The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of (...) hepatitis C transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration. (shrink)

The Principles of Corporate Governance require that business conduct conform to the law. In recent years, news reports of business misconduct have cast doubt on a conclusion that conformity is the prevalent practice. This article explores the influence of law on business conduct by comparing the law’s requirements and purposes with actual business conduct in the market. Specifically, it explores whether certain legal regimes are more effective than others in inducing greater commitment to legal compliance by corporate actors. The (...) conclusion drawn is that the prevalent legal regime – a vague common law or legislative mandate – is typically associated with corporate conduct that evades or ignores the law’s mandate or its underlying purpose. (shrink)

Most academic papers on ethics in pandemics concentrate on the duties of healthcare professionals. This paper will consider non-professional healthcare workers: do they have a moral obligation to work during an influenza pandemic? If so, is this an obligation that outweighs others they might have, e.g., as parents, and should such an obligation be backed up by the coercive power of law? This paper considers whether non-professional healthcare workers—porters, domestic service workers, catering staff, clerks, IT support workers, (...) etc.—have an obligation to work during an influenza pandemic. It uses data collected as part of a study looking at the attitudes of healthcare workers to working during a pandemic to suggest the philosophical arguments explored. These include: being in a position to do good, the ethics of work, competing obligations to family members and in particular to children and the obligations of citizens in a state of national emergency. We also look at whether compulsory measures are justified to support a national health service during a health emergency. We conclude that even if they are, compulsion should not be restricted to non-professionals who happen to be working in the health service at the time. Rather, compulsion involving a larger pool of people with the relevant skills and abilities is more equitable. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, (...) and thoroughly integrated both vertically and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

Solnica et al argue that “Jewish law and modern secular approaches based on professional responsibilities obligate physicians to care for all patients even those with communicable diseases”. The authors base their viewpoint on the opinion of Rabbi Eliezer Waldenberg and apply it to suggest that physicians are obligated to endanger themselves during epidemics, such as COVID-19. It is argued that Solnica et al’s analysis of Rabbi Waldenberg’s text and their conclusion that healthcare workers are obligated to endanger themselves while (...) treating patient who suffer from contagious illness during epidemics according to Jewish law suffer from various shortcomings. Indeed, Jewish law looks favourably on healthcare workers who take a reasonable risk in treating their patients in the context of epidemics. However, it is considered a voluntary supererogatory act—not obligatory. Solnica et al may express a legitimate ethical viewpoint. However, it does not seem to represent the mainstream approach of what Jewish law would demand as obligatory from its practitioners. (shrink)

The term corporate social responsibility is often used in the boardroom, classroom, and political platform, but what does it really mean? Do corporations have ethical or philanthropic duties beyond their obligations to comply with the law? How does CSR relate to business ethics, stakeholder management, sustainability, and corporate citizenship? Mark Schwartz provides a concise, cutting-edge introduction to the topic, analyzing many case studies with the help of his innovative “Three Domain Approach” to CSR. _Corporate Social Responsibility_ (...) also provides a chronology of landmark contributions to the concept of CSR and includes CSR resources on organizations, global codes and criteria, corporate CSR reports, and websites and blogs. It is an invaluable resource for students, instructors, and business leaders looking to master the basics of CSR. (shrink)

Imagine a study in which HIV-infected pregnant women are given antiretroviral treatment to determine how effectively it will prevent HIV transmission during childbirth. Each mother’s involvement in this study ends with the birth of her child, at which time her access to antiretrovirals provided by the study also ceases. At the outset of the study, the investigator and sponsor agree that after the child’s birth, they will refer mothers who require treatment for their HIV to a national program that (...) provides antiretroviral treatment and care. Assuming the Institutional Review Board raises no objections to this plan, should the research team consider their ethical obligations to participants fulfilled? If the investigator and sponsor were to consult the Common Rule, they would find little to suggest that there are any further ethical issues to address. (shrink)

A murder case that had some features in common with the Tarasoff case occurred in Sasebo City, Japan, in 2014. A 15-year-old high school girl was murdered and her 16-year-old classmate was arrested on suspicion of homicide. One and a half months before the murder, a psychiatrist who had been examining the girl called a prefectural child consultation centre to warn that she might commit murder, but he did not reveal her name, considering it his professional duty to keep (...) it confidential. Article 134 of the Japanese Criminal Law states that doctors should not disclose patient information obtained in clinical practice without a legitimate reason, but the Japanese Supreme Court has not specified what constitutes a legitimate reason. Mass media and commentators suggested that the murder could have been prevented if the psychiatrist had disclosed the girl's name to the authorities or had isolated her coercively in a psychiatric ward. However, the authors disagree with such claims. This article discusses obligations imposed on concerned individuals and third party members in cases involving ethical dilemmas regarding patient confidentiality and information disclosure. It is concluded that everyone should fulfill their obligations to prevent such tragedies and one should judge the appropriateness of others’ actions based not on the consequences of their actions, but on the processes used to decide on a course of action and their commitment. It is necessary for us to establish a society in which concerned parties can do what they think is ethically best without fearing ungrounded charges. (shrink)

ABSTRACT Medical AID organisations such as Médecins Sans Frontières receive several requests from individuals and international academic institutions to conduct research at their implementation sites in Africa. Do AID agencies have an ethical duty to comply with research requests? In this paper we respond to the views and constructed theories (albeit unfounded) of one such researcher, whose request to conduct research at one of our sites in the Democratic Republic of Congo was turned down.

On one view of ethical development, someone not yet virtuous can reliably progress by engaging in what meaningfully resembles virtuous conduct. However, if the well-intended conduct is psychologically demanding, one's character, precisely because one is not yet virtuous, may worsen rather than improve. This risk of degradation casts doubt on the developmental view. I counter the doubt through one interpretation and one application of the Mengzi. In passage 2A2, invoking the image of a farmer who “helped” the crop grow (...) by pulling the sprouts, MENG Ke cautions, “do not help it grow.” I defend a novel interpretation: do not advance with a naïve negligence about your psycho-physiological constitution. I also show how to advance with realistic care by pointing out an overlooked application of a much-discussed cultivation technique illustrated in Mengzi 1A7: ethical reflection can conciliate one with one’s ongoing or past advanced action, lowering the action’s risk of degradation. (shrink)

The first part of Immanuel Kant's Metaphysics of Morals , Rechtslehre , has usually been discussed as a political treatise. But there are parallels between law and ethics in Kant; lawgiving in either realm is a combination of precept and incentive. In works that present his core moral philosophy of inner freedom, this freedom is an internal ethical freedom based on an underlying purely moral incentive, whose adequacy is a transcendental assumption of this part of Kant's moral philosophy. But (...) this inner freedom is paralleled by Kant's account of external freedom, where our external rights, including rights to property, are secured based on the deterrent effect of punishment under criminal law for violations of the rights of others. When we look at the Rechtslehre thus as part of Kant's practical philosophy we notice: Kant's view is that the validity of a legal precept entails an adequate incentive for acting in accord with the precept. The scope of law, and hence of imputation under law, is limited in various ways by the reach of the external incentives of deterrence, including actions based on a so-called "right of necessity." There are parallels between Kant's arguments for extending the categorical imperative as a principle for the use of our freedom to ends in the Tugendlehre and to objects in the Rechtslehre . Kant's theory of punishment, though retributivist in how it assigns appropriate punishment, is teleological/deterrent in providing incentives for not violating positive laws. Der erste Teil in Kants Werk Die Metaphysik der Sitten , die Rechtslehre , wird üblicherweise als eine politische Abhandlung diskutiert. Aber es gibt Parallelen zwischen Recht und Ethik bei Kant. Gesetzgebung ist in beiden Bereichen eine Kombination von Gesetz und Triebfeder. In den Arbeiten, die das eigentliche Herzstück von Kants Tugendlehre behandeln, ist die Freiheit eine innere ethische Freiheit, die auf einer rein moralischen Triebfeder basiert, deren Angemessenheit und Zulänglichkeit eine transzendentale Annahme dieses Teils von Kants Moralphilosophie ist. Die innere Freiheit hat jedoch eine Parallele in Kants Darstellung der äußeren Freiheit. Hier geht es um die Sicherung unserer äußeren Rechte, einschließlich des Rechts auf Eigentum, durch den Abschreckungseffekt einer Strafe für die Verletzung der Rechte Anderer. Wenn wir die Rechtslehre gerade als Teil von Kants praktischer Philosophie verstehen, dann stellen wir fest: Kant geht davon aus, daß gültige juridische Normen stets ausreichende Triebfedern dafür enthalten, daß unser Handeln diesen Normen entspricht. Der Bereich des Rechts, und damit auch der Zurechnung unter Rechtsgesetzen, wird auf unterschiedliche Weise von der Wirksamkeit äußerer Triebfedern zur Abschreckung begrenzt. Das gilt auch für Handlungen, die auf dem sogenannten "Notrecht" beruhen. Zwischen Kants Argumenten in der Tugendlehre für die Erweiterung des kategorischen Imperativs als eines Prinzips für den Gebrauch unserer Freiheit durch die Annahme, daß es Zwecke gibt, die zugleich Pflicht sind, und dem Argument in der Rechtslehre für die Notwendigkeit der Anerkennung von Eigentumsrechten bestehen signifikante Parallelen. Kants Theorie der Strafe ist, obwohl vergeltungstheoretisch mit Blick auf die Frage der Angemessenheit einer Strafe, jedenfalls auch teleologisch/abschreckungstheoretisch konzipiert, nämlich insoweit, als die Androhung von Strafen Triebfedern für die Befolgung der positiven Rechtsgesetze bereitstellt. (shrink)

In this essay I will discuss the relationship between two of the most basic ideas in political and legal philosophy: the justification of the state and state legitimacy. I plainly cannot aspire here to a complete account of these matters; but I hope to be able to say enough to motivate a way of thinking about the relation between these notions that is, I believe, superior to the approach which seems to be dominant in contemporary political philosophy. Today showing that (...) a state is justified and showing that it is legitimate are typically taken to require the very same arguments. I will argue that this contemporary stance obscures the difference between two central ways in which we should morally evaluate states, and it generates confusions about other serious practical issues, such as those surrounding our moral obligations to comply with law. I begin with brief discussions of the ideas of justification and legitimacy and with an attempt to capture what ought to be most central in our concerns about these ideas. I turn then to two basic ways of thinking about the relation between justification and legitimacy that I want to distinguish: what I will call the Lockean and the Kantian approaches. Next, I argue that the minority Lockean approach to this issue captures essential features of institutional evaluation that the majority Kantian approach does not; and I add brief mention of one further complication facing any adequate account of political evaluation. (shrink)

A continuing need for care for elderly, combined with looser family structures prompt the question what filial obligations are. Do adult children of elderly have a duty to care? Several theories of filial obligation are reviewed. The reciprocity argument is not sensitive to the parent–child relationship after childhood. A theory of friendship does not offer a correct parallel for the relationship between adult child and elderly parent. Arguments based on need or vulnerability run the risk of being unjust (...) to those on whom a needs-based claim is laid. To compare filial obligations with promises makes too much of parents’ expectations, however reasonable they may be. The good of being in an unchosen relationship seems the best basis for filial obligations, with an according duty to maintain the relationship when possible. We suggest this relationship should be maintained even if one of the parties is no longer capable of consciously contributing to it. We argue that this entails a duty to care about one’s parents, not for one’s parents. This implies that care for the elderly is not in the first place a task for adult children. (shrink)

The law persists because people have reasons to comply with its rules. What characterizes those reasons is their interdependence: each of us only has a reason to comply because he or she expects the others to comply for the same reasons. The rules may help us to solve coordination problems, but the interaction patterns regulated by them also include Prisoner's Dilemma games, Division problems and Assurance problems. In these "games" the rules can only persist if people (...) can be expected to be moved by considerations of fidelity and fairness, not only of prudence.This book takes a fresh look at the perennial problems of legal philosophy - the source of obligation to obey the law, the nature of authority, the relationship between law and morality, and the nature of legal argument - from the perspective of this conventionalist understanding of social rules. It argues that, since the resilience of such rules depends on cooperative dispositions, conventionalism, properly understood, does not imply positivism. (shrink)

Many political theorists argue that immigration restrictions are unjust and defend broadly open borders. In this paper, I examine the implications of this view for individual conduct. In particular, I argue that the citizens of states that enforce unjust immigration restrictions have duties to disobey certain immigration laws. States conscript their citizens to help enforce immigration law by imposing legal duties on these citizens to monitor, report, and refrain from interacting with unauthorized migrants. If an ideal of open borders (...) is true, these laws are unjust. Furthermore, if citizens comply with their legal duties, they contribute to violating the rights of migrants. We are obligated to refrain from contributing to rights-violations. So, citizens are obligated to disobey immigration laws. I defend the moral requirement to disobey immigration laws against the objection that disobedience to the law is excessively risky and the objection that citizens have political obligations to obey the law. (shrink)

The Israeli approach to advertising consists of two complementary sets of norms, legal norms and moral‐ethical norms. Advertising legislation demands honest disclosure. The Israeli legislator refrains from intervening in fundamental rights such as freedom of expression, free trade, occupation, and liberty of contract in advertising. However, there are also few interventions to prevent phenomena that are dangerous or abusive, especially to groups needing protection. The Israeli courts do try to apply moral considerations in cases tried by them, but living (...) up to moral responsibilities is different from complying with legal obligations. Advertisers in Israel have a(i) Treatise(r), consisting of ten ethical guidelines, which neither sums up advertising ethics in its entirety nor is legally binding. Sociological and psychological features of the culture need to be examined in order to spell out what truth and honesty in advertising actually mean in this society, and the manner in which these values are practised. Lacking sanctions in public law against misleading consumers or manipulation based on false facts, consumers must find remedy in civil actions which rely on moral and ethical rules. (shrink)

The Israeli approach to advertising consists of two complementary sets of norms, legal norms and moral‐ethical norms. Advertising legislation demands honest disclosure. The Israeli legislator refrains from intervening in fundamental rights such as freedom of expression, free trade, occupation, and liberty of contract in advertising. However, there are also few interventions to prevent phenomena that are dangerous or abusive, especially to groups needing protection. The Israeli courts do try to apply moral considerations in cases tried by them, but living (...) up to moral responsibilities is different from complying with legal obligations. Advertisers in Israel have a(i) Treatise(r), consisting of ten ethical guidelines, which neither sums up advertising ethics in its entirety nor is legally binding. Sociological and psychological features of the culture need to be examined in order to spell out what truth and honesty in advertising actually mean in this society, and the manner in which these values are practised. Lacking sanctions in public law against misleading consumers or manipulation based on false facts, consumers must find remedy in civil actions which rely on moral and ethical rules. (shrink)

Human rights discourse has been likened to a global lingua franca, and in more ways than one, the analogy seems apt. Human rights discourse is a language that is used by all yet belongs uniquely to no particular place. It crosses not only the borders between nation-states, but also the divide between national law and international law: it appears in national constitutions and international treaties alike. But is it possible to conceive of human rights as a global language or lingua (...) franca not just in a figurative or metaphorical sense, but in a literal or linguistic sense as a legal dialect defined by distinctive patterns of word choice and usage? Does there exist a global language of human rights that transcends not only national borders, but also the divide between domestic and international law? Empirical analysis suggests that the answer is yes, but this global language comes in at least two variants or dialects. New techniques for performing automated content analysis enable us to analyze the bulk of all national constitutions over the last two centuries, together with the world’s leading regional and international human rights instruments, for patterns of linguistic similarity and to evaluate how much language, if any, they share in common. Specifically, we employ a technique known as topic modeling that disassembles texts into recurring verbal patterns. The results highlight the existence of two species or dialects of rights talk—the universalist dialect and the positive-rights dialect—both of which are global in reach and rising in popularity. The universalist dialect is generic in content and draws heavily on the type of language found in international and regional human rights instruments. It appears in particularly large doses in the constitutions of transitional states, developing states, and states that have been heavily exposed to the influence of the international community. The positive-rights dialect, by contrast, is characterized by its substantive emphasis on positive rights of a social or economic variety, and by its prevalence in lengthier constitutions and constitutions from outside the common law world, especially those of the Spanish-speaking world. Both dialects of rights talk are truly transnational, in the sense that they appear simultaneously in national, regional, and international legal instruments and transcend the distinction between domestic and international law. Their existence attests to the blurring of the boundary between constitutional law and international law. (shrink)

This study assesses the extent to which job application forms violate the New Zealand Human Rights Act. The sample for the study includes 229 job application forms, collected from a variety of large and small, public- and private-sector organizations that together employ approximately 200,000 workers. Two hundred and four or 88% of the job application forms contain at least one violation of the Act. One hundred and sixty five or 72% contain two or more and 140 or 61% contain three (...) or more violations. The most common violations concern age, gender, nationality, and disability. The least common concern political opinion, ethical belief, religious belief, and sexual orientation. Despite widespread violations, many forms do have non-discriminatory questions that yield the same kind of useful information as discriminatory questions. Employers could incorporate these into their job application forms to bring themselves into compliance with the law. The same lessons also generally apply to North American employers, given the high degree of comparability between American, Canadian, and New Zealand anti-discrimination laws. (shrink)

Would it be ethical to deploy autonomous weapon systems (AWS) if they were unable to reliably recognize when enemy forces had surrendered? I suggest that an inability to reliably recognize surrender would not prohibit the ethical deployment of AWS where there was a limited window of opportunity for targets to surrender between the launch of the AWS and its impact. However, the operations of AWS with a high degree of autonomy and/or long periods of time between release (...) and impact are likely to remain controversial until they have the capacity to reliably recognize surrender. (shrink)

This paper examines recent attempts to defend Rule-Consequentialism against a traditional objection. That objection takes the form of a dilemma, that either Rule-Consequentialism collapses into Act-Consequentialism or it is incoherent. Attempts to avoid this dilemma based on the idea that using RC has better results than using AC are rejected on the grounds that they conflate the ideas of a criterion of rightness and a decision procedure. Other strategies, Brad Hooker's prominent amongst them, involving the thought that RC need contain (...) no overarching concern to maximize the good are acknowledged to avoid the original dilemma, but lead to further problems of motivating and justifying RC in the absence of such a concern. The paper argues that Hooker's attempt to deal with these problems by using a 'Reflective Equilibrium plus method is unsuccessful. (shrink)

On January 18, 2006, the United States Supreme Court unanimously held that the constitutional challenge to New Hampshire's Parental Notification Prior to Abortion Act would be remanded to the United States Court of Appeals for the First Circuit, to determine whether the Court of Appeals could, consistent with New Hampshire's legislative intent, formulate a narrower remedy than a permanent injunction against enforcement of the parental notification law in its entirety.In 2003, New Hampshire enacted the Parental Notification Prior to Abortion (...) Act. The Act specifies, in pertinent part, that “No abortion shall be performed upon an unemancipated minor or upon a female for whom a guardian or conservator has been appointed… until at least 48 hours after written notice of the pending abortion has been delivered....” The Act allows for three exceptions where a physician may perform an abortion on a minor child without parental or guardian notification. (shrink)

This paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are: (1) The obligation to protect patients against COVID-19 spread; (2) The obligation to maintain professional competence and remain available for patients; (3) Clinicians’ role and place in society in relation to COVID-19; (4) The obligation to encourage societal vaccination uptake. These arguments stand up well against potential objections and provide a compelling case to consider (...) acceptance of COVID-19 vaccination a duty for all clinicians. This duty brings with it the implication that vaccine refusal amounts to a dereliction of the professional’s ethical obligations, which means such clinicians should be subject to disciplinary action. Furthermore, this duty provides grounding for mandatory vaccination policies for clinicians. (shrink)

The relationship between dementia and criminal behavior perplexes legal and health care systems. Dementia is a progressive clinical syndrome defined by impairment in at least two cognitive domains that interferes with one's activities of daily. Dementia symptoms have been associated with behaviors that violate social norms and constitute criminal actions. A failure to address a gap in policies that support appropriate management of individuals with dementia reflects a failure in our social obligation to care for those (...) who are most vulnerable amongst us. Categorical protections, informed by precedent models applied to juveniles and individuals with psychiatric illness, could help meet a social obligation to provide protections to individuals with dementia. We propose an approach that integrates affirmative defenses to mitigate criminal liability and sentencing restrictions to prevent cruel and unusual punishment. (shrink)

On January 18, 2006, the United States Supreme Court unanimously held that the constitutional challenge to New Hampshire's Parental Notification Prior to Abortion Act would be remanded to the United States Court of Appeals for the First Circuit, to determine whether the Court of Appeals could, consistent with New Hampshire's legislative intent, formulate a narrower remedy than a permanent injunction against enforcement of the parental notification law in its entirety.In 2003, New Hampshire enacted the Parental Notification Prior to Abortion (...) Act. The Act specifies, in pertinent part, that “No abortion shall be performed upon an unemancipated minor or upon a female for whom a guardian or conservator has been appointed… until at least 48 hours after written notice of the pending abortion has been delivered....” The Act allows for three exceptions where a physician may perform an abortion on a minor child without parental or guardian notification. (shrink)

Despite the long history of beliefs about the therapeutic properties of work for people with mental ill health, rarely has therapeutic work itself been a focus for historical analysis. In this article, the development of a therapeutic work ethic (1813—1979) is presented, drawing particular attention to the changing character and quality of beliefs about therapeutic work throughout time. From hospital factories to radical ‘antipsychiatric’ communities, the article reveals the myriad forms of activities that have variously been considered fit work (...) for people with mental health problems. While popular stereotypes of basket-weaving paint a hapless portrait of institutional work, a more nuanced reading of therapeutic work and its political and philosophical commitments is advanced. The article concludes by arguing that the non-linear and inherently contested development of therapeutic work is less the effect of paradigmatic shifts within the therapeutic professions, but rather evidence of a broader human struggle with work. (shrink)

This chapter provides a survey of Kierkegaard's views of systematic theology, doctrine, and dogmatics. It demonstrates that while Kierkegaard's view of theology is generally negative, for he regards it as a human enterprise created in order to avoid doing God's Word, his attitude to doctrine and dogmatics is nuanced and complex. Kierkegaard rejects doctrine insofar as it objectifies Christianity, but nevertheless generally accepts the classic doctrines of the Christian faith and sees no reason to reform them. This ambivalence toward doctrine (...) stems from his conviction that the task facing the believer is not to reflect on doctrine, but to appropriate and apply it existentially to his/her own individual existence. Similarly, although Kierkegaard rejects the efforts of contemporary dogmaticians, dogmatics itself is valid insofar as it reproduces the paradoxical character of Christianity and the decision between faith and offense with which Christian dogmas confront every human being. (shrink)

In Mengzi 6A4, Gaozi states that “yì 義 (propriety, rightness) is external, not internal.” In 6A5, Meng Jizi says of yì that “...it is on the external, not from the internal.” Their defenses are met with Mengzi’s resistance. What does he perceive and resist in these statements? Focusing on several key passages, I compare six promising interpretations. 6A4 and a relevant part of 2A2 can be rendered comparably sensible under each of the six. However, what Gaozi says in 6A1 (...) clearly is evidence to Mengzi that, of the six views, Gaozi holds three although he does not convey them in his statement. As for Meng Jiz’s defense of his statement, Meng Jizi cites a special occasion where one is required to act one way even though one would feel a different way. Mengzi’s response has been traditionally interpreted as boiling down to a dissenting opinion about empirical psychology, that the agent on that special occasion would in fact feel the same way as they ought to act. But on a more charitable reading, the point Mengzi makes is conceptual: Though the satisfaction of yì may not require that the feeling and the act align perfectly in this case, cases where the alignment obtains are conceptually prior. This not only refutes Meng Jizi’s statement but also enables a more elegant explanation of why the Mengzi rightly has no record of Mengzi affirming that yì is internal. I conclude that 6A5 itself uniquely favors one interpretation, as far as Meng Jizi’s position is concerned: How one feels is irrelevant to whether one satisfies yì. (shrink)

Many people are uncomfortable with the idea that pleasure from certain sources is genuinely beneficial. These sources can be sorted into two classes: ones that involve others’ pain; and ones that involve what seems to be damage rather than benefit to the person involved. Here’s an example of the latter: a woman who claims that she enjoys her work performing in hard-core pornographic films. Some find it hard to take such a claim at face value – they instinctively assume (...) that the woman is insincere or self-deceived.1 The reason seems a strongly paternalistic one: because the activity is assumed to be bad, it’s thought that only someone who was in some way damaged could genuinely like it. A statement from Brian Hill, the director of a documentary about such women, illustrates this: ‘I felt certain that she couldn’t enjoy what she does, that there must be some reason why she’s undergoing this kind of experience. But there was nothing: no messed-up childhood, no sense of pain or humiliation.’ Forced to conclude that the woman in question really does enjoy her work, Hill changes his view to imply that the pleasure gained cannot be truly beneficial: ‘When I hear a young woman talking about doing videos of fisting and asphyxiation, I have to wonder what it’s doing to her – even if she says that she’s having fun.’. (shrink)

Many accounts of the moral duty to obey the law either restrict the duty to ideal democracies or leave the duty’s application to non-ideal societies unclear. This article presents and defends a partial account of the moral duty to obey the law in non-ideal societies, focusing on the duty to obey judicial orders. We need public judicial authority to prevent objectionable power relationships that can result from disputes about private agreements. The moral need to prevent power imbalances in private relationships (...) grounds a qualified moral duty to obey judicial decisions. The parties to a dispute are morally required to comply with a judicial order in their dispute if all of the following conditions obtain: the parties’ dispute was in good faith, the court’s resolution of the dispute is more impartial than either party’s own judgment, the order does not call for violation of important natural duties or important artificial duties that the duty-bearer incurred involuntarily, and the primary aim of disobeying the court order would be to advance an ordinary, non-political project, not to call public attention to an injustice. The moral duty to obey judicial decisions can survive significant departures from ideal fairness. (shrink)

This paper suggests the adoption of a ‘capability approach’ to key concepts in healthcare. Recent developments in theoretical approaches to concepts such as ‘health’ and ‘disease’ are discussed, and a trend identified of thinking of health as a matter of having the capability to cope with life’s demands. This approach is contrasted with the WHO definition of health and Boorse’s biostatistical account. We outline the ‘capability approach’, which has become standard in development ethics and economics, and show how (...) existing work in those areas can profitably be adapted to healthcare. Cases are used to illustrate the value of adopting a capability approach. (shrink)

We examined cynicism as a mediator of the influence of managers’ mission-congruent communication and behavior about ethical standards (a form of supervisory behavioral integrity) on employee attitudes and intended behavior. Results indicated that cynicism partially mediates the relationship between supervisory behavioral integrity and organizational commitment, but not the relationship between supervisory behavioral integrity and intent to comply with organizational expectations for employee conduct.

Some authors argue that the ethics of medical care and the ethics of research differ, and that it is a mistake to conflate the two. They propose “that medical research and medical treatment are two distinct forms of activities, governed by different ethical principles.” This raises the question of whether physicians who are also clinical investigators may separate their role as physician from that of researcher when they are involved in clinical trials, thereby avoiding the obligations required in the (...) physician-patient relationship. Miller and Brody suggest that medical training is to blame for what they believe is the physicians’ tendency to confound the obligations of research and practice. “Physician-investigators, after all, went to medical school” they explain. They believe that considering research with patients outside the ethical framework of the physician-patient relationship may be “difficult and threatening” to physicians who have “psychological needs” to consider the ethical obligations flowing from their relationship with their patients. (shrink)

Some authors argue that the ethics of medical care and the ethics of research differ, and that it is a mistake to conflate the two. They propose “that medical research and medical treatment are two distinct forms of activities, governed by different ethical principles.” This raises the question of whether physicians who are also clinical investigators may separate their role as physician from that of researcher when they are involved in clinical trials, thereby avoiding the obligations required in the (...) physician-patient relationship. Miller and Brody suggest that medical training is to blame for what they believe is the physicians’ tendency to confound the obligations of research and practice. “Physician-investigators, after all, went to medical school” they explain. They believe that considering research with patients outside the ethical framework of the physician-patient relationship may be “difficult and threatening” to physicians who have “psychological needs” to consider the ethical obligations flowing from their relationship with their patients. (shrink)

Duty of care is the core ethical responsibility of healthcare workers. Getting the workforce vaccinated will provide safety to the public, protect the vulnerable population and provide a safe working environment. While most agree that healthcare workers should be prioritised in the vaccination programme, mandatory vaccination remains a complicated and contentious issue with political, legal and ethical dimensions. This study aims to determine the ethical considerations associated with mandatory vaccinations among healthcare workers. A total of (...) 152 abstracts were identified of which, 142 were excluded based on abstracts because they did not meet the inclusion criteria. The remaining ten articles were further evaluated with three articles that fit the inclusion criteria specifically discussing mandatory vaccination among healthcare workers and the ethical issues. Benefits, risks, effectiveness, equity and justice, autonomy, reciprocity and trust were used as a framework to discuss the ethical considerations which resonated both directly from the included papers, as well as more generally from the other literature associated with this search. There is limited literature on the topic of ethical considerations associated with COVID-19 mandatory vaccination of healthcare workers, as a systematic review identified only 3 papers. Benefits, risks, effectiveness, equity and justice, autonomy, reciprocity and trust were among the seven ethical considerations identified and discussed. (shrink)

Since Oregon implemented its Death with Dignity Act, many additional states have followed suit demonstrating a growing understanding and acceptance of aid in dying processes. Traditionally, the patient has been the one to request and seek this option out. However, as Death with Dignity acts continue to expand, it will impact the role of physicians and bring up questions over whether physicians have the ethical obligation to facilitate a conversation about AID with patients during end (...) of life discussions. Patients have the right to make informed decisions about their health, which implies that physicians have an obligation to discuss with and inform patients of the options that will accomplish the patients’ goals of care. We will argue that physicians have an ethical obligation to inform certain patients about AID during end of life care discussions. We will also address what this obligation encompasses and explore guidelines of when and how these conversations should occur and proceed. Earlier guidelines, presented by various palliative care and ethics experts, for proceeding with such conversations have mostly agreed that the discussion of hospice and end of life care with patients should be initiated early and that the individual goals of a patient during the remaining duration of life should be thoroughly examined before discussion of appropriate options. In discussing AID, physicians should never recommend but inform patients about the basics so that they can make an informed decision. If patients express further interest in AID, the physician should open up the dialogue to address the reasoning behind this decision versus other possible treatments to ensure that patients clearly comprehend the process and implications of their decision. Ultimately, any end of life choice should be made by patients with the full capacity to express what they envision for the remaining duration of life and to comprehend the advantages and disadvantages of all the possible options. (shrink)

There is considerable concern that climate change will displace many people in developing countries from their homes. This article examines whether developed countries are morally obligated to assist people displaced by climate change in developing countries. The article argues that there may not be a moral duty to assist climate change migrants as a category. Nonetheless, developed countries may have duties to assist vulnerable people elsewhere and may be obligated to assist climate change migrants along with other vulnerable people. (...) In addition, there likely is a duty to assist a particular subset of climate change migrants, specifically the citizens of small island countries existentially threatened by climate change. The article concludes by assessing the implications of its moral analysis for the focus of law and policy. Instead of developing new treaties to assist climate change migrants as a number of academics and practitioners have recently proposed, law and policy should be concerned with assisting migrants at risk generally, and/or the citizens of small island countries existentially threatened by climate change. (shrink)

This paper offers a qualified defence of physician non-compliance with antiabortion legislation in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. The paper examines two ethically troubling trends of post-Dobbs legislation: narrow and vague maternal health exemption clauses and mandatory reporting of miscarriages in jurisdictions where patients may criminal prosecution for medically induced abortions. It then examines and defends a professional obligation on the part of physicians to comply with the (...) law. This obligation, however, is defeasible. The paper then argues that physicians’ obligations to comply with the law is defeated when the law is illegitimate and following the law would constitute bad medical practice. Finally, it argues that the ethically troubling trends in post-Dobbs antiabortion legislation may meet these criteria. (shrink)

BackgroundThe COVID-19 pandemic has presented extraordinary challenges to worldwide healthcare systems, however, prevalence remains low in some countries. While the challenges of conducting research in high-prevalence countries are well published, there is a paucity from low COVID-19 countries.MethodsA PRISMA guided systematic review was conducted using the databases Ovid-Medline, Embase, Scopus and Web of Science to identify relevant articles discussing ethical issues relating to research in low prevalence COVID-19 countries.ResultsThe search yielded 133 original articles of which only 2 fit the (...) inclusion criteria and aim, with neither specific to low prevalence. Most of the available literature focused on clinical management and resource allocation related to high prevalence countries. These results will be discussed under the ethical dimensions of equity, individual liberty, privacy and confidentiality, proportionality, public protection, provision of care, reciprocity, stewardship and trust..ConclusionsA systematic review failed to identify articles relating to COVID-19 research ethics, specific to low prevalence countries. It shows that there is a significant gap in the literature that warrants further investigation. Common ethical principles were used to present a distinct set of challenges experienced by a country with a low prevalence of COVID-19. This unique perspective of some of the common ethical problems surrounding research, may help guide further discussion and guide research in similar countries. (shrink)

Researchers designing a clinical trial may be aware of disputed evidence of serious risks from previous studies. These researchers must decide whether and how to describe these risks in their model informed consent document. They have an ethical obligation to provide fully informed consent, but does this obligation include notice of controversial evidence? With ACCORD as an example, we describe a framework and criteria that make clear the conditions requiring inclusion of important controversial risks. The ACCORD (...) model consent document did not include notice of prior trials with excess death. We develop and explain a new standard labeled risk in equipoise. We argue that our approach provides an optimal level of integrity to protect the informational needs of the reasonable volunteers who agree to participate in clinical trials. We suggest language to be used in a model consent document and the informed consent discussion when such controversial evidence exists. (shrink)

The legal requirements and justifications for collecting patient-identifiable data without patient consent were examined. The impetus for this arose from legal and ethical issues raised during the development of a population-based disease register. Numerous commentaries and case studies have been discussing the impact of the Data Protection Act 1998 and Caldicott principles of good practice on the uses of personal data. But uncertainty still remains about the legal requirements for processing patient-identifiable data without patient consent for research purposes. This (...) is largely owing to ignorance, or misunderstandings of the implications of the common law duty of confidentiality and section 60 of the Health and Social Care Act 2001. The common law duty of confidentiality states that patient-identifiable data should not be provided to third parties, regardless of compliance with the DPA1998. It is an obligation derived from case law, and is open to interpretation. Compliance with section 60 ensures that collection of patient-identifiable data without patient consent is lawful despite the duty of confidentiality. Fears regarding the duty of confidentiality have resulted in a common misconception that section 60 must be complied with. Although this is not the case, section 60 support does provide the most secure basis in law for collecting such data. Using our own experience in developing a disease register as a backdrop, this article will clarify the procedures, risks and potential costs of applying for section 60 support. (shrink)

Objective: To identify factors that predict physicians’ intent to comply with the American Medical Association’s ethical guidelines on gifts from the pharmaceutical industry.Methods: A survey was designed and mailed in June 2004 to a random sample of 850 physicians in Florida, USA, excluding physicians with inactive licences, incomplete addresses, addresses in other states and pretest participants. Factor analysis extracted six factors: attitude towards following the guidelines, subjective norms , facilitating conditions , profession-specific precedents , individual-specific precedents (...) and intent. Multivariate regression modelling was conducted.Results: Surveys were received from 213 physicians representing all specialties, with a net response rate of 25.5%. 62% of respondents were aware of the guidelines; 50% had read them. 48% thought that following the guidelines would increase physicians’ credibility and professional image; 68% agreed that it was important to do so. Intent to comply was positively associated with attitude, subjective norms, facilitators and sponsorship of continuing medical education events, while individual-specific precedents had a negative relationship with intent to comply. Predictors of intent were attitude, subjective norms, the interaction term , sponsorship of CME events and individual-specific precedents.Conclusions: Physicians are more likely to follow the AMA guidelines if they have positive attitudes towards the guidelines, greater subjective norms, fewer expectations of CME sponsorship and fewer individual-specific precedents. Physicians believing that important individuals or organisations expect them to comply with the guidelines are more likely to express intent, despite having fewer beliefs that positive outcomes would result through compliance. (shrink)

The central question in political philosophy is whether political states have the right to coerce their constituents and whether citizens have a moral duty to obey the commands of their state. In this 2005 book, Christopher Heath Wellman and A. John Simmons defend opposing answers to this question. Wellman bases his argument on samaritan obligations to perform easy rescues, arguing that each of us has a moral duty to obey the law as his or her fair share of the communal (...) samaritan chore of rescuing our compatriots from the perils of the state of nature. Simmons counters that this, and all other attempts to explain our duty to obey the law, fail. He defends a position of philosophical anarchism, the view that no existing state is legitimate and that there is no strong moral presumption in favor of obedience to, or compliance with, any existing state. (shrink)

A number of authors have commented on the topic of mandated reporting in cases of suspected child maltreatment and the application of this requirement to researchers. Most of these commentaries focus on the interpretation of current legal standards and offer opinions for or against the imposition of mandated reporting laws on research activities. Authors on both sides of the issue offer ethical arguments, although a direct comparison and analysis of these opposing arguments is rare. This article critically examines the (...) ethical arguments made by authors on both sides of the debate. The conclusion is reached that researchers should be mandated reporters of child maltreatment because the current arguments do not justify their exclusion from current ethical and legal standards. The author makes recommendations for the ethically responsible conduct of research in regard to this topic and legal implications are discussed. (shrink)

The article discusses the possible consequences that can be faced by a Member State of the European Union if its national court does not comply with the obligation to make a reference for a preliminary ruling to the Court of Justice. The TFEU does not specify any sanctions applicable to a state when its national court disregards its obligation under Article 267 TFEU. Therefore, the analysis focuses on the practice of the Court of Justice and its (...) interpretation by scholars. At the outset, the author analyses whether refraining from making a reference for a preliminary ruling can lead to the duty to pay damages to an individual. Taking into account the criteria of a sufficiently serious breach formulated in the Köbler case, the author comes to the conclusion that the infringement of the obligation to make a reference for a preliminary ruling is one of the most important criteria in assessing whether a Member State has to pay damages for any loss suffered by an individual, but the infringement itself is not sufficient to make a state liable. (shrink)

Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions frequently focus on facilitating ‘healthy choices’, with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual (...) level, unable to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours, as well as with doctors’ frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians’ ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities. No data are available. (shrink)

A growing number of professional associations and occupational groups are creating codes of ethics with the goal of guiding their members, protecting service users, and safeguarding the reputation of the profession. There is a great deal of literature dealing with the question to what extent ethical codes can achieve their desired objectives. The present paper does not contribute to this debate. Its aim is rather to investigate how rational it is to comply with codes of (...) conduct. It is natural and virtually inevitable for a reflective person to ask why one should pay any attention to ethical codes, in particular if following a code is not in one’s own interest. In order to achieve the aim of this paper, I shall discuss reasons that only appear to be reasons for complying with a code. In “Code-independent reasons” section, I shall present genuine practical reasons that, however, turn out to be reasons of the wrong kind. In “Code-dependent reasons” section finally presents the most important reasons for complying with ethical codes. The paper argues that while ethical codes do not necessarily yield reasons for action, professionals can have genuine reasons for complying with a code, which may, however, be rather weak and easily overridden by reasons for deviating from the code. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)