Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fact that therapy has been initiated entails a (...) claim to continue therapy that cannot be attributed to patients who have not yet received therapy. This intrinsic difference between withholding and withdrawing therapy is of moral importance. In many instances, patients will waive this claim. But when one considers withdrawing therapy from one patient to help another in a setting of scarce resources, this intrinsic moral difference comes into sharp focus. In an era of shrinking medical resources, this difference cannot be ignored. (shrink)

This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.

The National Conference of Catholic Bishops has argued for significant government involvement in health care in order to assure respect for what they regard as the right to health care. Critics charge that the bishops are wrong because health care is not a right. In this article, it is argued that these critics are correct in their claim that health care is not a right. However, it is also argued that the premise that health care is not a right does (...) not imply that the market is the most equitable and just system for providing health care. Natural law arguments in the tradition of Roman Catholic social teaching lead to the conclusion that a just and prosperous society has a moral obligation to provide health care even if there is no such right. Further, there are strong moral grounds for concluding that the bishops are correct in their claim that health care ought not to be considered a market commodity. It is argued that if health care ought not to be considered a commodity, then national health insurance is the best available alternative for fulfilling the social obligation to distribute health care resources justly and fairly at this time in American history. The bishops' case for government involvement can be made on the strength of the Catholic tradition in theological argumentation, independent of the claim that health care is a right. (shrink)

The introduction of conscience clauses after the 1973 US Supreme Court decision in Roe v. Wade allowed physicians and nurses to opt out of medical procedures, particularly abortions, to which they were morally opposed. In recent years pharmacists have requested the same consideration with regard to dispensing some medicines. This paper examines the pharmacists’ role and their professional and moral obligations to patients in the light of recent refusals by pharmacists to dispense oral contraceptives. A review of John Rawls’s concepts (...) of the “original position” and the “veil of ignorance”, along with consideration of the concept of compartmentalisation, are used to assess pharmacists’ requests and the moral and legal rights of patients to have their prescriptive needs met. (shrink)

Utilitarianism, For and Against contains in a single volume a slightly revised version of An Outline of a System of Utilitarian Ethics which J. J. C. Smart published in 1961, together with a critique of it by Bernard Williams. Stuart Hampshire gives another critique in Morality and Pessimism.* After touching on Hampshire I shall outline what seems distinctive of Smart's utilitarianism then consider Williams’ objections.If I remember rightly, Bentham wrote an ‘analysis of the effects of Christianity on the temporal happiness (...) of mankind’. In his Leslie Stephen Lecture, Hampshire gives utilitarianism a similar examination. We all know that for its fathers, utilitarianism was not simply a moral theory. They set out to do good in the world. Hampshire acknowledges that for long utilitarianism did much good. (shrink)

Cooperation towards public goods relies on credible threats of punishment to deter cheats. However, punishing is costly, so it remains unclear who incurred the costs of enforcement in our evolutionary past. Theoretical work suggests that human cooperation may be promoted if people believe in supernatural punishment for moral transgressions. This theory is supported by new work in cognitive psychology and by anecdotal ethnographic evidence, but formal quantitative tests remain to be done. Using data from 186 societies around the globe, I (...) test whether the likelihood of supernatural punishment—indexed by the importance of moralizing “high gods”—is associated with cooperation. (shrink)

Is it a mistake to use "true" or "false" in certain contexts? White sets the stage for dealing with this issue by laying out a field of usages. He develops his position by characterizing and criticizing contemporary treatments of these data, moving rapidly from case to case. His numerous summaries and conclusions, obviously based on a wider view of the material than is presented in the text, may leave the uninitiated alternately puzzled, bristling, or suspicious. While White's data are expressed (...) clearly, the goal of his arguments and his organizational principles are frequently less apparent. White's discussions of fiction and modality are of particular historic interest. Here we find Frege and Russell arguing about whether they can argue about the King of France. We meet with Aristotle's ancient problem of the future naval battle, witness latter-day skirmishes over the nature of moral language, and find Leibniz, Hume, and Kant debating the logic of necessity and contingency. Are there really different types of truth which correspond with different modalities and existence presuppositions, as White seems to assume? This question, harking back to books 5 and 6 of Plato's Republic, is passed over by White in his usage-oriented quest for the sense of "truth." Truth will suit both student and researcher alike and is to be recommended for its breadth of concern and for its 18 pages of bibliography.--M. D. P. [[sic]]. (shrink)

The general topic is morality, divided into three notions, Action, Wisdom and Grace. The lectures are lively historical reflections on these notions seen in the context of Greek thought, especially that of Plato and Aristotle.--R. D. P.

This collection of reprinted social philosophy broadly surveys and introduces problems and positions vis-à-vis the concept of right. Using the tools of ordinary language analysis, M. MacDonald evaluates the attempts of other writers to resolve the tensions between civil and moral responsibility. H. L. A. Hart argues that "... if there are any moral rights at all, it follows that there is at least one natural right." His laudatory deductive exercise and categorization of rights suggests no leads for answering the (...) hypothetical he poses. While MacDonald and Hart raise no gut issues, G. Vlastos gives a common sense analysis of the main stream of classical debate, couching his inquiry in terms of conflicts between collective and distributive justice. His article both includes the scope and surpasses the stopping points of the earlier selections. Through leading to a philosophical discussion of the workings of the denial of human rights within the segregationist position, R. Wasserstrom unmasks the practical stakes involved in what the others leave as an academic problem. H. Morris's witty analysis of a hypothetical "right to be punished" lays bare the fact that social institutions embody some concept of right, duty, and obligation. He leaves the reader with the unanswered but clearly indicated question of which concept of right does one want society to sanction. Also included are: J. Locke's The Second Treatise of Civil Government, Chapters two and five; J. Bentham's Anarchical Fallacies; The Virginia Declaration of Rights ; Declaration of the Rights of Man and of Citizens ; Universal Declaration of Human Rights ; and a portion of the Declaration of Independence of the U.S.A.--M. D. P. (shrink)

After a brief review of pragmatic arguments against emotivism, the author of this monograph proceeds to outline and criticize two conflicting concepts of the morally right in Dewey's writings. A third interpretation, involving an "interaction of the factual and the normative" is advanced as more conformable to the spirit of instrumentalism.--A. D. P. M.

Illustrations: 1 B/w Illustration Description: Pranab Kumar Sen, Professor Emeritus, Jadavpur University in whose honour this volume has been prepared was one of the leading philosophers of our country and a highly respected teacher. It carries thirty-five articles which deal with different branches of philosophy,viz., philosophical logic, philosophy of language, ontology, theory of knowledge, Kant exegesis, moral philosophy, social philosophy, philosophy of art. As Sen's philosophical interests and expertise were wide the authors had ample freedom in their choice of topics. (...) This volume will be of interest to those who are acquainted with sophisticated literature in analytic philosophy, scholars working in different branches of philosophy and also general readers of modern philosophy. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

Stephen Kearns and Daniel Star have made the following interesting proposal concerning the relation between practical reasons and evidence : Necessarily: A fact F is a reason for you to φ iff F is evidence that you ought to φ We're not sure about this. Although moving from left to right might be OK, the converse is problematic. For example, the fact that your reliable friend told you that you have overriding moral reason to φ is ….

This paper concludes a special feature of Sustainability Science that explores a broad range of social value theoretical traditions, such as religious studies, social psychology, indigenous knowledge, economics, sociology, and philosophy. We introduce a novel transdisciplinary conceptual framework that revolves around concepts of 'lenses' and 'tensions' to help navigate value diversity. First, we consider the notion of lenses: perspectives on value and valuation along diverse dimensions that describe what values focus on, how their sociality is envisioned, and what epistemic and (...) procedural assumptions are made. We characterise fourteen of such dimensions. This provides a foundation for exploration of seven areas of tension, between: (1) the values of individuals vs collectives; (2) values as discrete and held vs embedded and constructed; (3) value as static or changeable; (4) valuation as descriptive vs normative and transformative; (5) social vs relational values; (6) different rationalities and their relation to value integration; (7) degrees of acknowledgment of the role of power in navigating value conflicts. In doing so, we embrace the 'mess' of diversity, yet also provide a framework to organise this mess and support and encourage active transdisciplinary collaboration. We identify key research areas where such collaborations can be harnessed for sustainability transformation. Here it is crucial to understand how certain social value lenses are privileged over others and build capacity in decision-making for understanding and drawing on multiple value, epistemic and procedural lenses. (shrink)

In vitro fertilisation is now an established technique for treating some forms of infertility, yet it remains ethically controversial. New developments, such as embryo donation and embryo freezing, have led to further discussion. We briefly discuss the ethical aspects of IVF, focusing on the issues of resource allocation, the 'unnaturalness' of the procedure, the moral status of the embryo, surrogate motherhood, and restrictions on access to IVF. We argue that, on the whole, IVF is an ethically justifiable method of assisting (...) infertile couples. (shrink)

This paper concludes a special feature of Sustainability Science that explores a broad range of social value theoretical traditions, such as religious studies, social psychology, indigenous knowledge, economics, sociology, and philosophy. We introduce a novel transdisciplinary conceptual framework that revolves around concepts of ‘lenses’ and ‘tensions’ to help navigate value diversity. First, we consider the notion of lenses: perspectives on value and valuation along diverse dimensions that describe what values focus on, how their sociality is envisioned, and what epistemic and (...) procedural assumptions are made. We characterise fourteen of such dimensions. This provides a foundation for exploration of seven areas of tension, between: (1) the values of individuals vs collectives; (2) values as discrete and held vs embedded and constructed; (3) value as static or changeable; (4) valuation as descriptive vs normative and transformative; (5) social vs relational values; (6) different rationalities and their relation to value integration; (7) degrees of acknowledgment of the role of power in navigating value conflicts. In doing so, we embrace the ‘mess’ of diversity, yet also provide a framework to organise this mess and support and encourage active transdisciplinary collaboration. We identify key research areas where such collaborations can be harnessed for sustainability transformation. Here it is crucial to understand how certain social value lenses are privileged over others and build capacity in decision-making for understanding and drawing on multiple value, epistemic and procedural lenses. (shrink)

The place of philosophical medical ethics in medical education and clinical practice has recently been questioned. Although partially valid, the criticisms do not warrant abandoning the enterprise. Instead a reappraised model, based on Aristotelean concepts of intellectual and moral virtue is suggested.

Making research data readily accessible during a public health emergency can have profound effects on our response capabilities. The moral milieu of this data sharing has not yet been adequately explored. This article explores the foundation and nature of a duty, if any, that researchers have to share data, specifically in the context of public health emergencies. There are three notable reasons that stand in opposition to a duty to share one’s data, relating to: (i) data property and ownership, (ii) (...) just distribution of benefits and burdens and (iii) the contemporary ethos of science. We argue each reason can be successfully met with corresponding rationale in favour of data sharing. Further support for data sharing has been echoed in policies of health agencies, funding bodies and academic institutions; in documents on the ethical conduct of biomedical research; and in discussions on the nature of public health. From this, we ascertain that sharing data is the morally sound default position. This article then highlights the key roles reciprocity and solidarity play in supporting the practice of data sharing. We conclude with recommendations to regard public health research data as a common-pool resource in order to build a framework for stable data sharing management. (shrink)

Many enhancement technologies are distributed by healthcare professionals—by physicians—who are held to the Hippocratic Oath and the goals of medicine. While the ethics of enhancement has been widely discussed with regard to the social justice, humanism, morals and normative values of these interventions, their place in medicine has not attracted a great deal of attention. This paper investigates the potential for enhancement technologies to fulfil the goals of medicine, arguing that they play a role in promoting the health of individuals, (...) and thus, an unavoidable place in medicine. It also warns of potential dangers, suggesting a set of guidelines to initiate conversations regarding the role and responsibilities of physicians practising in an era of enhancement. (shrink)

Debates about the underdetermination of theory by data often turn on specific examples. Cases invoked often enough become familiar, even well worn. Since Helen Longino’s discussion of the case, the connection between prenatal hormone levels and gender-linked childhood behaviour has become one of these stock examples. However, as I argue here, the case is not genuinely underdetermined. We can easily imagine a possible experiment to decide the question. The fact that we would not perform this experiment is a moral, rather (...) than epistemic, point. Finally, I suggest that the ”underdetermination’ of the case may be inessential for Longino to establish her central claim about it. (shrink)

Employing the tools of logical analysis, Åquist presents a very careful, though cumbrously formalistic, reassessment of Price's Review of the Principal Questions in Morals, a treatise which he considers as the best in its field before Sidgwick and Moore.--A. P. D. M.

In ‘The nature of moral judgments and the extent of the moral domain’, Fraser criticises findings by Kelly et al. that speak against the moral/conventional distinction, arguing that the experiment was confounded. First, we note that the results of that experiment held up when confounds were removed . Second, and more importantly, we argue that attempts to prove the existence of a M/C distinction are systematically confounded. In contrast to Fraser, we refer to data that support our view. We highlight (...) the implications for the moral/conventional theory. (shrink)

Recent studies lead to the paradoxical conclusion that the act of affirming one's egalitarian or prosocial values and virtues might subsequently facilitate prejudiced or self-serving behavior, an effect previously referred to as ?moral credentialing.? The present study extends this paradox to the domain of academic misconduct and investigates the hypothesis that such an effect might be limited by the extent to which misbehavior is rationalizable. Using a paradigm designed to investigate deliberative and rationalized forms of cheating (von Hippel, Lakin, & (...) Shakarchi, 2005), we found that when participants had credentialed themselves (vs. a nonclose acquaintance) via a set of hypothetical moral dilemmas, they were more likely to cheat on a subsequent math task, but only if cheating was highly rationalizable. When cheating was difficult to rationalize, moral credentialing had almost no impact on cheating. (shrink)

Employing the tools of logical analysis, Åquist presents a very careful, though cumbrously formalistic, reassessment of Price's Review of the Principal Questions in Morals, a treatise which he considers as the best in its field before Sidgwick and Moore.--A. P. D. M.

In Kant and the Role of Pleasure in Moral Action, Iain Morrisson offers a new view on Kant’s theory of moral action.

More than half of the book is devoted to what is almost a catalogue exposition of Western moral philosophy from Kant to Nowell-Smith. Although the author claims in the preface to have included "suitable references to Indian points of view, including the Buddhist," what references there are are usually too general, and never fully explained to be of any use to Western readers. Exposition tends to be disjointed, and the English leaves much to be desired. On the whole there is (...) much eclecticism and little originality.--A. P. D. M. (shrink)

This is a book both sober and optimistic, both analytical and humane. In the course of a virtual reinstatement of a Socratic ethics, it is claimed that: analytic philosophy can decide moral issues, at least indirectly, by clarifying the relevant concepts; moral philosophers are wrong in saying that there can be no argument about generally accepted standards; our failure to resolve cases of ultimate ethical disagreement is only a measure of our ignorance of the human machine, and confusion about our (...) shared purposes; students of moral concepts cannot be neutral with respect to morals--analytic philosophers should not disguise their role as social reformers.--A. P. D. M. (shrink)

The study reports on the results of an empirical investigation of the education and recruitment processes used in HIV vaccine trials conducted in South Africa. Interviews were conducted with 21 key informants involved in HIV vaccine research in South Africa and three focus groups of community advisory board members. Data analysis identified seven major themes on the relationship between education and recruitment: the process of recruitment, the combined dual role of educators and recruiters, conflicts perceived by field staff, pressure to (...) achieve recruitment targets, problems in achieving comprehension, accountability and education as capacity building. The results raise ethical concerns about the adequacy of current informed consent processes in these settings. The study findings bear directly on current debates about issues of exploitation and the scope of moral responsibilities of researchers and funding agencies to assure that HIV clinical prevention research is conducted ethically. (shrink)

Some philosophers think that there is a gap between is and ought which necessarily makes normative enquiry a different kind of thing than empirical science. This position gains support from our ability to explicate our inferential practices in a way that makes it impermissible to move from descriptive premises to a normative conclusion. But we can also explicate them in a way that allows such moves. So there is no categorical answer as to whether there is or is not a (...) gap. The question of an is-ought gap is a practical and strategic matter rather than a logical one, and it may properly be answered in different ways for different questions or at different times. (shrink)

It has been argued that Plato sought to make his rulers invulnerable to any kind of wrongdoing. In this paper we argue that this (humanly impossible) claim misunderstand the ways in which Plato shapes his state precisely in order to make the rulers safe from what could corrupt them.

The place of scientific results, the role of scientific method, and the impact of the scientific temper in ethical theory are surveyed. The concept of an "existential perspective of an ethical theory"--"its view of the world and its properties, man's nature and condition, insofar as these enter into its understanding of moral processes and moral judgments"--is sketched and used to clarify the diversity of ethical approaches. Edel promises, but does not here develop, a scientific ethics based on the behavioral sciences.--A. (...) P. D. M. (shrink)

This volume investigates the role of the arts in character education. Bringing together insights from esteemed philosophers and educationalists, it looks to the arts for insight into human character and explores the arts' relationship to human flourishing and the development of the virtues. Focusing on the moral value of art and considering questions of whether there can be educational value in imaginative and non-narrative art, the nine chapters herein critically examine whether poetry, music, literature, films, television series, videogames, and even (...) gardening may improve our understanding of human character, sharpen our moral judgement, inculcate or refine certain skills required for virtue, or perhaps cultivate certain virtues themselves. Bringing together research on aesthetics, ethics, moral and character education, this book will appeal to students, researchers and academics of philosophy, arts, and education as well as philosophers of education, morality, aesthetics, and teachers of the arts. (shrink)

The crisis in donor organ and tissue supply is one of the most difficult challenges for transplant today. New policy initiatives, such as the driver's license option and requiredrequest, have been implemented in many states, with other initiatives, such as mandatedchoice and presumedconsent, proposed in the hopes of ameliorating this crisis. At the same time, traditional acquisition of organs from human cadavers has been augmented by living human donors, and nonheartbeating human donors, as well as experimental animal and artificial sources. (...) Despite these efforts, the crisis persists and is perhaps most tragic when it threatens the lives of children, driving parents to sometimes desperate measures. Herein, we address one very controversial step some parents have taken to obtain matching tissue or organs for their needy children—that is, having a child, in part, for the purpose of organ or tissue procurement. (shrink)

This study examined health professionals’ (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)—controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios—BD, uncontrolled DCD and controlled DCD—were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (1) In the (...) context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors’ loss of circulatory function could be reversed, and raises questions about “death” as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs’ discomfort must be further identified and addressed. (shrink)

This research aims to identify the ethical issues perceived by intensive care nurses in their everyday practice. It also aims to understand why these situations were considered an ethical issue and what interventions/strategies have been or are expected to be developed so as to minimize them. Data were collected using a semi-structured interview with 15 nurses working at polyvalent intensive care units in 4 Portuguese hospitals, who were selected by the homogenization of multiple samples. The qualitative content analysis identified end-of-life (...) decisions, privacy, interaction, team work, and health-care access as emerging ethical issues. Personal, team, and institutional aspects emerge as reasons behind the experience of these issues. Personal and team resources are used in and for solving these issues. Moral development and training are the most significant strategies. (shrink)