Moral norms are the rules of morality, those that people actually follow, and those that we feel people ought to follow, even when they don’t. Historically, the social sciences have been primarily concerned with describing the many forms that moral norms take in various cultures, with the emerging implication that moral norms are mere arbitrary products of culture. Philosophers, on the other hand, have been more concerned with trying to understand the nature and source of rules that all cultures ought (...) to follow, with relatively little regard for what people actually do. The tension between the two approaches has to do with whether there are any standards higher than the whims of culture in determining right and wrong. Typically, the social sciences say “no”, pointing at the diversity of moral beliefs. Most philosophers (along with people of moral conviction) feel that there must be some deeper source of morality than the trends and fads of culture. Unfortunately, the nature and source of such standards has remained something of a mystery. Recent work on the evolution of norms has changed this picture dramatically. (shrink)

Empirical research has discovered that experimental subjects in ultimatum bargaining situations generally fail to play the decision-theoretic optimum strategy, and instead play something between that strategy and a fair split. In evolutionary dynamics, fair division and nearly fair division strategies often go to fixation and weakly dominated strategies can do quite well. Computer simulations were done using three different ultimatum bargaining games as determinates of fitness. (1) No tendency toward the elimination of weakly dominated strategies was observed, with or without (...) mutation. (2) Strategies making fair demands had sizable basins of attraction. (3) In a system where five different demands can be made, demands closest to (approximately) 91% had the largest basins of attraction. (4) If the strategies have thresholds for acceptable demands, rather than individuated responses to each demand, the apparent optimum demand may be quite low: 64% for one set of trials. (shrink)

The evolution of economic altruism is one of the most vigorous areas of study at the intersection of biology, economics, and philosophy. The basic problem is easily understood. Biological organisms, be they people or paramecia, have ample opportunity to confer benefits on others at relatively low cost to themselves. If conferring such benefits becomes common, the overall productivity of the population in which it occurs is increased. Presumably, there is no advantage to refusing such benefits, but it is also the (...) case that there is considerable advantage to pursuing a strategy according to which such benefits are accepted, but not conferred. In populations where individuals interact at random with others and when individuals play pure strategies (i.e., they always confer or do not confer benefits), the inevitable outcome is that altruistic behavior is driven to extinction. (Axelrod 1984) Nonetheless, there is ample evidence that self-sacrificing behavior is common in nature. (Sober and Wilson 1998) Consequently, individuals must not be interacting at random. The pressing question is then: what patterns of non-random interaction are responsible for the prevalence of altruistic behavior, and more theoretically, what sorts of plausible mechanisms exist that could generate the right kind of non- 1 The research reported here was supported by Canada ????? grant # ????? and the Centre for Applied Ethics at the University of British Columbia. (shrink)

The role of physicians in armed conflict -- International humanitarian law -- International criminal law -- Customary status of international humanitarian law -- The relevant human rights norms applicable to the work of physicians in armed conflict -- The interpretation of the reference to medical ethics and generally accepted medical standards pursuant to the Vienna Convention on the Law of Treaties -- Medical ethics in international law -- A pluralistic approach to medical ethics -- The documents by the World Medical (...) Association (WMA) -- Conclusion, recommendations and outlook. (shrink)

The enduring psychiatric myth is that particular personal, interpersonal and social problems in living are manifestations of ‘mental illness’ or ‘mental disease’, which can only be addressed by ‘treatment’ with psychiatric drugs. Psychiatric drugs are used only to control ‘patient’ behaviour and do not ‘treat’ any specific pathology in the sense understood by physical medicine. Evidence that people, diagnosed with ‘serious’ forms of ‘mental illness’ can ‘recover’, without psychiatric drugs, has been marginalized by drug-focused research, much of this funded by (...) the pharmaceutical industry. The pervasive myth of psychiatric drugs dominates much of contemporary ‘mental health’ policy and practice and raises discrete ethical issues for nurses who claim to be focused on promoting or enabling the ‘mental health’ of the people in their care. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

In Memory of Ed PellegrinoEuthanasia in Belgium is not limited to terminally ill patients. It may be applied to patients with chronic degenerative diseases. Currently, people in Belgium wish to make it possible to euthanize incompetent patients who suffer from dementia. This article explains the Belgian law and then explores arguments for and against euthanasia of patients with dementia. It probes the dementia paradox by elucidating Dworkin’s distinction between critical and experiential interests, arguing that at the end-of-life this distinction is (...) not clearcut. It argues against euthanasia for patients with dementia, for respecting patients’ humanity and for providing them with more care, compassion, and good doctoring. (shrink)

Various authors have argued that in the future not only will it be technically feasible for human minds to be transferred to other substrates, but this will become, for most humans, the preferred option over the current biological limitations. It has even been claimed that such a scenario is inevitable in order to solve the challenging, but imperative, multi-agent value alignment problem. In all these considerations, it has been overlooked that, in order to create a suitable environment for a particular (...) mind – for example, a personal universe in a computational substrate – numerous other potentially sentient beings will have to be created. These range from non-player characters to subroutines. This article analyzes the additional suffering and mind crimes that these scenarios might entail. We offer a partial solution to reduce the suffering by imposing on the transferred mind the perception of indicators to measure potential suffering in non-player characters. This approach can be seen as implementing literal empathy through enhanced cognition. (shrink)

Moral norms are the rules of morality, those that people actually follow, and those that we feel people ought to follow, even when they don’t. Historically, the social sciences have been primarily concerned with describing the many forms that moral norms take in various cultures, with the emerging implication that moral norms are mere arbitrary products of culture. Philosophers, on the other hand, have been more concerned with trying to understand the nature and source of rules that all cultures ought (...) to follow, with relatively little regard for what people actually do. The tension between the two approaches has to do with whether there are any standards higher than the whims of culture in determining right and wrong. Typically, the social sciences say “no”, pointing at the diversity of moral beliefs. Most philosophers (along with people of moral conviction) feel that there must be some deeper source of morality than the trends and fads of culture. Unfortunately, the nature and source of such standards has remained something of a mystery. Recent work on the evolution of norms has changed this picture dramatically. (shrink)

Anthropogenic climate change has become a hot button issue in the scientific, economic, political, and ethical sectors. While the science behind climate change is clear, responses in the economic and political realms have been unfulfilling. On the economic front, companies have marketed themselves as pioneers in the quest to go green while simultaneously engaging in environmentally destructive practices and on the political front, politicians have failed to make any significant global progress. I argue that climate change needs to be framed (...) as an ethical issue to make serious progress towards the path to a sustainable human civilization. In an effort to motivate the urgency needed to confront climate change, I argue that climate change seriously affects human beings living here and now, and if one cares about unnecessarily harming fellow innocent living human beings, then one should care about one’s own environmental impact related to climate change. Since this argument does not depend upon any specific philosophical, religious, or ethical tradition but applies regardless of one’s particular background, I hope to induce genuine concern among all human beings regarding this issue. (shrink)

Book reviewed in this article: To Do No Harm: DES and the Dilemmas of Modern Medicine. By Roberta J. Apfel and Susan M. Fisher.

From over 2000 years ago the ideal expressed in the Hippocratic Oath has encouraged doctors never knowingly to do harm: primum non nocere. Over 25 years ago the management writer Peter Drucker proposed it as the basis of a management ethic, ‘the right rule for the ethics managers need, the ethics of responsibility’.1 He argued then that the rule had wide scope encompassing for instance executive compensation, management rhetoric and the management of business impacts. In 2000 the United Nations (...) Global Compact embodied a Principle 7 enjoining ‘a precautionary approach to environmental challenges’ as defined in Principle 15 of the 1992 Rio Declaration. But what can such precautionary injunctions mean in practice? And what of conflicts with other values? Robin Attfield lays out the key questions he argues need to be asked about the Precautionary Principle if it is to be taken seriously and acted upon soundly. His focus is on the management of vulnerable resources — specifically planetary ecosystems — with whose management knowingly or otherwise we are all concerned. (shrink)

Guidelines for revisions to Diagnostic and Statistical Manual of Mental Disorders, 5th edition asked those proposing certain types of revision to consider potential harms to patients. Specifically, those proposing new diagnoses were to consider whether ‘the harm that arises from the adoption of the proposed diagnosis exceed[s] the benefit that would accrue to affected individuals’, and potential for harm was cited as a possible reason for keeping a diagnosis in the appendix rather than promoting it to the main (...) classification. The ‘do no harm’ criterion was referred to in... (shrink)

New reproductive technologies allow parents some choice over their children. Various moral principles have been suggested to regulate such choices. This article starts from a discussion of Julian Savulescu's Principle of Procreative Beneficence, according to which parents ought to choose the child expected to have the best quality of life, before combining two previously separate lines of attack against this principle. First, it is suggested that the appropriate moral principles of guiding reproductive choices ought to focus on general wellbeing rather (...) than prioritizing that of the child and, second, that they ought to be non-maximizing. Though neither of these suggestions is entirely novel, combining them results in a new, and arguably more plausible, principle to regulate procreative choices, which I call the Principle of Generalized Procreative Non-Maleficence. According to this principle, the primary obligation on parents is not to cause harm to other people through their reproductive choices. (shrink)

Edmund Pellegrino has argued that the dramatic changes in American health care call for critical reflection on the traditional norms governing the therapeutic relationship. This paper offers such reflection on the obligation to do no harm. Drawing on work by Beauchamp and Childress and Pellegrino and Thomasma, I argue that the libertarian model of medical ethics offered by Engelhardt cannot adequately sustain an obligation to do no harm. Because the obligation to do no harm is not based (...) simply on a negative duty of nonmaleficence but also on a positive duty of beneficence, I argue that it is best understood to derive from the fiduciary nature of the healing relationship. (shrink)

In a television news documentary series such as Boston Med, doctors’ duty to their patients may be at odds with the duty of TV journalists to their audience. If this happens, who should win out? The patients. If there is any possibility that harm is being done to patients, we must put them first, and turn off the cameras.

Screening for asymptomatic disease is a routine aspect of contemporary public health practice. However, it is also controversial, because it leads to overdiagnosis and overtreatment, with many arguing that programmes are “ineffective,” i.e., the “costs” outweigh the “benefits.” This paper explores a more fundamental objection to screening programmes: that, even if they are effective, they are ethically impermissible because they breach the principle of non-maleficence. In so doing, it suggests a new approach to the ethics of risk, justifying a concern (...) with how policies affect individuals’ absolute ex-ante prospects. Part 1 sets up the tension between screening and non-maleficence. Part 2 introduces and motivates a novel interpretation of the non-maleficence principle, “ex-ante Do No Harm,” which resolves this tension. Part 3 defends and clarifies this principle by discussing its relationship to the ex-ante Pareto principle. Part 4 discusses the worry that risk estimates are too “subjective.”. (shrink)

Climate change presents urgent ethical challenges. It causes us to revisit what it means to ‘do’ professionalism and invites us to enter what Fisher described as the ‘forgotten zone’ of human-nature relationships, posing the troubling question of whether we can continue to valorise a version of being human on the same terms as before.This article begins by considering the relevance of global warming to professional practice, foregrounding the commitment to do no harm. It poses as problematic the manner in (...) which climate change knowledges have been taken up by the ‘psy subject’. It concludes by considering how we might story different versions of being alive in, and to, the natural world. (shrink)

I argue in this essay that there can be harm due to philosophy that is not directly expressed in violent imagery. The harm is instead a concealed and delayed detrimental effect of an assumption of non-violence in a working model, defined as a picture of a field of enquiry and the methods required to approach it. Theses for the extended mind, as developed by Andy Clark and others, lead to a form of harm that follows from the (...) models they work with. These engineering, tool and function-based models seek smooth interactions and transparency. Following points made by Kim Sterelny in the philosophy of biology, I argue that claims for smoothness and transparency conceal underlying conflict in the situations they seek to describe and explain. This concealment leads to harm, defined as a diminishing of our capacities to flourish in a given environment. (shrink)

Health care reform poses numerous challenges. A core challenge is to make health care more efficient and effective without causing more harm than benefit. Additionally, those fashioning health-care policy must encourage patients to exercise caution and restraint when expending scarce resources; restrict the ability of politicians to advance their careers by promising alluring but costly entitlements, many of which they will not be able to deliver; face the demographic challenges of an aging population; and avoid regulations that create significant (...) inefficiencies and restrict access to health care. Given such real-world challenges, how should health care be reformed in the United States or elsewhere? This number of The Journal of Medicine and Philosophy examines many of the complex issues that must be considered in reforming a health-care system. (shrink)

This collection of essays, brings together essays from leading figures in the field of medical law and ethics. The compilation of articles undertaken by Prof. Sheila A.M. McLean, University of Glasgow, UK, address the key issues currently challenging scholars in the field.

At the outset of World War I - the "Great War" - Freud supported the Austro-Hungarian Empire for which his sons fought. But the cruel truths of that bloody conflict, wrought on the psyches as much as the bodies of the soldiers returning from the battlefield, caused him to rethink his stance and subsequently affected his theory: Psychoanalysis, a healing science, could tell us much about both the drive for war and the ways to undo the trauma that war inherently (...) breeds, but its principles could just as easily serve the enemy's desires to inculcate its own brand of "truth." Even a century later, psychoanalysis can still be used as much for the justifications of warfare and propaganda as it is for the defiance of and resistance to those same things. But it is in the investigation of the motives and methods behind these uses that psychoanalysis proves its greatest strength. To wit, this edited collection presents published and unpublished material by analysts, writers, and activists who have worked at the front lines of psychic life and war from various stances. Set at a point of tension and contradiction, they illustrate the paradoxical relation of psychoanalysis as both a site of resistance and healing and a necessary aspect of warmaking, propaganda, and militarism. In doing so, we venture from the home front - from the trauma of returning veterans to the APA's own complicity in CIA "black sites" - across international borders - from the treatment of women in Latin American dictatorships to the resistance to occupation in Palestine, from mind control to an ethics of responsibility. Throughout, a psychoanalytic sensibility deconstructs the very opposition that it inhabits, and seeks to reestablish psychoanalysis as the healing discipline it was conceived to be. (shrink)

There are significant differences in the way that regulators treat lawyers and doctors who are found dishonest. Paula Case has found that lawyers are much more likely than doctors to be struck off after a dishonesty finding. This article considers why dishonesty by lawyers is treated more seriously than that of doctors. Analyses of 'trust' in professions make comparisons between doctors and lawyers and invariably report that lawyers are less trusted, but on a flawed basis. However, in the context of (...) interpreting individual cases, practices, and what they say about regulatory approaches or policy, the practical differences between what lawyers and doctors do are rarely commented upon. This undermines the relevance of comparisons that do not recognise the differences and risks missing a deeper understanding of how professions are regulated or how they should be regulated. Ultimately, morality tests are applied. (shrink)

One of the goals of medicine is to improve well-being, in line with the principle of beneficence. Likewise, scientists claim that the goal of human embryonic stem cell research is to find treatments for diseases. In hESC research, stem cells are harvested from a 5-day-old embryo. Surplus embryos from infertility treatments or embryos created for the sole purpose of harvesting stem cells are used in the research, and in the process the embryos get destroyed. The use of human embryos for (...) research purpose raises ethical concern. In this context, the religious leaders play the role to be the moral compass and “reality check” to engage with the public. In Malaysia, the Ministry of Health has outlined the Guidelines for Stem Cell Research and Therapy, reflecting on Islamic principles. Since there has not been much focus on the viewpoints of other faiths in Malaysia, this study attempts to explore the ethical guiding principles deliberated by religious leaders from the Buddhist, Hindu and Catholic traditions and identify if there is a common ground between the mainstream religious views and principles of medical ethics, in relation to hESC research. Eleven religious leaders representing the Buddhist, Hindu and Catholic traditions were interviewed. Interestingly, though reasoning of religious leaders came from different angles, their underlying concerns revolve around the values of “do no harm” and “intention to save lives”. These values are also the key principles in medical ethics. The findings are applied to answer the question as to whether religious and medical guiding principles can co-exist and complement in ethical decision-making, without compromising the values. (shrink)

_Covert treatment raises a number of ethical and practical issues in psychiatry. Viewpoints differ from the standpoint of psychiatrists, caregivers, ethicists, lawyers, neighbours, human rights activists and patients. There is little systematic research data on its use but it is quite certain that there is relatively widespread use. The veil of secrecy around the procedure is due to fear of professional censure. Whenever there is a veil of secrecy around anything, which is aided and abetted by vociferous opposition from some (...) sections of society, the result is one of two: 1) either the activity goes underground or 2) it is reluctantly discarded, although most of those who used it earlier knew it was needed. Covert treatment has the dubious distinction of suffering both such secrecy and disapproval. Covert treatment has a number of advantages and disadvantages in psychotic disorders. The advantages are that it helps solve practical clinical problems; prevents delays in starting treatment, which is associated with clinical risks and substantial costs; prevents risk of self-destructive behaviour and/or physical assault by patient; prevents relapse; and prevents demoralization of staff. The disadvantages are that it maybe used with malafide intent by caregivers with or without the complicity of psychiatrists; it may be used to force conformity in dissenters; and the clinician may land himself in legal tangles even with its legitimate use. In addition, it may prevent insight, encourage denial, promote unhealthy practices in the treating staff and prevent understanding of why noncompliance occurs in the first place. Some support its use in dementia and learning disorders but oppose it in schizophrenia. The main reason is that uncooperative patients of schizophrenia (and related psychoses) are considered to be those who refuse treatment but retain capacity; while in dementia and severe learning disorder, uncooperative patients are those who lack capacity. This paper disputes this contention by arguing that although uncooperative patients of schizophrenia (and related psychoses) apparently retain capacity, it is limited, in fact distorted, since they lack insight. It presents the concept of insight-unconsciousness in a patient of psychosis. Just as an unconscious patient has to be given covert medical/surgical treatment, similarly an insight-unconscious patient with one of the different psychoses (in the acute phase or otherwise) may also have to be given covert treatment till he regains at least partial insight. It helps control psychotic symptoms and assists the patient in regaining enough insight to realize he needs treatment. Another argument against covert treatment is that people with schizophrenia have the capacity to learn and therefore can learn that they are required to take medications, but if medications are given covertly it may well fuel their paranoia. However, it should be noted that the patient who has lack of insight cannot learn unless he regains that insight, and he may need covert treatment to facilitate this process. Covert treatment can fuel the paranoia, true, but it can also control the psychotic symptoms sufficiently so that regular treatment can be initiated. In a patient who refuses to accept that he is sick and when involuntary commitment is not an option to be considered, covert treatment is the only option, apart from physical restraint. Ultimately, a choice has to be made between a larger beneficence (control of symptoms and start of therapy) and a smaller malevolence (necessary therapy, but without the patient's knowledge and consent). A number of practical clinical scenarios are outlined wherein the psychiatrist should adopt covert treatment in the best interests of the patient. Ethical issues of autonomy, power, secrecy and malafide intent arise; each of these can be countered only by non-malfeasance (above all, do no harm) under the overarch of beneficence (even above that, dare to care). An advance directive with health care proxy that sanctions covert treatment is presented. Questions raised by the practical clinical scenarios are then answered. The conclusions are as follows: covert treatment, i.e, temporary treatment without knowledge and consent, is seldom needed or justified. But, where needed, it remains an essential weapon in the psychiatrist's armamentarium: to be used cautiously but without guilt or fear of censure. However, the psychiatrist must use it very judiciously, in the rarest of rare cases, provided: i) he is firmly convinced that it is needed for the welfare of the patient; ii) it is the only option available to tide over a crisis; iii) continuing efforts are made to try and get the patient into regular psychiatric care; iv) the psychiatrist makes it clear that its use is only as a stop-gap; v) he is always alert to the chances of malevolence inherent in such a process and keeps away from conniving or associating with anything even remotely suspicious; and vi) he takes due precautions to ensure that he does not land into legal tangles later. The need of the hour is to explore in greater detail the need and justification for covert treatment, to lay out clear and firm parameters for its legitimate use, follow it up with standard literature and, finally, to establish clinical practice guidelines by unconflicted authors. The term "covert treatment" is preferable to "surreptitious prescribing"; they should not be used synonymously, the latter term being reserved for those cases where there is malafide intent._. (shrink)

Chemical castration laws, such as one recently adopted in the U.S. State of Louisiana, raise challenging ethical concerns for physicians. Even if such interventions were to prove efficacious, which is far from certain, they would still raise troubling concerns regarding the degree of medical risk that may be imposed upon prisoners in the name of public safety as well as the appropriate role for physicians and other health care professionals in the administration of pharmaceuticals to competent prisoners over the inmates’ (...) unequivocal objections. This paper argues that the concerns raised by chemical castration are grave enough that, until they are adequately addressed by policymakers, physicians ought not to participate in the process. (shrink)

untangled and ordered in a theoretical framework focusing on evaluations doing no harm, tackling bad and doing good. Divided into four parts a diverse group of subject experts present a practical look at ethics, utilizing practical experience to analyze how ethics have been applied in evaluations, and how new approaches can shape the future of ethics. The chapters collectively create a common understanding of the potential role of ethics to infuse policy decisions and stakeholder initiatives with evaluations that provide (...) better insight and potential solutions for problems, going beyond "what works" to what needs to be done and what would help. The methodological scope ranges from working in contexts of fragility, conflict and violence, to participatory and decolonised approaches, including the ethical imperatives posed by global crises such as climate change, inequity and exploitative international relations. Ethics for Evaluation presents evaluators, commissioners of evaluation, policy makers and practitioners with inspiration for an ethical perspective on how evaluation can contribute towards solving problems. It presents a solid foundation for inclusive terminology and ethics guidance that would be the heart of a global exercise in professionalization of ethical evaluation practice. (shrink)

Team reflexivity has gained increasing research attention as an effective response to the core challenge of constant learning, innovation, and adaptation in teams due to changing circumstances. Under the right conditions, empirical studies have found that team reflexivity can improve team performance, team learning, team innovation, team creativity, and team member well-being. Thus, research shows that team reflexivity is an effective means to improve teamwork and team outcomes. This book addresses the problem that team reflexivity research is focused too narrowly (...) on improving these empirical team outcomes while neglecting the importance of normative principles and values in good teamwork, such as the do no harm principle. Therefore, this book proposes that the team reflexivity concept needs broader reframing and deeper reflection to realize normative principles and values in teams as a precondition for good teamwork, e.g., do no harm. It further presents two team reflexivity tools and applies them in the cases of burnout prevention and speaking up freely in teams to illustrate the point of this book: Do no harm in teams requires team reflexivity, and vice versa, team reflexivity requires do no harm. (shrink)

This paper argues that the rules that constitute a market protect autonomy and increase welfare in healthcare. Markets do the former through protecting rights to self-ownership and a cluster of rights that protect its exercise. Markets protect welfare by organizing and protecting trades. In contrast, prohibition destroys legitimate markets, giving rise to so-called black markets that harm both the autonomy and well-being of agents. For example, a fee-for-service medical system is a highly developed and specialized market. It is individuals (...) working together, through the division of labor, to provide mutual insurance. This coordination, and the benefits it makes possible, is not possible without injunctions against harm. Prohibitions on harm are not mere ethical niceties, they are practice rules for both healthcare and markets. Placing the doctor within a healthcare market actually reinforces the doctor’s moral obligation, and the legal enforcement of that obligation, not to harm. Similarly, markets reinforce patient rights to self-determination through legal and institutional enforcement of the harm principle in the form of the protection of certain basic welfare rights to life, bodily integrity, property, trade, and contract. Since the establishment of markets protects agent autonomy and welfare, and prohibition directly harms the same, there are strong reasons for establishing markets to protect trade in precisely those areas where autonomy and well-being are most vulnerable to exploitation, for example, the trade in human kidneys. (shrink)

Recent studies show that returning global health trainees often report having felt inadequately prepared to deal with ethical dilemmas they encountered during outreach clinical work. While global health training guidelines emphasize the importance of developing ethical and cultural competencies before embarking on fieldwork, their practical implementation is often lacking and consists mainly of recommendations regarding professional behavior and discussions of case studies. Evidence suggests that one of the most effective ways to teach certain skills in global health, including ethical and (...) cultural competencies, is through service learning. This approach combines community service with experiential learning. Unfortunately, this approach to global health ethics training is often unattainable due to a lack of supervision and resources available at host locations. This often means that trainees enter global health initiatives unprepared to deal with ethical dilemmas, which has the potential for adverse consequences for patients and host institutions, thus contributing to growing concerns about exploitation and “medical tourism.” From an educational perspective, exposure alone to such ethical dilemmas does not contribute to learning, due to lack of proper guidance. We propose that the tension between the benefits of service learning on the one hand and the respect for patients’ rights and well-being on the other could be resolved by the application of a simulation-based approach to global health ethics education. (shrink)

The legalisation of euthanasia creates a certain tension when it is compared with those traditional medical principles that seem to embody respect for the sanctity of life. It also creates a real need for us to explore what we mean by harm in relation to dying patients. When we consider that we must train physicians so that they not only understand ethical issues but also show the virtues in their clinical practice, it becomes important for us to strive to (...) train them in virtue rather than mere knowledge. We can only do this by conveying a real sense of the needs of the patient and an ability to relate to patients as people not problems. Such attitudes take shape in a training programme in which practical situations are explored and discussed and the limits of scientific medical responses to those challenges are exposed. Keywords: bioethics education, euthanasia, moral judgment, training, virtue CiteULike Connotea Del.icio.us What's this? (shrink)

ABSTRACT:Do corporations have a duty to promote just institutions? Agreeing with Hsieh’s recent contribution, this article argues that they do. However, contrary to Hsieh, it holds that such a claim cannot be advanced convincingly only by reference to the negative duty to do no harm. Instead, such a duty necessarily must be grounded in positive obligation. In the search of a foundation for a positive duty for corporations to further just institutions, Stephen Kobrin’s notion of “private political authority” offers (...) a promising connecting point. Political authority implies political responsibility; Political obligation, however, includes more than merely not doing any harm—it is essentially positive obligation. The implications of the new political responsibilities of multinational corporations may even go far beyond the particular duty to promote just institutions; they may be symptomatic for a much more profound shift from an individual to a collective age. (shrink)