As these opening quotes acknowledge, the Prisoner’s Dilemma (PD) represents a core puzzle within the formal mathematics of game theory.3 Its rise in conspicuity is evident figure 2.1 above demonstrating a relatively steady rise in incidences of the phrase’s usage between 1960 to 1995, with a stable presence persisting into the twenty first century. This famous two-person “game,” with a stock narrative cast in terms of two prisoners who each independently must choose whether to remain silent or speak, each (...) advancing self-interest at the expense of the other and thereby achieving a mutually suboptimal outcome, mires any social interaction it is applied to into perplexity. The logic of this game proves the inverse of Adam Smith’s invisible hand: individuals acting on self interest will achieve a mutually suboptimal outcome. However, as this chapter illuminates, the assumptions underlying game theory drive this conclusion. (shrink)

In this short, dense essay, Jean Cavaillès evaluates philosophical efforts to determine the origin - logical or ontological - of scientific thought, arguing that, rather than seeking to found science in original intentional acts, a priori meanings, or foundational logical relations, any adequate theory must involve a history of the concept. Cavaillès insists on a historical epistemology that is conceptual rather than phenomenological, and a logic that is dialectical rather than transcendental. His famous call (cited by Foucault) to abandon "a (...) philosophy of consciousness" for "a philosophy of the concept" was crucial in displacing the focus of philosophical enquiry from aprioristic foundations toward structural historical shifts in the conceptual fabric. This new translation of Cavaillès's final work, written in 1942 during his imprisonment for Resistance activities, presents an opportunity to reencounter an original and lucid thinker. Cavaillès's subtle adjudication between positivistic claims that science has no need of philosophy, and philosophers' obstinate disregard for actual scientific events, speaks to a dilemma that remains pertinent for us today. His affirmation of the authority of scientific thinking combined with his commitment to conceptual creation yields a radical defense of the freedom of thought and the possibility of the new. (shrink)

The article discusses the problem of the possibility of knowing the future, especially the future of social phenomena compared with the future of natural ones. This problem is formulated as a dilemma: the future can be explored or can be only constructed. The idea of constructive character of knowledge of the future is viewed in two possible interpretations.The first one is a special case of the constructivist interpretation of knowledge, according to which different pictures of the future are arbitrarily (...) constructed on the basis of information about the past and current state. The second interpretaion can be presented in the form of a praxeological question: what should be an action in relation to the future, first and foremost to the future of social phenomena - cognitive or creative. It is shown that, in the first case, there is an ability to interpret knowledge of the future from the point of view of epistemological realism, in the second case, both cognitive and creative types of activity as a pragmatic position in relation to the future are necessary and cognitive activity cannot be reduced to creative one. It is also shown that forecaster’s dilemma reflects the problematic nature of forecasting under the conditions of transformation of scientific rationality and point of view of common sense, which is observed in recent decades. (shrink)

Solipsism indicates an epistemological position that denies the existence of ‘others’ by asserting that the ‘self’ is the only thing that can be known to exist. For sophist philosophers, the belief that “we can not know anything, and even if we do so, we cannot communicate it” is central to this theory. However, until now there has been little academic scholarship that has tried to provide answers to the pressing issues raised by solipsism. In Solipsist Ontology: Physical Things and Personal (...) Perceptual Space, Ural aims to redefine solipsism by analyzing and elaborating on traditional philosophical problems, such as empiricism and rationalism, as well as discussing problems of language, communication, and meaning. Ural reveals where solipsism has been previously ignored, pseudo-problems have arisen that disguise the sources of the problems with prejudices that concern the philosophical problems in question. Notably, many current, as well as traditional problems of ontology, epistemology, and language are bound up in discourses of solipsism. Ural argues that discarding solipsism as a philosophical discourse hinders new interpretations of traditional philosophical thought. This book offers a fresh perspective to solipsism by defining it in relation to concepts such as ‘physical things,’ ‘personal perceptual space’ and ‘identity.’ Importantly, Ural proposes that an understanding of ‘identity’ is not necessary in order to redefine solipsism. By building a logical system that fashions communication and solipsism as interrelated, it is possible to reject ‘identity’ as a useless concept and thus overcome the classic solipsist dilemma of “we are not able to communicate.” This original piece of research is an important and timely contribution to the field of philosophy that will be of great interest to teachers, researchers, and students. (shrink)

Guiden til Søren Kierkegaards værk Frygt og Bæven er vigtig, fordi det er et værk, som mange finder det svært eller direkte usympatisk at læse, så her skulle være lidt tilgængelige tilgange til forståelsen heraf. Det er troens paradoks, der behandles i værket, og det undersøges via historien om Abraham og Isak. Det er et etisk dilemma af dimensioner, for ikke blot er det et mord, der bliver planlagt, men det er også et mord på Abrahams egen søn, hvis (...) det altså gennemføres, som Gud har befalet. Det, der interesserer pseudonymet Johannes, er det modsætningsforhold, der findes mellem religion og etik, for der er en etisk pligt, som vi alle kender i henhold til, hvad man må og ikke må, eller hvad der er redeligt eller uredeligt. Der er imidlertid også en pligt for Gud, når man er troende, og den pligt kan vise sig at gå imod ordentlighed og lovlighed. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Among various cases that equally admit of evidentialist reasoning, the supposedly evidentialist solution has varying degrees of intuitive attractiveness. I suggest that cooperative reasoning may account for the appeal of apparently evidentialist behavior in the cases in which it is intuitively attractive, while the inapplicability of cooperative reasoning may account for the unattractiveness of evidentialist behaviour in other cases. A collective causal power with respect to agreed outcomes, not evidentialist reasoning, makes cooperation attractive in the Prisoners' Dilemma. And a (...) natural though unwarranted assumption of such a power may account for the intuitive appeal of the one-box response in Newcomb's Problem. (shrink)

Although deeply committed to the model of nondirective counseling, most genetic counselors enter the profession with certain assumptions about health and disability—for example, that it is preferable to be a hearing person than a deaf person. Thus, most genetic counselors are deeply troubled when parents with certain disabilities ask for assistance in having a child who shares their disability. This ethical challenge benefits little from viewing it as a conflict between beneficence and autonomy. The challenge is better recast as a (...) conflict between parental autonomy and the child's future autonomy. (shrink)

Bioethics introduces students to the most relevant historical, epistemological, methodological, and practical aspects of bioethics. The book presents readers with some of the most thought-provoking writing in the field, along with an original introduction to each reading. Selections range from the work of great philosophers like Aristotle, Immanuel Kant, and John Stuart Mill, to contemporary writings and reports. Readers explore various ideologies and philosophies including the seminal work of Tom Beauchamp and James Childress on principles of biomedical ethics and the (...) dialogical approach to bioethics. They also consider controversial topics straight from the headlines of the day, such as the collision between paternalism and autonomy, futility, human research, genetic manipulation, and active and passive euthanasia. Bioethics encourages students to think objectively and impartially in order to resolve the ethical dilemmas that stem from biotechnological empowerment and biomedical techniques. The book is suitable for courses in biomedical, research, and practical ethics, as well as those that discuss moral philosophy. It can be used as a stand-alone text, or as a supplement to standard textbooks. Erick Valdes earned a Ph.D. in philosophy from the University of Chile as well as a Ph.D. in political philosophy from Paris-Sorbonne University in France. He is an adjunct research scholar at the Kennedy Institute of Ethics, Georgetown University, where he conducts advanced research on bioethics and biolaw. In addition, Dr. Valdes teaches bioethics, research ethics, theories of democracy and international human rights at George Mason University and American University. He is the author of nine books on bioethics and political philosophy and has published in both English and Spanish. He has written extensively on bioethics and biolaw for international journals, and served as a visiting professor at universities in England, France, Spain, Russia, Mexico, Colombia, Argentina, and Chile. (shrink)

Teaching economics has been shown to encourage students to defect in a prisoner's dilemma game. However, can ethics training reverse that effect and promote cooperation? We conducted an experiment to answer this question. We found that students who had the ethics module had higher rates of cooperation than students without the ethics module, even after controlling for communication and other factors expected to affect cooperation. We conclude that the teaching of ethics can mitigate the possible adverse incentives of the (...) prisoner's dilemma, and, by implication, the adverse effects of economics and business training. (shrink)

P.S. Greenspan uses the treatment of moral dilemmas as the basis for an alternative view of the structure of ethics and its relation to human psychology. In its treatment of the role of emotion in ethics the argument of the book outlines a new way of packing motivational force into moral meaning that allows for a socially based version of moral realism.

Thinking about ethics -- Philosophical ethics -- Why not do wrong? -- Is the ethical a human construct or a factual realm? -- Do you just do what is right or do you try to predict the outcomes? -- Natural law and virtue ethics -- Ethics and the bible -- Learning from the wisdom of the world -- Humanism : do we need god to realize that people just matter? -- Ethical dilemmas -- Dilemmas in bed -- Dilemmas in business (...) -- Dilemmas in medicine -- Dilemmas involving violence and power -- Dilemmas in government and leadership -- Dilemmas and the future : the environment, animals, and plants -- Dilemmas in the cyber world -- Making a decision -- Becoming a morally serious person -- Taking an ethical position. (shrink)

This is a breakthrough work expanding the debate of the dilemmas of life and death in contemporary American society by carrying it beyond the insights of Western religious and philosophic thought to include ethical perspectives of the Hindu tradition. The topics covered are the timely ethical issues that concern both Americans and all people of the world — abortion, suicide, euthanasia, and the environment. A lively East-West dialogue probes the roots of each issue in its native setting, and the fruit (...) of this historical approach is a clear-cut analysis of up-to-date cases, giving their current status in terms of ethics, religion, philosophy, medicine, and law. Unlike traditional textbooks that concentrate on a theoretical analysis to the exclusion of practical issues, this book does justice to both theoretical and practical ethics. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

In six compelling chapters, this book recounts conversations that discuss what is ethical, why it does not occur more often, and how can we improve ethical conduct in our personal and public lives. The conversations include Knowing Ethical Principles, Learning How to Apply Principles in Practice, Moral Reminders, Accountability for Conduct, Addressing Structural Problems, and Ethical Vigilance. Major ethical perspectives are discussed in conversational format, as are fascinating ethical dilemmas taken from actual cases to evaluate and improve our ability to (...) identify ethical principles and make decisions that reflect concerns beyond self-interest. (shrink)

Background: There are intriguing and challenging ethical dilemmas in the practice of palliative care in a traditional developing society.Objective: To review the different ethical issues involved in cancer and palliative care in developing countries, with special reference to India.Methods: Published literature on pain relief and palliative care in the developing countries was reviewed to identify ethical issues and dilemmas related to these, and ways in which ethical principles could be observed in delivery of palliative care in such countries are discussed.Results: (...) The literature review revealed a number of ethical dilemmas and challenges that professionals, cancer patients and their families encountered during palliative care. It was noted that patients’ preferences and decisions are influenced by family members. Dilemmas leave the professionals and families confused about how ethical their actions have been. Specific ethical issues were noted in relation to the availability and use of oral morphine for pain relief, spiritual care, lack of adequate palliative care services, and palliative care education.Conclusions: The four principles of ethics posed difficulties in understanding the complex ethical issues in a developing country with a traditional background. Ethical issues need to be handled delicately and sensitively in palliative care settings, within the framework of the traditions and culture of the society and financial constraints. The possible role of ethics committees in palliative care settings to help decision-making needs to be studied and discussed. (shrink)

The purpose of this article is show that second-order logic, as understood through standard semantics, is intimately bound up with set theory, or some other general theory of interpretations, structures, or whatever. Contra Quine, this does not disqualify second-order logic from its role in foundational studies. To wax Quinean, why should there be a sharp border separating mathematics from logic, especially the logic of mathematics?

If we seek to analyse causation in terms of counterfactual conditionals then we must assume that there is a class of counterfactuals whose members (i) are all and only those we need to support our judgements of causation, (ii) have truth-conditions specifiable without any irreducible appeal to causation. I argue that (i) and (ii) are unlikely to be met by any counterfactual analysis of causation. I demonstrate this by isolating a class of counterfactuals called non-projective counterfactuals, or NP-counterfactuals, and indicate (...) how counterfactual analyses of causation must appeal to them to account for the correct causal judgements we make. I show that the truth-conditions of NP-counterfactuals are specifiable only by irreducible appeal to causation. A dilemma then holds: if counterfactual analyses of causation eschew appeal to NP-counterfactuals they are empirically inadequate, but if they appeal to NP-counterfactuals they are circular and thus conceptually inadequate. (shrink)

Allthough small business accounts for over 90% of businesses in U.K. and indeed elsewhere, they remain the largely uncharted area of ethics. There has not been any research based on the perspective of small business owners, to define what echical delemmas they face and how, if at all, they resolve them. This paper explores ethics from the perspective of small business owner, using focus groups and reports on four clearly identifiable themes of ethical delemmas; entrepreneurial activity itself, conflicts of personal (...) values with business needs, social responsibility and the impact of owners' personality on business ethics. The mechanisms for resolving ethical dilemmas is not at all clear, as there appears to be a web of filters which are used in an inter-connected way. However a common starting point for resolving an ethical delemma which involves others is based on identifying who it is (e.g., a friend or institution) and the quality of the relationship with that person. The research yielded a rich source of material on business ethics and it is clear that future researchers must focus on this sector if business ethics is to make significant advances. (shrink)

Is capitalism inherently predatory? Must there be winners and losers? Is public interest outdated and free-riding rational? Is consumer choice the same as self-determination? Must bargainers abandon the no-harm principle? Prisoners of Reason recalls that classical liberal capitalism exalted the no-harm principle. Although imperfect and exclusionary, modern liberalism recognized individual human dignity alongside individuals' responsibility to respect others. Neoliberalism, by contrast, views life as ceaseless struggle. Agents vie for scarce resources in antagonistic competition in which every individual seeks dominance. This (...) political theory is codified in non-cooperative game theory; the neoliberal citizen and consumer is the strategic rational actor. Rational choice justifies ends irrespective of means. Money becomes the medium of all value. Solidarity and good will are invalidated. Relationships are conducted on a quid pro quo basis. However, agents can freely opt out of this cynical race to the bottom by embracing a more expansive range of coherent action. (shrink)

The ability to design technological solutions that address sustainability is considered pivotal to the future of the planet and its people. As technology professionals engineers are expected to play an important role in sustaining society. The present article aims at exploring sustainability concepts of newly enrolled engineering students in Denmark. Their understandings of sustainability and the role they ascribe to sustainability in their future professional practice is investigated by means of a critical discourse analysis including metaphor analysis and semiotic analysis. (...) The sustainability construal is considered to delimit possible ways of dealing with the concept in practice along the engineering education pathway and in professional problem solving. Five different metaphors used by the engineering students to illustrate sustainability are identified, and their different connotative and interpretive implications are discussed. It is found that sustainability represents a dilemma to the engineering students that situates them in a tension between their technology fascination and the blame they find that technological progress bears. Their sustainability descriptions are collected as part of a survey containing among other questions one open-ended, qualitative question on sustainability. The survey covers an entire year group of Danish engineering students in the first month of their degree study. (shrink)

Online education lacks the moral and ethical engagement as well as the empathic interactions that are essential and integral to true liberal education, including business. While the online venue can provide useful information and put libraries at the hands of the student or employee, there is an implicit lack of focus on the sacredness and centrality of the person, his or her values, attitudes, needs, and expectations. The focus of online education is on the delivery of data, not the student’s (...) engagement with the material or the process. Critically absent from online education is the ability to explore the transformation of data as it changes, first to information, then to knowledge, and finally to wisdom, within each person. Finally, absent is the ability to raise the level of abstraction. Since all needs to be measurable in concrete terms in online education, we are left with the language of metrics, such as deliverables, outcomes, inputs, and outputs. Where is the person in all of this? Where is the focus on the moral compass that is so necessary in any type of education? (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult (...) case and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Context: In the past two decades, the so-called 4E approaches to the mind and cognition have been rapidly gaining in recognition and have become an integral part of various disciplines. Problem: Recently, however, questions have been raised as to whether, and to what degree, these different approaches actually cohere with one another. Specifically, it seems that many of them endorse mutually incompatible, perhaps even contradictory, epistemological and metaphysical presuppositions. Method: By retracing the roots of an alternative conception of mind and (...) cognition, as propounded by Varela, Thompson & Rosch, we provide an outline of the original philosophical framework of enactivism and neurophenomenology. We focus on its three central tenets - reflexivity, subject-world co-determination, and the construal of cognition as situated, skillful and embodied action - and show how they collectively add up to a radical change in attitude towards the age-old philosophical dilemmas. Results: We show how contemporary enactivist and embodied approaches relate to the original Varelian conception, and argue that many of them, despite frequent claims to the contrary, adopt significantly less radical philosophical positions. Further, we provide some tentative suggestions as to why this dilution of the original impetus might have occurred, paying special attention to the deep-rooted disparities that span the field. Implications: It is argued that more attention should be paid to epistemological and metaphysical tenets of different proposals within the 4E movement in general and enactivism in particular. Additionally, in emphasizing the inescapable multilayeredness and contextuality of scientific knowledge, enactivism and neurophenomenology accord with pluralist accounts of science and might provide important contributions to contemporary debates in the field. Constructivist content: The epistemological odyssey, construed as a journey to find a middle way between realism and idealism, is a central tenet of anti-representationalist, non-dualist constructivist approaches aimed at avoiding age-old philosophical traps. (shrink)

The introduction of Western healthcare, via colonialism, into Africa facilitated a confrontation of indigenous and exogenous “medical” knowledge as well as the attendant praxis. Although colonialism has been expunged from the shores of Africa, the epistemic and ideological frictions it introduced into the sphere of healthcare linger and raise different dilemmas. Against this background, this paper explores pragmatic and ethical approaches that may help engage these tensions in the context of drug development based on validated traditional phytomedicines.

In today's turbulent business climate, business ethics are more important than ever. Surveys of employees show that misconduct is on the rise. Cover stories reporting indictments, prosecutions, and penalties imposed for unethical business conduct appear almost daily. Legislatures pass requirements elevating the levels of punishment and their enforcement against corporations and individuals. Organizations face pressure to design and implement effective ethics and compliance programs. As a result, businesses and businesspeople are increasingly worried that their conduct might cross lines that put (...) their wealth and reputations at risk. Business Ethics: What Everyone Needs to Know ® explains what those lines are, how not to cross them, and what to do when they are crossed. Written for both businesspeople facing real-life dilemmas and students studying ethical questions, this succinct book uniquely surveys materials from moral philosophy, behavioral science, and corporate law, and shares practical advice. Experts J.S. Nelson and Lynn A. Stout cover a wide array of essential topics including the legal status of corporations, major ethical traps in modern business, negotiations, whistleblowing and liability, and best practices. Written in a short question-and-answer style, this resource provides engaging and readable introductions to the basic principles of business ethics, and an invaluable guide for dealing with ethical dilemmas. (shrink)

In a small village in the Nile Delta, Wamai is faced with a decision. His wife died three years ago in childbirth leaving him with two small children to raise, a small plot of land, and two goats. By local standards he is a well-off; his goats produce milk for his children and his land feeds his goats. He, his goats, and his children use the same water supply. Gaining access to water will cost him one goat jeopardizing his milk (...) supply and his ability to sustain his tiny hers. But Wamai also wants to marry again. The bride-price is two goats. (shrink)

Conventional and well-established guidelines for the ethical conduct of clinical research are necessary but not sufficient for addressing research dilemmas related to public health research. There is a particular need for a public health ethics framework when, in the face of an epidemic, research is urgently needed to promote the common good. While there is limited experience in the use of a public health ethics framework, the value and potential of such an approach is increasingly being appreciated. Here we use (...) two examples of adolescent women as potential candidates for participation in microbicide trials to illustrate how ethical decisions for public health research can be enhanced by drawing on both traditional research ethics guidance, and the emerging framework for public health ethics. (shrink)

There is virtually no philosophical consensus on what, exactly, imperfect duties are. In this paper, I lay out three criteria which I argue any adequate account of imperfect duties should satisfy. Using beneficence as a leading example, I suggest that existing accounts of imperfect duties will have trouble meeting those criteria. I then propose a new approach: thinking of imperfect duties as duties held by groups, rather than individuals. I show, again using the example of beneficence, that this proposal can (...) satisfy the criteria, explaining how something can both have the necessity characteristic of duty, while also allowing agents the latitude which seems to attach to imperfect duties. (shrink)

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

Moral strangerhood is due in part to competing worldviews. The profession of nursing is experiencing a paradigm shift which creates ethical dilemmas for both Christian nurses and Christian patients. Nursing's new focus on spirituality and spiritual care presents itself as broadly defining a desired state or patient outcome — spiritual integrity — supposed to be applicable to all patients of all faiths. Analysis of nursing's definition of spirituality reveals assumptions and values consistent with an Eastern/New Age worldview which may cause (...) hostility towards Christian patients stereotyped as dogmatic or noncompliant. (shrink)

I use a version of the case in "sophie's choice" as an example of the strongest sort of dilemma, With all options seriously wrong, And no permissible way of choosing one of them. This is worse, I argue, Than a choice between conflicting obligations, Where the agent has an overriding obligation "to choose", And does nothing wrong, Once the choice is made, By ignoring one of his prior obligations. Here, "contra" marcus, Guilt seems inappropriate.