The art of medicine stimulates the attitude of mind which concedes that on certain issues the patient knows what is right for him or her, and the public senses what is best for it. Not because they are right, but because on these issues there is no absolute right. —Anthony MooreThe benefits of fine literature, narrative analysis, and the listening to and telling of stories in education are well known (Carson 2001; Guillemin and Gillam 2006; Hunter 1996; Moore 1978; Nussbaum (...) 1990). Literature must not be overlooked in the planning or the delivery of health education and care. Narrative opens readers’ minds by promoting a plethora of viewpoints about stories and life. Through the facilitation of student-centred activities students can critically mull over central points of the story. In discerning meaning, conversations between students are generated around the crucial question, “Whose story is it?” Coincidentally this question drives, or ought to drive, medical integrity.Practitioners m. (shrink)

The Rawlsian institutional approach holds that distributive principles apply to socioeconomic institutions rather than transactions within the institutional framework. Critics claim that the approach is baseless. I defend Rawls’s institutionalism by showing that it has a rational basis: Rawls “constructs” a theory of justice from considered judgments, especially ideas found in the political culture and historical conditions of democracy, including the fact of reasonable pluralism, which supports his institutionalism. I use Rawls’s “fact-sensitive constructivism” to interpret his claim that “utilitarianism does (...) not take seriously the distinction between persons.” Rawls’s claim refers to his contrast between impartial spectator reasoning for the classical principle of utility and his original position, which aims to motivate the original position’s use of mutually disinterested parties to an agreement as more accurately reflecting democracy’s fact of reasonable pluralism. Rawls then shows that these original position conditions, meant to reflect separate persons in democracy, justify his egalitarian principles over classical utility. I extend his contrast to act-egalitarianism to show that Rawls’s fact-sensitive constructivism supports his institutionalism. I argue that the original position, which reflects separate persons, only justifies the institutional difference principle and that the natural reasoning for act-egalitarianism does not take seriously the separateness of persons. (shrink)

G. A. Cohen argues that Rawls’s difference principle is incompatible with his endorsement of incentives inequality—higher pay for certain professions is just when that pay benefits everyone. Cohen concludes that Rawls must reject both incentives inequality and ‘institutionalism’—the view that egalitarian principles, including the difference principle, apply exclusively to social institutions. I argue that the premises of Cohen’s ‘internal criticism’ of Rawls require rejecting two important parts of his theory: a ‘subjective circumstance of justice’ and a ‘shared conception of justice’. (...) These are important parts of Rawls’s ‘constructivism’. Constructivism is the view that a conception of justice is the solution to a practical interaction problem and is solved in part by examining the facts of the problem. Thus, an upshot of my arguments is that this Cohen/Rawls dispute reduces to another dispute over ‘constructivism’. (shrink)

I examine the main anticosmopolitan Rawslian argument, the ‘basic structure argument.’ It holds that distributive justice only applies to existing basic structures, there are only state basic structures, so distributive justice only applies among compatriots. Proponents of the argument face three challenges: 1) they must explain what type of basic structure relation makes distributive justice relevant only among compatriots, 2) they must explain why distributive justice (as opposed to allocative or retributive) is the relevant regulative concept for basic structures, and (...) 3) they must put forth a plausible concept of distributive justice. I show that Rawlsians support what I will call the ‘division of labor thesis’ to answer the first two challenges. Briefly, the division of labor thesis holds that distributive justice only becomes relevant where members of a division of labor jointly produce some socioeconomic product. To meet the third challenge, Rawlsians seem to accept what Elizabeth Anderson calls the ‘modern systemic concept of distributive justice’ – the idea that distributive justice organizes entire economic systems with respect to their distributive consequences or the relationships they maintain. I argue that if Rawlsians accept the systemic concept, they should reject the anticosmopolitan basic structure argument. (shrink)

In this article, the important but neglected link between workplace safety-enhancing behavior and ethics is explored. Using data from 237 employees from five manufacturing plants in the Midwest, we investigated how specific local ethical climate types are linked to incidences of injuries and two types of safety-enhancing behaviors: safety compliance and safety participation. It was hypothesized that egoist climates are positively related to injuries and negatively related to safety-enhancing behaviors. In contrast, it is proposed that both benevolent and principled climates (...) have negative relationships with injuries and positive relationships with safety-enhancing behaviors. Results provided support only for our principled climate types while benevolence has the desired negative relationship with injuries. Egoism and benevolence are not related to safety-enhancing behaviors. Theoretical and practical implications of findings are discussed. (shrink)

One of the central problems of personal identity is to determine what we are essentially . In response to this problem, Lynne Rudder Baker espouses a psychological criterion, that is, she claims that persons are essentially psychological. Baker’s theory purports to bypass the problems of other psychological theories such as Dissociative Identity Disorder and the problem of individuating persons synchronically. I argue that the theory’s treatment of Dissociative Identity Disorder leads to untenable results, is invalid, and consequently fails to individuate (...) persons. (shrink)

Thomas Pogge argues that John Rawls’s priority of liberty rule is not constraining enough: it permits morally unacceptable restrictions of basic liberties. Because of this, Pogge claims that Rawls fails in his two central ambitions: to construct a moral conception that (1) opposes utilitarianism and (2) matches his judgments in reflective equilibrium. Pogge attributes this error to Rawls’s “purely recipient-oriented theorizing”—assessing a society’s basic structure based on how its citizens fare. I argue that Rawls’s theory does not allow restrictions of (...) liberty that are offensive to moral considerations. I then explain how my arguments against Pogge show that Rawls’s idea of reflective equilibrium is crucial for assessing a society’s basic structure and how it follows from this that Rawls’s theorizing is not purely recipient-oriented. (shrink)

Worldwide, the literature reports that many residents in long‐term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations (...) with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add‐on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC. (shrink)

The arts of rule cover the exercise of power by princes and popular sovereigns, but they range beyond the domain of government itself, extending to civil associations, political parties, and religious institutions. Making full use of political philosophy from a range of backgrounds, this festschrift for Harvey Mansfield recognizes that although the arts of rule are comprehensive, the best government is a limited one.

Mrs. Duong had coronary artery disease, ischemic cardiomyopathy, and mildly altered mental status when her case was presented before an advanced heart therapy medical review board. She was accepted for left ventricular assist device placement pending additional insight into her cognitive state. Before the LVAD could be implanted, however, Mrs. Duong went into cardiogenic shock, and her heart failure team placed an intra‐aortic balloon pump in her subclavian artery. Within two weeks, Mrs. Duong became IABP dependent and deconditioned. The attending (...) deemed her as lacking capacity to make complex medical decisions, and the medical review board officially declined her for LVAD placement. The heart failure and CICU teams feel that Mrs. Duong is not being helped by the care they are giving her. They recommend terminal weaning of the IABP and initiation of comfort care. Her family disagrees, pointing to activities like continued eating and interacting with family. At an impasse after yet another family meeting, the attending for the heart failure team asks the clinical ethics consultant, “Do we have to replace the balloon pump when it fails?”. (shrink)

Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention—a bridge to recovery or transplant—not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of (...) withdrawal, including distributive justice, quality of life, patients’ rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned. (shrink)

This volume inaugurates a new critical edition of the writings of the great English philosopher and sage Francis Bacon - the first such complete edition for more than a hundred years. It contains six of Bacon's Latin scientific works, each accompanied by entirely new facing-page translations which, together with the extensive introduction and commentaries, offer fresh insights into one of the great minds of the early seventeenth century.

Efforts to professionalize the field of bioethics have led to the development of the Healthcare Ethics Consultant-Certified (HEC-C) Program intended to credential practicing healthcare ethics consultants (HCECs). Our team of professional ethicists participated in the inaugural process to support the professionalization efforts and inform our views on the value of this credential from the perspective of ethics consultants. In this paper, we explore the history that has led to this certification process, and evaluate the ability of the HEC-C Program to (...) meet the goals it has set forth for HCECs. We describe the benefits and weaknesses of the program and offer constructive feedback on how the process might be strengthened, as well as share our team’s experience in preparing for the exam. (shrink)

Until the time of Karl Marx and John Stuart Mill, philosophers generally held economics to be an integral element of moral philosophy. These days, the language of values—moral, aesthetic, and cognitive—dominates philosophic discourse, even though contemporary philosophers rarely hold economics to be integral to moral philosophy. Examining the thought of Friedrich Nietzsche and the art of Marcel Proust, Edward Andrew provides the first sustained critical analysis of values discourse, an analysis that deconstructs its content and its form.

This study delves into the intricate world of tipping, examining how restaurant chefs and chef-owners account for and morally justify this practice. While previous research has paved the way for understanding several of the nuances of tipping in the dining experience, little attention has been given to chefs’ perspectives on its moral dimensions. In today’s evolving restaurant dining landscape, tipping practices have become increasingly contentious. Therefore, it is imperative to grasp the ethical intricacies of tipping experiences, as they hold significant (...) implications for social and economic interactions. This study focuses on interviews with culinary artisans—the masterminds behind the dining experience, including executive chefs, chef-owners, sous chefs, chefs de cuisine, private chefs, and pop-up chefs. Through these conversations, we explore the moral justifications for tipping, unintended consequences that arise, and the advent of tip coercion. Our findings shed light on the moral reasoning and ethical dynamics behind tipping practices. These findings offer a foundation for shaping theoretical frameworks, informing practical solutions, and guiding policy decisions in this complex realm. (shrink)

George Grant’s bleak assessment of the prospects of technological civilization owed a lot to his reading of Martin Heidegger and Jacques Ellul. However, Grant understood technological development within the context of liberal theory and capitalist practice. Grant explained why liberalism is the doctrine most appropriate to the development of productive forces, or the most complete exploitation of natural and human resources. Unlike most North American conservatives, Grant was not a friend of capitalism but of civil servants who restrain capitalist accumulation (...) in the name of the common good or national community. Grant was what Gad Horowitz called a Red Tory and offered a unique perspective of how American technique has closed us off from love and contemplation, leaving us with the one-dimensional problem-solving mentality of the social engineer. (shrink)

Historically, Thomas Aquinas has been controversial for his use of Averroistic-Aristotelian metaphysics. Because of his doctrine of simplicity many of argued that this entails a necessitarian view of nature—a debate that would pass through Spinoza, Descartes, and even to this day. Nevertheless, Thomas would prevail, not only to sainthood, but to become the patron of education and the Teacher of the Church. The task in this paper is to demonstrate that, contrary to many current contentions in Protestant, and especially Evangelical (...) circles, Aristotelian/Thomistic metaphysics remains a suitable, viable, even preferable framework for Christian Theism and, for the purposes of this paper, scientific thought. The specific focus will be on creation metaphysics and the relationship between current science and Christian thought raised by Lydia Jaeger. I will conclude with an example of the ability of radical contingency in Thomas to both satisfy contemporary physics and frame a consistent and coherent Christian Theism. (shrink)

The Black Circle explores the Russian roots of one of the most brilliant and seminal thinkers of the twentieth century. The subtitle, A Life of Alexandre Kojève, is perhaps misleading because Jeff...

We thoughtlessly use the Nietzschean language of values to encompass our moral principles, our intuitions of the holy and the beautiful, our need for truth. Yet Nietzsche showed that “values” are the creations or products of human will, not discoveries of intelligence, illuminations of love, or exigencies of need. We hear talk of “absolute values” or “objective values” as if there can be values without evaluation: Nietzsche was clear that nothing is intrinsically good or valuable in itself; values are human (...) choices, estimations, decisions, the expressions of human will. An alternative language is more appropriate to communicate what we hold to be intrinsically valuable, namely Würde . Human beings have value if we can use them for our own purposes but they have an invaluable dignity beyond whatever purposes we may have in mind for them. Activities may have an intrinsic worthiness whatever the market demand or current estimation establishes their value to be. (shrink)

This paper discusses recent attempts to defend metaphysics as a worthwhile form of inquiry. According to such views, metaphysics concerns the world’s fundamental structure. I question whether this view can establish that metaphysical disputes are relevant to the rest of our theoretical activities. I take this relevance to be a criterion for whether disputes are worthwhile (or, as I call them, “significant”). I argue that the structure approach is unsatisfactory because appropriately structural disputes need not be worthwhile disputes, and vice (...) versa. So, the structure approach threatens to render metaphysics irrelevant to our broader theorizing, undermining many of its legitimate successes, like the role theorizing about metaphysical modality played in the development of modal logic. Thus these structure-based views provide a poor defense of metaphysics. I then offer an alternative conception of metaphysics as an attempt to understand our most ubiquitous theoretical notions. (shrink)

David Carr, 2003, London, RoutledgeFalmer. Pp. xiii + 294. Hbk. £60.00 and Pbk £18.99.

The majority of healthcare professionals regularly witness fragility, suffering, pain and death in their professional lives. Such experiences may increase the risk of burnout and compassion fatigue, especially if they are without self-awareness and a healthy work environment. Acquiring a deeper understanding of vulnerability inherent to their professional work will be of crucial importance to face these risks. From a relational ethics perspective, the role of the team is critical in the development of professional values which can help to cope (...) with the inherent vulnerability of healthcare professionals. The focus of this paper is the role of Communities of Practice as a source of resilience, since they can create a reflective space for recognising and sharing their experiences of vulnerability that arises as part of their work. This shared knowledge can be a source of strength while simultaneously increasing the confidence and resilience of the healthcare team. (shrink)

Teresa Bejan’s Mere Civility is a scholarly, thoughtful, provocative, witty and well-written book with intellectual biographies of Roger Williams, Thomas Hobbes, and John Locke to illustrate differ...

Patrons of Enlightenment emphasizes the dependency of thinkers upon patrons and compares the patron-client relationships in the French, English, and Scottish republics of letters.