Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

Corruption poisons corporations in America and around the world, and has devastating consequences for the entire social fabric. In this article, we focus on organizational corruption, described as the abuse of authority for personal benefit, and draw on Weber’s three ideal-types of legitimate authority to develop a theoretical model to better understand the antecedents of different types of organizational corruption. Specifically, we examine the types of business misconduct that organizational leaders are likely to engage in, contingent on their legitimate authority, (...) motives, and justifications. We conclude by suggesting managerial implications of our theoretical model and propose directions for future research. (shrink)

While it is uncontroversial to point to the liberal roots of feminism, a major issue in English-language feminist political thought over the last few decades has been whether feminism's association with liberalism should be relegated to the past. Can liberalism continue to serve feminist purposes? This book examines the positions of three contemporary feminists - Martha Nussbaum, Susan Moller Okin and Jean Hampton - who, notwithstanding decades of feminist critique, are unwilling to give up on liberalism. This book examines why, (...) and in what ways, each of these theorists believes that liberalism offers the normative and political resources for the improvement of women's situations. It also brings out and tries to explain and evaluate the differences among them, notwithstanding their shared allegiance to liberalism. In so doing, the books goes to the heart of recent debates in feminist and political theory. (shrink)

This article examines the attempts by John Rawls in the works published after Political Liberalism to engage with some of the feminist responses to his work. Rawls goes a long way toward addressing some of the major feministliberal concerns. Yet this has the unintended consequence of pushing justice as fairness in the direction of a more comprehensive, rather than a strictly political, form of liberalism. This does not seem to be a problem peculiar to Rawls: rather, any form of liberalism (...) hospitable to feminist concerns must be, at the very least, a partly comprehensive, rather than a strictly political, doctrine. (shrink)

If liberal theory is to move forward, it must take the political nature of family relations seriously. The beginnings of such a liberalism appear in Mary Wollstonecraft's work. Wollstonecraft's depiction of the family as a fundamentally political institution extends liberal values into the private sphere by promoting the ideal of marriage as friendship. However, while her model of marriage diminishes arbitrary power in family relations, she seems unable to incorporate enduring sexual relations between married partners.

In this 60th anniversary of Business & Society essay, we seek to make three main contributions at the intersection of governance and artificial intelligence. First, we aim to illuminate some of the deeper social, legal, organizational, and democratic challenges of rising AI adoption and resulting algorithmic power by reviewing AI research through a governance lens. Second, we propose an AI governance framework that aims to better assess AI challenges as well as how different governance modalities can support AI. At the (...) heart of our framework lies the governance forces that apply to institutions, organizations, and individuals, who ultimately provide, regulate, and use AI decision-making. We discuss how businesses may harness AI’s economic power through governance solutions without creating or amplifying societal biases and inequalities. Third, as part of our section on future research, we identify a set of governance trade-offs in AI adoption, suggest future research avenues to conceptually strengthen research on the governance of AI, and lay out key policy recommendations. (shrink)

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

Since the late 2000s trans pregnancy has received increasing public and academic attention, and stories of the ‘pregnant man’ have become a media staple. Existing research has critiqued such spectacularization and the supposed tension between maleness, masculinity, and pregnancy that underpins it. Extending that work, this article draws on interview data from an international study of trans reproductive practices and analyzes participants' experiences of being, and expecting themselves to be, perceived in public space not as spectacularly ‘pregnant men’, but as (...) fat men. As a starting point we take the experience of one participant whose heavily pregnant participation in a five-kilometer race prompted the question: ‘Why is the chubby guy running?’ Using Judith Butler's concept of the cultural intelligibility of gender, we ask why the question asked was not: ‘Why is the pregnant guy running?’ We further consider the degree to which pregnant trans people manage their unintelligibility within the matrix of pregnancy, fatness, and trans/gender and how this reveals the limits of gender intelligibility itself. (shrink)

One of the major purposes of this article is to show that friendship was one of Nietzsche's central concerns and that he shared Aristotle's belief that it takes higher and lower forms. Yet Nietzsche's interest in friendship is overlooked in much of the secondary literature. An important reason for this is that this interest is most evident in the works of his middle period, and these tend to be neglected in commentaries on Nietzsche. In the works of the middle period, (...) Nietzsche suggests that there is a close connection between friendship and selfhood, contending that an individual's friendships reflect something about his or her identity. Following Aristotle, he believes that friendship can make a significant contribution to self-knowledge and self-improvement, which are both closely associated with his notion of self-overcoming. Nietzsche encourages individuals to adopt an aesthetic approach to the self: they should refashion themselves by consolidating their strengths, minimising their weaknesses and developing themselves in new directions. The works of the middle period suggest, however, that not only can friendship foster self-overcoming, but that the talent for friendship is one of the marks of a higher human being. Recognising this requires some reconsideration of Nietzsche's putative individualism and the belief that he holds great individuals to be utterly independent and indifferent to the judgements of others. It also requires a revision of the common interpretation that he is unremittingly sceptical about pity and other forms of fellow-feeling. Yet while Nietzsche generalises about friendship in the works of the middle period and contrasts its superior and inferior forms, he remains sensitive to its particularity. He never adopts a wholly formulaic approach to this relationship, but recognises that difference and responsiveness to particularity are among its central characteristics. (shrink)

Citizenship and its education is again gaining importance in many countries. This paper uses England as its primary example to develop a Habermasian perspective on this issue. The statutory requirements for citizenship education in England imply that significant attention be given to the moral and social development of the learner over time, to the active engagement of the learner in community and to the knowledge skills and understanding necessary for political action. This paper sets out a theoretical framework that offers (...) a perspective on learning suitable for these far-reaching aims. We argue that schools need to shift from the currently dominant discourse of accountability to incorporate a discourse of care in order to make room for an effective and appropriate pedagogy for citizenship. Habermas’s social theory gives us a theoretical framework that properly locates schools within the lifeworld as part of civil society. Schools should therefore attend to hermeneutical and emancipatory concerns, not only to strategic interests. We put these in the context of Habermas’s social theory to paint an alternative vision learning for citizenship education which is based in developing the dispositions, values and attitudes necessary for lifelong learning with a view to developing ongoing communicative action. (shrink)

Response to Emily A. Largent, Franklin G. Miller and Steven Joffe, A Prescription for Ethical Learning, Hastings Center Report, 43, s1, (S28-S29), (2013).

This article examines the 2008 report of the Quebec Government’s Consultation Commission on Accommodation Practices Related to Cultural Differences which was co-authored by Charles Taylor. Summarizing its main themes, it identifies points of intersection with Taylor’s political thought. Issues of citizen equality, including gender equality, secularism, integration and interculturalism, receive special attention.

This study contributes to our understanding of how work-related values, including ethics, are connected with the readiness to change in Estonian organizations. Research in Estonian companies involved 747 respondents. The author examined the influence of work-related values on attitude towards change and organizational learning. Empirical research in Estonian organizations indicates that work-related values predict attitude towards change and organizational learning. This study indicates the need for ethical conduct to achieve a competitive advantage in Estonia. Guidelines for managers and a model (...) of value-based change management are subsequently developed. (shrink)

During the last decade and a half, Estonia has concentrated predominantly on economic development in its narrowest sense. Currently, the emphasis is gradually moving towards a broader approach, including an increasingly social agenda. The research question here concerns the awareness of corporate social responsibility among Estonian owners and managers. Empirical research in Estonia indicates that there has been a shift towards recognizing the importance of social responsibility, but this primarily concerns the “lower layers” of social responsibility, recognizing the importance of (...) economic responsibility and in some respects also public responsibility. Responses in interviews show a certain amount of personal initiative, but these are single examples rather than a general trend and are not enough to change the overall picture. Still, in any assessment of the current situation regarding social responsibility in Estonia, emphasis should be laid on the fact that changes are taking effect and will continue to do so. In transition economies, including Estonia, we should not overlook the fact that, at least in the early years of transition, the focus is on a rapid economic development where the social side will inevitably be left in the background and economic development will take place at the expense of social and environmental development. (shrink)

One important and consistent thread of Charles Taylor’s thought that has not yet received the attention it deserves is his philosophy of freedom. Taylor’s 1979 defense of positive liberty in response to Isaiah Berlin’s “Two Conceptions of Liberty” is, of course, well known. But there is a way of seeing reflection on freedom as a thread that runs, sometimes silently but always significantly, through his whole body of work. Taylor can be seen as asking what freedom means, how many varieties (...) it has, what it (or they) require, how it (or they) are supported and promoted, or threatened and diminished. Throughout his work, Taylor tacitly encourages us to think about what types of freedom are possible and desirable for embodied entities. (shrink)

Despite its centrality for an understanding of Nietzsche's thought, the term ressentiment does not appear in his writings before Beyond Good and Evil. This article argues that the roots of the idea of ressentiment appear in his middle period writings when he discusses vanity [die Eitelkeit].

A combination of social forces has thrown marriage into question in westernised societies at the end of the millennium. This uncertainty creates space for new ways of thinking about marriage. In this context, we examine the idea of marriage as friendship. We trace its genealogy in the work of Mary Wollstonecraft, John Stuart Mill and Harriet Taylor and then subject it to critical scrutiny using some of Michel de Montaigne’s ideas. We ask how applic- able the ideal of higher friendship (...) is to marriage and what might be gained and lost by a synthesis of marriage and friendship. Grounding the discussion in historical sources is valuable because the topic is so little explored in the contemporary philosophical literature. This approach also allows any enduring value in these historical texts to be elicited. (shrink)

Friedrich Nietzsche believes that self-love is a necessary ingredient for healthy individualism. This chapter explores the connections between his conceptions of egoism, self-love, and vanity in the middle period works. It is argued that the roots of Nietzsche’s later concept of ressentiment appear in these works, for several of the features associated with vanity, such as heteronomy and the absence of self-love, come to be characteristic of ressentiment. The chapter then moves into a discussion of what room there might be (...) for a conception of justice, in an analysis that imputes so much power to egoism. (shrink)

This article engages Friendship: A Central Moral Value by Michael H. Mitias. It questions Mitias’ distinction between friendship as a moral and theoretical concern as opposed to a practical one. It distinguishes the narrow from the wide meanings of philia in Aristotle’s approach. It looks at the resonances of classical approaches in later theories of friendship, while also attending to the innovations of later thinkers. It suggests that the moral paradigms Mitias delineates might not be as hegemonic nor as hermetically (...) sealed as he suggests. Mitias’ contribution is better understood as an addition to moral philosophy than to friendship studies. (shrink)

Friedrich Nietzsche is typically seen as a radical critic of the western philosophical tradition. This article considers why this image is so widely accepted. It argues that part of the reason for its acceptance is that Nietzsche paints a picture of himself as the independent, radical innovator in his later writings. If we look at the works of the middle period, we find that by contrast, he repeatedly situates himself within wider traditions and discusses what he has learned from them.

Lifelong learning is something which one does for oneself that no one else can do for one: it is a public and personal human activity, rather than private or individualistic. One of the features of the education system is the paucity of a language for learning as process and participative experience. Personalised learning requires a sense of the worth-whileness of 'being a learner' - a virtue in the 21st century. A sense of one's own worth as a person is essential (...) to understanding one's identity as a learner. Research suggests the human capacity to learn can be understood as a form of consciousness which is characterised by particular values, attitudes and dispositions, with a lateral and a temporal connectivity. This 'consciousness' has several dimensions which are all related to becoming a person, with a learning identity. They also enable the learner to become aware of and appropriate what is of worth and map onto the sorts of core values that learning communities espouse. Awareness of self and of one's own worth as a person is a necessary condition for 'becoming a learner' and for identifying and engaging with 'what is of worth'. Furthermore, a sense of self as a learner is formed in relationship, and understood as one learns to tell one's own story, as a participant in the conversation of the learning community. Character is the way in which we refer to that quality of personhood in which there is rooted the capacity to change and learn over time. (shrink)

Bioethics is clearly a field in transition, if not confusion. Bioethics began as a scholarly, reflective, academic enterprise. Increasingly, however, some in bioethics are not as interested in producing scholarship as they are in practicing bioethics by providing services to institutions and clients.Bioethics also began as an interdisciplinary line of inquiry, with its major contributors all trained in some established discipline. We were and for the most part still are a field composed of theologians, philosophers, lawyers, physicians, nurses, and social (...) scientists who work in bioethics. Today, however, some young people actually aspire to be bioethicists. Increasingly, they have the option of being trained directly in bioethics, without any other disciplinary background.We are not the first field to find itself engaged in these kinds of transitions. In this short piece, I consider very briefly how two fields--health psychology and epidemiology- have approached similar branch points. (shrink)

_Linguistics and Aphasia_ is a major study of recent developments in applying psycholinguistics and pragmatics to the study of acquired language disorders and their remediation. Psycholinguistic analyses of aphasia interpret disorders in terms of damaged modules and processes within what was once a normal language system. These analyses have progressed to the point that they now routinely provide a model-based rationalefor planning patient therapy. Through a series of case studies, the authors show how the psycholinguistic analysis of aphasia can be (...) assessed for its effectiveness in clinical practice. Pragmatic approaches to the study of aphasia are of more recent origin. Ruth Lesser and Lesley Milroy evaluate their considerable significance to the study of aphasia and their relevance to practical issues of diagnosis and treatment. Controversial analysis, in particular, offers a fruitful and productive framework within which to assess the functional adequacy of the language used by aphasic speakers in everyday contexts. (shrink)

Advocates for the professionalization of clinical bioethics argue that bioethics professionals play an important role in contemporary medicine and patient care, especially when addressing complex ethical questions that arise in the delivery of reproductive medicine. For bioethics consultants to serve effectively, they need adequate training in the medical and ethical issues that patients and clinicians will face, and they need skills to facilitate effective dialog among all parties. Because clinical ethics consultation is a “high‐stakes endeavor” that can acutely affect patient (...) care, efforts are under way to ensure that bioethics consultants have the competence to provide such guidance. Yet to date, no studies have examined whether the training of bioethics consultants meets the needs of health care professionals who are on the front lines of such issues. In fact, limited information is available on the reproductive health issues that bioethics training programs address or the degree to which these programs meet the needs of patients confronting reproductive health decisions and their clinicians. It is therefore important to answer this key question: What are the primary ethical issues encountered in reproductive medicine that currently affect patient care? Equally important, are bioethics training programs prepared to address those issues?To begin to answer these questions, we conducted parallel surveys of directors of graduate bioethics training programs and obstetrician‐gynecologists. The goal of this project is to lay the groundwork to establish a working partnership between bioethics educators and reproductive medicine practitioners to address the often troubling and frequently complex ethical issues in reproductive medicine. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Chair’s Perspective on the Work of the Advisory Committee on Human Radiation ExperimentsRuth Faden (bio)On January 15, 1994, President Clinton created the Advisory Committee on Human Radiation Experiments in response to his concern about the increasing number of reports describing alleged unethical conduct of the U.S. Government, and institutions funded by the government, in the use of, or exposure to, ionizing radiation in human beings at the height of (...) the Cold War. He directed the Committee: (1) to uncover the history of human radiation experiments and intentional environmental releases of radiation; (2) to identify the ethical and scientific standards for evaluating these events; and (3) to make recommendations to ensure that whatever wrongdoing may have occurred in the past will not be repeated.The Committee was composed of 14 members: a citizen representative and 13 experts in bioethics, radiation oncology and biology, epidemiology and statistics, public health, history of science and medicine, nuclear medicine, and law. We reported to a cabinet-level group (the Human Radiation Interagency Working Group) convened by the president, which includes the secretaries of defense, energy, health and human services, and veterans affairs; the attorney general; the administrator of the National Aeronautics and Space Administration; the director of the Central Intelligence Agency; and the director of the Office of Management and Budget.On April 21, 1994, at the end of the first day of our first meeting, President Clinton invited us to the White House to personally communicate his commitment to the process we were about to undertake. He urged us to be fair, thorough, and unafraid to shine the light of truth on this hidden and poorly understood aspect of our nation’s past. Our most important task, he said, was to tell the full story to the American public. [End Page 215] At the same time, we were to examine the present, to determine how the conduct of human research today compares with that of the past, and to assess whether, in light of this inquiry, changes need to be made in the policies of the federal government. Eighteen months later, the Committee’s attempt to tell the story of the past and to report on our inquiry into the present was delivered to the president in a 900-page Final Report (ACHRE 1995) and several supplemental volumes.The Committee’s charge was enormous. We were asked to conduct a massive investigation into events that occurred as much as 50 years ago and that involved the highest reaches of the defense establishment and the medical community. This investigation necessitated an examination of the conduct and policies of six federal agencies and countless agents in the private sector, as well as the location and interpretation of hundreds of thousands of documents, many of which were buried in obscure locations or were still classified.In addition, the Committee was instructed to establish standards for judging, in moral terms, the events that it uncovered. This charge necessitated the confrontation of contentious debates in moral thought and theory about history, relativism, and the significance of context in moral judgment. But our purpose was not to engage in these debates in the abstract. Although the Committee was not expressly charged with considering issues relating to remedies, including financial compensation, we felt obliged to address the type of remedies that we believed the government, as an ethical matter, should provide to subjects of experiments where the circumstances warranted such a response. Thus our deliberations about relativism and moral judgment were tied to concrete recommendations for public policy and were conducted in a public context that included participants from numerous adversarial legal proceedings.In tandem with our reconstruction of the past, we undertook three projects to examine the current state of human radiation experiments. First, we studied how each federal agency that currently conducts or funds research involving human subjects regulates and oversees its research activity. Second, from among the very large number of federally-supported research projects involving human subjects, we randomly selected 125 projects for closer scrutiny. We reviewed all available relevant documentation for each project in order to assess how well it appeared to protect the rights and interests of the participating subjects. Third... (shrink)