This paper proposes an ethical framework for rationing publicly financed health care. We begin by classifying alternative rationing criteria according to their ethical basis. We then examine the ethical arguments for four rationing criteria. These alternatives include rationing high technology services, non-basic services, services to patients who receive the least medical benefit, and services that are not equally available to all. We submit that a just health care system will not limit basic health care to persons unable to pay for (...) it. Furthermore, justice in health care requires limiting publicly-financed non-basic health care, striving for equality in access to basic health care, and relying on medical benefit to ration non-basic health care. (shrink)

A caregiver from the dominant U.S. culture and a patient from a very different culture can resolve cross‐cultural disputes about treatment, not by compromising important values, but by focusing on the patient's goals.

Background: The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care “upstream”. The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Methods: Directed content analysis was used to review ethics consultation notes from an academic children’s hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues derived (...) and modified from published quality improvement protocols. Results: Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (shrink)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

Part III: Now presents solely, clinical ethics. --.

He then proceeds with an examination of the picture theory developed by Wittgenstein, Carnap, and Goodman, and concludes with an examination of Patricia Churchland, Ruth Millikan, Robert Cummins, and Mark Rollins. The use of the historical development of representationalism to pose a central problem in contemporary cognitive science is unique.

After distinguishing different species of Legal Moralism I outline and defend a modest, positive Legal Moralism, according to which we have good reason to criminalize some type of conduct if it constitutes a public wrong. Some of the central elements of the argument will be: the need to remember that the criminal law is a political, not a moral practice, and therefore that in asking what kinds of conduct we have good reason to criminalize, we must begin not with the (...) entire realm of wrongdoing, but with conduct falling within the public realm of our civic life; the need to look at the different processes of criminalization, and to ask what kinds of consideration can properly figure in those processes; the need to attend to the relationship, and the essential differences, between criminal law and other modes of legal regulation. (shrink)

How can a system of criminal punishment be justified? In particular can it be justified if the moral demand that we respect each other as autonomous moral agents is taken seriously? Traditional attempts to justify punishment as a deterrent or as retribution fail, but Duff suggests that punishment can be understood as a communicative attempt to bring a wrong-doer to repent her crime. This account is supported by discussions of moral blame, of penance, of the nature of the law's demands, (...) and of the proper meaning and purpose of the criminal process of trial and verdict: it deals both with the ideals that should inform a system of criminal law and the extent to which those ideals are actualised in existing institutions and practices. The conclusion is pessimistic: punishment cannot be justified within our legal system; and this gap between the ideal and the actual presents us with serious moral dilemmas. (shrink)

Aim To study the views of people in a largely Muslim country, Kuwait, of the acceptability of a life-ending action such as physician-assisted suicide (PAS). Method 330 Kuwaiti university students judged the acceptability of PAS in 36 scenarios composed of all combinations of four factors: the patient's age (35, 60 or 85 years); the level of incurability of the illness (completely incurable vs extremely difficult to cure); the type of suffering (extreme physical pain or complete dependence) and the extent to (...) which the patient requests a life-ending procedure, euthanasia or PAS (no request, some form of request, repeated requests). In all scenarios, the patients were women who were receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. Results Five clusters were found. For 44%, PAS was always very unacceptable, no matter what the circumstances. For 23%, it was unacceptable, but less so if the patient was older or requested it repeatedly. For 16%, it was unacceptable if the patient was young but was acceptable if the patient was elderly. For 5%, it was unacceptable if the patient had extreme pain but was acceptable if completely dependent. For 11%, it was unacceptable if the patient did not request it but acceptable if she did. Conclusion The majority of the Kuwaiti university students opposed PAS either categorically or with a slight variation according to circumstances. Nonetheless, a minority approved of PAS in some cases, particularly when the patient was elderly. (shrink)

After an initial discussion (§i) of what a theory of criminal law might amount to, I sketch (§ii) the proper aims of a liberal, republican criminal law, and discuss (§§iii–iv) two central features of such a criminal law: that it deals with public wrongs, and provides for those who perpetrate such wrongs to be called to public account. §v explains why a liberal republic should maintain such a system of criminal law, and §vi tackles the issue of criminalization—of how we (...) should determine the proper scope of the criminal law. (shrink)

The reputation Theologoumena Arithmeticae has acquired is largely that of being an odd, and frequently opaque, compilation of arithmological lore. As a sourcebook for this aspect of the Pythagorean tradition it is, of course, invaluable. However, its poor reputation is increased, and its historical value lessened, by the depredations time has wrought on the text. ThA was never great prose: it is a compilation, largely from the lost Theologoumena Arithmeticae of Nicomachus of Gerasa and from Anatolius' Peri Dekados; and the (...) text which cannot be safely or conjecturally assigned to these two sources often reads like little more than the written-up notes of some student. However, the treatise contains passages of considerable lucidity, within the context of its peculiar framework. (shrink)

The reputation Theologoumena Arithmeticae has acquired is largely that of being an odd, and frequently opaque, compilation of arithmological lore. As a sourcebook for this aspect of the Pythagorean tradition it is, of course, invaluable. However, its poor reputation is increased, and its historical value lessened, by the depredations time has wrought on the text. ThA was never great prose: it is a compilation, largely from the lost Theologoumena Arithmeticae of Nicomachus of Gerasa and from Anatolius' Peri Dekados; and the (...) text which cannot be safely or conjecturally assigned to these two sources often reads like little more than the written-up notes of some student. However, the treatise contains passages of considerable lucidity, within the context of its peculiar framework. (shrink)

Certainly the most elaborate single extant monument of Renaissance French prose literature, Michel de Montaigne's "Essais" presents a subject matter that often discusses and analyzes concepts of language in general as well as language as a vehicle of its own expression. This study addresses the author's exploration of the dedalus of language as he ambles and rambles its roads, streets, and alleys; draws the portrait of his philosophy of language or philology; and concludes his affirmative and positivistic attitude toward language (...) and its literary application or the art and artistry of literature. The great Renaissance humanist's depiction of language in the "Essais" is analyzed in this book on the basis of its division among intellectual, moral, and aesthetic aspects. This threefold reduction, finding its derivation in the critical work of Aristotle, Auerbach, and Bowen, is also related to the few particular and the important general critical studies of Montaigne and his vision and use, creation and re-creation of language. (shrink)

In this article, we consider two independently appealing theories—the Growing-Block view and Humean Supervenience—and argue that at least one is false. The Growing-Block view is a theory about the nature of time. It says that past and present things exist, while future things do not, and the passage of time consists in new things coming into existence. Humean Supervenience is a theory about the nature of entities like laws, nomological possibility, counterfactuals, dispositions, causation, and chance. It says that none of (...) these entities are fundamental, since if they were, this would entail the existence of irreducible necessary connections between matters of fact. Instead, these entities supervene on a fundamental, non-nomological ‘Humean mosaic’ of property instances at spacetime points. We will further explain and motivate the Growing-Block view and Humean Supervenience in Sects. 2 and 3, but first, we turn to our master argument. (shrink)

Epistemic decision theorists aim to justify Bayesian norms by arguing that these norms further the goal of epistemic accuracy—having beliefs that are as close as possible to the truth. The standard defense of Probabilism appeals to accuracy dominance: for every belief state that violates the probability calculus, there is some probabilistic belief state that is more accurate, come what may. The standard defense of Conditionalization, on the other hand, appeals to expected accuracy: before the evidence is in, one should expect (...) to do better by conditionalizing than by following any other rule. We present a new argument for Conditionalization that appeals to accuracy‐dominance, rather than expected accuracy. Our argument suggests that Conditionalization is a rule of coherence: plans that conflict with Conditionalization don't just prescribe bad responses to the evidence; they also give rise to inconsistent attitudes. (shrink)

Gender discrimination and sexual harassment of female police officers by their male counterparts remain areas of liability where police departments appeared to have failed to effectively confront the nagging issues. However, the appreciable level of research conducted on these issues in the global North has not been matched by the South, where issues bordering on sexual violence have cultural underpinnings. Drawing from the case of the Nigeria Police Force, feminist analysis was used to explore the lived reality of 43 female (...) officers in a qualitative study. Participants expressed distress in abiding by structural discriminatory regulations against female officers which include non-admittance of married women into the force, forbidding unmarried officers from getting pregnant, and a stipulated minimum of three-year work period before a female officer can marry. Findings also indicated that participants suffer a variety of sexual harassment, intimidation, and, violence from their male colleagues, while they feel constrained in reporting their victimization. Important policy and practical implications requiring the Nigerian police to address hegemonic masculinity and promote gender equality were provided. (shrink)

I discuss two problems for the standard Anglo-American account of recklessness, and the distinctions between intention, recklessness, and negligence. One problem concerns the over-breadth of recklessness as thus defined—that it covers agents whose actions display different kinds of culpability. The other problem concerns the importance attached to awareness of risk in distinguishing recklessness from negligence—that one who is unaware of the risk that he takes or creates sometimes displays just the same kind of fault as an advertent risk-taker. We can (...) work towards solutions to these problems by contrasting the Anglo-American schema with the German schema: this distinguishes intention from negligence. Dolus eventualis, properly understood, constitutes a distinctive kind of fault, which should be distinguished from advertent negligence within the category of what the Anglo-American schema counts as recklessness: this helps to solve the first problem, of over-breadth. As for the second problem, we can see why the difference between advertent and inadvertent risk-taking is not always normatively significant by noticing that an agent’s failure to realise the risk he is creating can itself display a significant fault in the structure of the practical reasoning that informs his action—just the same kind of fault as that displayed by an advertent risk-taker. The upshot of this discussion is a new schema of types of criminal fault; I finally note some problems with the practicability of such a new schema. (shrink)

On the basis of a communicative theory of criminal punishment, I show how mercy has a significant but limited role to play in the criminal law—in particular (although not only) in criminal sentencing. Mercy involves an intrusion into the realm of criminal law of values and concerns that are not themselves part of the perspective of criminal law: a merciful sentencer acts beyond the limits of her legal role, on the basis of moral considerations that conflict with the demands of (...) penal justice. Sometimes, however (but in a decent system of law in a decent society, rarely), that is how citizens should act. Finally, I discuss, and criticise, two attempts to find a place for mercy within a communicative conception of punishment, and argue that repentance is not an appropriate ground for leniency or mercy in sentencing. (shrink)

We show that five important elements of the ‘nomological package’— laws, counterfactuals, chances, dispositions, and counterfactuals—needn’t be a problem for the Growing-Block view. We begin with the framework given in Briggs and Forbes (in The real truth about the unreal future. Oxford studies in metaphysics. Oxford University Press, Oxford, 2012 ), and, taking laws as primitive, we show that the Growing-Block view has the resources to provide an account of possibility, and a natural semantics for non-backtracking causal counterfactuals. We show (...) how objective chances might ground a more fine-grained concept of feasibility, and furnished a places in the structure where causation and dispositions might fit. The Growing-Block view, thus understood, provides the resources to explain the close link between modality and tense, so that it predicts modal change as time passes. This account lets us capture not only what the future might hold for us, and also what might have been. (shrink)

First paragraph: Some reasons for action are relational. I have a relational reason to Φ when I have reason to Φ in virtue of a relationship in which I stand, or a role that I fill; absent that relationship or that role I would not have that reason to Φ ; others who do not stand in that relationship or fill that role do not have that reason to Φ . I have a relational reason to feed this child -- (...) that he is my child: absent that parental relationship, I might still have a reason to feed him, as might others who are not his parents -- for instance that he is starving; but absent that relationship, I would not have and others cannot have that specific relational reason to feed this child. I have a relational reason to respond to this person's philosophical queries -- that she is my student: absent that pedagogical relationship, I might still have reason to respond to her questions, as might others who are not her teachers -- for instance that it is good to help such seekers after philosophical insight; but absent that relationship, I would not have and others cannot have that specific relational reason to respond to her queries. I have relational reason to pay John ￡10 -- that I borrowed it from him and promised to repay him today: absent that promissory relationship I might still have, and others might have, reason to give him ￡10 -- for instance that he is impoverished and I am (or they are) rich; but absent that promissory relationship, neither I nor others could have that specific relational reason to give him ￡10. (shrink)

The fourth volume in the Criminalization series, this volume explores some of the most general principles and theories of criminalization. It includes not only philosophical work, but also historical, legal, and sociological investigations into criminalization, clarifying the state of the discipline today.

I am interested in extending modal calculi by adding propositional quantifiers, given by the rules for quantifier introduction: provided that p does not occur free in A.

This collection of original essays, by some of the best known contemporary criminal law theorists, tackles a range of issues about the criminal law's 'special part' - the part of the criminal law that defines specific offences. One of its aims is to show the importance, for theory as well as for practice, of focusing on the special part as well as on the general part which usually receives much more theoretical attention. Some of the issues covered concern the proper (...) scope of the criminal law, for example how far should it include offences of possession, or endangerment? If it should punish only wrongful conduct, how can it justly include so-called 'mala prohibita', which are often said to involve conduct that is not wrongful prior to its legal prohibition? Other issues concern the ways in which crimes should be classified. Can we make plausible sense, for instance, of the orthodox distinction between crimes of basic and general intent? Should domestic violence be defined as a distinct offence, distinguished from other kinds of personal violence? Also examined are the ways in which specific offences should be defined, to what extent those definitions should identify distinctive types of wrongs, and the light that such definitional questions throw on the grounds and structures of criminal liability. Such issues are discussed in relation not only to such crimes as murder, rape, theft and other property offences, but also in relation to offences such as bribery, endangerment and possession that have not traditionally been subjects for in depth theoretical analysis. (shrink)

25 leading contemporary theorists of criminal law tackle a range of foundational issues about the proper aims and structure of the criminal law in a liberal democracy. The challenges facing criminal law are many. There are crises of over-criminalization and over-imprisonment; penal policy has become so politicized that it is difficult to find any clear consensus on what aims the criminal law can properly serve; governments seeking to protect their citizens in the face of a range of perceived threats have (...) pushed the outer limits of criminal law and blurred its boundaries. To think clearly about the future of criminal law, and its role in a liberal society, foundational questions about its proper scope, structure, and operations must be re-examined. What kinds of conduct should be criminalized? What are the principles of criminal responsibility? How should offences and defences be defined? The criminal process and the criminal trial need to be studied closely, and the purposes and modes of punishment should be scrutinized. Such a re-examination must draw on the resources of various disciplines-notably law, political and moral philosophy, criminology and history; it must examine both the inner logic of criminal law and its place in a larger legal and political structure; it must attend to the growing field of international criminal law, it must consider how the criminal law can respond to the challenges of a changing world.Topics covered in this volume include the question of criminalization and the proper scope of the criminal law; the grounds of criminal responsibility; the ways in which offences and defences should be defined; the criminal process and its values; criminal punishment; the relationship between international criminal law and domestic criminal law. Together, the essays provide a picture of the exciting state of criminal law theory today, and the basis for further research and debate in the coming years. (shrink)

Part of the Studies in Crime and Public Policy series, this book, written by one of the top philosophers of punishment, examines the main trends in penal theorizing over the past three decades. Duff asks what can justify criminal punishment, and then explores the legitimacy of actual practices by examining what would count as adequate justification for them. Duff argues that a "communicative conception of punishment," which he presents as a third way between consequentialist and retributive theories, offers the most (...) fruitful way of understanding punishment's meaning and justification. Duff addresses such questions as how much sentences should be constrained by proportionality requirements; what modalities of punishment best communicate their intended meaning; and what decisionmaking procedures he envisions. This book will appeal to criminologists, philosophers, and others interested in theories of punishment. (shrink)