Various U.S. laws, such as the Clean Air Act and the Food Quality Protection Act, require additional protections for susceptible subpopulations who face greater environmental health risks. The main ethical rationale for providing these protections is to ensure that environmental health risks are distributed fairly. In this article, we (1) consider how several influential theories of justice deal with issues related to the distribution of environmental health risks; (2) show that these theories often fail to provide specific guidance concerning policy (...) choices; and (3) argue that an approach to public decision making known as accountability for reasonableness can complement theories of justice in establishing acceptable environmental health risks for the general population and susceptible subpopulations. Since accountability for reasonableness focuses on the fairness of the decision-making process, not the outcome, it does not guarantee that susceptible subpopulations will receive a maximum level of protection, regardless of costs or other morally relevant considerations. (shrink)

That Jehovah's Witnesses cannot refuse life-saving blood transfusions on behalf of their children has acquired the status of virtual “consensus” among bioethicists. However strong the consensus may be on this matter, this article explores whether this view can be plausibly defended on liberal principles by examining it in light of one particularly well worked-out liberal political theory, that of Rawls. It concludes that because of the extremely high priority Rawls attributes to “freedom of conscience,” and the implication from the original (...) position that parents must act paternalistically toward their children as their protectors, Jehovah's Witnesses cannot legitimately be barred from making decisions on behalf of their children, even when the consequences of such decisions are serious and irremediable. (shrink)

According to various accounts, intervention in pediatric decisions is justified either by the best interests standard or by the harm principle. While these principles have various nuances that distinguish them from each other, they are similar in the sense that both focus primarily on the features of parental decisions that justify intervention, rather than on the competency or authority of the parties that intervene. Accounts of these principles effectively suggest that intervention in pediatric decision making is warranted for both physicians (...) and the state under precisely the same circumstances. This essay argues that there are substantial differences in the competencies and authorities of physicians and the state, and that the principles that guide their interventions should also be conceived differently. While both the best interests standard and the harm principle effectively incorporate important aspects of physicians’ ethical obligations, neither adequately reflects the state’s ethical obligations. In contrast to physicians, the state has major obligations of distributive justice and neutrality that should form an integral part of any proposed ethical principles guiding state intervention in pediatric decision making. The differences are illustrated by examining recent cases involving parental refusal of chemotherapy in aboriginal Canadian communities and parental refusal of blood transfusions by Jehovah’s Witnesses. (shrink)

Several commentators have tried to ground legal prohibitions of kidney sales in some form of Kant’s moral arguments against such sales. This paper reconsiders this approach to justifying laws and policies in light of Kant’s approach to law in his political philosophy. The author argues that Kant’s political philosophy requires that kidney sales be legally permitted, although contracts for such sales must remain unenforceable. The author further argues that Kant’s approach to laws, such as those governing kidney distribution, was formed (...) in part by considering and rejecting an assumption frequently employed in the bioethics literature, namely, that legal duties can be grounded directly in moral duties. The author explains some of Kant’s reasons for rejecting this assumption and concludes that arguments pertaining to the legality of kidney sales developed on the basis of Kant’s moral philosophy should no longer be considered tenable. (shrink)

During the last several decades, professional medicine has undergone profound changes in its organization. In particular, the growth of managed care organizations and publicly funded medicine has increasingly standardized physician working conditions and reimbursement. While it is sometimes disputed whether the profession of medicine is suffering reduced autonomy as a whole, there is little doubt that individual physicians are losing autonomy (Burdi and Baker 1999; Harrison and Schulz 1989; Iglehart 1992). As a result, physicians are increasingly attracted to various mechanisms (...) for retaining some control over their individual practice (Choudhry and Brennan 2001). Such mechanisms may include organization .. (shrink)

Abstract:Bioethicists are sometimes thought to have heightened obligations by virtue of the fact that their professional role addresses ethics or morals. For this reason it has been argued that bioethicists ought to “whistleblow”—that is, publicly expose the wrongful or potentially harmful activities of their employer—more often than do other kinds of employees. This article argues that bioethicists do indeed have a heightened obligation to whistleblow, but not because bioethicists have heightened moral obligations in general. Rather, the special duties of bioethicists (...) to act as whistleblowers are best understood by examining the nature of the ethical dilemma typically encountered by private employees and showing why bioethicists do not encounter this dilemma in the same way. Whistleblowing is usually understood as a moral dilemma involving conflicting duties to two parties: the public and a private employer. However, this article argues that this way of understanding whistleblowing has the implication that professions whose members identify their employer as the public—such as government employees or public servants—cannot consider whistleblowing a moral dilemma, because obligations are ultimately owed to only one party: the public. The article contends that bioethicists—even when privately employed—are similar to government employees in the sense that they do not have obligations to defer to the judgments of those with private interests. Consequently, bioethicists may be considered to have a special duty to whistleblow, although for different reasons than those usually cited. (shrink)

Bioethicists working on national ethics commissions frequently think of themselves as advisors to the government, but distance themselves from any claims to actual authority. Governments however may find it beneficial to appear to defer to the authority of these commissions when designing laws and policies, and might appoint such commissions for exactly this reason. Where does the authority for setting laws and policies come from? This question is best answered from within a normative political philosophy. This paper explains the locus (...) of moral authority as understood within one family of normative political theories—liberal political theories—and argues that most major “liberal” commentators have understood both the source and scope of ethics commissions’ authority in a manner at odds with liberalism, rightly interpreted. The author argues that reexamining the implications of liberalism for bioethics commissions would mean changing what are considered valid criticisms of such commissions and also changing the content of national bioethics commission mandates. The author concludes that bioethicists who participate in such commissions ought to carefully examine their own views about the normative limits of governmental authority because such limits have important implications for the contribution that bioethicists can legitimately make to government commissions. (shrink)

In Righting Health Policy, MacDougall argues that bioethics has not developed the tools best suited for justifying health law and policy. Using Kant’s practical philosophy as an example, he explores the promise of political philosophy for making normatively justified recommendations about health law and policy.

Legal standards of disclosure in a variety of jurisdictions require physicians to inform patients about the likely consequences of treatment, as a condition for obtaining the patient’s consent. Such a duty to inform is special insofar as extensive disclosure of risks and potential benefits is not usually a condition for obtaining consent in non-medical transactions. -/- What could morally justify the physician’s special legal duty to inform? I argue that existing justifications have tried but failed to ground such special duties (...) directly in basic and general rights, such as autonomy rights. As an alternative to such direct justifications, I develop an indirect justification of physicians’ special duties from an argument in Kant’s political philosophy. Kant argues that pre- legal rights to freedom are the source of a duty to form a state. The state has the authority to conclusively determine what counts as “consent” in various kinds of transactions. The Kantian account can subsequently indirectly justify at least one legal standard imposing a duty to inform, the reasonable person standard, but rules out one interpretation of a competitor, the subjective standard. (shrink)

One of six commentaries on “Obesity: Chasing an Elusive Epidemic,” by Daniel Callahan, from the January‐February 2013 issue.

The ends of medicine are sometimes construed simply as promotion of health, treatment and prevention of disease, and alleviation of pain. Practitioners might agree that this simple formulation captures much of what medical practice is about. But while the ends of medicine may seem simple or even obvious, the essays in this issue demonstrate the wide variety of philosophical questions and issues associated with the ends of medicine. They raise questions about how to characterize terms like “health” and “disease”; whether (...) medicine’s goals should be extended to include enhancement beyond normal human function; and whether the ends of medicine are binding on those involved in health care outside of professional medicine, such as pharmaceutical companies. They also give philosophical attention to patient experiences, and so raise questions about whether current practices achieve the ends of medicine from the perspective of the patient. Together these essays demonstrate the important role played by a conception of medicine’s ends in a wide variety of issues and problems in the philosophy and ethics of medicine. (shrink)

Tax compliance is a concern to governments around the world. Prior research (Alm, J. and I. Sanchez: 1995, KYKLOS 48, 3–19) has attributed unexplained inter-country differences in compliance rates to differences in social norms. Economics researchers studying tax compliance in the United States (U.S.) (see for example J. Andreoni et al.: 1998, Journal of Economic Literature 36, 818–860) have called for more attention to social (as opposed to economic) influences on tax compliance. In this study, we extend this prior research (...) by explicitly examining the role of social norms [Cialdini, R. and M. Trost: 1998, The Handbook of Social Psychology (Oxford University Press, New York)] on tax compliance in three different countries. We test our research hypotheses using a hypothetical compliance scenario, which was administered in Australia, Singapore, and the U.S. There were differences in compliance rates and social norms among the three countries. Factor analysis of the social norm questions identified three distinct social norm constructs. Two of these factors were significant in explaining tax compliance behavior. The first and most influential factor was taxpayers’ own personal moral beliefs, along with the beliefs of those close to them (e.g., friends and important others). The second significant factor represented societal views of proper behavior. We conclude that social norms help to explain tax compliance intentions and why tax compliance rates are higher than would be predicted by strictly economic models. (shrink)

Plato's geometrical theory of what we now call chemistry, set out in the Timaeus, uses triangles, his stoicheia, as the fundamental units with which he constructs his four elements. A paper claiming that these triangles can be divided indefinitely is criticized; the claim of an error here in the commentary by F.M. Cornford is unfounded. Plato's constructions of the elements are analyzed using simple point group theory. His procedure generates fully symmetric polyhedra, but Cornford's 'simpler' alternatives generate polyhedra with low (...) symmetries and multiple isomeric forms. However, Cornford's principle of constructing larger triangles by assembling smaller ones is still valid. (shrink)

Galileo's refutation of the speed-distance law of fall in his Two New Sciences is routinely dismissed as a moment of confused argumentation. We urge that Galileo's argument correctly identified why the speed-distance law is untenable, failing only in its very last step. Using an ingenious combination of scaling and self-similarity arguments, Galileo found correctly that bodies, falling from rest according to this law, fall all distances in equal times. What he failed to recognize in the last step is that this (...) time is infinite, the result of an exponential dependence of distance on time. Instead, Galileo conflated it with the other motion that satisfies this ‘equal time’ property, instantaneous motion. (shrink)

In this reply, we respond to the comments of Palmerino and Laird on our article, "Galileo's Refutation of the Speed Distance Law of Fall Rehabilitated," published in the same issue of Centaurus.

The author develops the claim that humans characteristically maintain a sense of protectedness by creating various forms of metaphysical illusion, replacing the tragic finitude and transience of human existence with a permanent and eternally changeless reality. One such illusion forms around planet earth itself, transformed into an indestructible metaphysical entity. It has become increasingly difficult, in the face of the ravages of climate change, to maintain the illusion of earth’s indestructibility, and with it, a sense of safety. The author refers (...) to the feelings evoked by the crumbling of metaphysical illusion as Apocalyptic anxiety¬—the dread of the end of human civilization. This Apocalyptic dread needs to be confronted (not evaded) in a comportment of dwelling—with our vulnerable planet and with our vulnerable fellow human beings. (shrink)

When the President’s Commission of 1983 concluded that there is an “ethical obligation” to secure universal access to a decent minimum of health care, some hoped that this standard would be achieved in the United States within a few years. Nearly 30 years later, when we began work on this issue of the Journal of Medicine and Philosophy (JMP), that standard had yet to be achieved, although the bills that would later become the Affordable Care Act (ACA) were then working (...) their way through Congress. Now, the ACA has been passed and signed into law. The provisions of that bill aim at achieving universal access to an “essential health benefits (EHBs) package". (shrink)

The claim is frequently made that structured collections of individuals who are themselves subjects of mental and cognitive states – such collections as courts, countries, and corporations – can be, and often are, subjects of mental or cognitive states. And, to be clear, advocates for this so-called group-minds hypothesis intend their view to be interpreted literally, not metaphorically. The existing critical literature casts substantial doubt on this view, at least on the assumption that groups are claimed to instantiate the same (...) species of mental and cognitive properties as individual humans. In this essay, I evaluate a defensive move made by some proponents of the group-oriented view: to concede that group states and individual states aren’t of the same specific natural kinds, while holding that groups instantiate different species of mental or cognitive states – perhaps a different species of cognition itself – from those instantiated by humans. In order to evaluate this defense of group cognition, I develop a view of natural kinds – or at least of the sort of evidence that supports inferences to the sameness of natural kind – a view I have previous dubbed the ‘tweak-and-extend’ theory. Guided by the tweak-and-extend approach, I arrive at a tentative conclusion: that what is common to models of individual cognitive processing and models of group processing does not suffice to establish sameness of cognitive (or mental) kinds, properties, or state-types, not even at a generic or overarching level. (shrink)

In the era of “big data,” science is increasingly information driven, and the potential for computers to store, manage, and integrate massive amounts of data has given rise to such new disciplinary fields as biomedical informatics. Applied ontology offers a strategy for the organization of scientific information in computer-tractable form, drawing on concepts not only from computer and information science but also from linguistics, logic, and philosophy. This book provides an introduction to the field of applied ontology that is of (...) particular relevance to biomedicine, covering theoretical components of ontologies, best practices for ontology design, and examples of biomedical ontologies in use. After defining an ontology as a representation of the types of entities in a given domain, the book distinguishes between different kinds of ontologies and taxonomies, and shows how applied ontology draws on more traditional ideas from metaphysics. It presents the core features of the Basic Formal Ontology (BFO), now used by over one hundred ontology projects around the world, and offers examples of domain ontologies that utilize BFO. The book also describes Web Ontology Language (OWL), a common framework for Semantic Web technologies. Throughout, the book provides concrete recommendations for the design and construction of domain ontologies. (shrink)

Traditional whistleblowing theories have purported that whistleblowers engage in a rational process in determining whether or not to blow the whistle on misconduct. However, stressors inherent to whistleblowing often impede rational thinking and act as a barrier to effective whistleblowing. The negative impact of these stressors on whistleblowing may be made worse depending on who engages in the misconduct: a peer or advisor. In the present study, participants are presented with an ethical scenario where either a peer or advisor engages (...) in misconduct, and positive and the negative consequences of whistleblowing are either directed to the wrongdoer, department, or university. Participant responses to case questions were evaluated for whistleblowing intentions, moral intensity, metacognitive reasoning strategies, and positive and negative, active and passive emotions. Findings indicate that participants were less likely to report the observed misconduct of an advisor compared to a peer. Furthermore, the findings also suggest that when an advisor is the source of misconduct, greater negative affect results. Post-hoc analyses were also conducted examining the differences between those who did and did not intend to blow the whistle under the circumstances of either having to report an advisor or peer. The implications of these findings for understanding the complexities involved in whistleblowing are discussed. (shrink)

This essay develops the thesis that the essence of psychoanalysis lies in emotional phenomenology.

Case-based reasoning has long been used to facilitate instructional effectiveness. Although much remains to be known concerning the most beneficial way to present case material, recent literature suggests that simplifying case material is favorable. Accordingly, the current study manipulated two instructional techniques, incremental case presentation and forecasting outcomes, in a training environment in an attempt to better understand the utility of simplified versus complicated case presentation for learning. Findings suggest that pairing these two cognitively demanding techniques reduces satisfaction and detracts (...) from the effectiveness of the learning approach. Implications regarding the use of instructional techniques in training programs are discussed. (shrink)

In the present essay we explore a form of linguistic witchery (Wittgenstein) aimed at forging a sense of unity from incompatible visions of reality—namely, the formation of oxymoronic hybrids.