The world is riddled with human suffering, poverty, and destitution. In the face of this moral tragedy, the least that the global wealthy can do is try to support aid programs aimed at relieving the plight of the very poor. Many political leaders, pop stars, and religious personalities have realized this, and routinely urge us to be more sensitive to the conditions of the distant needy. Giving aid thus seems to be one of the most important moral imperatives of our (...) time. (Published: 22 June 2011) Citation: Ethics & Global Politics, Vol. 4 , No. 2, 2011, pp. 125-134. DOI: 10.3402/egp.v4i2.7220. (shrink)

Competent patients have considerable legal authority to control life‐and‐death care. They may refuse medical life support, including medically delivered food and fluids. Even when they are not in need of any life‐saving care, they may expedite death by refusing food and water by mouth—voluntarily stopping eating and drinking, or VSED. Neither right is limited to terminal illness. In addition, in four U.S. states, competent patients, if terminally ill, may obtain lethal drugs for aid‐in‐dying.For people who have dementia and are no (...) longer competent, however, control over the end of life is much less extensive. They may have written a clear advance directive for refusing life‐saving care in specified circumstances yet subsequently find themselves living for years in severe dementia with no need for life‐saving care that could be refused. Chronic progressive dementia is not itself life threatening until its very final stage. Even in jurisdictions that permit active aid‐in‐dying, individuals with advanced dementia are not eligible; they lack the required current competence, and they are seldom deemed terminally ill. As for the right to VSED, its very name—voluntarily stopping eating and drinking—is seen as excluding noncompetent persons.One option for ensuring that one does not live years in severe dementia is to use advance directives to withhold food and water by mouth. The driving element behind VSED is that forcing people to ingest food is as objectionable an intrusion on bodily integrity, privacy, and liberty as imposing unwanted medical treatment. Thus, if incompetent people do not lose their rights to refuse life‐saving treatment, and if people when competent have just as strong a right to VSED as they do to refuse life‐saving treatment, then people do not lose their right to VSED when incompetent either. They only have to exercise it by AD. (shrink)

Coercion is morally objectionable: it’s bad to be coerced and it’s wrong to coerce people. But why is coercion objectionable? In this paper, I advance an egalitarian account of what’s objectionable about coercion. The account is rooted in the idea that certain relationships, like those of master to slave and lord to peasant, are relationships of subordination or domination. These relationships are morally objectionable. Moreover, such relationships are in part constituted by asymmetries of power. A master subordinates a slave because (...) the master has more power over the slave than vice versa. The account says that coercion is objectionable because it creates such asymmetries of power, and so creates relationships of subordination. I show how this account can address its most serious problems, and how it can illuminate what’s wrong with blackmail, exploitation, withholding aid, and compulsion. (shrink)

ZusammenfassungEntscheidungen am Lebensende sind Bestandteil der ärztlichen Tätigkeit. In dieser Studie wurden Berliner Medizinstudierende zu ihren Kenntnissen der rechtlichen Grundlagen und ihrer ethischen Bewertung von passiver und aktiver Sterbehilfe befragt. Im Wintersemester 2002/2003 wurde eine schriftliche Befragung zu ethischen und rechtlichen Aspekten der Sterbehilfe unter den Teilnehmenden eines Pflichtkurses für Medizinstudierende im fünften Studienjahr an der Charité, Universitätsmedizin Berlin durchgeführt. Gruppenunterschiede im Antwortverhalten wurden mit dem χ2-Test nach Pearson geprüft. Von 102 Studierenden beantworteten 85 den Fragebogen (Rücklaufquote = 82,5%). Es (...) wussten 46 Medizinstudierende (54,1%), dass die Therapiebegrenzung am Lebensende legal sein kann; 70 (82,3%) hielten dies für ethisch akzeptabel. Die Tötung auf Verlangen in bestimmten Situationen hielten 35 Studierende (41,2%) für ethisch akzeptabel; 28 (33,0%) befürworteten die Legalisierung der Tötung auf Verlangen in bestimmten Situationen. Im Vergleich zu Ärztinnen und Ärzten in Deutschland wurde die Tötung auf Verlangen von weniger Studierenden abgelehnt. Angesichts der bestehenden Unsicherheiten bei den Studierenden hinsichtlich der rechtlichen und ethischen Bewertung von Entscheidungen am Lebensende sollten diese Aspekte in der medizinischen Ausbildung stärker berücksichtigt werden. (shrink)

Photo by Hannah Busing on Unsplash INTRODUCTION Religion has long provided guidance that has led to standards reflected in some aspects of medical practices and traditions. The recent bioethical literature addresses numerous new problems posed by advancing medical technology and demonstrates an erosion of standards rooted in religion and long widely accepted as almost axiomatic. In the deep soul-searching that pervades the publications on bioethics, several disturbing and dangerous trends neglect some basic lessons of philosophy, logic, and history. The bioethics (...) discourse on medical aid in dying emphasizes similarity over previously recognized important distinguishing features. For example, it overplays a likeness between assistance in dying and the withdrawal of life-saving technology. In many bioethics’ topics, arguments based on a logical continuum are used to question the lines demarcating important moral differences. l. The Line Between Ethical and Not: Logic Based on Continuum Careful case selection, often either end of a continuum, allows the tearing down or ridiculing of many rules and codes across most professions and fields of interest. This situation holds true for traffic laws as well as medical ethics guidelines. It is relatively simple for those who desire to attack a particular viewpoint by selecting a case that makes that position seem untenable. In the ethics realm, good and bad medicine exist at opposite ends of an ethical continuum, with many practices lying in between. For example, much of medical ethics exists between the Nazi criminal physicians and the most sainted nurse or physician. A gradual progression occurred over less than two decades from a utilitarian position that supported limited euthanasia for those with certain mental illnesses to genocide. German society embraced a utilitarian ethic in which the value of human life no longer was intrinsic but instrumental.[1] Many morally significant points on a continuum were then ignored as the misguided utilitarian policy rampantly continued. A point in the continuum to distinguish between ethically justifiable and that which is not can be difficult to identify compared to the two extremes. This continuum is not unique to ethics but can be applied to almost any other aspect of human life and endeavor. Between a severely ill schizophrenic person and a superbly well-adjusted individual, there is a continuum of mental and psychological function. The existence of a continuum should not paralyze thinking and prevent us from drawing lines and identifying moral differences based on objective criteria as well as moral philosophy. Yet, by focusing on a continuum, many bioethicists use logic to disregard dividing lines between an "ethical" and an "unethical" act. Unfortunately, sometimes bioethicists draw revolutionary conclusions that would change the scope of medical practices which is accepted as ethical. There are many examples of similar shifts on the continuum. Many authors argue for the ethical permissibility of abortion by pointing out that the human fetus is no different in various characteristics, one arguing it is as like an ape or chick as it is like a person,[2] and does not achieve unique human and individual characteristics until well into the first year of life.[3] While human fetuses arguably do not have certain distinctive qualities of personhood, most people shy away from the logical next conclusion: permitting infanticide. For example, Joshua Lederberg condemns infanticide, in the face of biological illogic, because of our emotional commitment to infants, to me, a relatively weak explanation. Sir Francis Crick suggests we might consider birth at two days of life in order to decide whether an infant is a "suitable" member of society.[4] Giublini and Minerva suggest that infanticide should be permissible since late pregnancy abortions are permissible, arguing there is no significant difference between a fetus just before birth and an infant just after birth.[5] Clearly the continuum approach would allow for subjective arguments in favor of later infanticide at other points many days post-birth. Years ago, with a cynical tone, I mentioned infanticide as a further step on the continuum beyond abortion, and I was rightly shouted down as being deliberately provocative to assert the logic would ever stretch so far. While it is not an accepted mainstream position, the movement in academic settings from widespread condemnation to limited possible acceptance of infanticide has taken place in an incredibly short time. Public opinion and medical opinion in these areas have shifted dramatically in a short time. In another area, from a biological and chemical point of view, there is a continuum from man down to a single carbon atom. Yet, it would not seem logical to ignore the emotional differences, the meaning of personhood, or the moral distinction between killing an insect and killing a person. ll. A False Continuum: Medical Aid in Dying I assert that there has been an erosion of ethical guidelines in recent years attributable to using continuums to camouflage important distinctions. James Rachels’ work on active and passive euthanasia, which contends that the two are ethically identical, exemplifies that logic.[6] He illustrates this thesis, using a continuum to compare different scenarios with like consequences as morally equivalent, by comparing the deliberate drowning of a child with a deliberate failure to rescue a drowning child when easily able to do so. The author's comparison proposes that since much of the medical profession has already made peace with withholding treatment in order to hasten death, consistency inexorably demands that we permit active euthanasia as well.[7] When permission for active euthanasia was first introduced, it was limited exclusively to patients suffering severely from an intractable, incurable, and irreversible disease. These guidelines have been continuously eroded. There is now a substantial serious consideration for permitting active euthanasia of healthy elderly individuals who feel that they have completed their lives and are "tired of living."[8] There are many moral and factual differences along the ethical continuum. In human life, there is a difference between a live baby and a fetus, between a viable fetus and one that is not, between a fetus and a zygote, and between a zygote and a sperm cell. Similarly, there is a difference between pulling a trigger to kill someone and not interfering in preventing his death, which is reprehensible though both may be. There is a difference between not resuscitating an 80-year-old man with cancer when his heart stops and injecting him with a fatal dose of potassium chloride. I argue that an overt act of taking life repels civilized human beings is to be commended and encouraged as the reverence for human life or even for just a moment of human life is one of the great contributions of our civilization. CONCLUSION As an orthodox Jew, I feel that divinely inspired guidelines that have stood the test of centuries shape my beliefs, and such guidelines contradict medical aid in dying. I cannot speak to the viewpoint of those who do not access religion in defining their moral stance, nor do I implicate them in the current bioethics' trends, as I am not aware of the personal role of religion in the lives of most such authors. While many nonreligious people have a firm philosophical grounding and oppose medical aid in dying, I suggest that in the absence of any religious or other absolute standards, developing logically defensible ethical guidelines may be challenging. At the least, religion may play a role in defining the points on the continuums that are ethically meaningful and refuting the trending beliefs that if the endpoint is the same, allowing different methods of arriving at that end are somehow ethically equal. The continuum of ways death may result does not negate analysis of whether death is brought about in ways that recognize the importance of life. The German philosopher Hans Jonas said, "It is a question whether without restoring the category of the sacred, the category most thoroughly destroyed by the scientific enlightenment, we can have an ethics able to cope with the extreme powers that we possess today and constantly increase and are compelled to use."[9] While countries vary on the role of religion in policy, with many emphasizing freedoms of religion, a recent position paper released by a group of Jewish, Christian, and Moslem leaders suggested the need for agreement on the unique sanctity of human life.[10] I would recommend that such a document serve as an example of consensus on critical foundational bioethical guidelines for democratic secular societies. - [1] Alexander L Medical science under dictatorship. New England Journal of Medicine, 241, p39-47 DOI10.1056/NEJM194907142410201 [2] Lederberg J. A geneticist looks at contraception and abortion, Annals of Internal Medicine 67, sup 2, 25-27. https:/doi.org/10.7326/0003-4819-67-3-25 [3] Ibid. [4] Editorial, Sociology: Logic of biology. Nature 220, 429 https://www.nature.com/articles/220429b0 [5] Giublini A Minerva F After-birth abortion: why should the baby live. J Med Ethics 39, 261- [6] Rachels J Active and passive euthanasia. New England Journal of Medicine 292, 78-80 [7] Ibid. [8] Cohen-Almagor R Euthanizing people who are "tired of life". in Euthanasia and Assisted Suicide-Lessons from Belgium. Ch 11 of Euthanasia and Assisted Suicide, Cambridge University Press pp173-187. 2017 and DOI; https://doi.org/10.1017/9781108182799.012 [9] Hans Jonas, Technology and Responsibility: Reflections on the New Tasks of Ethics, 1972, found as Chapter IX, Philosophical Essays, 1980. https://inters.org/jonas-technology-responsability [10] A position paper of the Abrahamic Monotheistic religions on matters concerning the end-of-life. Vatican Press 28 October 2019 https://press.vatican.va/content/salastampa/en/bollettino/pubblico/2019/10/28/191028f.html. (shrink)

An individual’s right to refuse life-sustaining treatment is a fundamental expression of patient autonomy; however, supporting this right poses ethical dilemmas for healthcare providers when the patient has attempted suicide. Emergency physicians encounter patients who have attempted suicide and are likely among the first medical providers to face the dilemma of honoring the patient’s DNR or intervening to reverse the effects of potentially fatal actions. We illustrate this issue by introducing a case example in which the DNR of a terminally (...) ill woman was not honored because the cause of her cardiac arrest was suicide. We argue that although a terminal diagnosis should change the way health care providers respond to a suicide attempt, many of the theoretical underpinnings for how one should treat suicide attempts—especially the criterion of external reasonability, that is the action to withhold or withdraw life-sustaining measures is reasonable independent of the precipitating event—are common to all situations :3–12, 2013). The presumption that patients who attempt suicide lack capacity due to acute mental illness is flawed because it fails to account for a competent individual’s reasonable preference to not be forced to live in an unbearable, terminal condition. In states without legislation allowing physician aid in dying, patients and providers must grapple with these limitations on a case-by-case basis. In cases where the patient has a limited life expectancy and there is not concern for psychiatric illness as the primary cause of the suicidal action, we argue that the negative right to refuse life-sustaining treatment should prevail. (shrink)

The article addresses issues at the nexus of physician industrial action, moral agency, and responsibility. There are situations in which we find ourselves best placed to offer aid to those who may be in vulnerable positions, a behavior that is consistent with our everyday moral intuitions. In both our interpersonal relationships and social life, we make frequent judgments about whether to praise or blame someone for their actions when we determine that they should have acted to help a vulnerable person. (...) While the average person is unlikely to confront these kinds of situations often, those in the medical professions, physicians especially, may confront these and similar situations regularly. Therefore, when physicians withhold their services for whatever reason in support of industrial action, it raises issues of moral responsibility to patients who may be in a vulnerable position. Using theories of moral responsibility, vulnerability, and ethics, this paper explores the moral implications of physician industrial action. We explore issues of vulnerability of patients, as well as the moral responsibility and moral agency of doctors to patients. Determining when a person is vulnerable, and when an individual becomes a moral agent, worthy of praise or blame for an act or non-action, is at the core of the framework. Notwithstanding the right of physicians to act in their self-interest, we argue that vulnerability leads to moral obligations, that physicians are moral agents, and the imperatives of their obligations to patients clear, even if limited by certain conditions. We suggest that both doctors and governments have a collective responsibility to prevent harm to patients and present the theoretical and practical implications of the paper. (shrink)

This article enumerates and critically examines the potential grounds on which we might treat the case of a patient with an advance directive who attempted suicide, differently from one whose injuries were the result of an accident. Grounds for differentiation are distilled into two potential justifications. The first addresses the concern that withholding or withdrawing care from a patient with self-inflicted injuries would be aiding and abetting suicide. The second examines concerns about the patient’s decisionmaking capacity. Ultimately, it is (...) argued that while there might be legitimate reasons to hold the advance directive of a suicidal patient to a different standard of scrutiny, the fact that the patient’s medical state was self-inflicted should not, in and of itself, necessarily invalidate the guidance of the directive. Finally, four practical recommendations are offered for negotiating similar cases. (shrink)

Stories told about violence, trauma, and loss inform knowledge of post-conflict societies. Stories have a context which is part of the story-teller’s life narrative. Reasons for silences are varied. This article affirms the importance of telling and listening to stories and notes the significance of silences within transitional justice’s narratives. It does this in three ways. First, it outlines a critical narrative theory of transitional justice which confirms the importance of narrative agency in telling or withholding stories. Relatedly, it (...) affirms the importance of story-telling as a way to explain differentiated gender requirements within transitional justice processes. Second, it examines gendered differences in the ways that women are silenced by shame, choose silence to retain self-respect, use silence as a strategy of survival, or an agential act. Third, it argues that compassionate listening requires gender-sensitive responses that recognize the narrator’s sense of self and needs. (shrink)

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts purposefully (...) to ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible. (shrink)

The ethical issues around decision making on behalf of infants have been illuminated by two empirical research studies carried out in Scotland. In-depth interviews with 176 medical and nursing staff and with 108 parents of babies for whom there was discussion of treatment withholding/withdrawal, generated a wealth of data on both the decision making process and the management of cases. Both staff and parents believe that parents should be involved in treatment limitation decisions on behalf of their babies. However, (...) whilst many doctors and nurses consider the ultimate responsibility too great for families to carry, the majority of parents wish to be the final arbiters. We offer explanations for the differences in perception found in the two groups. The results of these empirical studies provide both aids to ethical reflection and guidance for clinicians dealing with these vulnerable families. They demonstrate the value of empirical data in the philosophical debate. (shrink)

End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not “futile.” Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to (...) withdraw life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, “If this were not an attempted suicide, would a request to withdraw care be reasonable?” We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not ?futile.? Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to (...) withdraw life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, ?If this were not an attempted suicide, would a request to withdraw care be reasonable?? We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

In Canada, there have been a growing number of criminal HIV nondisclosure cases where public health records have been subpoenaed to aid in police investigations and/or to be presented in court as evidence against HIV-positive persons. This has led some to suggest that nurses provide explicit warnings about the limits of confidentiality in relation to crimes related to HIV nondisclosure, while others maintain that a robust account of the limits of confidentiality will undermine the nurse–client relationship and the public health (...) goals of reducing HIV/sexually transmitted infection transmission. This article engages with this issue by exploring whether and how public health nurses endeavor to control information about the limits of confidentiality at the outset of HIV posttest counseling. The data indicate variation in practices, as nurses pragmatically balance ethical and professional concerns; although some nurses intentionally withhold information about the risk of subpoena, others report talking to clients about confidentiality in ways that focus on the risk of harm associated with criminalization. The discussion argues that practice variation also illuminates medico-legal relations between health care and the criminal justice system. Data are drawn from qualitative interviews with 30 nurses working at four public health units in Ontario. (shrink)

How can Christian ethics make a significant contribution to health care ethics in today's Western, pluralistic society? Robin Gill examines the 'moral gaps' in secular accounts of health care ethics and the tensions within specifically theological accounts. He explores the healing stories in the Synoptic Gospels, identifying four core virtues present within them - compassion, care, faith and humility - that might bring greater depth to a purely secular interpretation of health care ethics. Each of these virtues is examined in (...) turn, using a range of topical issues including health care rationing, genetics, HIV/AIDS, withholding/withdrawing nutrition from PVS patients, and the empirical evidence which suggests a connection between religion and health. Professor Gill also argues that these four virtues are shared by other major religious and humanistic traditions and that, together with secular principles, they can enrich health care ethics even in a pluralistic society. (shrink)

In American legal journals over the last decade there were hundreds of pages of articles worrying over threats to justice and freedom arising from the power to withhold benefits. Government officials have tremendous discretion to offer or withhold foreign aid, ration-books, government contracts and jobs, welfare subsidies, public housing, tariff protection, academic grants, alien resident status, paroles, or exemption from conscription or combat, from arrest or prosecution or imprisonment. Right-wing economists have worried about welfare-state emphasis on administrative discretion rather than (...) the rule of law. And left-wing economists have worried about the rich man's power to intimidate the poor man by threatening to cut off his productive work. (shrink)

Rabbi Bleich is one of the world's foremost authorities on the subject of Jewish perspectives on the ethical questions which arise in the wake of modern medical technology. In these essays, which are intended for all who are concerned with these issues, Rabbi Bleich covers such questions as the care of the terminally ill, including the vexing issue of whether the family may decide to withhold information from the person who is terminally ill, artificial insemination, genetic engineering the moral status (...) of the handicapped. AIDS, and immoral medical experimentation. (shrink)

In the summer of 1941, Harald Sverdrup, the Norwegian-born Director of the Scripps Institution of Oceanography (SIO) in La Jolla, California, was denied security clearance to work on Navy-sponsored research in underwater acoustics applied to anti-submarine warfare. The clearance denial embarrassed the world renown oceanographer and Arctic explorer, who repeatedly offered his services to the U.S. government only to see scientists of far lesser reputation called upon to aid the war effort. The official story of Sverdrup's denial was the risk (...) of blackmail over relatives in occupied Norway. Declassified documents tell a different story. Although Sverdrup's integrity was defended on the highest levels of U.S. science, doubt was cast upon him by members of his own institution, who accused him of being a Nazi sympathiser. Personal distrust, rooted in scientific and intellectual disagreement, spilled over into questions about Sverdrup's loyalty and judgement. These doubts were considered sufficient grounds for withholding clearance, until Roger Revelle, a former student of Sverdrup now working within the Navy, was able to obtain a limited clearance for Sverdrup to develop techniques to forecast surf conditions during amphibious assaults. After the war, this work was credited with saving many lives, but at the time it placed Sverdrup out of the mainstream of Navy-sponsored oceanographic research. In being denied access to major areas of scientific work, Sverdrup's position as a leader of American oceanography was undermined.The loyalty case of Harald Sverdrup illustrates the emergence of an institutional apparatus through which the U.S. military began to control and shape the organisation of American science in the twentieth century. Military sponsorship of scientific research, begun during the open conflicts of World War II and continuing into the simmering tensions of the Cold War, involved explicit control by the U.S. military of who had access to critical information. This in turn meant who could do science in conjunction with the military. As the U.S. Navy became the principal sponsor of oceanography in the post-war years, clearance to do military work became to a great extent clearance to do oceanography. Choices about who could be trusted were also choices about who would do science, and what kind of science they would do. (shrink)

The Fairtrade movement is a group of businesses claiming to trade ethically. The claims are evaluated, under a range of criteria derived from the Utilitarian ethic. Firstly, if aid or charity money is diverted from the very poorest people to the quite poor, or the rich, there is an increase in death and destitution. It is shown that little of the extra paid by consumers for Fairtrade reaches farmers, sometimes none. It cannot be shown that it has a positive impact (...) on Fairtrade farmers in general, but evidence suggesting it harms others is presented. Many of the weaknesses are due to an attempt to impose political views on farmers and others. Secondly, the unfair trading criteria require that sellers do not lie about their product, nor withhold information that might alter the decisions of a substantial proportion of buyers. It is argued that the system only can exist because of the failure of the Fairtrade industry to give the facts on what happens to the money and what it can be proved it achieves. This unfair trading compromises the reputation of charities in general. Much of the trading may constitute the criminal offence of Unfair Trading in the EU. (shrink)

World War II broke out as the result of an alliance between Germany and Soviet Union with the aim to conquer and partition Poland. Having broken off the treaty of friendship and co-operation, Germany attacked the USSR in 1941, forcing the Soviet Union to change sides from that of a German ally to the ally of the anti-German coalition. In 1943, following the German discovery of the graves of Polish officers murdered by Soviet forces in Katyń, Stalin declared that the (...) crime had been committed by the German army and broke off diplomatic relations with the Polish Government-in-Exile in London which had requested that an official investigation be launched by the Red Cross committee in Geneva. Some one hundred German officers were sentenced to death for the Katyń massacre as the result of Stalin’s prosecution trials. 50 years later, the world was rocked by the discovery of a document signed by Stalin ordering the execution of Polish officers in Katyń.In a secret meeting in 1943 in Teheran, President Roosevelt and Stalin agreed on the plan to annex Poland’s eastern territories.The decision to stage an independent fight for independence during the Warsaw Uprising was justified by the inevitable approach of the Red Army, the fear of German reprisal actions for disobeying the order to participate in fortification works, the fear of a spontaneous uprising fuelled by a Soviet radio broadcast in Polish which appealed to the people of Warsaw to put up a fight against the oppressor.Stalin’s decision to withhold the Soviet offensive and ban American and British planes carrying humanitarian aid for Warsaw from landing in Soviet airports contributed to the downfall of the Uprising. The Warsaw Uprising was a cue for the civil outbreaks that followed in Slovakia, Romania, Bulgaria, Paris and Prague. The halt on the Soviet Army’s offensive, which enabled the German forces to eliminate the Polish centre of political command subordinate to the Government-in-Exile in London, limited the European territory that fell subject to Soviet supremacy. The memory of the heroic fight put up by the entire population of Warsaw deterred the Soviet Union’s ambitions to curtail Poland’s sovereignty. (shrink)

A sustained analysis of the moral permissibility of withholding or of the obligation to disclose information to an adopted child is lacking in the literature on parental duties, disclosures, and adoption. These two sets of questions raise issues that appear to fall within the parameters of the concepts of stewardship and gratitude. I propose that adoptive parents are the stewards of the information they receive concerning their child and I show how stewardship and gratitude can aid adoptive parents as (...) they negotiate the terrain of disclosure. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Basic Resources in Bioethics*Mary Carrington Coutts (bio)OrganizationsKennedy Institute of Ethics Georgetown University Washington, DC 20057 National Reference Center for Bioethics Literature 800-MED-ETHX or 202-687-3885The Hastings Center 255 Elm Road Briarcliff Manor, NY 10510 914-762-8500Society for Health and Human Values 6728 Old McLean Village Drive McLean, VA 22101 703-556-9222NOTE: There are numerous organizations in the United States and abroad that deal with bioethical issues. For a more comprehensive listing of (...) those organizations, see:American Hospital Association. Directory of Biomedical Ethics Organizations. Chicago: American Hospital Association, 1989.National Reference Center for Bioethics Literature. International Directory of Bioethics Organizations edited by Robert Iosco. Washington, DC: Georgetown University, 1986.Encyclopedia and DictionaryDictionary of Medical Ethics. Edited by A.S. Duncan, G.R. Dunstan, and R.B. Welborn. New rev. ed. New York: Crossroad, 1981. [End Page 75]Encyclopedia of Bioethics. Edited by Warren T. Reich. 4 vols. New York: Macmillan-Free Press, 1978; or 1982 reprint in 2 volumes available to members of the Kennedy Institute of Ethics through the membership office, 202-687-8099.Online DatabaseBioethicsline. Produced by the Kennedy Institute of Ethics for the National Library of Medicine. Searchable through the MEDLARS system. Focuses on questions of ethics and public policy in the fields of health care and biomedical research. Searches available upon request to the National Reference Center for Bioethics Literature. For information on securing a personal access code from the National Library of Medicine, call 800-638-8480.BibliographiesBibliography of Bioethics. Edited by LeRoy Walters and Tamar Joy Kahn. Washington, DC: Kennedy Institute of Ethics, Georgetown University. Issued annually since 1975. Corresponds to the BIOETHICSLINE database. Provides references to resources on ethical and public policy issues in medicine and biomedical research. Includes abstracts; arranged by broad subject categories.Ethics in Nursing. Edited by Terry Pence. 2nd ed. New York: National League for Nursing, 1986. An annotated bibliography of nursing ethics. Includes author and subject indexes.Goldstein, Doris M. Bioethics: A Guide to Information Sources. Detroit: Gale Research, 1982. A selected, annotated bibliography to the literature of bioethics.The Hastings Center's Bibliography of Ethics, Biomedicine and Professional Responsibility. Compiled by the staff of the Hastings Center. Frederick, MD: University Publications of America, 1984.Medical Ethics: An Annotated Bibliography. Edited by Mark Siegler, Peter A. Singer and David L. Schiedermayer. Philadelphia: American College of Physicians, 1988.Current Awareness ServicesNOTE: Several journals have sections where they highlight new publications. See, for example, the "In The Literature" section of the Hastings Center Report, or the "Medicolegal Reference Shelf" section of Law, Medicine and Health Care. Other services include:BioLaw. Edited by James F. Childress and Ruth D. Gaare. Frederick, MD: [End Page 76] University Publications of America, 1983 to present. Annual with bimonthly updates. (Previous title: Bioethics Reporter.) A compendium of articles and legal documents on ethical and legal issues in medicine, health care administration and human experimentation. Includes the text of important legal decisions in the Resources section.New Titles in Bioethics. Edited by Luanda Fitch Huttlinger. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. Published monthly 1975-1989; quarterly 1990—present. List of acquisitions by the National Reference Center for Bioethics Literature. Organized by subject categories. Includes ordering information for difficult-to-find items. Annual cumulation available.Scope Notes Series. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. A series of issue briefs including annotated bibliographies on the following popular bioethical topics:No 1. Dangerousness, September 1982, 5 p.No 2. Living Wills and Durable Powers of Attorney: Advance Directive Legislation and Issues, Revised February 1990, 15 p.No 3. Ethics Committees in Hospitals, Revised June 1989, 12 p.No 4. Diagnosis Related Groups and the Prospective Payment System, June 1984, 11 p.No 5. Baby Fae, January 1985, 19 p.No 6. Surrogate Mothers, Revised January 1988, 12 p.No 7. Withholding or Withdrawing Nutrition or Hydration, Revised September 1988, 12 p.No 8. AIDS: Law, Ethics and Public Policy, April 1988, 12 p.No 9. Bioethics Audiovisuals 1982 to Present, September 1988, 12 p.No 10. Ethical Issues in... (shrink)

En este artículo exploramos desde la literatura, por medio de Suenan timbres de Luis Vidales, la dinámica de las nacientes urbes colombianas que inician un proceso acelerado de modernización, carente de un desarrollo adecuado del pensamiento moderno, a la par con los nuevos avances materiales, lo que imposibilita debatir la pertinencia y el proceso de este tipo de transformaciones. Circunstancia que lleva a Colombia a experimentar los idiotismos de la modernización sin modernidad, impidiéndoles a los hombres entender las necesidades y (...) conflictos que genera el progreso. Estas aldeas de principios del siglo XX se convierten rápidamente en proyectos de ciudades determinadas por la aparición de nuevos objetos, creando una atmósfera móvil y ruidosa por oposición a la pasividad de las aldeas, realidad que nos recrea Vidales desde una poética comprometida con los cambios sociales y políticos como poeta de la crítica en Colombia. In this paper, from the literature of Luis Vidales’s Suenan timbres, we explore the dynamics of Colombian rising cities that initiate an accelerated modernization process, deprived of an appropriate development of modern thinking, along with the new material advances, which makes it impossible to debate the relevance and the process followed by these types of transformations. This situation leads Colombia to experience the idiotism of modernization without modernity, impeding men to understand the needs and conflicts generated by progress. These villages from twentieth century beginnings quickly turn into city projects determined by the arrival of new objects, creating a mobile and noisy atmosphere, opposed to villages’ passivity. From poetics committed to social and political change, Vidales recreates reality as a poet of criticism in Colombia. (shrink)

Macroergonomic compatibility refers to the extent to which macroergonomic factors and elements interact positively with humans. It is one of the most complex constructs to measure in work systems and in ergonomics. The goal of this paper is to determine the levels of MC in a manufacturing system. As methods, we use the macroergonomic compatibility index and the Macroergonomic Compatibility Questionnaire. The MCQ was administered in its three versions to collect data about the macroergonomic practices implemented in the manufacturing company. (...) Regarding results, all the macroergonomic factors and most of the macroergonomic elements showed a low level of MC; that is, MCI < 0.7. Only macroergonomic elements Education, Knowledge, and Skills reached a medium level; namely, MCI = 0.709. The factor with the highest level of MC was the Person factor. Similarly, the whole manufacturing system showed a low level of MC. In conclusion, the studied manufacturing company requires urgent macroergonomic interventions. Also, we found that the MCI can effectively measure the level of MC of MFEs and can guide the implementation of macroergonomic practices and explain the MC construct. (shrink)

The previous decade has seen renewed critical interest in the multiple realization argument. These criticisms constitute a "second wave" of challenges to this central argument in late-20th century philosophy of mind. Unlike the first wave, which challenged the premise that multiple realization is inconsistent with reduction or type identity, this second wave challenges the truth of the multiple realization premise itself. Since psychoneural reductionism was prominent among the explicit targets of the multiple realization argument, one might think that this second (...) wave of challenges provides important aid and comfort to reductionists. In this paper, however, I provide reasons for thinking it does not. This is not to the detriment of psychoneural reductionism because, as I also argue here, and unrecognized by the current non-reductive orthodoxy in philosophy of mind, one key argument among the first wave of criticisms of the multiple realization argument has never been adequately rejoined. (shrink)

Burnout syndrome and obesity are two growing conditions that affect employees’ health and company productivity. Recently, several studies have pointed to a possible relationship between both phenomena. However, such a relationship has not been clearly defined. This research analyzes the relationship between BS dimensions and body mass index, the latter being treated as a moderator variable among obese senior and middle managers in the Mexican maquiladora industry through a structural equation model. A total of 361 senior and middle managers completed (...) both the Maslach Burnout Inventory-General Survey [with emotional exhaustion, cynicism, and professional efficacy as subscale dimensions] and a sociodemographic questionnaire. The results showed a statistically significant relationship between EE and PE, with BMI acting as a moderator variable. The results showed that when BMI increases as a moderator variable, the strength of the relationship between EE and PE also changes. For example, although PE had a negative value of 0.14 before the moderator effect, the value increased up to 0.32 when the BMI was factored into the relationship. Therefore, maquiladora industries are being advised to increase their investments on the identification and prevention of employees’ EE and obesity. Such interventions would promote a better quality of life and could prevent economic losses resulting from poor employee performance. (shrink)

Objective: Little empirical evidence exists to support either side of the ongoing debate over whether legalising physician aid in dying would undermine patient trust.Design: A random national sample of 1117 US adults were asked about their level of agreement with a statement that they would trust their doctor less if “euthanasia were legal [and] doctors were allowed to help patients die”.Results: There was disagreement by 58% of the participants, and agreement by only 20% that legalising euthanasia would cause them to (...) trust their personal physician less. The remainder were neutral. These attitudes were the same in men and women, but older people and black people had more agreement that euthanasia would lower trust. However, overall, only 27% of elderly people and 32% of black people thought that physician aid in dying would lower trust. These views differed with physical and mental health, and also with education and income, with those having more of these attributes tending to view physician aid in dying somewhat more favourably. Again, however, overall views in most of these subgroups were positive. Views about the effect of physician aid in dying on trust were significantly correlated with participants’ underlying trust in their physicians and their satisfaction with care. In a multivariate regression model, trust, satisfaction, age, and white/black race remained independently significant.Conclusion: Despite the widespread concern that legalising physician aid in dying would seriously threaten or undermine trust in physicians, the weight of the evidence in the USA is to the contrary, although views vary significantly. (shrink)

Adoption of the Millennium Development Goals triggered much discussion among donor states, multilateral institutions, and developing countries towards changing dysfunctional patterns of interaction that seemed to put the MDGs at risk from their inception. Initially in these high-level discussions, accountability was understood in a state-centric way, primarily as accountability to donors. This needed to be modified with the shift towards developing-country ownership of development strategies and programs. Yet an even greater change was in store when civil society organizations were included (...) in the discussions, since their focus was on accountability to project-affected persons and communities. Hence a new and irreducible conception of accountability came on stage. I characterize this as accountability to the subjects of development and show how it is required and justified by development ethics, based on values of agency and justifiability. This results in a dual standard for accountability: reducing stakeholders’ vulnerability to harmful and inequitable outcomes, and ensuring the justifiability of development projects to affected persons and communities. (shrink)

This paper examines how people think about aiding others in a way that can inform both theory and practice. It uses data gathered from Kiva, an online, non-profit organization that allows individuals to aid other individuals around the world, to isolate intuitions that people find broadly compelling. The central result of the paper is that people seem to give more priority to aiding those in greater need, at least below some threshold. That is, the data strongly suggest incorporating both a (...) threshold and a prioritarian principle into the analysis of what principles for aid distribution people accept. This conclusion should be of broad interest to aid practitioners and policy makers. It may also provide important information for political philosophers interested in building, justifying, and criticizing theories about meeting needs using empirical evidence. (shrink)

This paper uses the concept of epistemic injustice to shed light on the discriminatory treatment of experts in and by development aid. While the literature on epistemic justice is largely based on...

Peter Singer’s defense of the duty to aid the world’s poor by the pond analogy is self-defeating. It cannot be both true that you ought to save the drowning child from a pond at the expense of ruining your shoes and that you ought to aid the world’s poor if you thereby do not sacrifice anything of comparable moral importance. Taking the latter principle seriously would lead you to let the child in front of you drown whenever you could thereby (...) save more children in the developing world. Though Singer can defend the duty to aid the world’s poor starting from consequentialist principles requiring you to make things go best in the impartial sense, he cannot have it invoking the commonsense judgment about what you ought to do in the pond case. There is no sound path from commonsense morality to Singer’s principles of beneficence. (shrink)

This article challenges an argument from Tom Donaldson''s recent bookThe Ethics of International Business with a claim that distributive justice, deemed in many circles to impose a duty of mutual aid on individuals and nations, establishes a basis for holding multinational corporations to such a duty as well. The root idea I advocate is that Rawls'' theory of justice can be deployed — beyond its original intent yet in line with its spirit — to underwrite aprima facie obligation of international (...) business to render aid to ameliorate suffering on behalf of the inhabitants of developing countries in which they operate. (shrink)

Critiques of development aid from its recipient’s sometimes draw our attention to the perception of paternalism on the part of ‘development industry’ actors. Even within participatory project designs, critical voices recount experiences of clear power divides and informal hierarchies determining the content and form of ‘cooperation’. While neoliberal as well as neo-Marxist scholars base their critiques on a distributive scheme of global justice, post-development theory emphasizes respect and recognition as the central aspect of justice Indeed, post-development theorists continue to complain (...) of neo-colonial power structures between nations as well as on a micro-level between the ‘experts’ and local people. The latter feel misrecognized in being judged according to the parameters of Western actors within the international community. This article explores how charges of misrecognition within development cooperation challenge the assumption by many liberal political theorists that more global justice could be achieved through more aid. (shrink)

Agricultural decision making is characterized by two challenges common to multiple arenas: linking science to decision making and linking science and decision making across multiple levels. The U.S. agricultural research, education, and extension system was designed to address these challenges. By investigating this system, this study deepens the understanding of science and decision making, specifically exploring the notion of boundary organizations in two significant ways. First, it provides a preliminary test of the hypothesis that boundary organizations mediate between the shifting (...) domains of science and policy, finding that they are instrumental in creating and maintaining an integrated system of assessment and decision making for addressing depletion of the High Plains Aquifer. Second, it extends the concept of boundary organization beyond the science-policy dimension to incorporate the dimension of levels of organization—not only bridging science and policy but linking science and policy across different levels. (shrink)

It may seem that epistemic and practical rationality weigh reasons differently, because ties in practical rationality tend to generate permissions and ties in epistemic rationality tend to generate a requirement to withhold judgment. I argue that epistemic and practical rationality weigh reasons in the same way, but they have different "default biases". Practical rationality is biased toward every option being permissible whereas epistemic rationality is biased toward withholding judgment's being required.

In this paper I try to defend three claims: first, that there is a requirement to aid and a correlative right to be aided; second, that the conditions under which this right applies can be precisely stated and given a convincing contractualist rationale; and third, that the existence of this right has no relevance for the justifiability of social welfare programs.

In this paper I try to defend three claims: first, that there is a requirement to aid and a correlative right to be aided; second, that the conditions under which this right applies can be precisely stated and given a convincing contractualist rationale; and third, that the existence of this right has no relevance for the justifiability of social welfare programs.

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the (...) ethical analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment. (shrink)

Several authors have recently endorsed the thesis that there is what has been called pragmatic encroachment on knowledge—in other words, that two people who are in the same situation with respect to truth-related factors may differ in whether they know something, due to a difference in their practical circumstances. This paper aims not to defend this thesis, but to explore how it could be true. What I aim to do, is to show how practical factors could play a role in (...) defeating knowledge by defeating epistemic rationality—the very kind of rationality that is entailed by knowledge, and in which Pascalian considerations do not play any role—even though epistemic rationality consists in having adequate evidence. (shrink)

'The ethical landscape', the title given to part of a course devised by Mr. Moore, is described in full in this paper. The whole course is a new adventure in medical education designed to help students to explore the ethical problems in the practice of medicine. The 'ethical landscape' is seen through discussion based on passages from literature depicting doctors' and patients' dilemmas. As the results summarized in the tables show, the students found the course well worth while, and thought (...) that they had gained a new insight into the problems with which they would be confronted and also into their own personalities and those of their fellow students whom previously they had only known superficially. The Chairman of the course, Mr. Moore, was also subjected to assessment from his students, because on the skill of the Chairman such a course would fail or succeed. (shrink)