Various U.S. laws, such as the Clean Air Act and the Food Quality Protection Act, require additional protections for susceptible subpopulations who face greater environmental health risks. The main ethical rationale for providing these protections is to ensure that environmental health risks are distributed fairly. In this article, we (1) consider how several influential theories of justice deal with issues related to the distribution of environmental health risks; (2) show that these theories often fail to provide specific guidance concerning policy (...) choices; and (3) argue that an approach to public decision making known as accountability for reasonableness can complement theories of justice in establishing acceptable environmental health risks for the general population and susceptible subpopulations. Since accountability for reasonableness focuses on the fairness of the decision-making process, not the outcome, it does not guarantee that susceptible subpopulations will receive a maximum level of protection, regardless of costs or other morally relevant considerations. (shrink)

When the President’s Commission of 1983 concluded that there is an “ethical obligation” to secure universal access to a decent minimum of health care, some hoped that this standard would be achieved in the United States within a few years. Nearly 30 years later, when we began work on this issue of the Journal of Medicine and Philosophy (JMP), that standard had yet to be achieved, although the bills that would later become the Affordable Care Act (ACA) were then working (...) their way through Congress. Now, the ACA has been passed and signed into law. The provisions of that bill aim at achieving universal access to an “essential health benefits (EHBs) package". (shrink)

This study examined how structuring case-based ethics training, either through (a) case presentation or (b) prompt questions, influences training outcomes. Results revealed an interaction between case presentation and prompt questions such that some form of structure improved effectiveness. Specifically, comparing cases led to greater sensemaking strategy use and decision-ethicality when trainees considered unstructured rather than structured prompts. When cases were presented sequentially, structuring prompts improved training effectiveness. Too much structure, however, decreased future ethical decision making, suggesting that there can be (...) too much of a good thing when structuring case-based ethics education. Implications for designing ethics training programs are discussed. (shrink)

Case-based reasoning has long been used to facilitate instructional effectiveness. Although much remains to be known concerning the most beneficial way to present case material, recent literature suggests that simplifying case material is favorable. Accordingly, the current study manipulated two instructional techniques, incremental case presentation and forecasting outcomes, in a training environment in an attempt to better understand the utility of simplified versus complicated case presentation for learning. Findings suggest that pairing these two cognitively demanding techniques reduces satisfaction and detracts (...) from the effectiveness of the learning approach. Implications regarding the use of instructional techniques in training programs are discussed. (shrink)

One of the most remarkable features of human societies is our ability to cooperate with each other. However, the benefits of cooperation are not extended to everyone. Indeed, another hallmark of human societies is a division between us and them. Favoritism toward members of our group can result in a loss of empathy and greater tolerance of harm toward those outside our group. The current study sought to investigate how in-group bias impacts the developmental emergence of concerns for fairness and (...) care. We investigated the impact of in-group bias on decisions related to care and fairness in children. Participants made decisions about how to allocate resources between themselves and a peer who was either an in-group or out-group member. In decisions related to care, participants were given two trial types on which they could decide whether to give or throw away a positive or negative resource. In decisions related to fairness participants and peer partners each received one candy and participants decided whether to allocate or throw away an extra candy. If the extra candy was distributed it would place either the participant or their recipient at a relative advantage, whereas if the extra candy was thrown away the distribution would be equal. We found that on fairness trials children’s tendency to allocate resources was similar toward in-group and out-group recipients. Furthermore, children’s tendency to allocate resources changed with age such that younger participants were more likely to allocate extra candies to themselves, whereas older participants were more likely to allocate extra candies to their recipient. On trials related to care we did observe evidence of in-group bias. While distribution of positive resources was greater than negative resources for both in-group and out-group recipients, participants distributed negative resources to out-group recipients more often compared to in-group recipients, a tendency that was heightened for young boys. This pattern of results suggests that fairness and care develop along distinct pathways with independent motivational supports. (shrink)

That Jehovah's Witnesses cannot refuse life-saving blood transfusions on behalf of their children has acquired the status of virtual “consensus” among bioethicists. However strong the consensus may be on this matter, this article explores whether this view can be plausibly defended on liberal principles by examining it in light of one particularly well worked-out liberal political theory, that of Rawls. It concludes that because of the extremely high priority Rawls attributes to “freedom of conscience,” and the implication from the original (...) position that parents must act paternalistically toward their children as their protectors, Jehovah's Witnesses cannot legitimately be barred from making decisions on behalf of their children, even when the consequences of such decisions are serious and irremediable. (shrink)

In Righting Health Policy, MacDougall argues that bioethics has not developed the tools best suited for justifying health law and policy. Using Kant’s practical philosophy as an example, he explores the promise of political philosophy for making normatively justified recommendations about health law and policy.

During the last several decades, professional medicine has undergone profound changes in its organization. In particular, the growth of managed care organizations and publicly funded medicine has increasingly standardized physician working conditions and reimbursement. While it is sometimes disputed whether the profession of medicine is suffering reduced autonomy as a whole, there is little doubt that individual physicians are losing autonomy (Burdi and Baker 1999; Harrison and Schulz 1989; Iglehart 1992). As a result, physicians are increasingly attracted to various mechanisms (...) for retaining some control over their individual practice (Choudhry and Brennan 2001). Such mechanisms may include organization .. (shrink)

According to various accounts, intervention in pediatric decisions is justified either by the best interests standard or by the harm principle. While these principles have various nuances that distinguish them from each other, they are similar in the sense that both focus primarily on the features of parental decisions that justify intervention, rather than on the competency or authority of the parties that intervene. Accounts of these principles effectively suggest that intervention in pediatric decision making is warranted for both physicians (...) and the state under precisely the same circumstances. This essay argues that there are substantial differences in the competencies and authorities of physicians and the state, and that the principles that guide their interventions should also be conceived differently. While both the best interests standard and the harm principle effectively incorporate important aspects of physicians’ ethical obligations, neither adequately reflects the state’s ethical obligations. In contrast to physicians, the state has major obligations of distributive justice and neutrality that should form an integral part of any proposed ethical principles guiding state intervention in pediatric decision making. The differences are illustrated by examining recent cases involving parental refusal of chemotherapy in aboriginal Canadian communities and parental refusal of blood transfusions by Jehovah’s Witnesses. (shrink)

Several commentators have tried to ground legal prohibitions of kidney sales in some form of Kant’s moral arguments against such sales. This paper reconsiders this approach to justifying laws and policies in light of Kant’s approach to law in his political philosophy. The author argues that Kant’s political philosophy requires that kidney sales be legally permitted, although contracts for such sales must remain unenforceable. The author further argues that Kant’s approach to laws, such as those governing kidney distribution, was formed (...) in part by considering and rejecting an assumption frequently employed in the bioethics literature, namely, that legal duties can be grounded directly in moral duties. The author explains some of Kant’s reasons for rejecting this assumption and concludes that arguments pertaining to the legality of kidney sales developed on the basis of Kant’s moral philosophy should no longer be considered tenable. (shrink)