This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings , is exploitative of surrogate women. Arising out of consideration of (...) the heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative. (shrink)

Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of (...) an as-fair-as-possible dispute resolution process that incorporates an appropriated-justified, defensible critical-care obligation threshold. (shrink)

Bianchi, Stanley, and Sutander argue in an insightful, cogent manner for the consideration of harm reduction as an ethically-defensible, non-paternal management approach for capable persons...

Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of (...) an as-fair-as-possible dispute resolution process that incorporates an appropriated-justified, defensible critical-care obligation threshold. (shrink)

Historically, the triage of temporarily scarce health resources has served narrow utilitarian ends. The recent H1N1 pandemic experience provided an opportunity for expanding the theoretical foundations/understandings of critical care triage in the context of declared infectious pandemics. This paper briefly explores the ethics-related challenges associated with the development of modern critical care triage protocols and provides descriptions of some ‘enhanced fairness’ features which were developed through the use of an inclusive deliberative engagement process by a Canadian provincial Department of Health.

The modern practice of organ donation after cardiocirculatory death (DCD) emerged in the 1990s as a response to the alarmingly wide gap between the number of transplantable organs available through organ donation after neurological death and the urgent organ transplantation needs of persons in end-organ failure. Various important ethical dimensions of DCD have been considered and debated by prominent organ donation/transplantation theorists and clinicians.In this article, consideration of some of these ethical elements provides a foundation for a proposed set of (...) ethically informed, pragmatic conditions that could assist in the development of health policies to guide the practice of organ donation after cardiocirculatory death. (shrink)

It is often challenging for mental health‐care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health‐care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care‐related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately guided by existing rules based on legal precedents, (...) there is a gap in decision‐making support in other mental health‐care domains. This article proposes that a set of targeted, decision‐making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization). (shrink)

Interest in the future, clinical implementation of uterus transplantation for uterine factor infertility was recently boosted by the demonstration of proof-of-concept for deceased uterus donation/transplantation. The ethical dimensions of living and deceased uterus transplantation are explored and addressed in the paper through their comparison to the ethical elements of an existing, legal, assisted reproduction practice in some high-income countries, i.e., gestational surrogacy. A set of six ethics lenses is used in the comparative analysis: reproductive autonomy and rights, informed choice/consent, relevant (...) critical relational theories, health equity, theoretical application of the accepted living donation standard, and comparative benefits and burdens considerations. Gestational surrogacy, as currently practiced in some high-income countries, is the assumed, theoretical base-threshold for determination of ethical acceptability in assisted reproduction practices. The analysis demonstrates that : 1) the ethical acceptability of living uterus donation/transplantation is less than that of gestational surrogacy in high-income countries, and 2) the ethical acceptability of deceased uterus donation/transplantation is roughly equivalent to that of gestational surrogacy. This leads to the conclusion that, at the present time, only one version of uterus transplantation practice, i.e., deceased uterus transplantation, should be considered ethically acceptable for possible clinical implementation in high-income countries. (shrink)

Overby and colleagues (2015) draw our critical attention to a variety of ethical challenges associated with the practice of controlled donation after circulatory determination of death (cDCDD). Alt...

There has been contentious debate over the years about whether there are morally relevant similarities and differences between the three practices of continuous deep sedation until death, physician-assisted suicide, and voluntary euthanasia. Surprisingly little academic attention has been paid to a comparison of the uses of these practices in the two types of circumstances in which they are typically performed. A comparative domains of ethics analysis methodological approach is used in the paper to compare 1) the use of the three (...) practices in paradigm circumstances, and 2) the use of the practices in paradigm circumstances to their use in non-paradigm circumstances. The analytical outcomes suggest that a bright moral line cannot be demonstrated between any two of the practices in paradigm circumstances, and that there are significant, morally-relevant distinctions between their use in paradigm and non-paradigm circumstances. A thought experiment is employed to illustrate how these outcomes could possibly inform the decisions of hypothetical deliberators who are engaged in the collaborative development of assisted dying regulatory frameworks. (shrink)

MacKay and Robinson (2016) provide a critical analysis of four organ donation registration options using an expanded conception of manipulation introduced by Jennifer Blumenthal-Barby (Blumenthal-B...

The complex health and social circumstances of living-at-risk, frequent users of emergency departments (aREDFUs) in the health jurisdictions of high-income countries, and the related, significant challenges posed for emergency departments and the health care providers working within them, are identified and explored in the paper. Ethical analyses of a set of relevant domains are performed, i.e., individual and relational autonomy considerations, relevant social construction and personal responsibility conceptions, patient welfare principles (beneficence, nonmaleficence, continuity of care), harm reduction methodologies and their (...) applications, health equity, and justice considerations of the distributive, formal and social types. The outcomes of these analyses demonstrate that there are ethically compelling reasons for emergency departments to adopt an ethics-informed, policy-based approach to the longitudinal care and management of living-at-risk, frequent users of emergency departments. From a formal justice perspective, the development and uses of such an approach are justified by a demonstrable relevant difference between living-at-risk, frequent users of emergency departments and other persons and groups of patients who visit emergency departments. We propose an example of such a policy-based approach. Examples of possible, pragmatic applications of this approach, which help ensure that aREDFUs who present to the ED are managed in a fair and optimally consistent manner, are provided for the consideration of an urban emergency department’s policymaking working group. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 57-59, June 2011.

This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings, is exploitative of surrogate women. Arising out of consideration of the (...) heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative. (shrink)

In this critical commentary, a set of ethical considerations of relevance to the (currently contested) interpretation of irremediability for medical assistance in dying (MAiD) in circumstances where the sole-underlying medical condition is a mental health disorder is explored and analyzed. Based on the application of an ethics lens, a practical description of irremediability is proposed for intended use as guidance by Canadian mental health care clinicians, MAiD assessors and providers, and provincial/territorial professional regulatory authorities.

Despite successful transplantation outcomes in Europe, uncontrolled organ donation after circulatory determination of death has essentially been a non-starter in North America. In this paper, I identify and explore a set of interesting, ethics-related considerations that are of relevance to this organ donation-transplantation practice. The analysis provides a theoretical platform for my development of a proposal for the creation of a particular ethical practice and policy space for kidney uDCDD in the U.S. and Canada that recognizes and aims to effectively (...) address the various, identified challenges and constraints. (shrink)

A provocative question has emerged since the Supreme Court of Canada’s decision on assisted dying: Should Canadians who request, and are granted, an assisted death be considered a legitimate source of transplantable organs? A related question is addressed in this paper: is controlled organ donation after assisted death (cDAD) more or less ethically-problematic than standard, controlled organ donation after circulatory determination of death (cDCDD)? Controversial, ethics-related dimensions of cDCD that are of relevance to this research question are explored, and morally-relevant (...) distinctions between cDAD and cDCD are identified. In addition, a set of morally-relevant advantages of one practice over the other is uncovered, and a few potential, theoretical issues specifically related to cDAD practice are articulated. Despite these concerns, the analysis suggests a counterintuitive conclusion: cDAD is, overall, less ethically-problematic than cDCDD. The former practice better respects the autonomy interests of the potential donor, and a claim regarding irreversibility of cessation of the donor’s circulatory function in the cDAD context can be supported. Further, with cDAD, there is no possibility that the donor will have negative sensory experiences during organ procurement surgery. Although the development of appropriate policy-decision and regulatory approaches in this domain will be complex and challenging, the comparative ethical analysis of these two organ donation practices has the potential to constructively inform the deliberations of relevant stakeholders, resource persons and decision makers. (shrink)

The contentious, topical debate about whether faith-based health care organizations should be granted accommodation on the basis of institutional conscientious objection to medical assistance is dying is addressed through a comparative analysis of arguments on both sides of the issue that references such relevant considerations as: claimed ‘moral-authority’, competing rights-based claims, obligations arising from patient welfare principles, formal justice, dissimilarity in consequences, and two illustrative arguments from analogy. The analysis leads to the conclusion that nonconditional accommodation on the basis of (...) institutional conscientious objection to MAiD is not ethically acceptable in Canada. A compromise mechanism, consisting of a suggested set of pragmatic conditions, is proposed that could effectively balance the competing moral responsibilities that arise from this conclusion and a core assumption of the paper, i.e., that some dominant faith-based health institutions can legitimately request, and expect, that provincial/territorial governments pay them a measure of respect in their operational, health-care-delivery decision making because of these institutions’ long history of providing high quality, health care in Canada. It is further suggested that provincial/territorial governments only allow large, publicly funded, faith-based health care organizations to enact a conditional version of accommodation on the basis of institutional conscientious objection to MAiD in circumstances where the organization has entered into a formal agreement with the relevant health department to meet the proposed, compromise conditions. (shrink)

Early on in the development of Practicing Healthcare Ethicists Exploring Professionalization (PHEEP), the founding members recognized the need to address and meet two important goals: (1) the creation of a dynamic, rigorous process to support the exploratory work, and (2) the establishment of the means—deliberative engagement—to generate and justify the substantive content of professionalization-related products, such as practice standards and position statements. Drawing from social justice and deliberative democracy conceptions and insights (among others), the authors identify and describe the core (...) elements of the “process scaffolding” and “deliberative means” that inform PHEEP’s deliberative engagement methodology. The paper demonstrates how these process and substantive features have been meaningfully instantiated in the decision making framework established by PHEEP for its use in the development of professionalization-related products by Canadian practicing healthcare ethicists. (shrink)

This paper examines an under-explored issue in organ donation: whose decision making authority should be privileged posthumously in the context of known, explicit consent for donation? Current practices in Canada support the family as the ultimate decision maker, despite the existence of legislative support in many Canadian provinces for the potential donor as legitimate decision maker. Arguments for and against privileging the family and the potential donor are identified. Informing the question of “who should decide” are considerations of individual and (...) relational autonomy, distributive and social justice, personhood, and arguments “from distress”. Tensions and competing obligations emerge from an exploration of these considerations that call for further, inclusive dialogue and deliberation on this important organ donation issue. (shrink)

This paper explores how using a domains of ethics analysis approach might constructively contribute to an enhanced understanding (among those without specialized ethics training) of ethically-complex health care practices through the consideration of one such sample practice, i.e., deep and continuous palliative sedation (DCPS). For this purpose, I select four sample ethics domains (from a variety of possible relevant domains) for use in the consideration of this practice, i.e., autonomous choice, motives, actions and consequences. These particular domains were choosen because (...) of their relevance to the analysis of DCPS and their relative ease of access to those without ethics training. The analysis demonstrates that such an approach could facilitate the emergence of accessible arguments and discussion points that could enhance the understanding and appreciation of this and other health care practices with strong ethics dimensions. (shrink)

Jeffrey E. Brower presents and explains the hylomorphic conception of the material world developed by Thomas Aquinas, according to which material objects are composed of both matter and form. In addition to presenting and explaining Aquinas's views, Brower seeks wherever possible to bring them into dialogue with the best recent literature on related topics. Along the way, he highlights the contribution that Aquinas's views make to a host of contemporary metaphysical debates, including the nature of change, composition, material constitution, (...) the ontology of stuff vs. things, the proper analysis of ordinary objects, the truthmakers for essential vs. accidental predication, and the metaphysics of property possession. (shrink)

When you think of compassion, what comes to mind? Kindness, understanding, tenderness, empathy, maybe warmth? Compassion can be all those things - but it is much more. Drawing on his many years of experience as a clinical psychologist and researcher, Dr James Kirby brings together hard science and real-life examples to offer a guide to a more compassionate life and society. Kirby debunks the myth that compassion is simple a feeling and shows us how it is a motivational (...) force that can shape our behaviour and relationships with each other and the world. He considers how it might help with self-criticism, parenting and grief, and he explores what part artificial intelligence might play in a compassionate future. In this engaging and timely book, Kirby traverses philosophy, psychology and pop culture to show how we can choose compassion to make our lives healthier, happier and more meaningful. (shrink)

Closest-possible-world analyses of counterfactuals suffer from what has been called the ‘problem of counterpossibles’: some counterfactuals with metaphysically impossible antecedents seem plainly false, but the proposed analyses imply that they are all (vacuously) true. One alleged solution to this problem is the addition of impossible worlds. In this paper, I argue that the closest possible or impossible world analyses that have recently been suggested suffer from the ‘new problem of counterpossibles’: the proposed analyses imply that some plainly true counterpossibles (viz., (...) ‘counterlogicals’) are false. After motivating and presenting the ‘new problem’, I give reasons to think that the most plausible objection to my argument is not compelling. (shrink)

This is annotated bibliography of the field of business ethics. It identifies and summarizes useful journals, textbooks, anthologies, and articles.

Since the global financial crisis in 2008, corporations have faced a crisis of trust, with growing sentiment against ‘elites and ‘big business’ and a feeling that ‘something ought to be done’ to re-establish public regard for corporations. Trust and trustworthiness are deeply moral significant. They provide the ‘glue or lubricant’ that begets reciprocity, decreases risk, secures dignity and respect, and safeguards against the subordination of the powerless to the powerful. However, in deciding how to restore trust, it is difficult to (...) determine precisely what should be done, by whom, and who will bear the cost, especially if any action involves a risk to overall market efficiency and corporate profitability. The paper explores whether corporations have a moral duty to be trustworthy, to bear the cost of being so and thus contribute to resolving the current crisis of trust. It also considers where the state and other social actors have strong reason to protect and enforce such moral rights, while acknowledging that other actors have similar obligations to be trustworthy. It outlines five ‘salient factors’ that trigger specific rights to trustworthiness and a concomitant duty on corporations to be trustworthy: market power, subordination (threat and intimidation), the absence of choice, the need to preserve systemic trust, and corporate political power which might undermine a state’s legitimacy. Absent these factors and corporations do not have a general duty to be trustworthy, since a responsible actor in fair market conditions should be able to choose between the costs and benefits of dealing with generally trustworthy corporations. (shrink)

What can we know about God by reason alone? Philosophical theology is the attempt to obtain such knowledge. An ancient tradition, which is perhaps more influential now than ever, tries to derive the attributes of God from the principle that God is the greatest possible being. Jeff Speaks argues that that constructive project is a failure. He also argues that the related view that the concept of God is the concept of a greatest possible being is a mistake. In the (...) last chapter, he sketches an alternative path forward. (shrink)

This Element has two aims. The first is to discuss arguments philosophers have made about the difference God's existence might make to questions of general interest in metaethics. The second is to argue that it is a mistake to think we can get very far in answering these questions by assuming a thin conception of God, and to suggest that exploring the implications of thick theisms for metaethics would be more fruitful.

This article suggests an iconic turn in cultural sociology. Icons can be seen, it is argued, as symbolic condensations that root social meanings in material form, allowing the abstractions of cognition and morality to be subsumed, to be made invisible, by aesthetic shape. Meaning is made iconically visible, in other words, by the beautiful, sublime, ugly, or simply by the mundane materiality of everyday life. But it is via the senses that iconic power is made. This new approach to meaning (...) is compared with others — with materialism, semiotics, aestheticism, moralism, realism, and spiritualism. (shrink)

This study assesses the impact had by institutional isomorphic pressures in the organisational fields of 185 businesses operating within the United Kingdom. The emphasis throughout is on how external institutions affect the socially and environmentally responsible aspects of an organization’s purchasing practice. Factor analyses and a linear regression model are employed to test the influence of these pressures. Initial findings suggest that what other industry participants are doing in this area is not as important in affecting the procurement practice of (...) the focal organisation as is the managers’ perception of how legitimacy is awarded by stakeholders and, indeed, if competitors with well-developed social and environmental supply chain management programs are perceived favourably in the industry. (shrink)

“Imaginationland” is an Emmy winning, three‐part story from South Park's eleventh season that was later reissued as a movie with all of the deleted scenes included. This chapter talks about the connection between imagination and something philosophers like to call critical thinking‐that is, being able to cut through the crap and see things clearly‐something that seems to be in short supply these days, especially when it comes to thinking about terrorist threats. The chapter deals with unimaginative leadership by discussing a (...) scene from South Park that cuts to a debriefing room at the Pentagon. In more recent times, the use of the term “Terrorism” has broadened. In Bruce Hoffman's book, Inside Terrorism, he has identified several elements common among terrorist acts, as they are thought of today. (shrink)

Preface : plant theory? -- The first birth of biopower : from plant to animal life in Foucault -- Thinking plants, with Aristotle and Heidegger -- Animal and plant, life and world in Derrida, or, The plant and the sovereign -- From the world to the territory : vegetable life in Deleuze and Guattari, or, What is a rhizome? -- Coda : what difference does it make?

Practical approaches to the notions of subsets and extension sets are compared, coming from broadly set-theoretic and category-theoretic traditions of mathematics. I argue that the set-theoretic approach is the most practical for ‘looking down’ or ‘in’ at subsets and the category-theoretic approach is the most practical for ‘looking up’ or ‘out’ at extensions, and suggest some guiding principles for using these approaches without recourse to either category theory or axiomatic set theory.

From Greco-Roman antiquity through to European enlightenment, philosophy and religious thought were inseparably interwoven. This book explores intellectual worlds of Abrahamic religious traditions, their approaches to scriptural hermeneutics, and their interaction over many centuries on common ground of inheritance of classical Greek philosophy.

Jeffrey Bloechl traces the evolution of Levinas's thought to argue that his conception of God is dependent on his existential phenomenology.

Justice requires giving people what they deserve. Or so many philosophers – and according to many of those philosophers, everyone else – thought for centuries. In the 1970’s and 1980’s, however, perhaps under the influence of Rawls’s (1971) desert-less theory, desert was largely cast out of discussions of distributive justice. Now it is making a comeback. In this chapter I consider recent research on the concept of desert, arguments for its requital, and connections between desert and other distributive ideals. I (...) suggest that desert-sensitive theories of distributive justice, though they face obstacles, have a promising future. (shrink)

Recently in this journal, Jessica Morley and colleagues (AI & SOC 2023 38:411–423) review AI ethics and education, suggesting that a cultural shift is necessary in order to prepare students for their responsibilities in developing technology infrastructure that should shape ways of life for many generations. Current AI ethics guidelines are abstract and difficult to implement as practical moral concerns proliferate. They call for improvements in ethics course design, focusing on real-world cases and perspective-taking tools to immerse students in challenging (...) situations with relatable personal, social and environmental implications. The present paper considers the ACTWith model of moral cognition for use in such training contexts. Morley and colleagues' paper and contemporary literature are reviewed. Whistleblowing as a source for relatable case studies is discussed, and the purpose of ethics education considered. The ACTWith model is introduced, and correlations with contemporaries noted. The ACTWith model has been successfully employed in a broad range of technology ethics courses in the Netherlands and South Korea. Illustrations are offered. Correlations with contemporary efforts are drawn in the context of software engineering. Summary discussion considers strengths and limitations of the ACTWith program. Overall, the paper emphasizes training high-level moral reasoning through guided inquiry education informing lifetime professional practice, and indicates an outstanding need for teachers able to do the job. (shrink)

Institutional review boards, tasked with facilitating ethical research, are often pulled in competing directions. In what we call the protection-inclusion dilemma, we acknowledge the tensions IRBs face in aiming to both protect potential research participants from harm and include under-represented populations in research. In this manuscript, we examine the history of protectionism that has dominated research ethics oversight in the United States, as well as two responses to such protectionism: inclusion initiatives and critiques of the term vulnerability. We look at (...) what we know about IRB decision-making in relation to protecting and including “vulnerable” groups in research and examine the lack of regulatory guidance related to this dilemma, which encourages protection over inclusion within IRB practice. Finally, we offer recommendations related to how IRBs might strike a better balance between inclusion and protection in research ethics oversight. (shrink)

Soren Kierkegaard's Fear and Trembling is one of the most widely read works of Continental philosophy and the philosophy of religion. While several commentaries and critical editions exist, Jeffrey Hanson offers a distinctive approach to this crucial text. Hanson gives equal weight and attention to all three of Kierkegaard’s "problems," dealing with Fear and Trembling as part of the entire corpus of Kierkegaard's production and putting all parts into relation with each other. Additionally, he offers a distinctive analysis of (...) the Abraham story and other biblical texts, giving particular attention to questions of poetics, language, and philosophy, especially as each relates to the aesthetic, the ethical, and the religious. Presented in a thoughtful, well-informed, and fresh manner, Hanson’s claims are original and edifying. This new reading of Kierkegaard will stimulate fruitful dialogue on well-traveled philosophical ground. (shrink)

We prove several results about groups of finite Morley rank without unipotent p-torsion: p-torsion always occurs inside tori, Sylow p-subgroups are conjugate, and p is not the minimal prime divisor of our approximation to the "Weyl group". These results are quickly finding extensive applications within the classification project.