In a democratic society, the social rules are imposed by all upon each. As “recipients” of the rules, we tend to think that they should be designed to engender the best attainable distribution of goods and ills or quality of life. We are inclined to assess social institutions by how they affect their participants. But there is another, oft-neglected perspective which the topic of health equity raises with special clarity: As imposers of the rules, we are inclined to think that (...) harms we inflict through the rules have greater moral weight than like harms we merely fail to prevent or to mitigate. What matters morally is not merely how we affect people, but how we treat them through the rules we impose. While current (consequentialist and Rawlsian) theorizing is dominated by the first perspective and thus supports purely recipient-oriented moral conceptions, an adequate approach to social justice requires a balancing of both. Such balancing results in a relational conception of justice, which distinguishes various ways in which an institutional scheme may causally affect the quality of life of its participants.This essay argues that the strength of our moral reason to prevent or mitigate particular medical conditions depends not only on what one might call distributional factors, such as how badly off the people affected by these conditions are in absolute and relative terms, how costly prevention or treatment would be, and how much patients would benefit from given treatment. Rather, it depends also on relational factors, that is, on how we are related to the medical conditions they suffer. It then discusses some implications of this view for understanding responsibilities for international health outcomes. (shrink)

If we are responsible for taking care of our health, are we blameworthy when we become sick because we failed to meet that responsibility? Or is it immoral to blame the victim of sickness? A moral perspective that is sensitive to therapeutic concerns will downplay blame, but banishing all blame is neither feasible nor desirable. We need to understand the ambiguities surrounding moral responsibility in four contexts: (1) preventing sickness, (2) assigning financial liabilities for health care costs, (3) (...) giving meaning to human suffering, and (4) interacting with health care professionals. We also need to distinguish different kinds of blame, explore the interplay of justice and compassion in avoiding unjustified blaming of victims, and work toward a unified moral-therapeutic perspective that encourages individuals to accept responsibility while avoiding destructive forms of blaming. (shrink)

Remedial responsibility is the prospective responsibility to assist those in great need. With tens of millions of people worldwide suffering from severe poverty, questions about the attribution of remedial responsibility and the nature of the relevant duties of assistance are among the most pressing of our time. This article concerns the question of whether remedial responsibility for severe poverty is a matter of justice or of humanity. I discuss three kinds of situation in which an (...) agent owes remedial responsibility to another suffering from severe poverty. In the first, the remedially responsible agent foreseeably and avoidably caused the poverty. In the second, the poverty was caused by forces outside the control of any agent, such as natural disaster. And in the third situation, the agent who was originally attributed remedial responsibility fails to fulfil it, and so remedial responsibility for the poverty in question is acquired by a secondary bearer. According to David Miller, remedial responsibility is a matter of justice in the first two situations, but not in the third. I argue that his grounds for thinking that remedial responsibility in the second situation are in tension with his view that remedial responsibility is not a matter of justice in the third situation. This has important implications in our world in which remedial responsibilities too often go unfulfilled. (shrink)

Animals are an important part of our social, economic and corporate world. Their wellbeing is significantly affected by the ways in which humans treat them. However, animals have long remained (and, indeed, continue to remain) effectively invisible in the business ethics and corporate responsibility discourse. This article argues in favor of the moral necessity of according animal welfare a higher priority in business. In line with most streams in both recent and traditional animal ethics, this article derives the avoidance (...) of unnecessary animal suffering as the moral minimum standard for responsible management in the livestock industry. Based on a broad range of different interpretations of what animal suffering may be necessary, the article discusses three distinct ways in which humans working in the animal industry could meet their moral responsibility to avoid unnecessary suffering, and, with this, increase animal welfare: by ameliorating circumstances for animals, by aiming at a two-pronged transformation, or by transforming into a “zero-suffering” business. Considering animal welfare as a legitimate ethical value in and of itself is a first step towards overcoming the anthropocentric bias in today's sustainability and corporate responsibility debate. (shrink)

Two kinds of claims of responsibility arise in regard to health and medical care. Claims of one kind are obligation-limiting claims about individuals’ responsibility for coming to need health care. It may be argued, for example, that individuals have no claim to state-sponsored care for injuries they suffer as a result of risky activities such as mountain climbing, sky diving, or smoking. The claim is that because they are responsible for what has happened to them, others are not (...) obligated to pay for their care. In a different context, it is claimed that because patients are, or should be, responsible for the kind of treatment they receive. They therefore need to be informed about the treatment options available to them so that they can decide which of these treatments, if any, they will undergo. The lecture provides an account of responsibility that fits claims of both of these kinds and explains how they are related. (shrink)

That we are morally responsible for what we do willingly and knowingly is a commonplace. That our moral responsibility extends as far as to cover at least the intended consequences of our voluntary actions and perhaps also the ones we did not intend, but could or did foresee, is equally beyond dispute. But what about omissions? Are we, or can we be, (equally) morally responsible for the harm that has occured because we did not prevent it, even though we (...) could have done so? Say, for all the enormous suffering, caused daily by famine, deprivation and curable diseases in the Third World countries? Moral intuitions and practices that one could consult in this matter seem to leave us in the dark. We regularly ascribe responsibility to people for harms resulting from their negligence or failure to fulfill professional duties. On the other hand, we tend to think that unless there is some evidence of the causal contribution that agents made to a harmful event and/or state, it is not really fair to blame it on them. And finally, to complicate things even more, most of us deny that omissions could effect anything (any change) in the world and consequently regard them as causally impotent (as well as possibly harmless). (shrink)

Wealth and income are highly predictive of health and longevity. Egalitarians who maintain that this “socioeconomic-status gradient” in health is unjust are challenged by the fact that a significant component of it is owed to the higher prevalence of certain kinds of voluntary risk-taking among members of lower socioeconomic groups. Some egalitarians have argued that these apparently free personal choices are not genuinely free, and that those who make them should not be held morally responsible for the resulting harms to (...) their health. I argue to the contrary that such choices usually are fully free, and that those who make them are responsible for their consequences. This does not imply, however, that society cannot also be responsible for those consequences. It is responsible for them if they are statistically foreseeable and avoidable outcomes of unjust public institutions and policies. I show that many of the harms to health that contribute to the voluntary behavioral component of the SES health gradient satisfy that description. Society can therefore be morally responsible for those harms, even though the individuals who suffer them are also fully responsible for them. (shrink)

The first impacts of climate change have become evident and are expected to increase dramatically over the next decades. Thus, it becomes more and more pressing to decide who has to compensate those people who suffer from negative impacts of climate change but have neither contributed to the problem nor possess the resources to cope with the consequences. Since the frequently invoked Polluter Pays Principle cannot account for all climate-related harm, I will take a closer look at the much more (...) controversial Beneficiary Pays Principle. It is argued that, appropriately qualified, the Beneficiary Pays Principle can help to identify additional duty-bearers. Based on these results, I briefly comment on three different policy options to generate funds for compensation. (shrink)

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms (...) of health behaviour could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others. (shrink)

Climate change and other harmful large-scale processes challenge our understandings of individual responsibility. People throughout the world suffer harms—severe shortfalls in health, civic status, or standard of living relative to the vital needs of human beings—as a result of physical processes to which many people appear to contribute. Climate change, polluted air and water, and the erosion of grasslands, for example, occur because a great many people emit carbon and pollutants, build excessively, enable their flocks to overgraze, or otherwise (...) stress the environment. If a much smaller number of people engaged in these types of conduct, the harms in question would not occur, or would be substantially lessened. However, the conduct of any particular person (and, in the case of climate change, of even quite large numbers of people) could make no apparent difference to their occurrence. My carbon emissions (and quite possibly the carbon emissions of much larger groups of people dispersed throughout the world) may not make a difference to what happens to anyone. When the conduct of some agent does not make any apparent difference to the occurrence of harm, but this conduct is of a type that brings about harm because many people engage in it, we can call this agent an overdeterminer of that harm, and their conduct overdetermining conduct. In this essay we explore the moral status of overdetermining harm. (shrink)

The problems of global health are truly terrible. Millions suffer and die from diseases like tuberculosis, HIV/AIDS, and malaria. One way of addressing these problems is via a Global Health Impact labeling campaign. If even a small percentage of consumers promote global health by purchasing Global Health Impact products, the incentive to use this label will be substantial. One might wonder, however, whether consumers are morally obligation to purchase any these goods or whether doing so is even morally permissible. This (...) paper suggests that if the proposal is implemented, purchasing Global Health Impact labelled goods is at least morally permissible, if not morally required. Its argument should, moreover, be of much more general interest to those considering different kinds of ethical consumption. (shrink)

While it is well recognized that many everyday consumer behaviors, such as purchases of sweatshop goods, come at a cost to the global poor, it has proven difficult to argue that even knowing, repeat contributors are somehow morally complicit in those outcomes. Some recent approaches contend that marginal contributions to distant harms are consequences that consumers straightforwardly should have born in mind, which would make consumers seem reckless or negligent. Critics reasonably reply that the bad luck that my innocent purchase (...) contributes distantly to harm provides insufficient grounds for moral blame; moreover, such distant and seemingly inevitable collective effects are not by themselves obvious reasons for agents to refrain from acting. Granting these criticisms, I argue that the harm that agents do through knowing contributions to distant collective harm actually builds on the morally sparse agential phenomenology of everyday purchases and decisions: contributors who knowingly disregard distant harms, rather than being reckless or negligent about consequences they should have foreseen, very directly perpetuate the moral invisibility and the lack of recognition from which the global poor generally suffer. This provides agents with clearer moral reasons to refrain from knowing participation in unstructured collective harms, and clearer reason to bear them in mind in acting. (shrink)

Although many people seem to share the intuition that multinational companies carry a responsibility for the working conditions in their supply chains, the justification offered for this assumption is usually rather unclear. This article explores a promising strategy for grounding the relevant intuition and for rendering its content more precise. It applies the criteria of David Miller's connection theory of remedial responsibility to different forms of supply chain governance as characterized by the Global Value Chains framework. The analysis (...) suggests that the criteria for identifying MNEs as remedially responsible for bad working conditions in their direct suppliers are fulfilled in many cases, even though differentiations are required with regard to the different supply chain governance structures. MNEs thus have a duty to make sure currently bad working conditions in their suppliers are changed for the better. Moreover, since production in supply chains for structural reasons continuously generates remedial responsibility of MNEs for bad working conditions in their suppliers, it puts the prospective responsibility on them to make sure that their suppliers offer acceptable working conditions. Further, it is suggested that the remedial responsibility of MNEs might require them to make financial compensation to victims of bad working conditions and in grave cases initiate or support programs to mitigate disastrous effects suffered by them. (shrink)

This article analyses that state responsibility in international law is contractual liability, as a state infringes its obligations to another state (states), stemming out of international law. Member State liability in damages to a private party for breach of European Union law is, contrarily, non-contractual liability to a private party. Having analysed the elements of internationally wrongful act, it is stated that the elements of internationally wrongful act can be used to determine the elements of breach of the European (...) Union law. Thus if an international court declares that a state committed an internationally wrongful act, it would be possible to maintain that the elements of breach of the European Union law are met as well. The author of this article notes that it is very important to identify a particular state institution, which has infringed the European Union or international law, as not attributing to the state the acts of the state institution under the European Union or international law, there should be no possibility to apply state liability in damages to a private party for breach of the European Union law or state responsibility in international law – the state can be liable only for acts of its institutions. This article also analyses the cases where application of both Member State’s liability in damages to a private party for breach of the European Union law and state responsibility in international could be possible. In such case a private party can suffer damages if a Member State breaches an international agreement, concluded by the European Union, imposing particular obligations on that Member State. Therefore, it is ascertained that a private party should not have to prove the second condition of liability – sufficient seriousness of the breach1 – if an international court foremost states that a Member State commited an internationally wrongful act – breached its obligation arising out of an international agreement entered into by the European Union. Such an infringement would be considered to be as sufficiently serious per se. (shrink)

Metaphysical determinism argues that God divinely predetermines everything, including human suffering. Contrary to metaphysical determinism, free will or libertarianism argues that not everything is predetermined by God. Therefore, evil does not serve any divine purpose. Libertarianism argues that metaphysical determinism is simply incoherent because it holds that God can predetermine an action and, at the same time, holds that He could stop such an action. This study seeks to find out which of these two views might be promising in (...) responding to the problem of suffering. Contrary to these two positions, this study argues that suffering must be understood contextually. The above-stated responses do not always provide viable answers to the problem of suffering because they are often generalised and conceived from the God-eye view without considering the sufferers’ perspectives.Contribution: Although there are a plethora of publications on metaphysical determinism and freewill, this study re-examined both and sheds a nuance for a further development of these two competing views. The article argues that none of these two responses offers the best response to the problem; rather, each has its strengths and weaknesses because they seem to focus on God rather than the sufferer. (shrink)

ABSTRACT We frequently accuse heavy drinkers and drug users of self‐deception if they refuse to admit that they are addicted. However, given the ways in which we usually conceptualize it, acknowledging addiction merely involves swapping one form of self‐deception for another. We ask addicts to see themselves as in the grip of an irresistible desire, and to accept that addiction is an essentially physiological process. To the extent this is so, we, as much as the addicts, suffer from self‐deception, and (...) the responsibility for their state is in part ours. Conversely, since addicts are compelled to accept a self‐deceptive image of themselves, they are at least partially excused from blame for their self‐deception. (shrink)

Disaster research has grown in scope and frequency. Research in the wake of disasters and during humanitarian crises – particularly in resource-poor settings – is likely to raise profound and unique ethical challenges for local communities, crisis responders, researchers, and research ethics committees. Given the ethical challenges, many have questioned how best to provide research ethics review and oversight. We contribute to the conversation concerning how best to ensure appropriate ethical oversight in disaster research and argue that ethical disaster research (...) requires of researchers and RECs a particular sort of ongoing, critical engagement which may not be warranted in less exceptional research. We present two cases that typify the concerns disaster researchers and RECs may confront, and elaborate upon what this ongoing engagement might look like – how it might be conceptualized and utilized – using the concept of real-time responsiveness. The central aim of RTR, understood here as both an ethical ideal and practice, is to lessen the potential for research conducted in the wake of disasters to create, perpetuate, or exacerbate vulnerabilities and contribute to injustices suffered by disaster-affected populations. Well cultivated and deployed, we believe that RTR may enhance the moral capacities of researchers and REC members, and RECs as institutions where moral agency is nurtured and sustained. (shrink)

There is a long-standing debate concerning the eligibility of patients suffering from alcohol-related end-stage liver disease (ARESLD) for deceased donor liver transplantation. The question of retrospective and/or prospective responsibility has been at the center of the ethical discussion. Several authors argue that these patients should at least be regarded as partly responsible for their ARESLD. At the same time, the arguments for retrospective and/or prospective responsibility have been strongly criticized, such that no consensus has been reached. A (...) third option was proposed as a form of compromise, namely that responsibility should only be used as a tiebreaker in liver allocation. The present study provides an ethical investigation of this third option. First, we will provide an overview of the main arguments that have been offered for and against the use of responsibility as an allocation criterion. Second, we will explore the concept of responsibility as a tiebreaker in detail and discuss several types of situations, in which responsibility could be used as a tiebreaker, as well as the main ethical challenges associated with them. As we will show, an ethical justified use of responsibility as a tiebreaker is limited to a very restricted number of cases and is associated with a number of ethical concerns. For this reason, waiting time should be preferred as a tiebreaker in liver allocation, even though the criterion of waiting time, too, raises a number of equity-related concerns. (shrink)

Fyodor Dostoyevsky expressed a strange and surprising sentiment through one of the characters of The Brothers Karamazov. A dying young man named Markel declares: Every one of us has sinned against all men, and I more than others." He later says: "...every one of us is answerable for everyone else and for everything." Markel's absurd claims have engendered many reflections on the nature of suffering and what it means to be responsible for someone else's suffering. The world has (...) no shortage of pain and evil; what exactly is the relationship between suffering and responsibility? Markel's declarations press forward a question that drives this essay collection: how responsible should we consider ourselves for the suffering of the world? This volume is a collection of essays that struggle in various ways to understand and respond to several philosophical, theological and practical problems. In each case the authors grapple with issues surrounding suffering, immorality, evil, exploitation and oppression. The contributors share a clear concern for the ways that philosophers and theologians should respond to the problems of suffering and evil. They also share a conviction that these remain intense and central problems for philosophy and theology. Evil is an obstacle for belief, for morality, for hospitality, and for hope. This book struggles to address the particular and strong sense of responsibility that falls on Christians when it comes to understanding and, more importantly, responding to the problems of suffering and evil in the world. (shrink)

The current Ebola virus epidemic in Western Africa appears to be spiraling out of control. The worst-case projections suggested that the unchecked spread could result in almost 1.4 million cases by the end of January 2015 with a case fatality rate of at least 50%. The United States and European nations have begun to respond in earnest with promises of supplies, isolation beds, and trained health care personnel in an effort to contain the epidemic and care for the sick. However, (...) there is neither a vaccine nor specific treatment for Ebola infection, and therapy is ideally centered on supportive care. I have previously argued that the provision of palliative care is obligatory during an overwhelming health catastrophe, notably pandemic influenza. Since affected Ebola patients have best outcomes with technologically advanced intensive care—resources in scarce supply in the area—I suggest that the only acceptable approach to large numbers of very sick, dying, and suffering Ebola patients who overwhelm the resources available to successfully manage them is effective palliative care. However, this could hasten death in this vulnerable population and hence, while ethically and medically justifiable, is not without social risk. (shrink)

When pandemics hit communities, women are bound to suffer as most of the responsibilities of ensuring food security lie on them. This article assesses the impact of the COVID-19 pandemic on the role that church-going women play in food provision. The qualitative study used interviews and focus group discussions to examine the toll of the pandemic-induced restrictions, especially with regard to their disruption of activities that ensure the provision of food for the family. They sought to identify how an environment (...) as restrictive as the one that was imposed during the COVID-19 pandemic affects those largely responsible for food provision in urban Marondera – the women, in this case. The focus was extended to factor in how disasters and pandemics affect women and detract from their normative food procurement and provision roles in marginal societies and how these effects can be mitigated to allow women to carry on with their roles even in restrictive environments. This research was motivated by the recent COVID-19-imposed regulations that restricted the movement of people, restrictions that have only recently been relaxed and (in some cases) removed. We also sought to establish how gender roles are played out, together with whether they are exacerbated by pandemics, and in what ways these pandemics result in higher workloads on women. By utilising the Africana womanist theory, the study analysed women roles in food provision and food security in their societies within the restrictive environments of the pandemics.Contribution: This study concluded that there are gender inequalities that are exacerbated by these pandemics that result in higher workloads for women. It foregrounded how existing gender inequalities were exacerbated by the pandemic, resulting in higher workloads on women. It therefore recommended that women should form empowerment groups to help focus attention on food provision to mitigate challenges women face in this role. Finally, we averred that there ought to be consultation and participation of women on issues to do with pandemics to allow for their full and productive participation in critical roles of providing food. (shrink)

Anna Stilz claims that citizens of democratic states bear “task responsibility” to repair unjust harms done by their states. I will argue that the only situation in which Stilz’s argument for such “task responsibility” is not redundant, given her own premises, is a situation where the state leaves it up to the citizens whether to indemnify others for the harms done by the state. I will also show that Stilz’s “authorization view” rests on an unwarranted and implausible assumption (...) (which I call “the authorization principle”) about authorization and political obligation, and that this problem cannot be remedied by limiting the account to democratic states. I will then briefly turn to Pasternak’s account of citizen responsibility for state action and argue that it suffers from two deficiencies: first, she equates group membership with collective action, and second, she does not provide any explanation as to why citizens should incur liability for the acts of their state under the four conditions she highlights. I conclude that neither Stilz nor Pasternak succeed in showing that at least citizens of democratic states are liable (barring very special circumstances) for the acts of their states. (shrink)

This paper analyses a situation where a patient's suffering provoked feelings of compassion in a student nurse, and distress at her patient's circumstances. The reported behaviour of qualified nurses within the situation suggests that they lacked compassion, had inadequate knowledge, and that they failed to understand their patient's plight. An account of the situation is followed by an exploration of the nature of moral agency, and understanding in nursing. Nurses' capacity for moral imagination is shown to be of crucial (...) importance to the care that patients receive. The extent of nurses' responsibility for their behaviour is considered, and in particular, the extent of nurses' responsibility during times when they experience strain. Argument leads to the conclusion that we are justified in holding nurses responsible for their behaviour in situations of patient care, although we must not judge a nurse's behaviour too hastily. Attention is drawn to the need for a moral climate to sustain those nurses who struggle to give good patient care, despite the strain that is ever present within today's world of health care. (shrink)

Setting Up the Problem. What personal responsibilities do we, people living in rich countries, have for relieving miseries in the less fortunate countries? A great variety of prophets and philosophers urge us without qualification to do everything that we can. I mean, everything. Sartre holds that everybody “carries the weight of the whole world upon his shoulders; he is responsible for the world and for himself in whatever has to do with the character of their being.” Lévinas joins in: “I (...) am responsible for others without expecting any return, should it cost me my life. Any return is [the others’] business.” Peter Unger, following Peter Singer, asks us to do all that we can do to relieve suffering; and insists that the only limit, while the suffering continues, is our capacity to help. Jesus speaks most trenchantly of all: If you are to be saved, “Sell all you have and give it to the poor”, to which may be joined the injunction, powerfully worded in the Moffatt translation of the Bible, “You must be perfect as your heavenly Father is perfect”. (shrink)

The current Ebola virus epidemic in Western Africa appears to be spiraling out of control. The worst-case projections suggested that the unchecked spread could result in almost 1.4 million cases by the end of January 2015 with a case fatality rate of at least 50%. The United States and European nations have begun to respond in earnest with promises of supplies, isolation beds, and trained health care personnel in an effort to contain the epidemic and care for the sick. However, (...) there is neither a vaccine nor specific treatment for Ebola infection, and therapy is ideally centered on supportive care. I have previously argued that the provision of palliative care is obligatory during an overwhelming health catastrophe, notably pandemic influenza. Since affected Ebola patients have best outcomes with technologically advanced intensive care—resources in scarce supply in the area—I suggest that the only acceptable approach to large numbers of very sick, dying, and suffering Ebola patients who overwhelm the reso.. (shrink)

Pastoral care must recover its unique identity as a theological discipline. In addressing the reality of evil, pastoral care reinterprets divine power as compassionate and creative empowerment, the basis for hopeful activity.

Drawing on the philosophy of Emmanuel Levinas, James Hatley uses the prose of Primo Levi and Tadeusz Borowski, as well as the poetry of Paul Celan, to question why witnessing the Shoah is so pressing a responsibility for anyone living in its aftermath. He argues that the witnessing of irreparable loss leaves one in an irresoluble quandary but that the attentiveness of that witness resists the destructive legacy of annihilation. "In this new and sensitive synthesis of scrupulous thinking about (...) the Holocaust (beginning with scruples about the term Holocaust itself), James Hatley approaches all the major questions surrounding our overwhelming inadequacy in the aftermath of the irreparable. If there is anything unique (in a non-trivial sense) about the Holocaust, surely it is the imperious moral urgency that compels those who contemplate it to revise their view of what it means to be human, and to bear witness to such an event. (shrink)

Medical trainees should learn from the actions of Nazi physicians to inform a more just contemporary practice by examining the subtle assumptions, or moral orientations, that led to such heinous actions. One important moral orientation that still informs contemporary medical practice is the moral orientation of elimination in response to suffering patients. We propose that the moral orientation of presence, described by theologian Stanley Hauerwas, provides a more fitting response to suffering patients, in spite of the significant barriers (...) to enacting such a moral orientation for contemporary trainees. (shrink)

Consider the following hypothetical scenario: A patient suffering constant abdominal pain is referred to State Hospital A from her local clinic after not responding to simple analgesics for chronic pelvic pain associated with irregular menstruation. The doctors at State Hospital A discover that she has a suspicion of adenomyosis. She gives written informed consent for a hysterectomy. During routine postoperative check-ups she reports no alleviation of the pelvic pain, urinary frequency along with burning on micturition and a persistent vaginal (...) discharge. Preoperatively, she was not told that the surgeons had inserted a surgical mesh to prevent vault prolapse. She is given antibiotics and further simple analgesia. As her symptoms do not improve she self-refers to State Hospital B. She is informed that she needs a CAT scan. However, the hospital’s scanner has been out of order for three years. She is advised to go to State Hospital C, where the scanner works, but is not given a referral note. She is told by Hospital C that the doctors are too busy to see her, and as she does not have an appointment, and is not an emergency case she should go back to Hospital A. She does not want to go back to Hospital A, as during her last visit there, nursing staff accused her of being a nuisance and escorted her off the premises. She approaches Private Hospital D, where her abdomen and pelvis are scanned. The scan shows the surgical mesh inside her pelvis which had disintegrated. She is told that it is too risky to remove all the fragments, but that some could be removed at a cost - which she could not afford. The surgeon refers her back to State Hospital A with a referral note and copy of the CAT scan report. (shrink)

The purpose of this article is to deliberate the moral and legal dilemma entailed in the weapon of the labour strike as a pressure tactic on the Israeli Finance Ministry regarding job slots, budgets and, in effect, violating the collective agreement signed by the nurses and impairing patients’ treatment, as opposed to refraining from striking and suffering the heavy burden of work, the lack of trained personnel, low wages, and the inability to give patients proper, high quality treatment.

Anthropology's approach to answering the question of the role of suffering in our lives is limited to empirical data and at best describes an individual's capability to endure it and make sense of it. Levinas was at odds to find meaning in suffering once it had exceeded certain proportions. Various cultures demonstrate greater and lesser capacities for integrating corporate suffering when it has crossed a significant threshold. What is the role of ritual and productive suffering in (...) revealing meaning in suffering? Some examples are drawn from the experiences of pilgrims on the Camino de Santiago de Compostella. Drawing from Dr. Eleonore Stump's exploration of second-person narratives and relationships, a Christian philosophical-theological response is provided. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Suffering of Economic Injustice:A Response to Ulrich Duchrow and David LoyJoerg RiegerThat economic injustice is one of the central topics of our time is hard to dispute. Even those who seek to avoid the topic cannot escape the numbers and the stories of gross economic disparity. It affects life everywhere, as—using the language of the Occupy Wall Street movement—economic injustice pits the 99 percent against the 1 (...) percent even in the United States. More and more of us are not benefitting from capitalism anymore.Ulrich Duchrow’s presentation puts matters in stark relief when he reminds us that 60 million people are dying of hunger and its consequences every year. If we do the math based on this one number, this amounts to one Holocaust every two months. Nevertheless, even this large number shows only a tiny tip of the iceberg, as it does not include the countless millions who die from the consequences of malnourishment, from lack of resources like clean drinking water, employment opportunities, health care, and many other problems. In the United States alone, forty-five thousand people die annually simply because of the lack of affordable health care.1When we are dealing with economic injustice, we are dealing with what ultimately amounts to a matter of life and death. Here, all religion necessarily becomes engaged religion in one way or another: In the struggle between life and death caused by economic injustice, religion has the option of placing itself on the side of life. If it does not place itself on the side of life, I suspect that it places itself on the side of death by default. Neutral ground does not seem to exist here.Nevertheless, let us not forget that the topic of economic injustice is not just a matter of those who suffer from economic injustice; it is also a matter of those who impose the suffering of economic injustice on others. While people of religion often address the former topic, they often remain silent on the latter. Kwok Pui-lan and I have tried to deal with this problem in our recent book Occupy Religion.2 When we talk about economic injustice and the 99 percent, we must also talk about the 1 percent. I will return to this topic shortly.What I have presented so far amounts to a fairly dualistic picture. Given the current economic status quo, this dualism appears to be something that we have to contend [End Page 51] with, whether we like dualisms or not: As people are dying and lives are being destroyed, economic injustice confronts us with matters of life and death. While the dualisms of economic injustice are nothing to be celebrated, it may be necessary to fight back. It is significant to hear David Loy, who has consistently fought against dualisms in his work, admit that “there’s also a beneficial side” to dualism, for instance when Amos castigates those who “trample the head of the poor into the dust of the earth” and “crush the needy” (Amos 2:7, 4:1). Loy further understands that our societies may be “becoming more unjust.” I wonder what would happen, though, if Loy were to take a closer look at what this injustice looks like and if he were to take into consideration actual people whose lives are being destroyed by it. What might this mean for his understanding of the Buddhist concept of dukkha (suffering)?Loy understands social justice as distributive justice, referring the Hebrew prophets’ frustration that the rich have so much and the poor have so little. While he does not dismiss this discourse of justice, he seeks to shift gears as a Buddhist, arguing that economic suffering (dukkha) is based on “our delusive sense of self.” This shift leads me to wonder who is included in this use of the first person plural; whose “delusive sense of self” is Loy talking about? At first sight it looks as if he refers to all of us, claiming that all human beings equally share in this delusion that causes suffering. Let me suggest, however, that we take a closer look and investigate more carefully whose delusive... (shrink)

Pre-natal-diagnosis technologies allow parents to discover whether their child is likely to suffer from serious disability. One argument for state funding of access to such technologies is that doing so would be “cost-effective”, in the sense that the expected financial costs of such a programme would be outweighed by expected “benefits”, stemming from the births of fewer children with serious disabilities. This argument is extremely controversial. This paper argues that the argument may not be as unacceptable as is often assumed. (...) In doing so, it sets out a more general framework for assessing the relevance of efficiency calculations to policy-making. The final section also investigates the relationship between the paper’s arguments and claims about parental responsibility for child-bearing and rearing, with reference to Scanlon’s work on “substantive responsibility”. (shrink)

Priority for solid organ transplant generally does not consider the underlying cause of the need for transplantation. This paper argues that a distinctive set of factors justify assigning lower priority to willfully unvaccinated individuals who require transplant as a result of suffering from COVID‐19. These factors include the personal responsibility of the patients for their own condition and the public outrage likely to ensue if willfully unvaccinated patients receive organs at the expense of vaccinated ones. The paper then (...) proposes a three‐prong test for similar deviations from the current allocation standard that incorporates patient responsibility, foreseeability and avoidability, and the frequency of the occurrence. (shrink)

According to the expressivist objection, laws that only allow assisted dying for those suffering from certain medical conditions express the judgement that their lives are not worth living. I have recently argued that an autonomy-based approach that legally allows assisted suicide for all who make an autonomous request is a way to avoid the expressivist objection. In response to this, Thomas Donaldson has argued that rather than avoiding the expressivist objection, an autonomy-based approach extends this objection. According to Donaldson, (...) this is because helping a person achieve a goal requires endorsement of that goal. In this reply, I show that Donaldson misunderstands the target of the expressivist objection: it is not aimed at an individual’s attitude towards another person’s death but rather at a legal regulation. Moreover, helping someone end their life does not necessarily require endorsing this goal—instead, respect for a person’s autonomous choice can be another reason for providing assisted suicide. Donaldson also assumes that the autonomy-based approach requires doctors to accept autonomous requests for assisted dying. Yet, this approach merely makes it legal for individuals (not necessarily only doctors) to provide assisted suicide to autonomous persons but does not require anyone to do so. (shrink)

This study viewed students majoring in public relations as prospective public relations practitioners and explored their perceptions about corporate social responsibility (CSR) as their job attraction condition. The results showed that the students perceived CSR to be an important ethical fit condition of a company. One of the significant findings is that CSR can be an effective reputation management strategy for prospective employees, particularly when a company’s business is suffering. In examining the effect of CSR efforts on attitudinal (...) and behavioral outcomes, person–organization (P–O) fit appeared to serve as a mediator between CSR performances and organizational attractiveness. (shrink)

This edited collection represents an ongoing conversation for bringing healing cultures into suffering and evil. The pluralistic perspectives emerge from the creativity of this unique community of interpreters.

This article offers a reflection upon The Brothers Karamazov, interpreted as a theological and philosophical contribution to the debate over humanity’s practical relationship to suffering and vulnerability. The relationship is practical insofar as the questions with which Dostoevsky struggles all relate to human agency: How should we live in the continual presence of suffering? The article reconstructs a theology of suffering in The Brothers Karamazov as a form of anti-theodicy. Further, the theology of suffering in The (...) Brothers Karamazov is counterposed to Leo Tolstoy’s novella Hadji Murat. How does Dostoevsky’s “theology of suffering” fare in a comparison with one of the most perceptive portraits of power and powerlessness in world literature? In the proposed reading of the story, the elderly Tolstoy seeks to challenge the Christian theology that views responsibility for suffering and injustice primarily as an individual struggle with the metaphysical conditions of existence. (shrink)

Distant Suffering examines the moral and political implications for a spectator of the distant suffering of others as presented through the media. What are the morally acceptable responses to the sight of suffering on television, for example, when the viewer cannot act directly to affect the circumstances in which the suffering takes place? Luc Boltanski argues that spectators can actively involve themselves and others by speaking about what they have seen and how they were affected by (...) it. Developing ideas in Adam Smith's moral theory, he examines three rhetorical 'topics' available for the expression of the spectator's response to suffering: the topics of denunciation and of sentiment and the aesthetic topic. The book concludes with a discussion of a 'crisis of pity' in relation to modern forms of humanitarianism. A possible way out of this crisis is suggested which involves an emphasis and focus on present suffering. (shrink)

The current heated debate on the deteriorating status of the university raises a range of pertinent questions, including: What role can the humanities play in culture today in the face of the crisis of higher education? To answer this question, the authors begin by problematizing the relationship between culture, the humanities, and education. In the second part of the paper, they examine the changing role of the humanities in conjunction with the understandings of culture, and outline three salient ways in (...) which culture is conceived of today. Subsequently, they focus on the loss of the dominant status that culture suffered when everyday life was discovered in modernity. In the third part, they argue that everyday life, or rather social representations of everyday life and its practices, are currently becoming the chief criterion for assessing culture, the humanities, and education. However, everyday life remains complex both in theoretical conceptualizations and in research observations. For example, everyday life harbors a range of risks and anxieties which are veiled by its own obviousness and reinforced by socialization. The authors conclude that, given this, everyday life in democratic societies calls for the work of understanding, support, affirmation, and criticism, in which the humanities can retain their superior status. In the fourth part, the authors discuss non-consensual democracy, critical community, and the pedagogy of asylum as the forms of organization and action that promote an auspicious interconnection of culture, the humanities, and education. (shrink)

Background When a patient commits suicide while hospitalized in the psychiatric ward, the mental healthcare professionals (MHCPs) who have had the patient in their care encounter the family members immediately following the suicide. Professionals who encounter the bereaved in this first critical phase may have a significant impact on the grieving process. By providing ethically responsible and professionally competent care, they have the opportunity to influence what can alleviate and reduce suffering and promote health in a longer perspective. Aim (...) The aim of this study is to investigate MHCPs’ experiences in the encounter with family members who has been bereaved by suicide. Methods Data material consists of text from in-depth interviews with six MHCPs belonging to a total of five different psychiatric units in two hospitals. The findings have emerged through analysis using a hermeneutical approach based on Gadamer’s philosophical hermeneutics. Ethical considerations The study was approved by the Ombudsman for Privacy of the Norwegian Social Science Data Services and is based on informed consent and confidentiality. Findings Three themes emerged: Confirming the suffering. Creating encounter through dialogue. Providing consolation and reconciliation. Findings illuminate how MHCPs understand their responsibilities and how they act in the encounter with the bereaved following suicide. Conclusion The participants appear to be led by the responsibility that grows through witnessing the suffering of the bereaved. Encountering the family member’s aggression and threats against staff members is an ethical challenge to the professional’s ability to confirm the bereaved, create dialogue and provide consolation and reconciliation at the start of their grieving process. MHCPs need to be aware of the different reactions and needs of family members following suicide. More research is needed about how to provide sensitive and flexible care in ways that can be perceived as helpful for those left behind. (shrink)

Nowadays, the major depressive disorder is a common disease that negatively affects the life quality of many people around the world. As MDD symptoms are closely related with the changes in food and eating, the relation between patients’ emotional responses and food tastes could be used as criteria for diagnostic. Until now, studies on the emotional response to different food tastes for patients affected by MDD have been poorly described in literature. Therefore, the aim of this study was to evaluate (...) the emotional response of patients suffering from MDD to the imagined different food tastes and to compare the results with a control group. Emotional responses in tested participants were induced by using cards with words of basic food tastes such as “sweet,” “salty,” “bitter,” “sour,” and “neutral.” The assessment of emotional response was performed with FaceReader 6 software. The outcome of this study showed that participants with MDD expressed lower “happy” and “contempt” and higher “surprised” emotions, along with a higher negative valence mean, in comparison with controls for all tested basic tastes of food. When Likert scale was used, significant differences in response were only found for “sour” and “salty” imaginary tastes between healthy group and patients with MDD. The findings of this study provide the additional data on food–associated emotion analysis of MDD patients and could be useful for the further development of the contactless method for early diagnosis of MDD. (shrink)

The aim of this dissertation is to respond to a collection of conceptual and scientific threats to compatibilist accounts of free will, particularly reasons-responsive views. Compatibilists hold that free will is compatible with the truth of determinism. Some compatibilists also claim that some actual agent at least sometimes acts freely, where it is true that she acts freely in virtue of her satisfying a specific set of control and epistemic conditions. These conditions often include the possession of certain capacities, such (...) as the capacity to recognize reasons for acting and to act on the basis of those reasons. First, I address two pressing philosophical objections to the adequacy of compatibilist accounts of free will: Are reasons-responsive accounts of free will too permissive in their class of free agents? Must reasons-responsive theorists - and compatibilists more generally - concede that some agents who are manipulated or intentionally designed by others are none the less acting freely and morally responsible for their actions? I then survey a widely proposed scientific threat to compatibilist accounts of free will - and to any account of free will that requires the same basic capacities as compatibilists do: Even if the compatibilist account accurately captures the basic capacities that an agent requires to act freely, does neuroscientific work on practical decision-making and action production limit - or worse, speak against -- our actual exercise of free will, as compatibilists conceive of it? I argue that the compatibilist need not yield to these philosophical challenges to the adequacy of their accounts of free will and to their claim that some actual agents act freely, sketching plausible compatibilist-friendly reasons to doubt the potency of each challenge. Finally, I argue that the extant incompatibilist accounts of free will suffer from a previously undiagnosed, serious problem: that there is an irreconcilable tension between the way in which philosophers motivate the incompatibilist ability to do otherwise and the way in which they formally express it. I conclude by offering a diagnosis for the future of the free will debate given the arguments advanced. (shrink)

Moral and political philosophers no longer condemn harm inflicted on nonhuman animals as self-evidently as they did when animal welfare and animal rights advocacy was at the forefront in the 1980s, and sentience, suffering, species-typical behavior, and personhood were the basic concepts of the discussion. The article shows this by comparing the determination with which societies seek responsibility for human harm to the relative indifference with which law and morality react to nonhuman harm. When harm is inflicted on (...) humans, policies concerning negligence and duty of care and principles such as the ‘but for’ rule and the doctrine of double effect are easily introduced. When harm is inflicted on nonhumans, this does not happen, at least not any more. As an explanation for the changed situation, the article offers a shift in discussion and its basic terminology. Simple ethical considerations supported the case for nonhuman animals, but many philosophers moved on to debate different views on political justice instead. This allowed the creation of many conflicting views that are justifiable on their own presuppositions. In the absence of a shared foundation, this fragments the discussion, focuses it on humans, and ignores or marginalizes nonhuman animals. (shrink)

Why have some countries been able to implement quarantines and roll-out vaccines effectively quickly, while others have suffered with poor widescale public support and compliance? Part of the reason is because of a lack of fair, well-articulated government policies to deal with the costs of necessary lockdowns and other protocols, along with uneven citizen compliance and behaviour. We argue for a progressive reciprocity framework. We argue that governments have a responsibility to make the costs of mandatory restrictions of liberty (...) reasonable and this provides a reciprocal responsibility to comply and sacrifice freedom and some level of well-being for the common good. We introduce a “Quarantine Bill of Rights”, as both an ethical, economic, and responsible template for governments and citizens responding to pandemics. It provides incentives for greater public quarantine and vaccine compliance which can end future health crises faster, thereby reducing overall societal harm. We ask individuals to take responsibility during a pandemic, but this is a reasonable demand only if states themselves take responsibility for the ongoing welfare of their citizens, including those who bear the costs of government strategy to address pandemic threats, such as lockdowns and vaccination efforts. Our proposal also addresses the long-term economic damage when such crises have not been contained quickly enough. Such an accord should become a universal governing principle, perhaps under the auspices of the World Health Organization or another multilateral organization. Governments have responsibilities to all of their citizens, not merely citizens to each other. (shrink)

Mayerfeld’s aim in this work is to defend “the claim that we are subject to a prima facie duty to relieve suffering” and to clarify “the content of that duty”. In his analysis, Mayerfeld takes suffering in a psychological sense, that is, in the sense of how it feels to individuals. He denies the hedonistic utilitarian’s claim that only happiness and suffering are relevant to wellbeing or, for that matter, to morality. Nevertheless, Mayerfeld embraces a hedonistic conception (...) of happiness and suffering, identifying these experiences with “overall states of feeling at a particular moment”. (shrink)

Suffering, in one form or another, is present in all of our lives. But why do we suffer? On one reading, this is a question about the causes of physical and emotional suffering. But on another, it is a question about whether suffering has a point or purpose or value. In this ground-breaking book, Michael Brady argues that suffering is vital for the development of virtue, and hence for us to live happy or flourishing lives. After (...) presenting a distinctive account of suffering, and a novel account of its core element, unpleasantness, Brady proceeds to focus on three claims that are central to his picture. The first is that forms of suffering, like pain and remorse, can themselves constitute virtuous responses. The second is that suffering is essential for four important classes of virtue - virtues of strength, such as fortitude and courage; virtues of vulnerability, such as adaptability and humility; moral virtues, such as compassion; and the practical and epistemic excellences that make up wisdom. His final claim third is that suffering is vital for the social virtues of justice, love, and trust, and hence for the flourishing of social groups. (shrink)

American philosopher Josiah Royce is known for having concerned himself with the question of evil and experience of tragedy. In this essay, I focus not on the question of evil but rather on the associated problems of sin and tragedy, and the suffering that exists in their wakes. In particular, I take as my starting points Royce's claims that meaning is found and created only in the context of a community,2 that interpretation and a shared dedication to common goals (...) unite persons into a community,3 that these processes of interpretation and shared dedications create meaning in the community, and that human beings all crave meaningful lives. Given this framework, I argue that sins and tragic events are .. (shrink)