Practical conflicts pervade human life. Agents have many different desires, goals, and commitments, all of which can come into conflict with each other. How can practical reasoning help to resolve these practical conflicts? In this collection of essays a distinguished roster of philosophers analyse the diverse forms of practical conflict. Their aim is to establish an understanding of the sources of these conflicts, to investigate the challenge they pose to an adequate conception of (...) practical reasoning, and to assess the degree to which that challenge can be met. These essays will serve as a major resource for students of philosophy but will also interest students and professionals in related fields of the social sciences such as psychology, political science, sociology and economics. (shrink)

According to epistemic reductionism about practical reasons, facts about practical reasons can be reduced to facts about evidence for ought-judgements. We argue that this view misconstrues practical conflicts. At least some conflicts between practical reasons put us in a position to know that an action ϕ is optional, i.e. that we neither ought to perform nor ought to refrain from performing the action. By understanding conflicts of practical reasons as conflicts of (...) evidence about what one ought to do, epistemic reductionism fails to account for this. In conflict cases in which ϕ-ing is optional, epistemic reductionism suggests that we have equally strong evidence for and against assuming that we ought to ϕ, and thus cannot be in a position to know that it is not the case that we ought to ϕ. This is a serious flaw. (shrink)

Three medical ethicists take varied and often opposing stands on the ethical, social, and political issues that arise when religious and medical practices conflict. The interchange focuses on the tensions between the belief systems, institutional practices, and health-related decisions of Christian Scientists and those of a secularized medically oriented, broader society.

This volume contains contributions on different aspects of practical conflicts by: Peter Baumann Monika Betzler Ruth Chang Jon Elster Barbara Guckes Christine M. Korsgaard Isaac Levi Alfred R. Mele Joseph Raz Henry S. Richardson Peter Schaber J. David Velleman Nicholas White.

Background: The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves. Objectives: This study describes operating theatre nurses’ experiences of ethical value conflicts in perioperative practice. Research design: Qualitative design, narratives from 15 operating theatre nurses and hermeneutic (...) text interpretation. Ethical consideration: The study followed ethical principles in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee. Findings: The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient’s care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient’s best. This occurred when operating theatre nurses’ competence was not taken seriously and was ignored in patient care. Conclusion: Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations. (shrink)

Practitioners’ ethical orientation and responses vary between practice settings. Yet, currently, the ethics for midwifery practice that is explicit in the literature and which provides the ideals of socialization into practice, is that of bio(medical)ethics. Traditional bioethics, developed because of World War II atrocities and increased scientific research, is based on moral philosophy, normative theory, abstract universal principles and objective problem solving, all of which focus on right and wrong ‘action’ for resolving dilemmas. They exclude context and relationship. Personal narratives (...) of mothers and midwives contest the appropriateness of these accepted values and systems for childbirth because they induce conflict between work-place/service provider ethics and personal/professional midwifery ethics. In contrast to the disembedded and disembodied approach of biomedical ethics, an ethically adequate response in midwifery practice resonates more with the ethics of intimates, such as feminist virtue ethics. (shrink)

This study examines the extent to which scientific and biomedical journals have adopted conflict of interest (COI) policies for authors, and whether the adoption and content of such policies leads to the publishing of authors’ financial interest disclosure statements by such journals. In particular, it reports the results of a survey of journal editors about their practices regarding COI disclosures. About 16 percent of 1396 highly ranked scientific and biomedical journals had COI policies in effect during 1997. Less than 1 (...) percent of the articles published during that year in the journals with COI policies contained any disclosures of author personal financial interests while nearly 66 percent of the journals had zero disclosures of author personal financial interests. Nearly three fourths of journal editors surveyed usually publish author disclosure statements suggesting that low rates of personal financial disclosures are either a result of low rates of author financial interest in the subject matter of their publications or poor compliance by authors to the journals’ COI policies. (shrink)

The Cleveland Clinic Innovation Management and Conflict of Interest (“IM&COI”) Program implemented a policy on Conflicts of Interest in Clinical Practice in 2013. The policy requires review of financial interests greater than $20,000 in a year, or more than 5% equity in a company, when the clinician is prescribing or using products of the company with which they have a relationship. The IM&COI Committee developed definitions for low, medium and high levels of annual compensation and risk and uses a (...) “Matrix” to guide disclosure based on these factors. (shrink)

The paediatric intensive care unit (PICU) is a high-stress environment for parents, families and health care professionals (HCPs) alike. Family members experiencing stress or grief related to the admission of their sick child may at times exhibit challenging behaviours; these exist on a continuum from those that are anticipated in context, through to unacceptable aggression. Rare, extreme behaviours include threats, verbal or even physical abuse. Both extreme and recurrent ‘subthreshold’ behaviours can cause significant staff distress, impede optimal clinical care and (...) compromise patient outcomes. The unique PICU environment and model of care may magnify stressors for both families and staff and the family-centred approach to care (FCC) central to paediatric practice, may also contribute to contextual challenges. Pervasive conflict in paediatric healthcare is harmful for patients, families, PICU staff and the institution more broadly. We propose that caring for children and caring for staff are inseparable goals and the latter has been inadvertently but detrimentally deprioritised as FCC has become a primary focus. A transparent and graded hierarchy of responses to variable levels of challenging behaviour is necessary to ensure that families are supported, while HCPs remain protected in the workplace. This requires establishing firm limits supported by all teams and levels of the institution. As such, we aim to identify and clarify the context and impact of challenging parent and family behaviour in the PICU and to offer potential, proactive mitigation strategies, based on reflections and stakeholder discussion following recent clinical challenges and experiences in our unit. (shrink)

Pippin, Pinkard and Brandom are rightly seen as representatives of a distinct approach in contemporary Hegel scholarship. Still, their interpretations diverge due to different definitions and uses of conceptions of discursive practice. We focus on three ways in which such definitions and uses bear on their interpretations. First, while Lumsden has recently criticized Pinkard and Brandom for ‘discursive bias’ in their accounts of the contestation and upheaval of normative authority in Hegel’s Phenomenology, we note that Pinkard distinguishes between various modes (...) of reason-giving, and we argue that a further qualification of interdependencies between these modes may support his interpretation against such criticism. Second, Pinkard and Pippin have recently criticized Brandom’s conception of discursive score-keeping practice, and Pippin in particular has argued that the latter rests on an individualistic reductionism about content foreign to Hegel. However, we find that the real issue is that the modes of methodological abstraction and idealization assumed for Brandom’s conception of discursive practice leave out of account the historical alteration as well as the institutional embodiment of normative authority as emphasized by Pippin and Pinkard. Third, while Pippin and Pinkard both make Hegel’s notion of modern ethical life bear on a conception of practical rationality, their uses of a conception of discursive practice in such an undertaking betray divergent conceptions of the sociality of rational agents. (shrink)

Our society has long sanctioned, at least tacitly, a degree of conflict of interest in medical practice and clinical research as an unavoidable consequence of the different interests of the physician or clinical investigator, the patient or clinical research subject, third party payers or research sponsors, the government, and society as a whole, to name a few. In the past, resolution of these conflicts has been left to the conscience of the individual physician or clinical investigator and to professional (...) organizations. The public is no longer willing to allow health care providers to wholly govern their own conflicts of interest for several reasons. These include: new forms of health care financing and delivery that provide innovative and lucrative opportunities for physician or insurer enrichment at patient expense; the increased importance of commercial research support as peer-reviewed governmental research support has decreased; evidence that physicians and clinical investigators too frequently resolve conflicts of interest in their own favor; and a general societal mistrust of authority. This volume represents a multidisciplinary effort, drawing from philosophy, medicine, law, economics and public policy to identify and categorize conflicts of interest in medical practice and clinical research, and, where possible, to offer a mechanism for resolving them. Part I addresses conflicts of interest from a theoretical perspective, offering basic concepts and analytical frameworks. The second part discusses two topics prominent in current health care policy debates--self-referral and financial incentives to limit care. Part III examines conflicts of interest generated by pharmaceutical industry involvement in clinical practice and research. The final section deals with conflicts of interest in clinical research in several contexts, including institutional reviews boards, clinical trials, Cooperative Research and Development Agreements between government and private researchers, brokerage of research subjects by Contract Research Organizations, and cost-effectiveness studies. (shrink)

Background: This study was developed as a result of a court case involving conflicts between midwives’ professional practice and their faith when caring for women undergoing abortions in Scotland. Research questions: What are practising Roman Catholics’ perspectives of potential conflicts between midwives’ professional practice in Scotland with regard to involvement in abortions and their faith? How relevant is the ‘conscience clause’ to midwifery practice today? and What are participants’ understandings of Canon 1398 in relation to midwifery practice? Research (...) design: The theoretical underpinning of this study was Gadamer’s hermeneutic out of which the method developed by Fleming et al. involving a five-stage approach was utilised. Participants and research context: The research was conducted in the south of Scotland. A purposive sampling method was used. Eight participants who were practising Roman Catholics familiar with the subject of conscientious objection who were either midwives, lawyers (civil, canon or both) or priests contributed. Ethical considerations: The major ethical issues related to respect for autonomy, maintaining confidentiality and obtaining voluntary informed consent. Parish priests agreed to act as gatekeepers to prospective participants. All legal requirements were addressed regarding data collection and storage. Approval was given by the ethics committee of the university with which one of the researchers were associated. Findings: Three key themes provide an understanding of the situation in which midwives find themselves when considering the care for a woman admitted for an abortion: competing legal systems, competing views of conscience and limits of participation. Conclusion: Clear guidelines for practice should be developed by a multi-professional and consumer group based on an update of the abortion law to reflect the change from a surgical to medical procedure. Clarification of Canon 1398 in relation to what is and is not participation in the procurement of abortion would be of benefit to midwives with a conscientious objection. (shrink)

Social enterprises are hybrid organizations that primarily pursue social missions while also seeking economic gains. Drawing on workplace diversity and conflict theories, this article addresses recent calls for further research to explore how employees within social enterprises experience internal conflicts arising from the organizational pursuit of dual, competing missions (i.e., social and economic), and how social enterprises manage, and potentially overcome, these challenges. In the context of Korean social enterprise, we conducted a quantitative study that built on an initial (...) explorative qualitative study. Our research examined whether perceived participatory human resource management practices and diversity climate increase employees’ affective commitment by reducing their relational conflict. We further explored a boundary condition, perceived social impact, which strengthened this mediation relationship. Our results offer significant insights into social enterprise, business ethics, and broader management literature. Implications for future research and practice are also discussed. (shrink)

Conflicts of interest are common and exist in academia, government, and many industries, including pharmaceutical development. Medical journal editors and others have recently criticized “the pharmaceutical industry,” citing concerns over investigator access to data, approaches to analysis of clinical trial data, and publication practices. Merck & Co., Inc. is a global, research-driven pharmaceutical company that discovers, develops, manufactures, and markets a broad range of human and animal health products, directly and through its joint ventures. Although part of its mission (...) is to provide a superior rate of return to its investors, Merck does not believe this creates an irreconcilable conflict of interest, particularly in activities concerning clinical drug development. We employ rigorous scientific methods to design, conduct, analyze, and report results of clinical trials in the development of innovative drugs and vaccines, with a focus on meeting unmet medical needs and with an ethic that puts the interests of the patient first. This article describes Merck’s approaches to potential conflicts of interest in drug development, particularly with regard to clinical trials. We believe that proprietary interests of the Company can be respected while observing objectivity and transparency in communicating clinical research results. The standards for the review of manuscripts reporting such trials for peer-reviewed publication should be the same, whether they are from Merck or elsewhere. (shrink)

The term “euthanasia” is used in conflicting ways in the bioethical literature, as is the term “assisted suicide,” resulting in definitional confusion, ambiguities, and biases which are counterproductive to ethical and legal discourse. I aim to rectify this problem in two parts. Firstly, I explore a range of conflicting definitions and identify six disputed definitional factors, based on distinctions between (1) killing versus letting die, (2) fully intended versus partially intended versus merely foreseen deaths, (3) voluntary versus nonvoluntary versus involuntary (...) decisions, (4) terminally ill versus non-terminally ill patients, (5) patients who are fully conscious versus those in permanent comas or persistent vegetative states, and (6) patients who are suffering versus those who are not. Secondly, I distil these factors into six “building blocks” and combine them to develop an unambiguous, value-neutral taxonomy of “end-of-life practices.” I hope that this taxonomy provides much-needed clarification and a solid foundation for future ethical and legal discourse. (shrink)

Normative reasons for action are facts or considerations that contribute to the justification of an action. Sometimes, normative reasons for action conflict: one reason may favor doing something, while another may favor not doing it. These conflicts can be so radical that it seems difficult, if not impossible, to judge which reason should ultimately guide one’s actions. According to a theory of practical rationality known as reasons pluralism, there are some radical cases of conflict among normative reasons for (...) action in which there can be no fact of the matter about what one ought to do. This is because normative reasons fall into a plurality of types, and normative reasons of different types are incommensurable with one another. However, reasons pluralism is compatible with a principle that would enable us to judge when a normative reason of one type overrides a normative reason of another type. I will argue that this “Override Principle” is a facet of practical wisdom—an intellectual virtue. Practical wisdom, as Aristotle construed it, involves the ability to order one’s ends into a coherent system that allows for the attainment of a good life. The Override Principle is sure to be one criterion by which those endowed with practical wisdom would order their ends. (shrink)

Harry G. Frankfurt has put the problem of volitional conflict at the center of philosophical attention. If you care fundamentally about your career and your family, but these cares conflict, this conflict undermines the coherency of your decision standard and thereby your ability to choose and act autonomously. The standard response to this problem is to argue that you can overcome volitional conflict by unifying your foundational motivational states. As Frankfurt puts it, the ‘totality of things that an agent cares (...) about’ plus his ‘ordering of how important to him they are effectively specifies his answer to the question of how to live’ (The Reasons of Love(Princeton: Princeton University Press, 2004), p. 23). In this paper, I critically assess the three main reasons given for such a coherency requirement: 1) we can do only one action at a time; 2) our motivational states come with normative pressure towards coherency; and 3) conflicting motivational states provide us with an incoherent decision-making framework. I conclude that these reasons do not ground a coherency requirement for practical deliberation and argue that we can autonomously express ourselves as volitionally conflicted by acting on our conflicting motivational states over the course of multiple actions. (shrink)

The author distinguishes two concepts of practical reason: (a) practical reason as a source of practical principles, and (b) practical reason as the theory of thought operations connected with action. He proves that there is no practical recognition in the sense (a). We can deal with actions only on the basis of dichotomic semantics. Critical analyses of some theories of practical reason are presented (Kant, Lorenzen, Apel, Alexy). The critical part of the paper mainly (...) concerns the discourse theory and its implications for practical philosophy and jurisprudence. (shrink)

Minerals originated from eastern Democratic Republic of Congo (DRC) are blamed for financing violent conflict in the area over the past decade and have been called conflict minerals. They vividly demonstrate a key human rights issue facing responsible supply chain management. The conflict minerals issue has led to a significant shift in responsible supply chain management in two ways: extending producer responsibility to respect human rights in the total supply chain through establishing traceability and transparency; and developing legally binding supply (...) chain responsibility.This article examines an emerging effort to source conflict‐free minerals using closed‐pipe supply chain in the DRC as a new strategy to respond to the above paradigm shift. By exploring whether this new strategy can contribute to conflict prevention in the DRC, this article argues that the closed‐pipe supply chain allows building long‐term relationship with various stakeholders and has the potential to transform socio‐economic structures in the producing communities, thereby leading to peacebuilding in the long run. (shrink)

Community-based healthcare organisations manage competing, and often conflicting, priorities. These conflicts can arise from the multiple roles these organisations take up, and from the diverse range of stakeholders to whom they must be responsive. Often such conflicts may be titled conflicts of interest; however, what precisely constitutes such conflicts and what should be done about them is not always clear. Clarity about the duties owed by organisations and the roles they assume can help identify and manage (...) some of these conflicts. Taking divisions of general practice in Australia as an example, this paper sets out to distinguish two main types of conflicts of interest, so that they may be more clearly identified and more effectively managed. (shrink)

When anthropologists and other social scientists study health services in medical institutions, tensions sometimes arise as a result of the social scientists and health care professionals having different ideas about the ethics of research. In order to resolve this type of conflict and to facilitate mutual learning, we describe two general categories of research ethics framing: those of anthropology and those of medicine. The latter focuses on protection of the individual through the preservation of autonomy expressed through the requirement of (...) informed consent whereas the former focuses on broader political implications. After providing an example of a conflict, we outline four issues that characterize the occasional clashes between social scientists and medical staff: (1) a discrepancy in the way anthropologists perceive patients and medical staff; (2) ambiguity concerning the role of medical staff in anthropological research; (3) impediments to informed consent in qualitative research projects; and (4) property rights in data. Enhanced dialogue could serve to invigorate the ethical debate in both traditions. (shrink)

Conflicts of interest held by researchers remain a focus of attention in clinical research. Biases related to these relationships have the potential to directly impact the quality of healthcare by influencing decision-making, yet conflicts of interest remain underreported, inconsistently described, and difficult to access. Initiatives aimed at improving the disclosure of researcher conflicts of interest are still in their infancy but represent a vital reform that must be addressed before potential biases associated with conflicts of interest (...) can be mitigated and trust in the impartiality of clinical evidence restored. In this review, we examine the prevalence of conflicts of interest, evidence of the effects that disclosed and undisclosed conflicts of interest have had on the reporting of clinical evidence, and the emerging approaches for improving the completeness and consistency of disclosures. Through this review of emerging technologies, we recognize a growing interest in publicly accessible registries for researcher conflicts of interest and propose five desiderata aimed at maximizing the value of such registries: mandates for ensuring that researchers keep their records up to date; transparent records that are made available to the public; interoperability to allow researchers, bibliographic databases, and institutions to interact with the registry; a consistent taxonomy for describing different classes of conflicts of interest; and the ability to automatically generate conflicts of interest statements for use in published articles. (shrink)

Medical Professionals: Conflicts and Quandaries in Medical Practice offers a fresh approach to understanding the role-related conflicts and quandaries that pervade contemporary medical practice. While a focus on professional conflicts is not new in the literature, what is missing is a volume that delves into medical professionals' own experience of the conflicts and quandaries they face, often as a result of inhabiting multiple roles. The volume explores the ways in which these conflicts and quandaries are (...) exacerbated by broader societal forces, including changing scientific and technological paradigms, commercialization, and strengthened consumer movements, which simultaneously expand the scope of roles and responsibilities that medical professionals are expected to fulfill, and make it more difficult to do so. Several empirical chapters analyze data from qualitative interview studies with clinicians and other stakeholders. The studies highlight the burdens on clinicians who are expected to make informed and justified judgments and decisions in the midst of competing pressures; authors describe the methods that clinicians use to address the associated tensions within specific contexts. Two conceptual chapters follow and offer some innovative ways to think about the challenges facing medical professionals as they strive to make sense of the changing landscape within healthcare. The first reflects on the challenges to clinical practice in the midst of shifting and often competing definitions of disease and associated ideologies of care. The second reflects more broadly on the utility of value pluralism as a framework for conceptualizing and working through moral and professional quandaries. The book concludes with a chapter containing suggestions for how members of the medical profession might reframe their thinking about their roles, responsibilities, and decision-making in the midst of inevitable quandaries such as those presented here. This book will be of vital reading for academics, researchers, educators, postgraduate students, and interested health care practitioners and administrators. (shrink)

In their recent article, scholars Keisha Ray and Jane Fallis Cooper claim that “bioethicists should not be deterred from advocating for a healthy environment […] instead, […] underscore the importa...

This paper presents the responses of 118 executives to a mail survey which examined their views of business ethics and various business practices. In addition to identifying various sources of ethical conflict, current business practices are also examined with respect to how ethical or unethical each is believed to be. Results are also presented which outline executive responses to four ethical business situations. Overall conclusions to the study are outlined, as well as future research needs.

This article analyzes the conflict between traditional beliefs, cultural roles, and the search for individuality through the study of Fresia, a young Mapuche woman who renounced shamanistic practice. Her case demonstrates that the social transmission of traditional beliefs and symbols is not in itself enough to ensure the commitment of shaman/healers who must also internalize their cultural beliefs and attach personal meaning to them through their dreams, visions, and ritual practices. If this does not occur, as in Fresia's case, individuality (...) emerges and may contradict ideal cultural representations even in contexts such as that of the Mapuche where the concept of the person is inextricably bound up with one's role in the social system. (shrink)

The shift from government to governance has become a starting point for many studies of contemporary policy-making and democracy. Practices of Freedom takes a different approach, calling into question this dominant narrative and taking the variety, hybridity and dispersion of social and political practices as its focus of analysis. Bringing together leading scholars in democratic theory and critical policy studies, it draws upon new understandings of radical democracy, practice and interpretative analysis to emphasise the productive role of actors and political (...) conflict in the formation and reproduction of contemporary forms of democratic governance. Integrating theoretical dialogues with detailed empirical studies, this book examines spaces for democratisation, institutional design, democratic criteria and learning, whilst mobilising the frameworks of agonistic and aversive democracy, informality and decentred legitimacy in cases from youth engagement to the Israeli-Palestinian conflict. (shrink)

Major changes in the technological, societal, political, and economic environment have forced organizations across Europe to reshape and expand their strategic communication activities. However, knowledge of the future viability of public relations, employee and consumer communication, public affairs, or investor relations is often scarce. This has led to an increased demand for external consulting in the field. The quality of such intangible services is difficult to assess; this is a challenge for clients and consultants alike, and often results in conflict. (...) Communication research has rarely addressed this topic to date. This article expands the body of knowledge by introducing the key concepts, exploring drivers for quality assurance, and identifying sources of conflict in an empirical study of 1,558 communication practitioners in 43 European countries. The findings provide insights into current practices, indicate ways to secure quality and avoid conflict, and suggest directions for future research in an area of growing importance. (shrink)

Alasdair MacIntyre explores some central philosophical, political and moral claims of modernity and argues that a proper understanding of human goods requires a rejection of these claims. In a wide-ranging discussion, he considers how normative and evaluative judgments are to be understood, how desire and practical reasoning are to be characterized, what it is to have adequate self-knowledge, and what part narrative plays in our understanding of human lives. He asks, further, what it would be to understand the modern (...) condition from a neo-Aristotelian or Thomistic perspective, and argues that Thomistic Aristotelianism, informed by Marx's insights, provides us with resources for constructing a contemporary politics and ethics which both enable and require us to act against modernity from within modernity. This rich and important book builds on and advances MacIntyre's thinking in ethics and moral philosophy, and will be of great interest to readers in both fields. (shrink)

Gopal Sreenivasan’s new book, Emotion and Virtue, is an incredibly rich and impressive achievement. It is required reading for anyone working on issues related to character. In the spirit of book discussions in this journal, I will focus less on raising objections and more on exploring how the discussion could be extended in new directions or connected with related topics. The plan is to focus on four topics: (i) the scope of Sreenivasan’s project, (ii) his response to the situationist challenge, (...) (iii) some implications of his view for practical wisdom, and (iv) his account of virtue conflicts. (shrink)

Much of today's writing on medical ethics is strong on philosophical theory or on legal speculation, but weak on practice. In this book, practitioners in a wide range of specialties describe the process of making ethical decisions in their everyday work. A moral philosopher analyzes their conclusions, and the theological implications are developed by a Christian theologian and Rabbinic scholar. Thorough and eclectic, this book should be read by all who seek the good of the profession of medicine.