This chapter contains sections titled: Motivational Externalism Avoiding Brinksmanship Motivational Internalism A Creative High Shall We Close the Gateway?

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

In modern conditions payment systems have an important role in the economy, as they must provide effective economic means of payments. Accordingly, the development of payment systems in Ukraine appears as a relevant theoretical and practical problem. In the article the theoretical basis and features of payment systems in Ukraine were researched. Preconditions of systemically important payment systems development been analyzed, which are performed by the key principles of their organization and functioning. Realization of principles of systemically important payment systems (...) in Ukraine was investigated. The key principles of operation and functioning and their implementation in retail payment systems were determining, such as providing competitive services, security payments from outside interference, territorial and temporal availability, profitability of participation in the payment system, consumer protection, instant calculation of account balance, instant currency conversion and minimize currency risk. Recommendations for improving the procedures for conversion of currencies in the international card payment systems were provided in order to reduce currency risks for end-users and issuing banks, such as introducing restrictions on the period of submission for payment of international trade, as well prohibit use of trade-service enterprises for currency conversion their own exchange rates. The necessity of legislative regulation of the size of interchange fee in card payment systems to create more favorable conditions for the spread of retail electronic payment was determined as well as removal of legal restrictions on the issuance and use of electronic money and foreign exchange restrictions in order to create the conditions for international payment systems based on electronic money to enter the Ukrainian payment market. (shrink)

In “Property Rights and the Resource Curse” Leif Wenar argues that the purchase and sale of resources from certain countries constitutes a violation of property rights, and the priority in reforming global trade should be on protecting these property rights. Specifically, Wenar argues that the U.S. and other western liberal democracies should not be complicit in the trade of so-called cursed resources, and the extant legal system can be used to end the trade in cursed resources by prohibiting the importation (...) of cursed resources, litigating against companies that operate in resource-cursed countries, and imposing trade tariffs on third party countries’ exports if they trade in cursed resources. In this paper, I show that while Wenar is correct that the trade in cursed resources is morally objectionable and therefore creates additional moral obligations for participants in that trade, his normative assessment fails to take account of the complexity of the resource curse and his prescriptive proposal for clean trade will not reduce harm in resource-cursed countries. I suggest that the reduction of harm, rather than the enforcement of property rights, should be the normative and practical focus in evaluating and reforming trade in natural resources. (shrink)

John-Paul II’s encyclical Veritatis Splendor examines the commandments, in particular the Decalogue. In so far as it is the expression of ‘natural law’ applicable and reflexively accessible to all, it is a permanent charter not only of Christian inspired ethics but of every human ethic . Using the story of the rich young man, cited in the encyclical’s first chapter, we would like to elucidate in the first part, and in our own way, how prohibitions open the way for freedom (...) and the richness of human creativity.This will show that Christian ethics, for which the Decalogue is of essential importance, cannot limit itself to drawing borders. Prohibitions are only a necessary condition and not a sufficient ground for a Christian ethic inspired by the gospel whose heart is the living person of Jesus the Christ. A Christian ethic does not end with delimiting borders that make possible and protect certain fundamental values; it also opens its own perspectives for a tasteful shaping of a qualified freedom that is ‘won’ thanks to keeping the commandments. This in turn leads to the point of the second part: a look at ‘taste’ and aesthetics in ethics. This will show how a balanced Christian ethic will necessarily be marked by a bipolarity of prohibition and taste.[...]CONCLUSIONEthics is not a simple matter; it is a complex field wherein orientations, commandments and prohibitions, suggestions, examples and experiences all play a role. We hope that it is now evident that ethics, on the existential level of experience, can only function properly when there is a tension between prohibition and taste. A one-sided emphasis or absolutizing of one of the two leads to the self-destruction of ethics. Reducing ethics to obeying commandments and prohibitions leads to a rejection of ethics, while a narcissistic absolutizing of taste leads to a destruction of ethics in as far as it results in the aestheticism of pure taste and in arbitrariness. Only an ethic that remains normatively modest by focusing its attention on the essential delimiting rules that protect basic values opens perspectives towards a creative meaningful life as a ‘lively adventure’. (shrink)

In 2008 the Human Fertilisation and Embryology Act amendments made deliberately choosing to bring disability into the world, using assisted reproduction, a criminal offence. This paper considers whether the legal prohibition above, should influence other policy areas concerning the welfare of future children such as new possibilities presented by foetal surgery and in utero gene therapy. If we have legal duties to avoid disability in one context should this influence our avoidance of disability in this other context? This paper (...) investigates whether the State might have a stake in wider promotion of practices to reduce the degree of disability in foetuses that will come to exist. Not selecting for disability does not affect the welfare of any future individual, whereas treating in utero abnormalities can optimize the eventual child’s welfare; antenatal interventions stand to improve clinical outcomes and welfare should that specific child be born. I explore why the State may want to intervene in the antenatal setting and to what extent, if at all; the State should implement these technologies. I argue that if the State is justified in intervening to outlaw the choosing to create disabled lives using assisted reproductive techniques, it is also justified in putting pressure on prospective parents to accept therapies in utero to help their child be born less disabled. However, I qualify this with the argument that the State is not justified in using force or the criminal law in this situation during pregnancy. (shrink)

The Ottoman State contains many different ethnic elements which constituted a legal perspective. In this regard, the necessary precautions were taken to ensure that Muslims and non-Muslims live together peacefully in Vidin, a border city that was very important for the Western military expeditions of the Ottoman State known as “dār al-jihad wa-l-mujāhidīn” during the 18th century which set a historical example. The economic and social dimensions of the relations between the Muslim and non-Muslim population comprising the society in Vidin (...) who have shared the same city, neighborhood and public space during 1700-1750 were examined in this study and the conflicting subjects with regard to the ongoing relations between these two communities were tried to be determined. A total of 15 shari‘aregistries kept by the qāḍī (Muslim Judge) court for the related period located at the Oriental Department of National Library of Bulgaria constitute the main resources of the study. The shari‘aregistries that are the main resources of urban historical studies are full of countless examples that provide information on the relations between Muslims and non- Muslims in Vidin. The examination of these examples is of significant importance for putting forth the methods with which the nation system is applied by the Ottoman Empire as well as their opinions towards the non-Muslims they rule.SummaryVidin, located today in northwest Bulgaria was founded during the 1stcentury BC to the right of the River Danube by the Romans and named as Bononia. This settlement which was named as V’dinby the Muslims throughout the Middle Ages was transformed into a castle about 800 years after its foundation. The city that continuously changed hands due to its location at the border fell under the Ottoman rule after Battle of Nicopolis dated 1396. Vidin became one of the important border cities of the Ottoman against Serbia, Walachia and Hungary until the beginning of the 16thcentury. This importance of Vidin gradually decreased after the Ottoman Empire conquered Belgrade, Budin and Timişoara. Vidin retrieved its status as a border city against the Hungarians and the Wallachians after the Habsburgs dominated the region following the Great Turkish Wars that took place during 1683-1699, and thus regained its past importance. Even though the pressure influenced Vidin as a result disappeared with the 1739 Treaty of Belgrade, the conflicts between Austria and the Ottoman Empire did not end completely and continued throughout the 18thcentury. Vidin preserved its status as a first-degree border city for the Ottomans during the period of time, as examined in this study, which was also known as “dār al-jihad wa-l-mujāhidīn” starting from the beginning of the new century. Majority of the settled public were comprised of military classes in Vidin due to its geographical location where the Muslims and non-Muslims lived together. While the Muslim population was higher during the period of time following the establishment of the Ottoman rule, the non-Muslim population continued to increase throughout the 17thcentury reaching 23.961 taxpayer non-Muslim men in the 18thcentury. The Ottoman Empire based its ruling in Vidin, where almost the same number of Muslim and non-Muslims lived, on the principles of Islamic Law rules for non-Muslims. Since this legal system takes into consideration religious differences, non-Muslims were not held responsible from the prayers of Muslims and the actions that were not prohibited in their religion did not pose any contradictions with regard to Islamic law. The Ottoman Empire did not apply the Islamic Law on its non-Muslim citizens living in Vidin and allowed them to continue their social and religious lives based on their own religious principles in a special legal stance. Thanks to the system applied, the Muslim and non-Muslim community in Vidin were able to continue their daily lives without serious conflicts.The main purpose of this study is to explain how the Muslim and non-Muslim population related with each other in the city of Vidin during the second half of the 18thcentury and the dynamics with which they continued these relationships. Following this purpose, the cases between Muslims and non-Muslims in court records kept by the Vidin sharia court during 1700-1750 are examined. The relations between Muslims and non-Muslims are subject to two different classifications as economic and social issues, and each topic is supported and explained as sub-titles using different case examples. Majority of the relations between Muslims and non-Muslims in the city are economic according to Vidin court records. In this regard, it seems that there is no religious discrimination between the artisan groups in the city. In addition, many home, land, store and vineyard sales took place between the Muslims and non-Muslims which were resolved in the court mostly for registration purposes. It can also be understood from the court records that there were commercial relations between the Muslims and non-Muslims, that they had partnerships and that they lent money to each other which can be seen as an example of interpersonal support. Various social relationships were also established between the Muslim and non-Muslim population in Vidin during the period examined in this study. Even though non-Muslims had the right to carry out marriages and resolve their issues at their own community courts, it was observed that they frequently applied to the sharia courts for these purposes. They have developed witnessing relationships in such cases with the Muslims. The non-Muslim community did not experience any issues in finding Muslim witnesses for their cases with the Muslims; many Muslims acted as witness against their fellow Muslims without any hesitation. Two cases of injuries and few robbery issues were reflected in the courts of Vidin between the Muslims and non-Muslims during the fifty-year period examined in the study and no incident ending with death took place. Various singular cases took place between the two groups which were resolved at the sharia courts without escalating into severe conflicts. When all court records are taken into consideration, it can be understood that the Muslim judge of Vidin did not make any distinctions between the non-Muslims and Muslims and that he did not compromise from the principle of fairness. Both the Muslims and non-Muslims managed to live comfortably by acting carefully so as to not cross their own lines in both their economic and social relations in Vidin. When the faith-related conflicts that are taking place in our day in many regions of the world despite the level of education and culture are taken into consideration, it is very meaningful that people living in Vidin during the first half of the 18thcentury managed to live in peace. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

Automation is once again raising concerns about the threat it poses to employment. Feminists in the 20th century believed that technology could liberate women from undesirable labor. However, historically, industry and automation have not reduced women’s workloads but have instead favored unpaid work, flexibility, and work overload. Rather than mitigating the care and ecological crises, technological development has exacerbated them. This raises an important question for feminist theory: should technology be rejected as a way of reducing women’s workload? To (...) explore this, we analyze classical and contemporary contributions from feminist theorists on the future of work and technology. Using philosophical and feminist theoretical methods, our aim is to examine the relationships between these imaginings and home, family, design, and consumption. This article argues that a feminist analysis of work must include the technological dimension, considering the production of human beings as a strategic technology for feminist purposes. To imagine an alternative near future, the article draws on Donna Haraway’s making kin, emphasizing defamiliarization and refamiliarization of social and ecological relations, pluralist science, and technology for sustainable regeneration of life; and finally, as suggested in this analysis, the ironic persistence of labour in a post-industrial or post-capitalist era. (shrink)

ABSTRACT:Business ethics research has long been interested in understanding the conditions under which ethical consumption is consistent versus context-dependent. Extant research suggests that many consumers fail to make consistent ethical consumption decisions and tend to engage in ethical decisions associated with ingroup identity cues. To fill this gap, four experiments examine how construal levels moderate the influence of ingroup versus outgroup identity cues in ethical consumption. The studies support the contention that when consumers use concrete construal to (...) process information, they will focus on ingroup cues and make ethical consumption decisions that are aligned with ingroup biases. However, when consumers use abstract construal, they will act more consistently with their inner goals rather than focusing on ingroup and outgroup cues. Social goodwill, which indicates desires to give back to society, is identified as mediating the effects. The findings have important implications for ethical consumption and social influence literature. (shrink)

It is axiomatic that tobacco smoking is hazardous to health. The statistics are well documented and often very grim. For example, the 2008 World Health Organization Report on the global tobacco epidemic presented the following statistics: a hundred million people died of tobacco-related diseases globally in the 20th century; there are approximately over five million tobacco-related deaths every year; and an estimated one billion could die of tobacco-related diseases in this 21st century.Significantly, no other risky, self-indulgent addictive behaviors such as (...) cocaine abuse directly endanger bystanders as much as cigarette smoking or tobacco use endangers nonsmokers through secondhand tobacco smoke or inhaled environmental tobacco smoke. Environmental tobacco smoke comprises sidestream smoke and mainstream smoke. About 85 percent of environmental tobacco smoke is sidestream smoke, while the remainder is mainstream smoke. (shrink)

The author proves that rejecting the existence of permissive norms and limitation of norms to prohibitions and commands alone is possible only with reducing the idea of a function. The essence of the function is then the ability of the expression to generate independently the universal norm formation. Such manipulation is easy on the level of logical analysis, but proves risky from other points of view. If we want the deontic logic, which we construct, to consider the fact that (...) permission is pragmatically necessary for the law-maker to convey his normative preferences, we must solve the consequences of the adopted structure of the function of norms, which originate on the socio-linguistic level. It appears, however, that due to a lack of a pragmatic theory useful for lawyers, there is no proof that the pragmatically strong permission can be expressed by means of a lot of prohibitions and commands (dos and don’ts). Besides, reducing permissions only to the language of legal rules is an obligation to accept the structure of an act of communication, which can find its full motivation in the Husserl’s structure of the direct cognition. (shrink)

Ethical consumerism theory aims to describe, explain, and evaluate the ways in which producers and consumers use the market to support social and environmental values. The literature draws insights from empirical studies of sectors that largely take place on the legal market, such as textiles and agri-food. This paper takes a first step toward theorizing ethical consumerism in semi-legal sectors where market activities occur legally and illegally. How does extant theory extend to sectors such as sex work, cigarettes, and recreational (...) drugs? This study draws on the case of recreational cannabis (marijuana) in Portland, OR (USA). Data from 33 interviews, structured fieldwork at 64 dispensaries, and the US Census Bureau American Community Survey are analyzed using qualitative, quantitative, and spatial methods. The findings are compared to 12 suggestions that emerge from the literature on fair trade, organics, alternative agriculture, and political consumerism. I argue that not all ethical consumerism theory extends to semi-legal sectors. Cannabis closely resembles theoretical expectations in terms of supply/demand, prioritization of ethical issues, and pervasiveness of false claims, but differs in terms of who organizes, which types of strategies are pursued, and how ethical products are framed. The differences stem from several pervasive stigmas about cannabis. I also argue that the stigmas that set cannabis apart from other (more legal sectors) and present challenges to ethical consumerism in cannabis are directly related to the War on Drugs. These insights suggest that prohibition (and its lingering effects) can inhibit the emergence of ethical consumerism. (shrink)

The book in front of you is the first international academic volume on the legal, philosophical and economic aspects of the rise of 3D printing. In recent years 3D printing has become a hot topic. Some claim that it will revolutionize production and mass consumption, enabling consumers to print anything from clothing, automobile parts and guns to various foods, medication and spare parts for their home appliances. This may significantly reduce our environmental footprint, but also offers potential for innovation (...) and creativity. At the same time 3D printing raises social, ethical, regulatory and legal questions. If individuals can print anything they want, how does this affect existing systems of intellectual property rights? What are the societal consequences of the various types of products one can print with a 3D printer, for example weapons? Should all aspects of 3D printing be regulated, and if so, how and to what ends? How will businesses (have to) change their way of working and their revenue model in light of the shift to printing-on-demand? How will the role of product designers change in a world where everyone has the potential to design their own products? These and other questions are addressed in high quality and in-depth contributions by academics and experts, bringing together a wide variety of academic discussions on 3D printing from different disciplines as well as presenting new views, broadening the discussion beyond the merely technical dimension of 3D printing. Bibi van den Berg is Associate Professor at eLaw, the Center for Law and Digital Technologies at Leiden University, The Netherlands. Simone van der Hof is Full Professor at eLaw in Leiden and Eleni Kosta is Associate Professor at TILT, the Tilburg Institute for Law, Technology and Society at Tilburg University, The Netherlands. (shrink)

Wage-earners voluntarily accept to work under the control, and for the account of, firms run by entrepreneurs1; they do not decide what, how and how much, they must produce; wage-earners are not responsible for the consequences of their activities when they comply with entrepreneurs' orders12; inside the firm, wage-earners are subordinates. Outside the firm, wage-earners freely choose the way they spend their wages in the markets for commodities and services. Such is the 'stylised fact' which characterises the wage relationship in (...) our economies. Any theory of the wage relationship should account for this 'stylised fact' by deriving it from a consistent set of assumptions and propositions. Three main propositions are advocated in this paper: Mainstream economists conceive the 'wage' as being the price of a commodity ('labour power' or 'human labour') determined by a market – as for any other commodity and service. As a consequence, the wage relationship is thought of as an exchange relation ruled by equivalence; this view cannot be derived from the usual basic assumptions without violating the very logic of mainstream theory. Following this logic: either the wage relationship should be thought of as a relation between human beings having such different conditions that it cannot be interpreted as an exchange ruled by equivalence or 'human labour' is not to be found within the commodity space. In any case, the 'stylised fact' mentioned above is not accounted for by mainstream theory. 'Wage' is the name of the payment entrepreneurs give to other people with the view to making them participate in production under their control and for their account; wage payment is neither a purchase nor a sale – it just allows wage-earners to enter the market and spend in order to acquire the commodities they desire Wage-earners are, economically speaking, a means used by entrepreneurs for their own ends; exploitation (Fleurbaey's M-exploitation) is inherent in the wage relationship. Propositions 2 and 3 do not fit general equilibrium theory (inspired by Walras and rationalised by Arrow- Debreu); they do not fit modern mainstream theory either. They have no room in the theory of prices of production (inspired by Ricardo and rationalised by Sraffa). Moreover, they are not compatible with Marx's theory of labour power. An alternative approach is needed to satisfy them. Paving the way for that alternative theory requires us to show that 'human labour' cannot belong to the commodity space from the very point of view of mainstream theory; a sharp incompatibility between assumptions and conclusions would follow, and justify resorting to an alternative approach. This is our first step. A second step is to effectively resort to a monetary analysis – the alternative approach to real analysis, according to Schumpeter in his History of economic analysis. In a nutshell, we have to discard the commodity space postulate, and to think of economic relations as money mediation. Instead of a commodity space, we presuppose money to be a unit of account ($) combined with a means of payment. Instead of a permutation of goods and services exchanged amongst people, economic relations are payments. Individuals are no longer endowments and preferences, but accounts into which payments write down quantities of $. Conditions of people may differ according to the form of money circulation – this view allows us to deal with different types of economic relations; for what matters here, the wage relationship involves a specific form of circulation not reducible to that of exchange. The final step is to suggest that exploitation is inherent in the wage relationship; such exploitation has nothing to do with justice, since there is no norm whatsoever for the level of wage; it is also quite different from the exploitation Marx thought he had unveiled. This exploitation is simply due to the special situation of wage-earners vis-a-vis the market, which a specific form of circulation makes clear. 1 'Entrepreneur' here means, following Coase, 'the person or persons who, in a competitive system, take the place of the price mechanism in the direction of resources' (Coase, 1937, p. 388). 2 David Ellerman distinguishes between factual/de facto and legal or de jure responsibility. What I mean here is economic responsibility only. Another way at looking at it may use David Ellerman's propositions. The 'Invisible Judge' market gives the entrepreneur the property of raw material and labour – and also of the finished product sold in the market. The market gives nothing to the wage-earner inside the firm; outside the firm it gives her the property of consumption of goods she acquires out of her wage. Inside the firm, the wage-earner is not economically responsible. Arguing that if she kills someone, the wage- earner is responsible has nothing to do with the 'Invisible Judge'! (shrink)

In voicing commitments to the principle that the adoption of artificial-intelligence (AI) tools by armed forces should be done responsibly, a growing number of states have referred to a concept of “Responsible AI.” As part of an effort to help develop the substantive contours of that concept in meaningful ways, this position paper introduces a notion of “responsible reliance.” It is submitted that this notion could help the policy conversation expand from its current relatively narrow focus on interactions between an (...) AI system and its end-user to also encompass the wider set of interdependencies involved in fulfilling legal obligations concerning the use of AI in armed conflicts. The authors argue that to respect international humanitarian law and ensure accountability, states ought to devise and maintain a framework that ensures that natural persons involved in the use an AI tool in an armed conflict could responsibly rely at least on: (1) the tool’s technical aspects, (2) the conduct of other people involved in development and use of that AI tool; and (3) the policies and processes implemented at the state level. According to the authors, the “responsible reliance” notion could serve, among other examples, as a basis on which to articulate legal requirements, prohibitions, and permissions across diverse areas, from the design of AI tools to human-machine interactions to configuration of responsible-command frameworks. (shrink)

The demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA’s impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors. We conducted (...) a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1–4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation. Of the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09–12.12), with non-medical aetiology as associated factors. The enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions. (shrink)

The book reconstructs the history of Western ethics. The approach chosen focuses the endless dialectic of moral codes, or different kinds of ethos, moral doctrines that are preached in order to bring about a reform of existing ethos, and ethical theories that have taken shape in the context of controversies about the ethos and moral doctrines as means of justifying or reforming moral doctrines. Such dialectic is what is meant here by the phrase ‘moral traditions’, taken as a name for (...) threads of moral discourse, made in turn of other interwoven threads, including transmission of shared codes, appeals to reform of prevailing custom, rational argument about the justification of some precept on the basis of some shared general teaching or principle, and rational argument about the ultimate basis for principles and justification of authoritative teaching. That is, the approach adopted to the reading of ethical texts depends on a firm belief in the fact that philosophers hardly created any ethical doctrine out of nothing. The main point this book tries to highlight is how different philosophical theories emerged and followed each other as a result of attempts at accounting for what was going on in the world of moral traditions. Changes were propelled by controversies between different schools, and highly abstract arguments were the unintended effects of moves made by controversialists forced to transform (and occasionally to turn upside down) their own doctrines in order to face the challenge posed by other arguments. This is the reason why the book examines not only texts that already enjoy pride of place in the history of philosophy (Aristotle, Kant, Hegel), but also other texts usually treated in the histories of religions (the Bible, the Talmud, the Quran), and others considered to be much less philosophical (Plutarchus, Pufendorf). -/- 1. Plato and a response to ethical scepticism. Two different traditions of morality in VI-V century Greece are described. The birth of philosophical questioning of traditional morality and temporal and spatial variation of custom is described within the context of the v century crisis, the demise of traditional aristocratic and tyrannical rule and the birth of democracy. Two conflicting answers to the challenge are reconstructed, namely conventionalist or immoralist theories formulated by the Sophists and the eudemonist and intellectualist Socratic theory. Plato’s own reformulation of Socrates answer to the Sophists is reconstructed. His psychological views, his classification of the four cardinal virtues and his political theory are described as parts of a unitary system, culminating in an extremely realist moral ontology identifying the idea of the good with the essence of the (moral and extra-moral) world itself. -/- 2. Aristotle and the invention of practical philosophy. Aristotle’s invention of practical philosophy as a field separated from first philosophy is shown to be an implication of his break with Plato moral ultra-realism. Aristotle’s agenda in his moral works is arguably dependent on a polemical intention, namely dismantling Socratic intellectualism. The semi-inductive or virtuously circular method of practical philosophy is illustrated, starting with the received opinions of the better and wiser individuals and trying dialectically to sift what is left of mistake and inconsistence in such opinions, finally trying to correct mistakes and make the overall practical science more consistent. The chapter illustrates then the relationship of individual ethics, or ‘monastics’, with the art and the science of the pater familias, or ‘economics’, and the science of the ruler and citizen, or politics. The nature of virtues, or better, excellences of character, is discussed, highlighting the basic role of hexis, or ‘disposition’. Prudence, or better practical wisdom, is the focus of the chapter. Its relationship with bouleusis or deliberation is examined, and its autonomous status vis-à-vis theoretical knowledge is stressed. -/- 3. Diogenes and philosophy as a way of life. The chapter provides an overview of Hellenistic ethics, which almost amounts to Hellenistic schools of philosophy, in so far as ‘philosophy’ became in these centuries primarily the name for a way of life. The typical character of the Cynical movement is highlighted, that of a school of life, not a school aimed at providing any kind of intellectual training was to be provided. -/- 4. Epicurus and ethics as self-care. The peculiar character of the Epicurean school is described, a combination of a science of well-being aiming, more than at pleasure as in the popular view, at reduction of useless suffering, of unnecessary needs, and at a balanced selection of pleasures of the best and most durable kind. -/- 5. Epictetus and ethics as therapy of the passions. The various phases of Stoicism are described, and the shifting place given to ethics in the Stoic system of idea, culminating in the paradoxical view of ethics, its impossibility in principle notwithstanding, as the only truly significant and necessary part of philosophy. Cicero is treated, showing how his own synthesis of various Hellenistic trends is as a truly philosophical enterprise, deserving serious consideration after one or two centuries when he was confined to the role of literate. Epictetus is chosen as the best example of what the Stoic tradition could yield, an art of living based on sophisticated introspection, in turn aimed at making a kind of cognitive therapy possible, dismantling obnoxious passions at their root by systematically correcting false representations. -/- 6. Philo and the reconciliation of Torah and Platonism. A reconstruction of basic ideas from a few books of the Hebrew Bible is provided, starting with the Prophetic tradition and the focus on God’s mercy as the source of motivation and standard for human behaviour. Then a comparative analysis is undertaken of a parallel tradition, namely the three codifications of the Torā (Law or, better, Instruction), highlighting how a core of moral ideas may be recognized as a basis and preamble of codification of civil law, cultural practice, and regulation of ritual purity. The importance of Leviticus is stressed as the turning point when emphasis mercy, typical of the Prophetic tradition, is combined with the legal tradition, yielding the change in sensibility of the Second Temple time. Philo of Alexandria is described as one of the three leading figures – together with Rabbi Hillel and Rabbi Yeshua – at the apex the emergence of the mentioned new sensibility, gradually including mercy as an essential part of justice and establishing the starting point of both the Rabbinic and the Christian tradition. This consists precisely in the precept of one’s neighbour’s love or of the golden rule, two eventually identical precepts whose meaning is arguably more sober and sensible than the long-lasting Christian tradition deriving from John and Augustine has made us believe and no novelty vis-à-vis so-called Ancient-Testament teachings. -/- 7. Augustine and Christianity as Neo-Platonism. The first section examines the moral doctrines of so-called 'ethical Treaties' from the Talmud, a group of treaties, among which the best known is Pirqé Avot, that were left out of the six "orders" of the canon as they did not fit in any of the six groups of issues ritual or legal on which the division was based. According to Maimonides, their peculiar theme is provided by the Deòt, 'opinions', i.e., mental dispositions, that is, the translation of the Greek term hexeis and Arab akhlak (in turn providing in this language the name for ethics as such). The three topics I reconstruct are: i) the notion of Torah: The Torah is understood as the world order itself, or as the ‘Wisdom’ that existed even before creation and was ‘the tool by which the world was built’; however, the Torah is an earthly and human entity, as it was "received" by humans, and from that very moment belongs to them; ii) the relationship between love of God and love of neighbour; the treaties require us to study and practice the Torah ‘for its own sake’, that is, require us to act out of love, not out of fear or hope of reward; iii) the idea of sanctification of daily life: having disappeared with the destruction of the Temple the possibility of any conflict between liturgical service and everyday life, the latter is assumed to be in itself divine service: to give food to the poor has the same value as sacrifices in the Temple, and as an implication, the insistence become recurrent on the goodness of created things in themselves along with a polemic against ascetic currents. The conclusions drawn are: i) the moral teachings of the Talmud and those of Yeshua are, rather than similar, virtually identical; one may safely say that the precept of love and the golden rule are central ones for all Talmudic rabbis, that mercy plays an indispensable role alongside with justice, and the latter is not a different thing from one’s neighbour’s love; ii) a peculiarity of Talmud rabbis facing Yeshua is the idea of study as worship, and knowledge as a source of justice; but this is an idea of Judaism after the Temple's destruction that cannot be attributed to the Pharisees of Yeshua’s time; iii) the relation of study and practice in the Talmud parallels that between faith and deeds in Paul's epistles, that is, respectively faith or learning are a necessary and sufficient condition to be recognized as righteous , but deeds are the inevitable effect of either faith or learning. The sayings ascribed to Yeshua are examined first, yielding the conclusion that a close equivalent may be found for every saying in Talmudic literature and yet the whole is ascribed to one rabbi, with rather consistent stress on God’s mercy and unconditional forgiving as the mark of true imitation of God. Thus, Yeshua’s teaching is pure Judaism. The third section describes briefly the galaxy of Gnostic currents and Manichaeism, trying to sketch the profile of moral teachings resulting from an encounter of Asian spiritual traditions, Hellenistic lore and sparks of teachings from apocalyptic Jewish currents. The last section summarizes the turbulent history of several encounters between Christian currents and Hellenistic philosophical schools. The first one was with late Cynicism. Recent, rather controversial, literature discovered the jargon and a few topics from the Stoic-Cynical popular philosophy in a few books from the New Testament itself. This, far from proving that Rabbi Yeshua had been influenced by cynic preachers, is a proof of the necessity felt by Christian preachers to translate the original ‘Christian’ teaching into a Greek lexicon deeply impregnated with cynic terminology. The second was with Platonism, yielding the mild and temperate moral teaching of Clemens of Alexandria, teaching the sanctity of nature and the human body, the joy of moderate fruition of ‘natural’ kinds of pleasures, and the beauty of the marital life – in short, the opposite of the standard picture of Medieval Christianity. Ambrose of Milan brings about a different kind of synthesis, namely with Middle Platonism, where Stoic themes prevail. The most shocking case is Augustine, where an early Manichean education is overcome in a former phase by a synthesis of Plotinian Neo-Platonism and Christian preaching, yielding a sustained polemic with the Manicheans and rather optimistic views on life and Creation, the body and sexuality, and Hebrew-Judaic tradition not far from Clemens of Alexandria. In a later phase, occasioned by controversy on the opposite front, with such Christian currents as the Pelagians and Donatists, Augustine comes back to heavily anti-Judaic and world-denying ascetic attitudes where is earlier Manichean upbringing seems to emerge again. The tragedy of medieval Christianity will be the later Augustine’s overwhelming influence. A final section is dedicated to the monastic tradition where a curious mixture of world-denying asceticism with an astonishingly penetrating ‘science’ of introspection emerges. -/- 8. Al Farabi and the reconciliation of Islam and Platonism. The Qurān and the qadit, that is, collections of sayings ascribed to the prophet Muhammad contain a wealth of precepts and catalogues of virtues mirroring moral contents from the Jewish and the Christian traditions, among them the basic notion of imitation of the Deity, where mercy is assumed to be its basic trait. An important tradition within Islam, namely Sufism, stressed to the utmost degree the role of mercy, turning Islam into a mystic doctrine centred on retreat from the world, abandonment to God’s will, and a peaceful and fraternal attitude to our fellow-beings. A secular literary tradition originating in the Sassanid Empire, the literature of advice to the Prince had for a time a widespread influence in the newly constituted Arabic-Islamic commonwealth. In a later phase, the legacy of Hellenic philosophy made its way into the intellectual elite of the Islamic world. The first important legacy was Platonic, and the Republic became the main text for Islamic Platonism. Al-Farabi wrote an enjoyable remake of the Platonic Republic, arguing that the citizen’s virtues were the basis on which the political building needs to rest. The secular lawgiver is enlightened by the light of reason in his everyday practice of governance, but room is made for the Prophet as the voice of revealed truth that confirms and completes the rational truth that philosophy may afford. In a second phase also Aristotelian and Stoic influence were assimilated. Miskawayh’s treatise was the masterwork at the time Arabic philosophy reached its Zenith. It is a treatment of the soul’s diseases and their remedies, combining the Aristotelian doctrine of the golden mean with the Stoic doctrine of the passions and elements of Galenic medicine. Towards the eleventh-twelve centuries a war raged among theologians and philosophers, finally won by the former with disappearance of philosophy as such. The newly established mainstream, yet, was no kind of intolerant fanaticism. It drew from the work of mystic theologian Al-Ghazālī, the best heir of Sufism, teaching a tolerant and peaceful attitude to our fellow-beings and a passive attitude to destiny as an expression of the Divine will. -/- 9. Moshe ben Maimon and the reconciliation of Torah and Aristotelian ethics. The encounter between the Talmudic tradition and Hellenic philosophy had taken place a first time in Alexandria at the time of Philo but the two traditions had parted way again. In fact, the kind of Platonic Judaism founded by Philo survived only within Christianity, in the fourth Gospel and then in writings by Clemens of Alexandria. The Talmudic literature had absorbed just less striking traits from the Hellenic Philosophy, namely an idea of ethics as care of the self and a role for the education of character as propaedeutic to theoretical knowledge. In the Arabic-Islamic world, a second round started when Jewish authors writing in Arabic undertook the task to prove the full compatibility of the tradition deriving from Torah and Platonic philosophy. The culmination of this attempt is provided by Moshe ben Maimon who tried to use Aristotelian ethics as a language into which the teaching from the Pirké Avot could be translated. -/- 10. Thomas Aquinas and the reconciliation of Christian morality and Aristotelian ethics. In the first section the fresh start is described of philosophical ethics in Latin Europe at the turn of the Millennium. In a first phase, Anselm and Peter Abelard built on a Platonic and Augustinian legacy. In this phase. remarkable innovations are introduced, including Abelard’s claim of the obliging character of erring consciousness. In a second phase, the rediscovery of Nicomachean Ethics thanks to Latin translation of Arabic versions gives birth to a new wave of ethical studies, recovering the very idea of Aristotelian practical philosophy, with the potential implication of full legitimization of natural morality, i.e. ethics without Revelation. Aquinas’s ethics is a theological ethics out of which it would be vain to try to extract a self-contained philosophical ethics. His treatment of topics in philosophical ethics, yet, does not boil down to repetition of Aristotelian arguments but is rather a creative reshaping of such arguments. For example, he introduces also in the practical philosophy a first principle parallel to the principle of non-contradiction; and he also carries out a synthesis of Aristotelianism, Stoicism, and neo-Platonism. Even though it is essentially moral theology, Aquinas’s doctrine - unlike Augustine – grants full citizenship to "natural" morality, firstly by rejecting the claim that the corruption of human nature due to the original sin is so radical as to leave "pure nature" incapable of moral goodness. The doctrine is presented in a more sophisticated formulation in a few of the Quaestiones, such as De Malo and De Veritate, in the Summa contra Gentes and in the commentaries to Aristotle than in the famous Summa Theologica, but the latter work includes the only or the largest exposition of some decisive part of the theory. Thus, the Summa Theologica should be read for what it is more than criticized for not being what it was not meant to be. It was not meant to be the brilliant synthesis of all that Reason he had been able to produce with what Revelation had added about which the Neo-Thomists used to dream, but rather a manual for the training of preachers and confessors, where theoretical claims are not too demanding and a few serious tensions are left. Besides a jump between the Prima Secundae and the Secunda Secundae, being the former an essay in virtue theory and the latter a handbook for confessors, the most serious tension is perhaps the one between the ethics of right reason presented in most of Ia-IIae and the eudemonistic ethics developed in quaestiones 1-5 of the same part; the alternative ethical theory which also may be found in Augustine, the Stoic view of a cosmic reason eventually coincident with the moral law, was believed by Anselm (followed by John Duns Scotus and William of Ockham) to be incompatible with eudemonism. It is questionable whether Thomas could reduce the tension proving that it is just an apparent tension, in so far as the right reason and bliss derived from knowledge of God tend to coincide, but this is just a conjecture. Thomas’s ethics is a virtue ethic, not a law-based one, and moral judgment focuses on the virtues, particularly charity, not on the commandments and even less on absolute prohibitions; Thomas, however, would not have considered a drastic alternative between law and the virtues such as the one which has been advanced in late twentieth-century philosophy to be justified. Nonetheless, when it discusses ‘special’ virtues, it ceases to be an ethics of virtue and becomes a disappointing and often contradictory discussion of legal and illegal acts. Such a discussion takes most of the time ‘reasonable’ middle positions on controversial issues but not the alternative approach that Aristotelianism would have made possible; even when some occasional Aristotelian claim shows up, such as money’s barrenness as a reason against usury, this seems to be made by an author who apparently ignores the Aristotelian Thomas of the Prima Secundae. It is an ethic of human autonomy which recognizes the binding character of the individual conscience and, potentially, even a duty to disobey unjust laws. It is true that what Thomas writes in his discussion of death penalty and persecution of heretics is simply disgusting, and yet we should blame Thomas the man, not Thomist ethical theory. Finally, Thomas’s ethics is not ethical ‘absolutism’, as both traditionalist Catholic theologians and secularist enemies of dogmatic morality tend to believe. It is instead an ethic of prudential judgment. Exceptions to this approach – or better results of logical fallacies – are such claims as the absolute character of negative precepts and of the existence of "intrinsically evil acts", claims that simply cease to make sense in the light of Thomas’s own distinction between human act and natural act, carrying consequences Thomas did not live long enough to draw or was not consistent enough to dare to draw. -/- 11. Francisco de Vitoria and casuistry. The first topic illustrated is the discussion about the notion of pura natura, namely the human condition after the original sin and before divine revelation. The core notion was already there in Aquinas but was later developed by Caietanus (Thomas de Vio) with a number of interesting implications: firstly a view of human nature as such much more positive than Augustine’s and his followers’ view, including both Calvinists and Jansenists; secondly, the implication that the philosopher’s morality, as opposed to the Christian’s morality, is a quite respectable kind of morality; thirdly, that theocracy and prosecution of the unfaithful lacked justification, with more far-fetching consequences than Aquinas himself had dared to draw. The second topic is casuistry, a new name for a comparatively older way of thinking, which was already there in late Stoicism and Cicero as well as in the Talmudic literature. This is an approach aimed at yielding probable enough solutions for doubtful cases even in absence of completely safe staring points. The genre developed from medieval reference books for confessors and became by the sixteenth-century a sophisticated tool-box for dealing with various fields of applied ethics. Francisco Vitoria, the main authority of Baroque Scholasticism, was a controversial figure, among the proponents of the new discipline of casuistry and a consistent proponent of more separation between the religious and the civil authority, stricter limits to the legitimacy of war, innate rights of non-Christian nations in the New World based on the notion of pura natura, providing a standard of ‘natural’ goodness, previous to revelation, on which the Indian nations were judged to live in a naturally good condition, provided with the institutions of family, justice, and religion had accordingly a right to full respect by Christian sovereigns. Bartolomé de Las Casas, arguing along similar lines, was the leader of a historical battle in defence of the rights of the Indios. -/- 12. Michel de Montaigne and the art of living. A short description of one of the Renaissance Phyrronism, one of the classical philosophies revived in the fifteenth and sixteenth century. Montaigne combines the sceptical epistemology with an understanding of ethics – indeed of philosophy as a whole – in terms of an art of living inspired by two basic ideas, sagesse, that is, practical wisdom as the only kind of rationality available after theology, science, and tradition have declared bankrupt, and an aesthetic ideal of self-transformation through the art of writing and introspection. -/- 13. Pierre Nicole and neo-Augustinianism. The chapter illustrates first the vicissitudes of Augustinianism newly born after the late medieval triumph of Thomist Aristotelianism in the alternative Protestant and Catholic versions processed by the Calvinists and the Jansenists. Then it illustrates the doctrines of Pierre Nicole, Blaise Pascal’s best disciple, on the impossibility of introspection, on the ubiquity of self-deception, on the incurably evil character of the passion of love, and on the two moralities, the one of the man of the world, the morality of honesty which is indispensable for granting peace and order but devoid of any true value for eternal salvation, since the same external behaviour may be prompted by opposite motivations, and the morality of charity, the only true one but also useless to society. The third topic is Pierre Malebranche’s view of self-deception as a ubiquitous phenomenon accounting for human action and responsibility and his reformulated theory of self-love, no less ubiquitous than for Nicole and yet not as incurably evil, given the distinction between morally indifferent and even necessary amour de soi and vicious amour proper, a distinction on which the whole of Rousseau’s moral and political theory rests. -/- 14. Samuel von Pufendorf and the new science of morality. The chapter is dedicated to the discovery of the idea of a ‘new moral science’. Hugo Grotius is discussed first highlighting the real character of his project, much closer to the Thomist idea of a natural law accessible to non-corrupted human reason when human beings are living in a state of pura natura. Then Hobbes’s combination of scepticism, voluntarism, and conventionalism is described and both the continuity with Grotius’s new science, in the search for non-revealed rational morality, and the break with him, in the adoption of voluntarism and refusal of an intellectualist view of natural law, are illustrated. Pufendorf’s work is illustrated as a synthesis of the two previous attempts and the – up to Schneewind underestimated – paradigmatic example of the new science of morality. -/- 15. Richard Cumberland and consequentialist voluntarism. The chapter gives an overview of eighteenth-century Anglican ethics, noticing how the Cambridge tradition gave special weight to natural theology as opposed to positive or revealed theology – and how two Cambridge fellows, John Gay and Thomas Brown, elaborated on Cumberland’s (and Malebranche’s, as well as Leibniz’s) strategy for finding a third way between intellectualist view and voluntarist view of the laws of nature. The result of their elaboration was a kind of a rational-choice account of the origins of natural laws, where a law-giver God chooses among a number possible sets of laws on a maximizing criterion, and God’s maximandum is happiness for his creatures. The chapter notices also how such a solution aimed at solving at once the problem of evil and that of the foundation of moral obligation by proving how God’s choice was justified as far as it was the one minimising the amount of suffering in the world. 16. Richard Price and intuitionism. The chapter describes first the doctrines of the Cambridge Platonists, an example of hyper-rationalist reaction to Calvinism. Secondly it describes the sophisticated and universally ignored – from Sidgwick to Anscombe –version of what was later labelled ‘ethical intuitionism’ – showing how it escapes familiar objections and misrepresentations of intuitionism – from Mill to Rawls – in grounding its argument on transcendental arguments while carefully avoiding recourse to introspection and psychological evidence, which has been taken as a too easy target by critics of intuitionism. Thirdly, the chapter discusses Whewell’s ‘philosophy of morality’, as opposed to ‘systematic morality’, not unlike Kant’s distinction between a pure and an empirical moral philosophy. Whewell worked out a systematization of traditional normative ethics as a first step before its rational justification; he believed that the point in the philosophy of morality is justifying a few rational truths about the structure of morality such as to rule hedonism, eudemonism, and consequentialism; yet a system of positive morality cannot be derived solely from such rational truths but requires consideration of the ongoing dialectics between idea and fact in historically given moralities. Whewell’s intuitionism turns out closer to Kantian ethics than commentators have made us believe until now, and quite different from what Sidgwick meant by intuitionism. -/- 17. Adam Smith and the morality of role-switch. The chapter describes first, Hutcheson’s attempt at basing the ‘new science’ of natural law on different bedrock than Pufendorf and the English Platonists, namely a moral sense, a faculty whose existence is assumed to be proved on an empirical basis. The second step is a reconstruction of Hume’s rejoinder in terms of a new science of man including morality on an ‘experimental’ basis, that is, a ‘Newtonian’ hypothetical-deductive approach, distinguished from Hutcheson’s allegedly uncritical descriptive approach to human nature. The third step is a reconstruction of Adam Smith theory of morality understood as emerging from a spontaneous interplay of exchanges of situations (the most basic meaning of the word ‘sympathy’ as construed by this author). -/- 18. Jeremy Bentham and utilitarianism. The bulk of the chapter is dedicated to the doctrines of Jeremy Bentham. The Enlightenment spirit that suggested the idea of a new morality, free from religion, is illustrated. The notion of utility is illustrated as well as the subsequent formulations of the principle of utility. The idea of felicific calculus is discussed, showing how its inner difficulties prompted several reformulations of the principle of utility in order to avoid undesirable implications of proposed formulations. The role of the thesis of spontaneous convergence between interest and duty is discussed, showing how it left numberless questions open, and the distinction between the virtues of prudence, justice and beneficence is described as a way out of the deadlocks of classical utilitarianism. After Bentham, Mill’s reformed utilitarianism is reconstructed, showing how it is a kind of mixed system – as closer to common sense as it gives up Bentham’s claims to consistency and simplicity – resulting as unintended consequences from the controversies in which Mill was too keen to engage. The hidden agenda of the controversy between Utilitarianism and Intuitionism, going beyond the image of the battle between Prejudice and Reason, is described, showing how both competing philosophical outlooks turn out to be more research programs than self-contained doctrinal bodies, and such programs appear to be implemented, and indeed radically transformed while in progress thanks to their enemies no less than to their supporters. -/- 19. Immanuel Kant, practical reason and judgment. The chapter argues that Kant took from Moses Mendelssohn the idea of a distinction between geometry of morals and a practical ethic. He was drastically misunderstood by his followers precisely on this point. He had learned from the sceptics and the Jansenists the lesson that men are prompted to act by deceptive ends, and he was aware that human actions are also empirical phenomena, where laws like the laws of Nature may be detected. His practical ethics made room for judgment as a holistic procedure for assessing the saliency of relevant moral qualities in one given situation; this procedure yields the same results as the geometry of morals does for abstract cases but does so immediately and without balancing conflicting duties with each other, since what makes for the salient quality of a situation is perceived from the very beginning. Kant's practical philosophy is richer than the received image, making room for an ‘empirical moral philosophy’ or moral anthropology including treatment of commerce, needs, value and price, happiness and well-being; the overall social theory and philosophy of history is less different from Adam Smith's than the received image makes believe; the paradox of happiness is central to Kant's philosophy; a distinction between happiness and well-being is clearly drawn; the distinction plays a basic role in establishing a link between the economic and the moral life. -/- 20. Georg Wilhelm Friedrich Hegel and the critique of abstract universalism. The chapter describes first the Romantic movement and the implications some of its concerns, rescuing passions, community, tradition, the individual as the bearer of a unique destiny, and the longing for organic unity between the individual, mankind and nature. Hegel’s contribution is discussed then, highlighting how, on the one hand, he shared a number of these concerns and on the other he had more rationalist leanings. The notion of morality is the pivotal point of the reconstruction, highlighting how Hegel construes this notion as a key to his own diagnosis of the malaise of modernity – the separation of individual and Gemeinschaft – and how his attack on Kant turns around this very idea. -/- 21. Friedrich Nietzsche against Christianity and the Enlightenment. The chapter illustrates first the idea of deconstruction of the back-world of values. Nietzsche claims to be legitimate heir of the French moralists, Leibniz, Kant and Hegel, in so far as he allegedly carries out to its deepest implications their discovery of what lies behind traditional naïve belief in the existence of an objective realm of values just waiting for description by the philosopher. The two exemplars form which genealogy draws inspiration are the classical philologist’s historical reconstructions of lost meanings and the chemist’s decomposition of elements. Then the genealogy of the notions of good and evil carried out in the first dissertation of Genealogy of morals is illustrated with its paradoxical conclusion that will to power is in fact the only ‘genuine’ kind of goodness. The third point illustrated is the dialectic of ascetism and self-realization with its ambiguous outcome. The suggested interpretation of such outcome is that Nietzsche’s normative ethics is a kind of virtue ethics taking an aesthetic ideal as a normative standard -/- 22. George Edward Moore and ideal utilitarianism. The chapter discusses the ideas of common sense and common-sense morality in Sidgwick. I argue that, far from aiming at overcoming common-sense morality, Sidgwick aimed purposely at grounding a consist code of morality by methods allegedly taken from the natural sciences to reach, also in ethics, the same kind of “mature” knowledge as in the natural sciences. His whole polemics with intuitionism was vitiated by the a priori assumption that the widespread ethos of the educated part of humankind, not the theories of the intuitionist philosophers, was what was worth considering as the expression of intuitionist ethics. In spite of a naïve positivist starting-point, Sidgwick was encouraged by his own approach in exploring the fruitfulness of coherentist methods for normative ethics. Thus, Sidgwick left an ambivalent legacy to twentieth-century ethics: the dogmatic idea of a “new” morality of a consequentialist kind, and the fruitful idea that we can argue rationally in normative ethics albeit without shared foundations. Then it reconstructs the background of ideas, concerns and intentions out of which Moore’s early essays, the preliminary version, and then the final version of Principia Ethica originated. I stress the role of religious concerns, as well as that of the Idealist legacy. I argue that PE is more a patchwork of rather diverging contributions than a unitary work, not to say the paradigm of a new school in Ethics. I add a comparison with Rashdall’s almost contemporary ethical work, suggesting that the latter defends the same general claims in a different way, one that manages to pave decisive objections in a more plausible way. I end by suggesting that the emergence of Analytic Ethics was a more ambiguous phenomenon than the received view would make us believe, and that the wheat (or some other gluten-free grain) of this tradition, that is, what logic can do for philosophy, should be separated from the chaff, that is, the confused and mutually incompatible legacies of Utilitarianism and Idealism. -/- 23. Edmund Husserl and the a-priori of action. The chapter illustrates first the idea of phenomenology and the Husserl’s project of a phenomenological ethic as illustrated in his 1908-1914 lectures. The key idea is dismissing psychology and trying to ground a new science of the a priori of action, within which a more restricted field of inquiry will be the science of right actions. Then the chapter illustrates the criticism of modern moral philosophy carried out in the 1920 lectures, where the main target is naturalism, understood in the Kantian meaning of primacy of common sense. The third point illustrate is Adolph Reinach’s theory of social acts as a key the grounding of norms, a view that basically sketches the very ideas ‘discovered’ later by Clarence I. Lewis, John Searle, Karl-Otto Apel and Jürgen Habermas. A final section is dedicated to Nicolai Hartman, who always refused to define himself a phenomenologist and yet developed a more articulated and detailed theory of ‘values’ – with surprising affinities with George E. Moore - than philosophers such as Max Scheler who claimed to Husserl’s legitimate heirs. -/- 24. Bertrand Russell and non-cognitivism. The chapter reconstructs first the discussion after Moore. The naturalistic-fallacy argument was widely accepted but twisted to prove instead that the intuitive character of the definition of ‘good’, its non-cognitive meaning, in a first phase identified with ‘emotive’ meaning. Alfred Julius Ayer is indicated as a typical proponent of such non-cognitivist meta-ethics. More detailed discussion is dedicated to Bertrand Russell’s ethics, a more nuanced and sophisticated doctrine, arguing that non-cognitivism does not condemn morality to arbitrariness and that the project of a rational normative ethics is still possible, heading finally to the justification of a kind of non-hedonist utilitarianism. Stevenson’s theory, another moderate version of emotivism is discussed at some length, showing how the author comes close to the discovery of the role of a pragmatic dimension of language as a basis for ethical argument. Last of all, the discussion from the Forties about Hume’s law is described, mentioning Karl Popper’s argument and Richard Hare’s early non-cognitivist but non-emotivist doctrine named prescriptivism. -/- 25. Elizabeth Anscombe and the revival of virtue ethics. The chapter discusses the three theses defended by Anscombe in 'Modern Moral Philosophy'. I argue that: a) her answer to the question "why should I be moral?" requires a solution of the problem of theodicy, and ignores any attempts to save the moral point of view without recourse to divine retribution; b) her notion of divine law is an odd one more neo-Augustinian than Biblical or Scholastic; c) her image of Kantian ethics and intuitionism is the impoverished image manufactured by consequentialist opponents for polemical purposes and that she seems strangely accept it; d) the difficulty of identifying the "relevant descriptions" of acts is not an argument in favour of an ethics of virtue and against consequentialism or Kantian ethics, and indeed the role of judgment in the latter is a response to the difficulties raised by the case of judgment concerning future action. A short look at further developments in the neo-naturalist current is given trough a reconstruction of Philippa Foot’s and Peter Geach’s critiques to the naturalist-fallacy argument and Alasdair MacIntyre’s grand reconstruction of the origins and allegedly unavoidable failure of the Enlightenment project of an autonomous ethic. -/- 26. Richard Hare and neo-Utilitarianism. The chapter addresses the issue of the complex process of self-transformation Utilitarianism underwent after Sidgwick’s and Moore’s fatal criticism and the unexpected Phoenix-like process of rebirth of a doctrine definitely refuted. A glimpse at this uproarious process is given through two examples. The first is Roy Harrod Wittgensteinian transformation of Utilitarianism in pure normative ethics depurated from hedonism as well as from whatsoever theory of the good. This results in preference utilitarianism combined with a ‘Kantian’ version of rule utilitarianism. The second is Richard Hare’s two-level preference utilitarianism where act utilitarianism plays the function of eventual rational justification of moral judgments and rule-utilitarianism that of action-guiding practical device. -/- 27. Hans-Georg Gadamer and rehabilitation of practical philosophy. The post-war rediscovery of ethics by many German thinkers and its culmination in the Sixties in the movement named ‘Rehabilitation of practical philosophy’ is described. Among the actors of such rehabilitation there were a few of Heidegger’s most brilliant disciples, and Hans-Georg Gadamer is chosen as a paradigmatic example. His reading of Aristotle’s lesson I reconstructed, starting with Heidegger’s lesson but then subtly subverting its outcome thanks to the recovery of the central role of the notion of phronesis. -/- 28. Karl-Otto Apel and the revival of Kantian ethics. Parallel to the neo-Aristotelian trend, there was in the Rehabilitation of practical philosophy a Kantian current. This started, instead than the rehabilitation of prudence, with the discovery of the pragmatic dimension of language carried out by Charles Peirce and the Oxford linguistic philosophy. On this basis, Karl-Otto Apel singled out as the decisive proponent of the linguistic and Kantian turn in German-speaking ethics, worked out the performative-contradiction argument while claiming that this was able to provide a new rational and universal basis for normative ethics. An examination of his argument is some detail is offered, followed by a more cursory reconstruction of Jürgen Habermas’s elaboration on Apel’s theory. -/- 29. John Rawls and public ethics as applied ethics. Rawls’s distinction between a “political” and a “metaphysical” approach to one central part of ethical theory, namely the theory of justice, is interpreted as a formulation of the same basic idea at the root of both the principles approach and neo-casuistry, both discussed in the following chapter, namely that it is possible to reach an agreement concerning positive moral judgments even though the discussion is still open – and in Rawls’ view never will be close – on the basic criteria for judgment. -/- 30. Beauchamp and Childress and bioethics as applied ethics. The chapter presents the revolution of applied ethics while stressing its methodological novelty, exemplified primarily by Beauchamp and Childress principles approach and then by Jonsen and Toulmin’s new casuistry. -/- . (shrink)

This dissertation analyzes three legal doctrines that regulate unintentional aspects of criminal conduct. Chapter one defends the influence the law grants to an action’s unintended results in determining the extent of the agent’s criminal liability. First, I critique the argument that criminal law’s general mens rea requirement allows a result to affect the extent of a defendant’s criminal liability only if he possesses mens rea with respect to that result. The rules that define offenses and the rules that specify sentences (...) for individual criminal actions each guide conduct, but they do so differently. Effective offense definitions must be framed in terms of mental states, but effective sentencing rules need not be; therefore, mens rea must set the limits of liability, but the extent of liability need not depend on mens rea alone. Second, I argue that sentencing rules can most effectively guide offenders to reduce the risk that their offenses will unintentionally cause harm if those rules grade the seriousness of each offense based on its results, since the primary alternative, grading offenses based on their risk, requires methods of measuring and communicating risk that exceed the capacities of the criminal justice system. While chapter one addresses the extent of liability, chapters two and three address its scope: each presents an account of one of the two types of mens rea used to define unintentional crimes. Recklessness, the subject of chapter two, is often analyzed as requiring defendants to possess a belief (or similar mental state) directed towards the degree of risk an action creates. Defining offenses in terms of an agent’s beliefs about risk, however, guides individuals to evaluate actions in deliberation by estimating the degree of risk they create. And because individuals ordinarily cannot estimate risks accurately, such rules will not effectively guide them to reduce harm. Effective rules, I will argue, must identify prohibited actions in a different way—namely, through the features of those actions that make them unreasonably risky. The definition of recklessness does not itself identify those features directly; instead, by requiring individuals to comply with the standard of conduct of the law-abiding person, recklessness indirectly incorporates into law the social norms that regulate dangerous activities. To be reckless, then, defendants must recognize the features of their conduct in virtue of which it violates such a norm. Finally, chapter three analyzes negligence. Criminal negligence is paradoxical: even though culpability ordinarily requires advertence, negligent defendants are typically understood to be culpable for a risk they inadvertently create. Rather than rejecting culpability for negligence or expanding culpability beyond advertence, I dissolve the paradox by reconceptualizing negligence. Negligent defendants are culpable despite their failure to perceive one risk because they advert to a different risk—the risk that by failing to inquire before acting they will fail to uncover evidence of the risk that they do, in the end, actually fail to perceive. Negligence is epistemic recklessness, the culpable disregard of the risk of inadvertently performing a risky action. Though negligence, like recklessness, involves advertence to risk, it constitutes a distinct form of mens rea because it regulates a different aspect of conduct—the decision to inquire rather than the decision to act. And because omitting inquiry creates only a risk of a risk, negligence is systematically less risky than recklessness, and therefore less culpable. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Women and Health Research:A Report from the Institute of MedicineAnna C. Mastroianni (bio), Ruth Faden (bio), and Daniel Federman (bio)In recent years, claims have been made by segments of the research community and by women's health advocacy groups that clinical research practices and policies have not benefitted women's health to the same extent as men's health. Central to these claims has been an assertion that women have been inadequately (...) represented as subjects of clinical studies and that as a result neither health conditions unique to women—e.g., menopause—nor women's manifestations of health problems affecting both sexes—e.g., heart disease—have been investigated sufficiently.The scientific community, including federal agencies that sponsor and regulate clinical studies, is increasingly responsive to these claims and is taking steps to raise the level of women's participation in clinical studies. Controversy and concern have surrounded these actions, however. Two of the claims that have been made are: (1) that women are more difficult to study than men because of their cyclical hormonal changes; and (2) that conducting gender-specific subgroup analyses would increase the size of study populations, raise the cost of studies, and thereby reduce the number of studies that could be performed with the limited resources available. In addition, controversy over the inclusion of women of childbearing potential and pregnant women has been particularly salient. Concerns have been expressed about avoiding potential harm to existing or potential fetuses and about the possible legal and financial ramifications of such harm. A further concern involves the perceived difficulties in enrolling women in studies and retaining them for the duration of the studies.Against this backdrop, the Office of Research on Women's Health at the National Institutes of Health (NIH) asked the Institute of Medicine (IOM) in October 1992 to establish the Committee on the Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies. The Committee's charge was to: (1) consider the ethical and legal implications of including women, particularly pregnant women and women of childbearing potential, in clinical studies; (2) examine known instances of litigation regarding injuries to research subjects [End Page 55] and describe existing legal liabilities and protections; and (3) provide practical advice on these issues for consideration by NIH, institutional review boards (IRBs), and clinical investigators.The 16 Committee members came from diverse backgrounds: bioethics, law, epidemiology and biostatistics, public health policy, obstetrics and gynecology, clinical research, pharmaceutical development, social and behavioral sciences, and clinical evaluative sciences.1 Chaired by two of the authors of this article, Ruth Faden and Daniel Federman, and coordinated by the third, IOM Study Director Anna Mastroianni, the Committee met five times over a fourteen-month period, convened a one-and-one-half day invitational workshop, and commissioned several background papers. The Committee's deliberations were complicated by the announcement of new federal policies late in its term. Specifically, the Food and Drug Administration (FDA) issued guidelines (FDA 1993) to replace its 1977 guidelines, which prohibited the inclusion of women of childbearing potential in early phases of most clinical drug trials. In addition, Congress passed the NIH Revitalization Act of 1993 (P.L. 103-43), which contains provisions mandating the inclusion of women and racial and ethnic minorities in NIH-sponsored clinical research. In February 1994, the IOM Committee publicly issued its final report and recommendations, Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, publishing the workshop presentations and commissioned papers in a separate volume.Deliberations of the CommitteeA number of issues arose at the outset as the Committee considered its charge. A few members initially believed that verification of the underrepresentation of women relative to men in clinical studies as a whole was a prerequisite to providing policy recommendations. Others believed that such an examination would be an important contribution to the knowledge base, but that it was not necessary for addressing the Committee's charge. As summarized in the Committee's report, the Committee's research indicated that firm conclusions about the relative underrepresentation of women could not be drawn from the available data because of the lack of systematic information... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Nature and Altering It, and: Keeping God’s Earth: The Global Environment in Biblical PerspectiveJohn SniegockiNature and Altering It Allen Verhey Grand Rapids, Mich.: Eerdmans, 2010. 150 pp. $15.00.Keeping God’s Earth: The Global Environment in Biblical Perspective Edited by Noah Toly and Daniel Block Downers Grove, Ill.: IVP Academic, 2010. 300 pp. $25.00.Both of the books under review focus on how Christians should relate to the rest of God’s (...) creation. The first book, Nature and Altering It, is based on Allen Verhey’s 2008 Jellema Lectures at Calvin College. It is a rather brief book, which retains much of the lecture style. The purpose of the book is to explore how Christians should relate to the natural world. In the opening chapter, Verhey provides sixteen different definitions of “nature,” opting himself for a definition of nature as “everything but God” (12). Verhey further contends that any definition of nature is necessarily embedded in a broader vision or myth. In the second chapter he explores and critiques some of the dominant myths of our time, such as the “Baconian myth,” the “myth of the project of liberal society,” and the “myth of the project of capitalism.” These myths, he argues, together contribute to an instrumental view of nature, the priority of short-term economic interests, and a rather blind faith in science-technology and unlimited economic growth.In contrast to these and other myths and their harmful social and ecological consequences, Verhey stresses the importance of the “myth of the Christian Scriptures” (12). Among the central biblical themes he highlights are the distinction between God and creation and the prohibition of all forms of idolatry, including idolatry of science and technology, of economic growth, or of nature itself. Verhey also emphasizes the goodness of creation, creation’s promised future eschatological perfection, God’s deep concern for the poor and marginalized, and the vocation of humans to image God’s care for the world. “We image God,” Verhey states, “in self-giving, in practices of caring for and affirming the existence of the other, including the non-human other” (86–87).While focusing especially on the importance of narrative and storytelling, arguing that “the biggest danger for the Christian community is forgetfulness” [End Page 220] (120), Verhey also stresses the need for prophecy, wisdom, analysis, and policy work. Each should be shaped by the Christian narrative and give rise to actions that “already give some little token” of the fullness of shalom that is God’s promised future for humanity and creation (121). Among the specific ecological actions that Verhey recommends are planting a garden, living simply, prioritizing energy efficiency, and working for policy changes that will foster ecological sustainability.The volume Keeping God’s Earth, edited by Noah Toly and Daniel Block, explores from an evangelical Christian perspective the same basic question of how humans are to properly relate to God’s creation. The book begins with a chapter titled “Eschatology and Environmental Ethics,” followed by four paired sets of chapters exploring the topics of cities, biodiversity, water, and climate change. The first essay of each pair provides a factual overview of the topic. The second explores biblical theology relevant to the topic. The book concludes with an essay on environmental ethics and an afterword exploring the theme of Christ as “Gardener-King.”The four chapters that present factual overviews of ecological problems are very helpful, providing important background information upon which informed theological and ethical reflection depends. The chapter by renowned climatologist Sir John Houghton on global climate change is especially useful, highlighting the urgency of rapidly reducing greenhouse gas emissions and explaining why taking a “wait and see” attitude should be understood as morally irresponsible. “The truth is,” asserts Houghton, “that our global environment is deteriorating at an alarming rate, and unless we admit our destructive behaviors and seek more sustainable responses... our children’s children will have very little hope for a future” (189). Acknowledging such dire realities, David Gushee, in the book’s concluding chapter on ecological ethics, stresses that attention to ecology can be properly seen as the most pressing moral challenge that humanity faces. Ecological... (shrink)

This special issue examines critical ethical, legal, and policy debates surrounding brain trauma in sport, focusing on challenges in concussion management practices and protocols. Brain injury concerns extend beyond traditional contact sports like boxing, encompassing sporting activities involving rapid acceleration, deceleration, and surface impacts, such as cycling and equestrian sports. Among such problems are the identification and management of brain injuries, the roles of officials and healthcare professionals, and the broader implications for sport integrity and athlete careers. The special issue (...) is organized into four sections: ethics of concussion medicine, socio-legal aspects, sport ethical dimensions, and public health policies. Contributions discuss concussion management in youth sport, sport federations’ and athletes’ duties involvement in concussion-related research, strategies to support and enhance athlete autonomy, public health-informed brain injury frameworks, conflict of interest in concussion management protocols, litigation and liability in concussion research and collaboration, race and genomics in brain-injury scientific discourses, rule changes in sport to reduce head impact, the contextual nature of brain injury and athlete decision-making, the ethical use of genetic testing in brain-injury related research, marketing strategies to advertise tackle football to children and adolescents, and policy purposes and evidence underpinning concussion management practices. This comprehensive exploration offers diverse disciplinary insights, making it a crucial resource for sport humanities scholars, policymakers, and medical professionals. Keywords: brain injury, sport ethics, concussion, sport law, sport policy. (shrink)

In the UK, it has been proposed that alongside the current advice to abstain from alcohol completely in pregnancy, there should be increased screening of pregnant women for alcohol consumption in order to prevent instances of fetal alcohol spectrum disorder. The Scottish Intercollegiate Guidelines Network published guidelines in 2019 recommending that standardised screening questionnaires and associated use of biomarkers should be considered to identify alcohol exposure in pregnancy. This was followed in 2020 by the National Institute for Health and (...) Care Excellence Draft Quality Standard, which recommended that pregnant women should have information on their alcohol consumption recorded throughout their pregnancy and this information transferred to the child’s health records. Most recently, Public Health England has stated that the alcohol intake of all women should be recorded throughout pregnancy, not just at the initial booking appointment and that tools such as blood biomarkers and meconium testing should be researched in order to determine true prevalence rates of alcohol in pregnancy. We argue that this proposed enhanced screening undermines women’s autonomy and their legal right to be sufficiently informed to consent to screening. We argue that there is no evidence that this kind of screening will result in a reduction of fetal harm and there is a danger that undermining the autonomy of women and the trust relationship between women and healthcare professionals may even increase harm to future children. (shrink)

The Canadian residential sector contributes approximately 80 megatons of GHGs to the environment yearly. With the ratification of Kyoto Protocol, Canada has committed to reduce its 1990 GHG emission levels by at least 5% between 2008 and 2012. To meet this target, Canada must evaluate and exploit all feasible means to reduce fossil fuel energy consumption and GHG emissions. Test-case Canadian houses were modeled in the building-energy simulation software ESP-r. Requisite housing stock data were extracted from Canada's residential end-use (...) energy surveys. Photovoltaic and wind-turbine energy systems were assessed for their contribution to electricity generation and GHG savings. Typical household electrical consumption versus renewable electricity generation was assessed to estimate the GHG reduction, cost saving in electricity, and the impact of these technologies on single detached houses. With the use of net-metering, 100% of electricity requirements can be met by these technologies in certain cases, resulting in significant reductions in GHG emissions. (shrink)

There is a growing literature in neuroethics dealing with the problem of cognitive neuroenhancement for healthy adults. However, discussions on this topic have tended to focus on abstract theoretical positions while concrete policy proposals and detailed models are scarce. Furthermore, discussions tend to rely solely on data from the US, while international perspectives are mostly neglected. Therefore, there is a need for a volume that deals with cognitive enhancement comprehensively in three important ways: a) with conceptual implications stemming from different (...) points of view; b) with ethical, social and legal perspectives that would not be limited to one part of the world but reflect on the current situation in countries in Africa, Asia, Australia, Europe, North America and South America; and c) with discussions of concrete law and policy options. Contributors for the conceptual implications section will elaborate an important general issue (e.g. ethical acceptability of direct-to-consumer-marketing in case of cognitive enhancement drugs). Contributors for international perspectives section will provide a clear discussion on normative issues and cultural values, along with an analysis of empirical data on public attitudes on cognitive enhancement and/or prevalence (specific to the country in question). Contributors for law and policy section will offer a justification for the general policy type they argue for (1. prohibition, 2. discourage use, 3. laissez-faire, 4. encourage use, and 5. mandatory use) in the case of specific cognitive enhancement measure. Furthermore, they would evaluate the possible impact of a detailed regulatory model on consumption and demand, fairness in competitive settings and the social pressure to enhance. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Atonement, Justice, and Peace: The Message of the Cross and the Mission of the Church by Darrin W. Snyder Belousek, and: Restorative Justice: Theories and Practices of Moral Imagination by Amy LevadDana ScopatzReview of Atonement, Justice, and Peace: The Message of the Cross and the Mission of the Church DARRIN W. SNYDER BELOUSEK Grand Rapids, MI: Eerdmans, 2012. 668 pp. $55.00Review of Restorative Justice: Theories and Practices of (...) Moral Imagination AMY LEVAD El Paso, TX: LFB Scholarly Publishing, 2012. 300 pp. $80.00In Atonement, Justice, and Peace and Restorative Justice, the authors advocate for a restorative conception of justice, which they oppose to the “normal” retributive concept. Amy Levad draws on Aristotle and the virtue ethics tradition to write about “moral imagination” and restorative justice. Darrin Belousek uses Thomas Kuhn’s language to write about a “paradigm shift” in our understanding of theological themes relevant to restorative justice. Both contrast the restorative imagination or paradigm with a retributive one, although Levad also contrasts restoration with rehabilitation. Levad limits her study to restorative justice as [End Page 214] practiced in the criminal justice system, while Belousek expands his work to consider the Bible, theology, and multiple issues in society and in the church.Levad begins her book by discussing Aristotle’s idea of justice as equity, which she points out requires more discernment from judicial decision makers than it requires the algorithmic application of laws. In order for them to enact justice as equity, she argues, decision makers need a “vivid and expansive” moral imagination. Toward this end, she brings together two traditions: Aristotelian virtue ethics and modern literature on moral imagination. At the heart of her work is an ethnographic study intended to determine whether there are practices of restorative justice that can foster such a vivid and expansive moral imagination. After observing and interviewing participants in restorative justice programs in Colorado, Levad examined the narratives, metaphors, and symbols they used in order to determine whether and how they demonstrated a distinctively restorative moral imagination. Because the scope of her study was limited, and because she had difficulty getting a wide spectrum of roles involved in restorative justice to participate in the study, Levad’s results are more suggestive than conclusive. She acknowledges that we cannot generalize from them; although she draws on research methods from sociology and criminology, her findings do not meet their standards of evidence. Thus, the book’s greatest value lies in the recommendations it makes for further study. Empirical studies of the effectiveness of restorative justice practices have tended to focus on either reducing recidivism or the satisfaction of participants with the process. Levad brings to the fore two questions that have so far not been explored in previous research. First, how do restorative justice practices affect the moral imagination? And second, what effect might those practices have on ethical discernment? Her book takes some hopeful initial steps in addressing those questions.Although Levad writes as a Christian ethicist, she did not explicitly incorporate theological reflection into her study of state-sponsored programs. Belousek, by contrast, takes on an explicitly theological project of evaluating how interpretations of the significance of the cross of Jesus interact with such things as support for capital punishment, just war, and market economics. Since Belousek’s book is wide-ranging, this review will concentrate on the task it has in common with Levad’s book: that of reconceptualizing justice.In a fashion parallel to Levad’s use of Aristotle’s notion of justice as equity, which sometimes departs from strict legal justice, Belousek cites Paul’s vision of God’s justice “irrespective of” or “apart from” the law (372). Belousek begins by linking penal-substitutionary atonement theory to capital punishment, just war, and exchange economy in a single “paradigm,” arguing that they are all under-girded by what he calls the “Retributive Principle” (28). He then challenges this paradigm’s appropriateness for Christianity on biblical and doctrinal grounds. After examining arguments in favor of penal-substitutionary atonement in detail—drawing on the works of J. I. Packer and Thomas Schreiner, among [End Page 215] others—he turns to the scriptures cited in support... (shrink)

Background In 2021, Spain became the first Southern European country to grant and provide the right to euthanasia and medically assisted suicide. According to the law, the State has the obligation to ensure its access through the health services, which means that healthcare professionals’ participation is crucial. Nevertheless, its implementation has been uneven. Our research focuses on understanding possible ethical conflicts that shape different positions towards the practice of Medical Assistance in Dying, on identifying which core ideas may be underlying (...) them, and on suggesting possible reasons for this disparity. The knowledge acquired contributes to understanding its complexity, shedding light into ambivalent profiles and creating strategies to increase their participation. Methods We conducted an exploratory qualitative research study by means of semi-structured interviews (1 h) with 25 physicians and nurses from primary care (12), hospital care (7), and palliative care (6), 17 women and 8 men, recruited from Madrid, Catalonia, and Andalusia between March and May 2023. Interviews were recorded, transcribed, and coded in Atlas.ti software by means of thematic and interpretative methods to develop a conceptual model. Results We identified four approaches to MAiD: Full Support (FS), Conditioned Support (CS), Conditioned Rejection (CR), and Full Rejection (FR). Full Support and Full Rejection fitted the traditional for and against positions on MAiD. Nevertheless, there was a gray area in between represented by conditioned profiles, whose participation cannot be predicted beforehand. The profiles were differentiated considering their different interpretations of four core ideas: end-of-life care, religion, professional duty/deontology, and patient autonomy. These ideas can intersect, which means that participants' positions are multicausal and complex. Divergences between profiles can be explained by different sources of moral authority used in their moral reasoning and their individualistic or relational approach to autonomy. Conclusions There is ultimately no agreement but rather a coexistence of plural moral perspectives regarding MAiD among healthcare professionals. Comprehending which cases are especially difficult to evaluate or which aspects of the law are not easy to interpret will help in developing new strategies, clarifying the legal framework, or guiding moral reasoning and education with the aim of reducing unpredictable non-participations in MAID. (shrink)

This essay describes the background and possible reasons for legal intervention in the use of lime in the early bleaching industry and draws on the Statutes at Large and other Acts of Parliament as primary sources. The developing chemical knowledge that may have contributed to the later Acts of repeal is also considered in some detail. The earliest noted prohibition was in 1633 and the years 1823, 1825, and 1828 were important repeal dates. No related legislation later than 1828 (...) has been found. During the period from 1633 to 1828 there were many renewals and modifications to existing laws concerning linen and hempen manufacture; several of these contained subsections regarding bleaching. The considerable number of such Acts may account for the apparent confusion shown by earlier authors on this subject. Furthermore, the various Acts passed by the Irish House of Commons over its lifetime from 1400 to 1800, with its many interruptions, were published in a limited number of editions and are consequently held by few libraries. Ireland instituted its own laws and it was only after the Act of Union in 1800 that matters were dealt with by Westminster. Indeed, earlier historians have not always appreciated that, at certain periods of the history of the United Kingdom, Ireland and Scotland had their own separate parliaments. (shrink)

Can Covid-19 vaccines be used off-label? Should they be? These were questions on the minds of parents, pediatricians, and the media when the FDA fully approved the Pfizer-BioNTech Covid-19 vaccine for people aged 16 and up. Yet the American Academy of Pediatrics cautioned against pediatric off-label use of the vaccine, and the CDC Covid-19 Vaccine Provider Agreement appears to prohibit it. After briefly contextualizing ethical and legal precedents regarding off-label use, we offer an analysis of the ethical permissibility of and (...) considerations for pediatric off-label Covid-19 vaccination based on individual benefits, risks, and available alternatives. Our analysis challenges the ethics of a blanket prohibition on off-label pediatric Covid-19 vaccination, as it limits clinician ability to provide care they may determine to be clinically and ethically appropriate. At the same time, our analysis acknowledges that Covid-19 creates population-level ethical considerations that are at times in tension with individual health interests. (shrink)

Background In the Netherlands, using drugs to deliberately end the life of a severely defective newborn baby who is in extreme suffering can be permissible under very precise circumstances. This does not mean that all Dutch neonatologists are willing to engage in such behaviour. This paper discusses the use of neuromuscular blockers (NMBs) in connection with abstention decisions in neonatology and the boundaries between ‘deliberate ending of life’ and other end-of-life decisions. These boundaries are of paramount importance because, of (...) all end-of-life decisions, only ‘deliberate ending of life’ must be reported by the responsible doctor and exposes him to the risk of being prosecuted. Methods 14 Dutch neonatologists were presented with a hypothetical case of a severely asphyxiated baby who faces a long dying process after withdrawal of ‘medically futile’ (zinloos) life-sustaining ventilation. Doctors were asked whether it is acceptable to administer NMBs in this situation and whether such behaviour should be reported. Results and conclusions Doctors' responses were heterogeneous, showing that the acceptability of using NMBs in certain situations and the boundaries between end-of-life decisions are currently a subject of discussion among Dutch neonatologists. Many respondents reported feeling threatened by the potential involvement of the criminal law authorities in the system of control over ‘deliberate ending of life’. (shrink)

Given the costs of litigation high-profile court cases about withdrawing life-sustaining medical treatment for seriously ill children in England & Wales tend to be followed by discussion about how to avoid similar cases in future. Whilst two proposals, mediation and replacing the best interests standard with a harm threshold, have received broad attention, a proposal to replace the court by a specialist review committee has not been further investigated. This article analyses the effects of a putative replacement of the courts (...) by a specialist review committee using the process enacted by the futility clauses in the Texas Advance Directives Act (TADA) as a model. Under TADA life-sustaining treatment may legally be withdrawn when a review committee deems it futile and no alternative healthcare provider can be identified. The investigation finds that installing a national review committee with the power to decide whether life-sustaining treatment is futile would have reduced the number of court cases about withdrawal thereof in England & Wales to a handful over the last 3 decades. In addition to shorter procedures and costs savings, a national review committee modelled after TADA would have advantages for both clinicians and parents. Advantages for clinicians are more limited exposure to delivery of clinical care that may cause moral distress and less exposure to adverse press and social media content. Advantages for parents are that the process would establish them as ethical decision makers and offer the possibility of a transfer of the care of the child provided an alternative healthcare provider can be found. As such decisions taken by a specialist review committee may be more acceptable for parents than those of the courts. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:To Be or Not to Be:Waiving Informed Consent in Emergency ResearchCharles R. McCarthy (bio)The requirements for prior, legally authorized informed consent constitute a necessary condition for recruiting subjects into biomedical or behavioral research. However, informed consent requirements pose a serious problem for most research conducted in emergency care settings. For this reason, the Food and Drug Administration's (FDA) regulations governing investigational devices and the Department of Health and Human (...) Services' (HHS) regulations for the protection of human subjects allow narrow exceptions to the general requirements of informed consent. In a joint effort to clarify the applicability of the current FDA regulations and to better understand the intent of the HHS regulations as they apply to emergency research, the FDA and the National Institutes of Health (NIH) cosponsored a public forum on the ethical conduct of emergency research in January 1995.Although the forum was not designed as a consensus conference and participants vigorously disagreed on some of the details, a broad consensus emerged on several major points: (1) both HHS and FDA regulations should, in the immediate future, be interpreted to allow for randomized clinical trials in emergency situations so long as the subjects are carefully protected; and (2) consideration should be given to producing new, closely harmonized regulations from both agencies that will provide greater clarity concerning what kinds of emergency research may be allowed without obtaining prior informed consent.The FDA-NIH forum in January was occasioned primarily by controversy about the hypothermia research protocol described below, but it is obvious that many other kinds of emergency research also await the outcome of deliberations concerning waiver of informed consent in emergency situations. These include research into the care and treatment of: occlusive stroke; subarachnoid hemorrhage due to intracranial aneurysm; metabolic coma; status epilepticus; cardiac arrest; myocardial infarction; cardiac arrhythmia; hemorrhagic shock; pulmonary embolism; acute asthmatic attack; and poisoning. All of these conditions [End Page 155] are encountered in emergency settings where obtaining informed consent from the patient-subjects to participate in research is seldom possible, and obtaining consent from legally authorized representatives of the subjects is either not feasible, or, if obtained, is of doubtful validity.The Hypothermia Research Case and HHS RegulationsA $7.2 million grant for research on the use of hypothermia in the treatment of severe head trauma, the largest award ever made to the University of Texas Health Sciences Center at Houston, is in danger of expiring before the study is completed. The protocol, which involves the use of cooling blankets to induce hypothermia in patients suffering from severe head injuries, is designed to test the hypothesis that: "Early lowering of the body temperature of patients suffering from severe head trauma to approximately 91 degrees Fahrenheit will slow patients' metabolism and will/will not, as a consequence, reduce the rates of both morbidity and mortality in these patients." The protocol was approved by seven Institutional Review Boards (IRBs), each of which waived the requirement to obtain informed consent from research subjects in accordance with Sec. 46. 116(d) of the HHS Regulations for the Protection of Human Subjects.1However, NIH's Office for Protection from Research Risks (OPRR), which is responsible for assuring compliance with the HHS regulations, has taken a controversial regulatory position by requiring informed consent from a legally authorized representative of each subject to be entered in the hypothermia trial. Because the obtaining of surrogate consent has proved to be very difficult, OPRR's position has slowed the research to a point where it may have to be terminated.At issue in the controversy is a fundamental question of ethics and public policy. Is it ever permissible to involve incompetent subjects in research without either their consent, or the consent of their legally authorized representatives? Pertinent HHS regulations for the protection of human subjects seem to answer the question affirmatively by allowing local IRBs to waive some or all of the elements of informed consent under carefully limited circumstances (45 CFR 46 116(d)). Nevertheless, OPRR has signalled the research community that use of the informed consent waiver provision for the Houston hypothermia study is not permitted under the regulations. OPRR judged that the risks... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Update on Waiving Informed Consent in Emergency ResearchCharles R. McCarthyMadam: The closing statement of my article on Waiving Informed Consent in Emergency Research published in the June 1995 issue of the Kennedy Institute of Ethics Journal was: "No doubt we shall hear more of this issue."Indeed, we have heard much more on this issue. (1) In May 1995, after my article had already gone to press, the Food and (...) Drug Administration (FDA) and the National Institutes of Health (NIH) jointly published a report on the Public Forum on Informed Consent in Clinical Research Conducted in Emergency Circumstances. (2) On July 26, 1995, the Department of Health and Human Services (HHS) published in the Federal Register a Notice of Action Related to Emergency Research Activity (60 FR 38353-54). This action constituted a waiver of the requirement to obtain prior informed consent from subjects, as required by the Department's Regulations for the Protection of Human Subjects (45 CFR 46), for one specific NIH-funded project under strictly defined circumstances. (3) On September 21, 1995, FDA published a proposed rule to amend its current informed consent regulations (21 CFR 50) to permit harmonization of federal policies on emergency research and to reduce confusion as to when such research can proceed without obtaining prior informed consent from research subjects. The proposed regulation provides a narrow exception to the requirement for obtaining and documenting informed consent from each human research subject.The HHS waiver (a harbinger of a proposed amendment to its regulations) and the FDA proposed rule are intended to be harmonized so that an Institutional Review Board (IRB) in compliance with one set of regulations relative to the waiver of informed consent will be, ipso facto, in compliance with the other set of regulations.In brief: The FDA proposed amendments will allow an IRB to waive informed consent in emergency situations when:1. The human subjects are in a life threatening condition;2. Obtaining informed consent is not feasible because: (i) the subjects will not be able to provide consent because of their medical condition, (ii) the intervention must be administered before consent from legally authorized representatives is feasible, (iii) there is no reasonable way to identify prospectively the individuals likely to become eligible for the research because the emergence of the condition to be studied cannot be predicted reliably in particular individuals; [End Page 385]3. The opportunity to participate is in the interest of the subjects because: (i) a life threatening situation necessitates intervention, (ii) the risk of the intervention is reasonable in the light of what is known about the medical condition and the patient, the risks and benefits of current therapy, if any, and what is known about the risks and benefits of the proposed intervention or activity;4. The research could not practicably be carried out without the waiver;5. Additional protection of the rights and welfare of the subjects will be provided including, at least: (i) consultation (which may include consultation carried out by the IRB itself) with representatives of the communities from which the subjects will be drawn, (ii) public disclosure prior to commencement of the study sufficient to describe the study and its risks and benefits, (iii) public disclosure of sufficient information following completion of the study to apprise the community and researchers of the study and its results, and (iv) the establishment of an independent data and safety monitoring board;6. The IRB has reviewed and approved an informed consent document for use with subjects or legal representatives in situations in which obtaining such consent may be feasible for some subjects.The preamble to the proposed amendments to the regulations and the amendments themselves contain much more information than is presented here. Readers are therefore encouraged to study the proposals carefully. The public comment period ended November 6, and the FDA is expected to issue a final rule in 1996.Charles R. McCarthyKennedy Institute of Ethics Georgetown University Washington, DCCopyright © 1995 The Johns Hopkins University Press... (shrink)

Background Cardiopulmonary resuscitation and subsequent care are subject to various ethical and legal issues. Few studies have addressed ethical and legal issues in post-resuscitation care. Objective To explore nurses’ experiences of ethical and legal issues in post-resuscitation care. Research design This qualitative study adopted an exploratory descriptive qualitative design using conventional content analysis. Participants and research context In-depth, semi-structured interviews were conducted in three educational hospital centers in northwestern Iran. Using purposive sampling, 17 nurses participated. Data were analyzed by conventional (...) content analysis. Ethical considerations The study was approved by Research Ethics Committees at Tabriz University of Medical Sciences. Participation was voluntary and written informed consent was obtained. For each interview, the ethical principles including data confidentiality and social distance were respected. Findings Five main categories emerged: Pressure to provide unprincipled care, unprofessional interactions, ignoring the patient, falsifying documents, and specific ethical challenges. Pressures in the post-resuscitation period can cause nurses to provide care that is not consistent with guidelines, and to avoid communicating with physicians, patients and their families. Patients can also be labeled negatively, with early judgments made about their condition. Medical records can be written in a way to indicate that all necessary care has been provided. Disclosure, withdrawing, and withholding of therapy were also specific important ethical challenges in the field of post-resuscitation care. Conclusion There are many ethical and legal issues in post-resuscitation care. Developing evidence-based guidelines and training staff to provide ethical care can help to reduce these challenges. (shrink)

The United States has the fastest growing prison population in the world, and elevated incarceration rates, substance use, and human immunodeficiency virus (HIV) prevalence are fueling each other. Yet without a national guideline mandated for HIV care within the prison system, standards for state and federal prisons vary greatly.

Major neurocognitive changes occur during adolescence, making this phase as one of the most critical developmental period of life. Furthermore, this phase in life is also the time in youth substance use has its onset. Several studies demonstrated the differential associations of alcohol and cannabis use concerning the neurocognitive functioning of both males and females. Past and contemporary literature on gender-specific effects in neuroscience of addiction is predominantly based on cross-sectional datasets and data that is limited in terms of (...) measurement variability. Given the importance of gender-specific effects in addiction studies, and in order to address the two above-mentioned gaps in the literature, the present study aimed to compare neurocognitive functioning of male and female adolescents in the context of cannabis and alcohol use, while employing a longitudinal design with multiple repeated measurements. Participants were 3,826 high school students (47% female; mean age, 12.7), which were recruited from 31 high schools in the greater Montreal area. Participants were requested to complete annual surveys for five consequent years, from 7th to 11th grade, assessing their alcohol/cannabis use and neurocognitive functioning (working memory, delayed recall memory, perceptual reasoning, and inhibition control). The analytical strategy was focused on the longitudinal association between each predictor (female, male) and each of the outcomes (domains of neurocognitive functioning). Multilevel linear models assessed the association of alcohol and cannabis consumption and the four domains of neurocognitive functioning. Results revealed a gender by within-subject interaction, suggesting a weaker effect of yearly fluctuation of cannabis use on working memory among males compared to females. Our findings suggest a different pattern of neurocognitive impairment of female and male working memory after using cannabis over the course of adolescence. Early initiation of cannabis use potentially results in more spatial working memory deficits in female adolescents. This may negatively influence young females’ capacity in academic settings and lead to significant impairment in adulthood, which critically decreases the individual’s quality of life. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Death: A Persistent Controversial StateKevin Wm. Wildes S.J. (bio)Along with the moral questions surrounding research and experimentation, the moral questions of death and dying have ranked among the most central and formative sets of issues for the field of bioethics. While the questions of death and dying have a long history (Wildes 1996), the attempt to address them as secular questions is an element of what established bioethics as (...) a field of inquiry.The controversies of death and dying are not only formative of bioethics, but also are among the most persistent bioethical controversies. Today, almost 30 years after the Harvard Ad Hoc Committee’s definition of death and 20 years after the Quinlan decision, the questions of death and dying are still with us. Recently, the question of physician-assisted suicide once again gained national [End Page 378] attention with the trials of Dr. Kevorkian and the decisions of the Ninth and Second Circuit Courts on the constitutionality of the Washington and New York state laws prohibiting physician-assisted suicide. At the same time, questions and controversies about the appropriate extent of treatment and the determination of death in relationship to treatment continue to be problematic in health care.As I reviewed the literature in the area of death and dying, one central question emerged: Why, after so much reflection, energy, and discussion, do the problems around death and dying continue to persist? There is a recurring character to these questions that is indeed a wonder. In reviewing these moral controversies, one might ask what these controversies and their persistent character tell us about bioethics that can help us to understand the issues and the field.Some might blame the development of medical technology for the persistence of these issues of death and dying. The development and use of technological resources certainly is an important element of these continuing controversies. The use of medical technologies at the end of life allows us the possibility to sustain lives that would have been lost just a few decades ago. However, while medical technology certainly opens new horizons and possibilities, the development and deployment of technology does not sufficiently explain why these issues are so difficult and persistent. The question underlying the use of medical technology at the end of life is the question about which criteria are to be used to make judgments about the appropriate use of such technology. If the use of medical technology depends on the moral views one holds about death, suffering, and the appropriate use of resources, then such issues will be morally controversial in a society that is morally pluralistic.To address these questions, it is important to remember what is all too obvious and yet often forgotten. Death is not only a medical event. In this century, particularly in the last 40 years, we have reduced death to a medical event, yet, the medical meanings do not exhaust the event (see Engelhardt 1996, pp. 189–238). Death is also a social, cultural, and often religious event and the medical realities of death must be interpreted within these different contexts. As such, death will be the locus of different meanings and interpretations. By keeping these different structures of interpretation in mind, we are better able to understand why controversies around death and dying persist. Just as the meaning of death will vary from culture to culture, so too will the criteria of death vary. Different moral communities have different criteria for death—e.g., pulmonary or cognitive function. Put another way, different communities and cultures will have different views of what constitutes a good life, and those views influence the way death is understood. How one understands the obligations to support life also varies according to one’s moral commitments and values.One’s view of what counts as death, or what counts as a good death, is influenced [End Page 379] by the moral commitments that one holds. The persistent controversies over death and dying are a symptom of deep, widespread moral and cultural pluralism. These views are controversial because, in many ways, our deaths are no longer private. That is, the way we die often is tied to a health... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 15.2 (2005) 211-218 [Access article in PDF] Bioethics, Biolaw, and Western Legal Heritage Susan Cartier Poland Bioethics and biolaw are two philosophical approaches that address social tension and conflict caused by emerging bioscientific and biomedical research and application. Both reflect their respective, yet different, heritages in Western law. Bioethics can be defined as "the research and practice, generally interdisciplinary in nature, which aims to (...) clarify or resolve ethical questions raised by the advances and application of biomedical and biological sciences" (II, Miller 2000, p. 246). Biolaw, on the other hand, is a legal philosophical concept that can be defined as "the taking of agreed upon principles and practices of bioethics into law with the sanctions that law engenders" (p. 246). Some see biolaw as hierarchical, either evolving from or devolving into bioethics (p. 245), while others think of bioethics and biolaw as a continuum or gradation (p. 246). Whichever view one takes, bioethics and biolaw are, at the least, intertwined (II, Loureiro 2000, p. 71).Although bioethics came out of the U.S. in the 1970s, the field is now considered Anglo-American (II, Kemp 2000a, p. 67). Biolaw emerged in the 1990s from the French biodroit and has become associated with continental Europe (p. 68). These distinctions, however, are based on geopolitical entities. Another way to distinguish bioethics from biolaw is to look at their legal heritage and understand the differences between the common law and the civil law.Bioethics and biolaw share a Western legal heritage, specifically roots in Roman law. When the Roman empire in the West fell to Germanic tribes in 476 A.D., the Romans had developed a sophisticated system of law that included flexible standards and abstract, rather than concrete, modes of thought. In 528, Justinian, emperor of the surviving Roman empire in the East at Constantinople, ordered a compilation and consolidation of Roman law. Despite the rise of seventh century Islam, the split of the Christian church into eastern and western branches in 1054, and the Norman conquest of England in 1066, Roman law survived through the courts of canon law and was revived later in the twelfth century at the University of Bologna in Italy. By 1500, what would later become France and Germany had [End Page 211] "received" or recognized Roman law, albeit in varying degrees. Not a single event, the Reception, or "direct acceptance of Roman law as a principal source of law," is the definitive turning point in Western legal history that eventually produced the common law and civil law strands (I, Von Mehren 1957, p. 10).England, however, did not participate in the Reception, although its influence was felt at Oxford University, where Vacarious taught its precepts in 1151, and in the courts of canon law (I, Von Mehren 1957, p. 10). William the Conqueror already essentially had established the common law tradition when he merged Anglo-Saxon law with Norman law and created a centralized system of justice administration for the single fiefdom known as England.Aside from historical development, the common law and the civil law differ from other legal families in terms of their modes of thought, institutions, sources, and ideology (I, Zweigert and Kotz 1977, p. 62). In the common law, Roman legal concepts were shaped by Christian ethics through the canon law courts. In the civil law, Roman law became the basis for a legal science centered in the universities and interpreted by various schools, such as the commentators, the glossators, and the humanists. The civil law uses a central text as the starting point for legal reasoning and analysis. The common law develops over time through case law, that is, by judges applying principles from preceding cases to resolve the issue at hand. One writer describes the common law as "anything that is not prohibited is permitted" and the civil law as "anything that is not permitted is prohibited" (I, Karambelas 2005, p. 28).The common law and the civil law are only two of the three traditions in Western law. The third is socialist law. All three are... (shrink)

Accounts of big data practices often assume that they target individuals. Personalization, with all the risks of discrimination and bias it entails, has been the critical focus in accounts of consumption, government, social media, and health. This paper argues that personalization through models using large-scale data is part of a more expansive change in probabilization that, in principle, is not reducible to individual or ‘personal’ attributes and actions. It describes the ‘personalization’ of an online grocery shopping recommender system to (...) list a small number of grocery items of personal relevance for each of the millions of online grocery shoppers at a major UK supermarket chain. Drawing on a theory of probability proposed by the philosopher of science Karl Popper and anthropological work on shopping, it suggests that the attempt to generate personalized predictions necessarily incorporates impersonal relations to others and things. Using a mixture of discourse analysis and code-based reconstruction of key elements of the recommender system, it suggests that personalization is one facet of an open-ended weave of propensities associated with people and things in contemporary big data configurations. The paper explores how, in the context of recommender systems, the constitutive incompleteness of shopping lists, their propensity to expand or change, might be more important than their capacity to be personalized. (shrink)

Background: As a non–European Union member state, Albania is increasingly orienting itself on Western models regarding human rights, patient rights, and legal regulations for healthcare. Due to its limited fiscal and legal power, enforcing legal and ethical regulations poses a major problem. Aim: The aim of this study is to investigate nurse’s knowledge and experiences regarding ethical and legal issues in Albanian elder care in state-funded and privately run institutions. Research design: The study was conducted using an inductive and qualitative (...) design, utilizing a focused ethnographic approach, based on Roper and Shapira’s framework. Method: Data were collected between June 2017 and September 2018 using participant observation, field notes, and semi-structured interviews with 15 nurses in seven different elder care institutions. In total, 100 h of observation and 15 interviews were performed. Data analysis was based on Mayring’s qualitative content analysis. Ethical consideration: The approval for the study was obtained from UMIT—The Health and Life Sciences University, Austria. Findings: The findings of the study fell into the following main categories: “Everyday care issues,” “End-of-life issues,” “Legal issues,” and “Ethical-legal education and conflicts.” Discussion: The participants reported many ethical and legal issues when describing their everyday challenges and displayed a strong lack of ethical and legal education. Despite a wide spectrum in the quality of care between private and state-funded nursing homes, older people mostly do not know their own diagnosis. Conclusion: This study indicates that further ethical and legal education is needed. Furthermore, nurses need to be better prepared for ethical conflicts with families, as strengthening patient rights could come into conflict with traditional rights of the Albanian family. (shrink)

In terms of classical tafsir literature, it is possible that the speeches made to a person or group in the Qurʾān carry messages for other individuals or groups. According to some approaches that emerged in the modern period, when the speech was made and to whom it was directed not only determine the meaning, but also limits it. This dilemma has to be based on the theoretical dimension. The most obvious example of the transition of the speech from direct counterpart (...) to the other is the transition of the speeches made to the unbelievers to the believers. Therefore, in this study, the possibility of the transcendence of the speech in the Qurʾān will be handled in the context of the messages for believers in the speeches directed to the unbelievers. One aspect of the issue of the transcendence of the speech in the Qurʾān can be explained by the style that the Qurʾān follows. However, the subject should also be based on linguistic aspects. As a matter of fact, the expansion of the speech can sometimes be related to the meanings of words and sometimes with the possibilities and literary aspects of language, and sometimes with an analytical effort. In this study, the related examples will be analyzed and it will be revealed that the transition between the speeches in the Qurʾān is possible in terms of the style of the Qurʾān. In the study, the methodological findings related to the linguistic aspects of the issue will also be studied.Summary: The discourse that the Qurʾān is an address by God makes different associations in terms of classical literature and some modern methods of understanding. In the works of classical method and rhetoric, a theoretical framework is drawn around the nature, arbitrariness, conditions and types of the book. In this context, the varieties, indications and scopes of the addresses in the Qurʾān are discussed. While it is emphasized that the Qurʾān is an address in modernist contextualist approaches, it is stated that understanding the address requires having contextual information, therefore reading the address as a book evaporates meaning. Because, according to these approaches, the meaning is sought in the text with the transformation of address to book (verbal culture to written culture), thus the Qurʾān is converted from a literal meaning into a system. Knowing what the Qurʾān tells and why it tells that, depends on the comprehension of all the contextual elements of the Qurʾān, which was sent as an address. In fact, knowledge of when, where and when the Qurʾān was sent about what events and to whom it is addressed, is the data that is primarily considered in the comprehension of the verses, as emphasized by the classical interpretation literature. However, the perception of the classical interpretation evaluates these data in different categories in terms of the integrity of religion, judgment and experience. For example, the narrations on the reason of sending and the Makki-Madani information are only examples of the meanings of the verses. They sometimes serve as elements that contribute to the comprehension of the verses, while sometimes with the help of other chapters they can narrow the meanings of the verses. The realist-methodological basis of the method science provides the emergence of this holistic-categorical perspective.It is difficult to justify the claim that there is an absolute relationship between the address and the addressee in terms of the classical literature. In the classical literature, the expressions, which come in the form of an address and have a mandatory relationship with addressees, are dealt with the concept of direct address. Direct addresses are binding for the first addressees. Because when an address is mentioned, it is mandatory to have an addressee. It can be assumed that this discourse has the same position with the context theories considering its premises. However, it is not possible to compare these theories with each other in terms of the scope of the address. Classical theories of reasoning consider that direct addresses cover indirect addressees by methods, such as shar’i (legal) necessity or analogy (qiyas), while contextualists and historians can convert the text beyond the virtual level by identifying what a command means within the context of the address-addressee relationship. When the Qurʾān is completely considered as an address, or when direct addresses are taken into consideration, it is very difficult for the modern period's comprehension methods that the verses, which mention or address the disbelievers-polytheists, can also address Muslims. In fact, the dialectic of the address-addressee requires this. Moreover, the addressees (polytheists-Muslims) who are spoken within the context of the verses have two different beliefs that cannot be dealt with at the same time and mentioned in the same verse. Therefore, it is not possible to direct the messages given to the polytheists to the believers and to attribute the qualities in these verses to Muslims.However, the classical literature did not even consider as a problem to address Muslims with the verses that directly addressing unbelievers-polytheists. It is because both linguistics and facts requires this. The method practitioners and interpreters discussed this issue in a very wide range. They examined the transitivity of the book between parties, such as people of the book-Muslims, Muslims-unbelievers, Prophet-ummah. In the context of the interpretation literature and the perception of modern-day interpretation, the possibility of the transitivity of the book can be clarified in the context of the inclusiveness of a verse that speaks of polytheists-disbelievers to include Muslims, or the conversion of an address to polytheists-unbelievers to Muslims. Classical literature explains this point sometimes with the literal indication (circularization) and the circumstance of literary use of language (rhetoric) and sometimes with the possibility of the address (stylistic features).In verses and hadiths, belief bases categorical classes, such as believers, unbelievers, polytheists, hypocrites, people of the book are mentioned, as well as descriptions of the characteristic-practical dimensions of these classes. In this context, commands sometimes refer to the practices that need to be performed in order to be a believer, sometimes works that must not be performed by the believer, and sometimes matters that might put the believer's faith-practice integrity at risk when it is done. In the Qurʾān, in some of the addresses to the believers, it is apparent that they are prohibited from being like unbelievers or having unbeliever-like qualities. Moreover, sometimes negative results that may arise for Muslims when they act like unbelievers are cited in the verses. Sometimes at the end of the verses that address and mention Muslims, information is included on situations involving unbelievers and the torment they will encounter. In addition, in cases where adjectives belonging to opposing belief profiles are mentioned, the address to non-Muslims expresses warning, evaluation, gratitude and perseverance in faith for Muslims, while the address to Muslims contains elements of incentive and opportunity for non-Muslim groups. It is possible to justify this matter with the style of the Qurʾān. However, it can be said that the transitivity of the address in the Qurʾān takes place in two theoretical aspects. The first of these is related to linguistic-rhetoric premises and it is used in antithesis, allusion, metaphor etc. The second one is the similitude-comparison. Here, the comparison is a phenomenon that occurs in the mind without the need for propositions. Because when the mind hears these statements, it can instantly reach a stronger meaning than the literal wording. In this study, it is discussed whether it is possible to transition from direct addresses to indirect addressees, with reference to the problems of the modern period. In this context, the study primarily focuses on the fact that the Qurʾān sometimes transmits its messages and teachings to addressees through opposing belief systems. Thus, the manner adopted by the Qurʾān while directing certain commands and negations, not directly but through the opposing side, has been presented. In this study, the possibility of the verses that only mentions polytheists-unbelievers to also addressing Muslims was analyzed and these verses were compared with addresses to Muslims on the same matters. In the last part of the study, a theoretical framework was drawn on the subject and the method of interdisciplinary transitivity was determined. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Active Euthanasia and Assisted SuicidePat Milmoe McCarrick (bio)Although the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in its 1983 report, Deciding to Forego Life-Sustaining Treatment, described the words and terms "euthanasia," "right to die," and "death with dignity" as slogans or code words—"empty rhetoric," (I, p. 24), the literature reviewed for this Scope Note continues to use these terms. Therefore, to (...) discuss the termination of a patient's life by a physician at the patient's request, the phrase active euthanasia is used, and the supplying of a means by a physician whereby a patient can end his or her life is referred to as assisted suicide.Euthanasia, either as the "good death" from classical Greek or "mercy killing" to end unbearable suffering in the dying, has long been a topic of interest in western civilization (III, Brody 1989). In recent years, public awareness of this discussion about control over the time of one's death has been informed by a series of well-publicized events. They include the November 1991 rejection by a vote of 54 percent to 46 percent of the Washington state Initiative 119, which would have allowed the option of requesting one's physician to "aid-in-dying" for adult patients in a "medically terminal condition" (V, Gross 1991); two medical journal articles describing physician's actions in helping bring death to two patients (V, Anonymous 1988; V, Quill 1991); Dr. Jack Kevorkian's assistance in the suicide of three women (V, Belkin 1990; V, Wilkerson 1991); and the best seller status of a how-to book on committing suicide with opiates obtained from a physician (III, Humphry 1991).For the most part, material included in the annotated bibliography in Scope Note 18 has been chosen from works published in the four years since "It's Over, Debbie" (V, Anonymous 1988) appeared in early January 1988 in the Journal of the American Medical Association.Dr. Edmund D. Pellegrino (V, 1991, pp. 3118-19) presented opposing views about active voluntary euthanasia as follows:Those who favor voluntary euthanasia argue that it is a beneficent and compassionate act; it respects autonomy by preserving the patient's control of the manner, method, [End Page 79] and timing of death; it takes the matter outside the reach of "medical power" (accessed in this Scope Note's bibliography at V, Fletcher 1973; V, Nowell-Smith 1989) and scrupulosity; and it prevents the injustice that allows some patients to choose death by refusal of life-support measures, while denying others the right to do so by active euthanasia....The opponents of active euthanasia argue that it undermines the value of, and respect for, all human life (V, Kass 1989; V, Coyle 1990; V, Singer 1990). They fear that guidelines cannot avoid sliding down the "slippery slope" to involuntary euthanasia and selective devaluation of the lives of the most vulnerable among us.... If euthanasia is legal, it is predicted that patients will feel subtle pressure to conform so as to relieve the economic and emotional burdens they impose on family and friends.Euthanasia, its opponents further argue, is socially destructive: it undermines trust in physicians, desensitizes society to killing, and imperils the ground already gained in legitimating passive euthanasia(IV, Wolf 1989).Physicians were not particularly involved with a patient's death until after World War II when participation grew in proportion to the growth of technology. Since the complex, life-sustaining equipment that could forestall death was located in a hospital, death itself became almost completely medicalized (V, Dagi 1991). For terminally ill persons who would like to die a painless death, either by their own hand or with assistance, physicians have almost a monopoly on obtaining strong drugs for distribution to patients (V, Abrams 1990).Active euthanasia for human beings is not legalized anywhere in the world (V, VonDrehle 1991). It is classified as homicide or murder in all fifty states and in Great Britain, Canada, Australia, and the Phillippines (V, Nerland 1989). Twentysix states in the United States prohibit assisted suicide by statute (V, Rosenblum 1990).In 1969 in the Netherlands, a physician named Jan Hendrik van... (shrink)

Despite the central place of suffering in medical care, suffering in infants and nonverbal children remains poorly defined. There are epistemic problems in the detection and treatment of suffering in infants and normative problems in determining what is in their best interests. A lack of agreement on definitions of infant suffering leads to misunderstanding, mistrust, and even conflict amongst clinicians and parents. It also allows biases around intensive care and disability to affect medical decision-making on behalf of infants. In this (...) paper, I propose the concept of suffering pluralism, which is a novel multidimensional view of infant suffering based on subjective and objective components. The concept of suffering pluralism is more inclusive of the multiple ways in which infant suffering can occur. It acknowledges and defines a subjective component to infant suffering, while also focusing moral attention on objective well-being by describing it using the language of suffering. This concept allows us to better weigh up subjective and objective components of well-being. It also encourages clarity and consistency in claiming suffering, which is likely to improve communication and reduce conflict in medical decision-making for unwell infants and children. I will end by exploring possible critiques and limitations of this concept. (shrink)

Translated by Drew S. Burk and Anthony Paul Smith. Excerpted from Struggle and Utopia at the End Times of Philosophy , (Minneapolis: Univocal Publishing, 2012). THE END TIMES OF PHILOSOPHY The phrase “end times of philosophy” is not a new version of the “end of philosophy” or the “end of history,” themes which have become quite vulgar and nourish all hopes of revenge and powerlessness. Moreover, philosophy itself does not stop proclaiming its own death, admitting itself to be half dead (...) and doing nothing but providing ammunition for its adversaries. With our sights set on clearing up this nuance, we differentiate philosophy as an institutional entity, and the philosophizability of the World and History, of “thought-world,” which universalizes the narrow concept of philosophy and that of “capital.” We also give an eschatological and apocalyptical cause to this end, of “times” or “ages” rather than those of philosophical practice. Last but not least, it is the Future itself in the performativity of its ultimatum that determines this end times, reversing these times from the Identity the Future accorded to it, withdrawing the thought-world from the lie of its death. Why this style of axioms and oracles, these more or less subtle distinctions, old and debased, with an appeal to the ultimata , to end times and last words? We fight to give, parallel to the concept of Hell, its new theoretical position, for its philosophical return and its non-philosophical transformation. No more so than any other word, Hell is not a metaphor here, just the Principle of Sufficient World. Every man, no doubt, has his “hell” readily available, connivance, control, conformism, domestication, schooling, alienation, extermination, exploitation, oppression, anxiety, etc. We have our little list that the Contemporaries established in the previous century in the same way one used to construct lists of virtues and vices or honors and wealth. They invented it for us without knowing it, for us-the-Futures who have as our responsibility to invent its use. In the Christian and Gnostic tradition, the struggle of the End Times takes place “on earth.” The most sophisticated of believers have it taking place in Heaven as well, above all in Heaven. The various kinds of gnosis imagine infinite falls and vertiginous highs, the vertigo of salvation. On Earth as in Heaven, a hell is available. The Marxists have the law of profit and the control of production, the class struggle Capital imposes on man. The Nietzscheans, the dull grumble of the struggle in the foundations of World and History, the domestication of man, the society of control. The phenomenologists, the capture of being, the most superficial amongst them, the age of suspicion. But all of these “hells” are taken from World, History, Society, and Religion. What we call Hell is no longer of the order of these specific and total intra-worldly generalities, it is both more singular and more universal, no longer being at all of the same order, it is the determinant Identity of these small hells strung out through history but unified here in the name of the last Humaneity. It is even found within the French idiom for hell [ enfer ], en-fer literally means “in-irons.” We are as much “in-irons” as we are “alive” [ en-Vie ]. We believe in Hell but as non-philosophers and it is even because we are non-philosophers that we can believe in it outside of any sort of religion. Hell is less mythological than ideological, it combines philosophizability with universal capital. Under what form? A single term could work for them without being a metaphor or something they would participate in by analogy, a more innovative and conjectural term than control, more universal than profit. It would denote the growing and permanent extortion of a surplus-value of communication, of speed and of urgency in change, in productivity and in work, in the pressure of images and slogans. It would be worse than solicitation, more tenacious than capture, more active and persecutory than control, softer and more insidious than a frontal attack, just as perverse as questioning and accusation, less brutal and offensive than extermination, less ritualized than inquisition, it would be soft and dispersed, instantaneous and vicious, it would be a crime without declared violence. Collusion and conformism, it would be afraid to show itself. Related to rumor, from which it borrows its infinite and tortuous ways. It is harassment. As a modernized form of Hell, perhaps harassment has a long future in front of it, of innocent torture, slow assassination, in short the fall, but radical with no way of recovering and which tolerates only salvation. THE PHILOSOPHICAL PAST OF NON-PHILOSOPHY Non-philosophy is thus Man as the utopian identity of the philosophical form of the World, a utopia destined to transform it. We still have to understand these equations, in particular that of the being-uni-versed from Man, and this book adheres to this by re-exposing non-philosophy in a different way via one of its new possibilities. It uses this opportunity to once again take up formulations that lead to objections answering certain external critics, as well as revisiting diverging interpretations specific to non-philosophers. A portion of this book is devoted to going through these theories via a strict or “lengthy” presentation of non-philosophy, and its defense against more expeditious solutions. This work of rectification is the occasion, merely the occasion, for refocusing non-philosophy on Man (the “Man-in-person,” “Humaneity”), and in a more innovative manner, on its utopian vocation established since the book Future Christ . As for this “occasion,” it is quite obvious. A school of posture, not to say a school of thought, supposes a minimum of closure from the most liberating of knowledge, a heritage, its utilization, and its no less certain dispersal. Within its development, a variety of interpretations will no doubt appear, deviations that are as much normalizations, and a struggle against this multiplication of divergent tendencies. These are perhaps not inevitable evils, especially here, merely a normal development according to the twisting paths of history. But the problem is made worse by the fact that this school of non-philosophers is that of utopia. Not the former attempts devoted to commenting on the worst authoritarian and criminal forms of the past and the present, but utopia as the determinant principle for human life, or to put it another way, of the Future as an irreducible presupposition of (for) thinking the World and History. Non-philosophers are engaged in an aleatory navigation between the respect for the most rigorous utopia, whose rules are not that of the reproductive imagination but those from the Future determining imagination itself, as well as the temptations, diversions, and remorse of history. Little by little, we will begin to understand that the Future as we understand it no longer has any temporal consistency or positive content, without being an empty form or a nothingness, but that it is foreclosed to past and present History, just as it is foreclosed to the place of places, the World, and that it is the only method for establishing the practice of thinking in a non-imaginary instance. Because it is the World and History that are imaginary and have a terrible materiality, it is not necessarily utopia. We will overlap two objectives here: the defense of non-philosophy against the (non-) philosophers that we are, only occasionally, and the introduction of philosophy to a rigorous future. Together they set out to definitively render, without any possible return to philosophical conformism or towards the facilities of the past and present, the non-philosophical enterprise understood as utopia or uchronia. Imagination and speculation, left to themselves and thus undistinguished, are quite good for participating in the grand game of History but have little value or worse for the Future which is unimaginable and unintelligible and must be maintained as such. MAN-IN-PERSON AS SUSPENSION OF THE PHILOSOPHICAL CHORA The point where philosophical resistance is concentrated is without a doubt the invention of the Name-of-Man, first name, oracular as much as axiomatic, of the determining cause for the non-philosophical posture. And that which concentrates the differends is the style of non-philosophy as identity that possesses the dual aspect, of discipline and of the oeuvre, of the theorem and of the oracle. But the real difficulty in understanding the simplicity of non-philosophy is profoundly hidden in the depths of philosophy itself. Because philosophy, from Parmenides to Derrida, even Levinas, continues to be a divided gesture, without a veritable immanence, transforming its thematic contents of transcendence in also forgetting to transform the operative transcendence in the element from which the ontology of surface is established which we will call, in memory of Plato, the chorismos. The general effect of the chora literally gives place to philosophy, demanding binding and sutures to which we will once and for all “oppose” the Man-in-person, his power of cloning, and his future being. All philosophy contains a hinter-philosophy in which it deploys its operations and weaves its tradition like an understudy of a topographical nature and in the best of cases being itself topological. Philosophy as well consists of two levels, its pre-ontological operative conditions on the one hand, and its superficial theme on the other, it too has its presupposed, but is not aware of it or erases it within the unity of appearance named Logos. Rightly, the Logos, and its flash or lightning nature, possesses a “dark precursor,” the chora, which is as much a virtual image, and philosophy, dazzled by its own lightning flash, seems to completely forget about it at the same time it sets itself up within it. Non-philosophy risks taking this same path, of confusing what it believes to be the real with its phantom double, contenting itself to working on the thematic level of philosophy, not its surface objects and its idle chatter (we stopped talking about this a long time ago and in any case they are merely simple materials for inducing a work of transformation), but the transcendence-form of its objects. In the end it risks, through precipitation, taking back up the heritage of philosophy, a heritage of a misunderstood presupposed, even more profound than the play of transcendences. This is what the imperative of the radicality of immanence meant, to treat immanence in an immanent manner, not to make a new object out of it. And from here we get non- (philosophy) and its refusal of the Platonic chorismos , symbol of all abstraction, and thus all transcendental appearance. There are no illusions. The message will leave a heritage in tattered pieces and interpretations. But it was difficult not to dispute the differend to its core. There will be complete confusion of the multiple, possible, and necessary effectuations of non-philosophy with its interpretations. The non-philosophical or human freedom of philosophical effectuation and the philosophical freedom of interpretation. Effectuations demand non-philosophy to return to zero from the point of view of its philosophical material and thus also but within these limits the formulation of its axioms , but in no way providing from the outset divergent interpretations of the aforementioned axioms. They are divergent because they do not take into account the material from which these axioms are derived within non-philosophy, and because they do not see themselves as symptoms of another vision of the World. The utterances of non-philosophy are not mathematical theorems and pure axioms, they merely have a mathematical aspect . They are, by their extraction or origin, mathematical and transcendental. And by their determined function in-Real, within non-philosophy, they are identically in-the-last-Humaneity entities which have an aspect of an axiom and an aspect of interpretation (or an oracular aspect as we say) that attempts (sometimes it is ourselves who provide the occasion) to isolate and transform, in complete freedom of interpretation. There will be an opportunity to complain about the complex character of the language of non-philosophy, an idiom saturated with classical references, sophisticated in a contemporary way. Its freedom of decision up against the whole of philosophy demands these effects of “complication” and “privatization,” as the saying goes. But it also demands fighting against the drift [ dérive ] of the pedagogical-all and the mediatic-all that leads philosophy into the shallow depths of opinion, which is the site of its impossible death. The noble idealism of “pop-philosophy” has been consumed into a “philo-reality;” against this we propose philo-fiction. Parricide, which is at the bottom of these interpretations and which we can judge as being quite fertile, although it has informed tradition, only takes place once or within one lone meaning. In regards to Parmenides, it was possible; Plato introduced the Other as non-being and language, bringing into existence the philosophical system of the World, but is it possible to repeat it again with the same fecundity in regards to non-philosophy, this time in introducing (non) religion or (non) art, still mixing them without taking into account this mixture, alternatively as a philosophical or religious resentment? If philosophy begins via a crime, it is no doubt obliged to continue down similar pathways, to the effect that the crimes of philosophy, once the founding crime has been committed, are a reaction of self-defense. It is undoubtedly from this that we get Marx’s declaration that history begins by tragedy and repeats itself or ends in farce. The preservation of rigor and fecundity is, in every respect, a psychologically difficult task within a theory such as non-philosophy. Having posited an essential objective of liberation in regards to philosophy and its services, one has often understood this objective as an authorization of providing particular interpretations of its axioms and ends up obliterating their scope. This ends up confusing, on one hand, two kinds of freedoms in regards to non-philosophy, the freedom of its interpretations and the freedom of its effectuations. On the other hand, any defense of “principles” against precipitated interpretations is immediately taxed with a will to orthodoxy, a prohibitive objection when we are dealing with, as is the case here, a heretical theory of thought. Nevertheless, it is time to stop confusing heresy as the cause of thought with an ideology of heresies, which is certainly not at all our object, but rather a form of normalization. As for the “disciplinary” aspect, which is not the only aspect, it demands something other than philosophical “answers to objections,” a precision in the definition and use of its procedures in the formation of utterances, since non-philosophy is neither a supplementary doctrine interior to philosophy nor a vision of the world but one whose priority is a “vision of Man,” or rather Man as “vision” that implies a theory and a practice of philosophy. In the end, struggle is only one aspect of non-philosophy, not its whole or telos, struggle coming only from its materiality. In particular, if the discipline of non-philosophy is inseparable from struggle, it is not a question of reducing the monomaniacal obsession of its “marching orders.” This would reduce its complexity and kill its indivisibility, deploying it in a “long march” and a form of Maoization whose philosophical presuppositions no longer have any pertinence here, a case of the One and the Two, which are now cloned and no longer tied together. More generally, non-philosophy is a complex thought composed of a multitude of aspects, which is to say, unilateral interpretations, of a philosophical origin but reduced by their determination in-the-last-instance . The “liberalism” of non-philosophy is merely one of the aspects of which it is capable, not an essence. Similarly, it is only capable of having a “Maoist” aspect. Let us generalize. The weakness of non-philosophy is due to a specific cause, the determination-in-the-last-Humaneity of a subject for the World. Everything that has a right to the philosophical city can be said about it in turn and in a retaliatory mode since Man contributes nothing of himself that Man takes from the World. We can consider non-philosophy as being pretentious, absurd, idealistic, empty, materialistic, formalistic, contradictory, modern, post-modern, Zen, Buddhist, Marxist; it endures or tolerates, perhaps “appeals” to, or at least renders possible, sarcasms, ironies, and insults without even talking about the misunderstandings, partly for the same reason as psychoanalysis. All of this goes beyond simple “deviations.” They are its aspects, which is to say, its “unilateral” philosophical interpretations in both senses of the word, being either sufficient coming from the mouth of philosophers, or reduced to their absolute dimension of sufficiency and totality in the mouths of non-philosophers, and both times due to the weakness and strength of Man-in-person as their determination only in-the-last-instance. The non-philosopher is certainly not a Saint Paul fantasizing about a new Church. The non-philosopher is either a (Saint) Sebastian whose flesh is pierced with as many arrows as there are Churches, or a Christ persecuted by a Saint Paul. What is engaged in here is the practice of retaliation. A negative rule of the non-philosophical ethics of outlawed discussion by way of argumentation (the sufficient is you, the orthodox one is always you, you are the fashionable one, and when a master you are someone else) that is founded on the confusion of effectuations of non-philosophy and of its overall interpretations. Retaliation is the law but as with any too-human law, it must acquire a dimension that displaces it, or rather emplaces it and takes away its authority but not all of its effectiveness. If the non-philosopher is only authorized by himself, which is to say by philosophy but limited by the Real-of-the-last-instance, its critique of other non-philosophers can merely be retaliatory under the same conditions, only by the Real limited in-the last-instance. THE TREE OF PHILOSOPHICAL SAINTLINESS The thematic horizon or material of these debates is in the relationships between philosophy, religion as gnosis, and non-philosophy. It is inevitable, regarding non-philosophers in general (whether they are non-philosophers by name or simply its neighbors) that we often end up evoking Marx’s Holy Family and imagining, arranged on the neighboring branches of the tree of philosophy and annexed, sometimes abusively, to non-philosophy, authors who would quite evidently and quite rightly refuse this label. So it is that we find, for example, a Saint Michel, a Saint Alain, a Saint Gilles 1 without even mentioning the youngest who aspire as well to the freedom of “saintliness” and who make their muted voices heard here. If there is a Holy Family of non-philosophers, it extends completely beyond these three, provided that the sectarian spirit can save us. This book is organized in the following manner: To begin, in order to recall the essential part of the problematic, we have organized a Summary of Non-Philosophy , a vade-mecum of notions and basic problems, in a classical style. Secondly, there is Clarifications On the Three Axioms of Non-Philosophy , designed to posit their proper use as much as to elucidate their meaning. Thirdly, an analysis of Philosophizability and Practicity , both being extreme constituents of philosophical material or the contents of the third axiom. Fourthly, the heart of this work: Let us Make a Tabula Rasa of the Future or of Utopia as Method . Fifthly, we have a theoretical outline of a non-institutional utopia, The International Organization of Non-Philosophy, L’Organisation Non-Philosophique Internationale, (ONPHI) already created in practice but under the conditions of possibility and functioning from which here we put into question “de jure,” thus not without a perplexity concerning “facts,” in any case, without the capability of “getting to the bottom of things.” Sixthly, an essay characterizing The Right and the Left of Non-Philosophy , a brief topology of several philosophizing and normalizing positions of proponents or tenants of this problematic. Seventhly, Rebel in the Soul: A Theory of Future Struggle , a systematic discussion starting from a confrontation of non-philosophical gnosis and non-religious gnosis to the extent that they pose, posed or perhaps still will pose themselves as rivals to non-philosophy in a mixture of fidelity and infidelity. Despite the fact that it can also be read as putting non-philosophy into perspective: it pits against a standard Platonism two contemporary appropriations of Gnosticism. On the basis of the paradigm of Man who never ceases to come as the Future-in-person, each one of these moments strives to reestablish not the “true” non-philosophy and its orthodoxy, but the minimal conditions to respect in order to allow for its maximum fecundity. And in order to bring about one of the last possibilities of its development, making explicit Humaneity as a utopia-for-the-World. In introducing these considerations in the form of a “testament” and “ultimatum,” we want to indicate two things: First, that this is the last time we will intervene in order to caution non-philosophers against the temptation of returning and looking backwards towards philosophy. Only a disillusioned nostalgia for the former World and its traditions barely remain permissible to us.… Secondly, that non-philosophy is also a sort of ultimatum for considering one’s life and transforming one’s thought from the perspective of a uni-version rather than a conversion. Man as future is this ultimatum in action, not an impatient self-proclaimed genius, and philosophy is his testament. It is obviously the ultimatum that determines this testament as “old” with a view towards a life that is, itself, non-testamentary. In and of itself, the “old” can never bear a veritable eschaton. Thus, this book intersects according to the logic of this paradigm, under the sign of the ultimate or “last” as future, philosophy as testament and cautionary note for maintaining the non-philosophical oeuvre as “future” or “utopian.” We will see that between these two dimensions it cradles a theory of struggle. In the end, this book envisions non-philosophers in multiple ways. It inevitably sees them as subjects of knowledge, most often academics insofar as life in the world demands, but above all as close relatives of three great human types. The analyst and political militant are quite obvious, for non-philosophy is close to psychoanalysis and Marxism insofar as it transforms the subject in transforming philosophy. Here again, one must have a sense not of certain nuances but of aspects (of the interpretations, albeit unilateralized) and not in order to construct a simple proletarization or militarization of thought as theory. To be rigorous, rather than authoritarian or spiteful, is its task. And lastly, non-philosophy is a close relative of the spiritual but definitely not the spiritualist. Those who are spiritual are not at all spiritualists, for the spiritual oscillate between fury and tranquil rage, they are great destroyers of the forces of Philosophy and the State, which are united under the name of Conformism. They haunt the margins of philosophy, gnosis, mysticism, science fiction and even religions. Spiritual types are not only abstract mystics and quietists; they are heretics for the World. The task is to bring their heresy to the capacity of utopia, and their utopia to the capacity of the paradigm. NOTES We will recognize allusions, and sometimes references, to closely related or distant themes, but which are related, in the work of Michel Henry, Alain Badiou and via the representative of “non-religious” gnosis of a Platonic origin, in Gilles Grelet. It goes without saying that these discussions are current and local, neither concerning the ensemble of doctrines nor prejudging the eventual evolution of certain amongst them. This concerns defining certain proximities with non-philosophy (rather than adversaries which in some sense they are) and typological and emblematic differends (rather than conflicts with a certain author). (shrink)

In this article the paradoxical role of legal science in legal practice is discussed. On the one hand, legal scientists do not agree on the criterions of the scientific character of legal science. On the other hand, even in the legal cases that are especially complicated it is possible to arrive at theoretically unquestionable decisions. The author of the article concludes that legal practice is based on fundamental theoretical insights; however, in legal practice these insights are used more intuitively than (...) reflectively. Therefore, the aim of the article is to rationally reconstruct these theoretical insights with reference to the ideas of modern schools of legal philosophy. For this purpose the ideas of the theory of natural law are discussed. It is concluded that in legal practice two provisions of natural law are applied: legal decisions ought to be reasonable and must include existential ends (basic values). The evolution of the legal positivism is discussed in the article and it is concluded that legal positivism offers the criterions of the scientific character of legal science by framing the procedural rules of the democratic process of lawmaking. These rules anticipate such conditions: consensus concerning decision making; equal participation of all members of legal discourse confirming normative decisions; the acceptability of consequences after the realisation of normative decisions; the possibility to reaffirm normative decisions, if necessary. The ideas of virtue jurisprudence are discussed and it is claimed that virtue jurisprudence as a criterion of the scientific character of law proposes such theoretical position: the decisions concerning human rights must supply the value system (hierarchy) and the virtues which are formed and justified in the long legal tradition. The article represents the use of these criterions of the scientific character of legal science by Jurgen Habermas to debate about legal prohibition of the improvement of the human genome by using modern technologies of genome engineering in the Convention of Human Rights and Biomedicine (Oviedo, 1997). (shrink)

The number of credit delinquents in Korea had been growing steadily since 1997 and had reached 3,700,000 by the end of 2003, which was about 8.4% of the population. The government initiated several support programs, but the number of credit delinquents has decreased very slowly. In order to allow for successful recovery of credit delinquents, it is imperative to reduce debts in a more comprehensive manner, to clear the impediments for easy use of personal bankruptcy mechanisms, and to provide incentives (...) to encourage debtors to make progress on their repayment plans. While there has been much change in terms of learning to live with bankruptcy as an inevitable part of a market economy, there is still much to be done. The reality of "moral hazard" in bankruptcy discharge should be uncovered. Legal restraints discriminating against bankrupts must be removed. The repayment period of individual rehabilitation and individual workouts must be shortened to three years. Personal guarantors for debtors in rehabilitation proceedings should be protected as much as the debtors are during the repayment period in rehabilitation proceedings. Debtors need to be able to keep their mortgaged residences during the proceedings. The history of insolvency has shown that society can benefit as much as or more than debtors themselves from the discharge of unpaid debts because with a fresh start the debtor has an incentive to work hard. The starting point to personal bankruptcy law reform is this belief. (shrink)

Oocyte donation raises conflicts of interest and commitment for physicians but little attention has been paid to how to reduce these conflicts in practice. Yet the growing popularity of assisted reproduction has increased the stakes of maintaining an adequate oocyte supply and minimizing conflicts. A growing body of professional guidelines, legal challenges to professional self-regulation, and empirical research on the practice of oocyte donation all call for renewed attention to the issue. As empirical findings better inform existing conflicts and their (...) potential harms, we can better attempt to reduce these conflicts. To that end, the article first describes the nature of conflicts in oocyte donation and relevant regulations and professional guidelines. We then describe studies on conflicts at four phases of oocyte donation: recruitment, screening, stimulation, and post-stimulation monitoring. Next we consider three models for conflict reduction in medicine generally: improved professional self-regulation, outright restriction like Stark anti-referral laws, or the use of conflict mediators, like in living organ donation. We ultimately conclude that improved professional self-regulation is a reasonable starting place for oocyte donation. (shrink)

Background: Ethical and legal issues are increasingly being reported by health caregivers; however, little is known about the nature of these issues in geriatric care. These issues can improve work and care conditions in healthcare, and consequently, the health and welfare of older people. Aim: This literature review aims to identify research focusing on ethical and legal issues in geriatric care, in order to give nurses and other health care workers an overview of existing grievances and possible solutions to take (...) care of old patients in a both ethical and legally correct way. Methods: Using a systematic approach based on Aveyard, a search of the PubMed, CINAHL, and Ethicshare databases was conducted to find out the articles published on ethical and legal issues in geriatric care. Ethical considerations: The approval for the study was obtained from UMIT-The Health and Life Sciences University, Austria. Results: Only 50 articles were included for systematic analysis reporting ethical and legal issues in the geriatric care. The results presented in this article showed that the main ethical issues were related to the older people’s autonomy, respect for their needs, wishes and values, and respect for their decision-making. The main legal issues were related to patients’ rights, advance directives, elderly rights, treatment nutrition dilemma, and autonomy. Conclusion: Further education for professional caregivers, elderly people, and their families is needed on following topics: care planning, directive and living wills, and caregiver-family member relationships to guide and support the elderly people within their decision-making processes and during the end-of-life care. (shrink)

This paper is about the question of whether or not virtual rape should be considered a crime under current law. A virtual rape is the rape of an avatar in a virtual world. In the future, possibilities for virtual rape of a person him- or herself will arise in virtual reality environments involving a haptic device or robotics. As the title indicates, I will study both these present and future instances of virtual rape in light of three categories of legal (...) philosophical theories on rape in order to answer the aforementioned question. I will argue that a virtual rape in a future virtual reality environment involving a haptic device or robotics should in principle count as the crime of rape; for it corresponds to rape as it is viewed under the liberal theories that currently dominate the law. A surprising finding will be that a virtual rape in a virtual world re-actualizes the conservative view of rape that used to dominate the law in the Middle Ages and resembles rape as it is viewed under the feminist theories that criticize current law. Virtual rape in a virtual world cannot count as rape under current law; however, and at the end of this paper, I will suggest qualifying it as sexual harassment instead. (shrink)