In any society influenced by a plurality of cultures, there will be widespread, systematic differences about at least some important values, including moral values. Many of these differences look like deep disagreements, difficult to resolve objectively if that is possible at all. One common response to the suspicion that these disagreements are unsettleable has always been moral relativism. In the flurry of sympathetic treatments of this doctrine in the last two decades, attention has understandably focused on the simpler case in (...) which one fairly self-contained and culturally homogeneous society confronts, at least in thought, the values of another; but most have taken relativism to have implications within a single pluralistic society as well. I am not among the sympathizers. That is partly because I am more optimistic than many about how many moral disagreements can be settled, but I shall say little about that here. For, even on the assumption that many disputes are unsettleable, I continue to find relativism a theoretically puzzling reaction to the problem of moral disagreement, and a troubling one in practice, especially when the practice involves regular interaction among those who disagree. This essay attempts to explain why. (shrink)

Disorders of Consciousness (DoCs) raise difficult and complex questions about the value of life for persons with impaired consciousness, the rights of persons unable to make medical decisions, and our social, medical, and ethical obligations to patients whose personhood has frequently been challenged and neglected. Recent neuroscientific discoveries have led to enhanced understanding of the heterogeneity of these disorders, and focused renewed attention on the medical and ethical problem of misdiagnosis. -/- This book examines the entanglement of epistemic and ethical (...) uncertainty in DoCs and other medical contexts, and how they interact to create both epistemic and ethical risks. Philosopher and bioethicist L. Syd M Johnson pulls together multiple threads in this work: the ontological mysteries of consciousness, medical uncertainty about unconsciousness, ableist bias, withdrawal of treatment in neurointensive care, and the rarely questioned view that consciousness is essential to personhood and moral status. Johnson challenges longstanding bioethical dogmas about DoC patients, and argues for an ethics of uncertainty for contexts where there is a need for decisive action in the presence of unavoidable uncertainty. The ethics of uncertainty refocuses ethical inquiry concerning persons with DoCs, placing less emphasis on their contested personhood, and more on inductive risk and uncertainty, on respect for autonomy, and especially on epistemic justice. With applications to various decisional contexts where uncertainty and ethical risk interact, this ethical approach enables surrogate decision makers facing fraught and risky choices to fulfill their obligations as moral and epistemic agents. (shrink)

Moral Case Deliberations are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support, it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases. These limitations warrant (...) research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care. We used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted. The CES tool, called ‘moral compass’, guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy. By using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations. (shrink)

Two problems are considered here. One relates to who has moral status, and the other relates to who has moral responsibility. The criteria for mattering morally have long been disputed, and many humans and nonhuman animals have been considered “marginal cases,” on the contested edges of moral considerability and concern. The marginalization of humans and other species is frequently the pretext for denying their rights, including the rights to health care, to reproductive freedom, and to bodily autonomy. There is broad (...) agreement across cultural and philosophical traditions about the capacities and responsibilities of moral agents. I propose an inclusive and expansive way of thinking about moral status, situating it not in the characteristics or capacities of individuals, but in the responsibilities and obligations of moral agents. Moral agents, under this view, are not privileged or entitled to special treatment but rather have responsibilities. I approach this by considering some African communitarian conceptions of moral status and moral agency. I propose that moral agency can also be more expansive and include not just individual moral agents but collective entities that have some of the traits of moral agents: power, freedom, and the capacity to recognize and act on the demands of morality and acknowledge and respect the rights of others. Expanding who and what is a moral agent correspondingly extends moral responsibility for respecting rights and fostering the conditions for the health and well-being of humans and animals onto the collective entities who uniquely have the capacity to attend to global-scale health threats such as pandemics and human-caused climate change. (shrink)

Here, an epidemiological model considering pro and anti-vaccination groups is proposed and analyzed. In this model, susceptible individuals can migrate between these two groups due to the influence of false and true news about safety and efficacy of vaccines. From this model, written as a set of three ordinary differential equations, analytical expressions for the disease-free steady state, the endemic steady state, and the basic reproduction number are derived. It is analytically shown that low vaccination rate and no influx to (...) the pro-vaccination group have similar impacts on the long-term amount of infected individuals. Numerical simulations are performed with parameter values of the COVID-19 pandemic to illustrate the analytical results. The possible relevance of this work is discussed from a public health perspective. (shrink)

_The Routledge Handbook of Neuroethics_ offers the reader an informed view of how the brain sciences are being used to approach, understand, and reinvigorate traditional philosophical questions, as well as how those questions, with the grounding influence of neuroscience, are being revisited beyond clinical and research domains. It also examines how contemporary neuroscience research might ultimately impact our understanding of relationships, flourishing, and human nature. The _Handbook_ features easy-to-follow chapters that appear here for the first time in print and—written by (...) 61 key scholars and fresh voices—represent the wide range of viewpoints in neuroethics. The volume spotlights new technologies and historical articulations of key problems, issues, and concepts, and includes cross-referencing between chapters to highlight the complex interactions of concepts and ideas within neuroethics. These features enhance the _Handbook_’s utility by providing readers with a contextual map for different approaches to issues, and a guide to further avenues of interest. (shrink)

The Emerging Issues Task Force (Kellmeyer et al. 2019) identifies several important trends and concerns that neuroethics will encounter and grapple with in the com- ing decades. Among these are ethical issues related to the creation of new nonhuman entities, such as artificial intelligence systems, and human origin entities like brain organoids. The task force briefly mentions animal minds and animal rights, to which neuroethics to date has paid scant attention (Buller et al. 2014). As neuroscientific knowledge and knowledge from (...) other fields, including, to name a few, comparative psychology, primatology, ethology, biology, genetics, and medical sociology, accu- mulate, ethical concerns about the use of nonhuman ani- mals in research, agriculture, entertainment, and elsewhere will grow more visible and more urgent. Turning neuroethical attention toward nonhuman ani- mals also promises to illuminate issues related to specific human populations that are within the purview of a more expansive, forward-looking neuroethics. (shrink)

A weak form of intuitionistic set theory WST lacking the axiom of extensionality is introduced. While WST is too weak to support the derivation of the law of excluded middle from the axiom of choice, we show that beefing up WST with moderate extensionality principles or quotient sets enables the derivation to go through.

Ever since medical assistance in dying (MAID) became legal in Canada in 2016, controversy has enveloped the refusal by many faith‐based institutions to allow this service on their premises. In a recent article in this journal, Philip and Joshua Shadd have proposed ‘changing the conversation’ on this issue, reframing it as an exercise not of conscience but of an institutional right of self‐governance. This reframing, they claim, will serve to show how health‐care institutions may be justified in refusing to provide (...) MAID on moral or religious grounds. I argue that it will not make it easier to justify institutional refusal, and is likely to make it harder. (shrink)

The interconnections, common interests, and other linkages between the Jewish and Islamic traditions have long been a matter of interest to academics. Today the need to understand these relationships, and to emphasize commonalities rather than conflicts, is of the greatest public interest. The present volume of studies, likely the first such collection in the scholarly literature, explores the full range of interconnections between Jews and Muslims in all fields (intellectual history, religion, philosophy, social history, etc.) and in all periods, from (...) the Middle Ages till today. The essays have been written by some twenty distinguished scholars from North America, Europe, and Israel. The volume is dedicated to our esteemed colleague Joel L. Kraemer, John Barrows Professor Emeritus in the Divinity School and on the Committee on Social Thought of the University of Chicago. In the course of his distinguished career Professor Kraemer has made major contributions to our understanding of the intellectual and cultural history of the Jews in the Arabic world, Islamic and Jewish philosophy and their sources in ancient philosophy, the humanistic renaissance in Islam (on which he published two seminal monographs), and Maimonides (on which he has published many important papers and is completing a biography and a translation of Maimonides' letters, to appear in the Yale Judaica Series). (shrink)

L. Nandi Theunissen offers an original and provocative account of the value of humanity. Human beings have value just as anything of value has value: because we are capable of being of value to someone--in the first place, to ourselves. And this explains the key forms of ethical responsiveness that we owe to one another.

A standard objection to act utilitarian theories is that they are not helpful in deciding what it is morally permissible for us to do when we actually have to make a choice between alternatives. That is, such theories are worthless as decision procedures. A standard reply to this objection is that act utilitarian theories can be evaluated solely as theories about right-making characteristics and, when so evaluated, their inadequacy as decision procedures is irrelevant. Even if somewhat unappealing, this is an (...) effective reply to the standard objection. (shrink)

There is ongoing ethical and legal debate about withdrawing life sup- port for patients with disorders of consciousness (DOCs). Frequently fu- eling the debate are implicit assumptions about the value of life in a state of impaired consciousness, and persistent uncertainty about the quality of life (QoL) of these persons. Yet there are no validated methods for assessing QoL in this population, and a significant obstacle to doing so is their inability to communicate. Recent neuroscientific discoveries might circumvent that problem (...) and help shed light on QoL in DOCs. There is an ethical imperative to prioritize QoL research in this patient population, to provide evidence to inform treatment, research, and end of life decisions. A minimalist and pragmatic model of QoL is proposed, targeting positive and negative affect as domains for which there is po- tential to reach across the communication gap, and restore to these voiceless persons some measure of control. (shrink)

This article is about Gilles Deleuze's book Le Pli. Leibniz et le Baroque from 1988. It shows how Deleuze's notion of folding captures some basic intuitions in Leibniz and how they relate to each other. To this purpose, I propose five figures, all referring to the same basic fold, all illustrating how the consideration of such figures allows developing central elements of Leibniz's monadology. These figures can help, I hope, alleviate some of the fundamental difficulties in understanding Deleuze's approach to (...) the Monadology from the non-Deleuzian perspective of contemporary Leibniz scholarship and give a sense of the synthetic, explanatory force that Deleuze's notion of folding has in relation to Leibniz's monadological metaphysics. (shrink)

ABSTRACT‘Green’ concerns about nature, the environment or the climate have traditionally been juxtaposed with concerns about economic growth or job creation. Recently, however, a new type of conflict has appeared, in which different green concerns, for instance regarding mitigation of climate change and protection of landscape qualities, seem to collide. These environmental conflicts have so far received little scholarly attention. This article addresses the issue by a study of national and in particular local news media discussion on the construction of (...) wind turbines in Denmark, bringing together research traditions from environmental communication, discourse analysis, and place studies. Analytically, the study employs the notion of topos as the key meaning unit, referring to the premises upon which an argument is based. In addition to the empirical findings, the study points to methodological potential of the concept of topos to integrate qualitative and quantitative approaches within a discourse studie... (shrink)

Bioethicists have recently expressed concern over a lack of quality control within the field. This apprehension focuses on bioethics expanding in ways that obscure its distinctive ethical remit and the specialist reasoning skills it requires. This thesis about the quality and conduct of bioethics may have particular relevance for clinical ethics. As one of the youngest offshoots of bioethics, the field focuses on the ethical issues that arise specifically in a clinical context. However, non-ethics specialists are increasingly involved in this (...) field. This means that clinical ethics could be especially vulnerable to the quality control concerns articulated within bioethics. The growing public profile of clinical ethics means that concerns over quality in this area warrant specific attention by those concerned with declining standards in bioethics and those working in clinical ethics. (shrink)

The question that I address in this paper is whether there is a right to privacy. It is not the question whether in the United States there is a legal right to privacy or, more particularly, a constitutional right to privacy. There are any number of ordinary legal rights and specific constitutional rights that might be so described, and the U.S. Supreme Court has referred also to a generic “right to privacy” that is implicit in the U.S. Constitution. Nor is (...) the question that I address whether persons have a moral claim to privacy that others ought to respect. I assume that in many circumstances, respecting a person's claim to privacy is productive of the good and, if so, that the claim ought to be respected. Rather, my question is whether persons have a right to privacy not dependent on positive law, such that it ought ordinarily to be respected without regard to the consequences, good or bad, simply because it is right. (shrink)

The phenomenon whereby severely disabled persons self-report a higher than expected level of subjective well-being is called the “disability paradox.” One explanation for the paradox among brain injury survivors is “response shift,” an adjustment of one’s values, expectations, and perspective in the aftermath of a life-altering, disabling injury. The high level of subjective well-being appears paradoxical when viewed from the perspective of the non-disabled, who presume that those with severe disabilities experience a quality of life so poor that it might (...) make their lives not worth living. This presumption has profound consequences, for it may inform end-of-life choices made in advance directives, or influence decisions made by surrogates on behalf of persons who are unable to direct their own medical treatment. -/- Peterson et al propose a cautious, well-considered plan to use fMRI-based brain-computer interfaces to assess the decision making capacity of covertly aware, behaviorally non-responsive individuals who retain high levels of preserved cognition. Their plan, if it succeeds, could eventually restore autonomy and empower some severely disabled persons, allowing them to participate in clinical decision making. Peterson et al discuss possible in-principle objections to their proposal, among them the “argument from psychological health,” and the “changing sets of values” objection. These objections both presume that deviations from a pre-injury norm could indicate diminished decision making capacity. This presumption threatens the autonomy of the patient who is capable of making decisions, but whose post-injury decisions appear to diverge from pre-injury preferences or values. In light of the potential for response shift, and the disability paradox, it should not be inferred that changes in values or preferences are unreflective of the true current preferences of a brain-injured person, nor are they conclusive evidence of diminished capacity. Presuming diminished capacity on the basis of unexpected or unconventional preferences has, in the past, been used to disempower patients whose autonomy and capacity would not have been doubted had they made choices that accorded with the expectations or values of others. We must be cautious, and vigilant, to prevent similarly diminishing the autonomy of covertly aware, behaviorally non-responsive individuals on the basis of empirically and ethically questionable inferences about their decision making capacity. (shrink)

The Hellenistic Schools of Epicureanism, Cynicism and Stoicism are considered to constitute the first, albeit modest, wave of feminism. But the question: ‘Were the Stoics Feminists?’ has attracted little attention due to a paucity of available evidence. What this paper attempts is a comprehensive treatment of the subject. In particular it addresses two distinct claims that have been made about the Stoic attitude to women. The first claim challenges the view that the Stoics were thoroughgoing feminists. The second is that, (...) given the Stoic fixation on social duty, women's relegation to the domestic sphere is a consistent Stoic position. It is argued that Stoicism was fundamentally committed to the emancipation of women even though many of its proponents were inconsistent feminists. This inconsistency put them at odds with Stoicism's avowed mission to provide a critique of social convention and to promote the ideals of the cosmopolis. (shrink)

Jerry L. Walls argues that the doctrine of heaven is ripe for serious reconsideration. He contends not only that the orthodox view of heaven can be defended from objections commonly raised against it, but also that heaven is a powerful resource for addressing persistent philosophical problems, not the least of which concern the ground of morality and the meaning of life. Walls shows how heaven is integrally related to central Christian doctrines, particularly those related to salvation, and tackles the difficult (...) problem of why faith in Christ is necessary to save us from our sins. In addition, heaven is shown to illumine thorny problems of personal identity and to be an essential component of a satisfactory theodicy. Walls goes on to examine data from near-death experiences from the standpoint of some important recent work in epistemology and argues that they offer positive evidence for heaven. He concludes that we profoundly need to recover the hope of heaven in order to recover our very humanity. (shrink)

For all the discussion and debate about civil rights, it is striking how little attention is given initially to the question of what civil rights are. There is no well-understood principle of inclusion or exclusion that defines the category. Nor is there an agreed list of civil rights, except perhaps a very short, avowedly nonexhaustive one, with rather imprecise entries. Yet, if the extension of the category of civil rights is uncertain, its significance is not. All agree that it is (...) a principal task of government to protect civil rights, so much so, indeed, that a failure to protect them usually is regarded as outweighing substantial achievements of other kinds. But a right does not count as a civil right just because it is valuable or valued. Some of the rights most often asserted as civil rights reflect practical interests of their possessors considerably less than other actual or potential rights not so identified. In the United States, familiar legal doctrine provides a shortcut to the specification of civil rights. They are whatever is embraced by the provisions of the federal Civil Rights Acts: the right to vote, fair housing, equal employment opportunity, and so forth. That path, however, is not adequate for the present purpose. For the most part, the statutes refer explicitly or implicitly to federal constitutional rights, and the collective reference to them as civil rights is unexplained. The bases of the constitutional rights are too various to be a reliable guide to an independently designated category of civil rights. (shrink)

SETTING: Previous health policies in South Africa neglected the teaching of ethics and human rights to health professionals. In April 1995, a pilot course was run at the University of Cape Town in which the ethical dimensions of human rights issues in South Africa were explored. OBJECTIVES: To compare knowledge and attitudes of participating students with a group of control students. DESIGN: Retrospective cohort study. SUBJECTS: Seventeen fourth-year medical students who participated in the course and 13 control students from the (...) same class, matched for gender. INTERVENTIONS: Students participated in a one-week module on ethics and human rights. Five months after the course had been run, students completed a semi-structured questionnaire exploring their knowledge and attitudes with regards to ethics and human rights issues. MAIN OUTCOME MEASURES: Knowledge scores, attitude scores and various individual indicators of attitude. RESULTS: Clear benefits for overall knowledge score, for four out of five individual knowledge questions and for one of the attitude questions, were demonstrated. Participating students also appeared to be more convinced of the need for teaching on the ethical dimensions of human rights at postgraduate level and that such teaching should also be integrated in the curriculum. The low response rate amongst controls may have selected students who were more socially conscious, thereby leading to an underestimate of the true impact of the course. CONCLUSION: The evaluation indicates clear benefits of the course for undergraduate students, and supports arguments for the inclusion of such courses in the training of health professionals. This is particularly important given the challenges posed by the Truth and Reconciliation Commission to the health professions to address past complicity in human rights abuses through reorientation of medical training in South Africa. (shrink)

Uncertainties about how to achieve sustainable and reliable biobased value chains can be remedied by inclusion of local biomass producers. Such inclusion implies that the knowledge, values, interests and skills of these local producers are integrated into the set-up, design, development and associated distribution of risk and benefits of the specific value chain. To make sure that this inclusion is both fair and effective, capabilities of relevant actors need to be taken into account, i.e. the capabilities of biomass producers and (...) of companies and local governments. Building on these capabilities can lead to context sensitive design of biorefineries that allow for true inclusion of local stakeholders. We support this claim with reference to the case of sugarcane production in Jamaica. (shrink)

The period of the mid-1920s to the mid-1980s was a portentous period for Soviet psychology. As this period recedes into the past, the figure of L. S. Vygotskii rises more and more before us. Vygotskii died of tuberculosis when not quite 37 years old. He was a psychologist for only 10 years, and it was only in the last 6 of these that he did the work we now associate with his name. During those brief years Vygotskii wrote over 120 (...) works, including more than 10 large books. His was a short life — filled with inspired, indefatigable, and heroic work. A significant part of his written work has remained unpublished and indeed much of it remained unfinished. A seven-volume collection of Vygotskii's work is currently underway, and even this will not contain everything he wrote. The final volume of this collection will include his articles "The Sense of the Psychological Crisis" and "Spinoza's Theory of the Passions.". (shrink)

How are we to understand the role of bioethics in the health care system, government, and academe? This collection of original essays raises these and other questions about the nature of bioethics as a discipline.