In 2007 th eAustralian government declared that remote Aboriginal communities were in crisis and launched the Northern Territory Intervention.

Professionalism requires that physicians uphold the best interests of patients while simultaneously insuring just use of health care resources. Current articulations of these obligations like the American Board of Internal Medicine Foundation's Physician Charter do not reconcile how these obligations fit together when they conflict. This is the problem of dual agency. The most common ways of dealing with dual agency: “bunkering”—physicians act as though societal cost issues are not their problem; “bailing”—physicians assume that they are merely agents of society (...) and deliver care typically based on a strongly consequentialist public health ethic; or “balancing”—a vaguely specified attempt to uphold both patient welfare and societal need for judicious resource use simultaneously—all fail. Here I propose how the problem of dual agency might begin to be addressed with rigor and consistency. Without dealing with the dual agency problem and getting more specific about how to reconcile its norms when they conflict, the expectations of professionalism risk being written off as cute, nonbinding aphorisms from the medical profession. (shrink)

Principlism is simple. Four intuitive ideas, creating order out of moral chaos, at least categorizing considerations for better deliberation over right and wrong, good and bad, in a modern, plurali...

Important discussions about limiting care based on professional judgment often devolve into heated debates over the place of physicians in bedside rationing. Politics, loaded rhetoric, and ideological caricature from both sides of the rationing debate obscure precise points of disagreement and consensus, and hinder critical dialogue around the obligations and boundaries of professional practice. We propose a way forward by reframing the rationing conversation, distinguishing between the scale of the decision and its context avoiding the word “rationing.” We propose to (...) shift the terminology, using specific, descriptive words to defuse conflict and re-focus the debate towards substantive issues. These distinctions can clarify the real ethical differences at stake and facilitate a more constructive conversation about the clinical and social responsibilities of physicians to use resources ethically at the bedside and their role in allocating medical resources at a societal level. (shrink)

Important discussions about limiting care based on professional judgment often devolve into heated debates over the place of physicians in bedside rationing. Politics, loaded rhetoric, and ideological caricature from both sides of the rationing debate obscure precise points of disagreement and consensus, and hinder critical dialogue around the obligations and boundaries of professional practice. We propose a way forward by reframing the rationing conversation, distinguishing between the scale of the decision and its context avoiding the word “rationing.” We propose to (...) shift the terminology, using specific, descriptive words to defuse conflict and re-focus the debate towards substantive issues. These distinctions can clarify the real ethical differences at stake and facilitate a more constructive conversation about the clinical and social responsibilities of physicians to use resources ethically at the bedside and their role in allocating medical resources at a societal level. (shrink)

Revisionists and traditionalists appeal to Acts 15, welcoming the Gentiles, for analogies directing the church's response to homosexual persons. John Perry has analyzed the major positions. He faults revisionists for inadequate attention to the Jerusalem Decree and faults one traditionalist for using the Decree literally rather than through analogy. I argue that analogical use of the Decree must supplement rather than displace the plain sense. The Decree has been neglected due to assumptions that Paul opposed it, that it expired, or (...) because Gentiles wanted non-kosher meat. I argue that Paul continued to observe the Torah and supported the Decree, that it has not expired, and that Gentile desire for non-kosher meat is not a firm obstacle. Affirming the plain sense of the Decree, I develop the analogy from Acts 15 to homosexual persons. (shrink)

Traditional approaches to character education have been viewed by many educators as an attempt to establish self control within students to habituate them to prescribed behaviour and as nothing more than a ‘bits‐and‐pieces’ approach to moral education. While this is accurate for many character education programmes, integrated multi‐dimensional character education embraces both moral education and character formation. Students learn to identify and process social conventions within the core values of the school and community and have opportunities to learn practical reasoning (...) skills in schools where character education is integrated into all aspects of the schooling process. Reported in this article are several studies, including two large‐scale experimental investigations, that show integrated character education results in an improved school environment, student pro‐social and moral behaviour, and reading and maths test scores. Schools become more caring communities; student discipline referrals drop significantly, particularly in areas related to bullying behaviour; and test scores in moderately achieving schools increase nearly 50%. (shrink)

Revisionists and traditionalists appeal to Acts 15, welcoming the Gentiles, for analogies directing the church's response to homosexual persons. John Perry has analyzed the major positions. He faults revisionists for inadequate attention to the Jerusalem Decree and faults one traditionalist for using the Decree literally rather than through analogy. I argue that analogical use of the Decree must supplement rather than displace the plain sense. The Decree has been neglected due to assumptions that Paul opposed it, that it expired, or (...) because Gentiles wanted non-kosher meat. I argue that Paul continued to observe the Torah and supported the Decree, that it has not expired, and that Gentile desire for non-kosher meat is not a firm obstacle. Affirming the plain sense of the Decree, I develop the analogy from Acts 15 to homosexual persons. One strand of the church's conversation about homosexuality compares present-day acceptance of homosexuals to the church's acceptance of Gentiles in Acts 15. In a previous article, "Gentiles and Homosexuals," I presented the history of that strand. In a reply to my article, Olson proposes to reimagine the analogy via the "radical new perspective on Paul" and argues that doing so exposes problems with my original analysis. I defend myself against these criticisms, while also entering into the spirit of Olson's reimagined analogy. Expanding the scope beyond Acts to Paul opens up important facets that might otherwise be obscured. In particular, it includes voices that are sometimes silenced, and presses both sides for an account of sexuality grounded in vocation and God's purposes in creation. (shrink)

We reflect on Dr. Iserson’s article in this journal, in which he suggests that clinicians must “shove” patients towards appropriate care. While recognizing that overt clinical guidance is part of care, we suggest that its use should be tempered by the guidance’s responsiveness to the human and emotional experience of each patient.

Disruptions in dopamine transmission within the basal ganglia (BG) produce deficits in voluntary actions, that is, in the interface between cortically-generated goal representation and BG-mediated response selection. Under conditions of dopamine loss in humans and other animals, responses are impaired when they require internal generation, but are relatively intact when elicited by external stimuli.

Volume 20, Issue 4, May 2020, Page 76-78.

We agree with Lynch et al. that patients with chronic diseases and Band-Aid treatments are unlikely to benefit from a version of Operation Warp Speed or by deprioritizing standards of scientific ev...

Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious issues such as abortion and euthanasia. It is readily apparent that bioethics discourse lacks an empirical explanation for the broad differences about various topics in bioethics and health policy. In recent years, social and cognitive psychology has generated novel approaches for defining basic differences in moral (...) intuitions generally. We propose that if empirical research using social intuitionist theory explains why people disagree with one another over moral issues, then the results of such research might help people debate their moral differences in a more constructive and civil manner. We illustrate the utility of social intuitionism with data from a national physician survey. (shrink)

Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.

Obtaining informed consent is a cornerstone of biomedical research, yet participants comprehension of presented information is often low. The most effective interventions to improve understanding rates have not been identified.

Purpose: to characterize ethics course content, structure, resources, pedagogic methods, and opinions among academic administrators and course directors at U.S. medical schools. Method: An online questionnaire addressed to academic deans and ethics course directors identified by medical school websites was emailed to 157 Association of American Medical Colleges member medical schools in two successive waves in early 2022. Descriptive statistics were utilized to summarize responses. Results: Representatives from 61 (39%) schools responded. Thirty-two (52%) respondents were course directors; 26 (43%) were (...) deans of academic affairs, medical education, or curriculum; and 3 with other roles also completed the survey (5%). All 61 schools reported some form of formal ethics education during the first year of medical school, with most (n = 54, 89%) reporting a formal mandatory introductory course during preclinical education. Schools primarily utilized lecture and small-group teaching methods. Knowledge-based examinations, attendance, and participation were most commonly used for assessment. A large majority regarded ethics as equally or more important than other foundational courses, but fewer (n = 37, 60%) provided faculty training for teaching ethics. Conclusions: Despite a response rate of 39 percent, the authors conclude that medical schools include ethics in their curricula in small-group and lecture formats with heterogeneity regarding content taught. Preclinical curricular redesigns must innovate and implement best practices for ensuring sound delivery of ethics content in future curricula. Additional large-scale research is necessary to determine said best practices. (shrink)

Previous research (Kielbasa, Pomerantz, Krohn, & Sullivan, 2004; Pomerantz & Segrist, 2006) indicates that when psychologists consider a client with symptoms of depression or anxiety, payment method significantly influences diagnostic decisions. This study extends the scope of the previous research to consider clients with symptoms of social phobia and attention deficit hyperactivity disorder (ADHD). Psychologists in independent practice responded to vignettes of clients whose descriptions deliberately included subclinical impairment. Half of the participants were told that the clients would pay via (...) managed care; the other half were told that the clients would pay out-of-pocket. Confirming previous studies, payment method had a highly significant impact on diagnosis such that compared to out-of-pocket clients, managed care clients were much more likely to be assigned Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) diagnoses. Ethical implications relate to informed consent, accuracy and truthfulness in diagnosis, and psychologists' integrity. (shrink)

_Kant and Applied Ethics_ makes an important contribution to Kant scholarship, illuminating the vital moral parameters of key ethical debates. Offers a critical analysis of Kant’s ethics, interrogating the theoretical bases of his theory and evaluating their strengths and weaknesses Examines the controversies surrounding the most important ethical discussions taking place today, including abortion, the death penalty, and same-sex marriage Joins innovative thinkers in contemporary Kantian scholarship, including Christine Korsgaard, Allen Wood, and Barbara Herman, in taking Kant’s philosophy in new (...) and interesting directions Clarifies Kant’s legacy for applied ethics, helping us to understand how these debates have been structured historically and providing us with the philosophical tools to address them. (shrink)

When examined critically, Kant's views on sex and marriage give us the tools to defend same-sex marriage on moral grounds. The sexual objectification of one's partner can only be overcome when two people take responsibility for one another's overall well-being, and this commitment is enforced through legal coercion. Kant's views on the unnaturalness of homosexuality do not stand up to scrutiny, and he cannot (as he often tries to) restrict the purpose of sex to procreation. Kant himself rules out marriage (...) only when the partners cannot give themselves to one another equally – that is, if there is inequality of exchange. Because same-sex marriage would be between equals and would allow homosexuals to express their desire in a morally appropriate way, it ought to be legalized. (shrink)

This chapter contains sections titled: Sex Is Morally Problematic Sex Is (Conditionally) Good Exchanging Ourselves: Marriage in the Moralphilosophie Collins Kant and Political Liberalism Transforming Ourselves into Husbands and Wives: Marriage in the Metaphysics of Morals Is Something Wrong Because It Is Unnatural? Pleasure as an End of Nature Marital Equality as a Criterion of Legitimacy How the Same‐Sex Marriage Debate Should Proceed.

This chapter contains sections titled: The Moral Duty to Assist Others in Their Health Care Health Care Should Be Provided by the Government The Duty to Provide Truly Universal Health Care Rejecting the Liberal Model.

This chapter contains sections titled: Kant's Logocentrism Kant's Justification for Our Duties (with Regard) to Nonrational Animals Implications of Kant's View for Our Treatment of Animals Kantians Revising Kant: Wood and Korsgaard Problems with Wood and Korsgaard Kant's Response to Wolff: The Difference between Animal Choice and Moral Agency Evaluating Pain and Pleasure Kant's Practical Appeal Final Thoughts for the Nonanthropocentrist.

This chapter contains sections titled: The Ancient Practice of Abortion, and Continuing Controversies Universalized Maxims Are Not Retroactive The Formula of Humanity: Appealing to Personhood Thomson and Boonin: The Personhood of the Fetus Does Not Matter The Elements of Personhood: Self‐Consciousness, Humanity, Responsibility An Attempt to Bring Fetuses into Kant's Moral Community: The Appeal to Kind Another Common Strategy: The Argument from Potential Do We Have Indirect Duties to Fetuses? No Fetuses, No Children The Need for a Pragmatic Concept of (...) Personhood The Specter of Infanticide Kant's Appeal to God Problematic Implications of the Appeal to Personhood Our Kantian Heritage: Trouble with Those at the Margins of Personhood. (shrink)

This chapter contains sections titled: The Purpose of Marriage Consent and Coercion Mail‐Order Marriages as the Kantian Ideal Treating Mail‐Order Brides Merely as Means Attempts to Criticize Mail‐Order Marriages from a Kantian Perspective Are Mail‐Order Brides Coerced? Questioning the a priori Basis of Kant's Ethics Notes toward a Genealogy of Kantianism.

This chapter contains sections titled: How Kant Answers Hegel's Formalism Charge Basic Principles versus Particular Duties: Kant and Rawls What Is My Obligation to Reduce Poverty? Social Contexts Specify the Content of Maxims Herman's Rules of Moral Salience The Humanity of Others Is Not Simply Given Developing Moral Judgment: The Case of Kant Himself The Return of Hegel.

This chapter contains sections titled: Natural Purposiveness in the Critique of Judgment Furthering Nature's Purposes: The Stewardship Model The Value of Nature for Humanity Considering Future Generations Beauty as a Symbol of Morality Preserving the Sublime Developing Kantian Virtues Norton's Convergence Hypothesis and Light's Practical Pluralism The Appeal to Common Sense Kant's Place in the Debate over Environmental Policy.

This chapter contains sections titled: The Difference between Morality and Legality Retribution and the Death Penalty Consenting to Capital Punishment Determining the “Inner Wickedness” of the Accused The Fallibility of Justice Capital Punishment Cannot Be Categorically Demanded of Us A Moral Assessment of the Supposed Duty to Kill Do These Objections Rule Out All Punishments? Whose Dignity Is at Stake?

This chapter contains sections titled: Decision‐Making Procedures and Maxims in Corporate Settings The Need for Collective Responsibility in Business Ethics Applying the Categorical Imperative to Businesses Kant's Account of Moral Agency and the Categorical Imperative Must We Never Treat a Business Merely as a Means? Corporate Policies and Individual Agents Bowie's Defense of Collective Responsibility, and the Need for an Alternative Personal Responsibility within the Corporation The Choice Facing Business Ethicists: Kant or Collective Responsibility?

This chapter contains sections titled: Physician‐Assisted Suicide Refusing Life‐Saving Medical Treatment Organ Donation: Opt‐in or Opt‐out? Autonomy and the Body.

Most ethics guidelines for distributing scarce medical resources during the coronavirus pandemic seek to save the most lives and the most life‐years. A patient’s prognosis is determined using a SOFA or MSOFA score to measure likelihood of survival to discharge, as well as a consideration of relevant comorbidities and their effects on likelihood of survival up to one or five years. Although some guidelines use age as a tiebreaker when two patients’ prognoses are identical, others refuse to consider age for (...) fear of discriminating against the elderly. In this paper, I argue that age is directly relevant for maximizing health benefits, so current ethics guidelines are wrongly excluding or deemphasizing life‐stage in their triage algorithms. Research on COVID‐19 has shown that age is a risk factor in adverse outcomes, independent of comorbidities. And limiting a consideration of life‐years to only one or five years past discharge does not maximize health benefits. Therefore, based on their own stated values, triage algorithms for coronavirus patients ought to include life‐stage as a primary consideration, along with the SOFA score and comorbidities, rather than excluding it or using it merely as a tiebreaker. This is not discriminatory because patients ought to have equal opportunity to experience life‐stages. The equitable enforcement of that right justifies unequal treatment based on age in cases when there is a scarcity of life‐saving resources. A consideration of life‐stage would thus allow healthcare workers to responsibly steward public resources in order to maximize lives and life‐years saved. (shrink)

Kant is gaining popularity in business ethics because the categorical imperative rules out actions such as deceptive advertising and exploitative working conditions, both of which treat people merely as means to an end. However, those who apply Kant in this way often hold businesses themselves morally accountable, and this conception of collective responsibility contradicts the kind of moral agency that underlies Kant's ethics. A business has neither inclinations nor the capacity to reason, so it lacks the conditions necessary for constraint (...) by the moral law. Instead, corporate policies ought to be understood as analogous to legal constraints. They may encourage or discourage certain actions, but they cannot determine a person's maxim - which for Kant is the focus of moral judgment. Because there is no collective intention apart from any intentions of the individual agents who act as members of the corporation, an organization itself has no moral obligations. This poses a dilemma: either apply the categorical imperative to the actions of particular businesspeople and surrender the notion of collective responsibility, or apply a different moral theory to the actions of businesses themselves. Given the diffusion of responsibility in a bureaucracy, the explanatory usefulness of collective responsibility may force business ethicists to abandon Kant's moral philosophy. (shrink)

This remarkably comprehensive Handbook provides a multifaceted yet carefully crafted investigation into the work of Immanuel Kant, one of the greatest philosophers the world has ever seen. With original contributions from leading international scholars in the field, this authoritative volume first sets Kant’s work in its biographical and historical context. It then proceeds to explain and evaluate his revolutionary work in metaphysics and epistemology, logic, ethics, aesthetics, philosophy of science, philosophy of religion, political philosophy, philosophy of history, philosophy of education, (...) and anthropology. Key Features: • Draws attention to the foundations of Kant’s varied philosophical insights — transcendental idealism, logic, and the bridge between theoretical and practical reason • Considers hitherto neglected topics such as sexuality and the philosophy of education • Explores the immense impact of his ground-breaking work on subsequent intellectual movements Serving as a touchstone for meaningful discussion about Kant’s philosophical and historical importance, this definitive Handbook is essential reading for Kant scholars who want to keep abreast of the field and for advanced students wishing to explore the frontiers of the subject. (shrink)

Although Kant defends a cosmopolitan ideal, his philosophy is problematically vague regarding how to achieve it, which lends support to the empty formalism charge. How Kant would respond to the crisis in Syria reveals that judgement plays too central a role, because Kantian principles lead to equally reasonable but opposite conclusions on how to weigh the duty of hospitality to refugees against a state’s duty to its own citizens, the right of prevention towards ISIS against the duty not to harm (...) non-combatants, and the responsibility to protect the people of Syria against the duty of non-interference in its internal affairs. (shrink)

"This book argues for a mixed view of punishment that balances consequentialism and retributivism. He has published extensively on philosophy and applied ethics. A central question in the philosophy of law is why the state's punishment of its own citizens is justified. Traditionally, two theories of punishment have dominated the field: consequentialism and retributivism. According to consequentialism, punishment is justified when it maximizes positive outcomes. According to retributivism, criminals should be punished because they deserve it. This book defends a mixed (...) view that recognizes the strength of both of these intuitions. By this account, the legislature should develop institutional policies and statutory penalties that maintain the social order, that is, consequentialism. It establishes punishment policies to deter criminal activity. By contrast, the criminal judiciary should give individual defendants what they deserve, that is, retributivism and thus expressing the community's appropriate sense of resentment at being wronged. The book justifies the two-tiered model by showing how it accords with our moral intuitions, our assumptions about how what we know affects our moral obligations, and a commonly held theory of freedom. This approach is developed by engaging classic and contemporary work in the philosophy of law, and shows its advantages over competing approaches from contemporary retributivists and other mixed theorists. The work also defends consequentialism against a longstanding objection that the social sciences give us little guidance regarding which policies to adopt. It draws on cutting-edge criminological research to show how punishment theory can help us to address some of our most pressing social issues, including the death penalty, drug laws, and mass incarceration. The book will also be of interest to legal philosophers, social scientists, especially criminologists, sociologists, economists, and political scientists"--. (shrink)

German Idealism was without doubt one of the most fruitful, influential, and exciting periods in the history of philosophy. The Palgrave Handbook of German Idealism covers this revolutionary philosophical movement in remarkable detail and includes contributions from 36 of the leading scholars in the field, including Paul Guyer, Terry Pinkard, Violetta Waibel, Jason Wirth, and Günter Zöller. In his introduction, Matthew Altman investigates the meaning of idealism and sets the historical context. Ensuing chapters then consider the philosophical importance of (...) the movement’s four most important thinkers (Kant, Fichte, Schelling, and Hegel) and explore the areas of philosophy on which they had their greatest impact. A concluding chapter examines the legacy of German Idealism from the nineteenth century to the present day. (shrink)

In his theoretical philosophy, Immanuel Kant argues that experience comes from two sources that are radically different but equally necessary: the rule-governed activity of thinking and the givenness of sensations. He supposes that both could be traced to some common root but concludes that whatever it is, is in principle unknowable. Kant's idealist successors, J.G. Fichte and F.W.J. Schelling, each attempt to provide a unified account of experience by identifying the ultimate basis of subject and object—Fichte by referring to the (...) I's activity and Schelling by referring to the Absolute. Because we can know only appearances, an implication of Kant's transcendental inquiry, Fichte and Schelling have difficulty... (shrink)

Kant claims that animal suffering only matters if it affects us indirectly by making us more callous toward other persons. This seems inconsistent with Kant’s formal moral theory, and it seems to entail that we are morally better off if we remain willfully ignorant of animal suffering. In defense of Kant’s indirect view, I explain how psychological facts should play a role in the application of the categorical imperative. I then give three responses to the objection that Kant encourages willful (...) ignorance. First, supporting practices of animal exploitation facilitates a system that harms workers. Second, moral ignorance as a habit of mind makes us more likely to ignore morally relevant harm to other persons. Third, remaining intentionally ignorant is not in keeping with our capacity for intellectual self-determination. (shrink)

Governing bodies such as the World Anti-Doping Agency (WADA) and the National Collegiate Athletic Association (NCAA) make decisions about which drugs to prohibit athletes from using and the dosage...