Ambivalence (as in practical conflicts, moral dilemmas, conflicting beliefs, and mixed feelings) is a central phenomenon of human life. Yet ambivalence is incompatible with entrenched philosophical conceptions of personhood, judgement, and action, and is denied or marginalised by thinkers of diverse concerns. This book takes a radical new stance, bringing the study of core philosophical issues together with that of ambivalence. The book proposes new accounts in several areas – including subjectivity, consciousness, rationality, and value – (...) while elucidating a wide range of phenomena expressive of ambivalence, from emotional ambivalence to self-deception. The book rejects the view that ambivalence makes a person divided, showing that our tension-fraught attitudes are profoundly unitary. Ambivalence is not tantamount to confusion or to paralysis: it is always basically rational, and often creative, active, and perceptive as well. The book develops themes from Wittgenstein, Davidson, Sartre, and Freud. It engages with contemporary debates in Analytic Philosophy in addition to work ranging from Aristotle to Cultural Studies and Empirical Psychology, and considers a rich set of examples from daily life and literature. (shrink)

Rational Sentimentalism develops a novel theory of the sentimental values. These values, which include the funny, the disgusting, and the shameful, are profoundly important because they set standards for emotional responses that are part of our shared human nature. Yet moral philosophers have neglected them relative to their prominence in human mental life. The theory is sentimentalist because it holds that these values are emotion-dependent—contrary to some prominent accounts of the funny and the disgusting. Its rational aspect arises (...) from its insistence that the shameful (e.g.) is not whatever elicits shame but what makes shame fitting. Shameful traits provide reasons to be ashamed that do not depend on whether one is disposed to be ashamed of them. Furthermore, these reasons to be ashamed issue in reasons to act as shame dictates: to conceal. Sentimentalism requires a compatible theory of emotion and emotional fittingness. The book explicates a motivational theory of emotion that explains the peculiarities of emotional motivation, as other theories cannot. It argues that a class of emotions are psychological kinds with the same goal across cultures, despite differences in their elicitors. It then develops an account of fittingness that helps to differentiate reasons of fit, which bear on the sentimental values, from other considerations for or against having an emotion. Some significant and controversial conclusions emerge from rational sentimentalism. The sentimental values conflict with one another, and with morality, but nevertheless provide practical reasons that apply to humans—though not to all rational agents. (shrink)

The paper analyzes Max Weber’s concepts of rationality and rationalization as components of modernization processes in modern society. The author reconstructs Weber’s interpretation of “spiritual factors” of social development, which emerge in the ethos of Protestantism. The research demonstrates how Weber’s study of capitalism in terms of rationality corresponds with concepts of other classics of German sociology, such as Ferdinand Tönnies, Werner Sombart, Georg Simmel and others. The article emphasizes the relevance of Weber’s sociology for XX— XXI centuries and how (...) its basic concepts and methodological approaches have been further developed by scholars, including Ukrainian ones. Weber’s concept of rationality is applicable not only to the mental-epistemological sphere, it also acquires a social meaning. This approach has gained recognition in phenomenological sociology, theory of social systems, communicative theory and more. In addition to the formal rationality of the economy, modern social sciences use such concepts as social, aesthetic, ethical, environmental, and practical rationality. Weber’s “diagnosis of the age” is still a component of the “diagnosis” of modern society. The gap between values and interests remains an integral feature of the “risks and threats society” in the XXI century. This situation is especially evident in international relations, when “real politics” (Realpolitik), based on interests, becomes insensitive to “value postulates”. The author also discovers ways of value (moral and ethical) reclamation of modern society, particularly in the concepts of “ethical economy”, universalist ethics of discourse, global ethos and more. Keywords: purposive rationality, rationality (formal, material, communicative, systemic), value, ethos. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Treatment and the Problem of Equality:Whose Justice, Which Rationality?Floris Tomasini (bio)KeywordsInvoluntary treatment, democracy, equality, impartialityCraig Edwards in his article "Ethical Decisions in the Classification of Mental Conditions As Mental Illness" provides the reader with a socially normative, rather than a naturalistic understanding of mental illness, one that, in particular, promotes a normative understanding of mental illness as a form of evaluating dysfunctional personhood. In (...) doing so, Edwards is not interested in undermining psychiatric expertise, but exploring some of the practical consequences that flow from it, such as involuntary psychiatric treatment.My concern about psychiatric treatment in general and involuntary psychiatric treatment in particular, is three-fold, the third concern adding to the arguments already rehearsed by Edwards and others. The first concern is about the value neutrality of mental illness. Any dysfunctional conception of mental illness is not value neutral according to Fulford; dysfunction is, straightaway, a normative concept and is heavily influenced by a patient's desires and values. The second concern is about competing and conflicting values that arise in a person's psychiatric treatment. Again, there exists a legitimate variation in people's evaluative judgments about mental health conditions, for which a degree of democratic compromise might be required in negotiating conflicting values in a person's psychiatric treatment (Fulford and Colombo 2004). Without wishing to examine any of the philosophical foundations or counter-arguments to these claims in this short discussion paper, my third concern is about how to ethically negotiate between conflicting values in a person's psychiatric treatment. In other words, what might democratic compromise consist in? How might democratic compromise be implemented in terms of an ethically relevant principle?Any democratic enterprise, by definition, favors or is characterized by social equality and is egalitarian in nature (New Oxford English Dictionary 1999, 490). To be able to negotiate in the spirit of democratic compromise between competing and conflicting values in the process of psychiatric treatment, a principle of equal consideration of interests is vital.The essence of the principle of equal consideration of interests is that we give equal weight in our [End Page 101] moral deliberation to the like interests of all those affected by our actions (Singer 1979, 19). In other words, an interest is an interest whoever's interest that may be. So, for example, if the principle is about relieving pain, then the moral principle is about relieving the undesirability of pain as such, and not the undesirability of A's pain, which might be different from the undesirability of B's pain. Naturally, one may be able to distinguish that A's pain is greater than B's pain, in which case, under the equal consideration of interests principle, A's pain should be given greater weighting than B's pain in any conflict of interests. In short, in the evaluation of like interests, major interests outweigh minor interests.The significance of the principle of equal consideration of interests in decisions about mental health treatment in general, and about involuntary psychiatric detention and treatment more specifically, is that it should be possible (in theory at least) to able to democratically arbitrate on the basis of utility, whose interests take precedence when legitimate conflicts arise. The great practical advantage to the principle of equal consideration of interests is that it weighs' interests impartially—like well-balanced weighing scales; they favor where the interest is stronger or where several interests combine to outweigh a smaller number of similar interests. Most important, in the case of psychiatric treatment, it is a principle that takes no account of whose interests they are, avoiding any discriminatory stigma that may arise because of having made certain assumptions about being mentally ill. From the point of view of the equal consideration of interests, who the bearer is and how they are classified is, in itself, incidental to what the actual bearer's interests are and how they compete and conflict with others who have like interests. There are a number of practical consequences that flow from the principle of equal consideration when applied to psychiatric treatment (voluntary and involuntary) that need to be pinned down.Simple Negative DiscriminationClearly... (shrink)

Practical conflicts include conflicts in agents who judge, from the perspective of their own values, desires, beliefs, and the like, that one prospective course of action is superior to another but are tempted by what they judge to be the inferior course of action. A man who wants a late-night snack, even though he judges it best, from the identified perspective, to abide by his recent New Year's resolution against eating such snacks until he has lost ten (...) pounds, is the locus of a practical conflict. So is a woman who judges it best (in the same way) to run a mile this morning but is tempted to spend the entire morning working in her office instead. The topic of this essay is practical outcomes of conflicts of this kind. My concern, more specifically, is with outcomes of two general kinds: akratic (from the classical Greek term akrasia: want of self-control) and enkratic (from enkrateia: self-control) actions. (shrink)

From some perspectives, it seems obvious that emotions and feelings must be both reasonable and morally significant: from others, it may seem as obvious that they cannot be. This paper seeks to advance discussion of ethical implications of the currently contested issue of the relationship of reason to feeling and emotion via reflection upon various examples of affectively charged moral dilemma. This discussion also proceeds by way of critical consideration of recent empirical enquiry into these issues in the literature (...) of so-called emotional intelligence. In this regard, despite ambiguities in their accounts of the relationship of reason to emotion, advocates of emotional intelligence generally incline to therapeutic conceptions of emotional health which are not inconsistent with currently fashionable cognitivist accounts of feeling and emotion. All the same, it is arguable that therapeutic or other strategies which overplay the possibility of cognitive or other resolution of emotional conflict are prey to certain difficulties. First, they underemphasise those passive but identity-constitutive aspects of affect which are not obviously rationally accountable. Secondly, they insufficiently recognise the extent to which emotional conflicts can be significantly implicated in moral diversity. In view of either or both of these points, they may fail to appreciate the moral inappropriateness of attempts to resolve certain forms of emotional conflict or tension. (shrink)

PHILOSOPHY OF HUMAN RIGHTS: HUMAN RIGHTS IN LIGHT OF THEIR INTERNATIONAL PROTECTION Summary The book consists of two main parts: in the first, on the basis of an analysis of international law, elements of the contemporary conception of human rights and its positive legal protection are identified; in the second - in light of the first part -a philosophical theory of law based on the tradition leading from Plato, Aristotle, and St. Thomas Aquinas is constructed. The conclusion contains an application (...) of the results of the analysis conducted in the second part. The first part comprises four chapters. The first aims at revealing characteristics of human rights on the basis of an analysis of historical conditioning of the inter-national law of human rights and its development. The historical context displays the practical, vindicative, and critical character of the positive legal protection of human rights. Moreover, the process of change of positive human rights law is distinguished from the process of change of human rights as such. In the second chapter the content of human rights - a topic which is only auxiliary to the conducted analysis - is discussed. Basic typology and catalogues of rights proclaimed in the Universal Declaration of Human Rights and protected in the International Covenants of Human Rights are presented. The review of the content of rights aims at a more precise limitation of the field of research. The examination shows a diversity of rights which poses a serious challenge to the coherence of every philosophical theory of human rights. In the third chapter, central in the first part, international law is analyzed with regard to the characteristics of rights and the foundations of them. The analysis of documents shows a number of solutions referring to the anthropological foundations of rights. The inherent dignity of the human person is the source of all human rights. Each human being is recognized as free, and endowed with both reason and conscience. In the propounded conception of man individuals are not rivals but create a community which is a condition for their development. International law characterizes the rights as universal, inherent, inalienable and inviolable. The reconstructed conception also comprises the following basic elements: on the level of the structure of rights, a recognition of their equality, interdependence, and comprehensiveness; in the grounding of these rights, a recognition of the anthropological foundations of law; in the conception of positive law, a recognition of the secondariness of the positive law of human rights to human rights themselves, and a recognition of human rights and justice as the basis for legal order; in the conception of state, a recognition of the well-being of the individual as the fundamental aim of actions undertaken by political institutions, and recogni¬tion of rights which form an impassable boundary to the power of the state, includ¬ing its legislative actions. The characterization of the international legal paradigm serving for the under¬standing of human rights is supplemented by analyses of the structure of their posi¬tive legal protection. Various meanings of the terms "right" and "freedom" are distinguished. Subjective right, as basic structure of the positive legal protection of human rights, is understood as a complex relation formed by various legal situations of the subject of a right which create a functional whole in respect of the subordi-nation of human person to its good. Subordinating person to a good proper for it, expressed usually in a proclamatory norm, is the central element of particular rights around which further elements aiming at the realization of this good are built. In the second part of the book a philosophical theory is developed which allows for the location of a coherent foundation for the presented characterization of human rights and their positive legal protection. This part consists of two chapters. The first includes a review of some - not entirely satisfactory - means of founding of human rights; the second presents philosophical conceptions of law and man which may form a basis for the constructed theory. The review of arguments contained in the first chapter does not aim at a detailed analysis of various specific ways of argumentation encountered in works on this subject but rather at a concise presentation of the main possible lines of argumentation. These analyses also serve to emphasize the positive solutions which are pro¬posed later and to underscore the explanatory power of the elaborated theory. This theory, retaining accurate intuitions contained in the presented types of argumenta¬tion, helps in avoiding their consequences which are difficult to reconcile with the reconstructed paradigm of human rights. Efforts to base human rights on the norms of international law rightly take into account the necessity of determining the content of the rights and their positive legal protection as a means for the realization of man's good. These attempts, how¬ever, do not properly take into account the inherent character of human rights, which are independent of positive law and provide grounds for applying specific legislative measures and not others. Founding human rights on freedom accurately points at the freedom of an indi¬vidual as a constitutive element of some rights; however, absolutization of freedom leads, to a loss of an important element of the contemporary paradigm of under¬standing human rights. This foundation undermines recognition of the fact that human rights may set limits to both the freedom of others and the freedom of the subject of rights itself. Additionally, attempts at the so-called axiological justification of human rights are discussed. This type of justification has a few variants depending on the as¬sumed conception of value. Subjectivistic conceptions have similar advantages and disadvantages to the conceptions basing human rights on freedom; objectivistic conceptions while providing for the universality of human rights place, the fundamental aim of human rights protection beyond the individual human being - in the idealistically existing world of values; finally, conceptions rooting values and human rights in culture, while accurately noting that human rights are learned through the medium of culture, place the source of human rights beyond a concrete individual - in culture and processes which take place in it - which leads to difficulties in finding a basis for the universality of rights. Furthermore, attempts to ground human rights in specific characteristics of the human being are presented. This type of approach points to an important problem of dependence of the content of rights on what man is. However, recognition of specific characteristics of a human being as an ontic foundation of the existence of rights poses a danger to their universality since one has to accept that it is not enough to be a man to be a subject of rights, but a man possessing specific charac¬teristics. The second chapter aims at outlining solutions worked out by Saint Thomas Aquinas. For a fuller understanding of his propositions selected elements of Plato's and Aristotle's philosophy are presented. It was them who formulated the founda¬tions for reflection on law and justice in the ontological context. A qualification is made that Stoicism is not be analysed in depth. Although Thomas' concept of law was undoubtedly developed under the influence of the Stoic doctrine as well, it is not in this that one should look for the tools to understand the ontic foundations of human rights and law in general since the Stoic moral philosophy and philosophy of law were developed in the context of a theory of being which assumed monistic and pantheistic premises as foundations, leading to the recognition of a total subor¬dination of the human individual to a larger unity of which man is only a part. The analysis of Plato's and Aristotle's texts concentrates on problems of justice. Plato seems to be the first philosopher who reflected on the formula basic in the history of European thought: to render to each his due. It appears that justice as both a characteristic of man and his acts is understood in the perspective of that which is just, that which is a good for another man - the recipient of the act. The basis for determining what is just is the relation of correspondence between some¬one and something. While in the case of Plato this relation is based on something beyond its terms, namely on ideas, in the case of Aristotle the relation occurs on account of the elements of the relation itself. Something is just when it contributes to the develop¬ment of the recipient of an act realizing that which is just. At the same time, the realization of that which is just is a good for the agent. In the analysis of the just two types of relation are revealed: the relation of due-to-recipient occurring on account of the compatibility of that which is due, with the recipient of the act; and - a "superstructure" - a relation of obligation-of-subject occurring on account of the compatibility of the acting subject with the thing which should be done. The basis for being that which is due is formed by various potentialities of development of man - the recipient of agency; the basis of being that which is an obligation is the possibility of development of the subject of action. Aristotle distinguishes various types of freedom and points to the necessity of taking them into account in the discussion of justice. Among other things, as the core of man's freedom, he considers life for its own sake, which can be seen as his expression of the basic indices of the autotelic character of man - which is funda¬mental for later conceptions of dignity. The freedom which is described by him is not, however, inherent and inalienable; being free is conditioned by a factual possi¬bility of undertaking actions, which are not solely means to the realization of aims set by others. Thomas Aquinas takes over the Aristotelian research perspective both in his conception of man and of law. At the same time, however, he significantly enriches it. In anthropology he develops a conception of personal being. Drawing upon his distinction between existence ("that something is") and essence ("what something is"), he sees the basis for being a person in the dignity of personal being which is a certain way of existence of a rational being more perfect than that of non-personal beings. The person is a being which, by virtue of its act of existence, is individual¬ized in a specific way. It is an aim in itself. Expressing it in a negative way, one may say that it does not exist as a means for the realization of the aims of others and, in this sense, that it is free. As distinct from Aristotelian conclusions, being a person is not conditioned by the specific actions of a being. Dignity is inherent, based on that which is the foundation of the factual existence of every rational being. Although freedom requires that a being is rational, dignity still encompasses all being, all its properties and potentialities. Thus an act conforming with dignity has to take into account a whole human being. Among different types of that which is just, ius, the first place, from the point of view of understanding law, falls to "the just thing itself ("ipsa res justa"), which is right in the full meaning of the word. On the one hand, it is that which is due; on the other hand, it determines the way of acting in the utmost degree, since the course of every act is determined in the fullest extent by its aim. The content of ius may be determined both by elements independent of free decisions - ius naturale - and by free decisions taking into account the state of things - ius positivum. Recognition of the objective structure of being as the basis of law does not entail that it is possible or desirable to determine unequivocally "the only right" patterns of conduct. This concept is very well justified within the system proposed by Saint Thomas. Individualization of being is a significant element of the develop¬ment of a person as a person. It is attained by the realization of individual aims which are not unequivocally determined by circumstances and the nature common to all people. By virtue of free choices made in the sphere of that which is not by its nature unjust, the object of action becomes ius. Since in the realization of the person the individualization of human being is central, Aquinas clearly sees the need for the protection of the sphere of "dominion of will". This sphere itself constitutes ius naturale, something which is due to man independently of the acts of will. Therefore "law should forbid nothing which is not unjust" ("nihil debet lege prohiberi quod licite fieri potest", In 3 Sent., dist. 40, q. I, a. 1, 3). Besides the relation of due-to-recipient, ius also includes the relation of obligation-of-subject which is superimposed on the relation of due-to-recipient. As far as the ontic foundations of obligation are concerned, in explaining why man is subordinated to realization of the good of others, Aquinas generally follows Aristotle in accepting that this basis is the subordination to moral good - to actions conforming with the learned truth about reality. Aquinas' systemic solutions allow, however, to reach deeper and understand why moral development is also a development of the whole human being. This was difficult within Aristotle's system, since he was reluc¬tant to decide whether precedence should be given to intellectual or moral develop¬ment. The inclination to realise good of another appears to be a transcendental characteristic of being, based on its very existence. Morality understood as rational and free subordination to realize the good of another is a specifically personal way of the realization of this inclination. Thus just actions contribute to the actualization of being in the aspect of its existence and therefore to the actualization of being as a whole. Thomas' conception of natural law (lex naturalis) as participation in eternal law (lex aeterna), offers possibilities for grasping that which is just as something which is basically accessible cognition, independently of Revelation and independently of faith in God, and at the same time as something based in eternal law, understood as a design of God's wisdom. Eternal law, embracing all particular actions, is not, from the human perspective, accessible cognition directly. It is enacted in the struc-ture of the created being and - in case of human beings - in free choices taking this structure into account. In the concluding remarks, the results obtained earlier are applied directly to the contemporary conception of human rights. Human rights are understood in the first place as "just things" - concrete goods of man; as that which is due because of subordination, based on dignity, to the personal development of man. That which is just is understood as a relational - actual or potential - state of things, which exists by virtue of existing relations. Evaluations referring to that which is right are true when respective relations of due-to-recipient take place; norms of conduct are true when respective relations of obligation-of-subject take place. Examples of the application of the sketched theory outside the field of human rights are also presented. Procedural consequences of the developed theory are shown, such as the discrimination of two types of legislative procedures which differ significantly in the structure of argumentation: the first aims at recognition of that which is just independently of the will of the legislator, and the second, at making individual or collective "projects" of development compatible. Finally the possibilities of applying the theory to the increasingly important problems of the protection of the environment and the "rights" of animals are mentioned. The central issue is a philosophical conception of man and his freedom and a conception of law. It is also indispensable to turn to a general theory of being. The search for a comprehensive theory of human rights requires attention to the Abso¬lute Being - God - as well. This is important for at least two reasons. First, a conception of the Absolute Being is integral to philosophy of the systemic type -of which the present book is a piece. A conception of the Absolute Being is signifi¬cant for understanding all being, including, first of all, man as a personal being. Second, every theory of human rights which does not comprise the problem of the Absolute may be questioned as to whether solutions adopted in it do not lead, in consequence, to eliminating God from the perspective of the understanding of law. It is desirable that a philosophical theory should deal with this problem directly. A theory which eliminates God from the perspective of the understanding of rights will be unacceptable for all those who, for philosophical reasons or relying on faith, consider God as the author of inherent rights. Nevertheless, a theoretical approach to rights from the perspective of the Absolute Being should only be a possible extension of a philosophical approach which bases rights on something which is cognizable independently of the acceptance of the existence of God so that the theory is also acceptable for those who reject the existence of God or suspend their judgment on this subject. The pursued theory should therefore contain, on the one hand, reference to natural, faith-independent foundations of human rights, but on the other hand, point to a possible extension accounting for the Absolute Being. The analyses contained in this chapter have undoubtedly some historical value since they are based on source texts. Nevertheless, the use of these texts and not critical works was dictated, first of all, by a conviction that analyses embrace a given theory in the aspect selected by the interests of the researcher. Therefore to find out what past thinkers say on the subject characterized in the first part it is simpler to reach to the sources than to adopt the existing critical works. The pre¬sented reconstruction of Aquinas' views on philosophy of law incorporates proposi¬tions of supplementing and developing some of the ideas undertaken by him. Obligation to act in this and not an other way arises because human actions are subordinated to the conformity, on the one hand, of aims realized by these actions and, on the one hand, the order of being determining that which is favourable to man or destroys him. The content of the order of being is, on the one hand, determined by the structure of being independent from man's will and, on the other, by free decisions of man. (shrink)

Value and reasons for action are often cited by rationalists and moral realists as providing a desire-independent foundation for normativity. Those maintaining instead that normativity is dependent upon motivation often deny that anything called "value" or "reasons" exists. According to the interest-relational theory, something has value relative to some perspective of desire just in case it satisfies those desires, and a consideration is a reason for some action just in case it indicates that something of (...) class='Hi'>value will be accomplished by that action. Value judgements therefore describe real properties of objects and actions, but have no normative significance independent of desires. ;It is argued that only the interest-relational theory accounts for the practical significance of value and reasons. Against the Kantian hypothesis of prescriptive rational norms, I attack the alleged instrumental norm or hypothetical imperative, showing that the normative force for taking the means to our ends is explicable in terms of our desire for the end, and not as a command of reason. This analysis also provides a solution to the puzzle concerning the connection between value judgement and motivation. While it is possible to hold value judgements without motivation, the connection is more than accidental. This is because value judgements are usually but not always made from the perspective of desires that actually motivate the speaker. In the normal case judgement entails motivation. But often we conversationally borrow external perspectives of desire, and subsequent judgements do not entail motivation. ;This analysis drives a critique of a common practice as a misuse of normative language. The "absolutist" attempts to use and, as philosopher, analyze normative language in such a way as to justify the imposition of certain interests over others. But these uses and analyses are incoherent---in denying relativity to particular desires they conflict with the actual meaning of these utterances, which is always indexed to some particular set of desires. (shrink)

Pushing back against the potential trivialization of moral psychology that would reduce it to emotional preferences, this book takes an enactivist, self-organizational, and hermeneutic approach to internal conflict between a basic exploratory drive motivating the search for actual truth, and opposing incentives to confabulate in the interest of conformity, authoritarianism, and cognitive dissonance, which often can lead to harmful worldviews. The result is a new possibility that ethical beliefs can have truth value and are not merely a (...) result of ephemeral altruistic or cooperative feelings. It will interest moral and political psychologists, philosophers, social scientists, and all who are concerned with inner emotional conflicts driving ethical thinking beyond mere emotivism, and toward moral realism, albeit a fallibilist one requiring continual rethinking and self-reflection. It combines 'basic emotion' theories with hermeneutic depth psychology. The result is a realist approach to moral thinking emphasizing coherence rather than foundationalist theory of knowledge. (shrink)

Photo ID 71252867© Stepan Popov| Dreamstime.com Abstract While Medical Assistance in Dying (MAiD) has been legalized in Canada since 2016, it still excludes eligibility for persons who have mental illness as a sole underlying medical condition. This temporary exclusion was set to expire on March 17th, 2024, but was set 3 years further back by the Government of Canada to March 17th, 2027. This paper presents a critical appraisal of the case of MAiD for individuals with mental illness (...) as the sole underlying medical condition through the analysis of three ethical theories: principlism, deontology, and utilitarianism. Through evidence and discussion, it will be demonstrated that MAiD, in this context, may be ethically justifiable on the grounds of upholding human rights, protecting dignity, and minimizing suffering. Introduction In June of 2016, Medical Assistance in Dying (MAiD) was legalized in Canada.[1] Throughout the first six years, a temporary exclusion of eligibility for persons suffering solely from mental illness was extended.[2] The exclusion of mental illness as a sole underlying medical condition was set to expire on March 17, 2024.[3] However, on February 1, 2024, just over a month before the set expiration, the Government of Canada once again extended the exclusion, this time setting it back three years to March 17, 2027. There are currently several countries that allow MAiD for mental illness, including Belgium, the Netherlands, and Luxembourg.[4] Some countries, like Spain,[5] do not give specific guidance, leaving the matter under discussion by ethicists and courts. In these countries, there are specific (although different) requirements for the process; overall, for mental illness, the illness must be verifiable and not simply related to a perception of satisfaction with the length of life. This extension ignited discussion on whether MAiD for persons who have mental illness as a sole underlying medical condition in Canada is ethically acceptable. As a complex, multi-faceted, and interdisciplinary issue, ethicists assessing MAiD must take into account various moral obligations and considerations. This paper analyses MAiD in this context through the application of three ethical theories: principlism, deontology, and utilitarianism. This paper concludes that, based on the current evidence and knowledge of this developing situation, MAiD for persons with mental illness in Canada may be ethically justified on the grounds of upholding human rights, labour obligations, and dignity. Through the exploration of research and discussions, it will be demonstrated that society at large ought to protect liberty and act towards relieving suffering, thereby supporting the potential eligibility of MAiD for persons who have mental illness. Principlism: The Capacity and Ability to Assess and Decide for One’s Own Life Principlism is the application of four principles: autonomy, beneficence, non-maleficence, and justice. Principlism supports permitting MAiD for mental illness due to the importance of autonomy in decision-making, equitable and just practices for MAiD assessors, and reducing suffering for patients and their family member(s) and/or friend(s). Carter v. Canada, the Canadian Supreme Court ruling of 2015—which changed Canadian law to allow for MAiD—held that the prohibition of MAiD infringed on Canadians’ right to “life, liberty, and the security of the person.” In a unanimous decision, the Supreme Court of Canada decided that the criminal prohibition of MAiD violates the Canadian Charter of Rights and Freedoms.[6] The Court concluded that the criminal law prohibiting MAiD interfered with people’s autonomy and dignity, which are protected by the rights of liberty and security of the person.[7] The ruling emphasized that Canada’s constitution reflects the fundamental importance of individual autonomy in personal decision-making. Research provides evidence that MAiD improves autonomy: A study among psychiatric patients found that 8 of 48 psychiatric patients said the mere option of accessing MAiD was enough to assess their future options for living wholly.[8] These findings complement a study entailing interviews with 30 adults who have mental illness, which emphasized that the ability to access MAiD allows individuals to analyze their quality of life, envision their desired future, and make decisions accordingly.[9] Although not all participants agreed that mental illness as the only underlying medical condition was appropriate for MAiD eligibility, many participants agreed that patient autonomy in decision-making was paramount and should be respected. However, autonomy as an ethical principle does not immediately grant all persons with mental illness the option to access MAiD. There are multiple eligibility criteria for those who wish to receive MAiD, which still must be approved and assessed. Currently, eligibility criteria for MAiD states that individuals must “give informed consent to receive MAiD, meaning that the person has consented to receiving MAiD after they have received all information needed to make this decision.”[10] Consent requires capability or capacity, which is the ability to understand relevant information, appreciate its potential consequences, and make an informed decision for oneself.[11] Like for many other diseases, disabilities, and conditions, patient capability is determined on a case-by-case basis.[12] Given the stigma surrounding those struggling with mental health, this thorough case-by-case examination of an individual patient’s capability and capacity without prejudice or partiality should lead to equitable and fair treatment. Without appropriate testing, those with mental illness could be wrongly stripped of their decision-making power. Arguments against MAiD for those with mental illness have raised concerns about the potential for individuals to harm themselves and others. A survey of MAiD providers demonstrated that physicians believed that the bereavement experience following MAiD is challenging and profoundly distinct and that bereavement support for all members involved should be required.[13] However, while watching one die (of MAiD) may cause harm to their families, friends, and support system at large, it is also important to recognize that watching someone suffer and struggle through their mental health journey also poses significant harm. Qualitative studies in Ontario, Canada, have interviewed family members of persons with mental illness as a sole medical condition, and interviewees shared that witnessing the illness and its impacts on their close one's lives was a very difficult experience.[14] As it relates to MAiD, participants emphasized that those living with mental illness are in the best position to understand their own pain and suffering and, in turn, make their own decisions about relief.[15] In an interview, a MAiD provider stated that MAiD may provide less suffering and more peace, and that, although it “depends on the family,... usually the family is more prepared and at peace.”[16] On the contrary, a person who has mental illness may perceive choosing MAiD as beneficial to their family member(s) and/or friend(s). Among those who died by MAiD in 2021, 35.7 percent reported that they perceived themselves as a burden on their family and friends.[17] While some authors report their concerns regarding such social burden as a potential driving factor for MAiD requests, others report that there are other additional burdens associated with requesting MAiD that may be financial, societal, and personal.[18] As such, the extension of MAiD eligibility to those with mental illness will likely only allow a small number of people to be granted MAiD.[19] Many others will be diverted to appropriate services and treatments. Patients’ decision to choose MAID noted their ability to make choices about their own care, reflecting the value of autonomy.[20] Although it is difficult to determine what is good for families in individual cases, MAiD presents an option that is both beneficent and non-maleficent. Therefore, these arguments satisfy the principles which do not necessarily conflict with MAiD. Deontology: The Duty to Recognize Vulnerability and Relieve Suffering The argument here begins with the fundamental focus of deontology—that moral duty lies in an action rather than in its consequences. Further discussion is required to analyze the impact of MAiD on healthcare workers. The Canadian Medical Association (CMA) Code of Ethics and Professionalism requires physicians to abide by virtues, commitments, and responsibilities in delivering health care and service.[21] The code states that “a compassionate physician recognizes suffering and vulnerability, … and alleviate[s] the patient’s suffering.”[22] In the context of MAiD for persons with mental illness as a sole underlying medical condition, vulnerabilities could be wide in range. Many Canadians are concerned with the interaction between mental health and other social determinants of health, such as the lack of medical, disability, financial, housing, and social support and resources.[23] As a result, another layer to the ethical issue arises: Does permitting MAiD for mental illness treat the symptoms of the issue rather than the root problem itself (social, economic, and systemic inequities)? Some argue against MAiD, stating that the nation should first focus on developing better quality care and service.[24] Others support MAiD as a potential harm reduction approach, given that most of these unjust conditions require a higher level of long-term structural and public policy overhaul.[25] The CMA Code also calls upon physicians to recognize and alleviate patients’ suffering. Some argue that while physicians and medical professionals do work to relieve suffering, they are trained to do so through a primary care-based diagnose-and-treat approach.[26] Studies that have captured Canadian physicians’ experiences providing MAiD report that, although physicians stated that the work was rewarding, it came with many challenges, including strained relationships with coworkers, increased workload, and inadequate compensation.[27] Physicians report that a part of the problem is that MAiD rules are written by lawyers and experts who are removed from its reality in medical practice. As a result, there is a lack of clarity surrounding practice norms and a lack of support for physicians.[28] Thus, while healthcare practitioners have a duty to relieve patients’ suffering, they should feel adequately trained and supported in doing so. If physicians and healthcare professionals recognize vulnerability and relieve suffering, then they should act accordingly, regardless of potential associations or outcomes. Making persons with mental illness eligible for MAiD ensures that treatment to relieve their suffering is available. However, it is imperative that there are sufficient resources and support available to healthcare professionals to ensure that they feel prepared and supported to provide MAiD, should they wish to do so. Utilitarianism: Minimizing Intolerable Suffering and Dying with Dignity Overall, utilitarianism is largely concerned with the greatest happiness principle—to increase the amount of happiness for the greatest number of people. So far, this paper has analyzed individual, family, and practitioner-based ethical considerations. But if MAiD were to be extended to those with mental illness as a singular underlying medical condition, what implications would this have for the world and society at large? There is a global drive toward authorizing organized ending of life, with an increasing number of countries legalizing MAiD.[29] The medical system is generally seen as a safe and appropriate system to carry out MAiD, especially when suicide and self-harm are regarded as “alternatives.” Yet despite these worldwide efforts, many argue through the theory of utilitarianism that the inability to see long-term consequences renders MAiD a premature solution, particularly for those who are unable or unwilling to seek other forms of potentially healing treatment or for those who may undergo MAiD only for a technological innovation or biomedical advancement to later come along as a potential cure.[30] While it is true that MAiD does not prevent these “premature deaths,” it is also true that it does not claim to.[31] MAiD provides an option to alleviate intolerable suffering. Some individuals with severe mental illness do describe their condition as intolerable suffering. MAiD is seen as an option to minimize suffering. It can also be seen as a way to die with dignity and relief.[32] While predicting outcomes is difficult, extending MAiD eligibility for persons experiencing mental illness does not undermine its ability to end suffering. It allows eligible individuals to take charge of their health, their life, and their future. Conclusion Based on the current evidence, allowing MAiD for persons with mental illness as their sole underlying medical condition presents as an ethically justifiable action. The right to self-determination and fair accessibility demonstrates that there is more harm done by prohibiting MAiD for mental illness than allowing it. Such liberty is a right, and in the context of relieving suffering, it is a duty that healthcare workers must uphold, although the ability to opt out of providing MAiD is well established. Thus, to recognize vulnerability and relieve suffering means to provide methods, such as MAiD, for those deeply impacted by mental illness. These justifications stand at both the individual level and for society at large. Nevertheless, it remains imperative to take an upstream approach that addresses the social determinants of health and aims to prevent mental illness and promote long-term, beneficial social change for those suffering, struggling, and vulnerable in our communities. - [1] Jaro Kotalik and David W. Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives, 1st ed. 2023., The International Library of Bioethics, 104 (Cham: Springer International Publishing, 2023), https://doi.org/10.1007/978-3-031-30002-8. [2] Department of Justice Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law,” February 21, 2024, https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html. [3] Health Canada, “Final Report of the Expert Panel on MAiD and Mental Illness,” transparency - other, May 13, 2022, https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advi sory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html. [4] Federal Public Service (FPS) Health Belgium, “Federal Commission for the Control and Evaluation of Euthanasia,” n.d., https://consultativebodies.health.belgium.be/en/advisory-and-consultative-bodies/federal-commission- control-and-evaluation-euthanasia.; Government of Netherlands, “Is Euthanasia Allowed in the Netherlands?,” n.d., https://www.government.nl/topics/euthanasia/is-euthanasia-allowed.; “Information on Requesting Euthanasia or Assisted Suicide,” n.d., https://guichet.public.lu/en/citoyens/sante/fin-vie/euthanasie/euthanasie-assistance-suicide.html. [5] Luis Espericueta, First official report on euthanasia in Spain: A comparison with the Canadian and New Zealand experiences, Medicina Clínica (English Edition), Volume 161, Issue 10, 2023, Pages 445-447, ISSN 2387-0206, https://doi.org/10.1016/j.medcle.2023.06.021. [6] Government of Canada, “The Canadian Charter of Rights and Freedoms,” March 15, 2021, https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/. [7] Supreme Court of Canada, “Carter v. Canada,” Constitutional Law, 2015, https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do.; Kotalik and Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives. [8] Karandeep Sonu Gaind, “What Does ‘Irremediability’ in Mental Illness Mean?,” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 65, no. 9 (September 2020): 604–6, https://doi.org/10.1177/0706743720928656; Lieve Thienpont et al., “Euthanasia Requests, Procedures and Outcomes for 100 Belgian Patients Suffering from Psychiatric Disorders: A Retrospective, Descriptive Study,” BMJ Open 5, no. 7 (July 27, 2015): e007454, https://doi.org/10.1136/bmjopen-2014-007454. [9] Hamer Bastidas-Bilbao et al., “Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Qualitative Health Research 33 (September 29, 2023), https://doi.org/10.1177/10497323231197365. [10] Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law.” [11] Commission sur les soins de fin de vie, “Les conditions de l’admissibilité à l’aide médicale à mourir au Québec: la constance dans l’évolution de la loi concernant les soins de fin de vie,” June 9, 2023, https://csfv.gouv.qc.ca/ fileadmin/docs/autres_rapports/csfv_lcsfv_conditions_ amm_2023-06-29.pdf.; Trudo Lemmens, “When Death Becomes Therapy: Canada’s Troubling Normalization of Health Care Provider Ending of Life,” The American Journal of Bioethics 23, no. 11 (November 2, 2023): 79–84, https://doi.org/10.1080/15265161.2023.2265265. [12] Justine Dembo, Udo Schuklenk, and Jonathan Reggler, “‘For Their Own Good’: A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) Where Mental Illness Is the Sole Underlying Condition,” Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie 63, no. 7 (July 2018): 451–56, https://doi.org/10.1177/0706743718766055. [13] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020). [14] Bastidas-Bilbao et al., “Walking Alongside.” [15] Bastidas-Bilbao et al. [16] Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” 2020. [17] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025; Health Canada, “Third Annual Report on Medical Assistance in Dying in Canada 2021,” report on plans and priorities;transparency - other, July 26, 2022, https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-me dical-assistance-dying-2021.html; Lemmens, “When Death Becomes Therapy.” [18] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023.; Bastidas-Bilbao et al., “Walking Alongside.” [19] Olivia Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News,” Canadian Broadcasting Corporation, January 28, 2024, https://www.cbc.ca/news/politics/special-joint-committee-maid-mental-illness-report-1.7095679; Benjamin Lopez Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News,” Canadian Broadcasting Corporation, October 27, 2023, https://www.cbc.ca/news/politics/maid-canada-report-2022-1.7009704. [20] Hamer Bastidas-Bilbao et al., “Searching for Relief from Suffering: A Patient-Oriented Qualitative Study on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Social Science & Medicine 331 (August 1, 2023): 116075, https://doi.org/10.1016/j.socscimed.2023.116075. [21] Canadian Medical Association, “Canadian Medical Association Code of Ethics and Professionalism” (Canada: Canadian Medical Association, December 8, 2018), https://policybase.cma.ca/link/policy13937. [22] Canadian Medical Association. [23] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News.” [24] John Paul Tasker, “Liberal Government Promoting a ‘culture of Death’ with Medical Assistance in Dying Law, Conservative MP Says | CBC News,” Canadian Broadcasting Corporation, March 6, 2023, https://www.cbc.ca/news/politics/culture-of-death-medical-assistance-in-dying-mental-illness-1.6769504. [25] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Kayla Wiebe and Amy Mullin, “Choosing Death in Unjust Conditions: Hope, Autonomy and Harm Reduction,” Journal of Medical Ethics, April 26, 2023, https://doi.org/10.1136/jme-2022-108871. [26] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025. [27] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020), https://bcmj.org/articles/attitudes-and-expectations-regarding-bereavement-support-patients-family-m embers-and.; William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 9, 2021): 93–98, https://doi.org/10.7202/1084456ar. [28] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023. [29] Lemmens, “When Death Becomes Therapy.” [30] William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 1, 2021): 93–98, https://doi.org/10.7202/1084456ar. [31] Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News.” [32] A. Plaisance et al., “Quebec Population Highly Supportive of Extending Medical Aid in Dying to Incapacitated Persons and People Suffering Only from a Mental Illness: Content Analysis of Attitudes and Representations,” Ethics, Medicine and Public Health 21 (April 1, 2022): 100759, https://doi.org/10.1016/j.jemep.2022.100759. (shrink)

ABSTRACT: This paper understands mental attitudes such as emotions and desires to be dispositions to behavior. It also acknowledges that people are often ambivalent, i.e., that they may hold opposed attitudes towards something or someone. Yet the first position seems to entail that ambivalence is either tantamount to paralysis or a contradictory notion. I identify the problem as based on a reductive interpretation of the dispositional character of attitudes and of ambivalence. The paper instead defends a post-Davidsonian view of (...) the basic rationality of human life. By focussing on desire and emotion we can see that the mutually exclusive ways of life involved in ambivalence are manifested in the person’s conduct. (shrink)

Kant is the philosophical tradition's arch-anti-consequentialist – if anyone insists that intentions alone make an action what it is, it is Kant. This chapter takes up Kant's account of the relation between intention and action, aiming both to lay it out and to understand why it might appeal. The chapter first maps out the motivational architecture that Kant attributes to us. We have wills that are organized to action by two parallel and sometimes competing motivational systems. One determines us by (...) way of motives that are sensuous, natural and given from without, the other by motives that are intellectual, rational, and given from within. Each set of motives belongs to a system of laws – natural motives to the laws of nature, rational motives to the laws of freedom. For Kant, all things, including actions, are what they are in virtue of the laws governing them; actions, qua actions, are always governed by laws that govern individual wills. These laws are Kantian maxims, 'or subjective practical laws.' Maxims, for Kant, thus make actions the actions they are. The chapter then maps out the implications of this motivational architecture for Kant's theory of value. Maxims always advert to or 'contain' both ends and means. Ends are always specifications of one of two ultimate ends. Actions have the moral value they have depending on which of two ultimate ends the maxim adverts to. The possibilities are 'happiness,' or gratification of desires with sensuous origins, and 'duty,' or accord with the moral demand to will in ways that respect free rational agency wherever it is found. Only actions aimed at the latter – actions with rational motives – have moral value. Actions aimed at the former – actions with natural motives – though not immoral in themselves, become so when pursuit works against rational motives. For Kant, actions aimed at happiness are ultimately allied with efforts to sustain our 'animal' existence, and so are governed by terms and conditions given by the natural world. Actions aimed at duty, in contrast, are ultimately allied with efforts to impose a rational form on nature, to make it over, so to speak, according to values not given by nature itself. Actions aimed at duty, therefore, create a specifically moral world, one in which mores and norms, formal and informal arrangements, institutions, policies, and so on, realize, harmonize, and promote free rational agency itself. Finally, the chapter addresses motivations for Kant's view. The architecture of will and the theories of action and value he proposes allow Kant to accommodate a host of intuitions and commitments. His view makes room for metaphysically free agency, and for the lived experience of motivational freedom from ever-changing natural desires. It makes room for conflicts within the will while still holding out hope that resolution is possible. It accommodates views that the best human lives engage 'higher' faculties in sustained ways. It identifies a stable, necessary, universal end amidst the evident contingency, pluralism, and instability of most ends. It makes us, and not God or nature, the authors of our moral lives. In the end, Kant's 'anti-consequentialism,' his focus on intentions, is a way of insisting on actions that take their character and value from what should matter most to us, namely individual and collective free rational agency, rather than only and always taking the character of reactive responses to circumstance. (shrink)

In order to clarify the relationship between morality and law, it is necessary to define both concepts precisely. Cultural realities refer to concepts which are more specifically defined if we focus towards the genealogy of those realities, that is to say, their motivation, function and aim. Should we start from legal anthropology, comparative law and history of law, law arises as a social technique which coactively imposes ways of solving conflicts, protecting fundamental values for a society's co-existence. Values subject (...) to being protected are proposed by morality, the latter making subordination of law to morality inevitable. This explains that a great number of modern constitutions include a reference to fundamental moral values, that is to say, they have explicitly positivised moral contents. Legal reasoning, at all levels and expressions, needs to appeal to the aforementioned values. Constitutional reasoning, international law, legislative activity and judicial practice are studied to verify the latter. This subordination of law to morality sets out a serious problem: moralities are cultural realities which are only valid for a specific society. In order for law not to fall in a not very rational legal relativism, law should not be subordinated to morality, but to ethics, the latter understood as cross-cultural morality. The Universal Declaration of Human Rights was a step forward in this sense. (shrink)

BackgroundEthical decision-making of nurses could affect patients’ recovery and also decrease medical costs. To make ethical decisions, ICU nurses experience complicated ethical conflicts. Considering the multi-dimensional process of ethical decision-making, the present study was conducted to describe the experiences of ICU nurses regarding ethical decision making.MethodThe present research is a qualitative study with conventional content analysis approach that was done in 2020. Fourteen ICU nurses were interviewed using a semi-structured in-depth interview method. The interviews were recorded, transcribed verbatim, and (...) analyzed using Granheim and Landman approach.ResultsBeing torn by inevitable moral dilemma was defined as the main category which contained the categories of conflict with professional self, feeling squeezed between self-authority and demands of others, and Surrounded by organizational limitations.ConclusionsResults of the present study showed that moral dilemma is a situation in which the nurses are forced to choose between two options based on their equipment and facilities. In these situations, the nurses would hesitate between their internal conflicts and confusion between choosing their own benefits and patients’ benefits. To prevent ethical challenges in decision making, it is necessary to educate healthcare team about ethical dilemmas and empower the personnel for encountering ethical challenges. (shrink)

The primary goal of this monograph is to justify the possibility of building a hybrid theory of normative ethics which can combine ethical consequentialism, deontology and virtue ethics. The aim of the book is to demonstrate the possibility of constructing a synthetic theory from ethical traditions that are generally considered to be contradictory. In addition, I propose an outline of an original theory which tries to carry out such a synthesis. I call it Institutional Function Consequentialism. The justification for a (...) hybrid theory of normative ethics requires the resolution of certain meta-ethical issues. I discuss them in part 1.1. After a brief overview of my research aims I consider the answer to the following questions: “What kind of meta-ethical beliefs must we assume for normative ethics?” and "Why should we build ethical theories?". I also discuss the various forms of ethical scepticism, which should be rejected if we develop a hybrid theory of normative ethics. I also describe possible methods of justifying any ethical theory. At the end of part 1.1 I explain that the best method for justifying any ethical theory is the method of wide reflective equilibrium. In parts 1.2, 1.3 and 1.4 I analyse three main types of normative ethics which are considered to be competitive: consequentialism, deontology, and virtue ethics. Part 1.2 is about consequentialism and its difference between utilitarianism and teleological theories. I also present the main reasons for the popularity of consequentialism. In part 1.3 I define deontology, present its variations and show important benefits that motivate its continuous growth. In part 1.4 I discuss virtue ethics, which is often referred as the viable alternative to consequentialism and deontology. If we want to build any new ethical theory, first we should describe the problems of the old ones. For this reason, in chapter 2 I describe the most important arguments against ethical consequentialism, and in chapter 3 I explain the difficulties of deontology. Critical remarks on virtue ethics are considered in part 1.4. The last two chapters directly concern the main aim of the monograph. Because in chapter 3 I show that deontology suffers from a number of problems such as the paradox of deontology, in chapters 4 and 5 I present only consequentialist versions of hybrid theories. These versions try to avoid the common pleas of utilitarianism and combine the advantages of opponents to utilitarianism. I answer the question (4.1) "What is hybrid consequentialism?" and briefly describe (4.2) the most important examples of hybrid theories by others. I discuss the prerogatives without restrictions idea by Samuel Scheffler, rule consequentialism by Brad Hooker, Kantian consequentialism by Richard M. Hare, David Cummiskey and Derek Parfit and consequentializing procedure proposed by Douglas W. Portmore. In the last chapter I present a new hybrid version of consequentialism that I call Institutional Function Consequentialism. I start from the thesis (5.1) that traditional meta-ethics of analytic philosophy incorrectly defines the main field of its research. Rather than focusing on the philosophy of language and metaphysics it should try to answer one question: “What should morality and ethics be for?”. Therefore I introduce an original methodology for meta-ethics that I call the Functional Model of Analysis (FMA). It is a meta-ethical framework in which the fundamental questions concern the practical functions of normative domains such as morality and ethics and the most rational way of achieving them. FMA is meta-ethical project that (a) explains the persistence of fundamental ethical disagreement among experts, (b) sets the background for explaining or justifying the correct structure of the ethical theory, (c) gives the possibility to create a hybrid theory of normative ethics. In part 5.2 I formulate a generalized argument against various popular theories of normative ethics which states that most of the popular theories are too narrow and one-sided, causing permanent dispute between them. There are many distinct practical functions of morality that are usually based on different types of normative theories such as Aristotelian ethics, utilitarianism, contractarianism and contractualism. In order to remove these conflicts, the correct ethical theory should try to take into account all of these relevant features of moral life. Unfortunately, most ethical theories are mono-functional. This means that their supporters consciously or unconsciously (1) recognize or accept only one genuine practical function, (2) think that this one practical function overrides all other practical functions or (3) try to reduce all practical functions to the one that is chosen. In part 5.2 I present a description and justification of a new normative account that I call Hybrid Function Consequentialism. The formal scheme of this consequentialism can be summarized in the following way: we should act according to some important focal points P1…Pn with contents C1…Cn that are selected on the basis of considerations about which kind of P with C will bring the best realization of the best mix of normative functions F1...Fn. In the next part (5.2.2) I present the new way of “consequentializing” particular theories of normative ethics by applying the scheme of Hybrid Function Consequentialism. As an example of the use of this procedure, I formulate perfectionist virtue consequentialism, contractarian institution consequentialism, contractualist rule consequentialism and consequentialism of salvation. In part 5.3 I formulate an original theoretical concept that I call Institutional Function Consequentialism (IFC). It is a hybrid theory that is based on the previously described Functional Model of Analysis and a reflection on the role of institutions in modern developed societies. IFC claims that we should always act according to some rules, virtues, motives and intentions that constitute the homeostasis of normative institutions whose internalization by the overwhelming majority of each new generation has maximum expected value in terms of the best realization of the equilibrium of the most important practical functions of normative domains. Responsibility and sanctions related to wrongful actions should be dependent on the particular institution whose standards have been violated. IFC has several unique features which are described and justified in part 5.3. It is a form of hybrid consequentialism – it mixes features of consequentialism, deontology and virtue ethics. It does this on three different levels: justification, structure and content. The main focal point of the theory is not rules or virtues, but normative institutions. Values to be optimized in the framework of consequentialism are not "happiness", "well-being" or "preferences", but the fulfilment of normative functions. IFC is not limited to the field of ethics only, but it is a meta-normative account of justification for an entire social order which is comprised of a number of different institutions. It also assumes a specific, circular relationship between practical ethics (e.g. research on such important issues as civil disobedience, fair distribution of wealth, philosophy of punishment or autonomy of conscience), and the content of the general rules that may constitute the optimal homeostasis of institutions. It rejects the simplistic belief that moral thinking is based solely on deductive implications from general ethical principles or meta-ethical beliefs. (shrink)

An extensive literature has focused on the impact of new public management oriented structural changes on academics’ practice and identity. These critical studies have been resolute in concluding that NPM inevitably leads to a degeneration of academics’ ethos and values. Drawing from the moral philosophy of Alasdair MacIntyre, we argue that these previous analyses have overlooked the moral agency of the academics and their role in ‘moralizing’ and consequently shaping the ethical nature of their practices. The paper provides (...) a new theoretical understanding of NPM-oriented reforms in light of the virtue ethics approach, thereby directing the attention to the moral character and moral agency of academics. Our analysis of interviews collected in the business department of a Danish university provides an example of how individuals have divergent ethical understandings of these structural changes and enact/resist pre-defined social roles in different ways. While in some cases the NPM agenda of the institutions has triggered internal moral conflict and a crisis of moral character, in other cases the new logic resonates with academics’ values and evaluative standards. Partially departing from the theoretical ground of MacIntyre, we conclude that academics can play a crucial role in shaping the morality of NPM-oriented institutions and in transforming these settings into suitable contexts for the cultivation of virtues. (shrink)

I formulate and defend a realist theory of the truth of moral judgements according to which moral properties are synthetically but necessarily determined by natural properties of people, actions, or states of affairs. This view can be found in Moore's later ethical writings. The view reconciles two apparently conflicting intuitions: Moral properties supervene upon natural properties, but judgements about moral properties are generally not entailed by any judgements about natural properties. The view is realist in the (...) sense that moral judgements possess a truth-value independently of our means of knowing it. They are true or false in virture of a reality existing independently of us. ;One promising way of understanding this synthetic, necessary connection between moral and natural properties is in terms of the Kripke-Putnam account of natural kinds: Moral properties are type-identical with configurations of natural properties. But this turns out to be unsatisfactory. Another promising way of understanding this connection is on analogy with the connection between the mental and physical. I reject a token-identity theory of the moral and natural, but the analogy itself is helpful in understanding the relationship between the moral and natural. It offers a model for that relationship. ;I distinguish two senses in which supervenience could be understood in morality--ascriptive and descriptive--and argue that ascriptive supervenience depends on descriptive. A realist must defend descriptive supervenience. Moral properties decriptively supervene upon natural properties because moral differences must be explicable and justifiable in terms of natural differences. ;I construct an epistemology for moral properties in which natural properties are criteria, in Wittgenstein's sense, of moral properties. This conforms with the metaphysics of moral properties, and can be reconciled with the phenomenon of moral conflict. Finally, a careful formulation of moral realism is defended against Dummett's objections to realism generally. The moral realist cannot be forced to hold that there are moral truths that humans could not, even in principle, come to know. Yet this is what seems objectionable about realism in other realms. We can know all moral truths in principle, though perhaps not in practice. (shrink)

Available from UMI in association with The British Library. Requires signed TDF. ;The thesis consists in the development and application of an ideal utilitarian moral theory. ;In chapter one, classical Mental State and modern Desire theories of prudential value are rejected. In chapter two, perfectionism is rejected and an alternative ideal utilitarian Objective List theory is set out. In chapter three, it is argued that prudential rationality requires maximization and temporal neutrality. The aggregation and incommensurability of values (...) is discussed. In chapter four, it is argued that value alone gives rise to grounding reasons for action; the only values are prudential values; we are required to be personally as well as temporally neutral; moral rationality is maximizing. A problem arising when a certain form of incommensurability is combined with the notion of maximizing expected utility is examined. In chapter five, an intrapersonally indirect form of moral theory is defended. ;In the second, practical part of the thesis, the theory developed in the first part is applied to two moral problems: vegetarianism and future generations. In chapter six, the conclusion is that utilitarianism requires us to eat non-intensively-reared meat and to abstain from intensively reared meat. In chapter seven, population problems arising from Derek Parfit's work are considered in the light of the theory. (shrink)

The values of freedom and equality are at the heart of what it means for liberal states to do justice to their citizens. Yet, when it comes to the question of whether liberal states are capable of realizing the values of freedom and equality while controlling their borders, many philosophers are skeptical that liberalism and existing immigration arrangements can in fact be reconciled. After all, liberal states often deny entrance to prospective immigrants who are fleeing extreme forms of violence. They (...) also often police their borders in ways that are discriminatory and stigmatizing, contributing to a situation where immigrants are treated as morally inferior by society at large. Such practices conflict strongly with any commitment to the values of freedom and equality. -/- Luara Ferracioli here focuses on three key questions regarding the movement of persons across international borders: What gives some residents of a liberal society a right to be considered citizens of that society such that they have a claim to make decisions with regard to its political future? And do citizens of a liberal society have a prima facie right to exclude prospective immigrants despite their commitment to the values of freedom and equality? Finally, if citizens have this prima facie right to exclude prospective immigrants, are there moral requirements regarding how they may exercise it? The book therefore tackles the most pressing philosophical questions that arise from immigration: the questions of who can exercise self-determination, and why they have such a right in the first place. (shrink)

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician’s lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts ‘at the margins of professionalism’ as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where (...) professional ethics overlaps with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard’s account offers a framework for interpreting different types of moral conflicts ‘at the margins of professionalism’ to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas. (shrink)

International business faces a host of difficult moral conflicts. It is tempting to think that these conflicts can be morally resolved if we gained full knowledge of the situations, were rational enough, and were sufficiently objective. This paper explores the view that there are situations in which people in business must confront the possibility that they must compromise some of their important principles or values in order to protect other ones. One particularly interesting case that captures this (...) kind of situation is that of Google and its operations in China. In this paper, I examine the situation Google faces as part of the larger issue of moral compromise and integrity in business. Though I look at Google, this paper is just as much about the underlying or background views Google faces that are at work in business ethics. In the process, I argue the following: First, the framework Google has used to respond to criticisms of its actions does not successfully or obviously address the important ethical issues it faces. Second, an alternative ethical account can be presented that better addresses these ethical and human rights questions. However, this different framework brings the issue of moral compromise to the fore. This is an approach filled with dangers, particularly since it is widely held that one ought never to compromise one’s moral principles. Nevertheless, I wish to propose that there may be a place for moral compromise in business under certain conditions, which I attempt to specify. (shrink)

This book explores the relationship between the law and pervasive and persistent reasonable disagreement about justice. It reveals the central moral function and creative force of reasonable disagreement in and about the law and shows why and how lawyers and legal philosophers should take reasonable conflict more seriously. Even though the law should be regarded as the primary mode of settlement of our moral conflicts,it can, and should, also be the object and the forum of further (...) class='Hi'>moral conflicts. There is more to the rule of law than convergence and determinacy and it is important therefore to question the importance of agreement in law and politics. By addressing in detail issues pertaining to the nature and sources of disagreement, its extent and significance, as well as the procedural, institutional and substantive responses to disagreement in the law and their legitimacy, this book suggests the value of a comprehensive approach to thinking about conflict, which until recently has been analysed in a compartmentalized way. It aims to provide a fully-fledged political morality of conflict by drawing on the analysis of topical jurisprudential questions in the new light of disagreement. Developing such a global theory of disagreement in the law should be read in the context of the broader effort of reconstructing a complete account of democratic law-making in pluralistic societies. The book will be of value not only to legal philosophers and constitutional theorists, but also to political and democratic theorists, as well as to all those interested in public decision-making in conditions of conflict. (shrink)

This paper deals with the question of the conflict of constitutional rights with regard to basic rights. Two extreme accounts are outlined: the subsumptive approach and the particularistic approach, that embody two main conceptions of practical rationality. Between the two approaches there is room for a range of options, two of which are examined: the proportionalist approach, which conserves the scope of rights restricting their stringency, and the specificationist approach, which preserves the stringency of rights restricting their scope. I (...) will present arguments in defence of the latter. (shrink)

Incidental findings and secondary findings, being results that are unrelated to the diagnostic question, are the subject of an important debate in the practice of clinical genomic medicine. Arguments for reporting these results or not doing so typically relate to the principles of autonomy, non-maleficence and beneficence. However, these principles frequently conflict and are insufficient by themselves to come to a conclusion. This study investigates empirically how ethical principles are considered when actually reporting IFs or SFs and how value (...) conflicts are weighed. A qualitative focus group study has been undertaken, including a multidisciplinary group of professionals from Belgian centres for medical genetics. The data were analysed thematically. All eight Belgian centres participated in this study. Ethical values were frequently referred to for disclosure policies on IFs and SFs. Participants invoked respect for patient autonomy to support the disclosure of IFs and opt-out options for IFs and SFs, non-maleficence for the professional delineation of reportable IFs and opt-out options for IFs and SFs and beneficence for the mandatory reporting of actionable IFs, the delineation of reportable IFs and a current decline of actively pursued SFs. Professional assumptions about patients’ genetic literacy were an important factor in the weighing of values. In line with the traditional bioethical discourse, the mandatory reporting of actionable IFs might be interpreted as a “technological, soft paternalism”. Restricting patients’ choices might be acceptable, but then its motives should be valid and its beneficent outcomes highly plausible. Hence, the presuppositions of technological, soft paternalism - patients’ inability to make informed decisions, normative rationality, the efficacy of beneficent outcomes and the delineated spectrum of beneficence - should be approached critically. Moreover, distributive justice should be considered an important value in the delineation of the current scope of the ethical debate on IFs and SFs. This study of guiding values may stimulate the debate on the ethical grounds for a solid policy on IFs and SFs internationally. (shrink)

In this paper, I have tried to develop a critique of committee procedures and conflict of interest within research advisory committees and ethical review committees (ERCs). There are specific features of conflict of interest in medical research. Scientists, communities and the subjects of research all have legitimate stakeholdings. The interests of medical scientists are particularly complex, since they are justified by the moral and physical welfare of their research subjects, while the reputations and incomes of scientists depend on the (...) success of their science. Tensions of this kind must at times produce conflict of interest. It is important to recognise that conflicts of interest may unwittingly lead to manipulation of research subjects and their lay representatives on research committees. It is equally important to recognise distinctions between the legal and moral aspects of conflict of interest. Some practical suggestions are made which may go some way towards resolving these difficulties. They indicate what might be needed to ensure the validity of ethical discourse, and to reduce the risks associated with conflict of interest. (shrink)

BackgroundHealthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals’ moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.MethodSemi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited (...) using the snowball sampling method. Interviews were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person’s thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally’s taxonomy.ResultsAmong 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The “rules” category of justice and the “welfare of others” category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.ConclusionsThe nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider’s responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended. (shrink)

Moral dissensus is a distinct feature of our time. This is not only true of our post-modern culture in general, but also of business culture specifically. In this paper I start by explaining how modernist rationality has produced moral dissensus without offering any hope of bringing an end to it in the foreseeable future. Opting for a form of post-modernist rationality as the only viable way of dealing with moral dissensus, I then make an analysis of a (...) number of ways proposed by both specialists in the field of business ethics, as well as philosophers to deal with moral decision-making in this situation of moral dissensus. The conclusion reached is that none of these attempts succeeds in coming to terms with moral dissensus. I then formulate an alternative approach to moral decision-making which I call: Rational interaction for moral sensitivity. After explaining this approach, I defend it against some of the most obvious objections that might be raised against it in a business environment. When you''re talking birth control, what blocks it and freezes it out is that it''s not a matter of more or fewer babies being argued. That''s just on the surface. What''s underneath is a conflict of faith, of faith in empirical social planning versus faith in the authority of God as revealed by the teachings of the Catholic Church. You can prove the practicality of planned parenthood till you get tired of listening to yourself and it''s going to get nowhere because your antagonist isn''t buying the assumption that anything socially practical is good per se. Goodness for him has other sources which he values as much as or more than social practicality. (Robert M. Pirsig, Zen and the Art of Motorcycle Maintenance.). (shrink)

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician’s lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts ‘at the margins of professionalism’ as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where (...) professional ethics overlaps with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard’s account offers a framework for interpreting different types of moral conflicts ‘at the margins of professionalism’ to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas. (shrink)

One can agree with the critics of the Aristotelian theory of essences who say that the determination of the essence of a thing rests upon a linguistic decision, without accepting the conclusion that "a controversy as to whether rationality is of the essence of man is ultimately verbal." For linguistic decisions, that is, the acceptance of a classificatory scheme together with its associated system of definitions, may be motivated and justified by our knowledge of facts or our appreciation of values. (...) If, say, a Freudian and an Aristotelian were disputing the adequacy of defining man as a rational animal, the former might reject the definition on the grounds that the conscious intellect plays less of a causal role in human decisions and thinking than was once believed, whereas the latter might claim that reason ought to play a greater role if the good life be possible. Conflicts over definitions reflect theoretical and ethical differences. Once these differences are reconciled, the verbal conflict is no longer important. But the easing of the verbal conflict is not solely a verbal affair. It presupposes a harmonious adjustment of values and beliefs. The function of a philosophy of human nature is to formulate and discuss a definition of man which proposes certain human attributes as essential and which is to be justified to the extent that it best summarizes those features of human life which are of greatest causal and ethical significance. It is to be expected that, in order for a satisfactory definition to be reached, any number of philosophical problems would have to be dealt with along the way. A philosophy of man is a judgment about what is important in human affairs, but it is not for that reason arbitrary unless one is convinced that value judgments are arbitrary, that one cannot provide reasons, good or bad, for them. When, in the context of ethics, Aristotle cites the rational faculty rather than the capacity to laugh as the function of man, he was stressing that reason has greater importance than a sense of humor in moral deliberation. And when Marx, in his Theses on Feuerbach, claims: "The human essence is no abstraction inherent in each single individual. In its reality it is the ensemble of social relations," he was indicating that in order to understand why men act and think the way they do it is necessary to understand the society in which they live. (shrink)

The book reconstructs the history of Western ethics. The approach chosen focuses the endless dialectic of moral codes, or different kinds of ethos, moral doctrines that are preached in order to bring about a reform of existing ethos, and ethical theories that have taken shape in the context of controversies about the ethos and moral doctrines as means of justifying or reforming moral doctrines. Such dialectic is what is meant here by the phrase ‘moral traditions’, (...) taken as a name for threads of moral discourse, made in turn of other interwoven threads, including transmission of shared codes, appeals to reform of prevailing custom, rational argument about the justification of some precept on the basis of some shared general teaching or principle, and rational argument about the ultimate basis for principles and justification of authoritative teaching. That is, the approach adopted to the reading of ethical texts depends on a firm belief in the fact that philosophers hardly created any ethical doctrine out of nothing. The main point this book tries to highlight is how different philosophical theories emerged and followed each other as a result of attempts at accounting for what was going on in the world of moral traditions. Changes were propelled by controversies between different schools, and highly abstract arguments were the unintended effects of moves made by controversialists forced to transform (and occasionally to turn upside down) their own doctrines in order to face the challenge posed by other arguments. This is the reason why the book examines not only texts that already enjoy pride of place in the history of philosophy (Aristotle, Kant, Hegel), but also other texts usually treated in the histories of religions (the Bible, the Talmud, the Quran), and others considered to be much less philosophical (Plutarchus, Pufendorf). -/- 1. Plato and a response to ethical scepticism. Two different traditions of morality in VI-V century Greece are described. The birth of philosophical questioning of traditional morality and temporal and spatial variation of custom is described within the context of the v century crisis, the demise of traditional aristocratic and tyrannical rule and the birth of democracy. Two conflicting answers to the challenge are reconstructed, namely conventionalist or immoralist theories formulated by the Sophists and the eudemonist and intellectualist Socratic theory. Plato’s own reformulation of Socrates answer to the Sophists is reconstructed. His psychological views, his classification of the four cardinal virtues and his political theory are described as parts of a unitary system, culminating in an extremely realist moral ontology identifying the idea of the good with the essence of the (moral and extra-moral) world itself. -/- 2. Aristotle and the invention of practical philosophy. Aristotle’s invention of practical philosophy as a field separated from first philosophy is shown to be an implication of his break with Plato moral ultra-realism. Aristotle’s agenda in his moral works is arguably dependent on a polemical intention, namely dismantling Socratic intellectualism. The semi-inductive or virtuously circular method of practical philosophy is illustrated, starting with the received opinions of the better and wiser individuals and trying dialectically to sift what is left of mistake and inconsistence in such opinions, finally trying to correct mistakes and make the overall practical science more consistent. The chapter illustrates then the relationship of individual ethics, or ‘monastics’, with the art and the science of the pater familias, or ‘economics’, and the science of the ruler and citizen, or politics. The nature of virtues, or better, excellences of character, is discussed, highlighting the basic role of hexis, or ‘disposition’. Prudence, or better practical wisdom, is the focus of the chapter. Its relationship with bouleusis or deliberation is examined, and its autonomous status vis-à-vis theoretical knowledge is stressed. -/- 3. Diogenes and philosophy as a way of life. The chapter provides an overview of Hellenistic ethics, which almost amounts to Hellenistic schools of philosophy, in so far as ‘philosophy’ became in these centuries primarily the name for a way of life. The typical character of the Cynical movement is highlighted, that of a school of life, not a school aimed at providing any kind of intellectual training was to be provided. -/- 4. Epicurus and ethics as self-care. The peculiar character of the Epicurean school is described, a combination of a science of well-being aiming, more than at pleasure as in the popular view, at reduction of useless suffering, of unnecessary needs, and at a balanced selection of pleasures of the best and most durable kind. -/- 5. Epictetus and ethics as therapy of the passions. The various phases of Stoicism are described, and the shifting place given to ethics in the Stoic system of idea, culminating in the paradoxical view of ethics, its impossibility in principle notwithstanding, as the only truly significant and necessary part of philosophy. Cicero is treated, showing how his own synthesis of various Hellenistic trends is as a truly philosophical enterprise, deserving serious consideration after one or two centuries when he was confined to the role of literate. Epictetus is chosen as the best example of what the Stoic tradition could yield, an art of living based on sophisticated introspection, in turn aimed at making a kind of cognitive therapy possible, dismantling obnoxious passions at their root by systematically correcting false representations. -/- 6. Philo and the reconciliation of Torah and Platonism. A reconstruction of basic ideas from a few books of the Hebrew Bible is provided, starting with the Prophetic tradition and the focus on God’s mercy as the source of motivation and standard for human behaviour. Then a comparative analysis is undertaken of a parallel tradition, namely the three codifications of the Torā (Law or, better, Instruction), highlighting how a core of moral ideas may be recognized as a basis and preamble of codification of civil law, cultural practice, and regulation of ritual purity. The importance of Leviticus is stressed as the turning point when emphasis mercy, typical of the Prophetic tradition, is combined with the legal tradition, yielding the change in sensibility of the Second Temple time. Philo of Alexandria is described as one of the three leading figures – together with Rabbi Hillel and Rabbi Yeshua – at the apex the emergence of the mentioned new sensibility, gradually including mercy as an essential part of justice and establishing the starting point of both the Rabbinic and the Christian tradition. This consists precisely in the precept of one’s neighbour’s love or of the golden rule, two eventually identical precepts whose meaning is arguably more sober and sensible than the long-lasting Christian tradition deriving from John and Augustine has made us believe and no novelty vis-à-vis so-called Ancient-Testament teachings. -/- 7. Augustine and Christianity as Neo-Platonism. The first section examines the moral doctrines of so-called 'ethical Treaties' from the Talmud, a group of treaties, among which the best known is Pirqé Avot, that were left out of the six "orders" of the canon as they did not fit in any of the six groups of issues ritual or legal on which the division was based. According to Maimonides, their peculiar theme is provided by the Deòt, 'opinions', i.e., mental dispositions, that is, the translation of the Greek term hexeis and Arab akhlak (in turn providing in this language the name for ethics as such). The three topics I reconstruct are: i) the notion of Torah: The Torah is understood as the world order itself, or as the ‘Wisdom’ that existed even before creation and was ‘the tool by which the world was built’; however, the Torah is an earthly and human entity, as it was "received" by humans, and from that very moment belongs to them; ii) the relationship between love of God and love of neighbour; the treaties require us to study and practice the Torah ‘for its own sake’, that is, require us to act out of love, not out of fear or hope of reward; iii) the idea of sanctification of daily life: having disappeared with the destruction of the Temple the possibility of any conflict between liturgical service and everyday life, the latter is assumed to be in itself divine service: to give food to the poor has the same value as sacrifices in the Temple, and as an implication, the insistence become recurrent on the goodness of created things in themselves along with a polemic against ascetic currents. The conclusions drawn are: i) the moral teachings of the Talmud and those of Yeshua are, rather than similar, virtually identical; one may safely say that the precept of love and the golden rule are central ones for all Talmudic rabbis, that mercy plays an indispensable role alongside with justice, and the latter is not a different thing from one’s neighbour’s love; ii) a peculiarity of Talmud rabbis facing Yeshua is the idea of study as worship, and knowledge as a source of justice; but this is an idea of Judaism after the Temple's destruction that cannot be attributed to the Pharisees of Yeshua’s time; iii) the relation of study and practice in the Talmud parallels that between faith and deeds in Paul's epistles, that is, respectively faith or learning are a necessary and sufficient condition to be recognized as righteous , but deeds are the inevitable effect of either faith or learning. The sayings ascribed to Yeshua are examined first, yielding the conclusion that a close equivalent may be found for every saying in Talmudic literature and yet the whole is ascribed to one rabbi, with rather consistent stress on God’s mercy and unconditional forgiving as the mark of true imitation of God. Thus, Yeshua’s teaching is pure Judaism. The third section describes briefly the galaxy of Gnostic currents and Manichaeism, trying to sketch the profile of moral teachings resulting from an encounter of Asian spiritual traditions, Hellenistic lore and sparks of teachings from apocalyptic Jewish currents. The last section summarizes the turbulent history of several encounters between Christian currents and Hellenistic philosophical schools. The first one was with late Cynicism. Recent, rather controversial, literature discovered the jargon and a few topics from the Stoic-Cynical popular philosophy in a few books from the New Testament itself. This, far from proving that Rabbi Yeshua had been influenced by cynic preachers, is a proof of the necessity felt by Christian preachers to translate the original ‘Christian’ teaching into a Greek lexicon deeply impregnated with cynic terminology. The second was with Platonism, yielding the mild and temperate moral teaching of Clemens of Alexandria, teaching the sanctity of nature and the human body, the joy of moderate fruition of ‘natural’ kinds of pleasures, and the beauty of the marital life – in short, the opposite of the standard picture of Medieval Christianity. Ambrose of Milan brings about a different kind of synthesis, namely with Middle Platonism, where Stoic themes prevail. The most shocking case is Augustine, where an early Manichean education is overcome in a former phase by a synthesis of Plotinian Neo-Platonism and Christian preaching, yielding a sustained polemic with the Manicheans and rather optimistic views on life and Creation, the body and sexuality, and Hebrew-Judaic tradition not far from Clemens of Alexandria. In a later phase, occasioned by controversy on the opposite front, with such Christian currents as the Pelagians and Donatists, Augustine comes back to heavily anti-Judaic and world-denying ascetic attitudes where is earlier Manichean upbringing seems to emerge again. The tragedy of medieval Christianity will be the later Augustine’s overwhelming influence. A final section is dedicated to the monastic tradition where a curious mixture of world-denying asceticism with an astonishingly penetrating ‘science’ of introspection emerges. -/- 8. Al Farabi and the reconciliation of Islam and Platonism. The Qurān and the qadit, that is, collections of sayings ascribed to the prophet Muhammad contain a wealth of precepts and catalogues of virtues mirroring moral contents from the Jewish and the Christian traditions, among them the basic notion of imitation of the Deity, where mercy is assumed to be its basic trait. An important tradition within Islam, namely Sufism, stressed to the utmost degree the role of mercy, turning Islam into a mystic doctrine centred on retreat from the world, abandonment to God’s will, and a peaceful and fraternal attitude to our fellow-beings. A secular literary tradition originating in the Sassanid Empire, the literature of advice to the Prince had for a time a widespread influence in the newly constituted Arabic-Islamic commonwealth. In a later phase, the legacy of Hellenic philosophy made its way into the intellectual elite of the Islamic world. The first important legacy was Platonic, and the Republic became the main text for Islamic Platonism. Al-Farabi wrote an enjoyable remake of the Platonic Republic, arguing that the citizen’s virtues were the basis on which the political building needs to rest. The secular lawgiver is enlightened by the light of reason in his everyday practice of governance, but room is made for the Prophet as the voice of revealed truth that confirms and completes the rational truth that philosophy may afford. In a second phase also Aristotelian and Stoic influence were assimilated. Miskawayh’s treatise was the masterwork at the time Arabic philosophy reached its Zenith. It is a treatment of the soul’s diseases and their remedies, combining the Aristotelian doctrine of the golden mean with the Stoic doctrine of the passions and elements of Galenic medicine. Towards the eleventh-twelve centuries a war raged among theologians and philosophers, finally won by the former with disappearance of philosophy as such. The newly established mainstream, yet, was no kind of intolerant fanaticism. It drew from the work of mystic theologian Al-Ghazālī, the best heir of Sufism, teaching a tolerant and peaceful attitude to our fellow-beings and a passive attitude to destiny as an expression of the Divine will. -/- 9. Moshe ben Maimon and the reconciliation of Torah and Aristotelian ethics. The encounter between the Talmudic tradition and Hellenic philosophy had taken place a first time in Alexandria at the time of Philo but the two traditions had parted way again. In fact, the kind of Platonic Judaism founded by Philo survived only within Christianity, in the fourth Gospel and then in writings by Clemens of Alexandria. The Talmudic literature had absorbed just less striking traits from the Hellenic Philosophy, namely an idea of ethics as care of the self and a role for the education of character as propaedeutic to theoretical knowledge. In the Arabic-Islamic world, a second round started when Jewish authors writing in Arabic undertook the task to prove the full compatibility of the tradition deriving from Torah and Platonic philosophy. The culmination of this attempt is provided by Moshe ben Maimon who tried to use Aristotelian ethics as a language into which the teaching from the Pirké Avot could be translated. -/- 10. Thomas Aquinas and the reconciliation of Christian morality and Aristotelian ethics. In the first section the fresh start is described of philosophical ethics in Latin Europe at the turn of the Millennium. In a first phase, Anselm and Peter Abelard built on a Platonic and Augustinian legacy. In this phase. remarkable innovations are introduced, including Abelard’s claim of the obliging character of erring consciousness. In a second phase, the rediscovery of Nicomachean Ethics thanks to Latin translation of Arabic versions gives birth to a new wave of ethical studies, recovering the very idea of Aristotelian practical philosophy, with the potential implication of full legitimization of natural morality, i.e. ethics without Revelation. Aquinas’s ethics is a theological ethics out of which it would be vain to try to extract a self-contained philosophical ethics. His treatment of topics in philosophical ethics, yet, does not boil down to repetition of Aristotelian arguments but is rather a creative reshaping of such arguments. For example, he introduces also in the practical philosophy a first principle parallel to the principle of non-contradiction; and he also carries out a synthesis of Aristotelianism, Stoicism, and neo-Platonism. Even though it is essentially moral theology, Aquinas’s doctrine - unlike Augustine – grants full citizenship to "natural" morality, firstly by rejecting the claim that the corruption of human nature due to the original sin is so radical as to leave "pure nature" incapable of moral goodness. The doctrine is presented in a more sophisticated formulation in a few of the Quaestiones, such as De Malo and De Veritate, in the Summa contra Gentes and in the commentaries to Aristotle than in the famous Summa Theologica, but the latter work includes the only or the largest exposition of some decisive part of the theory. Thus, the Summa Theologica should be read for what it is more than criticized for not being what it was not meant to be. It was not meant to be the brilliant synthesis of all that Reason he had been able to produce with what Revelation had added about which the Neo-Thomists used to dream, but rather a manual for the training of preachers and confessors, where theoretical claims are not too demanding and a few serious tensions are left. Besides a jump between the Prima Secundae and the Secunda Secundae, being the former an essay in virtue theory and the latter a handbook for confessors, the most serious tension is perhaps the one between the ethics of right reason presented in most of Ia-IIae and the eudemonistic ethics developed in quaestiones 1-5 of the same part; the alternative ethical theory which also may be found in Augustine, the Stoic view of a cosmic reason eventually coincident with the moral law, was believed by Anselm (followed by John Duns Scotus and William of Ockham) to be incompatible with eudemonism. It is questionable whether Thomas could reduce the tension proving that it is just an apparent tension, in so far as the right reason and bliss derived from knowledge of God tend to coincide, but this is just a conjecture. Thomas’s ethics is a virtue ethic, not a law-based one, and moral judgment focuses on the virtues, particularly charity, not on the commandments and even less on absolute prohibitions; Thomas, however, would not have considered a drastic alternative between law and the virtues such as the one which has been advanced in late twentieth-century philosophy to be justified. Nonetheless, when it discusses ‘special’ virtues, it ceases to be an ethics of virtue and becomes a disappointing and often contradictory discussion of legal and illegal acts. Such a discussion takes most of the time ‘reasonable’ middle positions on controversial issues but not the alternative approach that Aristotelianism would have made possible; even when some occasional Aristotelian claim shows up, such as money’s barrenness as a reason against usury, this seems to be made by an author who apparently ignores the Aristotelian Thomas of the Prima Secundae. It is an ethic of human autonomy which recognizes the binding character of the individual conscience and, potentially, even a duty to disobey unjust laws. It is true that what Thomas writes in his discussion of death penalty and persecution of heretics is simply disgusting, and yet we should blame Thomas the man, not Thomist ethical theory. Finally, Thomas’s ethics is not ethical ‘absolutism’, as both traditionalist Catholic theologians and secularist enemies of dogmatic morality tend to believe. It is instead an ethic of prudential judgment. Exceptions to this approach – or better results of logical fallacies – are such claims as the absolute character of negative precepts and of the existence of "intrinsically evil acts", claims that simply cease to make sense in the light of Thomas’s own distinction between human act and natural act, carrying consequences Thomas did not live long enough to draw or was not consistent enough to dare to draw. -/- 11. Francisco de Vitoria and casuistry. The first topic illustrated is the discussion about the notion of pura natura, namely the human condition after the original sin and before divine revelation. The core notion was already there in Aquinas but was later developed by Caietanus (Thomas de Vio) with a number of interesting implications: firstly a view of human nature as such much more positive than Augustine’s and his followers’ view, including both Calvinists and Jansenists; secondly, the implication that the philosopher’s morality, as opposed to the Christian’s morality, is a quite respectable kind of morality; thirdly, that theocracy and prosecution of the unfaithful lacked justification, with more far-fetching consequences than Aquinas himself had dared to draw. The second topic is casuistry, a new name for a comparatively older way of thinking, which was already there in late Stoicism and Cicero as well as in the Talmudic literature. This is an approach aimed at yielding probable enough solutions for doubtful cases even in absence of completely safe staring points. The genre developed from medieval reference books for confessors and became by the sixteenth-century a sophisticated tool-box for dealing with various fields of applied ethics. Francisco Vitoria, the main authority of Baroque Scholasticism, was a controversial figure, among the proponents of the new discipline of casuistry and a consistent proponent of more separation between the religious and the civil authority, stricter limits to the legitimacy of war, innate rights of non-Christian nations in the New World based on the notion of pura natura, providing a standard of ‘natural’ goodness, previous to revelation, on which the Indian nations were judged to live in a naturally good condition, provided with the institutions of family, justice, and religion had accordingly a right to full respect by Christian sovereigns. Bartolomé de Las Casas, arguing along similar lines, was the leader of a historical battle in defence of the rights of the Indios. -/- 12. Michel de Montaigne and the art of living. A short description of one of the Renaissance Phyrronism, one of the classical philosophies revived in the fifteenth and sixteenth century. Montaigne combines the sceptical epistemology with an understanding of ethics – indeed of philosophy as a whole – in terms of an art of living inspired by two basic ideas, sagesse, that is, practical wisdom as the only kind of rationality available after theology, science, and tradition have declared bankrupt, and an aesthetic ideal of self-transformation through the art of writing and introspection. -/- 13. Pierre Nicole and neo-Augustinianism. The chapter illustrates first the vicissitudes of Augustinianism newly born after the late medieval triumph of Thomist Aristotelianism in the alternative Protestant and Catholic versions processed by the Calvinists and the Jansenists. Then it illustrates the doctrines of Pierre Nicole, Blaise Pascal’s best disciple, on the impossibility of introspection, on the ubiquity of self-deception, on the incurably evil character of the passion of love, and on the two moralities, the one of the man of the world, the morality of honesty which is indispensable for granting peace and order but devoid of any true value for eternal salvation, since the same external behaviour may be prompted by opposite motivations, and the morality of charity, the only true one but also useless to society. The third topic is Pierre Malebranche’s view of self-deception as a ubiquitous phenomenon accounting for human action and responsibility and his reformulated theory of self-love, no less ubiquitous than for Nicole and yet not as incurably evil, given the distinction between morally indifferent and even necessary amour de soi and vicious amour proper, a distinction on which the whole of Rousseau’s moral and political theory rests. -/- 14. Samuel von Pufendorf and the new science of morality. The chapter is dedicated to the discovery of the idea of a ‘new moral science’. Hugo Grotius is discussed first highlighting the real character of his project, much closer to the Thomist idea of a natural law accessible to non-corrupted human reason when human beings are living in a state of pura natura. Then Hobbes’s combination of scepticism, voluntarism, and conventionalism is described and both the continuity with Grotius’s new science, in the search for non-revealed rational morality, and the break with him, in the adoption of voluntarism and refusal of an intellectualist view of natural law, are illustrated. Pufendorf’s work is illustrated as a synthesis of the two previous attempts and the – up to Schneewind underestimated – paradigmatic example of the new science of morality. -/- 15. Richard Cumberland and consequentialist voluntarism. The chapter gives an overview of eighteenth-century Anglican ethics, noticing how the Cambridge tradition gave special weight to natural theology as opposed to positive or revealed theology – and how two Cambridge fellows, John Gay and Thomas Brown, elaborated on Cumberland’s (and Malebranche’s, as well as Leibniz’s) strategy for finding a third way between intellectualist view and voluntarist view of the laws of nature. The result of their elaboration was a kind of a rational-choice account of the origins of natural laws, where a law-giver God chooses among a number possible sets of laws on a maximizing criterion, and God’s maximandum is happiness for his creatures. The chapter notices also how such a solution aimed at solving at once the problem of evil and that of the foundation of moral obligation by proving how God’s choice was justified as far as it was the one minimising the amount of suffering in the world. 16. Richard Price and intuitionism. The chapter describes first the doctrines of the Cambridge Platonists, an example of hyper-rationalist reaction to Calvinism. Secondly it describes the sophisticated and universally ignored – from Sidgwick to Anscombe –version of what was later labelled ‘ethical intuitionism’ – showing how it escapes familiar objections and misrepresentations of intuitionism – from Mill to Rawls – in grounding its argument on transcendental arguments while carefully avoiding recourse to introspection and psychological evidence, which has been taken as a too easy target by critics of intuitionism. Thirdly, the chapter discusses Whewell’s ‘philosophy of morality’, as opposed to ‘systematic morality’, not unlike Kant’s distinction between a pure and an empirical moral philosophy. Whewell worked out a systematization of traditional normative ethics as a first step before its rational justification; he believed that the point in the philosophy of morality is justifying a few rational truths about the structure of morality such as to rule hedonism, eudemonism, and consequentialism; yet a system of positive morality cannot be derived solely from such rational truths but requires consideration of the ongoing dialectics between idea and fact in historically given moralities. Whewell’s intuitionism turns out closer to Kantian ethics than commentators have made us believe until now, and quite different from what Sidgwick meant by intuitionism. -/- 17. Adam Smith and the morality of role-switch. The chapter describes first, Hutcheson’s attempt at basing the ‘new science’ of natural law on different bedrock than Pufendorf and the English Platonists, namely a moral sense, a faculty whose existence is assumed to be proved on an empirical basis. The second step is a reconstruction of Hume’s rejoinder in terms of a new science of man including morality on an ‘experimental’ basis, that is, a ‘Newtonian’ hypothetical-deductive approach, distinguished from Hutcheson’s allegedly uncritical descriptive approach to human nature. The third step is a reconstruction of Adam Smith theory of morality understood as emerging from a spontaneous interplay of exchanges of situations (the most basic meaning of the word ‘sympathy’ as construed by this author). -/- 18. Jeremy Bentham and utilitarianism. The bulk of the chapter is dedicated to the doctrines of Jeremy Bentham. The Enlightenment spirit that suggested the idea of a new morality, free from religion, is illustrated. The notion of utility is illustrated as well as the subsequent formulations of the principle of utility. The idea of felicific calculus is discussed, showing how its inner difficulties prompted several reformulations of the principle of utility in order to avoid undesirable implications of proposed formulations. The role of the thesis of spontaneous convergence between interest and duty is discussed, showing how it left numberless questions open, and the distinction between the virtues of prudence, justice and beneficence is described as a way out of the deadlocks of classical utilitarianism. After Bentham, Mill’s reformed utilitarianism is reconstructed, showing how it is a kind of mixed system – as closer to common sense as it gives up Bentham’s claims to consistency and simplicity – resulting as unintended consequences from the controversies in which Mill was too keen to engage. The hidden agenda of the controversy between Utilitarianism and Intuitionism, going beyond the image of the battle between Prejudice and Reason, is described, showing how both competing philosophical outlooks turn out to be more research programs than self-contained doctrinal bodies, and such programs appear to be implemented, and indeed radically transformed while in progress thanks to their enemies no less than to their supporters. -/- 19. Immanuel Kant, practical reason and judgment. The chapter argues that Kant took from Moses Mendelssohn the idea of a distinction between geometry of morals and a practical ethic. He was drastically misunderstood by his followers precisely on this point. He had learned from the sceptics and the Jansenists the lesson that men are prompted to act by deceptive ends, and he was aware that human actions are also empirical phenomena, where laws like the laws of Nature may be detected. His practical ethics made room for judgment as a holistic procedure for assessing the saliency of relevant moral qualities in one given situation; this procedure yields the same results as the geometry of morals does for abstract cases but does so immediately and without balancing conflicting duties with each other, since what makes for the salient quality of a situation is perceived from the very beginning. Kant's practical philosophy is richer than the received image, making room for an ‘empirical moral philosophy’ or moral anthropology including treatment of commerce, needs, value and price, happiness and well-being; the overall social theory and philosophy of history is less different from Adam Smith's than the received image makes believe; the paradox of happiness is central to Kant's philosophy; a distinction between happiness and well-being is clearly drawn; the distinction plays a basic role in establishing a link between the economic and the moral life. -/- 20. Georg Wilhelm Friedrich Hegel and the critique of abstract universalism. The chapter describes first the Romantic movement and the implications some of its concerns, rescuing passions, community, tradition, the individual as the bearer of a unique destiny, and the longing for organic unity between the individual, mankind and nature. Hegel’s contribution is discussed then, highlighting how, on the one hand, he shared a number of these concerns and on the other he had more rationalist leanings. The notion of morality is the pivotal point of the reconstruction, highlighting how Hegel construes this notion as a key to his own diagnosis of the malaise of modernity – the separation of individual and Gemeinschaft – and how his attack on Kant turns around this very idea. -/- 21. Friedrich Nietzsche against Christianity and the Enlightenment. The chapter illustrates first the idea of deconstruction of the back-world of values. Nietzsche claims to be legitimate heir of the French moralists, Leibniz, Kant and Hegel, in so far as he allegedly carries out to its deepest implications their discovery of what lies behind traditional naïve belief in the existence of an objective realm of values just waiting for description by the philosopher. The two exemplars form which genealogy draws inspiration are the classical philologist’s historical reconstructions of lost meanings and the chemist’s decomposition of elements. Then the genealogy of the notions of good and evil carried out in the first dissertation of Genealogy of morals is illustrated with its paradoxical conclusion that will to power is in fact the only ‘genuine’ kind of goodness. The third point illustrated is the dialectic of ascetism and self-realization with its ambiguous outcome. The suggested interpretation of such outcome is that Nietzsche’s normative ethics is a kind of virtue ethics taking an aesthetic ideal as a normative standard -/- 22. George Edward Moore and ideal utilitarianism. The chapter discusses the ideas of common sense and common-sense morality in Sidgwick. I argue that, far from aiming at overcoming common-sense morality, Sidgwick aimed purposely at grounding a consist code of morality by methods allegedly taken from the natural sciences to reach, also in ethics, the same kind of “mature” knowledge as in the natural sciences. His whole polemics with intuitionism was vitiated by the a priori assumption that the widespread ethos of the educated part of humankind, not the theories of the intuitionist philosophers, was what was worth considering as the expression of intuitionist ethics. In spite of a naïve positivist starting-point, Sidgwick was encouraged by his own approach in exploring the fruitfulness of coherentist methods for normative ethics. Thus, Sidgwick left an ambivalent legacy to twentieth-century ethics: the dogmatic idea of a “new” morality of a consequentialist kind, and the fruitful idea that we can argue rationally in normative ethics albeit without shared foundations. Then it reconstructs the background of ideas, concerns and intentions out of which Moore’s early essays, the preliminary version, and then the final version of Principia Ethica originated. I stress the role of religious concerns, as well as that of the Idealist legacy. I argue that PE is more a patchwork of rather diverging contributions than a unitary work, not to say the paradigm of a new school in Ethics. I add a comparison with Rashdall’s almost contemporary ethical work, suggesting that the latter defends the same general claims in a different way, one that manages to pave decisive objections in a more plausible way. I end by suggesting that the emergence of Analytic Ethics was a more ambiguous phenomenon than the received view would make us believe, and that the wheat (or some other gluten-free grain) of this tradition, that is, what logic can do for philosophy, should be separated from the chaff, that is, the confused and mutually incompatible legacies of Utilitarianism and Idealism. -/- 23. Edmund Husserl and the a-priori of action. The chapter illustrates first the idea of phenomenology and the Husserl’s project of a phenomenological ethic as illustrated in his 1908-1914 lectures. The key idea is dismissing psychology and trying to ground a new science of the a priori of action, within which a more restricted field of inquiry will be the science of right actions. Then the chapter illustrates the criticism of modern moral philosophy carried out in the 1920 lectures, where the main target is naturalism, understood in the Kantian meaning of primacy of common sense. The third point illustrate is Adolph Reinach’s theory of social acts as a key the grounding of norms, a view that basically sketches the very ideas ‘discovered’ later by Clarence I. Lewis, John Searle, Karl-Otto Apel and Jürgen Habermas. A final section is dedicated to Nicolai Hartman, who always refused to define himself a phenomenologist and yet developed a more articulated and detailed theory of ‘values’ – with surprising affinities with George E. Moore - than philosophers such as Max Scheler who claimed to Husserl’s legitimate heirs. -/- 24. Bertrand Russell and non-cognitivism. The chapter reconstructs first the discussion after Moore. The naturalistic-fallacy argument was widely accepted but twisted to prove instead that the intuitive character of the definition of ‘good’, its non-cognitive meaning, in a first phase identified with ‘emotive’ meaning. Alfred Julius Ayer is indicated as a typical proponent of such non-cognitivist meta-ethics. More detailed discussion is dedicated to Bertrand Russell’s ethics, a more nuanced and sophisticated doctrine, arguing that non-cognitivism does not condemn morality to arbitrariness and that the project of a rational normative ethics is still possible, heading finally to the justification of a kind of non-hedonist utilitarianism. Stevenson’s theory, another moderate version of emotivism is discussed at some length, showing how the author comes close to the discovery of the role of a pragmatic dimension of language as a basis for ethical argument. Last of all, the discussion from the Forties about Hume’s law is described, mentioning Karl Popper’s argument and Richard Hare’s early non-cognitivist but non-emotivist doctrine named prescriptivism. -/- 25. Elizabeth Anscombe and the revival of virtue ethics. The chapter discusses the three theses defended by Anscombe in 'Modern Moral Philosophy'. I argue that: a) her answer to the question "why should I be moral?" requires a solution of the problem of theodicy, and ignores any attempts to save the moral point of view without recourse to divine retribution; b) her notion of divine law is an odd one more neo-Augustinian than Biblical or Scholastic; c) her image of Kantian ethics and intuitionism is the impoverished image manufactured by consequentialist opponents for polemical purposes and that she seems strangely accept it; d) the difficulty of identifying the "relevant descriptions" of acts is not an argument in favour of an ethics of virtue and against consequentialism or Kantian ethics, and indeed the role of judgment in the latter is a response to the difficulties raised by the case of judgment concerning future action. A short look at further developments in the neo-naturalist current is given trough a reconstruction of Philippa Foot’s and Peter Geach’s critiques to the naturalist-fallacy argument and Alasdair MacIntyre’s grand reconstruction of the origins and allegedly unavoidable failure of the Enlightenment project of an autonomous ethic. -/- 26. Richard Hare and neo-Utilitarianism. The chapter addresses the issue of the complex process of self-transformation Utilitarianism underwent after Sidgwick’s and Moore’s fatal criticism and the unexpected Phoenix-like process of rebirth of a doctrine definitely refuted. A glimpse at this uproarious process is given through two examples. The first is Roy Harrod Wittgensteinian transformation of Utilitarianism in pure normative ethics depurated from hedonism as well as from whatsoever theory of the good. This results in preference utilitarianism combined with a ‘Kantian’ version of rule utilitarianism. The second is Richard Hare’s two-level preference utilitarianism where act utilitarianism plays the function of eventual rational justification of moral judgments and rule-utilitarianism that of action-guiding practical device. -/- 27. Hans-Georg Gadamer and rehabilitation of practical philosophy. The post-war rediscovery of ethics by many German thinkers and its culmination in the Sixties in the movement named ‘Rehabilitation of practical philosophy’ is described. Among the actors of such rehabilitation there were a few of Heidegger’s most brilliant disciples, and Hans-Georg Gadamer is chosen as a paradigmatic example. His reading of Aristotle’s lesson I reconstructed, starting with Heidegger’s lesson but then subtly subverting its outcome thanks to the recovery of the central role of the notion of phronesis. -/- 28. Karl-Otto Apel and the revival of Kantian ethics. Parallel to the neo-Aristotelian trend, there was in the Rehabilitation of practical philosophy a Kantian current. This started, instead than the rehabilitation of prudence, with the discovery of the pragmatic dimension of language carried out by Charles Peirce and the Oxford linguistic philosophy. On this basis, Karl-Otto Apel singled out as the decisive proponent of the linguistic and Kantian turn in German-speaking ethics, worked out the performative-contradiction argument while claiming that this was able to provide a new rational and universal basis for normative ethics. An examination of his argument is some detail is offered, followed by a more cursory reconstruction of Jürgen Habermas’s elaboration on Apel’s theory. -/- 29. John Rawls and public ethics as applied ethics. Rawls’s distinction between a “political” and a “metaphysical” approach to one central part of ethical theory, namely the theory of justice, is interpreted as a formulation of the same basic idea at the root of both the principles approach and neo-casuistry, both discussed in the following chapter, namely that it is possible to reach an agreement concerning positive moral judgments even though the discussion is still open – and in Rawls’ view never will be close – on the basic criteria for judgment. -/- 30. Beauchamp and Childress and bioethics as applied ethics. The chapter presents the revolution of applied ethics while stressing its methodological novelty, exemplified primarily by Beauchamp and Childress principles approach and then by Jonsen and Toulmin’s new casuistry. -/- . (shrink)

Fundamental questions in value sensitive design include whether and how high-tech products/artefacts could embody values and ethical ideals, and how plural and incommensurable values of ethical and social importance could be chosen rationally and objectively at a collective level. By using a humanitarian cargo drone study as a starting point, this paper tackles the challenges that VSD’s lack of commitment to a specific ethical theory generates in practical applications. Besides, it highlights how mainstream ethical approaches usually related to (...) VSD are incapable of solving main ethical dilemmas raised by technological design for well-being in democratic settings. Accordingly, it is argued that VSD’s ethical-democratic import would substantially be enhanced by the espousal of a procedural ethics stance and the deliberative approach to value and welfare entailed by Amartya Sen’s capability approach. Differently from rival ethical–political theories, its normative and meta-ethical foundations better handle human diversity, value-goal pluralism, conflicting vested interests as well as the epistemic-moral disagreements typical of contemporary complex democracies. Particularly, Sen’s capability approach procedural-deliberative tenets result in an “objective-impartial” choice procedure selecting a “hierarchy” of plural incommensurable values and rational goals thus, suitable to validate an applied science such as welfare-oriented technological design in concrete social environments. Conclusions suggest that refining VSD with a capability-based procedural approach to ethics fosters the concern for democracy and social justice while preserving vital scientific-technical standards. Major advantages are at an applied level to delivering ethically and socially justified, but yet highly functional technologies and high-tech products/artefacts. (shrink)

This essay argues that Mark C. Murphy's original contribution to natural law ethics succeeds in finding a way between older metaphysical and newer purely practical approaches in this genre. Murphy's reconstruction of the function argument, critique of subjectivist theories of well-being, and rigorous formulation of a flexible welfarist theory of value deserve careful attention. I defend Kant against Murphy's critique and argue that Murphy faces the problem of showing that all his basic goods are morally inviolable. Although I (...) endorse Murphy's critique of radical virtue ethics, I raise objections to the basic moral norms he derives from his list of goods, and to the analysis of peace of mind and happiness as basic goods. (shrink)

Changing values may give rise to intergenerational conflicts, like in the ongoing climate change and energy transition debate. This essay focuses on the interpretative question of how this value change can best be understood. To elucidate the interpretation of value change, two philosophical perspectives on value are introduced: Berlin’s value pluralism and Dworkin’s interpretivism. While both authors do not explicitly discuss value change, I argue that their perspectives can be used for interpreting value (...) change in the case of climate change and the energy transition. I claim that Berlin’s pluralistic account of value would understand the value change as an intergenerational conflict and therefore provide a too narrow and static ground for understanding ongoing value change. Instead, by exploring Dworkin’s standpoint in moral epistemology, this essay distills a more encompassing perspective on how values may relate, converge, overlap, and change, fulfilling their functions in the course of climate change and energy transition. This perspective is further detailed by taking inspiration from Shue’s work on the interpretation of equity in the climate change debate. I argue that the resulting perspective allows us to see value change as a gradual process rather than as a clash between generations and their values. (shrink)

Background: Moral courage is defined as the courage to act in ethical conflicts based on individual or professional values despite the personal risks involved. Nurses justify their decisions to act morally courageously as part of their ethical decision-making. Objective: To describe registered nurses’ justifications for acting morally courageously, or not, in ethical conflicts where they needed moral courage. Research design: A narrative inquiry with a holistic content approach was used. Individual, in-depth interviews were conducted in January–February (...) 2023. The data were analysed using holistic content analysis. Participants and research context: Fourteen registered nurses with experience in situations where they needed moral courage participated. The nurses came from the somatic, palliative, mental health, and substance abuse care fields in Finland. Ethical considerations: Good scientific practice was followed. Ethical approval was obtained before data collection from the university’s ethics committee. Findings: The nurses needed moral courage in ethical conflicts with patients present and between professionals. Individual responsibility, professional ethics, and emotions were identified as bases of nurses’ justifications for morally courageous acts. The justifications for acting morally courageously, or not, had individual, contextual, and organisational perspectives. Morally courageous acts included starting a discussion about the conflict with other professionals and reporting the situation in writing within one’s organisation. Discussion and conclusions: The identified bases and perspectives of justifications illustrate the complexity of nurses’ decision-making in ethical conflicts, either leading to morally courageous acts or not. These results can inform nursing practice and research in developing processes to strengthen nurses’ moral courage and examining relationships between moral courage and other concepts, such as moral resilience. (shrink)

This article draws upon discursive psychology to explore the organization of public accountability in accounting for an alleged conflict of interest in journalism. The analysis focuses on the published record of an interview given by the editorial director of one of the major Romanian daily newspapers on the issue of an assumed conflict of interest involving a senior editor of the same newspaper. The analysis shows how a moral order is constituted by the use of various discursive resources: role (...) and professional incumbency discourse, disposition avowals and doing being fair/ democratic. This is a moral order where adherence to personal ethical principles, professional incumbencies and responsibilities are practically managed in dialogue and publicly displayed. Acting in-role, reporting a general disposition to engage in moral courses of action and making reference to the values of citizenship and democracy are all publicly available discursive resources used in this context to express a cautious moral judgement bounded and constrained by both personal and professional accountability perspectives. (shrink)

Scholars have long recognized the existence of myriad widespread deep disagreements on values, justice, morality, and ethics. In order to come to terms with such deep disagreements, resistant to rational solution, this article asserts the need for developing an ethics of disagreement. The reality that theoretical disagreements often turn into practical conflicts is a major justification for why such an ethics is necessary. This paper outlines an ethics of deep disagreement that is primarily conceived of as a form (...) of virtue ethics. Such an ethics asks opposing parties in moral and intellectual conflicts to acknowledge that (a) deep disagreements exist, (b) opposing positions should be recognized as worthy of respect, and that (c) one should seek dialogue and mutual understanding. This ethical approach conceives of toleration as a moral and political virtue and presents an argument for toleration based on deep disagreements. (shrink)

Philosophical and empirical work on the nature of the emotions is extensive, and there are many theories of emotions. However, all agree that emotions are not knee jerk reactions to stimuli and are open to rational assessment or warrant. This paper's focus is on the condition or conditions for compassion as an emotion and the likelihood that it or they can be met in nursing practice. Thus, it is attempting to keep, as far as possible, compassion as an emotion separate (...) from both moral norms and professional norms. This is because empirical or causal conditions that can make experiencing and acting out of compassion difficult seem especially relevant in nursing practice. I consider how theories of emotion in general and of compassion in particular are somewhat contested, but all recent accounts agree that emotions are not totally immune to reason. Then, using accounts of constitutive conditions of the emotion of compassion, I will show how they are often likely to be quite fragile or unstable in practice and particularly so within much nursing practice. In addition, some of the conditions for compassion will be shown to be problematic for nursing practice. It is difficult to keep ideas of compassion separate from morality, and this connection is noticeable in the claims made of compassion for nursing and so I will briefly highlight one such connection that of the need for normative theory to give an account of the value that emotions such as compassion presume and that compassionate motivation is separate from moral motivation and may conflict with it. The fragility or instability of the emotion of compassion in practice has implications for both what can be expected and what should be expected of compassion; at least if what is wanted is a realist rather than idealist account of “should.”. (shrink)

When international relations scholars think about international law they either ignore culture or offer highly deterministic accounts of its role. For the majority of scholars, international law is a rational construction, an institutional solution to the problem of order in an anarchical system, a body of rules and practices that reflect the contending interests and capabilities of major states. Issues of culture barely rate a mention. For others, culture is the deep foundation of international law, the structuring “mentality” that gives (...) law its form and content. International law, from this perspective, is a Western cultural artifact, globalized through centuries of imperialism and hegemony. These contrasting views lead to different expectations about the future of international law in today's culturally diverse international order. For rationalists, law's fate will be determined by the shifting configuration of interests that accompany new functional challenges and great power transitions. For the more culturally attuned, there are two possibilities. One is that functional utility will replace culture as law's foundation. International law may well be a Western cultural artifact, but “rational buy-in” will sustain it in a multicultural world. The other, more pessimistic, expectation is that the rule of international law will be fundamentally undermined by cultural diversity, particularly as rising non-Western powers articulate and promote markedly different cultural norms and values. (shrink)

In this paper, I take up Habermas’s recent writing on Rawls in Inclusion of the Other and focus on an example that Habermas discusses there, the Catholic stance on abortion. He brings in this example to question how such views could be rationally negotiated, under Rawls’s views of political liberalism, prior to arriving at an overlapping consensus. Habermas argues that Rawls must affirm the truth of moral constructivism in order to resolve the question of which conceptions of the good (...) make a valid claim on us. Though I have criticisms of how both Rawls and Habermas cast the issue of abortion, I argue that through properly understanding the role of the political ideal of citizenship in Rawls’s conception of political liberalism, we can find resources to contend with the problem Habermas finds here. I defend the capacity of political constructivism to resolve this issue without affirming the truth of moral constructivism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Moral Synonymy: John Stuart Mill and the Ethics of StyleDan BurnstoneI“A common language in which values may be expressed”: this is a phrase John Stuart Mill might well have used to describe utility—the common denominator of different ethical values in utilitarian moral reckoning. In fact, this is Mill’s phrase describing money as a circulating medium. 1 In utilitarianism, utility is the ubiquitous form of moral currency; (...) like money in the capitalist economy, it functions as the “universal equivalent” in the moral economy. 2 It is therefore unsurprising that economic idioms abound in discussions of utilitarianism, with their talk of trade-offs, calculation, and costs. But it is not the parallel with economic exchange that I want to focus on in this article. Mill’s reference to “a common language” points succinctly to a different connection which will be the center of attention, and that is between forms of ethical and linguistic equivalence.It is this conjunction that the term “moral synonymy” is intended to capture. By moral synonymy I want to indicate a particular conjunction of perspectives on ethics and language, or more precisely, style—a conjunction which, I shall argue, Mill’s work can help us both to see and to see through. A bare and schematic anticipation of my approach would be to say that what a belief in commensurability is to the realm of ethics, a belief in synonymy is to the realm of language. This article will explore the interrelationship of these two ideas. In the end I shall suggest that the collaboration between ethics and style denoted by moral synonymy imposes severe limitations on thinking about ethics and literature, and that an examination of moral synonymy and its [End Page 46] implications should be part of the currently revived attempts to work out the relationship between ethics and literature.Synonymy is the idea that identical meaning can be expressed in different linguistic forms. Style—as linguistic form of expression—can be varied or discarded without altering the body of sense it clothes. 3 To believe in moral commensurability is to believe that there is some common value by means of which different values can be measured against each other, and conflicts between them rationally decided. One leading candidate for the role of common value is, of course, utility, and utilitarianism will be taken here as typical of a commensurabilist approach. So, to outline the parallel between ethics and style that we will focus on: just as the believer in synonymy thinks that distinct linguistic styles may be shown to be so many different vehicles for expressing common meanings, so the utilitarian thinks that distinct values turn out ultimately to be so many forms for conveying the common value of utility. Utilitarians, as commensurabilists, happily commit the ethical variety of the “heresy of paraphrase.” They are happy to reduce different values merely to styles of utility. This is why I want to call utilitarianism a kind of moral synonymy.IIWe can understand ethical commensurability more clearly by turning briefly to Mill’s work. Mill relies on utility as the single criterion for settling ethical conflicts. In Utilitarianism he proposes happiness not as one among the ends or criteria of morality, but as the only one. He argues that “to desire anything except in proportion as the idea of it is pleasant, is a physical and metaphysical impossibility” (X, p. 238). Such assertions are the source of familiar difficulties for Mill’s moral theory, for there would seem to be ends other than happiness under the title of which people desire things. Moreover, some of these ends are arguably not only irreducible but also prone to come into conflict with utility (autonomy is a good example of one such value). So it is improbable that happiness is the unique categorial end. 4 There is in fact a tension—vital to Mill and to this article—between Mill’s formal philosophical adherence to utility and his practical recognition of the diversity of values; but nevertheless, he always professes ultimate allegiance to the idea that utility can be considered as the “common umpire” in ethical disputes (X, p. 226). [End Page 47]We... (shrink)

BackgroundMental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods31 MHPs working in court-mandated treatment settings were (...) interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach.ResultsWe first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. ConclusionsEven though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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This article explores the role of an international open society of mental health stakeholders in raising awareness of values and thereby reducing the vulnerability of psychiatry to abuse. There is evidence that hidden values play a key role in rendering psychiatry vulnerable to being used abusively for purposes of social or political control. Recent work in values-based practice aimed at raising awareness of values between people of different ethnic origins has shown the importance of what we call “values auto-blindness” (...) – a lack of awareness of one’s own values as a key part of our background “life-world” – in driving differential rates of involuntary psychiatric treatment between ethnic groups. It is argued that the vulnerability of psychiatry to abuse stems from values auto-blindness operating on the judgments of rationality implicit in psychiatric diagnostic concepts. Acting like a “hall of mirrors,” an international open society of mental health stakeholders would counter the effects of values auto-blindness through enhanced mutual understanding of the values embedded in our respective life-worlds across and between the diverse perspectives of its constituents. The article concludes by noting that a model for the required open society is available in the contemporary interdisciplinary field of philosophy and psychiatry. (shrink)

In the current climate of dramatic advances in the neurosciences, it has been widely assumed that the diagnosis of mental disorder is a matter exclusively for value-free science. Starting from a detailed case history, this paper describes how, to the contrary, values come into the diagnosis of mental disorders, directly through the criteria at the heart of psychiatry's most scientifically grounded classification, the American Psychiatric Association's DSM (Diagnostic and Statistical Manual). Various possible interpretations of the prominence of (...) values in psychiatric diagnosis are outlined. Drawing on work in the Oxford analytic tradition of philosophy, it is shown that, properly understood, the prominence of psychiatric diagnostic values reflects the necessary engagement of psychiatry with the diversity of individual human values. This interpretation opens up psychiatric diagnostic assessment to the resources of a new skills-based approach to working with complex and conflicting values (also derived from analytic philosophy) called 'values-based practice.' Developments in values-based practice in training, policy and research in mental health are briefly outlined. The paper concludes with an indication of how the integration of values-based with evidence-based approaches provides the basis for psychiatric practice in the twenty-first century that is both science-based and person-centred. (shrink)

Moral, social, political, and other “nonepistemic” values can lead to bias in science, from prioritizing certain topics over others to the rationalization of questionable research practices. Such values might seem particularly common or powerful in the social sciences, given their subject matter. However, I argue first that the well-documented phenomenon of motivated reasoning provides a useful framework for understanding when values guide scientific inquiry (in pernicious or productive ways). Second, this analysis reveals a parity thesis: values influence the social (...) and natural sciences about equally, particularly because both are so prominently affected by desires for social credit and status, including recognition and career advancement. Ultimately, bias in natural and social science is both natural and social— that is, a part of human nature and considerably motivated by a concern for social status (and its maintenance). Whether the pervasive influence of values is inimical to the sciences is a separate question. (shrink)

Background: The management of challenging behaviours in inpatient with intellectual disability and/or autism spectrum disorders can lead to an escalation of control measures. In these complex situations where patients have an intellectual disability/autism spectrum disorder accompanied by a psychiatric comorbidity, the experiences of caregivers related to the crisis management have rarely been studied. Purpose: This study examined the moral experiences of caregivers related to challenging behaviours’ management and alternatives to control measures. Research design: Using Charles Taylor’s hermeneutic framework, a (...) 2-month focused ethnography with a participatory approach was used. Participants and research context: Sixteen caregivers were interviewed in a Canadian mental health setting for adults with intellectual disability/autism spectrum disorder and psychiatric comorbidity. Ethical considerations: The research was conducted in compliance with the Declaration of Helsinki and local Research Ethics Board approval. Written informed consent was collected systematically from participants. Findings: By accounting for caregivers’ moral experiences, this study sheds light on a neglected dimension of the care relationship: the vulnerability of the caregiver. We highlight the main barriers and facilitators to alternatives to control measures. First, a caregiver’s vulnerability was characterised by the overall impact of challenging behaviours and the moral distress associated with the use of control measures and exclusion mechanisms of intellectual disability/autism spectrum disorder patients. Second, a strong ambiguity between care and control measures and a lack of inclusive approaches were identified as the two main barriers to challenging behaviour management. Third, the involvement, both professional and personal, of caregivers was deemed necessary to implement alternatives to control measures. Discussion: A conflict of values opposes two conceptions of autonomy: a rational autonomy, which is counterproductive to the reduction of control measures, versus a relational autonomy based on shared vulnerability. Conclusion: The recognition of caregiver’s vulnerability is a benchmark to create alternative approaches, which defuse the logic of control and promote an ethics of care within which caregivers’ self-concern can be understood as fostering mutual respect. (shrink)

Why should sovereign states obey international law? What compels them to owe allegiance to a higher set of rules when each country is its own law of the land? What is the basis of their obligations to each other? Conventional wisdom suggests that countries are too different from one another culturally to follow laws out of mere loyalty to each other or a set of shared moral values. Surely, the prevailing view holds, countries act simply out of self-interest, and (...) they eventually consent to norms of international law to regulate matters of common interest.In this groundbreaking book, Fernando Tesón goes against this prevailing thought by arguing, in the Kantian tradition, that a shared respect for individual human rights underpins not just the obligation countries feel to follow international law but also international laws themselves and even the very legitimacy of nations in the eyes of the international community. Tesón, both a lawyer and a philosopher, proposes that an overlapping respect for human rights has created a moral common ground among the countries of the world; and moreover, that such an outlook is the only one that is rationally defensible. It is this common set of values rather than self-interest that ultimately provides legitimacy to international law. Using the tools of moral philosophy, Tesón analyzes the concepts of sovereignty, intervention, and national interest; the contributions of social contact theory, game theory, and feminist theory; and the puzzles of self-determination and group rights.More than simply outlining his theory, Tesón goes on to give detailed examples of international laws, international institutions, and their human rights foundations, putting his ideas to work and addressing legal reforms called for by the theory. He suggests that treaties, for example, should be considered binding if, and only if, the consent to the treaty was given by a genuinely representative government, one that acts out of interest for the human rights of its citizens. Although the theoretical achievement of this book is to challenge received wisdom on the foundation of international law, the practical ambition is a call to reform the international legal system for the post–Cold War era, to substitute for the old order one that gives primacy to human dignity and freedom over state power. (shrink)

Reza Akbari Solving moral conflicts entails a decision-making process. So any suggested approach to moral conflicts is included in the domain of practical rationality. The practical rationality is based on theoretical rationality. Both the theoretical and practical rationality have a realistic kind of approach and an idealistic kind of approach. In the theoretical rationality, the idealistic approaches demand certainty in a strict sense, following epistemic guidelines; and in the practical rationality, they demand (...) the best possible choice. Nevertheless, there are some difficulties with the idealistic approaches. Concerning the realistic approaches, we can gain access to two truths: First, each situation is an individual circumstance and each person has certain epistemic features, and so it is not possible to present general, universalizable solutions to conflicts even in a particular scope. Second, the acceptance of some propositions is a voluntary act, and so cognitive space and previous beliefs of any individual have a role in the acceptance of a belief and the following universalizations. By attention to extensive emphasis of the religion on moral doctrines, it can be said that religious education through practical patterns has a positive role in solving moral conflicts. (shrink)

The central question of this paper is how modern liberal political theory can understand and make sense of value pluralism and the conflicts upon which it is premissed. It is a commonplace that liberalism was born out of conflict, and has been partly characterised ever since as a series of attempts to accommodate it within the framework of the nation state . However, it is also true that liberals have proposed many different routes to the resolution, or containment, (...) of conflict, and these different routes are manifestations of different understandings of conflict itself both within an individual life and between lives. Thus, some assert the irreducible heterogeneity of value: John Stuart Mill famously inveighs against the attempt to model all human life on a single pattern and tells us that ‘human beings are not sheep, and even sheep are not indistinguishably alike. A man cannot get a coat or a pair of boots to fit him unless they are either made to his measure or he has a whole warehouseful to choose from; and is it easier to fit him with a life than with a coat?’ . On Mill's account, plurality is the natural condition of humanity. We should neither hope for nor expect the elimination of conflict, and a world in which there is diversity is richer and better for it. (shrink)

Introduction: Responsibility and choice -- The idea of moral responsibility -- Complex choice situations -- Differing types of responsibility -- Hans Jonas' idea of "caring for beings" -- The moral experience of women -- Criticizing rational choice -- The rational choice model 5 -- Bounded rationality -- Myopic and deficient choices -- Violations of the axioms -- Rational fools -- The strategic role of emotions -- Social norms -- The communitarian challenge -- Duty, self-interest, and love -- Responsible (...) decision making -- Norms, goals, and stakeholders -- Choice as problem solving -- Ethical norms -- Who are the stakeholders? -- Co-evolving goals and alternatives -- Responsibility and the diversity of choices -- Rationality and respect -- Deontology -- Choices people can make -- The psychology of choice -- Prospect theory -- The "matching law" -- Incommensurability -- Modeling responsible decision making -- What is a responsible decision? -- Deontological payoffs -- Goal-achievement values -- Payoffs for the stakeholders -- Evaluation from multiple perspectives -- The maximin rule -- A geometric representation -- The procedural model -- Real world cases -- Donna's case -- The Ford Pinto case -- The World Bank environmental policy -- Applications in economics and public policy -- Responsibility and social justice -- The paradox of a paretian liberal -- Res ponsible agency in prisoner's dilemma situations -- Multidimensional cost-benefit analysis -- Ethical and social performance of business -- Nature, society, and future generations -- Epilogue: The responsible person. (shrink)