In late 2021, tennis star Chris Evert learned new genetic information about her sister, who died from ovarian cancer in January 2020. As Evert has explained in posts published by ESPN, her sister had a variant in the BRCA1 gene that was reclassified—upgraded—from a variant of uncertain significance (VUS) to pathogenic. Hearing about the variant’s reclassification likely saved Evert’s life. After getting genetic testing that showed she also carried the variant, Evert underwent prophylactic surgery. Clinical testing associated with the procedure (...) revealed she already had stage 1c ovarian cancer. The Wall Street Journal reported on a different variant reclassification story in 2019. Seven female relatives had prophylactic surgeries after cascade genetic testing indicated they each carried the same pathogenic variant in BRCA2. However, there was significant distress and confusion when one of the women received notice that the variant had been downgraded from pathogenic to a VUS. As these cases illustrate, reclassification of the clinical significance of genetic variants—which ranges from pathogenic, likely pathogenic, uncertain, likely benign and benign—can have profound impacts on individuals and families. Although genetic testing often provides valuable information, many identified variants are of uncertain significance, even in genes associated with disease. Many of these VUS will be reclassified as genomic data …. (shrink)

This chapter focuses on the question of who has duties regarding poverty and what those duties demand, from within the perspective of contemporary analytic normative philosophy. The chapter is structured in three sections. Section 1 considers the duties of those living in poverty, which might be either self-regarding or other-regarding duties, and which must be tempered by concerns of overdemandingness. Section 2 considers the duties of affluent individuals. These are imperfect duties grounded in affluent (...) individuals’ relations to the structures that produce poverty: relations of contribution, benefit, and ability to change. Section 3 considers duties of collective agents – including states, for-profits, charities, and civil society groups. The poverty-related duties of these collective agents are sometimes perfect and sometimes imperfect, and include both primary and secondary duties, and both positive and negative duties. (shrink)

Background: The coronavirus disease 2019 pandemic is impacting the delivery of healthcare worldwide, creating dilemmas related to the duty to care. Although understanding the ethical dilemmas about the duty to care among nurses is necessary to allow effective preparation, few studies have explored these concerns. Aim: This study aimed to identify the ethical dilemmas among clinical nurses in Spain and Chile. It primarily aimed to (1) identify nurses’ agreement with the duty to care despite high risks for themselves and/or their (...) families, (2) describe nurses’ well-being and (3) describe the associations between well-being and the duty to care. Research design: Cross-sectional self-reported anonymous data were collected between May and June 2020 via electronic survey distribution (snowball sampling). Ethical considerations: The Institutional Ethical Review Committees in both countries approved the study (CHUC_2020_33 and 27/2020). Findings: In total, 345 clinical nurses answered the primary question about the duty to care for the sick. Although in the total sample 77.4% agreed they have a duty to care for the sick, significant differences were found between the Spanish and Chilean samples. Overall, 53.6% of the nurses reported low levels of well-being; however, among those reporting low well-being, statistically significant differences were found between Spanish and Chilean nurses as 19.4% and 37.8%, respectively, disagreed with the statement regarding the duty to care. Discussion: Participants in both countries reported several ethical dilemmas, safety fears, consequent stress and low well-being. These results suggest that prompt actions are required to address nurses’ ethical concerns, as they might affect their willingness to work and psychological well-being. Conclusion: Our findings shed light on the ethical dilemmas nurses are facing related to the duty to care. Not only has the coronavirus disease 2019 pandemic given rise to ethical challenges, but it has also affected nurses’ well-being and willingness to work during a pandemic. (shrink)

_Kant, Duty and Moral Worth _is a fascinating and original examination of Kant's account of moral worth. The complex debate at the heart of Kant's philosophy is over whether Kant said moral actions have worth only if they are carried out from duty, or whether actions carried out from mixed motives can be good. Philip Stratton-Lake offers a unique account of acting from duty, which utilizes the distinction between primary and secondary motives. He maintains that the moral law should (...) not be understood as a normative moral reason but as playing a transcendental role. Thus a Kantian account of moral worth is one where the virtuous agent may be responsive to concrete particular considerations, whilst preserving an essential role for universal moral principles. _Kant, Duty and Moral Worth _is a lucid examination of Kant's moral thought that will appeal to Kant scholars and anyone interested in moral theory. (shrink)

Background Escalating levels of obesity place enormous and growing demands on Health care provision in the (U.K.) United Kingdom. Resources are limited with increasing and competing demands upon them. Ethical considerations underpin clinical decision making generally, but there is limited evidence regarding the relationship between these variables particularly in terms of treating individuals with obesity. Research aim To investigate the views of National Health Service (NHS) clinicians on navigating the ethical challenges and decision making associated with obesity management in adults (...) with chronic illness. Research design A cross-sectional, multi-site survey distributed electronically. Participants A consensus sample of nurses, doctors, dietitians and final year students in two NHS Trusts and two Universities. Ethical considerations Ethical and governance approvals obtained from a National Ethics Committee (11NIR035), two universities and two teaching hospitals. Results Of the total ( n = 395) participants, the majority were nurses (48%), female (79%) and qualified clinicians (59%). Participants strongly considered the individual to have primary responsibility for a healthy weight and an obligation to attempt to maintain that healthy weight if they wish to access NHS care. Yet two thirds would not withhold treatment for patients with obesity. Discussion While clinicians were clear about patient responsibility and obligations, the majority prioritised their duty of care and would not invoke a utilitarian approach to decision making. This may reflect awareness of obesity as a multi-faceted entity, with responsibility for support and management shared amongst society in general. Conclusions The attitudes of this sample of clinicians complemented the concept of the health service as being built on a principle of community, with each treated according to their need. However limited resources challenge the concept of needs-based decisions consequently societal engagement is necessary to agree a pragmatic way forward. (shrink)

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see more patients per (...) unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so. (shrink)

This article examines the actions and testimonies of 14 nurses who killed psychiatric patients at the state hospital of Meseritz-Obrawalde in the Nazi 'euthanasia' program. The nurses provided various reasons for their decisions to participate in the killings. An ethical analysis of the testimonies demonstrates that a belief in the relief of suffering, the notion that the patients would 'benefit' from death, their selection by physicians for the 'treatment' of 'euthanasia', and a perceived duty to obey unquestioningly the orders of (...) physicians were the primary ethical reasons that were stated for their behavior. However, 20 years had elapsed between the killings and the trial, thus giving ample opportunity for the defendants to develop comfortable rationales for their actions and for their attorneys to have observed successful defenses of others accused of euthanasia. (shrink)

Background: Nurses must balance their perceived duty to care against their perceived risk of harm to determine their willingness to report during disaster events, potentially creating an ethical dilemma and impacting patient care. Research aim: The purpose of this study was to investigate nurses’ perceived duty to care and whether there were differences in willingness to respond during disaster events based on perceived levels of duty to care. Research design: A cross-sectional survey research design was used in this study. Participants (...) and research context: Using a convenience sample with a snowball technique, data were collected from 289 nurses throughout the United States in 2017. Participants were recruited through host university websites, Facebook, and an American Nurses Association discussion board. Ethical considerations: Institutional review board approval was obtained from the University of Texas at Tyler and the University of Arkansas. Findings: Analysis of willingness to report to work based on levels of perceived duty to care resulted in the emergence of two groups: “lower level of perceived duty to care group” and “higher level of perceived duty to care group.” The most discriminating characteristics differentiating the groups included fear of abandonment by co-workers, reporting because it is morally the right thing to, and because of imperatives within the Nursing Code of Ethics. Discussion: The number of nurses in the lower level of perceived duty to care group causes concern. It is important for nursing management to develop strategies to advance nurses’ safety, minimize nurses’ risk, and promote nurses’ knowledge to confidently work during disaster situations. Conclusion: Level of perceived duty to care affects nurses’ willingness to report to work during disasters. Primary indicators of low perceived duty to care are amenable to actionable strategies, potentially increasing nurses’ perceived duty to provide care and willingness to report to work during disasters. (shrink)

In Group Duties, Stephanie Collins proposes a ‘tripartite’ social ontology of groups as obligation-bearers. Producing a unified theory of group obligations that reflects our messy social reality is challenging and this ‘three-sizes-fit-all’ approach promises clarity but does not always keep that promise. I suggest considering the epistemic level as primary in determining collective obligations, allowing for more fluidity than the proposed tripartite ontology of collectives, coalitions and combinations.

We investigate under what conditions contrary-to-duty (CTD) structures lacking temporal and action elements can be given a coherent reading. We argue, contrary to some recent proposals, that CTD is not an instance of defeasible reasoning, and that methods of nonmonotonic logics are inadequate since they are unable to distinguish between defeasibility and violation of primary obligations. We propose a semantic framework based on the idea that primary and CTD obligations are obligations of different kinds: a CTD obligation pertains (...) to, or pre-supposes, a certain context in which a primary obligation is already violated. This framework is presented initially as an extension of Standard Deontic Logic (SDL), a normal modal logic of type KD, and is illustrated by application to a series of examples. The concluding section is concerned with some resemblances between CTD and defeasible reasoning. We show first that the SDL-based framework contains a flaw and must be adjusted. A discussion of possible adjustments, including an alternative treatment in terms of a preference-based semantics, reveals difficulties that are reminiscent of problems in defeasible reasoning and intensional accounts of defeasible conditionals. (shrink)

A primary fiduciary bond, rarely examined, is that of neighbor. I distinguish this bond from others that may overlap it, those of fellow citizen or compatriot. I argue that the nature of moral identity and the nature of moral formation require moral agents to acknowledge the fiduciary duties of neighbor.

Private law is generally formulated in terms of rightduty relation at all but on a or liability” relation. A primary-liability claim is not a claim arising from the breach of a strict-liability duty. The recognition of primary-liability claims does not involve skepticism about duties or rules or legal relations and it is consistent with the analysis of private law in terms of corrective justice.

Background: Notwithstanding near-universal agreement on the theoretical importance of truthfulness, empirical research has documented gaps between ethical norms and physician behaviors. Although prior research has explored situations in which physicians may not be truthful with patients, it has focused on contexts within specialty practice. In this article, we report on a qualitative study of truthfulness in primary care. Methods: We conducted a qualitative study during December 2014–March 2015 involving both focus groups and in-depth, semistructured interviews with 32 primary (...) care physicians from the Boston, MA, and Baltimore, MD, metro areas in three specialties: internal medicine, family practice, and pediatrics. Interviews and focus groups were led using a semistructured guide, which explored situations in which primary care physicians find it difficult to be honest with patients; factors shaping truthfulness; and rationales for truthful and untruthful communication. Results: While physicians described outright lying to patients as rare, other deviations from truthfulness were not uncommon, including slanting and deliberately withholding information. Physicians described a range of factors as influencing truthfulness, from patient-level characteristics such as educational background to societal considerations including avoiding unnecessary tests and procedures. Physicians described truthfulness as an ethical requirement, deviations from which required further justification. Perceived justifications included promoting patient well-being and avoiding harm. Conclusions: Our results suggest a potential need to augment opportunities for training in “everyday ethics” challenges, such as the appropriateness of deception in response to patient requests for inappropriate tests or pain medications. Furthermore, they indicate that, in various circumstances encountered in primary care, physicians perceive other moral duties as potentially in conflict with the duty of truthfulness. Further ethical analysis should focus on identifying when deviations from complete truthfulness do and do not serve patients' interests, to guide physicians in striking a reasonable balance among principles of medical ethics that may conflict with one another. (shrink)

Many follow Kant in thinking that morally worthy actions must be carried out solely from the motive of duty. This outlook faces two challenges: (1) The One Feeling Too Few problem (actions that issue from, say, compassion also seem to have moral worth), and (2) The One Thought Too Many problem (some actions have moral worth precisely because they’re not motivated by duty). These challenges haven’t led Kantians to dispense with the motive of duty. Instead, they have proposed to push (...) it into the background. We should not (the thought goes) construe duty as a primary motive, a consideration that motivates the agent to act. Duty is best thought of as a secondary motive, a background concern that constrains her choice. Since it is consistent with acting from duty at the secondary level that one is motivated at the primary level by compassion, this move is thought to overcome both challenges. In this paper, I argue that secondary motive views don’t live up to their stated ambitions. Such proposals either fail to make progress on issues with which primary motive views continue to grapple, or they render the motive of duty ill-suited to underwrite a plausible account of moral worth. (shrink)

This chapter examines the issue of who has the duty to love a child, supposing that there is a right to be loved. It makes the striking claim that everyone has this duty, even when the biological parents are available. It explains that everyone’s having this duty does not mean that everyone has to do the same thing, and that biological parents should be given the status of primary dutybearers while others have associate duties to assist the (...) class='Hi'>primary dutybearers in carrying out this duty. This chapter also considers how demanding the duty to love a child should be and it argues that while there are limits as to how much we are required to sacrifice to fulfill this duty, we may be required to sacrifice more than what common sense morality supposes. (shrink)

Barbara Herman offers an interpretation of Kant's Groundwork on which an action has moral worth if the primary motive for the action is the motive of duty. She offers this approach in place of Richard Henson's sufficiency-based interpretation, according to which an action has moral worth when the motive of duty is sufficient by itself to generate the action. Noa Latham criticizes Herman's account and argues that we cannot make sense of the position that an agent can hold multiple (...) motives for action and yet be motivated by only one of them, concluding that we must accept a face-value interpretation of the Groundwork where morally worthy actions obtain only when the agent's sole motive is the motive of duty. This paper has two goals, one broad and one more constrained. The broader objective is to argue that interpretations of moral worth, as it is presented in the Groundwork, depend on interpretations of Kant's theory of freedom. I show that whether we can make sense of the inclusion of nonmoral motives in morally worthy actions depends on whether the 'always causal framework' is consistent with Kant's theory of freedom. The narrow goal is to show that if we adopt an 'always causal' framework for moral motivation, then Herman's position and her critique of the sufficiency-based approach fail. Furthermore, within this framework I will specify a criterion for judging whether an action is determined by the motive of duty, even in the presence of nonmoral motives. Thus, I argue Latham's conclusion that we must accept a face-value interpretation is incorrect. (shrink)

Healthcare is increasingly impacted by chronic short staffing of nurses, which causes and is caused by increased nurse burnout and decreased retention. Nurses’ unions seek to address these problems by proposing safer nurse-to-patient ratios, retention bonuses for working through the COVID-19 pandemic, Personal Protective Equipment (PPE) stockpiles, sabbatical leaves, measures aimed at reducing workplace violence, and maintaining or increasing wages and benefits to keep nurses at the bedside. Chronic short staffing and burnout directly affect the quality and availability of patient (...) care—as the International Council of Nurses has pointed out, there is no healthcare without healthcare workers. This article draws on Neiman’s argument that the US healthcare system is best understood as a system of competing interests aimed at fulfilling the community’s obligation to provide access to quality healthcare. Nurses’ unions use contract negotiations, legislative advocacy, and strikes to pressure other members of the healthcare community to address chronic short staffing, burnout, and retention. Nurses’ unions in the US thus play a unique role in the system of competing interest as an organized group whose primary interest aligns with the community’s obligation to provide access to quality healthcare. This article argues that nurses’ professional duty to care for patients includes a duty to support nurses’ unions as an important way to address the factors outside of nurses’ direct practice that impacts the quality and accessibility of the care that nurses provide to patients. This duty to support unions applies to unionized and non-unionized nurses in the US, and includes duties to participate in union activities, to not cross picket lines, and to avoid work for strikebreaking nurse agencies. (shrink)

Richard Henson attempts to take the sting out of this view of Kant on moral worth by arguing (i) that attending to the phenomenon of the overdetermination of actions leads one to see that Kant might have had two distinct views of moral worth, only one of which requires the absence of cooperating inclinations, and (ii) that when Kant insists that there is moral worth only when an action is done from the motive of duty alone, he need not also (...) hold that such a state of affairs is morally better, all things considered, than one where supporting inclination is present. Henson's proposals seem to me both serious and plausible. I do not think that either of his models, in the end, can take on the role Kant assigns to moral worth in the argument of the Groundwork. But seeing the ways Henson's account diverges from Kant's makes clearer what Kant intended in his discussion of those actions he credits with moral worth. [...] An action has moral worth if it is required by duty and has as its primary motive the motive of duty. The motive of duty need not reflect the only interest the agent has in the action (or its effect); it must, however, be the interest that determines the agent's acting as he did. (shrink)

The view that agents are not obliged to do more than their initial fair shares when their fellow duty bearers fail to comply has prominent defenders, including Liam Murphy and David Miller. While Murphy thinks that asking agents to take up other agents’ slack would be unfair, Miller claims that slack-taking cannot be required because primary responsibility does not migrate from noncompliers to compliers. This paper argues, by contrast, that there are a number of circumstances in which there is (...) a duty to take up the slack even though it is unfair and even though responsibility stays where it is. The central claim is that what agents owe to third parties is a separate issue from how they relate to fellow duty bearers. This proposal also runs counter to familiar defenses of slack-taking that weigh its unfairness against the moral importance of the interests at stake for third parties. (shrink)

A contrary-to-duty obligation is an obligation that tells us what ought to be the case if something that is wrong or forbidden is true. Alternatively, we might say that a contrary-to-duty obligation is a conditional obligation where the condition is fulfilled only if a primary obligation is violated. Consider this example: “If you have hurt her feelings, you should make amends.” Since contrary-to-duty obligations play an important role in our moral and legal thinking, we want to find a good (...) analysis of this concept. However, it has turned out to be difficult to formalize various contrary-to-duty obligations. This is illustrated by the so-called contrary-to-duty paradox. This paradox is generated when we try to symbolize various scenarios that include at least one contrary-to-duty obligation in many formal deontic systems, such as Standard Deontic Logic. Such symbolizations are often inconsistent or entail some other problematic consequences. This entry is a brief introduction to this problem. (shrink)

There exists a serious shortage of organs for transplantation in China, more so than in most Western countries. Confucianism has been commonly used as the cultural and ethical reason to explain the reluctance of Chinese and other East-Asian people to donate organs for medical purposes. It is asserted that the Confucian emphasis on xiao (filial piety) requires individuals to ensure body intactness at death. However, based on the original texts of classical Confucianism and other primary materials, we refute this (...) popular view. We base our position on the related Confucian norms of filial piety and ren (humaneness, humanity or benevolence), the tension between differentiated love and universal love, and belief in the goodness of human nature. In light of this, we argue that the Confucian ethical outlook actually calls for organ donation at an individual level, and supports an opt-out (presumed consent) system at the level of social policy. Furthermore, because the popular view is based on a number of dominant but misleading modes of thinking about cultural differences, our revisionist account of Confucian moral duties regarding organ donation has implications for developing a more adequate transcultural and global bioethics. These will be discussed and expanded upon. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so the (...) steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

Philosophers who, in the light of these attacks, have attempted to vindicate the motive of duty have done so in a half-hearted way, by stressing the motive of duty’s function as a secondary or limiting motivation, or by denying “that acting from duty primarily concerns isolated actions.” I will defend duty as a primary motive with respect to isolated actions. Critics of acting from duty and philosophers who have attempted to respond to them have done little work spelling out (...) exactly what it is for an agent to act from duty. To act explicitly on moral principle is to act from a type of concern for persons that is no less morally good than concern expressed in direct emotional responses. Concern mediated by moral principles is, in certain ways, morally superior to that expressed in direct emotional responses, even when the object of concern is an intimate such as a friend or loved one. (shrink)

I aspire to answer two questions regarding the concept of a corrective duty. The first concerns what it means to wrong others, thus triggering a demand for corrections (the ground question). The second relates to the proper content of corrective duties. I first illustrate how three prominent accounts of corrective duties—the Aristotelian model of correlativity, the Kantian idea that wronging corresponds to the violation of others’ right to freedom, and the more recent continuity view—have failed to answer the (...) two questions satisfactorily. I then introduce my proposal, which holds that we wrong others when we fail to treat their status as moral agents as a source of stringent constraints on our action. I call it the moral neglect account. Once we have identified a common aim of corrective duties (counterbalancing moral neglect), we can fill their content in the various contexts in which wronging has occurred. I conclude by observing that it is not the primary role of corrective justice to assign responsibilities for damage reparations; in fact, requests for compensation make more sense if framed in distributive rather than corrective terms. (shrink)

This paper explores ethical concerns arising in healthcare integration. We argue that integration is necessary imperative for meeting contemporary and future healthcare challenges, a far stronger evidence base for the conditions of its effectiveness is required. In particular, given the increasing emphasis at the policy level for the entire healthcare infrastructure to become better integrated, our analysis of the ethical challenges that follow from the logic of integration itself is timely and important and has hitherto received insufficient attention. We evaluated (...) an educational intervention which aims to improve child health outcomes by making transitions between primary to secondary care more efficient, ensuring children and parents are better supported throughout. The programme provided skills for trainee paediatricians and general practitioners (GPs) in co-designing integrated clinical services. The key ethical challenges of integrated care that arose from a clinical perspective are: professional identity and autonomy in an integrated working environment; the concomitant extent of professional responsibility in such an environment; and the urgent need for more evidence to be produced on which strategies for integrating at scale can be based. From our analysis we suggest a tentative way forward, viewed from a normative position broadly situated at the intersection of deontology and care ethics. We adopt this position because the primary clinical ethical issues in the context of integrated care concern: how to ensure that all duties of care to individual patients are met in a newly orientated working environment where clinical responsibility may be ambiguous; and the need to orientate care around the patient by foregrounding their autonomous preferences and ensuring good patient clinician relationships in clinical decision-making. (shrink)

The moral virtues are the normative foundations of peace. Building on this, thepaper argued that peaceful co-existence among religions and identities is possibleeven in a highly pluralized society. The study employed the philosophical-criticalmethod where factual and philosophical data are extrapolated from relevant literatures and are used to advance the main thesis via a rigorous philosophical dialectic. The study found that the moral virtues are the primary principles of thenatural law, which are naturally and spontaneously known through the practicalreason/conscience. In (...) as much as religions presuppose the existence of God, themoral virtues constitute God’s primary will for all men to accomplish and arethe first and highest duties of religions. Although, most religions, if not all, teachthe importance of the moral virtues, they are not given the highest position.Conflicts arise when religious laws, customs and traditions, which sometimesare contrary to the moral virtues, are given the highest priority. Thus, the paperargued that the moral virtues should be considered as the primary and overridingprinciples by which religious observance is judged as faithful or not. The paperconcluded that peace can be achieved when leaders of different religions anchortheir religious teachings, religious life, and the notion of religious fidelity mainlyor primarily on the moral virtues, and above all, love. Keywords: Philosophy of religion, peace, duties of religion, thin universalism, moralvirtues, natural law, Philippines. (shrink)

Evidence based medicine has had an increasing impact on primary care over the last few years. In the UK it has influenced the development of guidelines and quality standards for clinical practice and the allocation of resources for drug treatments and other interventions. It has informed the thinking around patient involvement in decision making with the concept of evidence based patient choice. There are, however, concerns among primary care clinicians that evidence based medicine is not always relevant to (...) primary care and that undue emphasis placed on it can lead to conflict with a clinician’s duty of care and respect for patient autonomy. In this paper we consider the impact of evidence based medicine on primary care, and the ethical implications of its increasing prominence for clinicians and managers in primary care. (shrink)

Supererogation has gained attention as a means of explaining the voluntary behaviours of individuals and organizations that are done for the benefit of others and which go above what is required of legislation and what may be expected by society. Whilst the emerging literature has made some significant headway in exploring supererogation as an ethical lens for the study of business there remain several important issues that require attention. These comprise, the lack of primary evidence upon which such examinations (...) have been made, attention has been given to only singular pro-social acts of organizations, and the focus has been upon the actions of large organizations. Furthermore, Heyd’s (Supererogation, Cambridge University Press, 1982) original taxonomy of six supererogatory acts, comprising Moral Heroism, Beneficence, Volunteering, Favour, Forgiveness and Forbearance, has been considered to be complete and other forms of supererogatory acts have not yet been explored. In order to address these gaps this study poses the research questions: First, it studies how a single, contemporary SME performs multiple supererogatory acts in its attempts to address its social and environmental goals that go beyond CSR. Second, it seeks to gain a deeper theoretical understanding of Heyd’s (Supererogation, Cambridge University Press, 1982) taxonomy of six forms of supererogation through the capture of primary data. This research makes a three-year case study examination of a single SME that has been formally recognized for its work in addressing social and environmental issues at local, national and global levels. Primary data are acquired of the supererogatory acts that it performs through a three-year participant observation case study, utilizing 61 interviews and 3 focus groups with internal and external stakeholders. In doing so, it addresses the empirical limitations of the extant research, substantiates each of the forms that supererogatory acts may take, and makes a contribution to the theory of supererogation by identifying a further class of act that is ‘Sharing’. (shrink)

The Irish Teaching Council introduced a new model of school-based and National Induction Programme for Teachers (NIPT) called Droichead (meaning ‘bridge’ in Gaelic) in 2013/14. The Droichead process is an integrated professional induction framework for newly qualified teachers. It was designed to provide whole-school support for teacher induction in both primary and post-primary schools. This study explores the implementation of Droichead in a post-primary school, and to gain insights as to its effectiveness and the potential to bring (...) about improvements. The study found that NQTs are un-prepared to assume full teaching duties after initial teacher education (ITE), and can benefit greatly from having mentors from within the school to guide them through their first year of teaching. The benefits of the process include emotional support for NQTs, practical help in terms of learning new teaching strategies, the promotion of reflective practice and assisting the professional development of teachers. Droichead was found to promote peer observation and can help leaders change the culture of an organisation to better embrace and support peer observation and review. The programme also promoted and developed leadership skills among the mentors, who cited a renewed enthusiasm for teaching from their involvement in Droichead. There were conflicting views on the involvement of the senior leadership team in the programme, and it would seem that the success of their inclusion depends largely on the individual style of leadership. The negative aspects of the Droichead process related to the ‘Cluster meetings’ which are compulsory for NQTs and were seen as being too similar to their initial teacher education. (shrink)

Recent discussions in the just war literature suggest that soldiers have a duty to assume certain risks in order to protect the lives of all innocent civilians. I challenge this principle of risk by arguing that it is justified neither as a principle that guides the conduct of combat soldiers, nor as a principle that guides commanders in the US military. I demonstrate that the principle of risk fails on the first account because it requires soldiers both to violate their (...) strict duty of obedience and loyalty and to exceed their special obligations to protect their fellow comrades, the state, the state's constituents and other protected civilians. I then illustrate that the principle of risk fails on the second account since it conflicts with the commander's primary obligation to protect and promote the welfare and lives of his or her soldiers. I conclude by arguing that we cannot reasonably expect soldiers and commanders to adhere to the principle of risk until there is a radical, institutional-level transformation of militaristic goals, values, strategies, policies, warrior codes and expectations of service members in the US Armed Forces. (shrink)

A critical issue facing the criminal justice system today is how best to promote ethical behavior by public prosecutors. The legal profession has left much of a prosecutor’s day-to-day activity unregulated, in favor of a general, catch-all admonition to “seek justice.” In this article the author argues that professional norms are truly functional only if those working with a given ethical framework recognize the system’s implicit dependence on character. A code of professional conduct in which this dependence is not recognized (...) is both contentless and corrupting. Building on the ethics of Aristotle and modern philosophers Alasdair MacIntyre and Bernard Williams, the author argues that virtue theory can help bridge the gaps in prosecutorial ethics where other forms of moral reasoning fail. The author analyzes three especially difficult ethical problems frequently confronted by prosecutors in the field. He demonstrates not only that the Model Rules of Professional Conduct and the ABA Criminal Justice Standards fail to answer any of these complex questions, but also that future attempts to more closely regulate how prosecutors should act in any of these nuanced situations are unlikely to succeed. The author argues that honesty, fairness, courage, and prudence are the primary virtues that citizens have a right to expect of their public prosecutors. He then demonstrates how these four key virtues might provide important guidance to conscientious prosecutors striving to do what is right. The author concludes by offering several insights into how the field of virtue ethics might inform both the structure and organization of government law offices, and the manner in which individual prosecutors working within these offices might perceive and fulfill their professional roles. (shrink)

The recent review by Monrad1 presents several issues about secondary vaccine trials. It lays out the case in which a vaccine has been tested through phases I–III and is being deployed. Subsequently, consideration is being given to conducting ‘trials for another vaccine for the pathogen’. Monrad states: ‘In summary, we may say that researchers have strong prima facie reasons not to conduct a secondary vaccine trial.’ Monrad discusses several factors meriting careful consideration about the need for developing and testing more (...) than one vaccine: relative efficacy, length of immunity, adverse reactions, ease of storage and administration, economic and logistical factors. What is not addressed are the ethical duties that exist when there are competing phase III vaccine candidates for COVID-19. We have serious concerns about potential ethical inadequacies about these ongoing trials and …. (shrink)

Ethically challenging or controversial medical procedures have prompted increasing requests for the exercise of conscientious objection, and caused concerns about how and when it should be practised. This paper clarifies definitions, especially with regard to discrimination, and explores the restrictions, duties, and practical limitations, in order to suggest criteria for its practice. It also argues that a conscientious refusal to treat, where there is therapeutic doubt, is a valid form of conscientious objection. An email survey sent to General Practitioners (...) (GPs), explored the adherence to the suggested criteria, and assessed the outcomes, in terms of acceptability, impact, and difficulties experienced by the GPs, their colleagues and their patients. The results demonstrate high acceptability of conscientious objection, and better outcomes when the suggested criteria are adhered to. The GPs would support education to improve the practice of conscientious objection to a professional level, which could further improve outcomes and acceptability. (shrink)

It is unclear that United States schools are doing sufficient work to identify and protect the interests of their LGB students this analysis, we rely on certain public-health research in social epidemiology to show that discrimination against LGB adolescents imposes morally significant harms to both adolescents and community. We apply "trust” and “social capital” to educational standards and practices as foundations for educational practices that work toward full equality of LGB students in regard to opportunity and other primary social (...) goods. (shrink)

It is the primary duty of business to satisfy consumer by providing quality goods and services at right place, right time, in right quantity at a fair price. The need for consumer protection is recognized by law makers in India since ancient times. It was very well realized that a consumer is prone to exploitation on the part of providers of goods and services. Therefore, the ancient Indian law codes regulated not only social conditions but also the economic life (...) of people by establishing human values and code of trade practices to protect the interests of buyers. This article is mainly based on the detailed study of ancient Indian literature, that is, Manu Smriti, Narada Smriti, Brihaspati Smriti and Arthshastra. (shrink)

Funeral Orations as Indicators of what a Good Life Ought to Be The central aim of this study was to uncover, based on funeral orations, what the Igbo of South-East Nigeria regard as the good life. Over two hundred and fifty funeral orations/tributes were investigated. These were classified into: tributes by spouses; by offspring; by close family members; by friends, associates and organizations. The study revealed that the notion of the good life among the Igbo was based on primary (...) duties and obligations at each of the four levels identified above and on related secondary duties and obligations. The good life was measured by the extent to which these duties and obligations were discharged and in the way their performance manifested in the provision of social amenities, help to educate members of the community and so on. What would ordinarily be regarded as virtues were considered desirable only in so far as they helped people fulfill their primary and secondary obligations, otherwise they were regarded as sterile or "bottled" virtues. (shrink)

ABSTRACTSome suggest that the duty of humanitarian intervention should be discharged by states that are historically responsible for the occurrence of violence. A fundamental problem with this suggestion is that historically responsible states might be ill-suited to intervene because they are unlikely to enjoy support from the local population. Cécile Fabre has suggested a way around that problem, arguing that responsible states ought to pay for humanitarian interventions even though they ought not to take part in the military operations. We (...) claim that Fabre’s idea is subject to two concerns. First, the duty to perform might not be appropriately transferrable from the historically responsible state to another state because it would allow the primary duty bearer to escape the worst costs of intervention. Second, an intervention might be as unlikely to generate local support when a historically responsible state pays for an intervention as when it performs it. These problems are enough to cast doubt on Fabr... (shrink)

According to the commonsensical model of educating researchers, young researchers must first acquire the knowledge achieved thus far and then solve new problems by developing applications of the accepted theory. This model, which presupposes a positivist theory of science, is incapable of explaining why the major breakthroughs in science have been carried out by young researchers. On the idealizational view of science, it becomes clear that commonsensical model must be rejected and replaced with an alternative, according to which the (...) class='Hi'>primary duty of young researchers is to revise the existing theories. It is the young researchers who are usually creative enough, ignorant enough, and exhibit a sufficient degree of nonconformism, to be capable of developing really new scientific theories. (shrink)

While citizens of developed countries enjoy lives of unmatched affluence, over a billion people struggle to subsist on incomes of less than $1/day. Can't we conclude that their poverty constitutes a glaring injustice? The answer almost certainly is yes—but not because some countries are rich, nor because of inadequate levels of redistribution. Liberal political theory traditionally maintains that persons are rights-holders, and the primary duty owed them is noninterference. Corrupt and tyrannical governments flagrantly violate the liberty rights of their (...) captive populations. External governments conspicuously fail to respect noninterference, however, when they erect barriers to trade between foreign nationals and their own citizens, subsidize domestic industries, prevent innocent movement across borders by would-be workers, and when they tender assistance to abusive states (such as foreign aid that lines the pockets of kleptocrats and enhances their power). The theory advanced here is similar to that of Rawls in rejecting an international difference principle, but unlike Rawls it advances an account of international justice as continuous with domestic principles of justice. (shrink)

The highest attainable standard of health is a fundamental human right, which has been part of international law since 1948. States and their institutions are the primary duty bearers responsible for ensuring that human rights are respected, protected, and fulfilled. However, more recently it has been argued that pharmaceutical companies have a coresponsibility to fulfill the human right to health. Most prominently, this coresponsibility has been expressed in the United Nations Millennium Goal 8 Target 4. “In cooperation with pharmaceutical (...) companies, provide access to affordable essential drugs in developing countries.”. (shrink)

The growing support for voluntary active euthanasia is evident in the recently approved Dutch Law on Termination of Life on Request. Indeed, the debate over legalized VAE has increased in European countries, the United States, and many other nations over the last several years. The proponents of VAE argue that when a patient judges that the burdens of living outweigh the benefits, euthanasia can be justified. If some adults suffer to such an extent that VAE is justified, then one may (...) conclude that some children suffer to this extent as well. In an attempt to alleviate the suffering of extremely ill neonates, the University Medical Center Groningen developed a protocol for neonatal euthanasia. In this article, I first present the ethical justifications for VAE and discuss how these arguments relate to euthanizing ill neonates. I then argue that, even if one accepts the justification for VAE in adults, neonatal euthanasia cannot be supported, primarily because physicians and parents can never accurately assess the suffering of children. I argue that without the testament of the patient herself as to the nature and magnitude of her suffering, physicians can never accurately weigh the benefits and burdens of a child’s life, and therefore any such system would condemn to death some children whose suffering is not unbearable. I conclude that because the primary duty of physicians is to never harm their patients, neonatal euthanasia cannot be supported. (shrink)

This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics—autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician–patient relationship is a deontological construct in which the physician’s primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological (...) Principlism. During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic. (shrink)

All over Europe, the provision of healthcare services is widely considered a primary duty of the government. Universal access to medical care can be considered a basic ingredient of the so-called “European social model.” But if universal access to medical care is seldom questioned, European governments—faced with expanding costs caused by an increasing demand driven by an aging population and technology-driven improvements—are contemplating the possibility of “rationing”1 treatments, or the possibility of allowing a greater role for private suppliers. If (...) a “multi-tier” healthcare system has long been anathema to the European leadership, guaranteeing a uniform access to state-of-the-art care seems to be well beyond the means of states suffering from persisting debt crisis. Was the failure of state-controlled “adequate” healthcare totally unpredictable? Far-sighted criticisms had been offered by two eminent thinkers in the classical liberal tradition, Herbert Spencer and Friedrich A. von Hayek . Neither author is usually recognized as a forerunner of contemporary critics of the welfare state, and both investigated the issue of the state financing and providing health services well before or right after the establishment of national health services. With the benefit of hindsight, reading Spencer and Hayek helps us to understand how the crisis of state-supplied healthcare is not rooted in the mere progress of clinical technology, but is rather the logical consequence of the theoretical basis of the model itself. Whereas modern theorists of the welfare state tend to offer theories that are impervious to a critical appraisal of their unintended consequences—insofar as they are framed in a language of “rights”—both Hayek and Spencer understood that human systems are complex, and that unwanted effects of public policy should be taken into account. Although Spencer emphasized the moral hazards accruing from the paternalism involved in governmental provision of health services, Hayek explained how modern healthcare systems differ from real, private insurance designed to offer proper coverage against risks. These authors appreciated that the politicization of healthcare was bound to result in both standardization of care and disregard for the responsibility that comes with personal freedom. These two “diagnoses before the illness” can help us in defining the challenges and the potential solutions that healthcare systems face today. Understanding the fatal conceits inherent in the very architecture of national health services can be the first step toward healing our healthcare systems. (shrink)

Suppose we can save either a larger group of persons or a distinct, smaller group from some harm. Many people think that, all else equal, we ought to save the greater number. This article defends this view (with qualifications). But unlike earlier theories, it does not rely on the idea that several people's interests or claims receive greater aggregate weight. The argument starts from the idea that due to their stakes, the affected people have claims to have a say in (...) the rescue decision. As rescuers, our primary duty is to respect these procedural claims, which we must do by doing what these people would decide, in a process where each is given an equal vote on the matter. So in cases where each votes in their own self-interest, respect for their equal right to decide, or their autonomy, will lead us to save the greater number. The argument is explained in detail, with special attention to the questions of how, exactly, it avoids aggregation, and of why majority rule is superior to lottery procedures. The view has further advantages. Especially, it explains the “partial” relevance of numbers in cases involving unequal harms, and it does so in a way that dissolves the appearance of paradox that besets theories of “partial aggregation.”. (shrink)

Philosophers may play the role of insider, e.g., serving as advisor to government commissions, or of outsider, commenting on the work of such commissions. Each role may raise dilemmas. It is argued that as insider the philosopher's primary duties should be to clarify and inform, as well as philosophize with the commissioners, and help them stay on a course in which moral considerations are given their proper weight. Fulfilling these duties means that the philosopher will sometimes have (...) to help produce a weaker intellectual document than he would prefer, or lose a chance to directly promote the public good. The insider philosopher will also have to consider whether it is appropriate for a policy proposal from a commission to differ from much current government policy, and how morally appropriate compromise can be reached among commissioners. Given his understanding of how an insider philosopher should function and how commission reports are constructed, the outsider philosopher can comment both on how close a report comes to being perfect of its type, and how far short of an ideal philosophical analysis even a perfect government report is. It may be appropriate for him to give greater weight to the public good, if his comments are very likely to affect it, than the insider philosopher. Examples for discussion are drawn from government reports on organ transplantation, embryo research, terminating care, and compensation for research subjects. Keywords: embryo research, government commissions, moral conflict, moral compromise, organ transplants, philosophers and public policy CiteULike Connotea Del.icio.us What's this? (shrink)

At the present time, when we are experiencing one of the extraordinary conditions in which the basics of life are shaken, exceptional practices concerning the sources of the meaning of the world of life have become one of the urgent issues for the sociology of religion to consider. This study discusses the reactions of people to the effects of the COVID-19 pandemic on the regularity of social life in the early stages in the framework of Muslim religious groups. Since the (...) forms of social organization reveal reactions in their own specific forms, a research design that considers the differences were preferred. The provision that ‘man is social by nature,’ which is the indispensable principle of social sciences, has been the main feature of important issues to elaborate in the restrictions of today’s pandemic. Religious socialization, which is important for the inquiry, is a phenomenon that is desired to be carried out on a continuous basis. Its performative dimension draws attention to important elements that affect the formation and the social ontology of the group, such as consciousness and solidarity. While some religious groups insist on face-to-face interaction and rituals, some of them prefer to use effectively digital tools and channels. This differing approach has become a public issue, especially during the pandemic process. On the other hand, there is a discussion in the context of the digital world of new media tools and the travel possibilities of transportation technology. The theoretical basis of this study, which deals with the insistence of religious groups on face-to-face interaction and rituals is represented from the scope of Erving Goffman. His analyzes face-to-face communication and his comments emphasizing the ritualistic nature of daily life are operationalized through two basic case studies: the first case is the persistence and practice of Tablīghī Djamā‘at, in its annual meetings in the early days of the pandemic. The discussion started with the practice of the religious group in Delhi (Nizamuddin Markaz), since they did not cancel their annual meeting despite the diagnosis of the disease. The second case is based on the ritual insistence of pilgrims in visiting shrines in the Iranian city of Qom. The insistence of the Shiite Islamic understanding on ritual and pilgrimage and the solidarity built with the consciousness based on it is a well-known phenomenon. In the Covid-19 pandemic, the risk of contamination caused by the mobility of the pilgrims coming to the city of Qom from countries such as Pakistan was discussed, as well as the contact and social distance during the Hajj. Two cases were handled with a qualitative design including case analysis method and descriptive analysis technique. The main purpose and intended contribution of the article are to reveal the insistence of face-to-face interaction through the performative based on rituals as an analytical explanatory on the social level. Inferences based on the analysis of religious groups’ response to restrictions in times of emergency build the importance of the issue. Case information identified in the context of the case study shows that groups with traditional interaction forms insist on their own practice in the field of uncertainty and initiative. Unless necessity eliminates the initiative, the determination of this insistence of traditional religious groups is not only theological but also ontological confirmation. It is understood that the members of the group took the initiative to represent their reputation within the group and their extent to dedicate to the group. The fact that Tablīghī Djamā‘at, the largest group of the transnational Islamic da‘wa (call), did not give up on a method based on demographic mobility, has been a matter of discussion. The insistence of the group is because of the methods that require every ordinary believer to accept to convey the da‘wa as his primary duty. On the other hand, Shiism, which stands out with its traditional structure and ritual intensity in the Islamic world, insisted on the initiative process in the pilgrimage phenomenon, on which it attached special importance and built its solidarity and identity on this phenomenon. This insistence aims preserving the dynamics and social ontology of the religious group in the performance of the membership system. Essentially, the individual in the group insists on his position in face-to-face interaction because having a role in a group also means having a face. Thus, this insistence performance by religious groups should also be read as a reflection of self-technologies. In the final analysis, the insistence put forward should be considered essentially in relation to the insistence on the position in social ontology. (shrink)

Clinicians and administrators have a professional obligation to contribute (OTC) to improvement of healthcare quality. At the same time, participation in embedded research poses risks to healthcare institutions. Disclosure of an institution’s sensitive information could endanger relationships with patients and undermine its reputation. The existing ethical framework (EF) for learning healthcare systems (LHSs) does not address the conflict between the OTC and institutional interests. Ethical guidance and policy regulation are needed to create a safe environment for embedded research. In this (...) article we analyse the EF for LHSs and the concept of professionalism. We suggest that the EF should be supplemented with an obligation to protect provider’s legitimate interests. We define legitimate interests as those that enable providers to discharge their primary duties. We argue that both the OTC and the obligation to protect legitimate interests are grounded in the concept of medical professionalism and can be understood as a matter of contract between a democratic society and medical professionals. The proposed supplemented EF can be implemented into a regulatory system in three different ways: theself-regulating: where providers decide themselves how to balance the ethical claims, the centralised: where a governmental institution decides the right balance between providers’ interests and interests of a health system; and themediating: where medical professionals, the state and patients negotiate their interests. Our article contributes to the discussion on ethical relevance of providers’ interests and the regulatory model for weighing opposite interests in LHSs. (shrink)

It was a surprise to many to read that Vatican II's document on the priesthood, 'Presbyterorum Ordinis', declared that 'priests, as co-workers with their bishops, have as their primary duty the proclamation of the Gospel of God to all'. Most would have thought that the primary duty of priests was the celebration of the sacraments, the pastoral care of the people of God, and leadership of the Christian community. This had probably been the dominant thinking since the Council (...) of Trent, which, while never articulating a theology of priesthood, did focus on the power of the priest to confect the Eucharist, to absolve the penitent and to anoint the sick and dying, but it did begin a renewal of Catholic preaching. (shrink)

The ultimate aim of this dissertation is to determine whether libertarian theories of property can be adequately grounded in Locke's theory of natural rights. I defend the thesis that Locke's theory has no room for a fundamental commitment to natural rights, including property rights. ;In the first three chapters, I challenge each component of the dominant interpretation of Locke's theory of property in this century, viz., that of C. B. Macpherson. In Chapter One, I criticize Macpherson's claim that Locke's view (...) allows unlimited appropriation. In Chapter Two, I agree with Macpherson that Locke defended a state in which the franchise was restricted to those who held significant property, viz., land. However, this can be reconciled with an initial contract into civil society that meets certain standards of rationality and fairness. Thus, while political power is not equally distributed in the state Locke describes, that is not necessarily inconsistent with a rational, free, and voluntary social contract. This shows that we need not see Locke as committed to the interests of the wealthiest members of society. In Chapter Three, I agree with Macpherson that Locke's view is that the purpose of contracting out of the state of nature is the protection of one's property. But I briefly argue that Macpherson does not take seriously Locke's concept of property right and the wide range of objects that count as property. If we pay careful attention to Locke's terminology, we can see that although the purpose of the state is the protection of property, that does not guarantee greater protection for the wealthy than it ensures the poor. ;In Chapter Four, I challenge a quite different thesis. James Tully has argued that Locke did not defend private property at all, but attacked it. I criticize this interpretation on the grounds that Locke explicitly allows certain practices that Tully takes to be violations of the law of nature as Locke construes it. I also criticize the claim that certain developments in a commercial economy, such as the consumption of valuable land, necessarily violate the law of nature. In addition, I argue that the idea of conventionally established property rights is inconsistent with Locke's account of how and why government comes to be established. ;In Chapter Five, I provide an account of the principles underlying Locke's account of rights, both within and without civil society. I argue that Locke's view is improperly construed as a view which gives pride of place to rights. Rather, rights are almost always derivative from duties, and in those cases where they are not derivative, they are subordinate to certain primary duties that oblige us in virtue of our status as God's creations. (shrink)