This paper argues that Rawls’ principles of justice provide a normative foundation for stakeholder theory. The principles articulate (at an abstract level) citizens’ rights; these rights create interests across all aspects of society, including in the space of economic activity; and therefore, stakeholders – as citizens – have legitimate interests in the space of economic activity. This approach to stakeholder theory suggests a political interpretation of Boatright’s Moral Market approach, one that emphasizes the rights/place of citizens. And this approach to (...) stakeholder theory – in terms of citizens – raises a further question, what rights and obligations do economic agents have, beyond those attached to their roles as citizens? Rawls would reject additional rights and obligations of this sort for two reasons, one tied to freedom and one tied to pluralism. Rawls’ work therefore presses us to re-conceptualize the place of ethical claims in the economic context. (shrink)

George Berkeley, Bishop of Cloyne, was an Irish philosopher and divine who pursued a number of grand causes, contributing to the fields of economics, mathematics, political theory and theology. He pioneered the theory of 'immaterialism', and his work ranges over many philosophical issues that remain of interest today. This volume offers a complete and accurate edition of Berkeley's extant correspondence, including letters written both by him and to him, supplemented by extensive explanatory and critical notes. Alexander Pope famously said 'To (...) Berkeley every virtue under heaven', and a careful reading of the letters reveals a figure worthy of admiration, sheds new light on his personal and intellectual life, and provides insight into the broad historical and philosophical currents of his time. The volume will be an invaluable resource for philosophers, modern historians and those interested in Anglo-Irish culture. (shrink)

Why do physicians have financial conflicts of interest? They arise because society expects physicians to act in their patients’ interest, while simultaneously, financial incentives encourage physicians to practice medicine in ways that promote their own interests or those of third parties. Because physicians’ clinical choices, referrals, and prescriptions affect the fortune of third parties, these third parties may offer physicians financial incentives to make income-driven clinical choices. In the past, physicians and scholars typically conceived of conflicts of interest as an (...) ethical issue to be resolved according to individual judgment or professional and organizational norms. However, society can mitigate or eliminate conflicts of interest by changing financial and organizational arrangements in medicine. Conflicts of interest, therefore, are as much matters of public policy and management as individual choices or social norms. (shrink)

Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than (...) generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)

Across the management, social science, and business ethics literatures, and in much of the philosophy literature, trust is characterized as a disposition to act given epistemic states—beliefs and/or expectations about others and about the risks involved. This characterization of trust is best thought of as epistemological because epistemic states distinguish trust from other dispositions. The epistemological characterization of trust is the amoral one referred to in the title of this paper, and we argue that this characterization is conceptually inadequate. We (...) outline and defend an alternative conception of trust as a moral phenomenon: when A trusts B to do something, A invites B to acknowledge and accept an obligation; when B accepts the invitation, B takes on an obligation; in that way trust creates an obligation. We conclude with an application, drawing out the difference between the epistemological conception of trust and our own in the context of Ghoshal et al.'s (Sloan Management Review 40:9—20, 1995, Academy of Management Learning & Education 4:75—91, 2005) critique of transaction cost theories of the firm. (shrink)

The prevailing view about the history of early modern philosophy, which the author dubs “the early modern tale” and wants to convince us is really a fairy tale, has it that the focus on ideas as a solution to various epistemological puzzles, first introduced by Descartes, created difficulties for the traditional ontological scheme of substance and mode. The early modern tale depicts the development of “the way of ideas” as abandoning ontology at least by the time of Berkeley. This, in (...) turn, fostered an antimetaphysical bias as modern philosophy developed further, elevating epistemology to its current primary status in the field. Marc Hight challenges this account by showing how, though the conception of ideas changed over time, the ontological status of ideas remained a central part of the discussion about ideas and influenced how even later thinkers like Locke, Berkeley, and Hume thought about them. By his reading of important texts in early modern philosophy, Hight aims not only to provide a more accurate history of philosophy for this period but also to resuscitate the value of metaphysics for philosophical analysis today.��. (shrink)

Public policy tries to promote appropriate drug use by allowing firms to market drugs in interstate commerce only for uses that the Food and Drug Administration has found to be safe and effective. Because of their medical knowledge, physicians are authorized to prescribe drugs even for uses unapproved by the FDA. Nevertheless, physicians have relied on drug firms for information on appropriate prescribing despite the inherent tension between drug firm dissemination of information to promote sales and rational prescribing. In the (...) past, physicians often relied particularly on drug firm advertising for information on drug use. Today, physicians rely on drug firms to finance continuing medical education. A historical review reveals connections between these two different ways commercial interests have influenced the information that physicians receive and points the way to needed reforms. (shrink)

The heart of the matter -- The evolution of the French medicine -- Coping with physicians' conflicts of interest in France -- The rise of a protected medical market : the United States before 1950 -- The commercial transformation : the United States, 1950-1980 -- The logic of medical markets : the United States, 1980 to the present -- Coping with physicians' conflicts of interest in the United States -- The evolution of Japanese medicine -- Coping with physicians' conflicts of (...) interest in Japan -- Reforms -- Professionalism reconsidered. (shrink)

Joseph Heath states that our paper “misinterpret[s]” and so misrepresents his account. The present Commentary corrects the record. Our paper (Cohen and Peterson 2019) outlined Heath’s account on his own terms; it explained that Heath distances himself from consequentialism. But then we argued that Heath is mistaken and so offered a repaired version of the market failures approach. Our central concern, in the original paper and in this short Commentary, is showing that the economic argument for markets is at the (...) same time ethical, and then being more precise about the ethical consideration that does the work. (shrink)

The case "Caprica Energy and Its Choices" concerns a fictionalized energy corporation choosing between three potential drilling sites. According to the published Teaching Note, the case is an exercise in the stakeholder approach to business: it requires balancing profit considerations with potential harm to those who live near those drilling sites. Though unintended, the case raises a further question not addressed in the case or in the Teaching Note: what gives Caprica Energy the right to impose risk on members of (...) the communities surrounding its drilling sites? The first section of the present article argues that, in such cases, manage- ment can only justify imposing risk on the local community by securing those stakeholders' consent. The second section outlines the implications for stakeholder theory and stake- holder management. The third section outlines one con- nection between this material and recent literature on the imposition of risk and moral theory; that section offers an account of what make this particular instance of imposing risk morally problematic, with reference to the directedness of the imposition. (shrink)

The Food and Drug Administration authorizes the marketing of a drug only for uses that the manufacturer has demonstrated to be safe and effective, based on evidence from at least two clinical trials. However, the FDA does not regulate the practice of medicine, so physicians may prescribe drugs in any manner they choose. Prescribing drugs in ways that deviate from the uses specified in the FDA-approved drug label, package insert, and marketing authorization is referred to as off-label prescribing. This occurs (...) when physicians prescribe a drug for a therapeutic purpose other than the one approved by the FDA; treat patients in a different age cohort or gender than the population on which it was tested; or prescribe a different dose, for a different duration of use, or a different mode of administration than indicated on the label. (shrink)

Prescribing drugs for uses that the FDA has not approved — off-label drug use — can sometimes be justified but is typically not supported by substantial evidence of effectiveness. At the root of inappropriate off-label drug use lie perverse incentives for pharmaceutical firms and flawed oversight of prescribing physicians. Typical reform proposals such as increased sanctions for manufacturers might reduce the incidence of unjustified off-label use, but they do not remove the source of the problem. Public policy should address the (...) cause and control the practice. To manage inappropriate off-label drug use, off-label prescriptions must be tracked in order to monitor the risks and benefits and the manufacturers’ conduct. Even more important, reimbursement rules should be changed so that manufacturers cannot profit from off-label sales. When off-label sales pass a critical threshold, manufacturers should also be required to pay for independent testing of the safety and effectiveness of off-label drug uses and for the FDA to review the evidence. Manufacturers should also finance, under FDA supervision, programs designed to warn physicians and the public about the risks of off-label drug use. (shrink)

Donald Davidson's work has been of seminal importance in the development of analytic philosophy and his views on the nature of language, mind and action remain the starting point for many of the central debates in the analytic tradition. His ideas, however, are complex, often technical, and interconnected in ways that can make them difficult to understand. This introduction to Davidson's philosophy examines the full range of his writings to provide a clear succinct overview of his ideas. This book begins (...) with an account of the assumptions and structure of Davidson's philosophy of language, introducing his compositionalism, extensionalism and commitment to a Tarski-style theory of truth as the model for theories of meaning. It goes on to show how that philosophical framework is to be applied and how it challenges the traditional picture. Marc Joseph examines Davidson's influential work on action theory and events and discusses the commonly made charge that his theory of action and mind leaves the mental as a mere 'epiphenomenon' of the physical. The final section explores Davidson's philosophy of mind, some of its consequences for traditional views of subjectivity and objectivity and, more generally, the relation between minded beings and the physical and mental world they occupy. (shrink)

This paper addresses the tactical question of how we ought to proceed in teachingbusiness ethics, taking as a starting point that business ethics should be concerned with cooperative,mutually beneficial outcomes, and in particular with fostering behavior that contributes to thoseoutcomes. This paper suggests that focus on moral reasoning as a tactical outcome—as a way ofachieving behavior in support of cooperative outcomes—is misplaced. Instead, we ought to focuson cultivating empathetic experiences. Intuitively, the problem we need to address in business ethicsis not (...) that our students (and that we ourselves) sometimes reason poorly, or that moral decisionmakingis subject to characteristic kinds of errors. The problem is that our students (and—again—we ourselves) do not always care enough, we do not modify our behavior consistently enough. (shrink)

The Problem of Doxastic Shift may be stated as a dilemma: on the one hand, the distribution of nominal complements of the form `the ψ that p’ strongly suggests that `that’-clauses cannot be univocally assigned propositionaldenotations; on the other hand, facts about quantification strongly suggest that `that’-clauses must be assigned univocal denotations. I argue that the Problem may be solved by defining the extension of a proposition to be a set of facts or, more generally, conditions. Given this, the logical (...) operation of descriptive predication can be introduced in a way that resolves the dilemma withoutsacrificing the singular term analysis of `that’-clauses. (shrink)

Joseph Heath defends competitive markets and conceptualizes business ethics with reference to Pareto efficiency, which he takes to be the “implicit morality of the market.” His justification for markets is that they generate Pareto efficient outcomes, meaning that markets optimally satisfy consumer preferences. And, for Heath, business ethics is the set of normative constraints—regulation and beyond-compliance norms—needed to preserve that outcome. The present paper accepts Heath’s claim that the economic justification for markets is ethical, in that satisfying consumer preferences is (...) a good. But, contra Heath, the ethical consideration at work is a consequentialist one; and acknowledging this consequentialism exposes limitations of Heath’s “market failures” approach to business ethics. We suggest two limitations, and we expect many will accept our argument that Heath’s conception of business ethics is too narrow. The present paper outlines two broader implications. First, acknowledging that the justification for markets is ethical eliminates the apparent—and false—conflict between purportedly amoral economic activity on one hand and ethical considerations on the other; instead, business ethics is a matter of weighing the consequentialist ethical benefit of economic activity and markets against other moral arguments/other ethical considerations. Second, Heath restricts business ethics to the constraints needed to protect the market’s ability to efficiently satisfy consumer preferences, constraints he calls “efficiency imperatives”; this restriction supports the widespread tendency to think that all social problems are economic; and, a business ethics so-conceived diminishes the perceived importance of noneconomic values—this attitude is dangerous. (shrink)

Through the 1960s, many people claimed that drug advertising was educational and physicians often relied on it. Continuing Medical Education (CME) was developed to provide an alternative. However, because CME relied on grants, industry funders chose the subjects offered. Now policymakers worry that drug firms support CME to promote sales and that commercial support biases prescribing and fosters inappropriate drug use. A historical review reveals parallel problems between advertising and industry-funded CME. To preclude industry influence and improve CME, we should (...) ensure independent funding by taxing medical industries, facilities and physicians. Independent public and professional authorities should create CME curricula. An independent agency should allocate all funds to educational institutions for approved curricula. (shrink)

Jared D. Harris, Brian T. Moriarty, and Andrew C. Wicks’ recent book collects eleven chapters by well-known scholars on the question of public trust in business, published along with an introduction and conclusion by the editors. But the collection doesn’t make progress on what this reviewer takes to be the two essential questions. This review outlines those questions and then addresses a further, more technical difficulty with the conceptualizations of trust at work across the chapters. The central theme here is (...) that business as an institution has obligations to society; we—the public—trust business to act on those obligations; and when business violates those obligations our trust is betrayed. The essays collected in this volume do not directly address the question of what those obligations are, but this should be the starting point for an investigation of public trust in business. (shrink)

Dissent and Philosophy in the Middle Ages offers scholars of Dante's Divine Comedy an integral understanding of the political, philosophical, and religious context of the medieval masterwork. First penned in French by Ernest L. Fortin, one of America's foremost thinkers in the fields of philosophy and theology, Dissidence et philosophie au moyen-%ge brings to light the complexity of Dante's thought and art, and its relation to the central themes of Western civilization. Available in English for the first time through this (...) superb translation by Marc A. LePain, Dissent and Philosophy will make a supremely important contribution to the discussion of Dante as poet, theologian, and philosopher. (shrink)

"A wide-ranging study of the 'way of ideas' and its metaphysics, culminating in a bold reinterpretation of Berkeley.".

The federal government indirectly subsidizes the pharmaceutical industry by funding basic research, various tax credits and deductions, patent rules, grants of market exclusivity, and other means, in order to spur drug development, promote public health, and improve medical care. But today, the pharmaceutical industry often neglects these goals and sometimes even undermines them, due to what Lawrence Lessig refers to as institutional corruption — that is, widespread or systemic practices, usually legal, that undermine an institution’s objectives or integrity. A key (...) source of institutional corruption is improper dependence by the institution or its key actors on the actions of third parties that have fundamentally different interests. It is the health care system’s improper dependency on pharmaceutical firms that allows them to displace some public policy goals and to compromise the attainment of others. (shrink)

External obstacles to properly understanding Wittgenstein’s philosophy of mathematics are not lacking, either. For one thing, there is the piecemeal way that his mathematical manuscripts have been made available. The editors of Remarks on the Foundations of Mathematics write that “the time has not yet come to print the whole of Wittgenstein’s MSS on these... topics”. One wonders what sorts of reasons there could be for that editorial choice.

This work studies early modern thought concerning the ontology of ideas. I endeavor to establish, contrary to some current scholarship, that the Early Moderns remained firmly in the grip of a substance/mode ontology narrowed from the substance/property distinction inherited from Aristotle. I argue that this traditional dichotomy provides the most philosophically and historically fruitful approach to understanding early modern thought. In particular, I demonstrate how the increasing radicalization in the metaphysics of the moderns is best explained by remaining within the (...) substance/mode ontology. Competing contemporary approaches, especially ones that attempt to employ concepts such as reification and object talk in place of the traditional ontology, do not sufficiently penetrate to the core issues facing the Moderns. Rather than seeking to abandon the categories of substance and mode, the Moderns sought, perhaps vainly, to find room for ideas within it. I proceed by providing background from Aristotle and the Medievals, go on to discuss the philosophical views of Descartes, Malebranche, Arnauld, Locke and Berkeley. The development of idea philosophy culminates in Berkeley, who creates a hybrid ontic category I call 'quasi-substance.' Ideas for Berkeley are ontically dependent on minds , but external to them in the sense that the relationship between ideas and minds are two-place . I demonstrate how this understanding explains the radical metaphysical positions he takes, especially his commitment to perceptual heterogeneity. I conclude that rather than abandoning the traditional ontic categories, the Moderns adhered to them desperately, and thus are best understood through them. (shrink)

I argue that Berkeley has reasonable grounds for believing both that (a) the supposition of the existence of material substance leads to atheism and (b) endorsing immaterialism provides a better support for the Christian faith than any rival that posits the existence of matter. Together, those claims lead to the conclusion that if one wants to be a Christian, there is good reason to think that one ought to be an immaterialist. Je montre que Berkeley a raison de croire que (...) l'existence de la matière conduit à l'athéisme et que la reconnaissance de l'immatérialisme donne un meilleur support à la croyance chrétienne que n'importe quelle autre assertion qui défend l'existence de la matière. Ensemble ces thèses mènent à la conclusion que pour qui veut être chrétien, il y a une bonne raison de croire qu'il faut être immatérialiste. (shrink)

Post-industrial societies confront common problems in pharmaceutical industry-physician relations. In order to promote sales, drug firms create financial relationships that influence physicians' prescriptions and sometimes even reward physicians for prescribing drugs. Three main types exist: kickbacks, gifts, and financial support for professional activities. The prevalence of these practices has evolved over time in response to changes in professional codes, law, and markets. There are certainly differences among these types of ties, but all of them can compromise physicians' independent judgment and (...) rational prescribing.Drug firms have paid kickbacks for prescribing drugs, purchasing drugs, switching brands prescribed, adding a drug to a hospital formulary, enrolling patients in post-marketing clinical trials, and writing practice guidelines that encourage the use of certain drugs. (shrink)

Improper dependencies slant policy over a drug's life span, biasing the development of new drugs, the testing and marketing approval for new drugs, and the monitoring of patient safety after drugs are marketed. This article examines five ways in which the public improperly depends on pharmaceutical firms that compromise the integrity of pharmaceutical policy. Today the public relies on pharmaceutical firms: (1) to set priorities on drug research and development; (2) to conduct clinical trials to test whether drugs are safe (...) and effective; (3) to decide what clinical trial data to disclose to the public; (4) to monitor post marketing drug safety; (5) to supply product information to physicians and to finance continuing medical education and other professional activities. The article suggests options to overcome each of these dependencies. (shrink)

Bernard Williams briefly discusses agent regret in his broader account of moral luck. The present paper first outlines one way to develop Williams’s notion with reference to the unintended harm; it then suggests that agent regret can be counteracted by externalizing the action that caused unintended harm, in Harry Frankfurt’s sense of externalization; and then the present paper argues that apology is a mechanism by which a person can externalize an offending action/effect—in that way counteracting agent regret. This function for (...) apology—self-repair—is different from others described in the literature, which address the role of apology in repairing relationships. The present paper describes a nonfictional example, that of a veteran of the U.S. war in Iraq who contacts a family gravely injured by him and his combat unit; the veteran is motivated to contact the family to apologize. The example serves as a prototypical case of agent regret. The example is taken from a recent literature on the clinical psychology of self-inflicted “moral injury”; categorizing this example of moral injury as agent regret also helps broaden our understanding of moral injury as a philosophical category and as a psychological phenomenon. (shrink)

It is argued that the finitist interpretation of wittgenstein fails to take seriously his claim that philosophy is a descriptive activity. Wittgenstein's concentration on relatively simple mathematical examples is not to be explained in terms of finitism, But rather in terms of the fact that with them the central philosophical task of a clear 'ubersicht' of its subject matter is more tractable than with more complex mathematics. Other aspects of wittgenstein's philosophy of mathematics are touched on: his view that mathematical (...) propositions are 'grammatical propositions' (and so, Strictly speaking, Not genuine propositions at all) and his view that in mathematics 'everything is algorithm, Nothing meaning'. His views on consistency and his anti-Foundationalism are linked with this central thesis. (shrink)

Bryan Norton proposes a "convergence hypothesis'* stating that anthropocentrists and nonanthropocentrists can arrive at common environmental policy goals if certain constraints are applied. Within his theory he does not, however, address the consideration ofnonconsequentualist issues, and, therefore, does not provide an argument for the convergence between consequentualist and nonconsequentualist ethical positions. In the case of biotechnology, nonconsequentualist issues can dominate the debate in both the fields of environmental ethics and bioethics. I argue that, the convergence hypothesis must be rejected when (...) tested against the case of biotechnology, and this limitation of convergence applies to any theory of reconciliation within the "health" concept because the achievement and preservation of "health "emphasizes a consequentualist outlook. I conclude that an inclusive ethics for ecosystem and human health should be explicit about this limitation. (shrink)

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

Joseph A. Bracken, S.J,. is one of the more significant North American theologians of the past 40 years. With 12 monographs, two edited or co-edited volumes, over 150 articles, numerous professional and popular conference presentations and media appearances, he is one of the foremost interlocutors in contemporary theological discourse. Having developed and consistently defended a comprehensive and intellectually rigorous worldview that combines the modern and classical Christian worldviews, Bracken has accomplished an invaluable service to the academy, the church, and the (...) world. He has not favored a particular theological or philosophical system, past or present. Instead, he culls what he judges to be true and good in a myriad of seemingly prima facie noncompossible thinkers and systems with divergent programs. Synthesizing the Catholic intellectual tradition and process-relational metaphysics, Bracken also incorporates aspects of German and Anglo-American Idealism, Pragmatism, recent philosophy of science, and a litany of past and present theologians and philosophers. The present volume is a Festschrift to honor Bracken’s career and accomplishments. It differs from the standard Festschrift genre in that the contributors, while certainly explicating and reflecting upon various aspects of his comprehensive worldview, offer their original contributions n a variety of topics. They do in dialogue with Bracken’s positions, simply as starting points, not as end points. The common theme of the Festschrift, then, is serious reflection on and in some cases critique of Bracken’s comprehensive process-relational, Catholic, and Trinitarian worldview and its pertinence for work in contemporary theology from a given perspective. Yet there is a certain richness coming from the diverse perspectives of the contributors whose work intersects with Bracken’s, and not always in terms of process thought per se. The contributors come from diverse backgrounds, not only in process and Roman Catholic theology but also including even other academic disciplines. They represent a balance of senior and junior scholars, and of genders. (shrink)