Eating disorders are mental illnesses that can have a significant and persistent physical impact, especially for those who are not treated early in their disease trajectory. Although many persons w...

Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine (...) is offered that describes the essence of defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: defensive medicine is deceptive and undermines patient autonomy; defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; defensive medicine exposes patients to harm without benefit; defensive medicine undermines trust in the profession; and defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism. (shrink)

Since the Supreme Court upheld the partial birth abortion ban in 2007, more U.S. abortion providers have begun performing intraamniotic digoxin injections prior to uterine dilation and evacuations. These injections can cause medical harm to abortion patients. Our objective is to perform an in-depth bioethical analysis of this procedure, which is performed mainly for the provider’s legal benefit despite potential medical consequences for the patient.

The expert clinical community is split about whether the difference between antidepressant treatment and treatment with placebos stems from the efficacy of the drug or from subjects’ heightened expectancy enhanced by side effects—i.e., enhanced placebo effects. Proving whether pharmacological efficacy has been established reliably by randomized controlled trials of antidepressant drugs is difficult, primarily because substituting a placebo for an effective treatment in the control arm of a trial is ethically questionable. I argue that clinical equipoise permits the use of (...) active placebo controls in trials that test antidepressants. Placebo controls for drug trials are ethically defensible and scientifically justified when we have evidence that a standard treatment might only work because of enhanced placebo effects, and when a respectable minority of the expert clinical community endorses these concerns. (shrink)

BackgroundDefensive medicine (DM) practice refers to the ordering or prescription of unnecessary treatments or tests while avoiding risky procedures for critically ill patients with the aim to alleviate the physician’s legal responsibility and preserve reputation. Although DM practice is recognized, its dimensions are still uncertain. The subject has been highly investigated in developed countries, but unfortunately, many developing countries are unable to investigate it properly. DM has many serious ramifications, exemplified by the increase in treatment costs for patients and health (...) systems, patients’ exposure to risks, and negative effects on the psychological health of both health providers and recipients. Ultimately, the most serious consequence is the ethical consequences.MethodsThis work is based on a review of the literature related to DM worldwide and a comparison with the available knowledge found in Jordan. It is qualitative with a descriptive nature, aiming to diagnose the current DM practice in Jordan.ResultsThis is the first published article that discusses DM in Jordan by diagnosing its ethical and economic consequences for the health system as well as for patients. Despite the knowledge of the reasons that support its practice, little is being done to solve this issue. The absence of agreeable medical malpractice law, the dearth of unified medical protocols, the overwhelming pressure imposed by patients on medical staff, and the deteriorating patient-physician relationship are some of the causes of DM practice. Surely, the solution to these issues is to focus on fortifying the ethical and humanitarian aspects on the side of both the physician and the patient to ensure positive collaboration. The ethical aim of the physician to treat the patient faithfully and do what is possible to help combined with the appreciation of the physician’s efforts and the choice to not take advantage of the physician through litigation could be the most reasonable solution in the near future.ConclusionJordan is suffering from DM due to the limited financial expenditure on the health sector and the impracticality of medical malpractice law. The authors highlight that the cardinal step in solving this dilemma is restoring the ethical dimension of the patient-physician relationship. (shrink)

Deception is common in dementia care, although its moral legitimacy is questionable. This paper conceptually clarifies when does dementia care involve deception and argues that care ethics is an appropriate ethical framework to guide dementia care compared with the mainstream ethical theories that emphasize abilities. From a perspective of care ethics, this paper claims that morally defensible deception is context-specific, embodied as a caring process that needs to be identified through instant, creative and interactive care procedures. According to (...) this argument, it further analyses and concludes the moral rationality of deception in five common cases. While deception is morally justified in many situations, another concern is that it is usually not the last resort but a means of convenience. As the ability to interact, autonomy and dignity of persons with dementia (PWDs) are generally ignored; nurses need more training and education to master the essential procedures to ensure that the value of authenticity and autonomy is maintained and considered throughout dementia care. (shrink)

Most people believe that it is sometimes morally permissible for a person to use force to defend herself or others against harm. In Defensive Killing, Helen Frowe offers a detailed exploration of when and why the use of such force is permissible. She begins by considering the use of force between individuals, investigating both the circumstances under which an attacker forfeits her right not to be harmed, and the distinct question of when it is all-things-considered permissible to use force (...) against an attacker. Frowe then extends this enquiry to war, defending the view that we should judge the ethics of killing in war by the moral rules that govern killing between individuals. She argues that this requires us to significantly revise our understanding of the moral status of non-combatants in war. Non-combatants who intentionally contribute to an unjust war forfeit their rights not to be harmed, such that they are morally liable to attack by combatants fighting a just war. (shrink)

The climate crisis is an enormous challenge for contemporary societies. Yet, public discussions on it often lead to anger, mocking, denial and other defensive behaviours, one prominent example of which is the reception met by the climate advocate Greta Thunberg. The paper approaches this curious phenomenon via shame. It argues that the very idea of anthropogenic climate change invites feelings of human failure and thereby may also entice shame. The notion of “climate shame” is introduced and distinguished from “climate (...) guilt”. Whereas climate guilt prioritises the flourishing of the environment and is focused on actions and morality, climate shame is concerned with human identity and selfhood. The paper then explores whether shame is a morally destructive or constructive emotion. Making use of both psychological and philosophical literature on shame, it argues that although shame faces many challenges that question its usefulness in moral pedagogy, these challenges can be met with “moral maturity”—moreover, following a utilitarian approach, the overall benefits of climate shame can justify its costs to individuals. My argument is that climate shame holds the potential of being a highly effective moral psychological method of persuasion, capable of inviting wholesale critical reflection on current, environmentally damaging practices and cultivation of more virtuous ways of co-existing with the rest of the natural world and other species. (shrink)

Heartbeat bills are laws prohibiting abortion in most circumstances once a fetal heartbeat can be detected, and are common in US states. They have been criticised as poorly designed and disingenuous. In this letter to the editor I examine these criticisms.

Volume 20, Issue 3, March 2020, Page 1-5.

In this article, I analyse the theory and practice of interventions in foreign civil wars to assist rebels fighting against violently oppressive government. I argue that the indirect nature of this kind of intervention gives rise to political complications that are either absent from or less obvious in humanitarian interventions aimed chiefly at defending human rights from imminent threats. An adequate theory must therefore accommodate three additional components. First, it requires a theory of indirect warfare accounting for how the ends (...) of the interveners’ added violence relate to those of the rebels’ violence. Second, it requires a theory of indirect political leadership, paying careful attention both to the political status of the rebel leaders vis‐à‐vis the people on whose behalf they fight and to the relationship between those leaders and the interveners. Third, the peculiarities of indirect military intervention mean that the violence it introduces isn’t easily explained purely in terms of defensive goals. An adequate account needs additionally to pay attention to the role of violence in shaping new political movements and institutions. The value of such goals is less easily quantified than those of humanitarian intervention, making it harder to set upper limits on permissible ‘proportionate’ harm. (shrink)

Over the last few decades, there have been intense debates concerning the effects of markets on the morality of individuals’ behaviour. On the one hand, several authors argue that markets’ ongoing expansion tends to undermine individuals’ intentions for mutual benefit and virtuous character traits and actions. On the other hand, leading economists and philosophers characterize markets as a domain of intentional cooperation for mutual benefit that promotes many of the character traits and actions that traditional virtue ethics accounts classify (...) as virtuous. In this paper, I join this debate and argue for three claims of general interest to philosophers, economists and policy makers. First, market transactions do not reliably promote individuals’ intentions for mutual benefit, and often select against such intentions. Second, the set of so-called market virtues lacks a substantial overlap with the set of character traits that traditional virtue ethics accounts classify as virtuous. And third, many seemingly virtuous actions observed in market contexts are merely actions in accordance with virtue rather than genuine actions from virtue. These three claims do not license opposition to markets, but challenge the main empirical and theoretical presuppositions of leading virtue ethics defences of markets. (shrink)

This essay examines the so-called phenomenon of defensive medicine and the problematic aspects of attempting to maintain the safest legal position possible. While physicians face genuine litigation threats they frequently overestimate legal peril. Many defensive practices are benign, but others alter patient care and increase costs in ways that are ethically suspect. Physicians should learn to evaluate realistically the legal risks of their profession and weigh the emotional, physical, and financial costs to the patient before employing a (...) class='Hi'>defensive measure. (shrink)

This study examines how the leading beverage company handles the strategic paradox between its core business and the social issue of obesity. A discursive analysis reveals how the organization does embrace a social goal related to obesity but not the paradoxical tension between this goal and its core business. The analysis further shows how the tension, along with the responsibility for the social goal, is projected outside the organization. This response is underpinned by the paradoxical constructions of consumers and the (...) concept of obesity in the organization’s communication. Based on these findings, I outline a new type of process for projection, one of the defensive mechanisms recognized in the literature. The findings increase our understanding of defensive responses to organizational paradoxes and help distinguish between different kinds of strategic paradoxes. They also highlight the need to further open up the complexity and multiplicity of strategic paradoxes related to corporate sustainability. (shrink)

MacIntyre is a major defender of the resurgence of the Aristotelian approach in ethical and political theory. He considers Aristotelianism not only a feasible, but also an intellectually superior alternative to most contemporary dominant ideologies, and to liberalism in particular. There is, however, an important and instructive modification to his view of what is admissible from Aristotle that should be accounted for. The paper traces MacIntyre’s search for a defensible restatement of the Aristotelian ethics and examines in particular his (...) changing attitude to metaphysics as the basis for ethics within his project. Different stages of the development to his proposed Aristotelian alternative are analyzed and evaluated. The paper tries to show that despite the fact that MacIntyre initially repudiated Aristotle’s metaphysical biology, nevertheless his account has always been (implicitly or explicitly) metaphysical. (shrink)

In this article, I consider the permissibility of forming defensive alliances, which is a neglected topic in the contemporary literature on the ethics of war and peace. Drawing on the jus ad bellum criterion of proportionality in just war theory, I argue that if permissible defensive force requires that its expected harms must be counterbalanced by its expected goods, then, permissible defensive alliance formation seems to also require that its expected harms must be counterbalanced by its (...) expected goods, as the latter can result in much the same consequences as the former. Moreover, due to the incommensurability of values in play when making proportionality judgments, I argue for a value pluralist understanding of the criterion. On this view, defensive alliance formation is proportionate if the expected gains in certain values (goods) intuitively justify the expected losses in others (harms) when compared to the alternative expected value trade-offs of not allying. To explore the implications of my theoretical claims I consider them in relation to John Mearsheimer’s influential account of the causes of the Russo-Ukrainian War. On this account, the West’s strategy to assimilate Ukraine and Ukraine’s pursuit of NATO membership post-annexation of Crimea were disproportionate because the expected harms were unjustified when compared to the alternative expected goods and harms of forgoing Ukrainian membership of NATO. This does not imply that Russia’s aggression is just, but it does imply that the West and Ukraine are partially responsible for the war and that they acted impermissibly in attempting to expand/join NATO. (shrink)

BackgroundMedical errors, unsatisfactory outcomes, or treatment complications often prompt patient complaints about healthcare providers. In response, physicians may adopt defensive practices to mitigate objections, avoid complaints, and navigate lengthy trial processes or other potential threats. However, such defensive medicine (DM) practices can carry risks, including potential harm to patients and the imposition of unnecessary costs on both patients and the healthcare system. Moreover, these practices may run counter to accepted ethical standards in medicine.MethodsThis qualitative study involved conducting semi-structured (...) interviews with 43 physicians, among whom 38 were faculty members at medical universities, 42 had administrative experience at various levels of the health system, and 23 had previously served as health system policymakers. On average, the participants had approximately 23.5 years of clinical experience. The selection of participants was based on purposive sampling. Data collection through interviews continued until data saturation was achieved.ResultsBased on the findings, DM manifests in both positive and negative forms, illustrated by instances like ordering unnecessary lab tests, imaging, or consultations, reluctance to admit high-risk patients, and avoiding high-risk procedures. The study participants identified a range of underlying and contextual factors contributing to DM, encompassing organizational-managerial, social, personal, and factors inherent to the nature of defensive medical practices. The results also highlight proposed strategies to address and prevent DM, which can be grouped into organizational-managerial, social, and those focused on modifying the medical complaints management system.ConclusionDM is a multifaceted and significant phenomenon that necessitates a comprehensive understanding of its various aspects, including interconnected and complex structures and underlying and contextual factors. While the results of this study offer a solid foundation for informing policy decisions within the healthcare system and include some explanatory policy suggestions, we encourage policymakers to complement the findings of this study with other available evidence to address any potential limitations and to gain a more comprehensive understanding of the policymaking process related to DM. (shrink)

The Moral Responsibility Account of Liability to Defensive Harm (MRA) states that an agent becomes liable to defensive harm if, and only if, she engages in a foreseeably risk-imposing activity that subsequently threatens objectively unjustified harm. Advocates of the account contend that liability to defensive harm is best understood as an aspect of distributive justice. Individuals who are liable to some harm are not wronged if the harm is imposed on them, and liability to defensive harm (...) thus helps ensure that harm is borne by whoever has least of an objection of justice against being burdened with it—or so advocates of the MRA insist. In this paper, I argue that liability to defensive harm is not grounded in considerations of distributive justice. While it depends on the wider societal context what allocation of a burden is distributively most just, liability to defensive harm is a distinctly localised affair. I propose that liability to defensive harm is best understood as part of the enforcement dimension of our rights to non-interference. Framing liability in this way does not invalidate the MRA. It does, however, render subjective impermissibility accounts of liability particularly promising. (shrink)

Clinician gate-keeping is the process whereby healthcare providers prevent access to eligible patients for research recruitment. This paper contends that clinician gate-keeping violates three principles that underpin international ethical guidelines: respect for persons or autonomy; beneficence or a favourable balance of risks and potential benefits; and justice or a fair distribution of the benefits and burdens of research. In order to stimulate further research and debate, three possible strategies are also presented to eliminate gate-keeping: partnership with professional researchers; collaborative research (...) design and clinician education. (shrink)

In the United States, police use of force experts often maintain that controversial police shootings where an unarmed person’s hand gesture was interpreted as their “going for a gun” are justifiable. If an officer waits to confirm that a weapon is indeed being pulled from a jacket pocket or waistband, it may be too late to defend against a lethal attack. This article examines police policy norms for self-defense against “uncertain threats” in three contexts: (1) known in-progress violent crimes, (2) (...) interactions with civilians behaving non-aggressively, and (3) interactions with civilians behaving aggressively. It is argued that the context of a known in-progress violent crime gives rise to threat probability-, fairness-, and lesser evil-based reasons for a norm permitting police officers to use lethal force. However, in the contexts of civilians behaving non-aggressively and civilians behaving aggressively, such a norm is not justifiable. In the former case, I introduce two conditions, the Justification condition and the Valuing Civilian Lives condition, which I argue are not presently met. In the latter case, these two conditions again are not met; aggression may moreover be excused or justified due to background injustices around race and the criminal justice system. (shrink)

An influential view in the ethics of self-defence is that causal responsibility for an unjust threat is a necessary requirement for liability to defensive harm. In this article, I argue against this view by providing intuitive counterexamples and by revealing weaknesses in the arguments offered in its favour. In response, adherents of the causal view have advanced the idea that although causally inefficacious agents are not liable to defensive harm, the fact that they may deserve harm can (...) justify harming them in the course of defending oneself. I argue that this strategy is ad hoc and leads to more problems than it solves. Once we allow normative facts outside our account of liability to affect a person's moral protection against harm, the lieability verdicts cannot tell us whether there is a relevant moral asymmetry between the victim and the target of defence. In conclusion, the causal view is wrong and causal responsibility for an unjust threat is not a necessary requirement for liability to defensive harm. (shrink)

A minimally responsible threatener is someone who bears some responsibility for imposing an objectively wrongful threat, but whose responsibility does not rise to the level of culpability. Minimally responsible threateners include those who knowingly commit a wrongful harm under duress, those who are epistemically justified but mistaken in their belief that a morally risky activity will not cause a wrongful harm, and those who commit a harm while suffering from a cognitive impairment which makes it prohibitively difficult to recognize and (...) act on what is morally required of them. The chapter argues that minimally responsible threateners can indeed be morally liable for the harms they impose. Put differently, culpability is not a necessary basis for liability. (shrink)

This article offers a brief synopsis of some of the main claims from The Morality of Defensive Force, and replies to the symposium contributions of Lars Christie, Lisa Hecht, and Jonathan Parry.

In this paper I explain the present adversarial collective bargaining process (ACB) and then critique it on legal and ethical grounds. A new methodology, that I describe as the collaborative collective bargaining process (CCB), will then be explained and similarly critiqued. I argue that replacing the present ACB model with the CCB model will result in better long-term results for all parties concerned. This is because the ACB model is comparable, in many respects, to the adversarial process used in court (...) litigation. It is a combat model based on power. ACB makes the battle lines clear, and it grants victory to the more convincing display of power, but it leaves casualties. Indeed it cannot operate except upon the casualties of the opposing party, and those casualties are the basis for ever-renewed combat. Tactics employed in ACB to achieve victory include deception, lying and the abandonment of truth as a moral value. I argue that, in sharp contrast, CCB can foster an environment which encourages candor and truthfulness. By following the CCB model, the parties can avoid the negative and self-defeating elements of ACB and can work together toward mutually beneficial goals by the use of an ethically defensible approach to labor negotiations. (shrink)

Defensive medicine is defined as a doctor’s deviation from standard practice to reduce or prevent complaints or criticism. The objectives of this study were to assess the prevalence of the practice of defensive medicine in the UK among hospital doctors and the factors affecting it.

This discussion paper explores the explanations and implications of defensive response strategies used to manage organizational crises. Current research is highlighted and future research directions are proposed. Key areas for future research include investigating long-term repercussions of defensive strategies, examining multistakeholder perspectives, and exploring ethical questions related to being defensive.

Three main claims are made in this paper. First, it is argued that Onora O’Neill has uncovered a serious problem in the way medical ethicists have thought about both respect for autonomy and informed consent. Medical ethicists have tended to think that autonomous choices are intrinsically worthy of respect, and that informed consent procedures are the best way to respect the autonomous choices of individuals. However, O’Neill convincingly argues that we should abandon both these thoughts. Second, it is argued that (...) O’Neill’s proposed solution to this problem is inadequate. O’Neill’s approach requires that a more modest view of the purpose of informed consent procedures be adopted. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. It is argued that contrary to what O’Neill claims, the wrongness of coercion cannot be derived from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Third, it is argued that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. Respect for autonomy is in trouble. In recent work in this journal1 and elsewhere,2 O’Neill has forcefully argued that respect for autonomy, as it has come to be used in medical ethics, is philosophically indefensible. If her arguments are sound, then, contrary to the standard view, respect for autonomy cannot be the source of the ethical requirement to seek informed consent before treating a patient or enrolling a participant in a trial. So her critique goes to the heart of contemporary medical ethics: if O’Neill is right, medical ethicists have systematically misunderstood two of the most fundamental concepts they deal with—respect for autonomy and informed consent. This paper has four sections. Section 1 distinguishes between three different ways of talking about respect for autonomy, and looks in more detail at the one that has come to be central to bioethical writing on informed consent—namely, the idea that we should respect autonomous choices. Section 2 argues, following O’Neill, that it is implausible to think that the purpose of informed consent requirements is to respect autonomous choices. Section 3 argues that O’Neill’s proposed reworking of autonomy and informed consent is inadequate. O’Neill’s approach requires us to adopt a more modest view of the purpose of informed consent procedures. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. I argue that contrary to what O’Neill claims, we cannot derive the wrongness of coercion from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Section 4 argues that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. (shrink)

Defence cases with an escalatory structure, in which the levels of violence between aggressor and defender start out as minor and then become major, even lethal, raise sharp problems for defence theory, and for our understanding of the conditions of defence: proportionality, necessity, and imminence. It is argued here that defenders are not morally required to withdraw from participation in these cases, and that defensive escalations do not offend against any of the conditions of defence, on an adequate understanding (...) of them. No plausible interpretation of proportionality or necessity excludes defensive permissions in escalatory cases. Moreover, the structure of escalatory defensive cases also sheds useful light on permissible responses to conditional deadly threats. This is because we can analyse conditional deadly threats as disguised cases of escalation. Because defensive resistance is permissible in escalatory cases, it is also permissible in cases involving conditional deadly threats. (shrink)

Obstetrics and gynaecology always has reputation for being a highly litigious. The field of obstetrics and gynaecology is surrounded by different circumstances that stimulate the doctors to practice defensive..

Abstract During the 20th century some versions of just war doctrine came to restrict the condition of just cause to defense, that is, these just war doctrines now hold it to be a necessary condition for the moral justifiability of any war that it be undertaken for defensive purposes. These purposes need not be self ? defensive but may be defensive of the welfare and legitimate rights of other polities and groups. Some reasons for war are obviously (...) not defensive, for example, the acquisition of territory or the assertion of imperialist control. But the boundaries of defensive warfare are unclear. I will consider two important cases in which this lack of clarity is proving to be morally significant: namely, preventive and punitive warfare undertaken for the sake of the goal of defense. I will argue that the normative rationale for limiting just cause to defense does not allow these as legitimate forms of defense. That rationale moves towards the view that one should not intend the deaths of enemies but only the restraint of their wrongdoing, and preventive and punitive warfare appear to involve intending the deaths of enemies. (shrink)

In this paper, I survey liberal and communitarian defenses of privacy, paying particular attention to defenses of privacy in the workplace. I argue that liberalism cannot explain all our of intuitions about the wrongness of workplace invasions of privacy. Communitarianism, on the other hand, is able to account for these intuitions.

International law and conventional morality grant that states may stand ready to defend their borders with lethal force. But what grounds the permission to kill for the sake of political sovereignty and territorial integrity? In this book leading theorists address this vexed issue, and set the terms of future debate over national defence.

Background Defensive medicine is physicians’ deviation from standard medical care which is primarily intended either to reduce or avoid medico legal litigation. Although the Federal Ethics Committee review in Ethiopia has shown that applications for medical/surgical error investigation claims are increasing at an alarming rate, there is no study to date done to estimate the degree of defensive practice done by the physicians with an intention of avoiding this increasing legal claim. This study assessed the practice of (...) defensive medicine among highly litigious disciplines (surgery) and described factors associated with its practice. Methods Cross sectional quantitative study using online survey questionnaires was conducted to assess the degree of defensive practice and six factors (age, years of experience, specialty, monthly income, place of practice and previous medico legal history) associated with its practice were assessed among surgeons working in Ethiopia. Results A total of 430 surgeons directly received an online survey questionnaire and 236 of them successfully completed the questionnaire making the response rate 51.2%. Nearly half of the study participants (51.7%) were aware of the concept of defensive medicine and 174 (74%) reported performing one form of defensive practice. Twenty-nine (12.3%) of the participants have legal dispute history, though only 1.3% of them ended up in penalty. Avoiding high risk procedures was the commonest defensive act performed by 60% of the participants, followed by ordering tests unnecessarily (52.1%). Multinomial logistic regression model showed that there was no association between age of the participant, place of practice, year of experience and defensive practice. This model also showed that cardiothoracic and vascular surgeons perform less defensively than surgeons with other specialty with P value of 0.02. Conclusion The practice of defensive medicine is widespread among surveyed Ethiopian surgeons and further studies are required to objectively estimate the effect of defensive practice on the health care system of the country. Policy makers need to develop strategy towards decreasing this high rate of defensive practice. (shrink)

This essay shows that a moral sense or moral sentiments alone cannot identify appropriate morals. To this end, the essay analyzes three defenses of Francis Hutcheson's, David Hume's, and Adam Smith's moral sense theories against the relativism charge that a moral sense or moral sentiments vary across people, societies, cultures, or times. The first defense is the claim that there is a universal moral sense or universal moral sentiments. However, even if they exist, a moral sense or moral sentiments alone (...) cannot identify appropriate morals. The second defense is to adopt a general viewpoint theory, which identifies moral principles by taking a general viewpoint. But it needs to employ reason, and even if not, it does not guarantee that we identify appropriate morals. The third defense is to adopt an ideal observer theory, which draws moral principles from sentimental reactions of an ideal observer. Yet it still does not show that a moral sense or moral sentiments alone can identify appropriate morals. (shrink)

BackgroundObstetrics and gynaecology always has reputation for being a highly litigious. The field of obstetrics and gynaecology is surrounded by different circumstances that stimulate the doctors to practice defensive medicine.MethodsThis study was directed to assess the extent and the possible effect of defensive medicine phenomenon on medical decision making among different grades of obstetric and gynaecologic Sudanese doctors, and to determine any experience of medical litigations with respect to sources and factors associated with it.ResultsA total of 117 doctors (...) were approached, their distribution according to job description was as follow: consultants registrars and specialists. The majority 89.7 % had the impression that litigation against doctors are increasing and 27.6 % had a direct experience of litigation. In this study less than one half of the surveyed doctors knew the concept of defensive medicine and 71.8 % reported practicing one or another form of defensive medicine. The different sources of the litigations reported by the doctors included: maternal death, perinatal death, other {misdiagnosis, intra-uterine fetal death, uterine perforation, rupture uterus}, fetal distress, injury to viscera and shoulder dystocia. In this study the experience of medical litigation was significantly observed among those who worked in area of blame culture. In logistic regression model, there was no significant difference between those who knew the concept of defence medicine and those who didn’t.ConclusionThere should be strategic plan to reduce the practice of defensive medicine and medical litigation against doctors. (shrink)

(1995). Responsibility Versus Defensiveness: Inclusion of Ethnicity in the Conceptualization of Theory. Ethics & Behavior: Vol. 5, No. 4, pp. 373-375.

This paper considers whether victims can justify what appears to be unnecessary defensive harming by reference to an honour-based justification. I argue that such an account faces serious problems: the honour-based justification cannot permit, first, defensive harming, and second, substantial unnecessary harming. Finally, I suggest that, if the purpose of the honour based justification is expressive, an argument must be given to demonstrate why harming threateners, as opposed to opting for a non-harmful alternative, is the most effective means (...) of affirming one’s honour. Along the way, I also suggest why I think that internalism about the constraints on defensive harming (the view that the satisfaction of the necessity constraint is a necessity condition of a threatener’s liability) is correct. Most importantly, externalism implies that threateners can be liable to suffer gratuitous harm. I take this to be an unattractive consequence of the view. (shrink)

Are corporations morally defensible sorts of entities? How might we go about showing that they are? Thomas Donaldson offers us the most detailed contractarian justification for the moral defensibility of corporations. In this paper I show how we can significantly develop this sort of justification to yield a more compelling contractarian justification, though one that is importantly conditional. The primary points I take up in this paper are these:1. The question Donaldson poses to generate his contract is not quite as (...) simple as may appear. The sort of transformation we need to consider is more complex than the sort Donaldson describes.2. Partly because of considerations that arise in discussing the first point, the contract we are considering is a more conditionalagreement. The terms of the agreement will vary depending on the kind of state we are assuming prevails. The sort of contract we wantto draw up is at least a three-way contract: between society, productive organizations and the state. The sort of agreement we reach will have the following form: society a agrees to allow productive organizations of type b to exist if we assume state c will do various things (d1 to dn), productive organizations will do various things (e1 to en) and members of society will do various things (f1 to fn). Importantly, if state c is not doing d1 to dn, productive organizations may not be morally defensible.3. The terms of the contract that can be derived would benefit from the introduction of some of Rawls’s apparatus.4. When we consider the right questions, with more of the background institutions filled in, and when we include some more social contract apparatus, we get a better contract which fills in for us not only the obligations of business but, importantly, many obligationsfor government as well. (shrink)

It is widely accepted that the ethical supervenes on the natural, where this is roughly the claim that it is impossible for two circumstances to be identical in all natural respects, but different in their ethical respects. This chapter refines and defends the traditional thought that this fact poses a significant challenge to ethical non-naturalism, a view on which ethical properties are fundamentally different in kind from natural properties. The challenge can be encapsulated in three core claims which the chapter (...) defends: that a defensible non-naturalism is committed to the supervenience of the ethical, that this commits the non-naturalist to a brute necessary connection between properties of distinct kinds, and that commitment to such brute connections counts against the non-naturalist’s view. Each of these claims has recently been challenged. Against Nicholas Sturgeon’s recent doubts about the dialectical force of supervenience, this chapter defends a supervenience thesis as deserving to be common ground among ethical realists. It is then argued that attempts to explain supervenience on behalf of the non-naturalist either fail as explanations, generate near-identical explanatory burdens elsewhere, or appeal to commitments that are inconsistent with core motivations for non-naturalism. The chapter concludes that, suitably refined, the traditional argument against nonnaturalism from supervenience is alive and well. (shrink)

I argue for the conditions that eco-sabotage (sabotage involving the protection of animals or the environment) must meet to be a morally permissible form of activism in a liberal democracy. I illustrate my case with Jessica Reznicek and Ruby Montoya’s oil pipeline destruction, the Sea Shepherd Conservation Society’s whale hunt sabotage, and the Valve Turners’ pipeline shut-off, climate necessity-defense. My primary contention is that just as it is permissible to destroy an attacker’s weapon in self- or other-defense, it is permissible (...) to engage in some forms of eco-sabotage. Taking inspiration from just war theory, I use the conditions of just cause, reasonable chance of success, proportionality, necessity, and discrimination to both conceptualize eco-sabotage as defense and illustrate the justificatory burden the eco-saboteur must meet. Often eco-sabotage is doubly pro-tanto wrong because it is illegal and involves property destruction. Overcoming these hurdles is particularly difficult because in seemingly bypassing democratic means of dispute resolution, the eco-saboteur seemingly coerces the other members of society by forcing idiosyncratic views upon them. Non-anthropocentric eco-sabotage grounded in defense of animal rights has mixed results regarding the democratic objection just described. I argue that anthropocentric eco-sabotage, grounded in defense of human rights, has the best chance of overcoming this objection, provided a persuasive case can be made for its reasonable chance of success. Passing a reasonable chance of success also causes problems for non-anthropocentric eco-sabotage grounded in species defense, while non-anthropocentric eco-sabotage grounded in defense against animal suffering has a lighter justificatory burden. (shrink)

Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development (...) of an as-fair-as-possible dispute resolution process that incorporates an appropriated-justified, defensible critical-care obligation threshold. (shrink)