Distributional semantic models (DSMs) are a primary method for distilling semantic information from corpora. However, a key question remains: What types of semantic relations among words do DSMs detect? Prior work typically has addressed this question using limited human data that are restricted to semantic similarity and/or general semantic relatedness. We tested eight DSMs that are popular in current cognitive and psycholinguistic research (positive pointwise mutual information; global vectors; and three variations each of Skip-gram and continuous bag of words (CBOW) (...) using word, context, and mean embeddings) on a theoretically motivated, rich set of semantic relations involving words from multiple syntactic classes and spanning the abstract–concrete continuum (19 sets of ratings). We found that, overall, the DSMs are best at capturing overall semantic similarity and also can capture verb–noun thematic role relations and noun–noun event-based relations that play important roles in sentence comprehension. Interestingly, Skip-gram and CBOW performed the best in terms of capturing similarity, whereas GloVe dominated the thematic role and event-based relations. We discuss the theoretical and practical implications of our results, make recommendations for users of these models, and demonstrate significant differences in model performance on event-based relations. (shrink)

Although deeply committed to the model of nondirective counseling, most genetic counselors enter the profession with certain assumptions about health and disability—for example, that it is preferable to be a hearing person than a deaf person. Thus, most genetic counselors are deeply troubled when parents with certain disabilities ask for assistance in having a child who shares their disability. This ethical challenge benefits little from viewing it as a conflict between beneficence and autonomy. The challenge is better recast as a (...) conflict between parental autonomy and the child's future autonomy. (shrink)

As these opening quotes acknowledge, the Prisoner’s Dilemma (PD) represents a core puzzle within the formal mathematics of game theory.3 Its rise in conspicuity is evident figure 2.1 above demonstrating a relatively steady rise in incidences of the phrase’s usage between 1960 to 1995, with a stable presence persisting into the twenty first century. This famous two-person “game,” with a stock narrative cast in terms of two prisoners who each independently must choose whether to remain silent or speak, each (...) advancing self-interest at the expense of the other and thereby achieving a mutually suboptimal outcome, mires any social interaction it is applied to into perplexity. The logic of this game proves the inverse of Adam Smith’s invisible hand: individuals acting on self interest will achieve a mutually suboptimal outcome. However, as this chapter illuminates, the assumptions underlying game theory drive this conclusion. (shrink)

The article discusses the problem of the possibility of knowing the future, especially the future of social phenomena compared with the future of natural ones. This problem is formulated as a dilemma: the future can be explored or can be only constructed. The idea of constructive character of knowledge of the future is viewed in two possible interpretations.The first one is a special case of the constructivist interpretation of knowledge, according to which different pictures of the future are arbitrarily (...) constructed on the basis of information about the past and current state. The second interpretaion can be presented in the form of a praxeological question: what should be an action in relation to the future, first and foremost to the future of social phenomena - cognitive or creative. It is shown that, in the first case, there is an ability to interpret knowledge of the future from the point of view of epistemological realism, in the second case, both cognitive and creative types of activity as a pragmatic position in relation to the future are necessary and cognitive activity cannot be reduced to creative one. It is also shown that forecaster’s dilemma reflects the problematic nature of forecasting under the conditions of transformation of scientific rationality and point of view of common sense, which is observed in recent decades. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Grey’s Anatomy focuses on the personal and professional life of protagonist Meredith Grey. Throughout the long series, a consistent theme is that the audience is confronted with moral dilemmas in Meredith’s professional work with patients as well as in her personal life. Grey’s decision-making often breaks professional protocol in order to do what she believes is best for her patients and those close to her. We argue that Grey’s approach to morality is representative of Simone de Beauvoir’s approach in The (...) Ethics of Ambiguity. In this text, Beauvoir argues that an existentialist ethic must reject a childlike approach to morality in which moral rules are absolute and moral dilemmas have obvious answers. Instead, she argues for a rejection of universalist ethics in favor of acknowledging the ambiguity of the moral realm. By tracing Meredith’s decision-making throughout the course of different seasons of the show, we argue that Meredith exemplifies an existential authenticity compatible with Beauvoir’s existentialist approach to ethics. (shrink)

This is a breakthrough work expanding the debate of the dilemmas of life and death in contemporary American society by carrying it beyond the insights of Western religious and philosophic thought to include ethical perspectives of the Hindu tradition. The topics covered are the timely ethical issues that concern both Americans and all people of the world — abortion, suicide, euthanasia, and the environment. A lively East-West dialogue probes the roots of each issue in its native setting, and the fruit (...) of this historical approach is a clear-cut analysis of up-to-date cases, giving their current status in terms of ethics, religion, philosophy, medicine, and law. Unlike traditional textbooks that concentrate on a theoretical analysis to the exclusion of practical issues, this book does justice to both theoretical and practical ethics. (shrink)

With the waves of reform occurring in mental health legislation in England and other jurisdictions, mental capacity is set to become a key medico-legal concept. The concept is central to the law of informed consent and is closely aligned to the philosophical concept of autonomy. It is also closely related to mental disorder. This paper explores the interdisciplinary terrain where mental capacity is located. Our aim is to identify core dilemmas and to suggest pathways for future interdisciplinary research. The terrain (...) can be separated into three types of discussion: philosophical, legal and psychiatric. Each discussion approaches mental capacity and judgmental autonomy from a different perspective yet each discussion struggles over two key dilemmas: whether mental capacity and autonomy is/should be a moral or a psychological notion and whether rationality is the key constitutive factor. We suggest that further theoretical work will have to be interdisciplinary and that this work offers an opportunity for the law to enrich its interpretation of mental capacity, for psychiatry to clarify the normative elements latent in its concepts and for philosophy to advance understanding of autonomy through the study of decisional dysfunction. The new pressures on medical and legal practice to be more explicit about mental capacity make this work a priority. (shrink)

Detroit Become Human (DBH) offers a stunningly visual gameplay experience that both tells a philosophical story and stimulates the moral reasoning process in players. The game features a futuristic world where highly intelligent androids are bought and sold as workers who take on menial labor tasks for humans. In this chapter, we explore three dimensions of moral reasoning: accounts of moral agency, ethical theories or frameworks, and accounts of moral patiency. We then explore how DBH addresses all of these philosophical (...) issues in its narrative and gameplay scenarios. Issues of moral agency are explored through some of the androids gaining consciousness and autonomy. Ethical theory is explored through various ethical dilemmas that emerge in the gameplay. Moral patiency is explored by questioning if the androids, conscious and unconscious, are worthy of moral concern and why. We then show how the gameplay structure offers a unique interactive opportunity for players to engage in the moral reasoning process. Additionally, through the questions it raises and scenarios it poses, DBH makes an implicit anti-speciesist argument regarding moral patiency. Additionally, it makes a secondary argument that suffering and struggle are necessary to develop the possibility of second-order desires and true freedom and agency. The interactive structure of the game, in which players’ choices have more weight than in many gameplay experiences, makes DBH a unique work of contemporary philosophical pop culture. (shrink)

Among various cases that equally admit of evidentialist reasoning, the supposedly evidentialist solution has varying degrees of intuitive attractiveness. I suggest that cooperative reasoning may account for the appeal of apparently evidentialist behavior in the cases in which it is intuitively attractive, while the inapplicability of cooperative reasoning may account for the unattractiveness of evidentialist behaviour in other cases. A collective causal power with respect to agreed outcomes, not evidentialist reasoning, makes cooperation attractive in the Prisoners' Dilemma. And a (...) natural though unwarranted assumption of such a power may account for the intuitive appeal of the one-box response in Newcomb's Problem. (shrink)

Teaching economics has been shown to encourage students to defect in a prisoner's dilemma game. However, can ethics training reverse that effect and promote cooperation? We conducted an experiment to answer this question. We found that students who had the ethics module had higher rates of cooperation than students without the ethics module, even after controlling for communication and other factors expected to affect cooperation. We conclude that the teaching of ethics can mitigate the possible adverse incentives of the (...) prisoner's dilemma, and, by implication, the adverse effects of economics and business training. (shrink)

P.S. Greenspan uses the treatment of moral dilemmas as the basis for an alternative view of the structure of ethics and its relation to human psychology. In its treatment of the role of emotion in ethics the argument of the book outlines a new way of packing motivational force into moral meaning that allows for a socially based version of moral realism.

The book contends that contrary to accepted interpretation, moral intuition, rather than any other form of reasoning, least of all formal logic, is the moral method found in the ethics of Aristotle, Aquinas, Kant and Dewey - the first four chapters of the book. These four thinkers represent a dialectical selection of ethical relativism and absolutism as well as a chronological succession from ancient to contemporary thought. The fifth and concluding chapter is a major presentation of the author's thesis on (...) moral intuition as the exact antidote against the dilemma ethics approach, which is widely used today with rapidly diminishing effect and interest. This chapter is a detailed illustration of how moral intuition works out concretely in the lived world. It stresses the unity of moral experience even as this is clouded over by our relatively fewer, but overdramatized, confrontations on some moral issues. (shrink)

Concerns an attempted refutation of nominalism put forward by John Burgess in the form of a dilemma argument. Argues that Burgess's argument is based upon a false dilemma.

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

It is not easy to see how self-deception is possible because the man who deceives himself seems to be required to play two incompatible roles, that of deceiver and that of deceived. This makes self-deception sound about as difficult as presiding at one's own funeral. Many attempts have been made to remove the air of paradox from self-deception. These attempts are all unsuccessful, and they are best seen as expressions of philosophical puzzlement rather than as actual solutions. In particular, the (...) whole of the literature on self-deception is vitiated by two serious confusions. First, deception is confused with deceit; secondly, it is wrongly assumed that every case of deceiving oneself is automatically a case of self-deception and so self-deception proper becomes confused with other things. (shrink)

Background: There are intriguing and challenging ethical dilemmas in the practice of palliative care in a traditional developing society.Objective: To review the different ethical issues involved in cancer and palliative care in developing countries, with special reference to India.Methods: Published literature on pain relief and palliative care in the developing countries was reviewed to identify ethical issues and dilemmas related to these, and ways in which ethical principles could be observed in delivery of palliative care in such countries are discussed.Results: (...) The literature review revealed a number of ethical dilemmas and challenges that professionals, cancer patients and their families encountered during palliative care. It was noted that patients’ preferences and decisions are influenced by family members. Dilemmas leave the professionals and families confused about how ethical their actions have been. Specific ethical issues were noted in relation to the availability and use of oral morphine for pain relief, spiritual care, lack of adequate palliative care services, and palliative care education.Conclusions: The four principles of ethics posed difficulties in understanding the complex ethical issues in a developing country with a traditional background. Ethical issues need to be handled delicately and sensitively in palliative care settings, within the framework of the traditions and culture of the society and financial constraints. The possible role of ethics committees in palliative care settings to help decision-making needs to be studied and discussed. (shrink)

The purpose of this article is show that second-order logic, as understood through standard semantics, is intimately bound up with set theory, or some other general theory of interpretations, structures, or whatever. Contra Quine, this does not disqualify second-order logic from its role in foundational studies. To wax Quinean, why should there be a sharp border separating mathematics from logic, especially the logic of mathematics?

Ravelingien et al1 argue that we should recategorise people in a permanent vegetative state as dead. Although the dilemma they describe is very real, their solution will not work. Other respondents to this paper have advanced several powerful arguments against the attempt to describe patients in a PVS as dead. Fortunately, the original argument contains sufficient resources for developing an alternative solution to this dilemma without having to radically change the current legal or social status of patients in (...) a PVS. In fact, patients in a PVS may be enrolled in xenotransplantation experiments, provided that their prior informed consent has been sought.The motivation for the original paper was to resolve an apparently intractable ethical conflict. On the one hand, there are powerful ethical and medical reasons for proceeding with research into the transplantation of non-human organs into human patients, whereas on the other, there are equally powerful ethical reasons for blocking whole-organ transplant experiments. These reasons are unusual in that special problems with xenotransplantation will block experiments that are permitted in other cases. In particular, the unquantifiable risk of a pandemic triggered by diseases such as porcine endogenous retrovirus crossing the species barrier will either block the research or expose subjects to the risk of indefinite quarantine . The authors also argue that the restrictions placed on transplant recipients and the possibility of long-term and intrusive monitoring, restrictions on sexual contacts and reproduction, and possible confinement represent excessive and ethically unjustifiable burdens. Over time, the recipients may wish to withdraw their consent, but the risks to public health would prevent them from doing so, thereby violating the basic principle that subjects of scientific and medical experiments should be able to revise or withdraw consent . …. (shrink)

Allthough small business accounts for over 90% of businesses in U.K. and indeed elsewhere, they remain the largely uncharted area of ethics. There has not been any research based on the perspective of small business owners, to define what echical delemmas they face and how, if at all, they resolve them. This paper explores ethics from the perspective of small business owner, using focus groups and reports on four clearly identifiable themes of ethical delemmas; entrepreneurial activity itself, conflicts of personal (...) values with business needs, social responsibility and the impact of owners' personality on business ethics. The mechanisms for resolving ethical dilemmas is not at all clear, as there appears to be a web of filters which are used in an inter-connected way. However a common starting point for resolving an ethical delemma which involves others is based on identifying who it is (e.g., a friend or institution) and the quality of the relationship with that person. The research yielded a rich source of material on business ethics and it is clear that future researchers must focus on this sector if business ethics is to make significant advances. (shrink)

Experiential acquaintance is an alleged relation between ourselves and our experiences that has sometimes been hypothesised as necessary for knowledge of our experiences. This paper begins with a clarification of ‘acquaintance’ and an explanation of ‘experience’ that focuses attention on a famous, but flawed, argument by G. E. Moore. It goes on to critically examine several recent arguments concerning experiential acquaintance and to show how internalist foundationalism can respond to a famous Sellarsian dilemma without appeal to a relation of (...) acquaintance with our experiences. It concludes that we can dispense with experiential acquaintance. (shrink)

The book offers an introduction to the moral concepts and value of health care. It is written by a moral philosopher, a doctor and a nurse and contains questions, cases and exercises which are suitable for medical, nursing and all students and commentators on health care. Moral dilemmas include consent, confidentiality, the giving or withholding of information, and the economics of health care. The issues of artificial reproduction, terminal care and the research and testing of drugs are addressed.

If we seek to analyse causation in terms of counterfactual conditionals then we must assume that there is a class of counterfactuals whose members (i) are all and only those we need to support our judgements of causation, (ii) have truth-conditions specifiable without any irreducible appeal to causation. I argue that (i) and (ii) are unlikely to be met by any counterfactual analysis of causation. I demonstrate this by isolating a class of counterfactuals called non-projective counterfactuals, or NP-counterfactuals, and indicate (...) how counterfactual analyses of causation must appeal to them to account for the correct causal judgements we make. I show that the truth-conditions of NP-counterfactuals are specifiable only by irreducible appeal to causation. A dilemma then holds: if counterfactual analyses of causation eschew appeal to NP-counterfactuals they are empirically inadequate, but if they appeal to NP-counterfactuals they are circular and thus conceptually inadequate. (shrink)

The ability to design technological solutions that address sustainability is considered pivotal to the future of the planet and its people. As technology professionals engineers are expected to play an important role in sustaining society. The present article aims at exploring sustainability concepts of newly enrolled engineering students in Denmark. Their understandings of sustainability and the role they ascribe to sustainability in their future professional practice is investigated by means of a critical discourse analysis including metaphor analysis and semiotic analysis. (...) The sustainability construal is considered to delimit possible ways of dealing with the concept in practice along the engineering education pathway and in professional problem solving. Five different metaphors used by the engineering students to illustrate sustainability are identified, and their different connotative and interpretive implications are discussed. It is found that sustainability represents a dilemma to the engineering students that situates them in a tension between their technology fascination and the blame they find that technological progress bears. Their sustainability descriptions are collected as part of a survey containing among other questions one open-ended, qualitative question on sustainability. The survey covers an entire year group of Danish engineering students in the first month of their degree study. (shrink)

Online education lacks the moral and ethical engagement as well as the empathic interactions that are essential and integral to true liberal education, including business. While the online venue can provide useful information and put libraries at the hands of the student or employee, there is an implicit lack of focus on the sacredness and centrality of the person, his or her values, attitudes, needs, and expectations. The focus of online education is on the delivery of data, not the student’s (...) engagement with the material or the process. Critically absent from online education is the ability to explore the transformation of data as it changes, first to information, then to knowledge, and finally to wisdom, within each person. Finally, absent is the ability to raise the level of abstraction. Since all needs to be measurable in concrete terms in online education, we are left with the language of metrics, such as deliverables, outcomes, inputs, and outputs. Where is the person in all of this? Where is the focus on the moral compass that is so necessary in any type of education? (shrink)

ABSTRACT Chapter 4, verse 34 of the Qur'an permits husbands to physically discipline recalcitrant wives. Modern Muslims who find this husbandly privilege discomfiting often rely on Muhammad's prophetic practice to mitigate the meaning of this verse. In light of Muhammad's example of never hitting his own wives, as found in one prophetic report, they reinterpret the verse as restricting and/or voiding a husband's right to physically discipline his wife. This essay provides a critical and expository survey of prophetic reports related (...) to the husbandly privilege to physically discipline wives. The essay argues that the modernists are correct in positing that Muhammad's prophetic practice was to morally censure husbands who hit their wives. However, taken as a whole, it is impossible to ignore that Muhammad's example also unilaterally upheld physical discipline as a husband's marital right. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult (...) case and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Is capitalism inherently predatory? Must there be winners and losers? Is public interest outdated and free-riding rational? Is consumer choice the same as self-determination? Must bargainers abandon the no-harm principle? Prisoners of Reason recalls that classical liberal capitalism exalted the no-harm principle. Although imperfect and exclusionary, modern liberalism recognized individual human dignity alongside individuals' responsibility to respect others. Neoliberalism, by contrast, views life as ceaseless struggle. Agents vie for scarce resources in antagonistic competition in which every individual seeks dominance. This (...) political theory is codified in non-cooperative game theory; the neoliberal citizen and consumer is the strategic rational actor. Rational choice justifies ends irrespective of means. Money becomes the medium of all value. Solidarity and good will are invalidated. Relationships are conducted on a quid pro quo basis. However, agents can freely opt out of this cynical race to the bottom by embracing a more expansive range of coherent action. (shrink)

There is virtually no philosophical consensus on what, exactly, imperfect duties are. In this paper, I lay out three criteria which I argue any adequate account of imperfect duties should satisfy. Using beneficence as a leading example, I suggest that existing accounts of imperfect duties will have trouble meeting those criteria. I then propose a new approach: thinking of imperfect duties as duties held by groups, rather than individuals. I show, again using the example of beneficence, that this proposal can (...) satisfy the criteria, explaining how something can both have the necessity characteristic of duty, while also allowing agents the latitude which seems to attach to imperfect duties. (shrink)

Context: In the past two decades, the so-called 4E approaches to the mind and cognition have been rapidly gaining in recognition and have become an integral part of various disciplines. Problem: Recently, however, questions have been raised as to whether, and to what degree, these different approaches actually cohere with one another. Specifically, it seems that many of them endorse mutually incompatible, perhaps even contradictory, epistemological and metaphysical presuppositions. Method: By retracing the roots of an alternative conception of mind and (...) cognition, as propounded by Varela, Thompson & Rosch, we provide an outline of the original philosophical framework of enactivism and neurophenomenology. We focus on its three central tenets - reflexivity, subject-world co-determination, and the construal of cognition as situated, skillful and embodied action - and show how they collectively add up to a radical change in attitude towards the age-old philosophical dilemmas. Results: We show how contemporary enactivist and embodied approaches relate to the original Varelian conception, and argue that many of them, despite frequent claims to the contrary, adopt significantly less radical philosophical positions. Further, we provide some tentative suggestions as to why this dilution of the original impetus might have occurred, paying special attention to the deep-rooted disparities that span the field. Implications: It is argued that more attention should be paid to epistemological and metaphysical tenets of different proposals within the 4E movement in general and enactivism in particular. Additionally, in emphasizing the inescapable multilayeredness and contextuality of scientific knowledge, enactivism and neurophenomenology accord with pluralist accounts of science and might provide important contributions to contemporary debates in the field. Constructivist content: The epistemological odyssey, construed as a journey to find a middle way between realism and idealism, is a central tenet of anti-representationalist, non-dualist constructivist approaches aimed at avoiding age-old philosophical traps. (shrink)

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

Moral strangerhood is due in part to competing worldviews. The profession of nursing is experiencing a paradigm shift which creates ethical dilemmas for both Christian nurses and Christian patients. Nursing's new focus on spirituality and spiritual care presents itself as broadly defining a desired state or patient outcome — spiritual integrity — supposed to be applicable to all patients of all faiths. Analysis of nursing's definition of spirituality reveals assumptions and values consistent with an Eastern/New Age worldview which may cause (...) hostility towards Christian patients stereotyped as dogmatic or noncompliant. (shrink)

I use a version of the case in "sophie's choice" as an example of the strongest sort of dilemma, With all options seriously wrong, And no permissible way of choosing one of them. This is worse, I argue, Than a choice between conflicting obligations, Where the agent has an overriding obligation "to choose", And does nothing wrong, Once the choice is made, By ignoring one of his prior obligations. Here, "contra" marcus, Guilt seems inappropriate.