The question of corporate moral responsibility – of whether it makes sense to hold an organisation corporately morally responsible for its actions,rather than holding responsible the individuals who contributed to that action – has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom(UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care (...) context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially a moral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish. (shrink)

The UK government is setting up a new kind of organisation as part of the National Health Service, the foundation trust. Foundation trusts will be more distanced from government than existing NHS bodies, and will have closer community links. In this paper I identify the importance of legitimacy in health care and explore the potential situation of foundation trusts in terms of the bases of their legitimacy as organisations. Relationships with community, stakeholders and government are all considered as sources of (...) legitimacy for foundation hospitals, and comparisons are made with other organisations, state, voluntary and private. I conclude that the blueprint of the foundation hospital creates a set of relationships which are incoherent and mutually conflicting, and conceals a crucial relationship with the state. I argue that these problems are likely to weaken the legitimacy of the foundation trust. (shrink)

Feeding difficulties in older patients who are suffering from dementia present problems with balancing conflicting ethical principles. They have been considered by several writers in recent years, and the views of nursing and care staff have been studied in different contexts. The present study used focus groups to explore the way in which nursing and care staff in a National Health Service trust deal with conflict between ethical principles in this area. Three focus groups were convened, one each from the (...) staff of three wards caring for patients with dementia. Case histories were discussed and transcripts analysed. It emerged that staff were aware of making fine judgements of utility concerning the spectrum of feeding methods available. Informants gave some weight to the principle of autonomy, but sought to balance that against their commitment to care. In explaining their perspectives, informants gave more weight to personal attitudes and trust culture than to professional ethics. (shrink)

This paper considers the social justice initiative of the Canadian Nurses Association (CNA). It focuses mainly on the two editions of the CNA's discussion document on social justice, and particularly on its emphasis on the principle of equity. The paper considers whether a coherent justification can be made for the CNA's espousal of equity, and the discussion focuses in turn on the principle of equity itself and on the CNA's position in relation to equity. A body of arguments supporting an (...) active moral role for professions, generally known as civic professionalism, provides a framework for exploring the CNA's role in this respect. Justifications for equity are explored in relation to the liberal‐contextualist spectrum, and civic professional arguments are subjected to the same structure of analysis. This is in turn related to evidence from the literature concerning nursing perceptions of equity. The paper concludes that contextualist justifications of equity and civic professionalism support one another more robustly than liberal justifications in relation to the CNA's initiative; and that they also sit more comfortably with the realities of the CNA's role in relation to nursing, and to the Canadian health care system. (shrink)

In this paper I explore the relationship between the Canadian state and Canada’s First Nations, in the context of the Canadian health care system. I argue that Canada’s provision of health care to its citizens can be best understood morally in terms of a covenant, but that the covenant fails to meet the needs of indigenous peoples. I consider three ways of changing the relationship and obligations linking Canada’s First Nations and the Canadian state, with regard to health care- assimilation, (...) accommodation and separation. I argue that all of these options create problems, and at present there is a good argument for working with the status quo, accepting that First Nations are outside the covenant, and securing the state’s commitment to their health care on the basis of their citizenship and the liberal principle of equal treatment of citizens by the state. (shrink)

In recent years there have been several calls in professional and academic journals for healthcare personnel in Canada to raise the profile of postcolonial theory as a theoretical and explanatory framework for their practice with Indigenous people. In this paper I explore some of the challenges that are likely to confront those healthcare personnel in engaging with postcolonial theory in a training context. I consider these challenges in relation to three areas of conflict. First I consider conflicts around paradigms of (...) knowledge, wherein postcolonial theory operates from a different base from most professional knowledge in health care. Second I consider conflicts of ideology, wherein postcolonial theory is largely at odds with Canada’s political and popular cultures. And finally I consider issues around the question of Canada’s legitimacy, which postcolonial theory puts in doubt. I suggest ways in which these conflicts might be addressed and managed in the training context, and also identify potential positive outcomes that would be enabling for healthcare personnel, and might also contribute to an improvement in Canada’s relationship with its indigenous peoples. (shrink)

The question of corporate moral responsibility – whether corporate bodies can be held morally responsible for their actions – has been debated by a number of writers since the 1970s. This discussion is intended to add to that debate, and focuses for that purpose on our understanding of the organisation. Though the integrity of the organisation has been called into question by the postmodern view of organisations, that view does not necessarily rule out the attribution of corporate agency, any more (...) than the postmodern view of the person rules out the attribution of individual agency. The postmodern view is opposed to a reifying, metaphysical view of corporate agency, but a semantic view of corporate agency would seem to sit more comfortably with it. A bigger problem for the idea of corporate moral responsibility arises from the fact that in Kantian terms organisations are not ends in themselves. In that sense they are not like persons, and this must limit their autonomy, and their responsibility. This aspect of organisations also limits their punishability. For these reasons corporate moral responsibility must be seen as more limited than the responsibility of persons. (shrink)

The National Institute for Health and Clinical Excellence (hereafter NICE) was created in 1998 to give guidance on which treatments should be provided by the British National Health Service, and to whom. So it has a crucial role as an agent of distributive justice. In this paper I argue that it is failing to adequately explain and justify its decisions in the public arena, particularly in terms of distributive justice; and that this weakens its legitimacy, to the detriment of the (...) National Health Service as a whole. I argue that this failure arises from the fact that NICE works within the frameworks of positivist science and liberal ethics, largely to the exclusion of other perspectives. This narrowness of view prevents NICE from properly connecting with the range of moral concerns represented in the population. I argue for NICE’s deliberations to become more inclusive, both in terms of epistemology, and also in terms of ethical perspectives. And I suggest a range of perspectives that could usefully be included. Finally I offer a framework of structures, philosophies and discussion process that will enable competing perspectives to be debated fairly and productively in this process. (shrink)

In recent years UK government policy has been drawing private companies into the operation of the British National Health Service as providers of health care. Hitherto the National Health Service has been the main employer of health care practitioners, but this may change as a result of this development. There is an issue as to whether professional health care practitioners owe the same moral commitment to an employer in the private sector as they would owe to an employer that is (...) part of the state-run National Health Service. I explore some arguments around this issue, focusing on ways of identifying organisational commitment to good health care. With regard to the practitioners commitment to the organisation I consider two strengths of commitment, normative and calculative. I then undertake an analysis of performance, regulatory regimes, and organisational obligations for both sectors. I conclude that while performance and regulatory regimes show little difference between sectors, there is a reasonably compelling argument in favour of a stronger moral commitment to state bodies based on organisational obligations. (shrink)

In this paper I put forward an ethical argument for the provision of extensive patient choice by the British National Health Service. I base this argument on traditional liberal rights to freedom of choice, on a welfare right to health care, and on a view of health as values-based. I argue that choice, to be ethically sustainable on this basis, must be values-based and rational. I also consider whether the British taxpayer may be persuadable with regard to the moral acceptability (...) of patient choice, making use of Rawls’ theory of political liberalism in this context. I identify issues that present problems in terms of public acceptance of choice, and also identify a boundary issue with regard to public health choices as against individual choices. (shrink)

In this paper I outline an approach to the distribution of resources between psychotherapy modalities in the context of the UK’s health care system, using recent discussions of Cognitive Behavioural Psychotherapy as a way of highlighting resourcing issues. My main goal is to offer an approach that is just, and that accommodates the diversity of different schools of psychotherapy. In order to do this I draw extensively on the theories of Justice and of Political Liberalism developed by the late John (...) Rawls, and adapt these to the particular requirements of psychotherapy resourcing. I explore some of the implications of this particular analysis, and consider how the principles of Rawlsian justice might translate into ground rules for deliberation and decision-making. (shrink)

[Stephen Yablo] The usual charge against Carnap's internal/external distinction is one of 'guilt by association with analytic/synthetic'. But it can be freed of this association, to become the distinction between statements made within make-believe games and those made outside them-or, rather, a special case of it with some claim to be called the metaphorical/literal distinction. Not even Quine considers figurative speech committal, so this turns the tables somewhat. To determine our ontological commitments, we have to ferret out all traces (...) of nonliterality in our assertions; if there is no sensible project of doing that, there is no sensible project of Quinean ontology. /// [Andre Gallois] I discuss Steve Yablo's defence of Carnap's distinction between internal and external questions. In the first section I set out what I take that distinction, as Carnap draws it, to be, and spell out a central motivation Carnap has for invoking it. In the second section I endorse, and augment, Yablo's response to Quine's arguments against Carnap. In the third section I say why Carnap's application of the distinction between internal and external questions runs into trouble. In the fourth section I spell out what I take to be Yablo's version of Carnap. In the last I say why that version is especially vulnerable to the objection raised in the second. (shrink)

This volume addresses how black, middle class, second generation Caribbean immigrants are often overlooked in contemporary discussions of race, black economic mobility, and immigrant communities in the US. Based on rich ethnography, Yndia S. Lorick-Wilmot draws attention to this persisting invisibility by exploring this generation's experiences in challenging structures of oppression as adult children of post-1965 Caribbean immigrants and as an important part of the African-American middle class. She recounts compelling stories from participants regarding their identity performances in public (...) and private spaces-including what it means to be "black and making it in America"-as well as the race, gender, and class constraints they face as part of a larger transnational community. (shrink)

Artificial insemination was the first conceptive technology to be widely used in agriculture. Whereas at the beginning of the twentieth century all cows in England and Wales were mated to bulls, by the end of the 1950s 60% conceived through artificial insemination. By then a national network of ‘cattle breeding centres’ brought AI within the reach of every farmer. In this paper I explore how artificial insemination, which had few supporters in the 1920s and 1930s, was transformed into an ‘indispensable’ (...) method for reproducing cattle. I discuss the factors that made organised AI possible , including changes in cultures of cattle breeding, novel State involvement in bovine reproduction, the rise of new ‘animal breeding research’ centres at Cambridge, Edinburgh and Reading universities, war preparations and central planning by the Milk Marketing Board . I go on to show that the unprecedented focus on bovine reproduction set in motion by the AI centres effectively generated new networks of reproductive research, through these the ‘biopower’ of the farm was incorporated into the clinic. The example of AI shows that by combining the history of reproductive technology in agriculture and medicine we can give a richer account of modern reproduction. (shrink)

This chapter defends the property dualism argument. The term “semantic premise” mentioned is used to refers to an assumption identified by Brian Loar that antiphysicalist arguments, such as the property dualism argument, tacitly assume that a statement of property identity that links conceptually independent concepts is true only if at least one concept picks out the property it refers to by connoting a contingent property of that property. It is argued that, the property that does the work in explaining the (...) possibility of a posteriori identities need not be a first-order property of the referent in question. On his view, the property dualism argument requires only a weaker semantic premise, which allows that the property in question be a higher order property. A refined version of the property dualism argument is formulated, which uses the weaker premise, and defends the argument against various objections. (shrink)

Postmodernism has evoked great controversy and it continues to do so today, as it disseminates into general discourse. Some see its principles, such as its fundamental resistance to metanarratives, as frighteningly disruptive, while a growing number are reaping the benefits of its innovative perspective. In Political Theory and Postmodernism, Stephen K. White outlines a path through the postmodern problematic by distinguishing two distinct ways of thinking about the meaning of responsibility, one prevalent in modern and the other in postmodern (...) perspectives. Using this as a guide, White explores the work of Heidegger, Foucault, Derrida, Lyotard, and Habermas, as well as 'difference' feminists, with the goal of showing how postmodernism can inform contemporary ethical-political reflection. In his concluding chapter, White examines how this revisioned postmodern perspective might bear on our thinking about justice. (shrink)

Mental causes are threatened from two directions: from below, since they would appear to be screened off by lower-order, e.g., neural states; and from within, since they would also appear to be screened off by intrinsic, e.g., syntactical states. A principle needed to parry the first threat -causes should be proportional to their effects- appears to leave us open to the second; for why should unneeded extrinsic detail be any less offensive to proportionality than excess microstructure? I say that the (...) second threat relies on a perversion of proportionality that would lay waste to all causal relations. (shrink)

Historical introduction -- Human being -- Identity and human incompletion in Sartre -- Identity and human incompletion in Aquinas -- Human understanding -- The subjective nature of objective understanding in Sartre -- The subjective nature of objective understanding in Aquinas -- Human freedom -- Freedom, choice, and the indetermination of reason in Sartre -- Freedom, choice, and the indetermination of reason in Aquinas -- Human fulfillment -- The possibility of human happiness in Sartre -- The possibility of human happiness in (...) Aquinas. (shrink)

'I think, therefore I am' - Descartes..'Such tricks hath strong imagination..That, if it would but apprehend some joy,..It comprehends some bringer of that joy;..Or in the night, imagining some fear,..How easy is a bush supposed a bear?' - Shakespeare..A unique compendium of key texts of psychology, from Aristotle to cutting-edge neuroscience.

Hegel's Philosophy of right concerns ideas on justice, moral responsibility, family life, economic activity and the political structure of the state. He shows how human freedom involves living with others in accordance with publicly recognized rights and laws.

Global Media Ethics is the first comprehensive cross-cultural exploration of the conceptual and practical issues facing media ethics in a global world. A team of leading journalism experts investigate the impact of major global trends on responsible journalism. The first full-length, truly global textbook on media ethics; Explores how current global changes in media promote and inhibit responsible journalism; Includes relevant and timely ethical discussions based on major trends in journalism and global media; Questions existing frameworks in media ethics in (...) light of the impact of global media; Contributors are leading experts in global journalism and communication. (shrink)

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)

What Is Political Theory? provides students with a comprehensive overview of the current state of the discipline. Ten substantive chapters address the most pressing topics in political theory today, including: - what resources do the classic texts still provide for political theorists? - what areas will political theorists focus on in the future? - can western political theory alone continue to provide a framework for responding to the challenges of modern political life? The authors assess the intellectual challenges to conventional (...) political theory, such as post-structuralism and the scientific study of politics that have revitalized the field in the last 30 years. They also broaden the perspective to take in non-western ideas and to reconceptualize political theory in the light of specifically global challenges. Students and teachers of political theory and political philosophy will find this book invaluable in understanding the factors that have shaped current political theory and which will guide its future development. (shrink)

If someone assaults you, should they get a milder penalty if they are rich than if they are poor? We wouldn't dream of passing a law that formalized such an arrangement. But the design of our legal systems in the US, UK, and elsewhere, which permits people with sufficient money to pay for better lawyers, means that wealth often does make a difference to legal outcomes. Justice, then, depends not only on the substance of the laws we pass, but on (...) the design of the system that administers and enforces them. Philosophers and legal theorists, however, have paid relatively little attention to what justice demands of the general design and structure of the legal system. Equal Justice argues among other things that market principles should not determine access to legal resources. If, for example, a large corporation sues a small startup, either the corporation has to use a law firm of the quality that the startup can afford or--which would be preferable, given the corporation's in-house lawyers--the startup would be given a subsidy to afford a top firm. The author builds on this core idea of equal access to resources to work out how the court system and the legal profession should be structured in order to ensure a generally just legal system. (shrink)

I examine the (mediated) correspondence between Spinoza and Robert Boyle concerning the latter’s account of fluidity and his experiments on reconstitution of niter in the light of the epistemology and doctrine of method contained in the Treatise on the Emendation of the Intellect. I argue that both the Treatise and the correspondence reveal that for Spinoza, the proper method of science is not experimental, and that he accepted a powerful under-determination thesis. I argue that, in contrast to modern versions, Spinoza’s (...) form of naturalism was a highly rationalist and anti-empirical one. I conclude with a brief account of the value of experience and experimentation for Spinoza’s scientific method. (shrink)

As a practising lawyer and judge, it is the insights gained from Stephen's own experience that give an added practical dimension to this work. As well as his accounts of the history of the branches of the law, Stephen gives several fascinating analyses of famous trials, and explores the relation of madness to crime and the relation of law to ethics, physiology, and mental philosophy. His discussion also includes the subjects of criminal responsibility, offences against the state, the (...) criminal jurisdiction of the Privy Council, libel, Indian criminal law and offences against religion. (shrink)

Philosophical Perspectives on Art presents a series of essays devoted to two of the most fundamental topics in the philosophy of art: the distinctive character of artworks and what is involved in understanding them as art. In Part I, Stephen Davies considers a wide range of questions about the nature and definition of art. Can art be defined, and if so, which definitions are the most plausible? Do we make and consume art because there are evolutionary advantages to doing (...) so? Has art completed the mission that guided its earlier historical development, and if so, what is to become of it now? Should architecture be classified as an art form? -/- Part II turns to the interpretation and appreciation of art. What is the target and purpose of the critic's interpretation? Is interpretation primarily directed at uncovering artists' intended meanings? Can apparently contradictory interpretations of a given piece both be true? Are interpretative evaluations entailed by descriptions of a work's aesthetic and artistic characteristics? In addition to providing fresh answers to these and other central questions in aesthetics, Davies considers the nature and content of metaphor, and the relation between the expressive qualities of a work of art and the emotions of its creator. (shrink)

J. JUDD OWEN AND JEFFREY STOUT SUGGEST THE NEED TO RETHINK OUR understanding of the normative commitments of liberal democracy in response to recent challenges from its "cultured despisers". In this essay I argue that Owen and Stout fail to redeem liberal democracy against these critics because they reject the possibility of constitutional neutrality with respect to an indeterminate plurality of religions. As a result, a religious test on citizenship is inevitable under any democratic constitution expressed in their terms, and (...) this test lays liberal democracy open to the despisers' main line of attack. As an alternative, I offer a defense of constitutional neutrality that is based on the work of Franklin I. Gamwell, who has developed a compound conception of justice for this purpose. Gamwell systematically distinguishes between formative and substantive conceptions of justice and the role they play in a theory of constitutional democracy. On Gamwell's account, a democratic constitution expressed as a formative conception of justice will be neutral with respect to all substantive moral disagreement. As such, it can be consistently affirmed by the adherents of an indeterminate plurality of religions. This account of liberal democracy avoids a religious test on citizenship and therefore can overcome the core objection raised against it by its contemporary critics. (shrink)

v. 1. The collective use and evolution of concepts.