We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to “need” and “the capacity to benefit”. Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer and (...) Wagstaff offers a visual and conceptual aid. Of the eight principles we illustrate, only two treat as relevant both a person’s initial health state and a person’s CTB per resource unit expended: allocate resources so as to most closely equalize final health states and allocate resources so as to equally restore health states to population norms. These allocative principles ought to be preferred to the alternatives if one deems relevant both a person’s initial health state and a person’s CTB per resource unit expended. Finally, we examine some possibilities for conceptualizing benefits as relative to how badly off someone is, extending Parfit’s thought on Prioritarianism. Questions arise as to how much intervention effects accruing to the worse off count for more and how this changes with improving health. We explicate some recent efforts to answer these questions, including in Dutch and British government circles. These efforts can be viewed as efforts to operationalize need as an allocative principle. Each effort seeks to maximize in the aggregate quanta of effect that are differentially valued in favor of the worst off. In this respect, each effort constitutes one type of Prioritarianism, which Parfit failed to differentiate from other types. (shrink)

Recent findings suggest that medical students’ moral competence decreases throughout medical school. This pilot study gives preliminary insights into the effects of two educational interventions in ethics classes on moral competence among medical students in Munich, Germany. Between 2012 and 2013, medical students were tested using Lind’s Moral Competence Test prior to and after completing different ethics classes. The experimental group participated in principle-based structured case discussions and was compared with a control group with theory-based case (...) discussions. The pre/post C-scores were compared using a Wilcoxon Test, ANOVA and effect-size calculation. The C-score improved by around 3.2 C-points in the EG, and by 0.2 C-points in the CG. The mean C-score difference was not statistically significant for the EG or between the two groups. There was no statistical significance for the teachers’ influence on C-score. In both groups, students with below-average C-scores improved and students with above-average C-scores regressed. The increase of the C-Index was greater in the EG than in the CG. The absolute effect-size of the EG compared with the CG was 3.0 C-points, indicating a relevant effect. Teaching ethics with PBSCDs did not provide a statistically significant influence on students’ moral competence, compared with TBCDs. Yet, the effect size suggests that PBSCDs may improve moral competence among medical students more effectively. Further research with larger and completely randomized samples is needed to gain definite explanations for the results. (shrink)

A small set of allocation principles is said to be behind several theories of distributive justice. However, disagreement about the appropriate relationship between these notions remains, so that compromises between principles may generate more agreement. Truncated utilitarianism is a prominent candidate. It demands maximising total wealth subject to a floor level of individual wealth for all people. Based on some well-known distributive notions, we developed a questionnaire setting and confronted student respondents with corresponding allocation problems, where an exogenously given poverty (...) line served as a floor. However, support for allocations resulting from this specific interpretation of truncated utilitarianism remained rather low. This is surprising because the respective solution was close to an equal split of resources, and aspects of efficiency and responsibility were explicitly introduced to promote more general acceptance. We argue that people may either wish to see higher floor levels or are more inequality averse than probably expected. Moreover, high support for an unconditional consideration of the poverty line can be witnessed, even though aspects of responsibility, but not efficiency arguments, display an influence. In general, attitudes with respect to the equality–efficiency trade-off are found to remain heterogeneous, although different equality concerns are prominent. Furthermore, trade-offs are moderated by the responsibility principle. (shrink)

Broadly speaking, the principle of public justifiability requires that the exercise of political power be justifiable to each and every person over whom that power is exercised. The idea of being justifiable to every person means being acceptable to any reasonable or otherwise qualified person, without such persons having to give up the comprehensive religious or philosophical doctrine they reasonably espouse. Public justifiability thus involves a partly idealized unanimity requirement, or as I will say, a criterion of multi-perspectival acceptability. (...) The demand for public justifiability can be specified in different ways, depending on what exactly has to be publicly justifiable, who is supposed to apply the principle, who counts as reasonable or otherwise qualified, and so on. One of these dimensions concerns the notion of acceptability. Should we care about acceptability to each reasonable perspective, based on all of the reasons that perspective accepts, or should we care about acceptability to all, based on only those reasons that all reasonable perspectives accept? This choice has been referred to by the distinction between "consensus" and "convergence." Sometimes people agree about practical conclusions but for different reasons, in which case their reasoning can be said to converge from different moral or philosophical starting points. Other times, people agree about their moral or philosophical starting points, but reach different practical conclusions, based on different beliefs about the factual context, different rankings of shared concerns, or different judgments about how to apply these concerns to specific situations. (shrink)

Broadly speaking, the principle of public justifiability requires that the exercise of political power be justifiable to each and every person over whom that power is exercised. The idea of being justifiable to every person means being acceptable to any reasonable or otherwise qualified person , without such persons having to give up the comprehensive religious or philosophical doctrine they reasonably espouse. Public justifiability thus involves a partly idealized unanimity requirement, or as I will say, a criterion of multi-perspectival (...) acceptability. The demand for public justifiability can be specified in different ways, depending on what exactly has to be publicly justifiable, who is supposed to apply the principle, who counts as reasonable or otherwise qualified, and so on. One of these dimensions concerns the notion of acceptability. Should we care about acceptability to each reasonable perspective, based on all of the reasons that perspective accepts, or should we care about acceptability to all, based on only those reasons that all reasonable perspectives accept? This choice has been referred to by the distinction between "consensus" and "convergence." Sometimes people agree about practical conclusions but for different reasons, in which case their reasoning can be said to converge from different moral or philosophical starting points. Other times, people agree about their moral or philosophical starting points, but reach different practical conclusions, based on different beliefs about the factual context, different rankings of shared concerns, or different judgments about how to apply these concerns to specific situations. (shrink)

Designed specifically for the educational needs of RN to BSN students This is a unique, innovative professional nursing ethics textbook designed specifically for the educational needs of RN to BSN students. Written by experts in the field, it discusses ethical concepts geared to the licensed nurse who has spent several years in practice but is learning high-level concepts and applications. The text addresses different areas of professional practice and is rich with case studies illustrating clinical scenarios involving ethical awareness and (...) decision-making. The book fulfills the necessary criteria for the AACN Essentials for Baccalaureate Education and the QSEN and ISOM competencies. Clear and concise, the text relates content to the nurse’s current practice and professional development without extraneous information typically included in other texts. Progressing from simple to complex, chapters build on previous practice experience to focus on ethical decision-making in a variety of practice environments. The book incorporates a “four boxes” decision-making model and addresses essential communication skills, how to recognize and resolve moral distress, and the role of an ethics committee. It discusses common ethical issues likely to be encountered and ethical practice as it relates to quality and safety. Case Study Dilemmas that include evidence-based research provide the opportunity to apply ethical decision-making principles. QSEN application principles are also featured in each chapter, and interactive exercises and questions and PowerPoints provide further opportunity for critical thinking. Key Features: Addresses the specific needs of students in the RN to BSN course Fulfills AACN Essentials, IOM Competencies, and QSEN KSAs Builds upon previous practice experience of RN to BSN students Discusses ethical decision-making in a variety of practice environments Includes Case Study Dilemmas to apply ethical decision-making principles. (shrink)

I argue against traditional virtue epistemology on which knowledge is a success due to a competence to believe truly, by revealing an in-principle problem with the traditional virtue epistemologist’s explanation of Gettier cases. The argument eliminates one of the last plausible explanation of Gettier cases, and so of knowledge, in terms of non-factive mental states and non-mental conditions. I then I develop and defend a different kind of virtue epistemology, on which knowledge is an exercise of a (...) class='Hi'>competence to know. I show how the account, while circular, is not viciously so. It explains both how knowledge is a mental state, as well as the relationship between knowledge and justification, including justified false beliefs and Gettier cases. Moreover, although direct virtue epistemology is compatible with many views on the nature of belief, it can explain how knowledge might be metaphysically more fundamental than belief as well. (shrink)

According to the principle of patient autonomy, patients have the right to be self-determining in decisions about their own medical care, which includes the right to refuse treatment. However, a treatment refusal may legitimately be overridden in cases where the decision is judged to be incompetent. It has recently been proposed that in assessments of competence, attention should be paid to the evaluative judgments that guide patients' treatment decisions.In this paper I examine this claim in light of theories (...) of practical rationality, focusing on the difficult case of an anorexic person who is judged to be competent and refuses treatment, thereby putting themselves at risk of serious harm. I argue that the standard criteria for competence assess whether a treatment decision satisfies the goals of practical decision-making, and that this same criterion can be applied to a patient's decision-guiding commitments. As a consequence I propose that a particular understanding of practical rationality offers a theoretical framework for justifying involuntary treatment in the anorexia case. (shrink)

As a supplement to other volumes in the Thinker’s Guide Library, this book provides a framework by which to assess the integration of critical thinking into an educational system The critical thinking competency standards articulated in this guide serve as a resource for teachers, curriculum designers, administrators and accrediting bodies.

The practice of unrestricted universal suffrage is unjust. Citizens have a right that any political power held over them should be exercised by competent people in a competent way. Universal suffrage violates this right. To satisfy this right, universal suffrage in most cases must be replaced by a moderate epistocracy, in which suffrage is restricted to citizens of sufficient political competence. Epistocracy itself seems to fall foul of the qualified acceptability requirement, that political power must be distributed in ways (...) against which there are no qualified objections. However, it is less intrinsically unjust than democracy with universal suffrage, and probably produces more just outcomes. Thus epistocracy is more just than democracy, even if not perfectly just. (shrink)

In this thoughtful article analyzing a UK court decision upholding a patient’s refusal of dialysis, the authors make the provocative but ultimately unpersuasive argument tha...

In 2011 it emerged that to induce the death penalty, United States authorities had begun giving injections of pentobarbital, a substance provided by Danish pharmaceutical company Lundbeck. Lundbeck's product pentobarbital is licensed for treatment of refractory forms of epilepsy and for usage as an anaesthetic, thus for a very different purpose. The Lundbeck case offers a difficult, but also interesting Corporate Social Responsibility (CSR) dilemma between choices facing a pharmaceutical company to stop the distribution of a medical substance in order (...) to avoid complicity in human rights violations, or to retain distribution of the substance in order not to impede access to the medicine for those patients who need it. The dilemma arose at a time when the United Nations (UN) Secretary General's Special Representative on Business and Human Rights, Professor John Ruggie, was finalizing a set of Guiding Principles to operationalize recommendations on business and human rights that he had presented to the UN Human Rights Council in 2008. The article discusses the dilemma in which Lundbeck was placed in from the perspective of the Guiding Principles on business and human rights and the 2008 Protect, Respect, Remedy UN Framework. The analysis seeks to assess what guidance may be gauged from the Guiding Principles in relation to the dilemma at hand and discusses the adequacy the Guiding Principles for dealing with acute human rights dilemmas of conflicting requirements in which a decision to avoid one type of violation risks causing violation of another human right. The article concludes by drawing up perspectives for further development of guidance on implementation of the UN Framework that could be considered by the newly established Working Group on Business and Human Rights and related UN bodies. (shrink)

The “participatory turn” cutting across technical approaches for appraising environment, risk, science, and technology has been accompanied by intense debates over the desired nature, extent, and quality of public engagement in science. Burgeoning work evaluating the effectiveness of such processes and the social study of science in society more generally is notable, however, for lacking systematic understanding of the very actors shaping these new forms science-society interaction. This paper addresses this lacuna by drawing on United Kingdom based in-depth empirical research (...) that made space for participatory appraisal experts to reflect on effective practice and novel questions of competence, expertise, and citizen-specialist relations within analytic-deliberative processes. Emerging practitioner principles warn that existing participatory models have not sufficiently considered constructivist perspectives on knowledge, analysis, and deliberation. Effective participatory appraisal under uncertainty needs to guard against the “technocracy of participation” by opening up to diversity, difference, antagonism, and uncertainties/indeterminacies. (shrink)

The “participatory turn” cutting across technical approaches for appraising environment, risk, science, and technology has been accompanied by intense debates over the desired nature, extent, and quality of public engagement in science. Burgeoning work evaluating the effectiveness of such processes and the social study of science in society more generally is notable, however, for lacking systematic understanding of the very actors shaping these new forms science-society interaction. This paper addresses this lacuna by drawing on United Kingdom based in-depth empirical research (...) that made space for participatory appraisal experts to reflect on effective practice and novel questions of competence, expertise, and citizen-specialist relations within analytic-deliberative processes. Emerging practitioner principles warn that existing participatory models have not sufficiently considered constructivist perspectives on knowledge, analysis, and deliberation. Effective participatory appraisal under uncertainty needs to guard against the “technocracy of participation” by opening up to diversity, difference, antagonism, and uncertainties/indeterminacies. (shrink)

This book provides a succinct, student-friendly outline of the principles, approaches, and issues in participant observation. An examination of these basic tenets is important for clarifying the philosophical rationale for conducting participant observation, making important research decisions, and appreciating the strengths and weaknesses of different approaches within the method. Participant observation as a formal means of inquiry is developed in close relation with the competing approaches of reality (ontology), truthfully apprehending reality (epistemology), and formal research (methodology). In this volume Jorgensen (...) discusses the resulting methodologies of positivism, humanism, and most recently postmodernism in relation to principles, approaches, and issues in participant observation. Specific features of participant observation, as exemplified in a wide range of classic and contemporary studies, are examined by way of these methodological approaches along with the troublesome complexities of values, politics, ethics, and contemporary debates over appropriate representations of the resulting findings about human life. This concise primer is suitable for undergraduate and graduate students in a wide range of disciplines such as anthropology, religious studies, sociology and nursing. (shrink)

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

In early 2011, news emerged that United States authorities had begun to apply injections of pentobarbital, a substance provided by Danish pharmaceutical company Lundbeck, when executing capital punishments. Lundbeck reported to be appalled by such unintended usage of pentobarbital, which is licensed for treatment of refractory forms of epilepsy and for usage as an anaesthetic.The human rights NGOs Reprieve and Amnesty International urged Lundbeck to ensure that pentobarbital was not made available to U.S. authorities for use in capital punishments. Lundbeck (...) argued that complete halting of provision of pentobarbital would be detrimental to patients suffering from conditions of severe epilepsy for whom the substance was developed and intended for treatment for life-threatening epileptic seizures. Lundbeck’s Danish headquarters also argued that controlling the provision of pentobarbital was out of Danish Lundbeck’s hands because the substance is produced at Lundbeck’s plant in the United States. Eventually, after talks with Amnesty International and Reprieve, Lundbeck in July 2011 announced that it would seek to put a stop to using pentobarbital in capital punishment through the introduction of a “drop-ship” program. (shrink)

Competent patients who refuse life saving medical treatment present a dilemma for healthcare professionals. On one hand, respect for autonomy and liberty demand that physicians respect a patient’s decision to refuse treatment. However, it is often apparent that such patients are not fully competent. They may not adequately comprehend the benefits of medical care, be overly anxious about pain, or discount the value of their future state of health. Although most bioethicists are convinced that partial autonomy or marginal competence (...) of this kind demands the same respect as full autonomy, Israeli legislators created a mechanism to allow ethics committees to override patients’ informed refusal and treat them against their will. To do so, three conditions must be satisfied: physicians must make every effort to ensure the patient understands the risks of non-treatment, the treatment physicians propose must offer a realistic chance of significant improvement, and there are reasonable expectations that the patient will consent retroactively. Although not all of these conditions are equally cogent, they offer a way forward to assure care for certain classes of competent patients without abandoning the principle of autonomy altogether. These concerns reach past Israel and should engage healthcare professionals wary that respect for autonomy may sometimes cause avoidable harm. (shrink)

Legal concepts can sometimes be unclear, leading to disagreements concerning their contents and inconsistencies in their application. At other times, the legal application of a concept can be entirely clear, sharp, and free of confusions, yet conflict with the ways in which ordinary people or other relevant stakeholders think about the concept. The aim of this chapter is to investigate the role of experimental jurisprudence in articulating and, ultimately, dealing with competing conceptual inferences either within a specific domain (e.g., legal (...) practice) or between, for example, ordinary people and legal practitioners. Although this chapter affirms the widespread assumption that experimental jurisprudence cannot, in and of itself, tell us which concepts should be applied at law, it highlights some of the contributions that experimental jurisprudence can, in principle, make to normative projects that seek to prescribe, reform, or otherwise engineer legal concepts. Thus, there is more that experimental jurisprudence can normatively offer than has usually been claimed. (shrink)

Developmentally, adolescence sits in transition between childhood and adulthood. Involving adolescents in their medical decision-making prompts important and complex ethical questions. Originating in the UK, the concept of Gillick competence is a dominant framework for navigating adolescent medical decision-making from legal, ethical and clinical perspectives and is commonly treated as comprehensive. In this paper, we argue that its utility is far more limited, and hence over-reliance on Gillick risks undermining rather than promoting ethically appropriate adolescent involvement. We demonstrate that (...) Gillick only provides guidance in the limited range of cases where legal decisional authority needs to be clarified. The range of cases where use of Gillick actually promotes adolescent involvement is narrower still, because several features must be present for Gillick to be enacted. Each of these features can, and do, act as barriers to adolescent involvement. Within these limited situations, we argue that Gillick is not specific or strong enough and is reliant on ethically contestable principles. Moreover, in most situations in adolescent healthcare, Gillick is silent on the ethical questions around involving adolescents. This is because it focuses on decisional authority—having the final say in decision-making—which is one small subset of the many ways adolescents could be involved in decision-making. The implication of our analysis is that use of Gillick competence tends to limit or undermine adolescent involvement opportunities. We propose that those working with adolescents should be judicious in seeking Gillick’s guidance, instead drawing on and developing alternative frameworks that provide a comprehensive model for adolescent involvement. (shrink)

Among the many components of legal preparedness for public health emergencies is the assurance that the public health workforce and its private sector partners are competent to use the law to facilitate the performance of essential public health services and functions. This is a significant challenge. Multiple categories of emergencies, stemming from natural disasters to emerging infectious diseases, confront public health practitioners. Interpreting, assessing, and applying legal principles during emergencies are complicated by the changing legal environment and differences in governmental (...) organization of emergency management functions. While law and legal competencies are essential to routine public health practices, once government declares a state of public health emergency or disaster, the legal landscape changes. Typical legal responses to protect the public's health may no longer be the norm. Public health practitioners, legal counsel, health care partners, and others need to be able to assess changing laws and policies and apply them in real-time. (shrink)

Among the many components of legal preparedness for public health emergencies is the assurance that the public health workforce and its private sector partners are competent to use the law to facilitate the performance of essential public health services and functions. This is a significant challenge. Multiple categories of emergencies, stemming from natural disasters to emerging infectious diseases, confront public health practitioners. Interpreting, assessing, and applying legal principles during emergencies are complicated by the changing legal environment and differences in governmental (...) organization of emergency management functions. While law and legal competencies are essential to routine public health practices, once government declares a state of public health emergency or disaster, the legal landscape changes. Typical legal responses to protect the public's health may no longer be the norm. Public health practitioners, legal counsel, health care partners, and others need to be able to assess changing laws and policies and apply them in real-time. (shrink)

A semantics of vagueness should reject the principle that every statement has a truth-value yet retain the classical tautologies. A many-value, non-truth-functional semantics and a semantics of super-valuations each have this result. According to the super-valuation approach, 'if a man with n hairs on his head is bald, then a man with n plus one hairs on his head is also bald' is false because it comes out false no matter how the vague predicate 'is bald' is appropriately made (...) precise. But why should a sentence in which components actually remain imprecise be regarded as actually false just because it would be false if its components were precise? On one of the alternative treatments of quantification allowed by the many-value approach, the sentence in question is assigned an intermediate value closer to 'false' than to 'true'. Despite the elegance of the super-valuation approach, there are reasons to prefer the many-value approach. (shrink)

Feminists have argued that oppressive socialization undermines the liberal model of autonomy. We contend that this argument can also be employed effectively as a challenge to the standard bioethical model of informed consent. We claim that the standard model is inadequate because it relies on presumptions of procedural autonomy and rational choice that overlook the problem of how agents are often socialized so that they adopt and internalize oppressive norms as part of their motivational structure. The argument that oppressive socialization (...) undermines liberalism’s view of autonomy is most relevant to what Beauchamp and Childress call the threshold elements of informed consent—competence and voluntariness. We show how these elements fail to account for morally relevant factors such as oppressive socialization. (shrink)

This is the result of a two year theological reflection on the religious and social activities of Catholic women’s organisations. The organisations are found to be active in the area of human rights and particularly women’s rights, as expressed in a critique of society and the Church, and in campaigning or working in the field of social concern. The background to their work is a view of the image of God in all people, which I have compared with the feminist (...) principle of Imago Dei. I find in the activities of these women’s organisations, which are inclined to be marginalized as they deal with day to day issues, Norvene West’s principle of ‘tender competence’ which describes their importance for a theological agenda and helps make them visible to theological reflection. (shrink)

This paper notes the critical response that the ‘competence movement’ has received from writers in philosophy of education and argues for a more positive assessment of what it offers in relation to: (i) the place of practical competence in a liberal education, (ii) the meritocratic principles underlying the competence movement, (iii) the ‘transparency’ of expectations in assessment, and even (iv) the element of practical competence in moral performance. It emphasises, however, that not all versions of ‘ (...) class='Hi'>competence’ can be defended in these terms and that this requires a more generic and cognitively laden concept of personal and professional competence. (shrink)

In contrast to the conventional fund management industry with a profit-oriented logic based on risk and return, ethical and faith-based funds should follow the religious principles of their investment-style philosophy. Islamic funds should obey the theological teachings of the primary sources of Islam, the Quran and Sunnah, as stakeholders expect these religious teachings to influence the investment decisions of fund managers. In practice, Islamic fund managers use Accounting and Auditing Organization for Islamic Financial Institutions ’s screening criteria, based on secondary (...) sources of Islam, which allow investments that are only partially halal to be included in their portfolios. This study finds that a more religious logic in screening practices, although impairing diversification, does not necessarily harm performance. Thus, Islamic investment funds, and the wider ethical fund management industry, should, and could, adopt stricter screening criteria that match their investment mandates and bring more ethical business practices to the industry. (shrink)

Swedenborg's Principles of Usefulness presents a possibly unsuspected historical undercurrent that further evidences Emanuel Swedenborg's pervasive influence on a whole host of historical figures-from poets and artists to philosophers and statesmen-whose contributions to the evolution of self and society have resonated throughout time and into the present. Besides having an impact on individual thinkers, Swedenborg's ideas worked their way into the various social reform traditions that vitalized the American landscape during the nineteenth and early-twentieth centuries. His concept of usefulness, best (...) demonstrated in the competing worldviews of the nation's liberal and conservative traditions, involved a commitment made by Swedenborgians, New Church members, and others to energize the nation and its people by envisaging the possibility of a much-desired Universal Human. (shrink)

SummaryChristians often presume that immediate and universally extensive divine governance of human behavior is incompatible with human agency and responsibility. Against this presumption, Kathryn Tanner argues for a distinctive metalinguistic paradigm whereby Christians can coherently speak of God’s transcendence in such a way that divine action could never in principle ‘compete’ with human action. Thus, it is said, God can comprehensively will each human action without thereby compromising significant human freedom and corresponding moral responsibility. In this article, it is (...) argued that Tanner’s non-competitivist paradigm fails to circumvent a theological version of the ‘direct argument’ for the incompatibility between human moral responsibility and causal determinism. (shrink)

Outlining the major competing theories in the history of political and moral philosophy--from Locke and Hume through Hart, Rawls, and Nozick--John Simmons attempts to understand and solve the ancient problem of political obligation. Under what conditions and for what reasons, he asks, are we morally bound to obey the law and support the political institutions of our countries?

The term ‘publicness’ is a keyword to explain the creation of a people in the history of modern education in Korea in which the relationship between the ruled and the ruling power rapidly changed from the perspective of continuity and discontinuity. In Korea, the term has been commonly used in three different contexts, and its meanings have changed since the 1894 Gabo Reform, the first reform for the modernization of Korea. Even when the ruling power changed in 1910 with Japanese (...) colonialism, the ruling class took the meaning of publicness as a governing institution, which had a very weak sense of publicness as an ethical principle of fairness or as public benefit and opinion. In contrast, the resisting power, which was fully established throughout the colonial era from 1910 to 1945, lacked the sense of publicness as a ruling institution, but embraced the two other concepts of publicness. This historical experience of the competing concepts of publicness materialized into the creation of a modern people through law and education even in the post-colonial period of modern Korea. Generally speaking though, the creation of a modern people in Korea has been strongly affected by the concept of publicness as a ruling institution through a nationalist education. (shrink)

There is no agreed minimum standard with regard to what is considered safe, competent nursing care. Limited resources and organizational constraints make it challenging to develop a minimum standard. As part of their everyday practice, nurses have to ration nursing care and prioritize what care to postpone, leave out, and/or omit. In developed countries where public healthcare is tax-funded, a minimum level of healthcare is a patient right; however, what this entails in a given patient’s actual situation is unclear. Thus, (...) both patients and nurses would benefit from the development of a minimum standard of nursing care. Clarity on this matter is also of ethical and legal concern. In this article, we explore the case for developing a minimum standard to ensure safe and competent nursing care services. Any such standard must encompass knowledge of basic principles of clinical nursing and preservation of moral values, as well as managerial issues, such as manpower planning, skill-mix, and time to care. In order for such standards to aid in providing safe and competent nursing care, they should be in compliance with accepted evidence-based nursing knowledge, based on patients’ needs and legal rights to healthcare and on nurses’ codes of ethics. That is, a minimum standard must uphold a satisfactory level of quality in terms of both professionalism and ethics. Rather than being fixed, the minimum standard should be adjusted according to patients’ needs in different settings and may thus be different in different contexts and countries. (shrink)

In spite of the growing interest in nursing ethics, few studies have focused on ethical dilemmas experienced by nurses working with clinical studies as ‘research nurses’. The aim of the present study was to describe and explore ethical dilemmas that Swedish research nurses experience in their day-to-day work. In a qualitative study a purposeful sample of six research nurses from five wards of differing disciplines in four Swedish hospitals was interviewed. The analysis displayed several examples of ethical dilemmas, primarily tensions (...) between the nurses’ obligations to the study and to the patients involved. A guiding moral principle for the nurses was patient-centeredness, where the interest of research must not override the interest of the patient. In situations where tensions between research and patient interests occurred, and doctors and nurses disagreed upon the judgement, the nurses sometimes chose to follow the doctors’ advice, and thus acted against their own moral judgment. Such situations seemed to create feelings of moral distress among the nurses. They described their profession as being ‘invisible’ and as lacking opportunities for ethical competence building. The conclusion is that research nurses frequently experience severe and difficult ethical dilemmas in their daily work. They need to be acknowledged as a particular profession in the health care organisation and encouraged to develop their specific ethical competence. (shrink)

What are moral principles? The assumption underlying much of the generalism–particularism debate in ethics is that they are (or would be) moral laws: generalizations or some special class thereof, such as explanatory or counterfactual-supporting generalizations. I argue that this law conception of moral principles is mistaken. For moral principles do at least three things that moral laws cannot do, at least not in their own right: explain certain phenomena, provide particular kinds of support for counterfactuals, and ground moral necessities, “necessary (...) connections” between obligating reasons and obligations. Moreover, neither a best-systems theory of moral principles nor any of the competing theories of moral principles proposed by Sean McKeever and Michael Ridge, Pekka Väyrynen, and Mark Lance and Margaret Little could vindicate the law conception of moral principles. I conclude with some brief remarks about what moral principles might be if they are not moral laws. (shrink)

The use of coercive measures in mental health care is an issue of ongoing concern (Cf. Fisher 1994; Janssen et al. 2008; Paterson and Duxbury 2007; Prinsen and Van Delden 2009; Widdershoven and Berghmans 2007; Wynn 2006). On the one hand, coercive interventions seem to infringe the patient’s right to self-determination (principle of autonomy). However, professionals are also committed to providing the care they deem necessary (principle of beneficence). In other words, professionals in mental health care are often (...) caught between the two (opposing) ideals of beneficence and autonomy. In medical practice, the right of self-determination is operationalized in the principle of informed consent. A medical physician is .. (shrink)

We describe a set of two computer‐implemented models that solve physics problems in ways characteristic of more and less competent human solvers. The main features accounting for different competences are differences in strategy for selecting physics principles, and differences in the degree of automation in the process of applying a single principle. The models provide a good account of the order in which principles are applied by human solvers working problems in kinematics and dynamics. They also are sufficiently flexible (...) to allow easy extension to several related domains of physics problems. (shrink)

One of the societal problems in a new influenza pandemic will be how to use the scarce medical resources that are available for prevention and treatment, and what medical, epidemiological and ethical justifications can be given for the choices that have to be made. Many things may become scarce: personal protective equipment, antiviral drugs, hospital beds, mechanical ventilation, vaccination, etc. In this paper I discuss two general ethical principles for priority setting (utility and equity) and explain how these principles will (...) often point in diverging directions. Moreover, each of these principles can be understood in different, again often competing, ways. Notwithstanding these controversies and conflicts, in the context of pandemic response there are at least some points of convergence: several policies can be justified by appeal to different ethical principles and theories. Convergence may be found with respect to a focus on saving the most lives (instead of other aggregative accounts); giving priority antiviral prophylaxis and therapy for life-saving pandemic responders; and, partly depending on epidemiology of the pandemic, to prioritise vaccination of children. Although decision-making about access to intensive care will involve choices with immediate tragic implications, the ethical complexity of these choices is relatively modest (although decisions will not be easy): there are persuasive moral reasons for giving priority to patients who are expected to benefit most within the shortest time. Finally, in the last section I tentatively argue that constraints on people’s freedom, as necessary for an effective public health approach, may support giving somewhat more weight to saving the most lives, than to concerns of equity. (shrink)

In the Crito, a dialogue that is highly influential for the traditions both of philosophy and of political thinking, Socrates resists the pleading of his friend Crito to escape the city that has condemned him. For Arendt, the dialogue instantiates the separation between humans as thinking beings and humans as acting beings, and so between political theory and philosophy. For others, the dialogue shows Socrates’ reasoning to be self-contradictory. Socrates’ introduction of the Athenian Laws as a world of greater moral (...) force than the empirical Athens of Crito’s appeal aims to ground principled action. Yet, there are many competing principles that, interpretively speaking, have been understood as validated by this dialogue. Is there any necessary or analytic principle that can be articulated and, if so, what are the grounds of such? Drawing on the theory and methods of Blum and McHugh’s analysis and Gadamer’s hermeneutics, this article seeks to demonstrate that practical action needs to be understood in an analytic context to grasp fully its ethical and political implications. Along the way, reference will be made to Garfinkel’s articulation of members’ methods for discovering agreements and Arendt’s articulation of the common world that the conversation among friends sustains. (shrink)

Many believe that we ought to save a large number from being permanently bedridden rather than save one from death. Many also believe that we ought to save one from death rather than a multitude from a very minor harm, no matter how large this multitude. I argue that a principle I call “Aggregate Relevant Claims” satisfactorily explains these judgments. I offer a rationale for this principle and defend it against objections.

Individual and institutional conflict of interests in biomedical research have becomes matters of increasing concern in recent years. In the United States, the growth in relationships — sponsored research agreements, consultancies, memberships on boards, licensing agreements, and equity ownership — between for-profit corporations and research universities and their scientists has made the problem of conflicts, particularly financial conflicts, more acute. Conflicts can interfere with or compromise important principles and obligations of researchers and their institutions, e.g., adherence to accepted research norms, (...) duty of care to patients, and open exchange of information. Disclosure is a key component of a successful conflict policy. Commitments which conflict with a faculty member's primary obligations to teaching, research, administrative responsibilities, or patient care also need attention. Institutional conflict of interests present different problems, some of which are discussed in an analysis of an actual problem posed by two proposed clinical trials. (shrink)

A dispute in epistemology has arisen over whether some class of things epistemic (things known or justified, for example) is closed under some operation involving the notion of what follows deductively from members of this class. Very few philosophers these days believe that if you know that p, and p entails q, then you know that q. But many philosophers think that something weaker holds, for instance that if you know that p, and p entails q, then you are in (...) a position to know that p, or if you know that p and you competently deduce p from q, then you know that q. However there are some considerations tracing back to Wittgenstein’s On Certainty and some early work by Fred Dretske that suggests even these weaker principles are false. (shrink)

Equal respect for persons is often appealed to as the grounding principle of democratic rule. I argue here that if it needs to account for the specific content of democratic political rights, it must be understood as respect for people as competent political decision-makers. However, the claim that respect is due to people as a response to their actual equal competence leads to a conflation of democratic legitimacy and substantive justice, resting on implausible factual assumptions and making it (...) impossible to advocate the effective equalization of political capabilities. Therefore, I suggest that the principle of equal respect should be decoupled from such a claim and be rephrased as simply prescribing that people be treated or publicly recognized as equally competent. I defend this interpretation against the publicity objection, according to which this take on the principle implies insincerity and therefore cannot serve as a public justification for democratic authority. (shrink)

This paper considers a guardianship model for the legal representation of future generations. According to this model, national and international courts should be given the competence to appoint guardians for future generations, if agents who care about the welfare of posterity apply for the creation of a guardianship in relation to a dispute that can be resolved by the application of law. This reform would grant guardians of future people legal standing or locus standi before courts, that is, the (...) right to bring an action before a court of law for adjudication. Although the guardianship model faces several difficult theoretical and practical problems pertaining to the representation of different near and distant future generations, it is argued that this model – and certain other legal norms intended to protect future basic needs – can be justified on the basis of the principle of liberty. (shrink)

The likelihood of a statement is often derived by generating an explanation for it and evaluating the plausibility of the explanation. The explanation discounting principle states that people tend to focus on a single explanation; alternative explanations compete with the effect of reducing one another’s credibility. Two experiments tested the hypothesis that this principle applies to inductive inferences concerning the properties of everyday categories. In both experiments, subjects estimated the probability of a series of statements and the conditional (...) probabilities of those conclusions given other related facts. For example, given that most lawyers make good sales people, what is the probability that most psychologists make good sales people? The results showed that when the fact and the conclusion had the same explanation the fact increased people’s willingness to believe the conclusion, but when they had different explanations the fact decreased the conclusion’s credibility. This decrease is attributed to explanation discounting; the explanation for the fact had the effect of reducing the plausibility of the explanation for the conclusion. (shrink)

Internationally, there is an on-going dialogue about how to professionalize ethics consultation services . Despite these efforts, one aspect of ECS-competence that has received scant attention is the liability of failing to adequately capture all of the relevant moral considerations in an ethics conflict. This failure carries a high price for the least powerful stakeholders in the dispute. When an ECS does not possess a sophisticated dexterity at translating what stakeholders say in a conflict into ethical concepts or principles, (...) it runs the risk of naming one side's claims as morally legitimate and decrying the other's as merely self-serving. The result of this failure is that one side in a dispute is granted significantly more moral weight and authority than the other. The remedy to this problem is that ECSs learn how to expand the diagnostic moral lens they employ in clinical ethics conflicts. (shrink)