This article offers a discussion of the relevance of empirical studies to normative ethics focusing on the new trend in bioethics called empirical bioethics. The author sees this trend as an answer to a call made by anthropologists decades ago that ethicists should be more aware of the situatedness of the moral institution of life. Through a discussion of two opposing views expressed in the final publications of the EU-funded EMPIRE-project, the middle way is sought between the (...) misconception of bioethics as pure philosophy on one side and the misconception of bioethics as sociology on the other. The author argues that empirical studies may be of relevance to the normative enterprise in at least three ways as illustrated in the EMPIRE-material. First, there is the relevance of empirical facts as descriptive premises in ethical arguments. Second, there is the relevance of empirical studies as means of mapping moral opinion and moral experience which ought to serve as one of two poles between which one oscillates in moral decision making – the other being the normative ethical theories. Third, there is the relevance of empirical studies of the capacity and function of the human mind, which may tell us something about the range of normative principles and rules.Keywords: Ethics, normative ethics, descriptive ethics, empirical bioethics. (shrink)

This chapter contains sections titled: Case Studies and Mid‐level Principles Justifying the Choice of an Ethical Theory References Further reading.

This volume links three different theoretical approaches that have a common focus on the relationship between biopolitics and bioethics. This collection of papers can be categorized into different domains that are representative of the contemporary usage of biopolitics as a concept. On the one hand, several chapters develop a clear and up-to-date understanding of the primary sources of the concept and related theories of Agamben, Negri or Foucault and approach the question of relevance within the field of (...) class='Hi'>bioethics. Another group of papers apply the philosophical concepts and theories of biopolitics (biopower, Homo Sacer, biocitizenship) on very specific currently debated bioethical issues. Some scholars rely on the more mundane understanding of (bio)politics and investigate how its relationship with bioethics could be philosophically conceptualized. Additionally, this work also contains papers that follow a more legally oriented analysis on the effects of contemporary biopolitics on human rights and European law. The authors are philosophers, legal scholars or bioethicists. The major strength of this volume is to provide the reader with major insights and orientation in these different contemporary usages of the concept and theories of biopolitics, within the context of its various ethically relevant applications. (shrink)

Christian philosophers have always been interested in clarifying the relationship between God and ethics. The theories presented on this topic can be divided into two kinds: “divine command” and “other.” In this paper I evaluate two interesting but ultimately incompatible versions of the “other” variety: one by George Mavrodes and one by Søren Kierkegaard. In the course of my analysis I argue that anyone who reads Kierkegaard’s Works of Love as presenting a divine command theory is mistaken.

This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory–practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members’ reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children’s interests (...) and rights. Different approaches to framing ethical questions are also considered. Being aware of the four theories’ influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children’s elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees’ influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors’ consent or refusal may be respected, with the support of clinical ethics committees. (shrink)

This article discusses the relation between empirical and normative approaches in bioethics. The issue of dwarf tossing, while admittedly unusual, is chosen as a point of departure because it challenges the reader to look with fresh eyes upon several central bioethical themes, including human dignity, autonomy, and the protection of vulnerable people. After an overview of current approaches to the integration of empirical and normative ethics, we consider five ways that the empirical and normative can be brought (...) together to speak to the problem of dwarf tossing: prescriptive applied ethics, theoretical ethics, critical applied ethics, particularist ethics and integrated empirical ethics. We defend a position of critical applied ethics that allows for a two-way relation between empirical and normative theories. Against efforts fully to integrate the normative and the empirical into one synthesis, we propose that the two should stand in tension and relation to one another. The approach we endorse acknowledges that a social practice can and should be judged both by the gathering of empirical data and by normative ethics. Critical applied ethics uses a five stage process that includes: (a) determination of the problem, (b) description of the problem, (c) empirical study of effects and alternatives, (d) normative weighing and (e) evaluation of the effects of a decision. In each stage, we explore the perspective from both the empirical (sociological) and the normative ethical point of view. We conclude by applying our five-stage critical applied ethics to the example of dwarf tossing. (shrink)

Relation between physicians and pharmaceutical industry is required for the benefit of the patient. But it may turn into business and overthrow the patients’ benefit. The relation might be in question at present and in future. Several questions are flowing in Bangladesh. To solve these queries we have explored the situation in developed and developing countries. The physicians and associations of pharmaceutical industries developed several ethical guidelines in those countries. They have addressed the long lasting issues (...) on gift provided to physician, cash back, sample, industry sponsored scientific meetings, research and hospitality. There are huge restrictions to ensure the right of the patient’s e.g. limitation of inexpensive gift by the pharmaceuticals, avoiding expensive medicine instead of equally effective low priced medicine. We are lacking behind to protect the patient right properly: regulation, adherence to existing guide line, lack of guidance from statutory bodies. The current scenario is far behind the right of patient. In Bangladesh it is not yet addressed either by professionals or by pharmaceutical associations. It is the immediate need to construct a guide line for physicians and pharmaceutical industry of Bangladesh.Bangladesh Journal of Bioethics 2015 Vol.6 (1):1-5. (shrink)

This study is a contribution to Chinese-Western dialogue of bioethics but perhaps the first one of its kind. From a Chinese-Western comparative ethical perspective, this work brings Chinese ethical theories, especially Confucian ethics, into a contemporary context of the epidemic of HIV/AIDS, and to see how the deeply-rooted thoughts of Confucius interact, compete, or integrate with concepts from Western ethical traditions. An underlying belief is that some ideas in Confucian ethics are important and insightful beyond their (...) cultural and historical origins in China and other Confucianism influenced societies.Methodologically, this thesis employs two approaches, conceptual normative analysis combined with critical interpretation. The ‘interpretive’ approach I employ, as an important methodology supplementing my normative analysis, not only deals with Chinese ancient texts, but also explains specific beliefs and practices in China.With a critical eye, this thesis carefully examines a number of key topics in the ethics of AIDS in China from a cross-cultural perspective. Topics including: views on personhood and the vulnerability of People Living with HIV/AIDS; prioritising and balancing the role of ‘harm reduction’ and the role of ‘eradication of deviant behaviour’ in AIDS policy in China; rights-based opt-out approach and duty-based family-centred approach in HIV testing and Biobanking; blood donation; moral responsibility and personal responsibility for health; and the popular rhetoric of ‘innocent infection’ versus ‘guilty infection’ in AIDS. My overall aim in this work is to present a cross-cultural bioethics study through the investigation of some ethical issues in AIDS in China from a Chinese-Western comparative perspective and also attempt to suggest a humane and effective policy for HIV/AIDS which I believe is appropriate to both traditions. I believe this work has contributed to our knowledge in three related but independent areas: the control of the epidemic of HIV/AIDS in China; medical ethics in China; and to both the methods and the utility of cross-cultural study of bioethics between China and the West. (shrink)

Bioethics urges us to question and debate fundamental moral issues that arise in health-related sciences. However, as a result of Western dominance and globalization, bioethical thinking and practice has inevitably been shaped and defined by Western theories. With recent discussions centering on the relationship between culture and bioethics, it is important to consider how and to what extent can bioethics reflect and accommodate non-Western values and beliefs? Debatably, many scholars working in the field of ‘African (...) class='Hi'>bioethics’ seek to construct a bioethical practice that is grounded in indigenous African values. Yet, how relevant are ancient African cultural norms to the lives and realities of the 21st century Sub-Saharan-Africans? This edited volume explores bioethics in Africa from pluralistic and inter-cultural perspectives. The selected papers offer diverse theoretical and practical perspectives on the bioethical challenges that are common and specific to the lives of Sub-Sahara Africans. The contributors define bioethics broadly (beyond ethical issues relating to biomedical and biotechnological science) to include applied ethics that concern all aspects of life. Multidisciplinary in approach, the contributions to this book consider bioethics in relation to philosophy, social work, psychiatry, African studies, religious studies, psychology, and medicine. The broad scope of this volume means it will be of interest to those studying and working in bioethics as well as the fields mentioned above. (shrink)

It is commonplace that care should be patient-centered. Nevertheless, no universally agreed-upon definition of patient-centered care exists. By consequence, the relation between patient-centered care as such and ethical principles cannot be investigated. However, some research has been performed on the relation between specific models of patient-centered care and ethical principles such as respect for autonomy and beneficence. In this article, I offer a detailed case study on the relationship between specific measures of patient-centered (...) care and the ethical principle of respect for autonomy. Decision Quality Instruments (DQIs) are patient-centered care measures that were developed by Karen Sepucha and colleagues. The model of patient-centered care that guided the development of these DQIs pays special attention to the ethical principle of respect for autonomy. Using Jonathan Pugh’s theory of rational autonomy, I will investigate how the DQIs relate to patient autonomy. After outlining Pugh’s theory of rational autonomy and framing the DQIs accordingly (Part I), I will investigate whether the methodological choices made while developing these DQIs align with respect for autonomy (Part II). My analysis will indicate several tensions between DQIs and patient autonomy that could result in what I call “structural paternalism.” These tensions offer us sufficient reasons, especially given the importance of the ethical principle of respect for autonomy, to initiate a more encompassing debate on the normative validity of Decision Quality Instruments. The aim of the present paper is to highlight the need for, and to offer a roadmap to, this debate. (shrink)

For decades there has been a controversial debate over how far religious faith communities are specifically engaged in ecological practices (EP). Therefore we studied four Austrian and two German Benedictine monasteries religious ethics and spirituality as a means of a driving force for initiating EP. We draw upon theories of organizational learning processes and capacity-building of sustainability to interpret our empirical findings. The majority of monasteries are highly engaged in EP, initiated either as an outcome of individual activities or through (...) a specific mostly informally acting group, but rarely an organizationally or systematically integrated goal of the monasteries, or a focus of capacity building. Monasteries follow a technical and economic decision-making process in implementing EP. Spirituality plays a limited role in the initiation of EP. The environment of monasteries–acceptance or critique against ecological practices–influences the monasteries decisions. Institutionalization of ecological practices into the monasteries organizational structure is rare. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Is Bioethics Applied Ethics?Robert M. VeatchBioethics is often referred to as a kind of applied ethics. The term applied ethics can be controversial if it is taken to imply that ethical theory from philosophy or religious ethics has to be the starting point for ethical analysis of some practical field such as medicine or law or politics. The term can be understood as requiring some (...) premises from an ethical theory that are then "applied" to some problem area, as a "top down" way of doing the work of moral reflection in a way that axioms in geometry are applied to present proofs of mathematical claim.The publication of an important work in the history of medical ethics, A History of Medical Ethics, provides an opportunity to reflect more carefully on what applied ethics means. That massive multi-authored volume edited by Robert Baker and Laurence McCullough (2007) is scheduled for publication this fall. With the permission of the Press, we have asked Baker and McCullough to prepare an article-length version of one of the central essays in that work. Their paper challenges the idea that ethical theory should be "applied" to medicine or other fields, putting forth an alternative of the "appropriation" of an ethical theory by the formulation of concepts, principles, moral rules, or other specifications that may turn out to be unique or at least modified for the particular field in question.In this issue of the Kennedy Institute of Ethics Journal, we publish the Baker-McCullough article together with five critical commentaries. We include two medical historians who have a sustained commitment to studying the history of ethics in medicine, two systematic ethicists who have an unusual level of commitment to studying ethics historically, and a physician with unusual sensitivity to the history of medical ethics. Each comments on the Baker-McCullough thesis and offers an alternative view of the link between ethical theory and the field of biomedical ethics.Daniel Fox triggered some of the initial reflection on the history of medical ethics in the 1970s. His work is discussed by Baker and McCullough. Fox is sympathetic with the Baker-McCullough appropriation thesis, viewing their position as complementary to his own, although he [End Page 1] urges more attention to the political aspects of medicine, professional dominance, and professional control of medical resources.Ulf Schmidt, a specialist on the historical aspects of research during the Nazi era, focuses on Baker and McCullough's use of that historical example of the appropriation of medical ethics.The two ethicists who comment both have had many years experience with historical aspects of medical ethics, and both worked on the historically important Belmont Report of the National Commission for the Protection of Human Subjects. Both question whether Baker and McCullough overstate the problem of the relation between application and appropriation. Albert Jonsen, as a member of the National Commission, concentrates on the Belmont Report, showing how he sees the report appropriating philosophical ethics.Tom Beauchamp, who was the primary staff person responsible for the report, provides a somewhat different read on the report and particularly on the role of Kantian ethics in the report's discussion of autonomy. Beauchamp accuses Baker and McCullough of having too narrow an understanding of the meaning of the term "applied," claiming that no people doing medical ethics today would simply apply ethical theory in a deductivist manner.Finally, Jeremy Sugarman, the physician ethicist, is, in a somewhat surprising turn, the cautious defender of the application that Baker and McCullough challenge. Although he ends up sympathetic with the appropriation that implies going beyond straight-forward top-down application, he outlines the value of ethical theory for the practical analysis of ethical problems in fields such as medicine.ReferenceBaker, Robert, and McCullough, Laurence, eds. 2007. A History of Medical Ethics. New York: Cambridge University Press, in press. [End Page 2]Google ScholarCopyright © 2007 Johns Hopkins University Press... (shrink)

This book successfully achieves to serve two different purposes. On the one hand, it is a readable physics-based introduction into the philosophy of science, written in an informal and accessible style. The author, himself a professor of physics at the University of Notre Dame and active in the philosophy of science for almost twenty years, carefully develops his metatheoretical arguments on a solid basis provided by an extensive survey along the lines of the historical development of physics. On the other (...) hand, this book supplies one long argument for Cushing´s own attitude in the philosophy of science. While former studies of the author, from which this book draws in part, focused each on one special episode in the history of science, this book gathers case material from many different parts of physics and epochs. The main goal of this book is ”to impress upon the reader the essential and ineliminable role that philosophical considerations have played in the actual practice of science” (p. xv). The book is beautifully edited and produced; it contains a wealth of illustrative figures, well-chosen short quotations from original sources and contemporary commentators (some longer quotations are relegated in an appendix at the end of a chapter) and does not dispense with insightful mathematical arguments in the main text (some advanced deductions are, however, relegated in the appendices). It contains nine parts, whereas only the first and the last one are exclusively devoted to philosophical issues. The seven remaining parts, each subdivided into three chapters, centre around one major episode (a theory, a world view, etc.) in the history of physics. The author presents this material in a clear and philosophically unbiased way so that also readers who do not share Cushing’s subsequent philosophical conclusions will find this inspiring book extremely useful. Part 1 (”The scientific enterprise”) discusses some traditional (”objectivist”) views concerning the status of scientific knowledge, ”the” scientific method, and the relation.... (shrink)

Ethical questions have traditionally been approached through conceptual analysis. Inspired by the rapid advance of modern brain imaging techniques, however, some ethical questions appear in a new light. For example, hotly debated trolley dilemmas have recently been studied by psychologists and neuroscientists alike, arguing that their findings can support or debunk moral intuitions that underlie those dilemmas. Resulting from the wedding of philosophy and neuroscience, neuroethics has emerged as a novel interdisciplinary field that aims at drawing conclusive relationships (...) between neuroscientific observations and normative ethics. A major goal of neuroethics is to derive normative ethical conclusions from the investigation of neural and psychological mechanisms underlying ethical theories, as well as moral judgments and intuitions. The focus of this article is to shed light on the structure and functioning of neuroethical arguments of this sort, and to reveal particular methodological challenges that lie concealed therein. We discuss the methodological problem of how one can—or, as the case may be, cannot—validly infer normative conclusions from neuroscientific observations. Moreover, we raise the issue of how preexisting normative ethical convictions threaten to invalidate the interpretation of neuroscientific data, and thus arrive at question-begging conclusions. Nonetheless, this is not to deny that current neuroethics rightly presumes that moral considerations about actual human lives demand empirically substantiated answers. Therefore, in conclusion, we offer some preliminary reflections on how the discussed methodological challenges can be met. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics and Natural Law: The Relationship in Catholic TeachingJ. Bryan Hehir (bio)In the discipline of Catholic moral theology, bioethics (traditionally described as medical ethics) has held a major place. The systematic development of bioethics has drawn principally upon a natural law ethic, supported by broader religious arguments. The purpose of this essay is to examine the status and role of natural law in Catholic teaching as (...) it bears upon bioethics.Natural Law and Catholic TheologyThe role of natural law in Catholic theology is rooted in a prior conviction about the complementary relationship of faith and reason. The conviction finds initial expression in patristic authors, then preeminently in Thomas Aquinas and consistently in modern papal teaching of the twentieth century. Flowing from this conviction, as a premise of Catholic theology and teaching, is the [End Page 333] notion that a second source of moral wisdom exists along side the revealed wisdom of the Hebrew and Christian scriptures. This second source of wisdom is the product of rational reflection upon human nature and experience. In the tradition of natural law ethics (expressed in a plurality of versions), such reflection affirms an objective moral order, accessible to reason and based upon a conception of the person as both spiritual and social. The spiritual nature, expressed in the capacity for reflection and free choice, is the foundation of the natural law ethic, providing the human person a unique status in the created order. The social nature of the person locates each human being in a framework of social relationships, articulated in a complex of rights and duties and finding expression in three basic communities: the family, civil society, and the human community.The fully developed framework of a natural law ethic has five dimensions. It yields a theory of society, a doctrine of the state, a charter of duties and rights, a jurisprudence, and an applied ethic. At each level of this framework, the natural law ethic is contested by other contemporary philosophical positions. In this article, space demands that stress must be placed on the natural law affirmations without trying to engage the critics.The centrality of the social nature of the person yields a theory of society that is organic in character, laying strong emphasis on the social fabric of existence. Hence the theory has traditionally emphasized both order and justice more strongly than claims of freedom. The doctrine of the state, in contemporary natural law arguments, supports a limited yet activist state, limited by constitutional restraints and human rights claims, yet activist in its conception of a broad range of social obligations, particularly to the poor. The charter of rights affirms a range of both political-civil and socio-economic rights; the traditional natural law emphasis on a structure of duties has been complemented in the twentieth century by its stress on the role of human rights. The jurisprudential theory of natural law has been its most prominent aspect; it affirms a moral grounding for civil law, but distinguishes precisely between the comprehensive nature of moral law and the more limited scope of civil law, restricted to the maintenance of public order in society. Finally, the natural law framework finds expression in Catholic teaching in three areas of applied ethics: social ethics (civil society and international relations), sexual ethics, and bioethics.History and StatusWhile a natural law ethic has been a staple of Catholic social and bioethical teaching, it has not held similar status in the wider arena of contemporary philosophical or theological ethics. Through the 1950s, therefore, one could find a strong consensus supporting natural law within the Catholic community and ongoing debates within the wider world of philosophy and bioethics. Since the 1960s, any description of the status and role of natural law must consider the debates within Roman Catholicism itself about the role and status of natural law. [End Page 334]It is possible to distinguish two stages of these internal arguments in the church. In the period from 1960 to 1990, three events in Catholicism directly influenced the standing of a natural law position: John XXIII’s encyclical Pacem In Terris (1963), Paul XI’s encyclical Humanae Vitae (1968), and the teaching of... (shrink)

It is argued that from a parallel reading of the Nicomachean Ethics and the Politics we can reconstruct a sketch of a systematic moral inquiry consisting of the following basic tenets: each citizen should be concerned with the achievement of his own eudaimonia to the extent possible by cultivating the necessary character traits, following the counsels of practical wisdom and being engaged in the proper activities; the pursuit of individual eudaimonia promotes at the same time collective eudaimonia, that is the (...) good of the city; the above relation can be conceived only by the supremely virtuous politicians of the ideal city who undertake the obligation to coordinate, uphold, enhance and secure — through various policies — the parallel and consistent achievement of both individual and collective good. This moral picture differs significantly from the one we extract if we confine ourselves to the Nicomachean Ethics and appears to be in line with our conception of a moral theory. (shrink)

Ethical challenges that arise within healthcare delivery institutions are currently categorized as either clinical or organizational, based on the type of issue. Despite this common binary issue-based methodology, empirical study and increasing academic dialogue indicate that a clear line cannot easily be drawn between organizational and clinical ethics. Disagreement around end-of-life treatments, for example, often spawn value differences amongst parties at both organizational and clinical levels and requires a resolution to address both the case at hand and large-scale (...) underlying system-level confounders. I refer to issues that contain elements of both clinical and organizational issues as hybrids and propose a new taxonomy to characterize hybrid cases. I contend that salient contextual features of an ethical issue, such as where it is identified, who it impacts and where it is ideally resolved in relation to its scope of impact, should inform procedure. Implementation of a Hybrid taxonomy viewing ethical issues as existing on a continuum furthers that end. The primary goals are to 1) systematize thinking about ethical issues that arise within healthcare delivery institutions and 2) allow the content of the ethical challenge to drive the process, rather than continuing to rely on the traditional binary issue-based choice. Failure to capture the complexity of hybrid situations perpetuates incomplete information and ultimately an inchoate resolution that creates more questions than answers. (shrink)

This article examines the relation between policies concerning Corporate Social Responsibility (CSR) and philosophical moral theories. The objective is to determine which moral theories form the basis for CSR policies. Are they based on ethical egoism, libertarianism, utilitarianism or some kind of common-sense morality? In order to address this issue, I conducted an empirical investigation examining the relation between moral theories and CSR policies, in companies engaged in CSR. Based on the empirical data I collected, (...) I start by suggesting some normative arguments used by the respondents. Secondly, I suggest that these moral arguments implicitly rely on some specific moral principles, which I characterise. Thirdly, on the basis of these moral principles, I suggest the moral theories upon which the CSR policies are built. Previous empirical studies examining the relation between philosophical moral theories and the ethical content of business activities have mainly concentrated on the ethical decision-making of managers. Some of the most prominent investigations in that regard propose that managers mainly act in accordance with utilitarian moral theory (Fritzsche, D. J. and H. Becker: 1984 , Academy of Management Journal 27 (1), 166–175; Premeaux, S. and W. Mony: 1993 , Journal of Business Ethics 12 , 349–357; Premeaux, S.: 2004 , Journal of Business Ethics 52 , 269–278). I conclude that CSR policies are not based on utilitarian thinking, but instead, on some kind of common-sense morality. The ethical foundation of companies engaged in CSR, thus, does not mirror the ethical foundation of managers. (shrink)

BackgroundThe participant recruitment process is a key ethical pivot point when conducting robust research. There is a need to continuously review and improve recruitment processes in research trials and to build fair and effective partnerships between researchers and participants as an important core element in ensuring the ethical delivery of high-quality research. When participants make a fair, informed, and voluntary decision to enroll in a study, they agree to fulfill their roles. However, supporting study participants to fulfill (...) study requirements is an important ethical obligation for researchers, yet evidenced as challenging to achieve. This paper reports on participants’ motivations to volunteer and remain part of a dietary study conducted in Kasungu District, Malawi.MethodsWe conducted twenty in-depth interviews (with chiefs, religious leaders, trial participants, and health surveillance assistants), five systematic ethnographic observations, and fourteen focus group discussions with trial participants and their partners. Interviews were audio-recorded and transcribed verbatim. We used a grounded theory methodology to analyse data that included coding, detailed memo writing, and data interpretation.FindingsThe findings reveal that many participants had concerns during the trial. Thematically, experiences included anxieties, mistrust of researchers, rumours, fears of exploitation, and misconceptions. Anonymous concerns collected from the participants were reported to the trial team which enabled the researchers to appropriately support participants. Despite initial concerns, participants described being supported and expressed motivation to take up their role.ConclusionThese findings highlight a diverse map of multiple notions of what is ethically relevant and what can impact participation and retention within a study. The study has revealed how embedding a responsive approach to address participants’ concerns and ethical issues can support trust relationships. We argue for the need to employ embedded ethics strategies that enhance informed consent, focus on participants’ needs and positive experiences, and support researchers to fulfill their roles. This work highlights the need for research ethics committees to focus on the risks of undue influence and prevent exploitation especially in settings with a high asymmetry in resources and power between researcher and participant groups.Trial Registration: The Addressing Hidden Hunger with Agronomy (Malawi) trial was registered on 5th March 2019 (ISCRTN85899451). (shrink)

This article examines the relation between policies concerning Corporate Social Responsibility and philosophical moral theories. The objective is to determine which moral theories form the basis for CSR policies. Are they based on ethical egoism, libertarianism, utilitarianism or some kind of common-sense morality? In order to address this issue, I conducted an empirical investigation examining the relation between moral theories and CSR policies, in companies engaged in CSR. Based on the empirical data I collected, I (...) start by suggesting some normative arguments used by the respondents. Secondly, I suggest that these moral arguments implicitly rely on some specific moral principles, which I characterise. Thirdly, on the basis of these moral principles, I suggest the moral theories upon which the CSR policies are built. Previous empirical studies examining the relation between philosophical moral theories and the ethical content of business activities have mainly concentrated on the ethical decision-making of managers. Some of the most prominent investigations in that regard propose that managers mainly act in accordance with utilitarian moral theory, 166–175; Premeaux, S. and W. Mony: 1993, Journal of Business Ethics12, 349–357; Premeaux, S.: 2004, Journal of Business Ethics52, 269–278). I conclude that CSR policies are not based on utilitarian thinking, but instead, on some kind of common-sense morality. The ethical foundation of companies engaged in CSR, thus, does not mirror the ethical foundation of managers. (shrink)

ABSTRACT:The relationship between philosophy and bioethics remains a matter of perennial debate, but there does appear to be a consensus on one issue: whatever bioethics might want to borrow from philosophical ethics, it won't be normative theories. This essay argues that theories can have an important role to play in bioethics, though it might not be the one traditionally assumed by philosophers.

Open any standard bioethics textbook, and therein can be found a host of subjects ranging from the abortion rights controversy to the morality of xenographic tissue transplantation. Just as there is a wide scope to the subject matter of bioethics, its practitioners come from a multitude of disciplines, including law, medicine, nursing, theology, philosophy, sociology, and anthropology. And yet, despite a rich variety of investigators and methods, bioethicists overlook numerous subjects that deserve to be addressed. In particular, they (...) neglect issues of public health, preventive medicine, and social medicine. Although topics such as physician-assisted suicide, prenatal genetic testing, and the ethics of new reproductive technologies constitute the contemporary canon of bioethics and deserve sustained analysis, these subjects are not so significant that they should eclipse other issues. For example, gun control policies, the regulation of food additives. immunization programs, prenatal care, leave programs enabling employees to care for dying relatives, the provision of nutrition and medical care to the homeless, and the use of emergency rooms by the most impoverished citizens are all topics neglected by bioethicists. (shrink)

Despite recommendations from the Cartwright Report ethical review by health ethics committees has continued in New Zealand without health practitioners ever having to acknowledge their dual roles as health practitioners researching their own patients. On the other hand, universities explicitly identify doctor/research-patient relations as potentially raising conflict of role issues. This stems from the acknowledgement within the university sector itself that lecturer/research-student relations are fraught with such conflicts. Although similar unequal relationships are seen to exist between health researchers (...) and their patients, the patient/subjects are not afforded the levels of protection that are afforded student/subjects. In this paper we argue that the difference between universities and health research is a result of the failure of the Operational Standard Code for Ethics Committees to explicitly acknowledge the vulnerability of the patient and conflict of interests in the dual roles of health practitioner/researcher. We end the paper recommending the Ministry of Health consider the rewriting of the Operational Standard Code for Ethics Committees, in particular in the rewriting of section 26 of the Operational Standard Code for Ethics Committees. We also identify the value of comparative ethical review and suggest the New Zealand's Health Research Council's trilateral relationship with Australia's NHMRC (National Health and Medical Research Council) and Canada's CIHR (Canadian Institute of Health Research) as a useful starting point for such a process. (shrink)

One of the most noteworthy features of David Gauthier's rational choice, contractarian theory of morality is its appeal to self-interested rationality. This appeal, however, will undoubtedly be the source of much controversy and criticism. For while self-interestedness is characteristic of much human behavior, it is not characteristic of all such behavior, much less of that which is most admirable. Yet contractarian ethics appears to assume that humans are entirely self-interested. It is not usually thought a virtue of a (...) class='Hi'>theory that its assumptions are literally false. What may be said on behalf of the contractarian? (shrink)

Open any standard bioethics textbook, and therein can be found a host of subjects ranging from the abortion rights controversy to the morality of xenographic tissue transplantation. Just as there is a wide scope to the subject matter of bioethics, its practitioners come from a multitude of disciplines, including law, medicine, nursing, theology, philosophy, sociology, and anthropology. And yet, despite a rich variety of investigators and methods, bioethicists overlook numerous subjects that deserve to be addressed. In particular, they (...) neglect issues of public health, preventive medicine, and social medicine. Although topics such as physician-assisted suicide, prenatal genetic testing, and the ethics of new reproductive technologies constitute the contemporary canon of bioethics and deserve sustained analysis, these subjects are not so significant that they should eclipse other issues. For example, gun control policies, the regulation of food additives. immunization programs, prenatal care, leave programs enabling employees to care for dying relatives, the provision of nutrition and medical care to the homeless, and the use of emergency rooms by the most impoverished citizens are all topics neglected by bioethicists. (shrink)

The concept of paternalism is intricately tied to the concept of autonomy. It is commonly assumed that when paternalistic interventions are wrong, they are wrong because they impede individuals’ autonomy. Our aim in this paper is to show that the recent shift towards conceiving of autonomy relationally highlights a separate conceptual space for a nonpaternalistic kind of interpersonal intervention termed maternalism. We argue that maternalism makes a twofold contribution to the debate over the ethics of interpersonal action and decision-making. Descriptively, (...) it captures common experiences that, while not unusual in everyday life, are largely absent from the present discussion. Normatively, it describes a type of intervention with justification conditions distinct from the standard framework of paternalism. We explicate these contributions by describing six key differences between maternalism and paternalism, and conclude by anticipating and responding to potential objections. (shrink)

"Human dignity" has been enshrined in international agreements and national constitutions as a fundamental human right. The World Medical Association calls on physicians to respect human dignity and to discharge their duties with dignity. And yet human dignity is a term--like love, hope, and justice--that is intuitively grasped but never clearly defined. Some ethicists and bioethicists dismiss it; other thinkers point to its use in the service of particular ideologies. In this book, Michael Barilan offers an urgently needed, nonideological, and (...) thorough conceptual clarification of human dignity and human rights, relating these ideas to current issues in ethics, law, and bioethics. Combining social history, history of ideas, moral theology, applied ethics, and political theory, Barilan tells the story of human dignity as a background moral ethos to human rights. After setting the problem in its scholarly context, he offers a hermeneutics of the formative texts on Imago Dei; provides a philosophical explication of the value of human dignity and of vulnerability; presents a comprehensive theory of human rights from a natural, humanist perspective; explores issues of moral status; and examines the value of responsibility as a link between virtue ethics and human dignity and rights. Barilan accompanies his theoretical claim with numerous practical illustrations, linking his theory to such issues in bioethics as end-of-life care, cloning, abortion, torture, treatment of the mentally incapacitated, the right to health care, the human organ market, disability and notions of difference, and privacy, highlighting many relevant legal aspects in constitutional and humanitarian law. (shrink)

Using a case-study involving bioethics and LGBTQ+ family-making, I demonstrate the appeal of a pragmatist ethics approach to bioethics. On the specific pragmatist view I offer, ethical progress is a matter of overcoming ethical problems. Ethical problems are here understood as conflicts that arise as we attempt to live out our values in the natural and social world and which prompt us to reflect upon and sometimes reinterpret or revise our values or practices. Pragmatism is (...) inherently nonideal in its theoretical approach, since it holds that the relevant conflicts that prompt moral inquiry are not conflicts among abstract ideals, but practical conflicts that arise from our interaction with the world. Ideals alone, then, cannot be a proper guide to bioethical progress. After laying out this approach to moral theorizing in more detail, I take up a case study, focusing on the value of genetic relations within families and the use of reproductive technologies to allow LGBTQ+ people to produce biologically related children. I use this case to show the value of nonideal approaches to bioethics. More specifically, I argue that pragmatism—as a nonideal theory—instructs us to evaluate these issues and family-making practices by considering the situatedness of LGBTQ+ people in a heteronormative society, and the ways in which that particular context produces practical conflicts as LGBTQ+ people and families attempt to live out their values in the social world. (shrink)

This book is aimed at analyzing the foundations of medical ethics by considering different moral theories and their implications for judgments in clinical practice and policy-making. It provides a review of the major types of ethical theory that can be applied to medical and bioethical issues concerning reproductive genetics. In response to the debate on the most adequate ethical doctrine to guide biomedical decisions, this book formulates views that capture the best elements in each, bearing in mind (...) their differences and taking into account the specific character of medicine. No historically influential position in ethics is by itself adequate to be applied to reproductive decisions. Thus, this book attempts to offer a pluralistic approach to biomedical research and medical practice. One usually claims that there are some basic principles which constitute the foundations of bioethics and medical ethics. Yet these principles conflict with each other and one needs some criteria to solve these conflicts and to specify the scope of application of these principles. Exploring miscellaneous ethical approaches as introduced to biomedicine, particularly to reproductive genetics, the book shall elucidate their different assumptions concerning human nature and the relations between healthcare providers, recipients, and other affected parties. The book attempts to answer the question of whether the tension between these ethical doctrines generates conflict in the field of biomedicine or if these competing approaches could in some way complement each other. In this respect, lecturers and researchers in bioethics would be interested in this reading this book. (shrink)

This book is aimed at analyzing the foundations of medical ethics by considering different moral theories and their implications for judgments in clinical practice and policy-making. It provides a review of the major types of ethical theory that can be applied to medical and bioethical issues concerning reproductive genetics. In response to the debate on the most adequate ethical doctrine to guide biomedical decisions, this book formulates views that capture the best elements in each, bearing in mind (...) their differences and taking into account the specific character of medicine. No historically influential position in ethics is by itself adequate to be applied to reproductive decisions. Thus, this book attempts to offer a pluralistic approach to biomedical research and medical practice. One usually claims that there are some basic principles which constitute the foundations of bioethics and medical ethics. Yet these principles conflict with each other and one needs some criteria to solve these conflicts and to specify the scope of application of these principles. Exploring miscellaneous ethical approaches as introduced to biomedicine, particularly to reproductive genetics, the book shall elucidate their different assumptions concerning human nature and the relations between healthcare providers, recipients, and other affected parties. The book attempts to answer the question of whether the tension between these ethical doctrines generates conflict in the field of biomedicine or if these competing approaches could in some way complement each other. In this respect, lecturers and researchers in bioethics would be interested in this reading this book. (shrink)

"Human dignity" has been enshrined in international agreements and national constitutions as a fundamental human right. The World Medical Association calls on physicians to respect human dignity and to discharge their duties with dignity. And yet human dignity is a term--like love, hope, and justice--that is intuitively grasped but never clearly defined. Some ethicists and bioethicists dismiss it; other thinkers point to its use in the service of particular ideologies. In this book, Michael Barilan offers an urgently needed, nonideological, and (...) thorough conceptual clarification of human dignity and human rights, relating these ideas to current issues in ethics, law, and bioethics. Combining social history, history of ideas, moral theology, applied ethics, and political theory, Barilan tells the story of human dignity as a background moral ethos to human rights. After setting the problem in its scholarly context, he offers a hermeneutics of the formative texts on Imago Dei; provides a philosophical explication of the value of human dignity and of vulnerability; presents a comprehensive theory of human rights from a natural, humanist perspective; explores issues of moral status; and examines the value of responsibility as a link between virtue ethics and human dignity and rights. Barilan accompanies his theoretical claim with numerous practical illustrations, linking his theory to such issues in bioethics as end-of-life care, cloning, abortion, torture, treatment of the mentally incapacitated, the right to health care, the human organ market, disability and notions of difference, and privacy, highlighting many relevant legal aspects in constitutional and humanitarian law. (shrink)

The present paper focuses on the issue of death from the perspective of ethics of social consequences. To begin with, the paper summarizes Peter Singer’s position on the issue of brain death and on organ procurement related to the definition of death. For better understanding of the issue, an example from real life is used. There are at least three prominent sets of views on what it takes to be called dead. All those views are shortly presented and analysed. Later, (...) the theory of ethics of social consequences is briefly presented. The paper looks for the position of this ethical theory in connection to the issue of death. The issue of organ procurement, which is closely connected to the problem of defining death, is used as a means for a better understanding of the issue. The issue of death is studied through the categories of moral subject and moral object. Using the standpoint of ethics of social consequences enables us to distinguish between the death of a moral agent and the death of the organism. That helps to soften many issues associated with the topic. (shrink)

In the traditions of narrative ethics and casuistry, stories have a well-established role. Specifically, illness narratives provide insight into patients’ perspectives and histories. However, because they tend to see fiction as an aesthetic endeavour, practitioners in these traditions often do not realize that fictional stories are valuable moral sources of their own. In this paper I employ two arguments to show the mutual relationship between bioethics and fiction, specifically, science fiction. First, both discourses use imagination to set a (...) scene and determine a perspective. Second, bioethics and science fiction share the family resemblance of expressing moral beliefs. I then consider how understanding bioethics and science fiction as interrelated discourses can be the basis of a methodology for inquiry into relational autonomy in the context of biotechnologies and medicine. As an example of this methodology, I analyse Fay Weldon’s novel The Cloning of Joanna May. (shrink)

We must therefore begin again from the metaphysical end of the main problem. We find in Whitehead's thought a picture of the kind of world in which value is possible, in which organic relatedness and continuity between diverse elements are made possible through "participation", through the agency of God. But we find that there is contradiction between his theory of value as atomic feeling and his whole metaphysics. True to our acceptance of "objectivity", we rather conceive value (...) to be the source and goal of feeling, the "participation of reality in ideality, of individuality in community". Both the nature and function of God in the world suggest that he is the absolute value in terms of which and because of which all "relative values" are achieved. ;The problem of the relation of value and existence is one of the special problems of value-theory in general. But it is particularly central not only to axiology but also to ontology, and the relation of these two fields to one another. It is the problem of a contrast between "realms" of Being; we are asking ourselves in what ways the contrast arises and is felt, and whether it can be metaphysically overcome. ;We must begin with an analysis of the value-situation in empirical terms. Ethics, as a field of thought concerned with value-factors, may serve to present the typical problems of the relation of value to existence: the objectivity of value, arising from a consideration of the judgment and definition of value and also from the normative character of ethical principles; the apprehension of value, following upon our admission, with Hartmann, of "objectivity" to value; the realization of value, introduced by the previous two problems taken together and by the further conception of the place and function of man the subject-agent. Thus, though we begin with the "phenomena" we find we must go beyond them to the metaphysical reference which they themselves presuppose. We agree with Hartmann that value has "objectivity" and is genuinely given in and for knowledge; we do not however concur that "objectivity" necessarily implies "essentiality" in value. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation (...) to its patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the... (shrink)

This book explores, in rich and rigorous ways, the possibilities and limitations of “thick” autonomy in light of contemporary debates in philosophy, ethics, and bioethics. Many standard ethical theories and practices, particularly in domains such as biomedical ethics, incorporate minimal, formal, procedural concepts of personal autonomy and autonomous decisions and actions. Over the last three decades, concerns about the problems and limitations of these “thin” concepts have led to the formulation of “thick” concepts that highlight the mental, corporeal, (...) biographical and social conditions of what it means to be a human person and that enrich concepts of autonomy, with direct implications for the ethical requirement to respect autonomy. The chapters in this book offer a wide range of perspectives on both the elements of and the relations between “thin” and “thick” concepts of autonomy as well as their relative roles and importance in ethics and bioethics. This book offers valuable and illuminating examinations of autonomy and respect for autonomy, relevant for audiences in philosophy, ethics, and bioethics. (shrink)

The first book to be devoted to the logic behind the application of ethical theories, this collection of essays explores the question of how many different moral traditions (utilitarianism, natural rights theory, Marxism, Christian moral theology, and Kantianism among others) view the relation between theory and concrete judgments. By considering many applications of moral theory in medical ethics the authors illustrate their point.

In Islamic law paternity is treated as a consequence of a licit sexual relationship. Since DNA testing makes a clear distinction between legal and biological paternity possible, it challenges the continued correlation between paternity and marriage. This article explores the foundations of paternity regulations in the Islamic ethico-legal tradition, with a particular focus on what is termed here “the licit sex principle,” and investigates the extent to which a harm-based argument can be made either by appeal to or (...) against Islamic paternity regulations. It argues that in Islamic bioethics the definition of harm and its boundaries is a function of both: (1) identification of legal and religious rights and the extent to which these rights are violated; and (2) balancing and reconciling perceived harm against both specific principles in relation to a given issue and also the overarching objectives of Islamic law. The article is divided into three main sections addressing the Islamic legal, ethical, and bioethical dimensions of paternity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Ethics: Balancing Praxis and TheoryEdmund D. Pellegrino (bio)When André Hellegers founded the Kennedy Institute, he envisioned a close collaboration between ethics and clinical practice. He even called for physician specialists whose expertise would be in both fields (Reich 1994, p. 324). A quarter of a century later, his vision and prediction have become realities. Clinical ethics is today a thriving entity with its own literature, practitioners, and (...) methodology.This clinical turn has, on the whole, been salutary. The abstractness of ethical theory has been tempered by the concreteness of clinical realities; clinicians have been helped to make bedside decisions even in the face of theoretical uncertainty and dissonance; and a variety of disciplines besides theology and philosophy have entered ethical discourse and enriched it.These advantages notwithstanding, clinical ethics has certain inherent traits that make it problematical. Some seek its norms in what “works” in practice or in paradigm cases (Jonsen and Toulmin 1988); others shape it to achieve consensus or satisfy the needs of public policy (Meilaender 1995); still others reduce bioethics to merely a method for the resolution of moral conflict. Rather than simply modulating theory by practice, clinical ethics can end up by repudiating theory entirely (Toulmin, in press). Taken to their logical conclusion, these tendencies make clinical ethics a species of the antifoundationalism that has strongly influenced moral philosophy in the last decade (Tollefsen 1995, pp. 3–18; Rockmore and Singer 1992). But antifoundationalism itself is a theory of ethics even though it supposedly denies the validity of any overarching theories.Antifoundationalism presents its own difficulties. For one thing it begs important questions that will not go away: for example, how do we know that a decision is a good one? what does it mean to say that a decision “works”? is the [End Page 347] outcome of a good decisional procedure itself a good decision? and to what extent are compromise and exigency admissible in moral decisions? Theoretical and “foundational” questions of this sort will not evaporate because they are ignored. They inevitably will be answered by begging the essential questions or grounding them solely in prelogical presuppositions.To avoid these difficulties, the advantages of clinical ethics must be retained without capitulation to the anti-theory bias of contemporary philosophy. This means that theory and practice must both be retained and be conceptually related to each other. To effect this we must take account of the long intellectual history of the relationship between the speculative and the practical intellect—i.e., between knowledge sought for its own sake and knowledge sought for some use beyond simply the possession of it (Lobkowicz 1967, pp. 78–81). Suffice it to say that medicine has long been the paradigm case for the union of theory and praxis. Relating them conceptually is an essential propaedeutic to any theory of moral praxis in medicine.The rest of this essay examines the inextricability of theory and practice in two of the three major branches of clinical ethics—the substantive and the professional. The third branch, procedural ethics—i.e., the ethics of the process of decision making—deals with informed consent, with respect for persons, professional colleagues, and families, and with the ethics of conflict resolution. Obviously, there are theoretical issues here as well. For want of space, procedural ethics will not be discussed, but it presents the same conjunction of theory and practice encountered in professional and substantive ethics.Substantive EthicsSubstantive ethics refers to the moral content rather than the process of moral decisions, to the moral status and permissibility of the specific clinical medical acts themselves—e.g., abortion, euthanasia, pre-implantation diagnosis, surrogate motherhood, withholding and withdrawing treatment, the physician as gatekeeper, and the like—the whole range of moral questions clinicians face in treating patients. Moral diversity and plurality on these issues is the most powerful force behind the dominance of procedural ethics. But, unfortunately, a morally valid decision-making procedure does not confer normative validity on the decision itself. Moral validity rests on questions that go beyond prevailing practices, on what we take to be the nature and moral status of persons, fetuses, and brain-damaged humans, the value or disvalue of... (shrink)

In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of (...) influence fall into the broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

Patient engagement in healthcare is increasingly discussed in the literature, and initiatives engaging patients in quality improvement activities, organizational design, governance, and research are becoming more and more common and have even become mandatory for certain health institutions. Here we discuss a number of ethical challenges raised by this engagement from patients from the perspectives of research, organizational/quality improvement practices, and patient experiences, while offering preliminary recommendations as to how to address them. We identified three broad categories of (...) class='Hi'>ethical issues that intersect between the different types of patient engagement: (1) establishing a shared vision about goals of patient engagement and respective roles; (2) the process and method of engaging with patients; and (3) practical aspects of patient engagement. To explain these issues, we build from our personal, professional, and academic experiences, as well as traditions such as pragmatism and hermeneutics that stress the importance of participation, empowerment, and engagement. Patient engagement can be highly valuable at numerous levels, but particular attention should be paid to the process of engaging with patients and related ethical issues. Some lessons from the literature on the ethics of participatory research can be translated to organizational and quality improvement practices. (shrink)

We have controversial intuitions about the rightness of retributive punishment, keeping promises for its own sake, and pushing the heavy man off of the bridge in the footbridge trolley case. How do these intuitions relate to ethical theories? Should ethical theories aim to fit with and explain them? Or are only uncontroversial intuitions relevant to explanatory ethical theorising? I argue against several views that we might hold about the relationship between controversial intuitions and ethical theories. (...) I then propose and defend the view that ethical theories should only aim to fit with and explain the intuitions that almost all people (who minimally understand the relevant issues) share. I argue that this view has interesting and important implications for ethical theorising and theorising about justice and equality. (shrink)

Instrumental values are often considered to be inferior to intrinsic values. One reason for this is that instrumental values are extrinsic and rely on two factors: (a) a means–end relationship that is (b) conducive to something of final or intrinsic value. In this paper, I will investigate the conditions under which bearers of instrumental value are given different value or owed different levels of respect. Such conditions include the number of means that are conducive to something of final or intrinsic (...) value as well as the form of causality that is implied. It will be suggested that different numbers and causal relations will imply different degrees of reverence or respect to the bearers of instrumental value. I will also critically investigate recent proposals such as relational values that allegedly go beyond the distinction between instrumental and intrinsic value. Drawing from this critical analysis, a nuanced picture of instrumental value will be provided. (shrink)

This paper introduces the concept of business-related conspiracy theories. Drawing on Aristotelian virtue ethics and undertaking a narratological and ethical analysis of 28 BrCTs found online, I emphasize that BrCTs are narratives with structures rooted in other latent macro- and meta-narratives, including centuries-old myths. In particular, I reconstruct the fictional world of BrCTs – one in which CSR and social contracts have failed – before identifying eight different types of actors as which people can morally situate themselves in their (...) relationships with business. Finally, I elaborate on the actors’ performances and their use of external and legitimate forces to end the story. The paper concludes with a discussion of potential future research to help combat BrCTs, as well as a call for the critical study of political CSR. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Philosophical Perspectives on Galen of Pergamum. Four Case-Studies on Human Nature and the Relation between Body and Soul by Robert VinkesteijnJulien DevinantVINKESTEIJN, Robert. Philosophical Perspectives on Galen of Pergamum. Four Case-Studies on Human Nature and the Relation between Body and Soul. Leiden: Brill, 2022. viii + 357 pp. Cloth, $155.00Vinkesteijn's book, stemming from his 2020 dissertation at Utrecht University, explores Galen's views on (human) (...) nature and the soul. Opting to sidestep the debate on the unity of Galen's thought, he offers a series of close readings of some of Galen's most philosophical writings, radiating from the short treatise The Capacities of the Soul Follow the Mixtures of the Body (QAM), which encapsulates the questions he investigates throughout the book. Although many of the texts and themes examined have been extensively discussed in previous scholarship, its strength lies in its steadfast and coherent defense of a long-favored interpretation of Galen as "somatizing the soul."Case Study 1 revisits QAM, which has sparked considerable debate in Galenic studies. It defends the idea, recently criticized, that despite Galen's agnostic statements about the substance of the soul elsewhere, he supports here the physicalist and more speculative thesis that the whole soul is indeed identical to the specific mixture of elemental qualities in the homoeomerous parts of the main psychic organs. Vinkesteijn maintains that this thesis aligns with Galen's general physiology, and that Galen's analysis of the soul as a formal aspect in a hylomorphic whole represents not an exegetical stance on Aristotelian positions but his own viewpoint, applicable to both the nonrational and rational parts. The study then rightly emphasizes Galen's conviction that our actions and affections can and should be modified by habituation. It argues that there is no basis for assuming that the identity thesis leads to a radically deterministic ethic. Indeed, it showcases the possibility of a second formation of our bodily mixture, with Galen attributing to the rational part of the soul a godlike potential for change and improvement of the soul's virtues—although it concedes the unlikelihood of such personal enhancement, as it hinges on rare natural predispositions.Case Study 2 focuses on Galen's definition of nature and his elemental theory; it focuses on the first book of Galen's Commentary on Hippocrates's On the Nature of Man (HNH) and examines the notable absence of the soul as an explanatory factor in an account of human nature. It argues that Galen articulates a concept of nature as a primary hylomorphic substance, shared by all beings subject to generation and decay and determining their secondary properties. The study then [End Page 557] examines Galen's use of his allegedly Hippocratic/Platonic method of division to dissect nature into its constantly interacting elemental powers of heating, cooling, moistening, and drying. Vinkesteijn then underscores the complexities in delineating mixtures from nature as an intelligent creator, challenging the dichotomy between a transcendent and an immanent formation of natural beings and pinpointing the difficulty in differentiating between the causality of nature and that of the soul in humans.Case Study 3 explores Galen's engagement with Plato's Timaeus, focusing on the soul–body relationship. It drives home the argument of the first study and aims to show how the fragments of Galen's lost Commentary on the Timaeus offer a somatizing interpretation of the soul. Extensively drawing on the disputed but recently reassessed Larrain fragments, it convincingly argues that they align with passages from Galen's attested works. Vinkesteijn highlights Galen's creative reading of the Timaeus, tailored to mirror his own doctrines. Beyond incorporating Aristotelian notions into his analysis, Galen is depicted as ingeniously reinterpreting the Platonic soul–body distinction. Notably, Vinkesteijn shows how Galen takes the river metaphor literally, as an indication of moisture abundance, and applies it beyond its original context of generation. This approach enables Galen to reinterpret Plato's ideas through the prism of elemental qualities and emphasize the association of the soul with lightlike or dry and hot substances, bridging the gap between the Platonic concept of the soul and Galen's physiological understanding of human nature.Case... (shrink)