Medical advances prolong life. They also sometimes prolong suffering. Should we protect life or alleviate suffering? This dilemma formed the foundation for a powerful right-to-die movement and a counterbalancing concern over an emerging culture of death. What are the qualities of a life worth living? Where are the boundaries of tolerable suffering? This book is based on a hugely popular undergraduate course taught at the University of Texas, and is ideal for those interested in the social construction of social worth, (...) social problems, and social movements. This book is part of a larger text, Who Lives, Who Dies, Who Decides?, http://www.routledge.com/9780415892476/. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Volume 25, Issue 2, February 2025, Page 157-159.

This research seeks to extend the literature of trust by examining whether the amount of trust that employees have in their supervisors is contingent upon the ethical system of belief utilized by their immediate supervisors. To help answer this question, it is hypothesized that employees have a greater degree of trust in immediate supervisors practicing the deontological ethical system of belief than in those practicing the teleological ethical system of belief. This study begins the search for the (...) moral frameworks that are the antecedents of trust in immediate supervisors. The results indicate that practicing a deontological approach to ethics may stimulate a greater degree of employee trust in immediate supervisors than a teleological approach; therefore, the ethical system of belief held by immediate supervisors affects his or her employees. (shrink)

The need to understand the systems that support ethical health research has long been recognized, but there are limited descriptions of actual health research ethics (HRE) systems. Using participatory network mapping methods, we empirically defined Malaysia's HRE system. 13 Malaysian stakeholders identified 4 overarching and 25 specific HRE system functions and 35 actors internal and 3 external to the Malaysian HRE system responsible for those functions. Functions requiring the most attention were: advising on legislation related to HRE; (...) optimizing research value to society; and defining standards for HRE oversight. Internal actors with the greatest potential for more influence were: the national network of research ethics committees; non-institution-based research ethics committees; and research participants. The World Health Organization, an external actor, had the largest untapped potential for influence overall. In summary, this stakeholder-driven process identified HRE system functions and actors that could be targeted to increase HRE system capacity. (shrink)

Developing a national code for psychologists is a complex process that requires endurance and a proper understanding of not only contemporary needs but also cultural conditions. There are many issues to be considered carefully. It is better to look at code development beyond a text creation and rather as a process in which an ethics system may be created. In order not to merely repeat well-known codes, there are several steps that should be considered. This article intends to address the (...) conflict between suitability to the larger ethical systems and creating an innovative text. As a recent example, the development of the Turkish Psychological Association (TPA) ethics code is presented. (shrink)

Over the last 50 years, the term professionalism has undergone a widespread expansion in its use and a semantic shift in its meaning. As a result, it is at risk of losing its descriptive and analytical value and becoming instead simply an empty evaluative label, a fate described by C. S. Lewis as ‘verbicide’. This article attempts to rescue professionalism from this fate by down-sizing its extension and reassigning some of its work to two other ethical domains, introduced as (...) the neologisms organizationalism and sur-moralism. Professionalism is defined as a morality based in system of obligations that are assumed by physicians over the course of their professional training and which primarily refer to two groups: patients and colleagues, including trainees. Organizationalism is also a morality, but the obligations are owed to the employing organization and on different grounds. A third ethical domain, here called sur-moralism, comprises actions that are not based in obligations. They are discretionary and potentially meritorious; they cannot be required by the profession or organization. This article presents a conceptual model of the three ethical domains and the shifting borders between them. One practical benefit of this typology is that physicians can more accurately understand the nature and sources of obligations that they are asked to accept, and when necessary prioritize them. Another is that physicians will be able to describe the potential tension between the three domains and understand how and why the borders between them can move. Both should help physicians to be more ethically oriented to their work settings. (shrink)

. American businesses and corporate executives are faced with a serious problem the loss of public confidence. Public criticism, increased government controls, and growing expectations for improved financial performance and accountability have accompanied this decline in trust. Traditional approaches to corporate governance, typified by agency theory and stakeholder theory, have been expensive to direct and have focused on short-term profits and organizational systems that fail to achieve desired results. We explain why the organizational governance theories are fundamentally, inadequate to (...) build trust. We advance a conceptual framework based on stewardship theory characterized by “covenantal relationships” and argue that design of governance mechanisms using a covenantal approach is more effective in building trust in organizations. A covenantal relationship is a specialized form of a relational contract between an employee and his or her organization. We argue that regardless of incentives and control mechanisms carefully designed through contractual mechanisms, in the absence of covenantal relationships it is extremely difficult to build trust within organizations. We propose that organizations are more likely to build trust – both at the organizational level and at the interpersonal level – when they create reinforcing and integrated systems that honor implied duties of “covenantal relationships.”. (shrink)

We define ethical system infrastructure as being composed of three major factors – means, motivation, and opportunity. Means are defined as organizational rules, policies, and procedures. Motivation focuses upon the values and the interests being pursued by the position occupant and the organizational value system, while opportunity is discussed in terms of the environment in which the dilemma occurs, proposing that position in the hierarchy presents its own unique set of ethical dilemmas. Ethical breeches are discussed in (...) terms of the interactional processes among means, motivation, and opportunity. Finally, a sequential process is suggested to use the infrastructural components to institutionalize organizational ethics training and subsequent behavior. (shrink)

Background: Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives (to implement research protocols and advance science), setting (research facilities), and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about (...) whether research nurses experience unique ethical challenges distinct from those experienced by nurses in traditional patient-care settings. Research objectives: The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice. Research design: The study utilized a qualitative descriptive design with individual interviews. Participants and research context: Participating nurses (N = 12) self-identified as having experienced ethical challenges during screening. The majority were Caucasian (90%), female (83%), and worked in outpatient settings (67%). Approximately 50% had > 10 years of research experience. Ethical considerations: The human subjects review board approved the study. Written informed consent was obtained. Findings: Predominant themes were revealed: (1) the inability to provide a probable good, or/do no harm, and (2) dual obligations (identity as a nurse vs a research nurse). The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship. Discussion: Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science. Conclusion: Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

My paper responds to certain themes of Professor John McMurtry's recent book, Unequal Freedoms: The Global Market as an Ethical System. Although I am in general sympathy with McMurtry's penetrating critique of conventional market theory and practice, I find Unequal Freedoms ambivalent on the critical question of whether endorsing and enacting the life-value code McMurtry proposes would require only a mitigation of the principles and definitive activities of the competitive market system or whether significant reforms within the system would (...) have to be deep structural ones. It is argued that the second alternative is inescapable. I defend my perspective from the point of view of a philosophical analysis of orthodox or neo-classical theory-construction about the competitive market order. In particular, I examine three fundamental principles of such modelling: the maximization of the satisfaction of self-interest, the unboundedness of consumer desire for material goods, and the distribution of monetized wealth. In order for McMurtry's "civil commons" to survive, the practice of each of these principles would need to be radically modified. However, in doing so, competitive capitalism would lose its essential identity as a socio-economic order. (shrink)

The goal of this paper is to investigate the ethical implications of emerging forms of control that have developed along with the use of ubiquitous information technology. Because it can be exerted at a distance, almost anytime and anywhere, IT-based control has become more subtle, indirect, and almost invisible, with many negative side effects. Yet the issues raised by this new form of control have rarely been interpreted, treated, and framed as ethical issues in business ethics literature. Thus, (...) a more comprehensive inquiry rooted in ethical concerns is necessary to improve understanding of this more subtle form of control, its ethical consequences, and the way ethical considerations can be taken into consideration and acted on by management. This article addresses this goal with a qualitative, exploratory case study of a telecommunications company, in which salespeople have been equipped with ubiquitous technology. The findings specify the characteristics and consequences of ubiquitous IT-based control, thereby inviting a rethinking of the ethical issues related to the privacy, autonomy, human dignity, and health of salespeople. In particular, this article highlights four ethical issues raised by the use of ubiquitous IT at work: the ambivalence of this use of ubiquitous IT at work, the subtlety of the control exerted by ubiquitous IT, the invasiveness of ubiquitous IT, and the self-reinforcement of ubiquitous IT-based control. Such issues are not often taken into account, suggesting that ethical considerations fail to enter into managerial decision making. This study directly raises questions about the intentions, responsibilities, and divisions across different categories of organizational members who participate in such control systems. It also provides useful insights into employees’ perceptions and offers guidance to managers who want to apply a professional code of ethics to the uses of ubiquitous IT. (shrink)

To tackle zoonotic disease threats, a One Health approach is currently commonplace and generally understood as an integrated effort of multiple disciplines to promote the health of humans, animals and the environment. To implement One Health strategies in zoonotic disease control, many countries set up early warning systems, in which human and veterinary health professionals cooperate. These systems, like the Dutch Zoonoses Structure, can be successful to detect emerging disease threats. However, these systems are not well equipped (...) to handle moral dilemmas that can arise in zoonotic disease control, like the culling of healthy animals. This research studies the role of normative presuppositions of professionals involved in zoonotic disease control policies in the Netherlands. We found that these professionals in general adhered to a holistic view of the One Health concept, however, in practice an anthropocentric approach was dominant. Public health was identified as the trumping moral value, which reveals an inherent field of tension with the core of One Health thinking. The lack of ethical expertise in control systems for zoonotic diseases can lead to misconception of ethical principles, like the precautionary principle which is frequently evoked to justify disease control measures. (shrink)

The recent publication of Merleau-Ponty’s work from the late Forties contributes valuable material for those interested in reconstructing a specifically Merleau-Pontian theory of value. In this paper, I examine how, in these texts, Merleau-Ponty’s political concerns show themselves to expand upon the famous analysis of the case of Schneider in Phenomenology of Perception. This retroactively offers an opportunity for a normative reading of the case of Schneider and for identifying Merleau-Ponty’s practical philosophy as concerned with preventing and healing agnosia in (...) politics and ethics. On the basis of this negative hypothesis—that the ethical project is to oppose agnosia—it becomes possible to formulate a positive ethics. There, the unpublished texts also expand upon the Phenomenology of Perception: they propose a humanism which relies on the notion of hermeneutic freedom as the chief practical virtue and elaborate, somewhat unexpectedly, an analysis of play as the existential attitude that corresponds to this virtue. I conclude with a meta-ethical assessment of the merits of this ethical construction. (shrink)

A more ethical economic system is now possible, one that rectifies the crisis spots of our current downturn while balancing the injustices of extreme poverty and wealth. Adam Arvidsson and Nicolai Peitersen, a scholar and an entrepreneur, outline the shape such an economy might take, identifying its origins in innovations already existent in our production, valuation, and distribution systems. Much like nineteenth-century entrepreneurs, philosophers, bankers, artisans, and social organizers who planned a course for modern capitalism that was more (...) economically efficient and ethically desirable, we now have a chance to construct new instruments, institutions, and infrastructure to reverse the trajectory of a quickly deteriorating economic environment. Considering a multitude of emerging phenomena, Arvidsson and Peitersen show wealth creation can be the result of a new kind of social production, and the motivation of continuous capital accumulation can exist in tandem with a new desire to maximize our social impact. Arvidsson and Peitersen argue that financial markets could become a central arena in which diverse ethical concerns are integrated into tangible economic valuations. They suggest that such a common standard has already emerged and that this process is linked to the spread of social media, making it possible to capture the sentiment of value to most people. They ultimately recommend how to build upon these developments to initiate a radical democratization of economic systems and the value decisions they generate. (shrink)

It has now become a realistic prospect for smart care to be provided at home for those living with long-term conditions such as dementia. In the contemporary smart care scenario, homes are fitted with an array of sensors for remote monitoring providing data that feed into intelligent systems developed to highlight concerning patterns of behaviour or physiological measurements and to alert healthcare professionals to the need for action. This paper explores some ethical issues that may arise within such (...) smart care systems, focusing on the extent to which ethical issues can be addressed at the system design stage. Artificial intelligence has been widely portrayed as an ethically risky technology, posing challenges for privacy and human autonomy and with the potential to introduce and exacerbate bias and inequality. While broad principles for ethical artificial intelligence have become established, the mechanisms for governing ethical artificial intelligence are still evolving. In healthcare settings the implementation of smart technologies falls within the existing frameworks for ethical review and governance. Feeding into this ethical review there are many practical steps that designers can take to build ethical considerations into the technology. After exploring the pre-emptive steps that can be taken in design and governance to provide for an ethical smart care system, the paper reviews the potential for further ethical challenges to arise within the everyday implementation of smart care systems in the context of dementia, despite the best efforts of all concerned to pre-empt them. The paper concludes with an exploration of the dilemmas that may thus face healthcare professionals involved in implementing this kind of smart care and with a call for further research to explore ethical dimensions of smart care both in terms of general principles and lived experience. (shrink)

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems (...) to support decision-making around cardiopulmonary resuscitation and the determination of a patient’s Do Not Attempt to Resuscitate status (also known as code status). The COVID-19 pandemic has made us keenly aware of the difficulties physicians encounter when they have to act quickly in stressful situations without knowing what their patient would have wanted. We discuss the results of an interview study conducted with healthcare professionals in a university hospital aimed at understanding the status quo of resuscitation decision processes while exploring a potential role for AI systems in decision-making around code status. Our data suggest that (1) current practices are fraught with challenges such as insufficient knowledge regarding patient preferences, time pressure and personal bias guiding care considerations and (2) there is considerable openness among clinicians to consider the use of AI-based decision support. We suggest a model for how AI can contribute to improve decision-making around resuscitation and propose a set of ethically relevant preconditions—conceptual, methodological and procedural—that need to be considered in further development and implementation efforts. (shrink)

The Direction of Medical Ethics The direction bioethics, and specifically medical ethics, will take in the next few years will be crucial. It is an emerging specialty that has attempted a great deal, that has many differing agendas, and that has its own identity crisis. Is it a subspecialty of clinical medicine? Is it a medical reform movement? Is it a consumer pro tection movement? Is it a branch of professional ethics? Is it a ra tionale for legal decisions and (...) agency regulations? Is it something physicians and ethical theorists do constructively together? Or is it a morally concentrated attack on high technology, with the prac titioners of scientific medicine and the medical ethicists in an adversarial role? Is it a conservative endeavor, exhibiting a Frankenstein syn drome in Medical Genetics ("this time, they have gone too far"), or a Clockwork Orange syndrome in Psychotherapy ("we have met hods to make you talk-walk-cry-kill")? Or does it suffer the afflic tion of overdependency on the informal fallacy of the Slippery Slope ("one step down this hill and we will never be able to stop") that remains an informal fallacy no matter how frequently it's used? Is it a restricted endeavor of analytic philosophy: what is the meaning of "disease," how is "justice" used in the allocation of medical resources, what constitutes "informed" or "consent?" Is it applied ethics, leading in clinical practice to some recommenda tion for therapeutic or preventive action? This incomplete list of questions indicates just how complex. (shrink)

As the average age of the population increases, so too do the number of people living with chronic illnesses. With limited resources available, the development of dialogue-based e-health systems that provide justified general health advice offers a cost-effective solution to the management of chronic conditions. It is however imperative that such systems are responsible in their approach. We present in this paper two main challenges for the deployment of e-health systems, that have a particular relevance to dialogue (...) and argumentation: collecting and handling health data, and trust. For both challenges, we look at specific issues therein, outlining their importance in general, and describing their relevance to dialogue and argumentation. Finally, we go on to propose six recommendations for handling these issues, towards addressing the main challenges themselves, that act both as general advice for dialogue and argumentation research in the e-health domain, and as a foundation for future work on this topic. (shrink)

A précis of my book Pragmatist Quietism: A Meta-Ethical System (OUP, 2022); forthcoming in Analysis along with commentaries and my replies.

The geographically inequitable distribution of physicians has long posed a serious social problem in Japan. The government tackled this problem by establishing and managing Jichi Medical University (JMU) and regional quotas (RQs) for medical schools. JMU/RQs recruit local students who hope to work as physicians in rural areas, educate them for 6 years without tuition (JMU) or with scholarship (RQs), and after graduation, assign them to their home prefectures for 9 years, including 4–6 years of rural service. JMU/RQs entrants now (...) occupy 11.6% of all medical school entrants. While JMU/RQs have been shown to be highly effective in securing physicians for rural areas, ethical issues related to these policies have been raised, such as whether the government truly needs to implement these policies using tax money, and whether it is acceptable to limit the personal freedoms of the physicians. In this paper, we discuss these issues from the perspectives of social justice, utilitarianism, luck egalitarianism, liberty, medical professionalism and consistency with national health insurance and the Japanese Constitution. We conclude that JMU/RQs are necessary and ethically valid policies, and also propose some institutional improvements to better secure the integrity and maturity of these systems. (shrink)

The paper aimed to reconstruct Twardowski's approach to the problem of free will and his analyses of the consequences of various solutions to this problem in ethics and criminal law. According to Twardowski, if we understand ‘free will’ as the possibility of making resolutions other than actually made, then (most probably) nobody has free will. Our resolutions are determined by a set of mental dispositions (character) and incentives that activate these dispositions. However, the existence of freedom of will such understood (...) is not a necessary condition for the correct functioning of ethical systems or criminal law. On the contrary, ethical systems and criminal law seem to assume that at least some of our resolutions are determined by our relatively stable dispositions. Only then can these resolutions and the actions that follow them be ascribed to certain agents. Twardowski's views on free will are presented here in the context of the metaphilosophical positions of the Lvov–Warsaw School, the central European branch of analytic philosophy. His position is also juxtaposed with Brentano's view of free will and Łukasiewicz's approach to the determinism/indeterminism debate. This juxtaposition illustrates the variety of philosophical positions and the diversity of the metaphilosophical toolkit applied in early analytic philosophy. (shrink)

Sahan et al draw much needed attention to the ethical complexity encountered by clinical laboratory scientists. They point out that, on the one hand, clinical laboratories are increasingly required to analyse ‘much broader swathes’ of genomic information than had previously been the case and to consider how best to report—or not report—the results that arise. On the other hand, they also note how clinical laboratory services are supporting genomic testing that is transitioning from specialist to mainstream services, such that (...) questions of whether and how to report genomic information must ‘accommodate the considerations of an expanded multidisciplinary team (MDT)’.1 These two factors, among others, increase both the ‘range and complexity’ of ethical dilemmas faced by clinical laboratory scientists. This trajectory will continue in line with trends towards further mainstreaming of genomic medicine, and the use of genomic sequencing (generating ‘much broader swathes’ of information) over more targeted approaches. In this challenging environment, Sahan et al contend that the notion of ‘ethical preparedness’ (EP) has a crucial role to play. Here ‘EP’ is understood as a state of both systems and individuals that is characterised by the ‘capability, opportunity and motivation to respond to the ethical issues arising in a particular clinical situation, as well as being able to anticipate ethical concerns in advance in areas where practice is rapidly evolving’.1 Notably, cultivating the …. (shrink)