthcare resource allocation. (shrink)

The last twenty-five years of published literature and curriculum development in bioethics suggest that the field enjoys a successful and stable marriage to philosophical ethical theory. However, the next twenty-five years could be very different. I believe the marriage is troubled. Divorce is conceivable and perhaps likely. The most philosophical parts of bioethics may retreat to philosophy departments, while bioethics continues on its current course toward a more interdisciplinary and practical field.I make no presumption that bioethics is integrally linked to (...) philosophical ethical theory. Indeed, I assume that the connection is contingent and fragile. Many individuals in law, theological ethics, political theory, the social and behavioral sciences, and the health professions carefully address mainstream issues of bioethics without finding ethical theory essential or breathtakingly attractive. This is not surprising. Moral philosophers have traditionally formulated theories of the right, the good, and the virtuous in the most general terms. (shrink)

In this commentary, I critically discuss the respective views of Gert and Beauchamp–Childress on the nature of so-called common morality and its promise for enriching ethical reflection within the field of bioethics. Although I endorse Beauchamp and Childress’ shift from an emphasis on ethical theory as the source of moral norms to an emphasis on common morality, I question whether rouging up common morality to make it look like some sort of ultimate and universal foundation for morality, untouched by the (...) dialectics of time and reflective equilibrium, was an equally good move. As for Gert’s magisterial conception of common morality, I conclude that certain elements of his system are controversial at best and woefully inadequate at worst. He has a tendency to find in common morality what he himself put there, and his highly restricted conception of duties of assistance strikes this reader as ad hoc, inadequately defended, and unworthy of a project whose goal is to lessen the amount of misery in the world. (shrink)

In his recent book, The Dimensions of Consequentialism, Martin Peterson puts forward a new version of consequentialism that he dubs ‘multidimensional consequentialism’. The defining thesis of the new theory is that there are irreducible moral aspects that jointly determine the deontic status of an act. In defending his particular version of multidimensional consequentialism, Peterson advocates the thesis—he calls it DEGREE—that if two or more moral aspects clash, the act under consideration is right to some non-extreme degree. This goes against the (...) orthodoxy according to which—Peterson calls this RESOLUTION—each act is always either entirely right or entirely wrong. The argument against RESOLUTION appeals to the existence of so-called deontic leaps: the idea is that endorsing RESOLUTION would not give each relevant moral aspect its due in the final analysis. Our paper argues that, contrary to Peterson, all moral aspects remain visible in what can properly be called the final analysis of a moral theory that involves RESOLUTION, moral aspects do not have to remain visible in judgements of all-things-considered rightness or wrongness, respectively, introduction of what Peterson calls verdictive reasons does not change the overall picture in favour of DEGREE. We conclude that multi-dimensional consequentialists should accept RESOLUTION rather than DEGREE. (shrink)

This paper explores the relationships that various applied ethics bear to each other, both in particular disciplines and more generally. The introductory section lays out the challenge of coming up with such an account and, drawing a parallel with the philosophy of science, offers that applied ethics may either be unified or disunified. The second section develops one simple account through which applied ethics are unified, vis-à-vis ethical theory. However, this is not taken to be a satisfying answer, for reasons (...) explained. In the third section, specific applied ethics are explored: biomedical ethics; business ethics; environmental ethics; and neuroethics. These are chosen not to be comprehensive, but rather for their traditions or other illustrative purposes. The final section draws together the results of the preceding analysis and defends a disunity conception of applied ethics. (shrink)

This paper discusses the importance of Richard M. Zaners work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics – applied ethics, casuistry, principlism, and conflict resolution – cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that the practice of clinical ethics is (...) bound up with the normative commitments of medicine as a therapeutic enterprise. (shrink)