Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

Ignorance is commonly assumed to be a lack of knowledge in Plato’s Socratic dialogues. I challenge that assumption. In the Protagoras, ignorance is conceived to be a substantive, structural psychic flaw—the soul’s domination by inferior elements that are by nature fit to be ruled. Ignorant people are characterized by both false beliefs about evaluative matters in specific situations and an enduring deception about their own psychic conditions. On my interpretation, akrasia, moral vices, and epistemic vices are products or forms of (...) ignorance, and a person who lacks knowledge is not necessarily ignorant. (shrink)

Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose that disrespect can usefully be understood as a failure to relate to people as equals. This characterisation is consonant with some accounts of respect but sometimes obscured by a (...) focus on respecting people’s autonomy and dignity. Emphasising equality is consistent with connections patients draw between being (dis)respected and (in)equality. It readily accommodates microaggressions as forms of disrespect, helping to understand how and why experiences of disrespect may be unintentional and to explain why even small instances of disrespect are wrong. Our view of disrespect with an emphasis on equality strengthens the demand that health systems take disrespect seriously as a problem of social injustice and tackle it at institutional, not just individual levels. It suggests several strategies for practical action. Emphasising relational equality is not an easy or short-term fix for disrespect, but it signals a direction of travel towards an important improvement ambition. (shrink)

This paper is an attempt to examine issues and problemsraised by agricultural biotechnology by drawing on the richnessof contemporary ideas in ethical theory and thereby contribute tothe project of establishing new approaches to these problems. Thefundamental argument is that many of the negative aspects ofagricultural biotechnology are generated at the level of theunderlying conceptual frameworks that shape the technology''sinternal modes of organization, rather than the unintendedeffects of the application of an inherently benevolent set oftechniques. If ``food ethics'''' is to address (...) the adverse impacts ofagricultural biotechnology, it must ultimately challenge theseconceptual frames, which, I argue, emerge from Enlightenment,liberal, political, and economic theory.The translation of traditional bioethics (focusing on principlessuch as autonomy and rights, justice, and well being) into foodethics does not produce the critical tools that are ableadequately to challenge the harmful legacy of Enlightenmentthinking. What is needed are reorientations of ethics that arecapable of formulating concepts and approaches that to someextent break with the presuppositions that underpin biotechnologyat its foundation. This paper suggests that narrative andfeminist critiques of medical bioethics are a good place to startin this project. (shrink)

There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and (...) somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes ; limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

This book addresses the metaphysics of Armstrongian states of affairs, i.e. instantiations of naturalist universals by particulars. The author argues that states of affairs are the best candidate for truthmakers and, in the spirit of logical atomism, that we need no molecular truthmakers for positive truths. In the book's context, this has the pleasing result that there are no molecular states of affairs. Following this account of truthmaking, the author first shows that the particulars in (first-order) states of affairs are (...) bare particulars. He then argues that the properties in states of affairs are simple, non-relational and concrete universals. Next, he argues that (material) relations in states of affairs are external relations. Lastly, he argues that a state of affairs is unified by a distinctive formal relation without giving rise to Bradley’s regress. (shrink)

This article introduces a non-Anglophone concept of gong qi as a metaphor for ‘corporation’. It contributes an endogenous perspective from a Sino-Japanese organizational context that enriches mainstream business ethics literature, otherwise heavily reliant on Western traditions. We translate the multi-layered meanings of gong qi based on analysis of its ideograms, its references into classical philosophies, and contemporary application in this Japanese multinational corporation in China. Gong qi contributes a perspective that sees a corporation as an inclusive and virtuous social entity, (...) and also addresses the elusive, implicit, and forever evolving nature of organizational life that is rarely noticed. We propose gong qi can be applied in other organizations and wider cultural contexts to show a new way of seeing and understanding business ethics and organization. Rather than considering virtue as a list of definable individual qualities, we suggest that the metaphor of gong qi reveals how virtue can be experienced as indeterminate, yet immanently present, like the substance of emptiness. This, then allows us to see the virtue of immanence, the beauty of implicitness, and hence, the efficacy of gong qi. (shrink)

It is the study of how Thomas Paine's religious beliefs shaped his political ideology and influenced his political activism.

What I call Mellor’s Question is the problem of whether determinables are properties of their determinates or properties of the particulars that possess these determinates. One can distinguish two basic competing theories of determinables that address the issue, implicitly if not explicitly. On the second-order theory, determinables are second-order properties of determinate properties; on the second-level theory, determinables are first-order properties of the particulars with these determinate properties. Higher-order properties are prima facie ontologically uneconomical, and in line with my general (...) view that ontological parsimony is vital to metaphysics, I consider it highly important which of the two theories is true. Firstly, I argue that the second-level theory offers the best explanation of the explananda (though the race is close), including the important but neglected phenomenon of ‘intermediate determinables’. Secondly, by paying attention to intermediate determinables and instantiation of higher-order properties, I argue that the second-level theory also is more ontologically economical. For these two reasons, this theory is preferable. (shrink)

This paper defends the case against (sparse) disjunctive properties by means of four Armstrongian arguments. The first of these is a logical atomist argument from truthmaking, which is, broadly speaking, ‘Armstrongian’ (Armstrong 1997). This argument is strong – although it stands or falls with the relevant notion of truthmaking, as it were. However, three arguments, which are prima facie independent of truthmaking, can be found explicitly early in Armstrong’s middle period. Two of these early arguments face a serious objection put (...) forward forcefully by Louise Antony (2003) and Alan Penczek (1997), respectively. I consider these objections and argue that they fail. Thus, even if the argument from truthmaking is indecisive, disjunctive properties should be rejected. (shrink)

RésuméL'ouvrage galéniqueSur les Éléments selon Hippocrateest une importante source d'information concernant les théories physiques de l'antiquité tardive. Les diverses doctrines atomistes discutées par Galien ainsi que les arguments employés par lui pour les réfuter ont été étudiés de près par les premiersMutakallimūn.Les abrégés de cet ouvrage, qui semblent avoir été écrits plusieurs siècles après Galien, et dont certains remontent aux débuts de la culture islamique, présentent un intérêt particulier. Dans cet article, nous donnons une édition, une traduction et une étude (...) d'un abrégé inconnu jusqu'ici, conservé dans un unique manuscrit, qui l'attribue à Ḥunayn ibn Isḥāq. Comme les autres abrégés, il s'agit en fait d'une doxographie de théories physiques qui ne reproduit pas toujours précisément ce que Galien a dit, mais qui reflète le discours de l'époque où elle a été rédigée. (shrink)

I defend an ontological distinction between three kinds of relation: internal,external and grounded relations. Even though, as we shall see, this trichotomy is basic, it is not found in influential contemporary metaphysics. Specifically, the widespread tendency, exemplified notably by David Armstrong, of not recognizing grounded relations as distinct from external relations, can be shown to be mistaken. I propose a definition of each of the three kinds of relation. Of vital importance to the parsimony of metaphysics, I also argue that (...) only external relations are ontologically fundamental. (shrink)

Reading feminist theory as a complex imaginative achievement, Feminist Imagination considers feminist commitment through the interrogation of its philosophical, political and affective connections with the past, and especially with the `race' trials of the twentieth century. The book looks at: the 'directionlessness' of contemporary feminist thought; the question of essentialism and embodiment; the racial tensions in the work of Simone de Beauvoir; the totalitarian character in Hannah Arendt; the 'mimetic Jew' and the concept of mimesis in the work of Judith (...) Butler. Vikki Bell provides a compelling rethinking of feminist theory as bound up with attempts to understand oppression outside a focus on 'women'. She affirms feminism as a site and mode of making these connections. What emerges is a profound work brimming with insight that will be required reading for anyone who is seriously interested in feminist theory and, more generally, contemporary social theory. (shrink)

Recruitment processes for clinical trials are governed by guidelines and regulatory systems intended to ensure participation is informed and voluntary. Although the guidelines and systems provide some protection to potential participants, current recruitment processes often result in limited understanding and experiences of inadequate decision support. Many trials also have high drop-out rates among participants, which are ethically troubling because they can be indicative of poor experiences and they limit the usefulness of the knowledge the trials were designed to generate. Drawing (...) on recent social-psychological and philosophical-ethical research on trial recruitment and patient participation in treatment decision-making, this paper identifies possibilities for improving communicative support for both initial decisions and ongoing participation in clinical trials. It highlights the potential of a shift in thinking about ‘voluntariness’, underpinned by relational understandings of autonomy, to encourage more nuanced judgements about the ethics of communication between trial staff and (potential) participants. The paper suggests that the idea of responsively enabling people to consider invitations or requests to participate in particular trials could serve as a general guide to communication. This might help ensure decisions about trial participation are meaningfully informed and voluntary, and that relationships between trial staff and participants contribute to positive experiences of trial participation and ultimately to the generation of the robust knowledge. (shrink)

In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’ (QI), and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, we note that QI and ethics can, in some respects, (...) be treated as closely related concerns and not simply as externally related agendas. To support our argument, we explore the gap between ‘quality’ and ‘ethics’ discourses and ask about the possible differences between ‘good quality healthcare’ and ‘good healthcare’. We suggest that the word ‘quality’ both adds to and subtracts from the idea of ‘good healthcare’, and in particular that the technicist inflection of quality discourses needs to be set in the context of broader conceptualisations of healthcare improvement. We introduce the distinction between quality as a measurable property and quality as an evaluative judgement, suggesting that a core, but neglected, question for an ethics of healthcare improvement is striking the balance between these two conceptions of quality. (shrink)

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the (...) family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

A 'social trap' is a situation where individuals, groups or organisations are unable to cooperate owing to mutual distrust and lack of social capital, even where cooperation would benefit all. Examples include civil strife, pervasive corruption, ethnic discrimination, depletion of natural resources and misuse of social insurance systems. Much has been written attempting to explain the problem, but rather less material is available on how to escape it. In this book, Bo Rothstein explores how social capital and social trust are (...) generated and what governments can do about it. He argues that it is the existence of universal and impartial political institutions together with public policies which enhance social and economic equality that creates social capital. By introducing the theory of collective memory into the discussion, Rothstein makes an empirical and theoretical claim for how universal institutions can be established. (shrink)

On the notion of responsibility employed by John Passmore in his classic Man’s Responsibility for Nature, the relationship of responsibility can only hold between persons (human beings, subjects), or groups and communities of them, and other persons. And in this relationship the persons that are responsible 'to' other persons are responsible 'for' how their actions affect these other persons, not to the direct object of these actions (in this case: nature). If this is correct, we cannot be responsible to nature (...) without conceiving of it as a ‘pseudo-person’, as Passmore calls it. However, non-anthropocentric environmental ethics requires such a moral relationship. The question is, therefore, how this can be allowed in a metaphysically acceptable way. To answer this I first provide an account of what it means to stand in the relation of being ‘responsible to’. Next, I describe two major paradigmatic examples of the metaphysics of nature that perfectly match the thesis that we can, and should, be responsible to nature (the Spinoza-inspired view and the Gaia hypothesis). Unfortunately, they have to be rejected for common sense or naturalist reasons. Finally, I therefore defend a 'fictionalist' view of nature (as person-like) that allows for this relationship. (shrink)

Daniel Dennett is arguably one of the most influential yet radical philosophers in America today. In this volume, Dennett is confronted by colleagues and critics, from philosophy, biology and psychology. His reply constitutes an extensive essay which clarifies, and develops further, central themes in his philosophy. The debate ranges over Dennett's whole corpus, but special attention is given to his major work on consciousness, Consciousness Explained. The volume includes a critical assessement of Dennett's views on behaviouralism and the subjectivity of (...) consciousness, the nature of perception and mental representation, intentional laws and computational psychology, the rationality of thought, culture as a virus, the architecture of mind, and the role of artifacts in thinking. Also included is an introduction to Dennett's philosophy and a full bibliography of his publications. (shrink)

I väntan på den engelska Festschriften, den definitiva biografin eller de självförhärligande memoarerna kommer här för första gången en samling porträtt av den internationellt mest uppmärksammade svenska statsvetaren, den kontroversielle samhällsdebattören Bo Rothstein. Få samhällsforskare har med sådan intensitet tagit universitetens tredje uppgift till intäkt för att ifrågasätta gängse uppfattningar om sakernas tillstånd i riket. Många är de läsare, tittare eller åhörare som knappast kunnat undgå att beröras av hans synpunkter på allt från metoo till tiggeri, något färre är nog (...) de som på allvar tagit del av hans forskningsresultat om korruption och statsförvaltning. I denna bok tecknar ett tjugotal svenska forskare, författare och vänner sin bild av forskaren, debattören och livsnjutaren Bo Rothstein."--Back cover. (shrink)

Bell argues that the dialogue that emanate from the aesthetic realm cannot be understood through a solely art-historical approach; instead, they must be understood as part of a collective endeavour. In this sense, the 'art' of post-dictatorship is not something that belongs to art or the artists themselves, but is about how the subjectivities and imaginations of new generations engage with questions of response, ethics and justice; and, in so doing, re-align themselves in relation to the past and to the (...) future. This book provides a valuable resource for those interested in the law, politics, art and sociology of contemporary Argentina. It will be of immense use to those studying in these areas and to those concerned more widely with transitional justice and memory politics. (shrink)

In this interview, Judith Butler speaks about her most recent work, especially Excitable Speech, in terms of how it represents a continuation of certain themes and how it represents moves into new terrains of debate. In particular, she addresses both possible critiques of her work, expecially around the issue of the possibility of political visions and the attention to speech when theorizing subjectification, and responds to questions around certain related themes such as: just what is the possibility of using the (...) same analytical framework to talk both about racializing and gendering processes? How useful is the concept of melancholia? How are textuality and visuality interconnected? (shrink)

This short piece introduces the Special Issue, giving both a general sense of the terms `belonging' and `performativity', and discussing key related concepts that unite the articles of the issue: difference and their differences; the politics of visuality; embodiment; and the idea of routes. The predominant themes as they appear in the different articles are discussed under these headings.

In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ’normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as ’explanatory complexity’. In brief, normative complexity relates to (...) the inherent difficulty of deciding what kinds of changes are ’improvements’ or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (’orchestrated conversations’) and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination. (shrink)

Modes of engagement. The reader may engage with this article in several different modes. It could be approached in straightforward, if quirky, sociological mode as an exploration of the idea that the literature on post‐divorce arrangements and step‐families, and especially literature, that attends to children's contact with their non‐resident fathers, can be re‐read in order to consider the issue of contact via communication technologies, a form of parent‐child contact not captured in the ways that ‘contact’ is measured in present studies. (...) Of interest in itself, perhaps, this point of entrance opens up onto further questions about the management of human affect, and how rearrangements in lines of affect have reverberations beyond those captured by an Oedipal model, insofar as they are not about contact and severance but are various kinds of displacement for all involved. In particular, I am concerned here with the rearrangement of affect for the fathers as their role becomes dispersed, shared and intermittent, a set of problematics that also includes the various ways in which the very body of the mother is removed or circumvented. On a second level the article speaks to a different literature, in that it is an elaboration of the notion of the network as a dispersed hybrid that entails both human and non‐human entities, within which any absolute distinction between human and non‐human is to be prob‐lematised but, I wish to argue, without losing the specificity of human interaction, that is, the questions of human emotion, human desire and human ethics. This elaboration moves toward a critique of the very ubiquity and endless utility of the network idea through the suggestion that its appeal may conceal moments and movements where more unexpected effects are taking place. Indeed, I suggest that there may be some twists in the familial dynamics of ‘households that no longer hold’, where some selected thoughts from a reading of Deleuze and Guattari, specifically around the notion of ‘becoming’, may lead one to read other stories than that proffered through the master trope of the network, ones that are maybe closer to some of the original impulses behind actor‐network theory. And thirdly, the article may be engaged as a reflection on contemporary ways in which familial life is governed in contemporary Britain. The family as both a site of economic arrangements and a site of the arrangement of human affect‐sexuality‐reproduction, are held together and in tension through forms of contemporary government of the family. Contemporary rationalities of familial morality seek to make its members responsible parents without intervening to the extent that they would seek to make them responsible spouses, seen here in the implication that fathers' economic responsibilities for children are not co‐extensive with their emotional connections to women.1 As opposed to any other familial figure ‐ such as the pater familias or the mother of Donzelot's thesis ‐who may have been the link between family and government, it is through the promotion of the figure of the child that familial life is presently and predominantly governed. It is my contention here that it is through the promise of non‐government that a notion of an ethical parent is promoted, whose duties to his children and his nation‐state should mean that the former should not need to be dependent upon the latter. Alongside other policies that seek to simultaneously promote familial life and paid work‐life through the notion of the ethical citizen, and the attendant judgements of those dependent on welfare state provision, contemporary policies surrounding the household that no longer holds expose the various and contradictory modes by which families are ‘made up’ within contemporary regimes. (shrink)

Whether the justification at stake is ethical or juridical, all attempts to argue for the welfare principle in Kant’s metaphysics of morals are unsuccessful. This principle cannot be justified a priori in Kant’s context. However, it is not only possible but also necessary to argue for a certain degree of social welfare in politics as the practice of right; otherwise, Kant’s project of political practice, with enlightenment as its core concept, will inevitably fail. Enlightenment requires that the state be committed (...) to reducing the impact of an unequal social structure on individuals so as to preserve the possibility of their enlightenment. However, it also imposes limits on state-sponsored social welfare because excessive social welfare could lead to a general minority. (shrink)

Many healthcare practices expose people to risks of harmful outcomes. However, the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifiable to expose individuals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that encourages attention to factors including questions of justice in the distribution of advantage and risk, people’s acceptance or otherwise of risks, and the scope individuals have to (...) influence the practices that generate risk. This paper investigates the ethical justifiability of preventive healthcare practices that expose people to risks including overdiagnosis. We applied Hansson’s framework to three such practices: an ‘ideal’ breast screening service, a commercial personal genome testing service, and a guideline that lowers the diagnostic threshold for hypertension. The framework was challenging to apply, not least because healthcare has unclear boundaries and involves highly complex practices. Nonetheless, the framework encouraged attention to issues that would be widely recognised as morally pertinent. Our assessment supports the view that at least some preventive healthcare practices that impose risks including that of overdiagnosis are not ethically justifiable. Further work is however needed to develop and/or test refined assessment criteria and guidance for applying them. (shrink)

Background: Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative into paediatric practice (...) using the discourse and methodology of healthcare quality improvement. -/- Discussion: Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. -/- Conclusions: We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods. (shrink)