In lieu of an abstract, here is a brief excerpt of the content:The Argument ofthe Natural History Mark Webb In the NaturalHistoryofReligion Hume claims there are two principal questions concerning religion: one "concerning its foundation in reason," and the other "concerning its origin in human nature." He forthrightly states that his concern here is to determine "[w]hat those principles are, which give rise to the original belief, and what those accidents and causes are, which direct its operation."1 That (...) is to say, his express intentis, via an empirically based study, to determine and elucidate the causal or natural origin of religion—its beliefs and practices. These are among his first remarks. Consider now his very last remarks: The whole is a riddle, an aenigma, an inexplicable mystery. Doubt, uncertainty, suspence of judgment appear the only result ofour most accurate scrutiny, concerning this subject. But such is the frailty of human reason, and such the irresistible contagion of opinion, that even this deliberate doubt could scarcely be upheld; did we not enlarge our view, and opposing one species ofsuperstition to another, set them a quarrelling; while we ourselves, during their fury and contention, happily make our escape, into the calm, though obscure, regions ofphilosophy. (NHR 4:363) These last remarks should strike one as enigmatic: for, given that his purported aim is to offer a naturalistic account ofwhy humans hold religious beliefs, it is strange that he should be content to end in mystery—particularly sosince theworkitselfonersaplausible account ofsuch origins. Still, even ifHume should have felt the project to have failed, what does that have to do with "suspense of judgment," "quarrelling superstitions," and especially his "happy escape"? But of course he is up to much more in the Natural History than he lets on. Indeed,he offersnotonly acausal accountofreligiousbeliefbutamoral critique ofitas well. Why shouldhe doboth in the same work? I suggest that the causal account and the moral critique are intimately connected; and that the work is first and foremost a moral critique intended to sever allegiance to "traditional religion"—traditional theism in general, and Christianityin particular. One aim ofthis paper Volume XVII Number 2 141 MARKWEBB is to offer a unified reading of the Natural History, while the other is to assess the cogency ofHume's project on this reading. To this end we should first situate the Natural History among Hume's other works. It follows the firstEnquiry which addresses inter alia the credibility of "revealed" religion (particularly section 10, "Of Miracles"), and the second Enquiry which advances a naturalistically based morality. It was completed about the time he began the Dialogues, the main contention ofwhich is that natural theology offers minimal if any support for most traditional religious claims. In the Natural History, then, it is reasonable to suppose he is assuming the cogency of his claims against revealed religion, the viability of a naturalistically based morality, and the utter inability of natural theology to ground either traditional religious tenets or morality. The Dialogues in particular illuminate Hume's thought: after concluding that a posteriori arguments offer absolutely no grounds for ascribing the traditional moral attributes to the Deity, Philo goes on to counter Cleanthes' claim—that "[r]eligion, however corrupted, is still better than noreligion atall"2—bycontendingthattraditional religion simply is unessential andeven harmful to the needs ofsociety. Hume advances his causal account because he believes both that traditional religion lacks any basis in reason, and that recourse to a supernatural origin is untenable. And it will become evident in the course of this paper that the Natural History is most accurately understood against the backdrop of his moral theory as expounded in the second Enquiry—indeed the former is an exercise in applied ethics. The Strategy ofthe Natural History The sceptical tone ofmany ofits passages should strike one as out of place. For the scepticism is directed not towards providing a causal account of the origin ofreligious beliefs and practices (the purported aim), but rather towards their plausibility. Yet one might well expect such passages if Hume is assuming that religion has no tenable basis in reason nor for its revelational claims, and that he intends the work to be more than merely a natural history—as indeed he does. Speaking of polytheism and the... (shrink)

Artificial intelligence, the "science and engineering of intelligent machines", still has yet to create even a simple "Advice Taker" [McCarthy, 1959]. We have previously argued [Waser, 2011] that this is because researchers are focused on problem-solving or the rigorous analysis of intelligence (or arguments about consciousness) rather than the creation of a "self" that can "learn" to be intelligent. Therefore, following expert advice on the nature of self [Llinas, 2001; Hofstadter, 2007; Damasio, 2010], we embarked upon an effort to design (...) and implement a self-understanding, self-improving loop as the totality of a (seed) AI. As part of that, we decided to follow up on Richard Dawkins' [1976] speculation that "perhaps consciousness arises when the brain's simulation of the world becomes so complete that it must include a model of itself" by defining a number of axioms and following them through to their logical conclusions. The results combined with an enactive approach yielded many surprising and useful implications for further understanding consciousness, self, and "free-will" that continue to pave the way towards the creation of safe/moral autopoiesis. (shrink)

This state-of-the-science volume brings together an array of leading authorities to comprehensively review theory and research in this burgeoning area.

Historically associated with military service, conscientious objection has become a significant phenomenon in health care. Mark Wicclair offers a comprehensive ethical analysis of conscientious objection in three representative health care professions: medicine, nursing and pharmacy. He critically examines two extreme positions: the 'incompatibility thesis', that it is contrary to the professional obligations of practitioners to refuse provision of any service within the scope of their professional competence; and 'conscience absolutism', that they should be exempted from performing any action contrary (...) to their conscience. He argues for a compromise approach that accommodates conscience-based refusals within the limits of specified ethical constraints. He also explores conscientious objection by students in each of the three professions, discusses conscience protection legislation and conscience-based refusals by pharmacies and hospitals, and analyzes several cases. His book is a valuable resource for scholars, professionals, trainees, students, and anyone interested in this increasingly important aspect of health care. (shrink)

Spiritual Traditions and the Virtues provides a philosophical appreciation of the spiritual life, showing how a certain conception of spiritual well-being, rooted in Thomas Aquinas's account of the virtues, can generate a distinctive vision of human life, and the possibilities for spiritual fulfilment.

There are many different kinds of libertarianism. The first is right libertarianism, which received its most powerful expression in Robert Nozick’s Anarchy, State and Utopia (1974), a book that still sets the baseline for discussions of libertarianism today. The second, I will call faux libertarianism. For reasons I will explain in this paper, most ‘man-on-the-street’ libertarians and most politicians who claim to be libertarians are actually this kind of libertarian. And third, there is left libertarianism, which is what I shall (...) spend most of this paper explicating. But I will not simply be surveying the views of those who identify as left libertarians and put this forth as if I were engaged in an exegetical exercise. Instead, what I shall set forth is a kind of manifesto, a statement of why I consider myself a left libertarian, one that takes this approach to political morality well beyond where it was left around the end of the last century by the previous generation of left libertarians. My hope is to provide those who find certain left libertarian ideas attractive a guide by which they can explain and harmonise their own views, recognise left libertarianism as a distinct comprehensive political doctrine, and feel more open to identify themselves as left libertarian too. (shrink)

Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five (...) distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient. (shrink)

The persistent failure of public schooling in low-income communities constitutes one of our nation's most pressing civil rights and social justice issues. Many school reformers recognize that poverty, racism, and a lack of power held by these communities undermine children's education and development, but few know what to do about it. A Match on Dry Grass argues that community organizing represents a fresh and promising approach to school reform as part of a broader agenda to build power for low-income communities (...) and address the profound social inequalities that affect the education of children. Based on a comprehensive national study, the book presents rich and compelling case studies of prominent organizing efforts in Chicago, New York City, Los Angeles, Denver, San Jose, and the Mississippi Delta. The authors show how organizing groups build the participation and leadership of parents and students so they can become powerful actors in school improvement efforts. They also identify promising ways to overcome divisions and create the collaborations between educators and community residents required for deep and sustainable school reform. Identifying the key processes that create strong connections between schools and communities, Warren, Mapp, and their collaborators show how community organizing builds powerful relationships that lead to the transformational change necessary to advance educational equity and a robust democracy. (shrink)

For years now, unionization has been under vigorous attack. Membership has been steadily declining, and with it union bargaining power. As a result, unions may soon lose their ability to protect workers from economic and personal abuse, as well as their significance as a political force. In the Name of Liberty responds to this worrying state of affairs by presenting a new argument for unionization, one that derives an argument for universal unionization in both the private and public sector from (...) concepts of liberty that we already accept. In short, In the Name of Liberty reclaims the argument for liberty from the political right, and shows how liberty not only requires the unionization of every workplace as a matter of background justice, but also supports a wide variety of other progressive policies. (shrink)

Exploitation and Economic Justice in the Liberal Capitalist State offers the first new, liberal theory of economic justice to appear in more than 30 years. The theory presented is designed to offer an alternative to the most popular liberal egalitarian theories of today and aims to be acceptable to both right and left libertarians too.

Electronegativity, described by Linus Pauling described as “The power of an atom in a molecule to attract electrons to itself” (Pauling in The nature of the chemical bond, 3rd edn, Cornell University Press, Ithaca, p 88, 1960), is used to predict bond polarity. There are dozens of methods for empirically quantifying electronegativity including: the original thermochemical technique (Pauling in J Am Chem Soc 54:3570–3582, 1932), numerical averaging of the ionisation potential and electron affinity (Mulliken in J Chem Phys 2:782–784, 1934), (...) effective nuclear charge and covalent radius analysis (Sanderson in J Chem Phys 23:2467, 1955) and the averaged successive ionisation energies of an element’s valence electrons (Martynov and Batsanov in Zhurnal Neorganicheskoi Khimii 5:3171–3175, 1980), etc. Indeed, there are such strong correlations between numerous atomic parameters—physical and chemical—that the term “electronegativity” integrates them into a single dimensionless number between 0.78 and 4.00 that can be used to predict/describe/model much of an element’s physical character and chemical behaviour. The design of the common and popular medium form of the periodic table is in large part determined by four quantum numbers and four associated rules. However, adding electronegativity completes the construction so that it displays the multi-parameter periodic law operating in two dimensions, down the groups and across the periods, with minimal ambiguity. (shrink)

What is conscientious objection? -- Should conscientious objectors be accommodated? -- Assessing objectors' beliefs and reasons -- Accommodation and conscientious provision.

Recognition of conscientious objection seems reasonable in relation to controversial and contentious issues, such as physician assisted suicide and abortion. However, physicians also advance conscience‐based objections to actions and practices that are sanctioned by established norms of medical ethics, and an account of their moral force can be more elusive in such contexts. Several possible ethical justifications for recognizing appeals to conscience in medicine are examined, and it is argued that the most promising one is respect for moral integrity. It (...) is also argued that an appeal to conscience has significant moral weight only if the core ethical values on which it is based correspond to one or more core values in medicine. Finally, several guidelines pertaining to appeals to conscience and their ethical evaluation are presented. (shrink)

The difficulties about other minds are deep and of central philosophical importance. This text explores attempts to apply Wittgenstein's concept of criteria in explaining how we can know other minds and their properties. It is shown that the use of criteria for this purpose is misguided.

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

For a long time, economic growth has been seen as the most promising source of funds to use toward reducing economic inequality, as well as a necessity if we are aiming at achieving full employment. But one of the most troubling aspects of the recent exponential rise in economic inequality is that this rise has occurred despite continued economic growth. Increases in national income have gone almost exclusively to the super-rich, while real wages for almost everybody else have stagnated or (...) even declined. And while the unemployment rate dropped significantly before the coronavirus pandemic hit, good, permanent, high-wage jobs with benefits had by then often been replaced by temporary, part-time, low-wage jobs without benefits, leaving even the employed feeling economically insecure. And now, of course, unemployment is again skyrocketing, and it is unclear how long it might take to come down. As a result, we have now arrived at a point of reckoning: can we continue to believe that liberal capitalism is the most promising combination of economic and political ideologies for securing a prosperous and just future? If not, what might replace it? Is the problem capitalism, or is it liberalism? Are we up against economic forces that we cannot influence or control, or is it our political will and the liberal values we endorse that are being tested? This paper looks at all these questions, and suggests how we might think about the prospects for a liberal future. (shrink)

The case for reparations for grievous acts of historical injustice has been getting a lot of attention lately. But I aim to broaden the discussion in two ways. First, I am not only going to talk about reparations as a means of rectifying the injuries inflicted by slavery and the genocide of indigenous peoples, the theft of their land, and the ongoing ripple effects of these historic wrongs. I am also going to talk about reparations for a wider variety of (...) historical injustices, including, most importantly, the long-term economic oppression of women, and the historical exploitation of labor. Second, I am not going to base my argument on the principle of equality, as most people currently do, but on the principle of liberty, as it is understood by libertarians on both the right and the left, at least as long as they believe what they say they believe. Not because I think that egalitarian demands for reparations are wrong. Rather, my point is that the principle of liberty, which is often raised as a defense to claims based on the principle of equality, actually leads to exactly the same place. Finally, I will discuss one possible form of reparations that has largely been ignored, but which has a special connection to libertarian principles, and I will show how it can provide some real relief without provoking the opposition that society-wide redistributive remedies usually face. (shrink)

Previous discussions of the evolution of the self have diverged greatly in their estimates of the date at which the capacity for self-thought emerged, the factors that led self-reflection to evolve, and the nature of the evidence offered to support these disparate conclusions. Beginning with the assumption that human self-awareness involves a set of distinct cognitive abilities that evolved at different times to solve different adaptive problems, we trace the evolution of self-awareness from the common ancestor of humans and apes (...) to the beginnings of culture, drawing upon paleontological, anthropological, biological, and psychological evidence. These data converge to suggest that that modern self-thought appeared just prior to the Middle-Upper Paleolithic transition, approximately 60,000 years ago.Recto running head: Evolution of the Self. (shrink)

In Liberalism with Excellence, Matthew Kramer makes an argument for how excellence may enter in into liberalism, despite liberalism’s strong commitment to neutrality. Kramer seeks to challenge not only the uncompromising rejection of this position by liberals such a Jonathan Quong, but also the so-called “blended” approach of “soft-perfectionist” scholars such as Joseph Raz and George Sher. In this essay, I do not so much challenge Kramer’s approach as offer an alternative for accomplishing the same thing. Under my proposal, certain (...) forms of excellence and neutrality can both be accommodated as long as state support for the form of excellence at issue is proportional to the support for such a form of excellence within the relevant polity, competing forms of excellence are non-rivalrous, and no one is forced to embrace a form of excellence with which they disagree. My proposal is therefore not what Ronald Dworkin derogatively characterized as “a checkerboard solution.” Rather than allowing the state to support contrary moral positions at one and the same time, it is a solution that takes morally compatible but nevertheless competing conceptions of excellence seriously, and exhibits neutrality by giving them proportional rather than full support. This neither forces anyone to pursue the particular forms of excellence the state supports nor prevents them from pursuing some other form of excellence entirely or, if they wish, no form of excellence at all. (shrink)

This book is the first comprehensive study of the meaning and measure of enforceability. While we have long debated what restraints should govern the conduct of our social life, we have paid relatively little attention to the question of what it means to make a restraint enforceable. Focusing on the enforceability of legal rights but also addressing the enforceability of moral rights and social conventions, Mark Reiff explains how we use punishment and compensation to make restraints operative in the (...) world. After describing the various means by which restraints may be enforced, Reiff explains how the sufficiency of enforcement can be measured, and he presents a unified theory of deterrence, retribution, and compensation that shows how these aspects of enforceability are interconnected. Reiff then applies his theory of enforceability to illuminate a variety of real-world problem situations. (shrink)

Process physics2 is, like all physics, a model of reality. However, unlike traditional substance-based versions, process physics implements many process philosophical concepts, perhaps most notably, the notion of internal relations. It argues that the universe can best be understood in terms of selfreferential semantic information that is remarkably similar to mathematical stochastic neural networks research in biology. It argues that information patterns generate new information through causal efficacy and, ultimately, internal integration, generating self-organising patterns of relationships. These patterns or relations (...) have an intrinsic value inherent in their self-actualisation and thereby experience a subjective unity in response to influences from the totality of their past. The result is an internally related self-organising stream of experiences that provides a defining essence objectively distinguishable in abstraction and as exhibiting all the characteristics of a quantum space and quantum matter. In process physics, therefore, quantum phenomena emerge where no prior assumption regarding their existence is made or prescribed at the start. Rather, they are internally generated as an inherent feature of an experientially becoming reality, growing in size over time and thus having an observable key feature — i.e. a ‘defining essence’ — of an expanding universe. Reality itself is now understood — and modeled — as having a primitive form of self awareness. By this we mean that it has, in the process philosopher Alfred North Whitehead’s words, prehensions of other actualities as objects in terms of their ‘provocation of some special activity within the subject’.3 In more biologically complex information systems these ultimately lead to experiential integration as conscious discrimination of contrasts in prior experiences. Reality is, ultimately, not about the identification of isolated individuals through externality, but related individuals through internality. The purpose of this paper is to arrive at a point whereby we might apply these ultimate principles of reality to management. To do this, we shall start by considering Whitehead’s own renderings of management issues, before turning to the use management studies has or has not made of his work. In the light of this discussion, we shall question the principle of deconstructive postmodernism that underpins this body of work. We shall then ask whether and to what extent Whiteheadian principles might help explain organisations as ‘event fields’ 4 within which ‘persons-in-communities’5 reside. This will then allow us to consider organisations in terms of a process reinterpretation of physics. In so doing, we shall uncover a final contradiction, between Whitehead’s understanding of organisation and his principles concerning the application of metaphysics, to which we shall at least indicate a solution. (shrink)

Many people have been enraged lately by the enormous increases in certain generic prescription drugs. But free marketeers defend these prices by arguing that they simply represent what the market will bear, and in a capitalist society there is accordingly nothing wrong with charging them. This paper argues that such a defense is actually contrary to the very principles that free marketeers claim to embrace. These prices are not only unjust and exploitative, but government interference with them would not render (...) the market less free, at least if what it means for a market to be “free” is properly understood. Everyone, even free marketeers with a libertarian or neoliberal bent, should accordingly be against this kind of profiteering. (shrink)

Those who provide medical care for infants born extremely prematurely, at what is often referred to as borderline viability, have long grown accustomed to working with the parent(s) to reach a deci...

Terrorism is commonly viewed as a form of war, and as a form of war, the morality of terrorism seems to turn on the usual arguments regarding the furtherance of political objectives through coercive means. The terrorist argues that his options for armed struggle are limited, and that the use of force against civilians is the only way he can advance his cause. But this argument is subject to a powerful response. There is the argument from consequences, which asserts that (...) terrorism is almost always counterproductive, even assuming the terrorist’s political objectives are legitimate. There is the argument from rights, which claims that terrorism violates the basic human rights of (at least) its civilian victims, and is therefore morally objectionable regardless of its consequences. And there is the argument from virtue, which notes that slaughtering civilians requires no skill or courage and therefore generates no honor or glory, making the terrorist not a virtuous warrior but a vicious one. But terrorism is not only a means of political coercion. It is also, in the view of many terrorists, a means of retribution. It is a means of exacting punishment on a political community the terrorist believes is collectively responsible for grievous wrongs certain members of that community have committed. And viewed as a means of retribution, the usual arguments made against terrorism-as-coercion have no moral force. To explain why terrorism-as-retribution is morally wrong, we must attack the notion of collective responsibility on which the terrorist relies. (shrink)

Within the Anglo-American world, economic liberalism is generally viewed as having only one progenitor—Adam Smith—and one offspring—neoliberalism. But it actually has two. The work of G. W. F. Hegel was also very influential on the development of economic liberalism, at least in the German-speaking world, and the most powerful contemporary instantiation of economic liberalism within that world is not neoliberlaism, but ordoliberalism, although this is generally unknown and certainly unacknowledged outside of Continental Europe. Accordingly, what I am going to be (...) doing in this piece is trying to bring ordoliberalism more directly into the light—I will argue that by comparing and contrasting the views of Smith and Hegel or at least between how Smith and Hegel tend to be currently (mis)understood, we can better understand both the roots and the nature of these two contemporary incarnations of economic liberalism, and the light this sheds, in turn, brings some interesting and important features of these two contemporary theories into view. From Smith, for example, neoliberals took the idea of the invisible hand, although I am going to argue that contemporary advocates of invisible hand theory have largely misconstrued or at the very least overstated the significance of this metaphor. From Hegel, in contrast, ordoliberals took the idea of the civil society, and I will argue that the civil society is a much better metaphor not only for Hegel's but also for Smith's views. Indeed, I will argue that ordoliberalism, not neoliberalism, is a better and more coherent instantiation of economic liberalism than neoliberalism could ever be. (shrink)

Despite the enormity of the financial losses flowing from the 2008 financial crisis and the outrageousness of the conduct that led up to it, almost no individual involved has been prosecuted for criminal conduct, much less actually gone to prison. What this chapter argues is that the failure to punish those in management for their role in this misconduct stems from a misunderstanding of the need to prove that they personally knew of this wrongdoing and harbored an intent to defraud. (...) But not only would negligence be a sufficient legal and moral basis for imposing terms of imprisonment in these cases, mere causal responsibility would also be enough, for causal responsibility has embed in it all we need to find those causally responsible morally responsible too, and once some basis for moral responsibility is established, the imposition of terms of imprisonment is both legally permitted and morally just. (shrink)

Process philosophy was on the periphery of academic thinking for much of the twentieth century. Whereas the focus of intellectual development was for the most part on scientific analysis, process philosophy argued for a more encompassing synthesis as well. Although the drive — the corpus delecti of formal research assessment funding exercises — for separate, discrete and latterly measurable bodies of knowledge arrived at from within increasingly autonomous academic disciplines has undoubtedly led to significant advance in many areas it has, (...) at the same time, rendered opaque the interconnectedness of all things and thereby diminished the perceived value of ideas developed in one field, in terms of their relevance to others. At its heart, this trend has arisen from a reliance upon a metaphysics of stasis; things are constant and can thus be analysed and re-analysed into ever finite and thoroughly separate elements. In contrast, a metaphysics of process suggests that change and interconnectedness are the predominant characteristics of nature. As such, it provides new directions for contemporary thought by enabling the development of ideas via an otherwise unavailable framework of coherence and comprehensiveness. One area in which process thought has proved helpful is organisation studies. This paper examines the role of interpersonal trust in organisations from a Whiteheadian perspective. As such, it aims to show how Whitehead’s thinking can be applied to complex human experiences in such a way as to reveal the nature of the processes that go toward their development. The paper begins with a theoretical explication of trust derived from the contemporary social scientific literature. The development of trust, a key component of human society, is argued to be a subjective and processual phenomenon. In the light of this discussion the paper uses appropriate elements of Whitehead’s Philosophy of Organism to provide a description of trust’s development in an individual for another individual, and its consequent impact on their cooperative behaviour. It thereby attempts to uncover the hitherto inaccessible micro-processes that go towards the development and continuation of interpersonal trust in organisational settings. In so doing, the paper seeks to demonstrate the explanatory power of an aspect of Whitehead’s work, his elucidation of human ‘emotional experience’, that is perhaps too often overlooked as a comparatively minor and non-technical use of his categoreal scheme. (shrink)

A US Department of Health and Human Services Final Rule, Protecting Statutory Conscience Rights in Health Care, and a proposed bill in the British House of Lords, the Conscientious Objection Bill, may well warrant a concern that—to borrow a phrase Daniel Callahan applied to self-determination—conscientious objection in health care has “run amok.” Insofar as there are no significant constraints or limitations on accommodation, both rules endorse an approach that is aptly designated “conscience absolutism.” There are two common strategies to counter (...) conscience absolutism and prevent conscientious objection in medicine from running amok. One, non-toleration, is to decline to accommodate physicians who refuse to provide legal, professionally accepted, clinically appropriate medical services within the scope of their clinical competence. The other, compromise or reasonable accommodation, is to impose constraints on accommodation. Several arguments for non-toleration are critically analyzed, and I argue that none warrants its acceptance. I maintain that non-toleration is an excessively blunt instrument to prevent conscientious objection in medicine from running amok. Instead, I defend a more nuanced contextual approach that includes constraints on accommodation. (shrink)

While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the context of the treatment of a particular individual, and argue that evidence of mechanisms is indeed key to various aspects of clinical practice, including assessing population-level research reports, diagnostic as well as therapeutic decision making, and the assessment of treatment effects. (...) We use the pulmonary condition bronchiectasis as a source of examples of the importance of mechanistic reasoning to clinical practice. (shrink)

The American Journal of Bioethics, Volume 11, Issue 11, Page 17-18, November 2011.

Consensus is growing among ethicists and lawyers that medical decision making for incompetent patients who were previously competent should be made in accordance with that person's prior wishes and desires. Moreover, this legal and ethical preference for the substituted judgment standard has found its way into the daily practice of medicine. However, what appears on the surface to be an agreement between jurists, bioethicists, and clinicians obscures the very real differences between disciplines regarding the actual implementation of the sub stituted (...) judgment standard. Ethicists and judges have carefully outlined how substituted judgments ought to be made and evaluated. Although differences arise, especially at the state court level, regarding the scope of the substituted judgment standard and its relation to other standards of surrogate decision making, agreement is fairly widespread on the priority of substituted judgment and on the necessity of sufficient evidence being available in order to support a particular substituted judgment. (shrink)

When faced with multiple claims to a particular good, what does distributive justice require? To answer this question, we need a substantive moral theory that will enable us assign relative moral weights to the parties' claims. But this is not all we need. Once we have assessed the moral weight of each party's claim, we still need to decide what method of distribution to employ, for there are two methods open to us. We could take the winner-take-all approach, and award (...) the good to the party with the strongest claim. On the other hand, we could divide the good proportionally, according to the relative strength of each party's claim. Because the choice between these two methods of distribution can have a dramatic impact on the resulting pattern of distribution, the choice presents a question of justice. But this is a question of justice that is often overlooked. As a result, we currently employ the principle of proportionality far less often than justice actually requires. If we focus on the question of distributive method, however, we are not only better able to understand how certain reasons enter into our all-things-considered moral judgments, we are also able to explain some perplexing but common aspects of our moral beliefs: how rights can be said to have peremptory force, yet still be balanced against other important interests; how justice can sometimes require compromise, yet sometimes require victory; and how a moral theory can avoid being too demanding while still being demanding enough. Key Words: autonomy • equality • indivisibility • inviolability • weighted lotteries • rights. (shrink)

Rawls intended the difference principle to be a liberal egalitarian principle of justice. By that I mean he intended it to provide a moral justification for a moderate amount of redistribution of income from the most advantaged members of society to the least. But since the difference principle was introduced, economic inequality has increased dramatically, reaching levels now not seen since just before the Great Depression, levels that Rawls surely would have thought perverse. Many blame this increase on the rise (...) of supply-side economics and the dramatic cuts in marginal tax rates enacted by the supply-siders for corporations and those already at the top of the income distribution. But I contend that the difference principle, or at least the ethos that the difference principle embodies and represents, is also partially to blame. Accordingly, the purpose of this paper is to explain how the difference principle, the ideas and arguments of the supply-siders, and this dramatic rise in inequality are connected, to identify where the difference principle went wrong, and to discuss what those who remain committed to the liberal egalitarian ideals that the difference principle was thought to represent might do about it. (shrink)

We apply an action-oriented approach to business ethics education, Giving Voice to Values (GVV), to the topic of sustainability. The increasingly problematic impact of unsustainable economic activity is demanding actionable responses from business. However, traditional business ethics education has focussed on awareness and decision-making and neglected action-oriented methods. The GVV curriculum offers an applied and process-driven ethics approach thatcomplements more analytical ethics pedagogies. Because of its focus on action and expressing personal values, GVV can be thought of as largely applicable (...) to the micro-level of interpersonal interactions. This paper illustrates GVV’s potential for much broader application by presenting two caselettes spanning the micro-level of workplace refurbishment to the global-level of the mass dumping of electronic waste. Ways of crafting conversations around these sustainability issues are presented and implications of the GVV approach for both the teaching and practice of sustainability ethics are discussed. (shrink)

We apply an action-oriented approach to business ethics education, Giving Voice to Values (GVV), to the topic of sustainability. The increasingly problematic impact of unsustainable economic activity is demanding actionable responses from business. However, traditional business ethics education has focussed on awareness and decision-making and neglected action-oriented methods. The GVV curriculum offers an applied and process-driven ethics approach thatcomplements more analytical ethics pedagogies. Because of its focus on action and expressing personal values, GVV can be thought of as largely applicable (...) to the micro-level of interpersonal interactions. This paper illustrates GVV’s potential for much broader application by presenting two caselettes spanning the micro-level of workplace refurbishment to the global-level of the mass dumping of electronic waste. Ways of crafting conversations around these sustainability issues are presented and implications of the GVV approach for both the teaching and practice of sustainability ethics are discussed. (shrink)

It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s/surrogate’s timely access to information, counseling, and referral. (2) Conscience-based (...) refusals will be accommodated only if a requested accommodation will not impede a patient’s timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on colleagues, supervisors, department heads, other administrators, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. Formal review may not be required in all cases, but when it is appropriate, several recommendations are offered about standards and the review process. A key recommendation is that when reviewing an objector’s reasons, contrary to what some have proposed, it is not appropriate to adopt an adversarial approach modelled on military review boards’ assessments of requests for conscientious objector status. According to the approach recommended, the primary function of reviews of objectors’ reasons is to engage them in a process of reflecting on the nature and depth of their objections, with the objective of facilitating moral clarity on the part of objectors rather than enabling department heads, supervisors, or ethics committees to determine whether conscientious objections are sufficiently genuine. (shrink)

In response to physicians who refuse to provide medical services that are contrary to their ethical and/or religious beliefs, it is sometimes asserted that anyone who is not willing to provide legally and professionally permitted medical services should choose another profession. This article critically examines the underlying assumption that conscientious objection is incompatible with a physician’s professional obligations (the “incompatibility thesis”). Several accounts of the professional obligations of physicians are explored: general ethical theories (consequentialism, contractarianism, and rights-based theories), internal morality (...) (essentialist and non-essentialist conceptions), reciprocal justice, social contract, and promising. It is argued that none of these accounts of a physician’s professional obligations unequivocally supports the incompatibility thesis. (shrink)

In this thoughtful and literate study, Schwehn argues that Max Weber and several of his contemporaries led higher education astray by stressing research--the making and transmitting of knowledge--at the expense of shaping moral character. Schwehn sees an urgent need for a change in orientation and calls for a "spiritually grounded education in and for thoughtfulness." The reforms he endorses would replace individualistic behavior, the "doing my own work" syndrome derived from the Enlightenment, with a communitarian ethic grounded in Judeo-Christian spirituality. (...) Schwehn critiques philosophies of higher education he considers misguided, from Weber and Henry Adams to Derek Bok, Allan Bloom, and William G. Perry Jr. He draws out valid insights, always showing the theological underpinnings of the so-called secular thinkers. He emphasizes the importance of community, drawing on both the secular communitarian theory of Richard Rorty and that of the Christian theorist Parker Palmer. Finally, he outlines his own prescription for a classroom-centered spiritual community of scholars. Schwehn's study will interest all those concerned with higher education in America today: faculty, students, parents, alumni, administrators, trustees, and foundation officers. (shrink)

Typically, a refusal to provide a medical service is an instance of conscientious objection only when the medical service is legal, professionally accepted, and clinically appropriate. That is, conscientious objection typically occurs only when practitioners reject prevailing norms or practices. Insofar as refusing to provide antibiotics for a viral infection does not violate prevailing clinical norms, there is no need for the physician in Case 1 to justify his refusal to provide antibiotics by appealing to his conscience.1 By contrast, insofar (...) as emergency contraception is legal and does not violate prevailing norms of good medical practice, the physician in Case 6 cannot justify his refusal to provide EC by... (shrink)