Professionals, it is said, have no use for simple lists of virtues and vices. The complexities and constraints of professional roles create peculiar moral demands on the people who occupy them, and traits that are vices in ordinary life are praised as virtues in the context of professional roles. Should this disturb us, or is it naive to presume that things should be otherwise? Taking medical and legal practice as key examples, Justin Oakley and Dean Cocking develop a rigorous articulation (...) and defence of virtue ethics, contrasting it with other types of character-based ethical theories and showing that it offers a promising new approach to the ethics of professional roles. They provide insights into the central notions of professional detachment, professional integrity, and moral character in professional life, and demonstrate how a virtue-based approach can help us better understand what ethical professional-client relationships would be like. (shrink)
Controlled Human Infection Model research involves the infection of otherwise healthy participants with disease often for the sake of vaccine development. The COVID-19 pandemic has emphasised the urgency of enhancing CHIM research capability and the importance of having clear ethical guidance for their conduct. The payment of CHIM participants is a controversial issue involving stakeholders across ethics, medicine and policymaking with allegations circulating suggesting exploitation, coercion and other violations of ethical principles. There are multiple approaches to payment: reimbursement, wage payment (...) and unlimited payment. We introduce a new Payment for Risk Model, which involves paying for time, pain and inconvenience and for risk associated with participation. We give philosophical arguments based on utility, fairness and avoidance of exploitation to support this. We also examine a cross-section of the UK public and CHIM experts. We found that CHIM participants are currently paid variable amounts. A representative sample of the UK public believes CHIM participants should be paid approximately triple the UK minimum wage and should be paid for the risk they endure throughout participation. CHIM experts believe CHIM participants should be paid more than double the UK minimum wage but are divided on the payment for risk. The Payment for Risk Model allows risk and pain to be accounted for in payment and could be used to determine ethically justifiable payment for CHIM participants.Although many research guidelines warn against paying large amounts or paying for risk, our empirical findings provide empirical support to the growing number of ethical arguments challenging this status quo. We close by suggesting two ways by which payment for risk could be calculated. (shrink)
In this article we argue that the worries about whether a consequentialist agent will be alienated from those who are special to her go deeper than has so far been appreciated. Rather than pointing to a problem with the consequentialist agent's motives or purposes, we argue that the problem facing a consequentialist agent in the case of friendship concerns the nature of the psychological disposition which such an agent would have and how this kind of disposition sits with those which (...) are commonly thought proper to relations of friendship. To the extent that we are right, then, the rejoinders which indirect consequentialists have offered to the problem of alienation are ill directed and so do not succeed in meeting the real problem. In articulating what we see as the source of the alienation problem which friendship poses for consequentialism, we also hope to clarify the general distinction between dispositions and motives and to show how certain kinds of guiding internalized normative dispositions help us to define and therefore distinguish between various types of relationships. Undertaking this task may also help to identify some of the crucial issues for an adequate moral psychology of friendship and its place in any plausible ethical theory. (shrink)
We thank the authors of the five commentaries for their careful and highly constructive consideration of our paper,1 which has enabled us to develop our proposal. Participation in research has traditionally been viewed as altruistic. Over time, payments for inconvenience and lost wages have been allowed, as have small incentives, usually in kind. The problem, particularly with controlled human infection model research or ‘challenge studies’, is that they are unpleasant and time-consuming. Researchers want to offer carrots to incentivise participation. We (...) are proposing that research participation be viewed as a job with the full suite of financial entitlements of fairly remunerated work, including payment for risk and labour law protections. This would be a significant shift from current practice and standards. Ambuehl, Ockenfels and Roth have grasped this basic point and have beautifully elaborated how a fair price could be arrived at using economic theory. They build on our proposal helpfully and suggest ‘ salary for time involvement that is adjusted to account for the amount of discomfort experienced during participation, insurance against ex post adverse outcomes and ex ante compensation for risks that cannot be compensated ex post.’3 This effectively addresses Fernandez Lynch and Largent’s2 concern that compensation for risk is inappropriate for harms which do not eventuate. However, because death cannot be compensated for, there must be payment for risk of death, as Ambuehl, Ockenfels and Roth convincingly argue.3 Indeed, the three-part model suggested by Ambuehl, Ockenfels and Roth makes us realise that job model would be a better title for our model than a payment for risk model. The alternative to a properly remunerated job model is the original altruistic model. However, this …. (shrink)
In many recent discussions of the morality of actions where both good and bad consequences foreseeably ensue, the moral significance of the distinction between intended and foreseen consequences is rejected. This distinction is thought to bear on the moral status of actions by those who support the Doctrine of Double Effect. According to this doctrine, roughly speaking, to perform an action intending to bring about a particular bad effect as a means to some commensurate good end is impermissible, while performing (...) an action where one intends only this good end and merely foresees the bad as an unintended sideeffect may be permissible. Consequentialists argue that this is a distinction which makes no moral difference to the evaluation of the initial act in the two cases, given that the overall consequences are the same in each case. In this paper we aim to show that a standard consequentialist line of argument against the moral relevance of the intention/foresight distinction fails. Consequentialists commonly reject the moral relevance of this distinction on the grounds that there is no asymmetry in moral responsibility between intending and foreseeing evil. We argue that even if this claim about moral responsibility is correct, it does not entail, as many Consequentialists believe, that there is no moral asymmetry between acts of intended and foreseen evil. We go on to argue that those consequentialists who do concede the moral relevance of the intention/foresight distinction at the level of agent evaluations cannot consistently make such a concession, and that such a position is in any case untenable, because it entails a complete severance of important conceptual connections between act and agent evaluations. (shrink)
This paper argues that the provision of effective informed consent by surgical patients requires the disclosure of material information about the comparative clinical performance of available surgeons. We develop a new ethical argument for the conclusion that comparative information about surgeons' performance - surgeons' report cards - should be provided to patients, a conclusion that has already been supported by legal and economic arguments. We consider some recent institutional and legal developments in this area, and we respond to some common (...) objections to the use of report cards on the clinical performance of surgeons. (shrink)
The standard problem with many slippery slope arguments is that they fail to provide us with the necessary evidence to warrant our believing that the significantly morally worse circumstances they predict will in fact come about. As such these arguments have widely been criticised as ‘scare-mongering’. Consequentialists have traditionally been at the forefront of such criticisms, demanding that we get serious about guiding our prescriptions for right action by a comprehensive appreciation of the empirical facts. This is not surprising, since (...) consequentialism has traditionally been committed to the idea that right action be driven by empirical realities, and this hard-headed approach has been an especially notable feature of Australian consequentialism. But this apparent empirical hard-headedness is very selective. While consequentialists have understood their moral outlook and commitments as guided by a partnership with empirical science – most explicitly in their replies to the arguments of their detractors – some consequentialists have been remarkably complacent about providing empirical support for their own prescriptions. Our key example here is the consequentialist claim that our current practises of partiality in fact maximise the good, impartially conceived. This claim has invariably been made without compelling support for the large empirical claims upon which it rests, and so, like the speculative empirical hand-waving of weak slippery slope arguments, it seems similarly to be undermined. While these arguments have presented us with ‘wishful thinking’ rather than ‘scare-mongering’, we argue in this paper that their complacency in meeting the relevant empirical justificatory burden remains much the same. (shrink)
Immanuel Kant argues in the Foundations that remote scenarios are diagnostic of genuine virtue. When agents commonly thought to have a particular virtue fail to exhibit that virtue in an extreme situation, he argues, they do not truly have the virtue at all, and our propensities to fail in such ways indicate that true virtue might never have existed. Kant’s suggestion that failure to show, say, courage in extraordinary circumstances necessarily silences one’s claim to have genuine courage seems to rely (...) on an implausibly demanding standard for warranted virtue attributions. In contrast to this approach, some philosophers—such as Robert Adams and John Doris—have argued for probabilistic accounts of warranted virtue attributions. But despite the initial plausibility of such accounts, I argue that a sole reliance on probabilistic approaches is inadequate, as they are insufficiently sensitive to considerations of credit and fault, which emerge when agents have developed various insurance strategies and protective capacities against their responding poorly to particular eventualities. I also argue that medical graduates should develop the sorts of virtuous dispositions necessary to protect patient welfare against various countervailing influences, and that repeated failures to uphold the proper goals of medicine in emergency scenarios might indeed be diagnostic of whether an individual practitioner does have the relevant medical virtue. In closing, I consider the dispositions involved in friendship. I seek to develop a principled way of determining when remote scenarios can be illuminating of genuine friendship and genuine virtue. (shrink)
The possibility of human reproductive cloning has led some bioethicists to suggest that potentiality-based arguments for fetal moral status become untenable, as such arguments would be committed to making the implausible claim that any adult somatic cell is itself a potential person. In this article I defend potentiality-based arguments for fetal moral status against such a reductio. Starling from the widely-held claim that the maintenance of numerical identity throughout successive changes places constraints on what a given entity can plausibly be (...) said to have the potential to become, I argue that the cell reprogramming that takes place in reproductive cloning is such that it produces a new individual, and so adult somatic cells cannot be potential persons. (shrink)
The many difficult ethical issues raised by family caregiving have been thrust into prominence by recent changes to hospital funding systems which encourage earlier discharge of patients. This paper investigates the sort of involvement that health professionals might justifiably have in family caregiving arrangements. It argues that the proper role of health professionals in protecting exhausted family caregivers can be clarified by considering some analogies with arguments about justifiable breaches of patient confidentiality. The paper also argues that health professionals who (...) seek to encourage neglectful adult children to help care for their sick parents should not do so by appealing to what a health professional takes those childrens’ filial duties to be. (shrink)
As the rising costs of lifestyle-related diseases place increasing strain on public healthcare systems, the individual’s role in disease may be proposed as a healthcare rationing criterion. Literature thus far has largely focused on retrospective responsibility in healthcare. The concept of prospective responsibility, in the form of a lifestyle contract, warrants further investigation. The responsibilisation in healthcare debate also needs to take into account innovative developments in mobile health technology, such as wearable biometric devices and mobile apps, which may change (...) how we hold others accountable for their lifestyles. Little is known about public attitudes towards lifestyle contracts and the use of mobile health technology to hold people responsible in the context of healthcare. This paper has two components. Firstly, it details empirical findings from a survey of 81 members of the United Kingdom general public on public attitudes towards individual responsibility and rationing healthcare, prospective and retrospective responsibility, and the acceptability of lifestyle contracts in the context of mobile health technology. Secondly, we draw on the empirical findings and propose a model of prospective intention-based lifestyle contracts, which is both more aligned with public intuitions and less ethically objectionable than more traditional, retrospective models of responsibility in healthcare. (shrink)
Alberto Giubilini and Francesca Minerva reject arguments from claims that fetuses and newborn infants are potential persons, because they argue that potential persons cannot be harmed.1 But whether or not potential persons can be harmed, is it clear that potential persons are entirely lacking in moral status, of a kind that could count as a reason against bringing about their demise? We do not generally regard potential as entirely lacking in moral value until it is actualised. For example, parents who (...) believe they have identified in their child an emerging musical talent commonly see this potential as having some value, however small, which would count as a reason against destroying that …. (shrink)
In this article, I respond to Alan Henderson’s critique of the quality of care argument for surgeon report cards. I discuss some significant US and UK studies demonstrating that surgeon report cards improve clinical outcomes. I also indicate that surgeon report cards are in any case supported by other important ethical arguments, such as arguments from surgeons’ professional accountability obligations, and from patients’ entitlements to be informed about the risks of surgery upon them.
In light of controversy surrounding the initial online publication of Alberto Giubilini and Francesca Minerva's article on ‘After-birth abortion: why should the baby live?’ in the Journal of Medical Ethics,1 ….
