QALY calcuations are currently being considered in the UK as a way of showing how the National Health Service (NHS) can do the most good with its resources. After providing a brief summary of how QALY calculations work and the most common arguments for and against using them to set NHS priorities, I suggest that they are an inadequate measure of the good done by the NHS because they refer only to its effects on what will be defined as the (...) ‘patient community’. The benefit of the NHS to the wider community is best regarded as a public good—everyone benefits from the general belief that the NHS is there to provide care for those who fall into a state of medical need. QALY ideology threatens this belief because it gives efficiency a higher priority than caring in response to need. It is a fallacy that a QALY maximising health service will be a greater good to society, because this sort of quest for efficiency threatens the caring basis of the Welfare State as such. (shrink)

Management and organization researchers are being called to conduct research that is more caring, yet the concept of care and how to practice it within the profession is undertheorized. Adopting a feminist epistemology and methodology, we develop the concept of care by weaving the personal, ethical, and political into the research process. First, we reflect critically on how aspects of care—attentiveness, responsibility, competence, and responsiveness (Tronto, Moral boundaries: a political argument for an ethic of care, Routledge, 1993; Tronto, Caring democracy: (...) markets, equality, and justice, New York University Press, 2013)—unfolded in our personal research experiences, and secondly, we conduct a review of articles published in management and organization studies and analyse expressed or concealed conceptions of care in scholars’ accounts of research purpose and ethics. We find three ethical sensibilities at the heart of enacting care: encountering the ‘other’, interpreting roles and responsibilities, and deliberating needs and resources. We contribute to a feminist research ethics by highlighting issues related to care that are concealed in dominant ethos guiding management and organization research. Further, we develop methodological insights for implementing an ethic of care as an alternative ethical standpoint in business research ethics. Finally, we provide suggestions for how to embed more care within research ethics practices in academic institutions. (shrink)

In recent years, an increasing number of medical books and papers attempting to analyse the concepts of health and disease from the perspective of evolutionary biology have been published.This paper introduces the evolutionary approach to health and disease in an attempt to illuminate the premisses and the framework of Darwinian medicine. My primary aim is to analyse to what extent evolutionary theory provides for a biological definition of the concept of disease. This analysis reveals some important differences between functional explanations (...) in the field of evolutionary biology and functional explanations in the field of medicine. Moreover, I shall argue that the biological functions relevant to the health of an organism cannot be determined on the basis of evolutionary theory. Accordingly, it seems that Darwinian medicine does not provide for the definition of a biological concept of disease. Still,Darwinian medicine may suggest why we are susceptible to certain diseases; it might also prove a suggestive heuristic on the basis of which new hypotheses concerning relevant treatments of various diseases might be advanced. (shrink)

Purpose – The purpose of this paper is to explore artificial moral agency by reflecting upon the possibility of a Moral Turing Test and whether its lack of focus on interiority, i.e. its behaviouristic foundation, counts as an obstacle to establishing such a test to judge the performance of an Artificial Moral Agent. Subsequently, to investigate whether an MTT could serve as a useful framework for the understanding, designing and engineering of AMAs, we set out to address fundamental challenges within (...) the field of robot ethics regarding the formal representation of moral theories and standards. Here, typically three design approaches to AMAs are available: top-down theory-driven models and bottom-up approaches which set out to model moral behaviour by means of models for adaptive learning, such as neural networks, and finally, hybrid models, which involve components from both top-down and bottom-up approaches to the modelling of moral agency. With inspiration from Allen and Wallace as well as Prior, we elaborate on theoretically driven approaches to machine ethics by introducing deontic tense logic. Finally, within this framework, we explore the character of human interaction with a robot which has successfully passed an MTT. Design/methodology/approach – The ideas in this paper reflect preliminary theoretical considerations regarding the possibility of establishing a MTT based on the evaluation of moral behaviour, which focusses on moral reasoning regarding possible actions. The thoughts reflected fall within the field of normative ethics and apply deontic tense logic to discuss the possibilities and limitations of artificial moral agency. Findings – The authors stipulate a formalisation of logic of obligation, time and modality, which may serve as a candidate for implementing a system corresponding to an MTT in a restricted sense. Hence, the authors argue that to establish a present moral obligation, we need to be able to make a description of the actual situation and the relevant general moral rules. Such a description can never be complete, as the combination of exhaustive knowledge about both situations and rules would involve a God eye’s view, enabling one to know all there is to know and take everything relevant into consideration before making a perfect moral decision to act upon. Consequently, due to this frame problem, from an engineering point of view, we can only strive for designing a robot supposed to operate within a restricted domain and within a limited space-time region. Given such a setup, the robot has to be able to perform moral reasoning based on a formal description of the situation and any possible future developments. Although a system of this kind may be useful, it is clearly also limited to a particular context. It seems that it will always be possible to find special cases in which a given system does not pass the MTT. This calls for a new design of moral systems with trust-related components which will make it possible for the system to learn from experience. Originality/value – It is without doubt that in the near future we are going to be faced with advanced social robots with increasing autonomy, and our growing engagement with these robots calls for the exploration of ethical issues and stresses the importance of informing the process of engineering ethical robots. Our contribution can be seen as an early step in this direction. (shrink)

The principled approach to theory building that has been a conspicuous mark of bioethical theory for the past generation has in recent years fallen under considerable critical scrutiny. Although some critics have confined themselves to reordering the dominant principles, others have rejected a principled approach entirely and turned to alternative paradigms. Prominent among critics are antiprin-ciplists, who want to jettison the principle-based approach altogether and adopt a casuistic model, and communitarians, who favor an eclectic model combining features of both the (...) casuistic model and a modified principled approach. Particularly conspicuous in virtually all such critiques is their challenge to the preeminence of the principle of autonomy. Critical barbs have been aimed not only at theories favoring a hierarchical ordering of moral principles that give first place to autonomy, but also at those that include autonomy among a set of ostensibly coequal principles. Though these critics have performed a valued function by displacing bioethical principles from their Olympian perch beyond actual decision-making contexts, some version of the principle of autonomy may, nonetheless, be well worth defending but for very different reasons than those put forward by its supporters. (shrink)

This paper assesses great apes’ abilities for pantomime and action imitation, two communicative abilities proposed as key contributors to language evolution. Modern great apes, the only surviving nonhuman hominids, are important living models of the communicative platform upon which language evolved. This assessment is based on 62 great ape pantomimes identified via data mining plus published reports of great ape action imitation. Most pantomimes were simple, imperative, and scaffolded by partners’ relationship and scripts; some resemble declaratives, some were sequences of (...) several inter-related elements. Imitation research consistently shows great apes perform action imitation at low fidelity, but also that action imitation may not represent a distinct process or function. Discussion focuses on how findings may advance reconstruction of the evolution of language, including what great apes may contribute to understanding ‘primitive’ forms of pantomime and imitation and how to improve their study. (shrink)

:I present arguments in favour of the view that the propositions expressed by utterances containing singularly referring terms have modes of presentation of the objects referred to by those terms as constituents. I rely on recent work by Sperber and Wilson, Recanati and other pragmatists, and claim that a Fregean account of singular reference is supported by this work. This is in opposition to Recanati himself, who in his book Direct Reference has argued for a view which is closer to (...) that of some neo‐Russellians. In particular, I argue contra Recanati for the truth‐conditional relevance of the modes of presentation associated with demonstratives and other referential terms. That is, 1 argue that these modes of presentation must be seen as part of the truth‐conditional content of utterance‐tokens containing such terms. (shrink)

Les titres donnés à la parabole de Luc 15,11-32 évoquent le plus souvent l’un de ses personnages, le fils cadet. Les deux frères ont cependant chacun leur importance. L’élément inattendu du récit n’est ni le retour du cadet ni l’accueil qui lui est fait. Les v. 12-24, centrés sur lui, ont suscité l’empathie du lecteur et certains acquis de lecture l’ont préparé à cet accueil. La surprise du récit se trouve dans l’intervention du fils aîné: son arrivée et le sommaire (...) du v. 27 révèlent le décalage entre cette fête et celles évoquées au début du chapitre 15: la thématique ‘perdu / trouvé’ et la dimension collective de la fête ont ici disparu. Alors que l’aîné est pris dans une logique de rétribution, le père évoque la fraternité en plus de la filiation, le basculement de valeurs en plus de la rétribution. L’irruption du fils aîné, en provoquant un décalage entre l’attente du lecteur et la situation racontée, est l’occasion de réaffirmer l’importance du retournement provoqué par «trouvé / perdu». Ce changement-là permet d’entrer dans la vraie joie, celle du royaume. Le retour du cadet n’est donc pas ce qui exclut l’aîné de la fête, mais au contraire ce qui permet la fête, et permet à l’aîné d’y être invité. (shrink)

Hannah James makes a persuasive case for the use of donated bodies and body parts in surgical training, enabling high fidelity training, improved competency of surgeons and reduced risk of harm to patients from trainees ‘learning on the job’.1 She also identifies some pertinent ethical questions that arise from this practice that should be considered by training organisations, regulatory authorities and the trainees themselves. Many countries throughout the world have regulated programmes, governed by strict ethical principles, for donating bodies, usually (...) to academic institutions for the purposes of medical education.2 In the UK the Human Tissue Authority sets out guiding principles for institutions licensed to handle human tissue including donation of bodies for anatomical examination, education and research; consent, dignity, quality, and honesty and openness.3 The Nuffield Council on Bioethics, in its 2011 report, Human Bodies: donation for medicine and research, identified a number of relevant ethical values including autonomy, altruism, justice, dignity, reciprocity, maximising welfare, and honesty and respect.4 While this report did not focus specifically on donation of human tissue for education and training the principles identified are equally relevant in this context. In terms of maximising welfare whole body donation for education and training provides benefit to many patients over a relatively short time frame …. (shrink)

Stimuli that resemble humans, but are not perfectly human-like, are disliked compared to distinctly human and nonhuman stimuli. Accounts of this “Uncanny Valley” effect often focus on how changes in human resemblance can evoke different emotional responses. We present an alternate account based on the novel hypothesis that the Uncanny Valley is not directly related to ‘human-likeness’ per se, but instead reflects a more general form of stimulus devaluation that occurs when inhibition is triggered to resolve conflict between competing stimulus-related (...) representations. We consider existing support for this inhibitory-devaluation hypothesis and further assess its feasibility through tests of two corresponding predictions that arise from the link between conflict-resolving inhibition and aversive response: 1) that the pronounced disliking of Uncanny-type stimuli will occur for any image that strongly activates multiple competing stimulus representations, even in the absence of any human-likeness, and 2) that the negative peak of an ‘Uncanny Valley’ should occur at the point of greatest stimulus-related conflict and not (in the presence of human-likeness) always closer to the ‘human’ end of a perceptual continuum. We measured affective responses to a set of line drawings representing nonhuman animal-animal morphs, in which each continuum midpoint was a bistable image (Exp. 1), as well as to sets of human-robot and human-animal computer-generated morphs (Exp. 2). Affective trends depicting classic Uncanny Valley functions occurred for all continua, including the nonhuman stimuli. Images at continua midpoints elicited significantly more negative affect than images at endpoints, even when the continua included a human endpoint. This illustrates the feasibility of the inhibitory-devaluation hypothesis and the need for further research into the possibility that the strong dislike of Uncanny-type stimuli reflects the negative affective consequences of cognitive inhibition. (shrink)

The aim of this article is to show the importance of moral sensitivity when including persons with dementia in research. The article presents and discusses ethical challenges encountered when a total of 15 persons with dementia from two nursing homes and seven proxies were included in a qualitative study. The examples show that the ethical challenges may be unpredictable. As researchers, you participate with the informants in their daily life and in the interviews, and it is not possible to plan (...) all that may happen during the research. A procedural proposal to an ethical committee at the beginning of a research project based on traditional research ethical principles may serve as a guideline, but it cannot solve all the ethical problems one faces during the research process. Our main argument in this article is, therefore, that moral sensitivity is required in addition to the traditional research ethical principles throughout the whole process of observing and interviewing the respondents. (shrink)

We examine recent evolution in corporate responsibility in the forest industry, an important natural-resource-based industry which is under rapid internationalisation and structural change under challenging financial pressures. We address two recent trends in corporate communication: corporate disclosure, that is the adoption of consistent external reporting standards [namely the Global Reporting Initiative (GRI) ], and the growing awareness of engagement with and impact on local communities through philanthropy, generation of prosperity, communication and the social impact of core activities. This study uses (...) a comparative qualitative case approach to forest industry multinational enterprises (MNEs) based on a combination of secondary (reporting, company newsletters and other documentation) and interview data. Three large-scale multinational forest industry firms, all pursuing different strategies in terms of internationalisation and geographical and product diversification, were chosen for the study: Stora Enso, SCA and Sappi Ltd. Our results show that the overall quality of sustainability reporting has improved in these companies from 2005 to 2009 with the adoption of GRI. However, based on our fourfold categorisation of social impact, the core social impact indicator in GRI (SO1) has been interpreted very differently in these MNEs, and the adoption of GRI has not actually much improved the comparability of the reports or transparency of practices. (shrink)

Because of the transfer of responsibility from hospitals to community-based settings, providers in home-based care have more responsibilities and a wider range of tasks and responsibilities than before, often with limited resources. The increased responsibilities and the complexity of tasks and patient groups may lead to several ethical challenges. A systematic search in the databases MEDLINE, CINAHL, and SveMed+ was carried out in February 2019 and August 2020. The research question was translated into a modified PICO (Population, Intervention, Comparison, and (...) Outcome) worksheet. A total of 40 articles were included. The review is conducted according to the Vancouver Protocol. The main findings from the systematic literature review show that ethical challenges experienced by healthcare and social care providers in home-based care are related to autonomy and balancing ethical principles, decisions regarding intensity of care, challenges related to priority settings, truth-telling, and balancing the professional role. Findings regarding ethical challenges within home-based care are in line with findings from institutional healthcare and social care settings. However, some significant differences from the institutional context are also highlighted. (shrink)

In recent years, critics of modern obstetrics have cited technology as responsible for women's discontent regarding childbirth. In this essay, I investigate and pry apart the connection between the quality of childbirth experience and technology. After identifying three factors considered constitutive of a ‘good birth,’ I demonstrate how technology can either facilitate or hinder each, but how dominant strains of birthing practice that reinforce female shame consistently undermine them all. It is not technology per se, but its sensitive application, which (...) may most effectively promote an optimal and affirming birth experience. (shrink)

As part of the roundtable, “Ethics and the Future of the Global Food System,” this essay discusses some of the major challenges we will face in feeding the world in 2050. A first challenge is nutritional: 690 million people are currently undernourished, while 2.1 billion adults are overweight or obese. The current global food system is insufficient in ensuring that the nutritious foods that make up healthy diets are available and accessible for the world's population. Moreover, by 2050, as the (...) global population increases, food demand will increase by 50–60 percent. A fundamental challenge is meeting this demand while not wreaking irreversible havoc on natural resources, the environment, and planetary systems. A body of scientific research has coalesced around the need to reduce food loss and waste, adopt environmentally sustainable production practices, and shift toward plant-dominant diets. Other long-standing food system problems include deficits in providing fair wages and decent working conditions for food system workers, threats to smallholder farmer livelihoods, and tens of billions of animals kept in welfare-deficit confinement conditions. These food system challenges are bad states of affairs that matter from a variety of moral perspectives. In other words, there is a robust moral case for addressing these challenges. Yet concerted policy action in this area is insufficient and largely absent, pointing to the underlying challenge and complexity of political inertia. (shrink)

BackgroundCRISPR-Cas9, a technology enabling modification of the human genome, is developing rapidly. There have been calls for public debate to discuss its ethics, societal implications, and governance. So far, however, little is known about public attitudes on CRISPR-Cas9. This study contributes to a better understanding of public perspectives by exploring the various holistic perspectives Dutch citizens have on CRISPR-Cas9.MethodsThis study used Q methodology to identify different perspectives of Dutch citizens (N = 30) on the use of CRISPR-Cas9. The Q-sort method (...) aims at segmenting audiences based on the structural characteristics of their perspectives. Participants individually ranked 32 statements about CRISPR-Cas9 and discussed their rankings in small groups. By-person factor analysis was performed using PQMethod. Participants’ contributions to the discussions were used to further make sense of the audience segments identified.ResultsFive perspectives on CRISPR-Cas9 were identified: (1) pragmatic optimism (2) concerned scepticism; (3) normative optimism; (4) enthusiastic support; and (5) benevolent generalism. Each perspective represents a unique position motivated by different ranking rationales. Sorting rationales included improving health, preventing negative impacts on society, and fear of a slippery slope. Overall, there is broad, but not universal support for medical uses of CRISPR-Cas9.ConclusionsResearch on CRISPR-Cas9 should prioritise the broadly supported applications of the technology. Research and public debates on CRISPR-Cas9, its uses, its broader implications, and the governance of CRISPR-Cas9 are recommended. A discourse that includes all perspectives can contribute to the embedding of future uses of CRISPR-Cas9 in society. This study shows that Q methodology followed by group discussions enables citizens to contribute meaningfully to discourses about research. (shrink)

The purpose of this article is threefold: to offer a vision of human flourishing in the academy premised upon ‘living in truth’, embracing lived experience and being in relation; to explore counterfactual thinking across the life-course, from the period of compulsory schooling to the end of life, with the emphasis on the latter; and to critique the practice of drawing upon philosophy to provide an interpretative framework through which to address the arts, drawing upon the work of Cora Diamond. The (...) movement towards death is explored through three vignettes, focusing on the lived experience of three ‘characters’ facing the prospect of their imminent demise: the philosopher Richard Rorty, the English television dramatist and screenwriter Dennis Potter and a consultant physician (the father of one of the authors). Drawing upon the work of the historian Timothy Snyder, the relevance of the claim made by Vaclav Havel that ‘essence precedes existence’ is explored in relation to the climate of the contemporary education system. The primacy of essence over existence is also a key feature of the vignettes of the lives of the three players that form the centrepiece of the article. These enable us to ‘think without thinking’, which is perhaps a counterfactual claim par excellence. (shrink)

We propose that IAM and déjà vu may not share a placement on the same gradient, per se, but the mechanism of cue familiarity detection, and a major differentiating factor between the two metacognitive experiences is whether the resulting inward directed search of memory yields retrieved content or not. Déjà vu may manifest when contentless familiarity detection is inexplicable by the experiencer.

The significance of private standards and associated local level initiatives in agri-food value chains are increasingly recognised. However whilst issues related to compliance and impact at the smallholder or worker level have frequently been analysed, the governance implications in terms of how private standards affect national level institutions, public, private and non-governmental, have had less attention. This article applies an extended value chain framework for critical analysis of Private Standards Initiatives (PSIs) in agrifood chains, drawing on primary research on PSIs (...) operating in Kenyan horticulture (Horticulture Ethical Business Initiative and KenyaGAP). The paper explores the legislative, executive and judicial aspects of governance in these southern PSIs highlighting how different stakeholders shape debates and act with agency. It is argued that governance is exercised ‘beyond the vertical’ in that one can identify wider horizontal processes of governance, including how the scope of key debates is constructed (especially in legislative governance) but analysis of executive governance emphasises the dominant role of the lead buyers. (shrink)

Studies regularly show that an age-based stereotype threat impairs older adults’ performance on memory tasks. Results regarding stereotype threat effects on false memories are less clear. Some studies suggest that education may moderate the relationship between an age-related stereotype threat and episodic memory performance in older adults. The present study aimed at examining the moderating role of education on the relationship between perceived stereotype threat and false memories in older adults. With this aim, 82 adults between 60 and 70 years (...) of age performed a Deese-Roediger-McDermott task followed by a free recall test and completed questionnaires assessing both their perception of an age-based stereotype threat and their education level. Regression analyses showed no effect of PST on the production of critical lures. However, as was expected, our results showed that in higher educated older adults, as the perception of stereotype increases, the production of critical lures increases. These results confirm the moderating role of education and highlight its key role in the relationship between the age-based stereotype threat and older adults’ susceptibility to false memories. (shrink)

This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform ‘hands on’ nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the (...) philosopher Emanuel Levinas (1906–1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses’ stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses’ responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable. (shrink)