Research on passive avoidance learning has demonstrated reliable differences between psychopaths and controls when avoidance errors result in electric shock but not in loss of money (Schmauk, 1970). Using monetary punishments, Newman, Widom, and Nathan (1985) found that psychopathic delinquents performed more poorly than controls in an experimental paradigm employing monetary reward as well as the avoidance contingency. The present study was conducted to replicate and extend these findings using adult psychopaths and a computer controlled task. Sixty white male (...) prisoners were assigned to groups using Hare's (1980) Psychopathy Checklist and administered a "go/no-go" discrimination task involving monetary incentives. One condition entailed competing reward and punishment contingencies; the other, two punishment contingencies. As predicted, psychopaths made significantly more passive avoidance errors than nonpsychopaths when the task contained competing goals (p < .05)but performed as well as controls when the subjects' only goal was avoiding punishment. Results corroborate earlier findings that psychopaths are relatively poor at learning to inhibit reward-seeking behavior that results in monetary punishment. (shrink)

Linking psychopathy to a specific brain abnormality could have significant clinical, legal, and scientific implications. Theories on the neurobiological basis of the disorder typically propose dysfunction in a circuit involving ventromedial prefrontal cortex (vmPFC). However, to date there is limited brain imaging data to directly test whether psychopathy may indeed be associated with any structural or functional abnormality within this brain area. In this study, we employ two complementary imaging techniques to assess the structural and functional connectivity of vmPFC in (...) psychopathic and non-psychopathic criminals. Using diffusion tensor imaging, we show that psychopathy is associated with reduced structural integrity in the right uncinate fasciculus, the primary white matter connection between vmPFC and anterior temporal lobe. Using functional magnetic resonance imaging, we show that psychopathy is associated with reduced functional connectivity between vmPFC and amygdala as well as between vmPFC and medial parietal cortex. Together, these data converge to implicate diminished vmPFC connectivity as a characteristic neurobiological feature of psychopathy. (shrink)

In the first meta-analytic review of the response modulation hypothesis (RMH), an attention-based model for understanding the etiology of psychopathy, Smith and Lilienfeld (2015) report that the average effect size for response modulation deficits in psychopathic individuals fell in the small to medium range (r = .20; p. < .001, d = .41). Moreover, support for the RMH extended to both psychopathy dimensions, across diverse assessments and settings, and spanned child, adult, female, and male samples. The analysis also revealed good (...) empirical support for a central tenet of the RMH, namely that response modulation deficits are not limited to the processing of threat or other emotion stimuli. Unfortunately, the Smith and Lilienfeld meta-analysis contains several theoretical and quantitative problems, including failing to distinguish adequately between the tasks used to evaluate RMH predictions and the theory itself, confusion regarding the evolution of the RMH and its impact on effect sizes, misinterpretations of RMH predictions and evidence regarding dominant response sets, passive avoidance, and primary task performance, and biased statements promoting the low fear model over the RMH. In this response, we endeavor to reduce misunderstanding by addressing the most salient issues, with the hope that increasing clarity will sharpen the focus of future research and result in more valid assessments of the RMH. (shrink)

Although Mealey's account provides several interesting hypotheses, her integration across disparate samples renders the value of her explanation for psychopathy ambiguous. Recent evidence on Psychopathy Checklist-identified samples (Hare, 1991) suggests primary emotional and cognitive deficits inconsistent with her model. Whereas high-anxious psychopaths display interpersonal deficits consistent with Mealey's hypotheses, low-anxious psychopaths' deficits appear more sensitive to situational parameters than predicted.

This article introduces a novel theoretical framework for psychopathy that bridges dominant affective and cognitive models. According to the proposed impaired integration (II) framework of psychopathic dysfunction, topographical irregularities and abnormalities in neural connectivity in psychopathy hinder the complex process of information integration. Central to the II theory is the notion that psychopathic individuals are “‘wired up’ differently” (Hare, Williamson, & Harpur, 1988, p. 87). Specific theoretical assumptions include decreased functioning of the Salience and Default Mode Networks, normal functioning in (...) executive control networks, and less coordination and flexible switching between networks. Following a review of dominant models of psychopathy, we introduce our II theory as a parsimonious account of behavioral and brain irregularities in psychopathy. The II theory provides a unified theoretical framework for understanding psychopathic dysfunction and integrates principle tenets of affective and cognitive perspectives. Moreover, it accommodates evidence regarding connectivity abnormalities in psychopathy through its network theoretical perspective. (shrink)

Psychopathic behavior is characteristically amoral, but to date research studies have largely failed to identify any systematic differences in moral judgment capability between psychopaths and non-psychopaths. In this study, we investigate whether significant differences in moral judgment emerge when taking into account the phenotypic heterogeneity of the disorder through a well-validated distinction between psychopathic subtypes. Three groups of incarcerated participants [low-anxious psychopaths (n 1⁄4 12), high-anxious psychopaths (n 1⁄4 12) and non-psychopaths (n 1⁄4 24)] completed a moral judgment test involving (...) hypothet- ical dilemmas. The moral dilemmas featured personal (i.e. involving direct physical harm) or impersonal (i.e. involving indirect or remote harm) actions. Compared to non-psychopaths, both groups of psychopaths were significantly more likely to endorse the impersonal actions. However, only the low-anxious psychopaths were significantly more likely to endorse the personal harms when commission of the harm would maximize aggregate welfare the utilitarian choice. High-anxious psychopaths and non-psychopaths did not significantly differ in their personal moral judgments. These results provide novel laboratory evidence of abnormal moral judgment in psychopaths, as well as additional support for the importance of considering psychopathic subtypes. (shrink)

Psychopathic individuals display a callous-coldhearted approach to interpersonal and affective situations and engage in impulsive and antisocial behaviors. Despite early conceptualizations suggesting that psychopathy is related to enhanced cognitive functioning, research examining executive functioning (EF) in psychopathy has yielded few such findings. It is possible that some psychopathic trait dimensions are more related to EF than others. Research using a 2-factor or 4-facet model of psychopathy highlights some dimension-specific differences in EF, but this research is limited in scope. Another complicating (...) factor in teasing apart the EF–psychopathy relationship is the tendency to use different psychopathy assessments for incarcerated versus community samples. In this study, an EF battery and multiple measures of psychopathic dimensions were administered to a sample of male prisoners (N. (shrink)

Psychopathy, which is characterized by a constellation of antisocial behavioral traits, may be subdivided on the basis of etiology: “primary” (low-anxious) psychopathy is viewed as a direct consequence of some core intrinsic deficit, whereas “secondary” (high-anxious) psychopathy is viewed as an indirect consequence of environmental factors or other psychopathology. Theories on the neurobiology of psychopathy have targeted dysfunction within ventromedial prefrontal cortex (vmPFC) as a putative mechanism, yet the relationship between vmPFC function and psychopathy subtype has not been fully explored. (...) In this study, we administered two laboratory decision-making tasks (the Ultimatum Game and the Dictator Game) to a group of prisoners (n=47) to determine whether the different subtypes of psychopathy (primary vs. secondary) are associated with characteristic patterns of economic decision-making, and furthermore, whether either subtype exhibits similar performance to patients with vmPFC lesions. Comparing primary psychopaths (n=6) to secondary psychopaths (n=6) and non-psychopaths (n=22), we found that primary psychopathy was associated with significantly lower acceptance rates of unfair Ultimatum offers and lower offer amounts in the Dictator Game. Moreover, primary psychopaths were quantitatively similar to vmPFC lesion patients in their response patterns. These results support the purported connection between psychopathy and vmPFC dysfunction, bolster the distinction between primary and secondary psychopathy, and demonstrate the utility of laboratory economic decision-making tests in differentiating clinical subgroups. (shrink)

Psychopathic behavior has long been attributed to a fundamental deficit in fear that arises from impaired amygdala function. Growing evidence has demonstrated that fear-potentiated startle (FPS) and other psychopathy-related deficits are moderated by focus of attention, but to date, no work on adult psychopathy has examined attentional modulation of the amygdala or concomitant recruitment of relevant attention- related circuitry. Consistent with previous FPS findings, here we report that psychopathy-related differences in amygdala activation appear and disappear as a function of goal-directed (...) attention. Specifically, decreased amygdala activity was observed in psychopathic offenders only when attention was engaged in an alternative goal-relevant task prior to presenting threat-relevant information. Under this condition, psychopaths also exhibited greater activation in selective-attention regions of the lateral prefrontal cortex (LPFC) than did nonpsychopaths, and this increased LPFC activation mediated psychopathy’s association with decreased amygdala activation. In contrast, when explicitly attending to threat, amygdala activation did not differ in psychopaths and nonpsychopaths. This pattern of amygdala activation highlights the potential role of LPFC in mediating the failure of psychopathic individuals to processfear and other important information when it is peripheral to the primary focus of goal-directed attention. (shrink)

Damasio and colleagues (A. R. Damasio, 1994; A. R. Damasio, D. Tranel, & H. Damasio, 1990) have theorized about a possible relationship between somatic markers and the behavior of psychopathic individuals (Ps), but, to date, there are no published data regarding the proposed relationship. The authors assessed 86 Caucasian and 71 African American male offenders using R. D. Hare's (1991) Psychopathy Checklist—Revised and used a modified version of Bechara and colleagues' (A. Bechara, A. R. Damasio, H. Damasio, & S. W. (...) Anderson, 1994; A. Bechara, H. Damasio, D. Tranel, & A. R. Damasio, 1997) gambling task to test the hypothesis that Ps would, consistent with the somatic marker hypothesis, fail to become risk averse. Results indicated that level of anxiety, but not psychopathy, was predictive of response choices. Several limitations and implications of the study are noted. (shrink)

Psychopathy is a personality disorder characterized by callous antisocial behavior and criminal recidivism. Here we examine whether psychopathy is associated with alterations in functional connectivity in three large-scale cortical networks. Using fMRI in 142 adult male prison inmates, we computed resting-state functional connectivity using seeds from the default mode network, frontoparietal network, and cingulo-opercular network. To determine the specificity of our findings to these cortical networks, we also calculated functional connectivity using seeds from two comparison primary sensory networks: visual and (...) auditory networks. Regression analyses related network connectivity to overall psychopathy scores and to subscores for the “factors” and “facets” of psychopathy: Factor 1, interpersonal/affective traits; Factor 2, lifestyle/antisocial traits; Facet 1, interpersonal; Facet 2, affective; Facet 3, lifestyle; Facet 4, antisocial. Overall psychopathy severity was associated with reduced functional connectivity between lateral parietal cortex and dorsal anterior cingulate cortex. The two factor scores exhibited contrasting relationships with functional connectivity: Factor 1 scores were associated with reduced functional connectivity in the three cortical networks, whereas Factor 2 scores were associated with heightened connectivity in the same networks. This dissociation was evident particularly in the functional connectivity between anterior insula and dorsal anterior cingulate cortex. The facet scores also demonstrated distinct patterns of connectivity. We found no associations between psychopathy scores and functional connectivity within visual or auditory networks. These findings provide novel evidence on the neural correlates of psychopathy and suggest that connectivity between cortical association hubs, such as the dorsal anterior cingulate cortex, may be a neurobiological marker of the disorder. (shrink)

Research on psychopathy among incarcerated, Caucasian males has consistently demonstrated deficits in emotion processing and response inhibition. Using the PCL-R to classify participants as psychopathic or non-psychopathic, this study examined the performance of incarcerated, Caucasian females on two laboratory tasks: A lexical decision task used to assess emotion processing and a passive avoidance task used to assess response inhibition. Contrary to prediction, deficits in performance typically exhibited by psychopathic males were not exhibited by psychopathic females in this sample. Implications of (...) these findings are discussed and an interpretation of the results in the context of the Response Modulation Hypothesis is presented. (shrink)

Exploratory factor analysis (EFA) of the Psychopathic Personality Inventory (PPI; S. O. Lilienfeld, 1990; S. O. Lilienfeld & B. P. Andrews, 1996) with a community sample has suggested that the PPI subscales may comprise 2 higher order factors (S. D. Benning, C. J. Patrick, B. M. Hicks, D. M. Blonigen, & R. F. Krueger, 2003). However, substantive and structural evidence raises concerns about the viability of this 2-factor model, particularly in offender populations. The authors attempted to replicate the S. D. (...) Benning et al. 2-factor solution using a large (N= 1,224) incarcerated male sample. Confirmatory factor analysis of this model resulted in poor model fit. Similarly, using the same EFA procedures as did S. D. Benning et al., the authors found little evidence for a 2-factor model. When they followed the recommendations of J.-W. van Prooijen and W. A. van der Kloot (2001) for recovering EFA solutions, model fit results provided some evidence that a 3-factor EFA solution could be recovered via confirmatory factor analysis. (shrink)

The Twin Earth thought experiment invites us to consider a liquid that has all of the superficial properties associated with water (clear, potable, etc.) but has entirely different deeper causal properties (composed of “XYZ” rather than of H2O). Although this thought experiment was originally introduced to illuminate questions in the theory of reference, it has also played a crucial role in empirically informed debates within the philosophy of psychology about people’s ordinary natural kind concepts. Those debates have sought to accommodate (...) an apparent fact about ordinary people’s judgments: Intuitively, the Twin Earth liquid is not water. We present results from four experiments showing that people do not, in fact, have this intuition. Instead, people tend to have the intuition that there is a sense in which the liquid is not water but also a sense in which it is water. We explore the implications of this finding for debates about theories of natural kind concepts, arguing that it supports views positing two distinct criteria for membership in natural kind categories – one based on deeper causal properties, the other based on superficial, observable properties. (shrink)

Informal logic has expanded the concept of an 'argument' beyond that presented traditionally by formal logicians-to include arguments as encountered in 'real-life'. Existent definitions of argument structure are argued to be inadequate by failing to fully recognise that, ultimately, arguments have a human source. Accordingly, a new definition is proposed which appeals to relevant cognitive and behavioural factors. The definition retains some traditional concepts, but introduces the term 'supportive' as a modification to 'premiss'. The concept of a 'persuader' is also (...) developed. The definition is argued to capture more fully the intricacies, subtleties and rich diversity of informal arguments. (shrink)

People often choose intuitive rather than equally valid nonintuitive alternatives. The authors suggest that these intuitive biases arise because intuitions often spring to mind with subjective ease, and the subjective ease leads people to hold their intuitions with high confidence. An investigation of predictions against point spreads found that people predicted intuitive options more often than equally valid nonintuitive alternatives. Critically, though, this effect was largely determined by people's confidence in their intuitions. Across naturalistic, expert, and laboratory samples, against personally (...) determined point spreads, and even when intuitive confidence was manipulated by altering irrelevant aspects of the decision context, the authors found that decreasing intuitive confidence reduced or eliminated intuitive biases. These findings indicate that intuitive biases are not inevitable but rather predictably determined by contextual variables that affect intuitive confidence. (shrink)

This book reviews and integrates the most recent research and theories on this exciting topic, and features original contributions from leading researchers ...

Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits (...) the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals. (shrink)

The philosophical relation between Martin Heidegger and Jean-Paul Sartre is important, partly because of the considerable influence of Heidegger on Sartre, and partly because of their critiques of each other.

Clinical ethics consultants should show bold moral courage in discharging their duties to patients, families, and healthcare providers. Given the corrosive impact on trust, and on the appropriate d...

Researchers designing a clinical trial may be aware of disputed evidence of serious risks from previous studies. These researchers must decide whether and how to describe these risks in their model informed consent document. They have an ethical obligation to provide fully informed consent, but does this obligation include notice of controversial evidence? With ACCORD as an example, we describe a framework and criteria that make clear the conditions requiring inclusion of important controversial risks. The ACCORD model consent document did (...) not include notice of prior trials with excess death. We develop and explain a new standard labeled risk in equipoise. We argue that our approach provides an optimal level of integrity to protect the informational needs of the reasonable volunteers who agree to participate in clinical trials. We suggest language to be used in a model consent document and the informed consent discussion when such controversial evidence exists. (shrink)

Neil Levy offers the most prominent moral principles that are specifically and exclusively designed to apply to neuroethics. His two closely related principles, labeled as versions of the ethical parity principle , are intended to resolve moral concerns about neurological modification and enhancement [1]. Though EPP is appealing and potentially illuminating, we reject the first version and substantially modify the second. Since his first principle, called EPP , is dependent on the contention that the mind literally extends into external props (...) such as paper notebooks and electronic devices, we begin with an examination of the extended mind hypothesis and its use in Levy’s EPP . We argue against reliance on EMH as support for EPP . We turn to his second principle, EPP , which is not dependent on EMH but is tied to the acceptable claim that the mind is embedded in, because dependent on, external props. As a result of our critique of EPP , we develop a modified version of EPP , which we argue is more acceptable than Levy’s principle. Finally, we evaluate the applicability of our version of EPP. (shrink)

According to agent-based approaches to virtue ethics, the rightness of an action is a function of the motives which prompted that action. If those motives were morally praiseworthy, then the action was right; if they were morally blameworthy, the action was wrong. Many critics find this approach problematically insensitive to an act’s consequences, and claim that agent-basing fails to preserve the intuitive distinction between agent- and act-evaluation. In this article I show how an agent-based account of right action can be (...) made sensitive to an act’s consequences. According to the approach which I defend, an action is right just in case it realizes an agent’s morally praiseworthy motive. Conversely, an action is wrong just in case it realizes a morally blameworthy motive. Specifying act-evaluation in terms of the realization, rather than the expression, of an agent’s motives allows an agent-based approach to distinguish between agent- and act-evaluation. This is because an agent may act from a morally praiseworthy motive, but fail to realize that motive. Her action will therefore not have been the right one, despite its being the expression of morally praiseworthy motives. (shrink)

Filmmakers use continuity editing to engender a sense of situational continuity or discontinuity at editing boundaries. The goal of this study was to assess the impact of continuity editing on how people perceive the structure of events in a narrative film and to identify brain networks that are associated with the processing of different types of continuity editing boundaries. Participants viewed a commercially produced film and segmented it into meaningful events, while brain activity was recorded with functional magnetic resonance imaging (...) (MRI). We identified three degrees of continuity that can occur at editing locations: edits that are continuous in space, time, and action; edits that are discontinuous in space or time but continuous in action; and edits that are discontinuous in action as well as space or time. Discontinuities in action had the biggest impact on behavioral event segmentation, and discontinuities in space and time had minor effects. Edits were associated with large transient increases in early visual areas. Spatial-temporal changes and action changes produced strikingly different patterns of transient change, and they provided evidence that specialized mechanisms in higher order perceptual processing regions are engaged to maintain continuity of action in the face of spatiotemporal discontinuities. These results suggest that commercial film editing is shaped to support the comprehension of meaningful events that bridge breaks in low-level visual continuity, and even breaks in continuity of spatial and temporal location. (shrink)

Some bioethicists have argued in favor of a sliding scale notion of competence, paternalistically requiring greater competence in relation to more significant risk. I argue against a sliding scale notion, taking issue with the positions of Allen E. Buchanan and Dan W. Brock, Ian Wilkes, and Joel Feinberg. Rejecting arguments that a sliding scale is supported by legal cases, by ordinary usage, and by fallible judgments about competence, I argue in favor of greater evidence of competence when risk is greater. (...) Two clinical cases are examined, both involving amputation, to show that my fixed concept of competence, with a requirement of clearer evidence of competence when risk is high, better accounts for good moral decisions in bioethics. (shrink)

Lukas J. Meier et al. offer the promise of a pathway for resolving clinical bioethical problems using an artificial intelligence interface. The ultimate goal, we assume, is...

Part 1: What is philosophy? Introduction -- A brief history of philosophy -- Part II: The evolution of philosophy. Reason -- Sense experience -- Reason, sense, and intuition -- Self-preservation/power -- Desire/Free will -- Science -- Language -- Additional human activities -- Philosophy : the lessons learned -- Part III: The philosophy of conscious energy. Pierre Teilhard de Chardin (1881-1955) -- The philosophy of conscious energy -- Comments.

Self-confidence is associated with many positive outcomes, and training programs routinely seek to build participants’ self-efficacy. In this article, however, we consider whether self-confidence increases unethical behavior. In a series of studies, we explore the relationship between negotiator self-efficacy—an individual’s confidence in his or her negotiation ability—and the use of deception. We find that individuals high in negotiator self-efficacy are more likely to use deception than individuals low in negotiator self-efficacy. We also find that perceptions of the risk of deception (...) mediate this relationship. By identifying negotiator self-efficacy as an antecedent to unethical behavior, our findings offer important theoretical and empirical insights into the use of deception, the role of individual differences in ethical decision making, and the broader consequences of self-confidence in business and society. (shrink)

Available for the first time in English, this is the definitive account of the practice of sexual slavery the Japanese military perpetrated during World War II by the researcher principally responsible for exposing the Japanese government's responsibility for these atrocities. The large scale imprisonment and rape of thousands of women, who were euphemistically called "comfort women" by the Japanese military, first seized public attention in 1991 when three Korean women filed suit in a Toyko District Court stating that they had (...) been forced into sexual servitude and demanding compensation. Since then the comfort stations and their significance have been the subject of ongoing debate and intense activism in Japan, much if it inspired by Yoshimi's investigations. How large a role did the military, and by extension the government, play in setting up and administering these camps? What type of compensation, if any, are the victimized women due? These issues figure prominently in the current Japanese focus on public memory and arguments about the teaching and writing of history and are central to efforts to transform Japanese ways of remembering the war. Yoshimi Yoshiaki provides a wealth of documentation and testimony to prove the existence of some 2,000 centers where as many as 200,000 Korean, Filipina, Taiwanese, Indonesian, Burmese, Dutch, Australian, and some Japanese women were restrained for months and forced to engage in sexual activity with Japanese military personnel. Many of the women were teenagers, some as young as fourteen. To date, the Japanese government has neither admitted responsibility for creating the comfort station system nor given compensation directly to former comfort women. This English edition updates the Japanese edition originally published in 1995 and includes introductions by both the author and the translator placing the story in context for American readers. (shrink)

This project explores the ethical obligations of food journalists. Using history, normative, and feminist theory, I argue that if specific media is going to be considered food journalism, then we should be able to identify its service to citizens. This project thus seeks a unified view for evaluating the democratic and caring potential of food journalism. I outline some of the contours of quality food journalism – its principles, practices and forms – through both historical and contemporary examples. I show (...) how both sets of food journalists adhere(d) to traditional notions of democracy-serving communication while also employing a more situated ethic of care. Ultimately, I argue that quality food journalists should adopt this care ethic addressing citizen-eaters, as this nourishes the relationships necessary for democratic worldmaking and gives us the best opportunity of collectively eating and living well. (shrink)

Prior studies report that the business group structure and the associated intra-group capital flows are prone to conflicts of interest between controlling shareholders and minority investors. Yet business group is a prevalent and stable structure around the globe, particularly where capital markets are underdeveloped. Using data from China, this paper empirically studies the trade-off between the negative and positive roles played by intra-group capital flows and tests the efficiency implications of such trade-off. We find that from the perspective of the (...) whole group, intra-group capital flows are most efficient when the groups are least subject to conflicts of interest between controlling shareholders and minority shareholders and when they face strong external financing constraints. (shrink)

Moral distress has been the subject of extensive research and debate in the nursing ethics literature since the mid-1980s, but the concept has received comparatively little attention from those working outside of applied ethics. In this article, I defend a care ethical account of moral distress, according to which the phenomenon is the product of an agent’s inability to live up to one of her caring commitments. This account has a number of attractions. First, it places a greater emphasis on (...) the importance of the relationship between the caregiver and her cared-for than that found in previous accounts. Second, it does not make problematic assumptions about the correctness of a caregiver’s moral judgments, as has been claimed in relation to previous accounts of moral distress. Finally, my account allows for a clear conceptual distinction to be drawn between moral distress and other forms of negative moral emotion such as guilt and regret. Earlier accounts draw this distinction by appealing to the causal aetiology of moral distress, but as I show here, such appeals are ultimately unsuccessful unless they are made from an explicitly care ethical starting point. One of the implications of my account is that moral distress has the potential to occur in the context of any caregiving relationship. This claim is explored in the final section of the paper, in relation to student-teacher and parent-child caregiving. (shrink)

Susan D. McCammon and Nicole M. Piemonte offer a thoughtful and thorough commentary on our manuscript entitled “Expanding the use of Continuous Sedation Until Death.” In this reply we attempt to clarify and further defend our position. We show how continuous sedation until death is not a “first resort” but rather a legitimate option among many that should available to terminally ill patients whose life expectancy is less than six months. We also attempt to show that we do not equivocate (...) the meaning of palliative care as the commentators suggested. We argue that the traditional notion of palliative care should move beyond relief of “experienced suffering” to relief of potential suffering for those whose life expectancy is less than six months. Lastly, we challenge the commentator’s position that the realm of ordinary medicine” should be the guide to care, by showing how the notion of ordinary medicine has been successfully challenged in both bioethical scholarship and the courts in a way that shows ordinary medicine to be an evolving concept rather than a static, universal guide. (shrink)

In this paper, I argue that care ethics should be understood as a form of value pluralism. Writers on the ethics of care tend not explicitly to address issues in the theory of value, although much of what has been written about care ethics may be taken to suggest that it endorses some form of value monism. I argue against this conception of care ethics by showing that the practical reality of caregiving is more accurately represented by a pluralist account (...) of value. Practices of care are plausibly guided by a number of distinct and potentially conflicting values. These include quality of life, autonomy, dignity, personal development, and the value of nurturant relationships. Whilst caring takes each of these values to be important in its own right, they are not always jointly realisable, and carers are sometimes forced to promote one such value at the expense of another. The possibility of conflict between values is, of course, precisely what a pluralist conception of value tells us to expect. In this respect, then, value pluralism more faithfully reflects the reality of caregiving than does value monism, and care ethicists ought for this reason to endorse it. (shrink)