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)

The thesis of this article is that there has never been any ground for the controversy between the doctrine of free will and determinism, that it is based upon a misapprehension, that the two assertions are entirely consistent, that one of them strictly implies the other, that they have been opposed only because of our natural want of the analytical imagination. In so saying I do not tamper with the meaning of either phrase. That would be unpardonable. I mean free (...) will in the natural and usual sense, in the fullest, the most absolute sense in which for the purposes of the personal and moral life the term is ever employed. I mean it as implying responsibility, merit and demerit, guilt and desert. I mean it as implying, after an act has been performed, that one " could have done otherwise " than one did. I mean it as conveying these things also, not in any subtly modified sense but in exactly the sense in which we conceive them in life and in law and in ethics. These two doctrines have been opposed because we have not realised that free will can be analysed without being destroyed, and that determinism is merely a feature of the analysis of it. And if we are tempted to take refuge in the thought of an "ultimate ", an "innermost" liberty that eludes the analysis, then we have implied a deterministic basis and constitution for this liberty as well. For such a basis and constitution lie in the idea of liberty. -/- The thesis is not, like that of Green or Bradley, that the contending opinions are reconciled if we adopt a certain metaphysic of the ego, as that it is timeless, and identifies itself with a desire by a " timeless act". This is to say that the two are irreconcilable, as they are popularly supposed to be, except by a theory that delivers us from the conflict by taking us out of time. Our view on the contrary is that from the natural and temporal point of view itself there never was any need of a reconciliation but only of a comprehension of the meaning of terms. (The metaphysical nature of the self and its identity through time is a problem for all who confront memory, anticipation, etc.; it has no peculiar difficulties arising from the present problem.) -/- I am not maintaining that determinism is true; only that it is true insofar as we have free will. That we are free in willing is, broadly speaking, a fact of experience. That broad fact is more assured than any philosophical analysis. It is therefore surer than the deterministic analysis of it, entirely adequate as that in the end appears to be. But it is not here affirmed that there are no small exceptions, no slight undetermined swervings, no ingredient of absolute chance. All that is here said is that such absence of determination, if and so far as it exists, is no gain to freedom, but sheer loss of it; no advantage to the moral life, but blank subtraction from it. -- When I speak below of "the indeterminist" I mean the libertarian indeterminist, that is, him who believes in free will and holds that it involves indetermination. (shrink)

We formulate a restricted version of the Tukey-Teichmüller Theorem that we denote by (rTT). We then prove that (rTT) and (BPI) are equivalent in ZF and that (rTT) applies rather naturally to several equivalent forms of (BPI): Alexander Subbase Theorem, Stone Representation Theorem, Model Existence and Compactness Theorems for propositional and first-order logic. We also give two variations of (rTT) that we denote by (rTT)+ and (rTT)++; each is equivalent to (rTT) in ZF. The variation (rTT)++ applies rather naturally to (...) various Selection Lemmas due to Cowen, Engeler, and Rado. (shrink)

This paper has two goals: 1) to understand justice as a cardinal virtue, according to Aquinas; and 2) to use his conception of justice as a cardinal virtue to understand how one engages in acts of “general” justice. The argument proceeds in four stages: 1) how Aquinas understands the virtues by looking to their “objects”; 2) the two distinct “modes” of the four cardinal virtues, as “general” and “specific” virtues; 3) the triangle of three kinds of justice, seen in terms (...) of their “objects”; 4) Aquinas’s doctrine of justice as a “general” virtue (ST 2-2.58.5–6) shows that we can perform operations of “general” justice in two ways, as do the ruler and his minsters, and as ordinary folk do. Surprisingly, it is the latter mode of acting for “general” justice that is primary, not the former. (shrink)

This paper has two goals: 1) to understand justice as a cardinal virtue, according to Aquinas; and 2) to use his conception of justice as a cardinal virtue to understand how one engages in acts of “general” justice. The argument proceeds in four stages: 1) how Aquinas understands the virtues by looking to their “objects”; 2) the two distinct “modes” of the four cardinal virtues, as “general” and “specific” virtues; 3) the triangle of three kinds of justice, seen in terms (...) of their “objects”; 4) Aquinas’s doctrine of justice as a “general” virtue shows that we can perform operations of “general” justice in two ways, as do the ruler and his minsters, and as ordinary folk do. Surprisingly, it is the latter mode of acting for “general” justice that is primary, not the former. (shrink)

Si bien la importancia de Avicena como fuente del pensamiento de Tomás de Aquino es generalmente reconocida, los detalles de esa dependencia apenas comienzan a trabajarse. Este artículo se ocupa de las enseñanzas de Avicena en lo que respecta a los “sujetos” de las ciencias teoréticas —física, matemáticas y metafísica— tal y como se presentan en la Introducción al Libro de la Curación. Posteriormente, se muestra su influencia en el comentario de Tomás de Aquino al De trinitate, de Boecio, q. (...) 5, art. 1. A través de una comparación entre Avicena y Tomás se muestra la profunda influencia que tuvo Avicena en la comprensión tomista del rango de las tres clases de ciencias teoréticas. (shrink)

No one is excused from doing what he ought to do merely because he is unwilling to do it. But what if others are unwilling to play their necessary role in some joint venture that you all ought to undertake: might that excuse you from doing what you yourself ought to do as part of that? It would, if you were genuinely willing to play your necessary part if they were. But the unwillingness of everyone involved cannot reciprocally serve to (...) excuse one another from doing what they ought to do. (shrink)

This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and (...) should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. (shrink)

Book reviewed in this article: Protecting The Vulnerable: A Reanalysis of Our Social Responsibilities. By Robert E. Goodin. Chicago: University of Chicago Press.

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the (...) field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a model (...) to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

I shall be dealing, throughout this book, with a set of related problems: the relationship between morality and reasoning in general, the way in which moral reasoning is properly to be carried on, and why morality is not arbitrary. The solutions to these problems come out of the same train of argument. Morality is not arbitrary, I shall argue, because the acceptance of certain qualities of character as virtues and the rejection of others as vices is forced on us by (...) the co-operative basis of human life. The co-operation in human life is unavoidable; the alternative is a literal Hobbesian state of nature, and that is impossible. It is not that co-operation between people is a good thing or even a very good thing; it is simply unavoidable in human life, and it is impossible unless the qualities of character counted as virtues are encouraged and are at least fairly common. The possibility of human life presupposes a theory of human nature, and working out that theory of human nature is the main job of moral philosophy. These virtues or qualities of character or attitudes lead us towards a theory of reasons. A person with a sense of justice is a person inclined to accept certain sorts of facts as reasons for acting, and if the virtues are presupposed by human life then the acceptance of those sorts of facts as reasons for acting is presupposed by human life. A condition of the life of reasoning beings (a more accurate term here than 'human beings') is that moral reasons are reasons for acting and are at the very basis of reasoning. And from this it follows that properly conducted moral reasoning is ultimately guided by the virtues rather than ultimately guided by a set of rules. (shrink)

Volume 20, Issue 4, May 2020, Page 71-73.

2. The Meno offers a dramatic demonstration of the validity of the first argument put forward for Anamnesis and the immortality of the soul in the Phaedo.

Robert Solomon has presented a version of business ethics in terms of virtues theory. It is a good thing that business ethics should be understood in terms of virtues theory, but the account that Solomon gives is seriously misleading in important respects. "A virtue is a pervasive trait of character that allows one to 'fit into' a particular society and to excel in it," he says. This is something that we might query: what a society will recognize as a virtue (...) might well be what fits that formula, but sometimes we shall want to recognize as a virtue what enabled somebody to stand out against his or her society and change it, and shall want to say that those traits that enable somebody to fit happily into (say) a slave society are vices rather than virtues. That is to say, a society's recognition of virtues, its application of virtues theory in picking out various character traits as valuable, will depend on other judgments common in that society, and we might well differ from that society in those judgments. (shrink)

This distinction has sometimes been read as purely epistemic, resting not on things, but on our knowledge of them: there is one world, not two, though it may be apprehended in two ways. But this view is patently at odds with the text. Knowledge and opinion are δυνάμεις, "faculties," to be distinguished and defined by their objects, no less than by the state of mind they produce, and Plato clearly states that the fallibility and unclearness of opinion is rooted in (...) the relative unreality of opinables. (shrink)

Qualifications are needed to make the point a tight one, but it seems quite plain that it is wrong to kill people. What is not so plain is why it is wrong to kill people, especially when one considers that the person killed will not be around to suffer the consequences afterwards. He does not suffer as a consequence of his death, and he need not suffer even while dying. There are various conditions more or less commonly accepted as making (...) it not wrong to kill somebody : I may kill somebody if he threatens to kill me and killing him is my only means of defending myself ; I may kill somebody if the leader of my society announces that we are in a state of war with the other person's society ; I may kill somebody if he is my slave or a member of another tribe or has passed the age of 65 ; I may kill somebody if he has committed such crimes as to be declared an outlaw; or I may kill somebody if he is in great and unrelievable pain. Each of these conditions is more or less widely accepted in this society or another as making killing permissible, so one cannot reasonably say simply that it is quite certain that killing people is wrong whether or not it is clear why killing people is wrong. But certainly some cases of killing people are wrong, and in working out just what makes these cases wrong we ought also to be working out just what conditions make killings permissible. (shrink)

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

This book is a timely new interpretation of the moral and political philosophy of Thomas Hobbes. Staying close to Hobbes's text and working from a careful examination of the actual substance of the account of natural law, R.E. Ewin argues that Hobbes well understood the importance of moral behavior to civilized society. This interpretation stands as a much-needed corrective to readings of Hobbes that emphasize the rationally calculated, self-interested nature of human behavior. It poses a significant challenge to currently fashionable (...) game theoretic reconstructions of Hobbesian logic. It is generally agreed that Hobbes applied what he took to be a geometrical method to political theory. But, as Ewin forcefully argues, modern readers have misconstrued Hobbes's geometric method, and this has led to a series of misunderstandings of Hobbes's view of the relationship between politics and morality. Important implications of Ewin's reading are that Hobbes never thought that "the war of each against all" was an empirical possibility for citizens; that his political theory actually presupposes moral agency; and that Hobbes's account of natural law forces us to the conclusion that Hobbes was a virtue theorist. This major contribution to Hobbes studies will be praised and criticized, welcomed and challenged, but it cannot be ignored. All philosophers, political theorists, and historians of ideas dealing with Hobbes will need to take account of it. (shrink)

Corporate social responsibility is a recognised and common part of business activity. Some of the regularly cited motives behind CSR are employee morale, recruitment and retention, with employees acknowledged as a key organisational stakeholder. Despite the significance of employees in relation to CSR, relatively few studies have examined their engagement with CSR and the impediments relevant to this engagement. This exploratory case study-based research addresses this paucity of attention, drawing on one to one interviews and observation in a large UK (...) energy company. A diversity of engagement was found, ranging from employees who exhibited detachment from the CSR activities within the company, to those who were fully engaged with the CSR activities, and to others who were content with their own personal, but not organisational, engagement with CSR. A number of organisational context impediments, including poor communication, a perceived weak and low visibility of CSR culture, and lack of strategic alignment of CSR to business and personal objectives, served to explain this diversity of employee engagement. Social exchange theory is applied to help explore the volition that individual employees have towards their engagement with CSR activities, and to consider the implications of an implicit social, rather than explicit economic, contract between an organisation and its employees in their engagement with CSR. (shrink)

Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined. Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. (...) Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions. Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8). Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature. (shrink)

This essay explores the role of informal logicand its application in the context of currentdebates regarding evidence-based medicine. This aim is achieved through a discussion ofthe goals and objectives of evidence-basedmedicine and a review of the criticisms raisedagainst evidence-based medicine. Thecontributions to informal logic by StephenToulmin and Douglas Walton are explicated andtheir relevance for evidence-based medicine isdiscussed in relation to a common clinicalscenario: hypertension management. This essayconcludes with a discussion on the relationshipbetween clinical reasoning, rationality, andevidence. It is argued that (...) informal logic hasthe virtue of bringing explicitness to the roleof evidence in clinical reasoning, and bringssensitivity to understanding the role ofdialogical context in the need for evidence inclinical decision making. (shrink)

There are a variety of puzzling features about this argument. One of them—questions of validity apart—is its apparent redundancy. Parmenides’ initial division provided him with an infinite plurality of parts. He might therefore have given an existence proof of infinitely many numbers, conceived as pluralities of units, by means of this division. Instead, he introduces a new principle of division for the purpose. Again, he derives the conclusion that Unity has infinitely many parts from the infinity of number; but he (...) has already shown that Unity is infinitely divisible into parts consisting of being and unity. In short, the new principle of division introduced for number seems unnecessary, and Parmenides has twice shown that Unity has infinitely many parts. (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)

Death, violent or otherwise, is a matter of widespread concern with ongoing debates about such matters as euthanasia and the nature of brain death. Philosophers have often argued about the rationality of fear of death. This book argues that that dispute has been misconceived: fear of death is not something that follows or fails to follow from reason, but rather, it forms the basis of reasoning and helps to show why people must be cooperating beings who accept certain sorts of (...) facts as reasons for acting. Within the context of this account of reasons, the book gives a new understanding of brain death and of physician-assisted suicide. (shrink)