BackgroundDuring the arrival of the COVID-19 pandemic, various professional ethical guidance was issued to (and for) health and social care professionals in England and Wales. Guidance can help to inform and support such professionals and their patients, clients and service users, but a plethora of guidance risked information overload, confusion, and inconsistency. MethodsDuring the early months of the pandemic, we undertook a rapid review, asking: what are the principles adopted by professional ethical guidance in England and (...) Wales for dealing with COVID-19? We undertook thematic content analysis of the 29 documents that met our inclusion criteria.ResultsThe 29 documents captured 13 overlapping principles: respect, fairness, minimising harm, reciprocity, proportionality, flexibility, working together, inclusiveness, communication, transparency, reasonableness, responsibility, and accountability.ConclusionsWe intend this attempt to collate and outline the prominent principles to be helpful, particularly, for healthcare practice during the COVID-19 pandemic and, hopefully, for future pandemic planning. We also offer some reflections on the guidance and the principles therein. After describing the principles, we reflect on some of the similarities and differences in the guidance, and the challenges associated not only with the specific guidance reviewed, but also with the nature and import of “professional ethical guidance”. (shrink)

Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians’ and parents’ decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatment preferences fail to protect a child’s basic needs or primary goods, (...) and both physicians and parents should be guided by a commitment to protect a child’s basic needs and primary goods. In contrast, we argue that no principle—neither Ross’s CPA, nor the best interest standard or the harm threshold—can serve as both an intervention principle and a guidance principle. First, there are as many correct intervention principles as there are different kinds of interventions, since different kinds of interventions can be justified under different conditions. Second, physicians and parents have different guidance principles, because the decisions physicians and parents make for a child should be informed by different values and balanced by different (potentially) conflicting commitments. (shrink)

Training guide by the Previous Rebbe for the molding of spirits, written for use by the first counselors at the first Lubavitch yeshiva, Tomchei Tmimim: practical, spiritual steps to move past transmitting intellectual ideas to developing character.

Through the centuries, women from all over the world remain vulnerable to their social status. In some developed countries the situation has improved, but there are many countries where it is still unbearable. United Nations Educational, Scientific and Cultural Organization aims to assist in this regard by addressing ethical issues pertaining to medicine, life sciences and related technologies as applied to human beings with consideration of women's social, legal and environmental dimensions. Yet pastoral counsellors on ground level are confronted with (...) the need for assistance to women who suffer because of this exploitation. Therefore, the aim of this article is to focus on biblical principles that can serve as anchors to guide women regarding their human vulnerability and personal integrity when they experience suffering and hardship. The challenge facing the pastoral counsellor is to guide women to accept the reality of their situation within a certain framework, to adequately deal with this and, in spite of overwhelming emotions, continue to grow in personal integrity and healing. (shrink)

It is widely thought that moral obligations are necessarily guidance giving. This supposed fact has been put to service in defence of the ‘ought-implies-can’ principle according to which one cannot be morally obligated to do the impossible, since impossible-to-satisfy obligations would not give guidance. It is argued here that the supposed fact is no such thing; moral obligations are not necessarily guiding giving, and so the ‘guidance argument’ for ought-implies-can fails. This is the result of no (...) non-trivial condition being ‘luminous’. (shrink)

In this short response to Kerstein and Bognar, we clarify three aspects of the complete lives system, which we propose as a system of allocating scarce medical interventions. We argue that the complete lives system provides meaningful guidance even though it does not provide an algorithm. We also defend the investment modification to the complete lives system, which prioritizes adolescents and older children over younger children; argue that sickest-first allocation remains flawed when scarcity is absolute and ongoing; and argue (...) that Kerstein and Bognar are mistaken to base their allocation principles on differences in personhood. (shrink)

The rapid diffusion of artificial intelligence (AI) technologies in the defence domain raises challenges for the ethical governance of these systems. A recent shift from the what to the how of AI ethics sees a nascent body of literature published by defence organisations focussed on guidance to implement AI ethics principles. These efforts have neglected a crucial intermediate step between principles and guidance concerning the elicitation of ethical requirements for specifying the guidance. In this article, we outline (...) the key normative choices and corresponding tradeoffs that are involved in specifying guidance for the implementation of AI ethics principles in the defence domain. These correspond to: the AI lifecycle model used; the scope of stakeholder involvement; the accountability goals chosen; the choice of auditing requirements; and the choice of mechanisms for transparency and traceability. We provide initial recommendations for navigating these tradeoffs and highlight the importance of a pro-ethical institutional culture. (shrink)

In “The Harm Principle Cannot Replace the Best Interest Standard: Problems With Using the Harm Principle for Medical Decision Making for Children,” Bester argues that conceptual and normative diffi...

According to one prominent critique of mainstream epistemology, discoveries about what it takes to know or justifiedly believe that p can’t provide the right kind of intellectual guidance. As Mark Webb puts it, “the kinds of principles that are developed in this tradition are of no use in helping people in their ordinary epistemic practices.” In this paper I defend a certain form of traditional epistemology against this “regulative” critique. Traditional epistemology can provide—and, indeed, can be essential for—intellectual (...) class='Hi'>guidance. The reason is that, in many cases, how you should proceed intellectually depends on what you already know or justifiedly believe: how you should treat counterevidence to your beliefs, for example, can depend on whether those beliefs count as knowledge. Therefore, to get guidance on how to proceed intellectually, it will often be essential to be able to figure out what you know or justifiedly believe. And to do that it will often be helpful to try to figure out what it takes to count as knowledge or justified belief in the first place. To do this is precisely to engage in mainstream epistemology. (shrink)

Our aims are to set forth a multiprinciple system for selecting among clinical trials competing for limited space in an immunotherapy production facility that supplies products under investigation by scientific investigators; defend this system by appealing to justice principles; and illustrate our proposal by showing how it might be implemented. Our overarching aim is to assist manufacturers of immunotherapeutic products and other potentially breakthrough experimental therapies with the ethical task of prioritizing requests from scientific investigators when production capacity is limited.

This article provides a critical comparative analysis of the substantive and procedural values and ethical concepts articulated in guidelines for allocating scarce resources in the COVID-19 pandemic. We identified 21 local and national guidelines written in English, Spanish, German and French; applicable to specific and identifiable jurisdictions; and providing guidance to clinicians for decision making when allocating critical care resources during the COVID-19 pandemic. US guidelines were not included, as these had recently been reviewed elsewhere. Information was extracted from (...) each guideline on: 1) the development process; 2) the presence and nature of ethical, medical and social criteria for allocating critical care resources; and 3) the membership of and decision-making procedure of any triage committees. Results of our analysis show the majority appealed primarily to consequentialist reasoning in making allocation decisions, tempered by a largely pluralistic approach to other substantive and procedural values and ethical concepts. Medical and social criteria included medical need, co-morbidities, prognosis, age, disability and other factors, with a focus on seemingly objective medical criteria. There was little or no guidance on how to reconcile competing criteria, and little attention to internal contradictions within individual guidelines. Our analysis reveals the challenges in developing sound ethical guidance for allocating scarce medical resources, highlighting problems in operationalising ethical concepts and principles, divergence between guidelines, unresolved contradictions within the same guideline, and use of naïve objectivism in employing widely used medical criteria for allocating ICU resources. (shrink)

Political philosophers frequently claim that political ideals can provide normative guidance for unjust and otherwise nonideal circumstances. This is mistaken. This paper demonstrates that political ideals contribute nothing to our understanding of the normative principles we should satisfy amidst unjust or otherwise nonideal circumstances.

This paper argues that, contrary to a common line of criticism followed by scholars such as Helga Kuhse, a particularistic version of virtue ethics properly elaborated, can provide sound moral guidance and a satisfactory account for moral justification of our opinions regarding, for instance, health care practice. In the first part of the paper, three criteria for comparing normative theories with respect to action‐guiding power are outlined, and it is argued that the presented particularistic version of virtue ethics actually (...) can provide more guidance than the universalistic theories favoured by Kuhse and others. In the second part of the paper it is claimed that universalist normative theories have serious problems accounting for the role that moral principles are supposed to play in the justification, of moral opinions, whereas the present version of virtue ethics accommodates a plausible alternative idea of justification without invoking moral principles or eschewing objectivity. (shrink)

Let the Guidance Constraint be the following norm for evaluating ethical theories: Other things being at least roughly equal, ethical theories are better to the extent that they provide adequate moral guidance. I offer an account of why ethical theories are subject to the Guidance Constraint, if indeed they are. We can explain central facts about adequate moral guidance, and their relevance to ethical theory, by appealing to certain forms of autonomy and fairness. This explanation is (...) better than explanations that feature versions of the principle that ‘ought’ implies ‘can’. In closing, I address the objection that my account is questionable because it makes ethical theories subject not merely to purely theoretical but also to morally substantive norms. (Published Online August 21 2006). (shrink)

ABSTRACT:The purpose of this paper is to formulate and defend a set of moral principles applicable to management. Our motivation is twofold: 1) to increase the coherence and utility of Integrative Social Contracts Theory (ISCT); and 2) to initiate an alternative stream of business ethics research. To those ends, we specify what counts as adequate guidance in navigating the ethical terrain of business. In doing so, a key element of ISCT, Substantive Hypernorms, is found to be flawed beyond repair. (...) So we propose and defend a remedy:prima faciemoral principles. After delineating the appropriate criteria and format for such principles, we formulate, explain, and defend five of them. We conclude with a brief comment on future research possibilities. (shrink)

Logic, the tradition has it, is normative for reasoning. But is that really so? And if so, in what sense is logic normative for reasoning? As Gilbert Harman has reminded us, devising a logic and devising a theory of reasoning are two separate enterprises. Hence, logic's normative authority cannot reside in the fact that principles of logic just are norms of reasoning. Once we cease to identify the two, we are left with a gap. To bridge the gap one would (...) need to produce what John MacFarlane has appropriately called a bridge principle, i.e. a general principle articulating a substantive and systematic link between logical entailment and norms of reasoning. This is Harman's skeptical challenge. In this paper I argue that Harman's skeptical challenge can be met. I show how candidate bridge principles can be systematically generated and evaluated against a set of well‐motivated desiderata. Moreover, I argue that bridge principles advanced by MacFarlane himself and others, for all their merit, fail to address the problem originally set forth by Harman and so do not meet the skeptical challenge. Finally, I develop a bridge principle that meets Harman's requirements as well as being substantive. (shrink)

Highlighting the distinct approaches to behavior guidance employed by law and aspirational religious institutions like Buddhism, focusing on the work of Lon Fuller. There is importance to both baseline or duty-centered rules such as found primarily in criminal law and deontic morality, as well as aspirational guidance principles that are found in religious law, virtue ethics, and sometimes seen in civil law. However, the specific assumptions and aims of these two modes of guidance must be harmonized to (...) be effective. (shrink)

The burgeoning field of medical ethics raises complicated questions for mental health researchers. The critical issues of risk assessment, beneficence, and the moral duties researchers owe their patients are analyzed in James DuBois's well written Ethics in Mental Health Research.

One prominent strand in contemporary moral particularism concerns the claim of "principle abstinence" that we ought not to rely on moral principles in moral judgment because they fail to provide adequate moral guidance. I argue that moral generalists can vindicate this traditional and important action-guiding role for moral principles. My strategy is to argue, first, that, for any conscientious and morally committed agent, the agent's acceptance of (true) moral principles shapes their responsiveness to (right) moral reasons and, second, (...) that if so, then those principles can contribute non-trivially to some reliable strategy for acting well that is available for use in the agent's practical thinking. My defense of these two claims appeals to an account of moral principles as a kind of hedged principles which I defend elsewhere, but my general line of argument should be acceptable to many other forms of generalism as well. I defend the epistemic significance of hedged principles in moral deliberation, and argue that the need for sensitivity to particulars in moral judgment doesn't supplant principles in moral guidance. I finish by arguing that the generalist model of moral guidance developed here isn't undermined by evidence from cognitive science about how we make moral judgments in actual practice, and that it compares favorably to particularism with respect to its capacity to offer adequate moral guidance. (shrink)

Health care is ubiquitous in the industrialized world. Yet, every medical development, technique, and procedure impacts the environment. Green bioethics synthesizes environmental ethics and biomedical ethics, thus creating an interdisciplinary approach to sustainable health care. Notably, green bioethics addresses not the structure of environmental sustainability in health-care institutions but the sustainability of individual health-care offerings. It parallels traditional biomedical ethics by providing four principles for ethical guidance: distributive justice, resource conservation, simplicity, and ethical economics. Through these four principles, green (...) bioethics presents a coherent framework for evaluating the sustainability of medical developments, techniques, and procedures. The future of our world may very well depend on how effectively we halt ecological destruction and conserve our resources in all areas of life. The principles of green bioethics, outlined in this book, will advance sustainability in health care. (shrink)

Recent calls have been made to move professional standards to a more principles-based perspective, supposing that emphasizing broad principles would eliminate the legalistic focus that rules may encourage, and accountants’ behavior would be more ethical and uniformly so. However, this supposition has yet to be empirically tested. The AICPA Code of Professional Conduct (Code) provides guidance in both forms: principles and rules. This experiment examines how the form of the Code affects independence judgments in a client acceptance context. We (...) also examine the potential for levels of moral development to influence the effectiveness of the Code.We find that subjects are more likely to consider their independence impaired, and are more likely to reject a questionable audit engagement, when rules-based (principles-based) reasoners are provided with Code rules (principles). Given the popularity of the view that rules-based standards are undesirable, these findings have significant implications for the profession as principles-based ethical standards are discussed. (shrink)

Recent calls have been made to move professional standards to a more principles-based perspective, supposing that emphasizing broad principles would eliminate the legalistic focus that rules may encourage, and accountants’ behavior would be more ethical and uniformly so. However, this supposition has yet to be empirically tested. The AICPA Code of Professional Conduct (Code) provides guidance in both forms: principles and rules. This experiment examines how the form of the Code affects independence judgments in a client acceptance context. We (...) also examine the potential for levels of moral development to influence the effectiveness of the Code.We find that subjects are more likely to consider their independence impaired, and are more likely to reject a questionable audit engagement, when rules-based (principles-based) reasoners are provided with Code rules (principles). Given the popularity of the view that rules-based standards are undesirable, these findings have significant implications for the profession as principles-based ethical standards are discussed. (shrink)

Excerpt from Some Principles of Moral Theology: And Their Application The present book is an attempt to bring together, from the Bible and from Christian experience, the principles which have guided the Church in dealing with individual souls; to test those principles by the light of modern knowledge; and to apply them to present-day conditions and needs. Some of the traditional terminology of moral theology has been discarded; much has been retained, either because it seemed the best medium for expressing (...) what had to be expressed, or because it would have been impossible otherwise to indicate the development and formulation of Christian thought on the subject. Thus the book may prove of interest not merely to the clergy and others who are confronted by the practical problems of conduct and morality, but also to students entering upon the study of moral theology for its own sake. The Church of England affords her clergy singularly little expert guidance in this matter of the direction of souls. Two branches of the subject - those which go by the names of Christian ethics and the theory and practice of the confessional respectively - have indeed been systematically and fully treated by recent writers and there is a wealth of practical experience to be drawn both from manuals of pastoral theology and from biographies. Moral theology, however, as will appear, com prises much more than the two topics just mentioned. Yet within the last fifty years, apparently, only three books have attempted to present the whole content of moral theology in such a form as should guide the theory and practice of the Church of England, and all three are out of print and consequently difficult of access. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. (shrink)

According to objectivism about the practical 'ought', what one ought to do depends on all the facts; according to perspectivism, it depends only on epistemically available facts. This essay presents a new argument against objectivism. The first premise says that it is at least sometimes possible for a normative theory to correctly guide action. The second premise says that, if objectivism is true, this is never possible. From this it follows that objectivism is false. Perspectivism, however, turns out to be (...) compatible with the plausible assumption about guidance. I defend the two premises on the basis of an account of what it is for a normative theory to guide action. Central to this account is the idea that correct action-guidance involves correct practical reasoning from a normative theory to an action, which requires that agents have the capacity to believe for the right reasons. Since objectivists about the practical 'ought' are committed to objectivism about the epistemic 'ought', it follows that agents lack this capacity and so are in principle unable to be correctly guided by a normative theory. This shows that recent attempts to reconcile objectivism with action-guidance are unsuccessful, which all assume that, if objectivism is true, it is at least sometimes possible for a normative theory to correctly guide action. (shrink)

On the one hand, the concept of truth is a major research subject in analytic philosophy. On the other hand, mathematical logicians have developed sophisticated logical theories of truth and the paradoxes. Recent developments in logical theories of the semantical paradoxes are highly relevant for philosophical research on the notion of truth. And conversely, philosophical guidance is necessary for the development of logical theories of truth and the paradoxes. From this perspective, this volume intends to reflect and promote deeper (...) interaction and collaboration between philosophers and logicians investigating the concept of truth than has existed so far.Aside from an extended introductory overview of recent work in the theory of truth, the volume consists of articles by leading philosophers and logicians on subjects and debates that are situated on the interface between logical and philosophical theories of truth. The volume is intended for graduate students in philosophy and in logic who want an introduction to contemporary research in this area, as well as for professional philosophers and logicians. (shrink)

Behavioural variant frontotemporal dementia (bvFTD) is characterized by an absence of obvious cognitive impairment and presence of symptoms such as disinhibition, social inappropriateness, personality changes, hyper-sexuality, and hyper-orality. Affected individuals do not feel concerned enough about their actions to be deterred from violating social norms, and their antisocial behaviours are most likely caused by the neurodegenerative processes in the frontal and anterior temporal lobes. BvFTD patients present a challenge for the traditional notion of autonomy and the medical and criminal justice (...) systems. Antisocial behaviour is often the earliest recognized manifestation of bvFTD. Given that the symptoms are not specific and that atrophy of the frontal lobes is only observable with structural neuroimaging in the later stages of the disease, it is hard to ascertain their autonomy. Recently proposed re-conceptualizations of autonomy (Dworkin’s, Jaworska’s, and Dubljević’s) can, however, be sufficiently redefined to provide explicit rules and offer nuanced guidance in such cases. A combination of notions of autonomy gives the most nuanced guidance with three modifications: 1) including socio-moral judgement in the notion of “normal cognitive competence,” 2) excluding in-principle un-endorsable ideals from the notion of “capacity to value,” and 3) redefining ideal-typical degrees of compulsion (mild, severe, and total). (shrink)

Recent attempts to develop and apply digital ethics principles to address the challenges of the digital transformation leave organisations with an operationalisation gap. To successfully implement such guidance, they must find ways to translate high-level ethics frameworks into practical methods and tools that match their specific workflows and needs. Here, we describe the development of a standardised risk assessment tool, the Principle-at-Risk Analysis (PaRA), as a means to close this operationalisation gap for a key level of the ethics (...) infrastructure at many organisations – the work of an interdisciplinary ethics panel. The PaRA tool serves to guide and harmonise the work of the Digital Ethics Advisory Panel at the multinational science and technology company Merck KGaA in alignment with the principles outlined in the company’s Code of Digital Ethics. We examine how such a tool can be used as part of a multifaceted approach to operationalise high-level principles at an organisational level and provide general requirements for its implementation. We showcase its application in an example case dealing with the comprehensibility of consent forms in a data-sharing context at Syntropy, a collaborative technology platform for clinical research. (shrink)

While some believe that the principle of double effect provides sound ethical guidance, others believe that it does not and have leveled various types of argument against it. One type of argument leveled against it proceeds by applying it to hypothetical “closeness” cases. This objection seeks to show that in such cases the principle permits what patently should not be permitted, and thus is unacceptable because it is too permissive. In this essay, I critically evaluate an argument (...) of this type developed by Alexander R. Pruss. Central to my strategy is to develop and defend a distinction between two kinds of means. I refer to them as closed-ended and open-ended means. I argue that once what is intended is understood in light of this distinction, the principle does not permit what patently should not be permitted, and thus need not be seen as being too permissive. (shrink)

This article clarifies the disagreement concerning ideal theory’s action-guiding capacity through the unpacking of two underlying disagreements. The first concerns the threshold for action-guidance on the scales of empirical and normative determinacy; I argue that the dispute between critics and proponents of ideal theory is not about whether ideal principles offer some specific information, but about which information should count as action-guiding. The second concerns the task of normative principles; I argue that the different weight critics and proponents attribute (...) to the risks associated with ideal theory may reflect diverging views on whether principles primarily generate or explain normative judgments. (shrink)

Many medical interventions have both negative and positive effects. When health care professionals cannot achieve a particular desired good result without bringing about some bad effects also they often rely on double-effect reasoning to justify their decisions. The principle of double effect is therefore an important guide for ethical decision-making in medicine. At the same time, however, it is a very controversial tool for resolving complex ethical problems that has been criticized by many authors. For these reasons, I examine (...) in this paper whether the principle of double effect can serve as a basis for ethical decisions in medicine. The conclusion reached in this article is that even though this principle has desirable effects on clinical conduct, it is only an unreliable guide and physicians and nurses cannot feel secure in continuing to use this principle for ethical guidance. (shrink)

The Oxford Philosophical Texts series consists of authoritative teaching editions of canonical texts in the history of philosophy from the ancient world down to modern times. Each volume provides a clear, well laid out text together with a comprehensive introduction by a leading specialist,giving the student detailed critical guidance on the intellectual context of the work and the structure and philosophical importance of the main arguments. Endnotes are supplied which provide further commentary on the arguments and explain unfamiliar references (...) and terminology, and a fullbibliography and index are also included.The series aims to build up a definitive corpus of key texts in the Western philosophical tradition, which will form a reliable and enduring resource for students and teachers alike.In his Principles of Human Knowledge Berkeley makes the striking claim that physical things consist of nothing but ideas, and so do not exist outside the mind. This establishes Berkeley as the founder of the idealist tradition in philosophy. Berkeley argues vigorously that once we correct ourunderstanding of the physical, we can find a new proof of the existence of God, refute sceptical attacks on human knowledge, and resolve many difficulties and paradoxes raised by the advance of science.The text printed in this volume is the 1734 edition of the Principles which is generally agreed to represent Berkeley's mature thought. Also included are the four important letters between George Berkeley and Samuel Johnson, written in 1729-30. The text is supplemented by a comprehensiveintroduction which looks at the structure and main arguments of the text, as well as discussing Berkeley's life, influences, and general philosophy. In addition the volume includes an analysis of the text, a glossary, detailed notes, and a full bibliography with guidance on further reading.This new edition of Berkeley's most famous work, published alongside his other masterpiece, the Three Dialogues (also edited by Jonathan Dancy) provides the student with a thorough introduction to the central ideas of one of the world's greatest philosophers. (shrink)

It is commonly thought that moral rules and principles, such as ‘Keep your promises,’ ‘Respect autonomy,’ and ‘Distribute goods according to need ,’ should play an essential role in our moral deliberation. Particularists have challenged this view by arguing that principled guidance leads us to engage in worse decision making because principled guidance is too rigid and it leads individuals to neglect or distort relevant details. However, when we examine empirical literature on the use of rules and principles (...) in other domains, we find that people can learn to use rules discriminately and that rule-based models tend to outperform even expert judgment. I argue that this evidence poses a problem for the moral particularist. If the particularist claims that we should not rely on decision-making rules when making practical decisions and it turns out that these rules help us make better decisions, then the particularists’ prescriptive account is deficient. However, if the particularist claims that we should rely on practical decision-making rules but not on moral rules, she needs to explain how practical rules are different from moral rules and why we should rely on the former but not the latter. (shrink)

The rapid development in healthcare technologies in recent years has resulted in the need for health services, whether publicly funded or insurance based, to identify means to maximise the benefits and provide equitable distribution of limited resources. This has resulted in the need for rationing decisions, and there has been considerable debate regarding the substantive and procedural ethical principles that promote distributive justice when making such decisions. In this paper, I argue that while the scientifically rigorous approaches of evidence-based healthcare (...) are claimed as aspects of procedural justice that legitimise such guidance, there are biases and distortions in all aspects of the process that may lead to epistemic injustices. Regardless of adherence to principles of distributive justice in the decision-making process, evidential failings may undermine the fairness and legitimacy of such decisions. In particular, I identify epistemic exclusion that denies certain patient and professional groups the opportunity to contribute to the epistemic endeavour. This occurs at all stages of the process, from the generation, analysis and reporting of the underlying evidence, through the interpretation of such evidence, to the decision-making that determines access to healthcare resources. I further argue that this is compounded by processes which confer unwarranted epistemic privilege on experts in relation to explicit or implicit value judgements, which are not within their remit. I suggest a number of areas in which changes to the processes for developing, regulating, reporting and evaluating evidence may improve the legitimacy of such processes. (shrink)

In this paper, I intend to articulate an answer to the powerful particularist objection against the notion of moral and legal reasoning based on universal principles. I defend a particular way of specifying and contextualising universal principles. I claim that this account preserves legal and moral justification conceived as subsumption to legal and moral principles. I also try to show how virtues can be reconciled with this account, i.e. what is the right place for virtues in legal adjudication. To carry (...) this out, I draw on a virtue epistemology. (shrink)

James Madison wrote, 'Had every Athenian citizen been a Socrates, every Athenian assembly would still have been a mob'. The contributors to this volume discuss and for the most part challenge this claim by considering conditions under which many minds can be wiser than one. With backgrounds in economics, cognitive science, political science, law and history, the authors consider information markets, the internet, jury debates, democratic deliberation and the use of diversity as mechanisms for improving collective decisions. At the same (...) time, they consider voter irrationality and paradoxes of aggregation as possibly undermining the wisdom of groups. Implicitly or explicitly, the volume also offers guidance and warnings to institutional designers. (shrink)

: The principle of equipoise traditionally is grounded in the special obligations of physician-investigators to provide research participants with optimal care. This grounding makes the principle hard to apply in contexts with limited health resources, to research that is not directed by physicians, or to non-therapeutic research. I propose a different version of the principle of equipoise that does not depend upon an appeal to the Hippocratic duties of physicians and that is designed to be applicable within (...) a wider range of research contexts and types—including health services research and research on social interventions. I consider three examples of ethically contentious research trials conducted in three different social settings. I argue that in each case my version of the principle of equipoise provides more plausible and helpful guidance than does the traditional version of the principle. (shrink)

BackgroundAs the COVID-19 pandemic develops, healthcare professionals are looking for support with, and guidance to inform, the difficult decisions they face. In the absence of an authoritative national steer in England, professional bodies and local organisations have been developing and disseminating their own ethical guidance. Questions inevitably arise, some of which are particularly pressing during the pandemic, as events are unfolding quickly and the field is becoming crowded. My central question here is: which professional ethical guidance should (...) the professional follow?Main bodyAdopting a working definition of “professional ethical guidance”, I offer three domains for a healthcare professional to consider, and some associated questions to ask, when determining whether – in relation to any guidance document – they should “bin it or pin it”. First, the professional should consider the source of the guidance: is the issuing body authoritative or, if not, at least sufficiently influential that its guidance should be followed? Second, the professional should consider the applicability of the guidance, ascertaining whether the guidance is available and, if so, whether it is pertinent. Pertinence has various dimensions, including whether the guidance applies to this professional, this patient and/or this setting, whether it is up-to-date, and whether the guidance addresses the situation the professional is facing. Third, the professional should consider the methodology and methods by which the guidance was produced. Although the substantive quality of the guidance is important, so too are the methods by which it was produced. Here, the professional should ask whether the guidance is sufficiently inclusive – in terms of who has prepared it and who contributed to its development – and whether it was rigorously developed, and thus utilised appropriate processes, principles and evidence.ConclusionAsking and answering such questions may be challenging, particularly during a pandemic. Furthermore, guidance will not do all the work: professionals will still need to exercise their judgment in deciding what is best in the individual case, whether or not this concerns COVID-19. But such judgments can and should be informed by guidance, and hopefully these preliminary observations will provide some useful pointers for time-pressed professionals. (shrink)

Pediatric intervention principles help clinicians and health-care institutions determine appropriate responses when parents’ medical decisions place children at risk. Several intervention principles have been proposed and defended in the pediatric ethics literature. These principles may appear to provide conflicting guidance, but much of that conflict is superficial. First, seemingly different pediatric intervention principles sometimes converge on the same guidance. Second, these principles often aim to solve different problems in pediatrics or to operate in different background conditions. The potential (...) for convergence between intervention principles—or at least an absence of conflict between them—matters for both the theory and practice of pediatric ethics. This article builds on the recent work of a diverse group of pediatric ethicists tasked with identifying consensus guidelines for pediatric decision-making. (shrink)

Educational gatekeeping functions in psychology serve to assess, remediate, and/or dismiss students and trainees with problematic professional competencies (STPPC). Recently, professional psychology graduate programs have increasingly focused on problems with professional competency, and they have begun to implement formal procedures to intervene with STPPC (Rubin et al., 2007). However, there has been considerably less literature addressing the ethics and ethical considerations of instituting these gatekeeping functions, especially in different stages of education and training in psychology. The American Psychological Association (APA; (...) 2002) Ethical Principles of Psychologists and Code of Conduct (Ethics Code) offers faculty and supervisors ethical principles and obligatory standards that provide guidance about how to implement highly ethical gatekeeping practices. The purpose of this article is to highlight the major ethical issues and dilemmas that faculty and supervisors may face when intervening with STPPC and provide recommendations for ethical gatekeeping practices that are inspired by the APA Ethics Code. (shrink)

The prioritisation of scarce resources has a particular urgency within the context of the COVID‐19 pandemic crisis. This paper sets out a hypothetical case of Patient X (who is a nurse) and Patient Y (who is a non‐health care worker). They are both in need of a ventilator due to COVID‐19 with the same clinical situation and expected outcomes. However, there is only one ventilator available. In addressing the question of who should get priority, the proposal is made that the (...) answer may lie in how the pandemic is metaphorically described using military terms. If nursing is understood to take place at the ‘frontline’ in the ‘battle’ against COVID‐19, a principle of military medical ethics—namely the principle of salvage—can offer guidance on how to prioritise access to a life‐saving resource in such a situation. This principle of salvage purports a moral direction to return wounded soldiers back to duty on the battlefield. Applying this principle to the hypothetical case, this paper proposes that Patient X (who is a nurse) should get priority of access to the ventilator so that he/she can return to the ‘frontline’ in the fight against COVID‐19. (shrink)

The philosophy of patient-centred care has become widely embraced but its implementation is dependent on interrelated factors. A factor that has received limited attention is the role of policy tools. In Ontario, one method government can use to promote healthcare priorities is through health regulatory colleges, which set the standard of practice for health professionals. The degree to which government policy in support of patient-centered care has influenced the direction provided by health regulatory colleges to their members, and ultimately impacted (...) actual patient care, remains unclear. This study investigates the extent to which Ontario’s health regulatory colleges have provided explicit written guidance to members related to the importance of patient-centred care. It also explores applied and theoretical explanations that may further our understanding of why patient-centred care has not been more fully embraced. Findings reveal that guidance provided by Ontario’s health regulatory colleges varies widely. Institutional barriers and the choice of policy tools for disseminating government preferences may hinder full implementation of the principles of patient-centred care. More fully understanding the role health regulatory colleges’ play in facilitating the implementation of health policy will contribute positively to dialogue and to efforts to achieve positive health system reforms. (shrink)

In October 2013, the Declaration of Helsinki was revised a seventh time in its 50 year history. While it is the most widely accepted set of ethical principles for the protection of patients participating in medical research, the Declaration of Helsinki has also been subject of constant controversy. In particular, its paragraph on the use of placebo controls in clinical trials divides the research community into active-control and placebo orthodox proponents, both continuously demanding revisions of the Declaration of Helsinki in (...) favour of their position. The goal of the present project is to compare the mainly theoretical controversy with regulatory implementation. We distributed a questionnaire to national drug regulatory authorities from different countries to collect information on the authorities’ respective approaches to interpretation and implementation of the Declarations’ placebo paragraph in the conduct of medical research. Our findings suggest that the majority of drug regulatory authorities have established a practice of a middle ground, allowing placebo controls in some instances. Various interpretations of “serious harm” and “methodological reasons” are proposed as well as safeguards to avoid abuse of the option to use placebo-controls. Leaving the placebo paragraph open to various interpretation is a result of the Declaration of Helsinki’s character as a guidance document. With the current version controversy will continue. The Declaration should be continued to be strengthened to enforce the appreciation of conducting medical research with the highest ethical standard. (shrink)

According to an infinite frequency principle, it is rational, under certain conditions, to set your credence in an outcome to the limiting frequency of that outcome if the experiment were repeated indefinitely. I argue that most infinite frequency principles are undesirable in at least one of the following ways: accepting the principle would lead you to accept bets with sure losses, the principle gives no guidance in the case of deterministic experiments like coin tosses and the (...) principle relies on a metaphysical property, ‘chanciness’, whose necessary and sufficient conditions are unknown. I show that a frequency principle that is based on the principal principle suffers from problems related to the definition of ‘chance’ or ‘chanciness’, which could lead to all three of the above problems. I introduce a version of the infinite frequency principle that does not rely on a notion of chance or chanciness and does not suffer from any of these problems. (shrink)