This book is a concise introduction to Maori philosophy, covering the symbolic systems and worldviews of the indigenous people of Aotearoa, New Zealand. This book addresses core philosophical issues including Maori notions of the self, the world, epistemology, the form in which Maori philosophy is conveyed, and whether or not Maori philosophy has a teleological agenda. The book introduces key texts, thinkers and themes and includes pedagogical features including: - A Maori-to-English glossary; - Accessible English translations of primary source material; (...) - Teaching notes, and reflections on how the studied material engages with contemporary debates - End-of-chapter discussion questions that can be used in teaching - Comprehensive bibliographies and guided suggestions for further reading. Maori Philosophy is an ideal text for students studying World Philosophies, or anyone who wishes to use indigenous philosophies or methodologies in their own research and scholarship. (shrink)

In many cases of family trauma, victims are left with the burden of rebuilding relationships that have been damaged. This paper illustrates that inappropriate pressure to forgive can harm victims of abuse. This pressure can come from a combination of assumptions. Firstly, often forgiveness is conflated with reconciliation, and those who put pressure on victims to forgive do so to avoid uncomfortable blame or estrangement. Secondly, anger is often inappropriately understood as a morally blameworthy emotion to hold. I draw on (...) Amia Srinivasan’s (2018) work on affective injustice to address this assumption and argue that pressure to forgo anger, forgive, and reconcile stems from a mistaken interpretation of these concepts and is ultimately harmful. I demonstrate this by using examples where victims have found their voices stifled by the mistaken coding of anger as morally blameworthy and forgiveness as morally required. (shrink)

Principles of procreative beneficence (PPBs) hold that parents have good reasons to select the child with the best life prospects. Sparrow (2010) claims that PPBs imply that we should select only female children, unlesswe attach normative significance to “normal” human capacities. We argue that this claim fails on both empirical and logical grounds. Empirically, Sparrow’s argument for greater female wellbeing rests on a selective reading of the evidence and the incorrect assumption that an advantage for females would persist even when (...) a serious gender imbalance is obtained. Logically, PPBs cite only pro tanto reasons and allow that the good of an individual child could be outweighed by other morally relevant considerations, such as those which take collectively suboptimal outcomes into account. There is thus no need to attach value to the “normal.”. (shrink)

"This collection of essays arises from the 7th annual Cambridge French Graduate Conference, held July 4-5, 2005, whose theme was 'threat'.".

Studies of implicit learning have shown that individuals exposed to a rule-governed environment often learn to exploit 'rules' which describe the structural relationship between environmental events. While some authors have interpreted such demonstrations as evidence for functionally separate implicit learning systems, others have argued that the observed changes in performance result from explicit knowledge which has been inadequately assessed. In this paper we illustrate this issue by considering one commonly used implicit learning task, the Serial reaction time task, and outline (...) what we see as an important problem associated with each of the commonly used methods used to assess explicit knowledge. This is that each measure requires a form of response which is dependent on the subjects having some knowledge of the serial-order of the sequence. We argue that such methods, or more specifically their analyses, seriously underestimate other sources of knowledge, which may be available to subjects during their performance of the SRT task. In support of this argument we demonstrate that subjects' serial-order knowledge can, in principle, be independent of subjects' knowledge of the statistical structure of the sequence, and we propose an alternative method for analysing performance on the Generate task which avoids this problem. (shrink)

The questions raised by Māori identity are not static, but complex and changing over time. The ethnicity known as “Māori” came into existence in colonial New Zealand as a new, pan-tribal identity concept, in response to the trauma of invasion and dispossession by large numbers of mainly British settlers. Ideas of Māori identity have changed over the course of succeeding generations in response to wider social and economic changes. While inter-ethnic marriages and other sexual liaisons have been common throughout the (...) Māori-Pākehā relationship, the nature of such unions, and the identity choices available to their descendants, have varied according to era and social locus. In colonial families, the memory of a Māori ancestor was often deliberately suppressed, and children were encouraged to deny that part of their history and “become” European New Zealanders: a classic form of what we call “trans-ethnicity.” From a Māori perspective, the relationship with Pākehā has been marked by a series of losses: loss of land, language, social cohesion, even loss of knowledge of whakapapa. This article explores this last form of loss, which leads to “suppressed” Māori identities, and possible effects of attempting to recover such lost Māori identity rights. (shrink)

A prominent defence of a market in organs from living donors says that if we truly care about people in poverty, we should allow them to sell their organs. The argument is that if poor vendors would have voluntarily decided to sell their organs in a free market, then prohibiting them from selling makes them even worse off, at least from their own perspective, and that it would be unconscionably paternalistic to substitute our judgements for individuals' own judgements about what (...) would be best for them. The author shows that this ‘Laissez-Choisir Argument’ for organ selling rests on a mistake. This is because the claim that it would be better for people in poverty to sell their organs if given the option is consistent with the claim that it would be even better for them to not have the option at all. The upshot is that objections to an organ market need not be at all paternalistic, since we need not accept that the absence of a market makes those in poverty any worse off, even from their own point of view. The author goes on to argue that there are strong theoretical and empirical reasons for believing that people in poverty would in fact be harmed by the introduction of a market for live donor organs and that the harm constitutes sufficient grounds for prohibiting a market. (shrink)

Intuitively, it seems that certain basic desires, or urges, are rationally impotent, i.e., that they provide no reasons for action (a famous example is Warren Quinn's story of a man who has a brute urge to turn on every radio he sees). This intuition seems to conflict with the internalist, or Humean subjectivist, claim that our desires give us reasons. But Harry Frankfurt's well-known subjectivist account, with its distinction between first- order and higher-order desires and its concepts of identification and (...) commitment, may be able to accommodate this intuition. Regan Lance Reitsma has argued that to do so, it needs to be supplemented with a concept of "personal ideals", which demand that we give no normative weight to certain inclinations. I argue that Reitsma's account depends on the unexplained assumption that some kinds of desire have special standing, and thus cannot improve on the explanation of the rational impotence of urges already available to Frankfurt. (shrink)

There is a libertarian argument for live donor organ markets, according to which live donor organ markets would be permitted if we simply refrained from imposing any substantive and controversial moral assumptions on people who reasonably disagree about morality and justice. I argue that, to the contrary, this endorsement of live donor organ markets depends upon the libertarians’ adoption of a substantive and deeply controversial conception of strong, extensive property rights. This is shown by the fact that these rights would (...) prevent states intervening in cases of preventable and intuitively impermissible wronging of others that can arise when free individuals engage in voluntary offers and exchanges. I outline two forms of such wronging: discrimination and disrespectful demands. I argue that although these types of acts are morally impermissible, the policy question of whether and how they should be regulated by states is non-trivial. I then argue that there is good reason to think that organ markets would rely on disrespectful demands. This may help explain the widespread moral repugnance people feel toward organ trading. It also provides a prima facie, though not decisive, case for states to prohibit such markets. (shrink)

This essay considers the ancient antecedents to the “new field” of the ethics of philanthropy, arguing that key questions such as “to whom should we give our money?” have already been explored by ancient authors and that the answers they give to these questions can be quite different to the answers given by contemporary scholars. By analysing the treatment of giving in Aristotle’s Nicomachean Ethics, Cicero’s De Officiis, and Seneca’s De Beneficiis, I argue that the focus of ancient thinkers upon (...) giving within one’s own community can be viewed as a possible response to a number of issues that have been raised by modern scholars, including the “problem of acting at a distance” and the “problem of accountability.” Moreover, these ancient thinkers have additional, positive reasons for thinking that philanthropy should take place within one’s own community, based upon their ideas of man’s natural duty to his political community, and the social benefits that can be derived from local philanthropy. The integration of ancient perspectives, then, into these modern debates, can serve to complement and broaden research in this emerging field. (shrink)

This paper examines how young peoples’ lived experiences with personal technologies can be used to teach engineering ethics in a way which facilitates greater engagement with the subject. Engineering ethics can be challenging to teach: as a form of practical ethics, it is framed around future workplace experience in a professional setting which students are assumed to have no prior experience of. Yet the current generations of engineering students, who have been described as ‘digital natives’, do however have immersive personal (...) experience with digital technologies; and experiential learning theory describes how students learn ethics more successfully when they can draw on personal experience which give context and meaning to abstract theories. This paper reviews current teaching practices in engineering ethics; and examines young people’s engagement with technologies including cell phones, social networking sites, digital music and computer games to identify social and ethical elements of these practices which have relevance for the engineering ethics curricula. From this analysis three case studies are developed to illustrate how facets of the use of these technologies can be drawn on to teach topics including group work and communication; risk and safety; and engineering as social experimentation. Means for bridging personal experience and professional ethics when teaching these cases are discussed. The paper contributes to research and curriculum development in engineering ethics education, and to wider education research about methods of teaching ‘the net generation’. (shrink)

I make the observation that English sentences such as “You have reason to take the bus or to take the train” do not have the logical form that they superficially appear to have. I find in these sentences a conjunctive use of “or,” as found in sentences like “You can have milk or lemon in your tea,” which gives you a permission to have milk, and a permission to have lemon, though no permission to have both. I argue that a (...) confusion of genuine disjunctions with sentences of the above form has motivated the mistaken acceptance by some philosophers of principles like the one I call “Liberal Transmission.” This is the principle that if you have a reason to do something, then you have a reason to do it in each of the possible ways in which it can be done (though not more than one of them). I argue that Liberal Transmission and its close relatives are false. Wide-scope reasons are defined as reasons that have a conditional or other logical connective within the scope of the reason operator. For example, a wide-scope instrumental reason might be: reason(if you have an end, take the means). By refuting Liberal Transmission, I show that you could have wide-scope instrumental reasons like this while nevertheless lacking any narrow-scope reason to take the means, or narrow-scope reason to not have the end. This enables me to respond to two major objections to the wide-scope approach to the instrumental principle that have been developed by Joseph Raz and by Niko Kolodny. (shrink)

Aims: The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress. Background: Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon. Design: Systematic literature (...) review and narrative synthesis (November 2015–March 2016). Data sources: Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts. Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis. Results: In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity. Conclusion: We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress. (shrink)

Reproduction is broadly recognised as fundamental to human flourishing. The presumptive priority of reproductive freedom forms the predominant position in the literature, translating in the non-sexual reproductive realm as an almost inviolable right to access assisted reproductive technology (ART). This position largely condemns refusal or restriction of ART by clinicians or the state as discriminatory. In this paper, I critically analyse the moral rights individuals assert in reproductive pursuit to explore whether reproductive rights entitle hopeful parents to ART. I demonstrate (...) that none of the protected actions performed, or entitlements generated are sui generis ‘reproductive’ rights, leading to the claim that there is no such thing as a right to reproduce. Under scrutiny, the reproductive right is a far narrower and weaker rights assertion than is recognised in the literature. I argue that the predominant position is grounded in a fundamental misunderstanding of the scope and strength of reproductive claims.I also highlight a significant conceptual inconsistency in the literature. On one hand, there is broad consensus that reproductive rights are predominantly negative, yet access to fertility treatment is framed as a component of the right. This wrongly contorts the negative nature of reproductive rights into a positive claim-right to ART. I conclude that this mistakenly frames ART access as sitting within the scope of reproductive freedom. I offer a revised conceptual paradigm of reproductive rights that has important clinical and policy implications for the provision and regulation of ART. (shrink)

Fertility clinicians participate in non-sexual reproductive projects by providing assisted reproductive technology (ART) to those hoping to reproduce, in support of their reproductive goals. In most countries where ART is available, the state regulates ART as a form of medical treatment. The predominant position in the reproductive rights literature frames the clinician’s role as medical technician, and the state as a third party with limited rights to interfere. These roles broadly align with established functions of clinician and state in Western (...) liberal democracies, where doctors have duties to provide safe, beneficial and legal healthcare to all who seek it. Recognised state responsibilities include safeguarding equitable access to medical services and protecting and promoting reproductive liberty.I argue against this normative moral framing of clinician and state involvement in non-sexual reproduction, suggesting that clinician and state join the non-sexual reproductive project at the point of triggering conception. Begetting a child is more than just the provision and regulation of healthcare; it generates rights and confers responsibilities on all who join this morally significant project. All who collaborate have the right to join or refuse to join the project. I suggest this is intuitively understood in the sexual realm, but not in the non-sexual realm. My key substantive claim is that non-sexual reproduction is a pluralist pursuit that morally implicates more than the genetic and gestational contributors. I find that while the moral basis of a clinician or the state’s right to refuse to join the ART project is the same as for those providing gestational or genetic input, the reasons that morally underpin their refusal differs. (shrink)

The present study endeavors to give a description of a famous case of sexual harass- ment at the workplace and critique it in terms of its embedment of an intertwined relationship between two pervasive ideologies prevalent in our society: patriarchy and consumerism. By focusing on the favorable conditions, ways of resolution, and outcomes of the lawsuit, this essay approaches the organization- al culture of Mitsubishi Motor Manufacturing of America through the lens of critical theory. Selective literature review on sexual harassment, (...) as well as general coverage of the event by the media and the parties involved demonstrate the validity of the claim that this study has made. (shrink)

Among the myriad of technical approaches and abstract guidelines proposed to the topic of AI bias, there has been an urgent call to translate the principle of fairness into the operational AI reality with the involvement of social sciences specialists to analyse the context of specific types of bias, since there is not a generalizable solution. This article offers an interdisciplinary contribution to the topic of AI and societal bias, in particular against the poor, providing a conceptual framework of the (...) issue and a tailor-made model from which meaningful data are obtained using Natural Language Processing word vectors in pretrained Google Word2Vec, Twitter and Wikipedia GloVe word embeddings. The results of the study offer the first set of data that evidences the existence of bias against the poor and suggest that Google Word2vec shows a higher degree of bias when the terms are related to beliefs, whereas bias is higher in Twitter GloVe when the terms express behaviour. This article contributes to the body of work on bias, both from and AI and a social sciences perspective, by providing evidence of a transversal aggravating factor for historical types of discrimination. The evidence of bias against the poor also has important consequences in terms of human development, since it often leads to discrimination, which constitutes an obstacle for the effectiveness of poverty reduction policies. (shrink)

Wittgenstein explores learning through practice in the Philosophical Investigations by means of an extended analogy with games. However, does this concern with learning also necessarily extend to education, in our institutional understanding of the word? While Wittgenstein's examples of language learning and use are always shared or social, he does not discuss formal educational institutions as such. He does not wish to found a ‘school of thought’, and is suspicious of philosophy acting as a theory that can be applied to (...) other areas of life. While Wittgenstein's focus on developing independent thinking was neither individualistic nor anti-institutional, it did, however, focus on developing the thinking of his students rather than theorising about how this could be applied on a large scale. An analysis of Hermann Hesse's novel, The Glass Bead Game will help us to pick up where Wittgenstein deliberately left off—thinking about how (or if) one can institutionalise learning methods that encourage thinking for oneself. These differences in the writers’ treatment of education will become evident in the differences between their game analogies. While language-games combat our ‘craving for generality’ in Philosophical Investigations, the Glass Bead Game represents this craving, and how it manifests itself throughout history in disciplines other than logic and philosophy of language. It also represents the potential for institutions to become insular, exclusive communities. (shrink)

Alongside clinical practice, medical schools now confront mounting reasons to examine nontraditional approaches to ethics. Increasing awareness of systems of oppression and their effects on the experiences of trainees, patients, professionals, and generally on medical care, is pushing medical curriculum into an unfamiliar territory. While there is room throughout medical school to take up these concerns, ethics curricula are well-positioned to explore new pedagogical approaches. Feminist ethics has long addressed systems of oppression and broader structures of power. Some of its (...) established concepts can offer distinct value as medical climates change and adapt in response to increased awareness of the experiences of marginalized individuals and populations. In this essay, we offer a set of concepts from feminist ethics that have a fundamental role to play in medical school curriculum: relationality, relational autonomy, and epistemic justice. Though these concepts are not exhaustive, they can be taught in tandem with the concepts that have historically grounded ethics education in medical school, such as autonomy and beneficence. Ultimately, we contend that these concepts hold particular value in ethics curriculum insofar as they diversify mainstream ethical approaches, directly address the pervasiveness of systems of oppression in medicine, and recognize the voices and concerns that may be marginalized in standard approaches. (shrink)

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the (...) academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context. (shrink)

The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally (...) in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses’ relationships with patients and families. We urge policy‐makers to ensure that nurses’ voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic. (shrink)

The predominant position in the reproductive rights literature argues that access to assisted reproductive technologies (ART) forms part of an individual’s right to reproduce. On this reasoning, refusal of treatment by clinicians (via provision) violates a hopeful parent’s reproductive right and discriminates against the infertile. I reject these views and suggest they wrongly contort what reproductive freedom entitles individuals to do and demand of others. I suggest these views find their origin, at least in part, in the way we define (...) “reproduction” itself. This paper critically analyses two widely accepted definitions of human reproduction and demonstrates that both are fundamentally flawed. While the process of reproduction includes the biological acts of begetting and bearing a child, I argue that it does not extend to include rearing. This reworked definition has little impact in the realm of sexual reproduction. However, it has significant ethical implications for the formulation and assignment of reproductive rights and responsibilities in the non-sexual realm in two important ways. First, a claim to access ART where one has an intention to rear a child (but does not beget or bear) cannot be grounded in reproductive rights. Second, lacking an intention to rear does not extinguish the reproductive rights and responsibilities for those who collaborate in the process. I conclude that clinicians collaborate in non-sexual reproduction at the point of triggering conception (begetting) and therefore have the right to refuse to be involved in non-sexual reproduction, in some instances, as do all reproductive collaborators. (shrink)

Volume 20, Issue 3, March 2020, Page 21-24.

Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases (“Moral Distress Reflective Debriefs”). We discuss how the debriefing literature and other clinical ethics (...) activities influenced the development of our approach. In particular, we focus on the role of the clinical ethicist as a facilitator with particular emphasis on encouraging perspective-taking and nurturing ethical attunement in a supportive manner. We suggest that this approach reduces the narrowing effects of frustration and anger that are often reported when individuals experience moral-constraint distress. Finally, we provide an example of Moral Distress Reflective Debriefs, elucidating how this supportive process complements ethics consultation and can mitigate the negative effects of moral distress. (shrink)

The German poet Barbara Köhler's 2007 poem-cycle Niemands Frau [Nobody's Wife] is more than a feminist response to Homer's Odyssey. In shifting the focus from the escapades of the hero Odysseus to the web of women characters that populates Homer's epic poem – Nausicaa, Circe, the Sirens, Helen, Ino Leucothea, the shades of the dead women whom Odysseus meets in Hades, and “Nobody’s wife” Penelope – Köhler also undertakes a grammatical shift: from the masculine singular pronoun “er” to the polyvalent (...) pronoun “sie” that denotes the feminine singular, the gender-unmarked plural and the formal “you.” “Sie” acts as the “quantum linguistic particle” that transports the reader from a world analogous to that conceived by Newtonian physics into a quantum universe of plural probabilities. Köhler's work explores the difference in power dynamics that results from this transformation, generating intriguing ways of reconceiving subjectivity, relationality, rationality, and authorship. Taken at their word, the poems open up a prospect of no longer insisting on the sovereign individual subject and his linear modes of narration, inheritance, calculation and grammatical proposition. (shrink)

Background The phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice. Research aim To explore the (...) concept of moral distress in nursing both empirically and conceptually. Methodology Feminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis. Ethical considerations The study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom. Findings The empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas. Discussion We suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress. Conclusion The empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. (shrink)

Thousands of lives are lost each year because of a lack of organs available for transplant, but currently, in the UK and many other countries, organs cannot be taken from a deceased donor without explicit consent from the donor or his or her relatives. Switching to an ‘opt‐out’ system for organ donation could substantially increase the supply of organs, and save many lives. However, it has been argued in some quarters that there are serious ethical objections to an opt‐out policy, (...) and that it would be better to adopt a different policy known as the ‘presumptive approach’, that requires explicit consent while also attempting to sway the choices of potential donors and family in the direction of donating, using various persuasive techniques. This article shows how reflection on the impact of a well‐known cognitive bias known as ‘status quo bias’ can explain why moving from the status quo to an opt‐out policy might be effective in increasing organ availability, even without impinging on anyone's autonomous choices, why we might have overestimated the strength of the objections to an opt‐out policy, and why the presumptive approach is morally objectionable, while an opt‐out policy is not. (shrink)

ABSTRACT:Clinical ethics consultants bear witness to the direct harms of intersecting axes of oppression—such as racism and classism—as they impinge on elucidating and resolving ethical dilemmas in health care. Health Care Ethics Consultation (HCEC) professional guidance supports recognizing and analyzing power dynamics and social-structural obstacles to good care. However, the most relied upon bioethical principles in clinical ethics have been criticized for insufficiency in this regard. While individual ethics consultants have found ways to expand their approaches, they do so in (...) an ad hoc way without frameworks to guide consistency. Motivated by the practical expertise of clinical ethicists, this essay offers a new framework to support openness to analyzing power imbalances and respecting marginalized voices and values. This framework is grounded in transformative justice, where the aim is to take responsibility for oppression by centering and responding to moral perspectives and value systems that are all too often silenced. (shrink)