Since at least the 1960s, deontic logicians and ethicists have worried about whether there can be normative systems that allow conflicting obligations. Surprisingly, however, little direct attention has been paid to questions about how we may reason with conflicting obligations. In this paper, I present a problem for making sense of reasoning with conflicting obligations and argue that no deontic logic can solve this problem. I then develop an account of reasoning based on the (...) popular idea in ethics that reasons explain obligations and show that it solves this problem. (shrink)

Learning to address moral dilemmas is important for participants on courses in business ethics and corporate social responsibility (CSR). While modern, rule-based ethical theory often provides the normative input here, this has faced criticism in its application. In response, post-modern and Aristotelian perspectives have found favour. This paper follows a similar line, presenting an approach based initially on a critical interpretation of Ross's theory of prima facie duties, which emphasises moral judgement in actual situations. However, the retention of a modern (...) element is suggested, with an invitation to hypothetically universalise detailed proposals for action, following Hare. This further step may reassure students/managers who seek additional closure in their decision-making. Some pedagogical implications are also briefly raised regarding the use of case material and the need to recognise questions of social interaction and personal character as features of dilemma resolution in actual organisational contexts. (shrink)

Barbeyrac's republication of and commentary on Leibniz' attack on Pufendorf's natural-law doctrine is often seen as symptomatic of the failure of all three early moderns to solve a particular moral-philosophical problem: that of the relationship between civil authority and morality. Making use of the first English translation of Barbeyrac's work, this article departs from the usual view by arguing that here we are confronted by three conflicting constructions of civil obligation, arising not from the common intellectual terrain of moral (...) philosophy, but from divergent religious and political cultures. If this approach makes the three constructions less susceptible to theoretical reconciliation, then it opens them to a more revealing historical investigation, in terms of the particular religious and political circumstances in which they arose, and which they were designed to address. The result is that these early modern struggles over the nature of civil obligation confront us again as unfinished historical business. (shrink)

Learning to address moral dilemmas is important for participants on courses in business ethics and corporate social responsibility (CSR). While modern, rule‐based ethical theory often provides the normative input here, this has faced criticism in its application. In response, post‐modern and Aristotelian perspectives have found favour. This paper follows a similar line, presenting an approach based initially on a critical interpretation of Ross's theory of prima facie duties, which emphasises moral judgement in actual situations. However, the retention of a modern (...) element is suggested, with an invitation to hypothetically universalise detailed proposals for action, following Hare. This further step may reassure students/managers who seek additional closure in their decision‐making. Some pedagogical implications are also briefly raised regarding the use of case material and the need to recognise questions of social interaction and personal character as features of dilemma resolution in actual organisational contexts. (shrink)

Tomasello describes how the sense of moral obligation emerges from a shared perspective with collaborative partners and in-group members. Our commentary expands this framework to accommodate multiple social identities, where the normative standards associated with diverse group memberships can often conflict with one another. Reconciling these conflicting obligations is argued to be a central part of human morality.

This paper addresses two questions. First can a binding promise conflict with other binding promises and thereby generate conflicting obligations? Second can binding promises conflict with other non-promissory obligations, so that we are obliged to keep so-called ‘wicked promises’? The answer to both questions is ‘yes’. The discussion examines both ‘natural right’ and ‘social practice’ approaches to promissory obligation and I conclude that neither can explain why we should be unable to make binding promises that conflict with (...) our prior obligations. There is also consideration of the parallel case of ‘wicked commands’. (shrink)

Enormous harms, such as climate change, often occur as the result of large numbers of individuals acting separately. In collective action problems, an individual has so little chance of making a difference to these harms that changing their behavior has insignificant expected utility. Even so, it is intuitive that individuals in many collective action problems should not be parts of groups that cause these great harms. This paper gives an account of when we do and do not have obligations (...) to change our behavior in collective action problems. It also addresses a question insufficiently explored in the literature on this topic: when obligations arising out of collective action problems conflict with other obligations, what should we do? The paper explains how to adjudicate conflicts involving two collective action problems and conflicts involving collective action problems and other sorts of obligations. (shrink)

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

The central dilemma concerning randomized clinical trials (RCTs) arises out of some simple facts about causal methodology (RCTs are the best way to generate the reliable causal knowledge necessary for optimally-informed action) and a prima facie plausible principle concerning how physicians should treat their patients (always do what it is most reasonable to believe will be best for the patient). A number of arguments related to this in the literature are considered. Attempts to avoid the dilemma fail. Appeals to informed (...) consent and mechanisms for minimizing the resulting harm are important for policy, but informed consent is problematic and mechanisms for minimization of harm do not address the dilemma. Appeals to some sort of contract model of justification are promising and illuminating. Keywords: randomized clinical trials, ethics CiteULike Connotea Del.icio.us What's this? (shrink)

There is an emerging awareness of the possibility of conflicts of interest in the practice of medicine in Croatia. The paper examines areas within the medical profession where conflicts of interest can and have occurred, probably not only in Croatia. Particularly addressed are situations when a doctor may have dual obligations and how independent ethics committees can help in decreasing the influence of a conflict of interest. The paper also presents extracts from the Croatian Code of Ethics for the (...) medical profession that address problems of conflict of interest. (shrink)

We show that Carmo and Jones’ condition 5 conflicts with the other conditions on their models for contrary-to-duty obligations. We then propose a resolution to the conflict.

There is an emerging awareness of the possibility of conflicts of interest in the practice of medicine in Croatia. The paper examines areas within the medical profession where conflicts of interest can and have occurred, probably not only in Croatia. Particularly addressed are situations when a doctor may have dual obligations and how independent ethics committees can help in decreasing the influence of a conflict of interest. The paper also presents extracts from the Croatian Code of Ethics for the (...) medical profession that address problems of conflict of interest. (shrink)

Archaeologists employed in governmental positions often deal with issues that produce conflicts between their professional duties to their employer, their ethical responsibilities to the resource, and their obligations as established by legislation. The paper examines some of the conflicts imposed on governmental archaeologists by each of these systems but focuses on the conflicts imposed by federal legislation and regulations on governmental archaeologists, using “Kennewick Man” as an example.

Interactions between medicine and the pharmaceutical and device industries have become widespread in medicine. Despite their promise for improving patient care through innovation, there are ways in which these relationships may compromise patient care by creating conflicts of interest for physicians—both actual and perceived—that may result in delivery of poorly justified treatment, mistrust of doctors by the public, and an undermining of the integrity of the medical profession (IOM 2009). Conflicts of interest can arise in all arenas of medicine, due (...) to discord between the responsibility to patients and the opportunity for personal financial gain. But academic medicine presents an additional interest to protect: .. (shrink)

I address a question in moral metaphysics: How are conflicts between moral obligations possible? I begin by explaining why we cannot give a satisfactory answer to this question simply by positing that such conflicts are conflicts between rules, principles, or reasons. I then develop and defend the “Dispositional Account,” which posits that conflicts between moral obligations are conflicts between the manifestations of obligating dispositions (obligating powers, capacities, etc.), just as conflicts between physical forces are conflicts between the manifestations (...) of (certain) causal dispositions (causal powers, capacities, etc.). This account combines the so-called “moral forces” interpretation of prima facie obligations with a dispositional moral metaphysic according to which the metaphysical grounds of moral obligations are not rules or laws, but rather real, irreducibly dispositional properties (or powers) of moral agents and patients. My principal aims are to offer a theoretically attractive and suitably metaphysical account of conflicts of obligation, and to show that the dispositional moral metaphysic that grounds the Dispositional Account can explain and accommodate plausible normative views that rule- and law-based alternatives cannot, as well as to answer objections that have been pressed against other accounts of moral conflict (especially Ross’s) that appeal to moral dispositions or forces. (shrink)

Morality has two key features: moral judgments are not solely determined by what your group thinks, and moral judgments are often applied to members of other groups as well as your own group. Cooperative motives do not explain how young children reject unfairness, and assert moral obligations, both inside and outside their groups. Resistance and experience with conflicts, alongside cooperation, is key to the emergence and development of moral obligation.

One of the popular albeit controversial ideas in the last century of moral philosophy is that what we ought to do is explained by our reasons. And one of the central features of reasons that accounts for their popularity among normative theorists is that they can conflict. But I argue that the fact that reasons conflict actually also poses two closely related problems for this popular idea in moral philosophy. The first problem is a generalization of a problem in deontic (...) logic concerning the existence of conflicting obligations. The second problem arises from a tension between the fact that reasons can conflict and a model of how reasons explain ‘ought’s that has been widely accepted. Having presented each of these problems, I develop a unified solution to them that is informed by results in both ethics and deontic logic. An important implication of this solution is that we must distinguish between derivative and nonderivative reasons and revise our conception how it is that reasons explain ‘ought’s. (shrink)

Conflicts of interest serve as a cipher for a radical rupture in the Flexnerian paradigm of medicine, and they can only be addressed if we recognize that health care is now practiced by institutions, not just individual physicians. By showing how "appropriate utilization of services" or "that which is medically indicated" is a function of socioeconomic factors related to institutional responsibilities, I point toward an administrative and organizational ethic as a needed component for addressing conflicts of interest. The argument is (...) developed by reviewing three important books. First, I consider Mark Rodwin's attempt to configure the economic structures of medicine so that classical fiduciary and scientific ideals can be fostered. Second, I consider E. Haavi Morreim's attempt to modify the classical ideals in order to account for new economic realities. Finally, by considering essays in a recent volume on conflicts of interest edited by Spece, Shimm, and Buchanan, I argue for a constructive dialectic between the approaches of Rodwin and Morreim. In order to properly address conflicts of interest, there must be a radical reassessment of medicine that accounts for the interrelation between scientific, ethical, and economic concerns. Until institutions come into view and professional ethics is developed to account for their role, legitimate interests and obligations of diverse parties cannot be harmonized. (shrink)

I explore various ways of integrating the framework for predeterminism, agency, and ability in[P.McNamara, Nordic J. Philos. Logic 5 (2)(2000) 135] with a framework for obligations. However,the agential obligation operator explored here is defined in terms of a non-agential yet personal obligation operator and a non-deontic (and non-normal) agency operator. This is contrary to the main current trend, which assumes statements of personal obligation always take agential complements. Instead, I take the basic form to be an agent’s being obligated (...) to be such that p. I sketch some logics for agential obligation based on personal obligation and agency, first in a fairly familiar context that rules out conflicting personal obligations (and derivatively, conflicting agential obligations), and then in contexts that do allow for conflicts (of both sorts). (shrink)

"Guanxi" involves interpersonal obligations, which may conflict with other obligations people have that are based on general or abstract moral considerations. In the West, the latter have been widely accepted as the general source of obligations, which is perhaps tied to social changes associated with the rise of capitalism. Recently, Western ethicists have started to reconsider the extent to which personal relationships may form a distinct basis for obligation. In administration and management, salient bases for decision-Making include (...) deontological, consequentialist and personalist ethics. The first may be reflected in a bureaucratic approach, the second in a price system, and the third in arrangements like "guanxi". Each has positive and negative aspects, but problems arise when they lead to conflicting obligations, as may occur for an office holder who has some obligations based in deontological considerations and others based in personal relationships. This is a type of conflict of interest. Such conflicts have been considered in the West, and remedies proposed. Problems arise especially in cases where it is not clear how to prioritise different obligations, and this has been noted as a difficulty in the Chinese legal system. Questions that need to be answered include not only questions about how to deal with conflicting obligations, but also questions about what institutions to accept as giving rise to obligations. Institutions themselves may be problematic not only because of their consequences for economic productivity, but because they are internally incoherent, and this may be manifested in frequent conflicts faced by office holders. (shrink)

Satisfying one's obligations is an important part of being human. However, people's obligations can often prescribe contradictory behaviors. Moral obligations conflict, and so do obligations to different groups. We propose that a broader framework is needed to account for how people balance different social and moral obligations.

In the United Kingdom (UK), ethical guidance for doctors assumes a therapeutic setting and a normal doctor–patient relationship. However, doctors with dual obligations may not always operate on the basis of these assumptions in all aspects of their role. In this paper, the situation of UK occupational physicians is described, and a set of models to characterise their different practices is proposed. The interaction between doctor and worker in each of these models is compared with the normal doctor–patient relationship, (...) focusing on the different levels of trust required, the possible power imbalance and the fiduciary obligations that apply. This approach highlights discrepancies between what the UK General Medical Council guidance requires and what is required of a doctor in certain roles or functions. It is suggested that using this modelling approach could also help in clarifying the sources of moral conflict for other doctors with “dual obligations” in their various roles. (shrink)

A prevailing issue in clinical research is the duty clinicians have to treat or prevent the progression of disease during a study that they are conducting. While all clinical researchers have a duty of care for the patients who participate in clinical research, intervening at the onset or progression of disease may skew results and have a negative impact on the scientific validity of a study. Extreme examples of failures to intervene can be found in the Tuskegee syphilis study and (...) in an attempt to determine if cervical smears were an accurate predictor of cancer, which was uncovered by the Cartwright Inquiry. However, the issue arises in all research where delay in intervention can cause harm. A current study in Singapore is investigating the significance of an ‘ultra-high risk’ state that may constitute the prodromal phase of psychosis. This project called ‘The Longitudinal Youth at Risk Study’ is potentially contentious because it is recruiting young people who are identified as being ‘at risk’ of developing psychosis. In this paper, the decision to offer treatment to all participants as well as a fast track for those who are assessed to have developed serious mental illness into treatment is discussed. It is argued that this approach is ethically justified because of the duty of care that is owed to research participants, and suggests that the principle of equipoise may be used to guide intervention decisions in other clinical research protocols. (shrink)

Two groups of agents, G1 and G2, face a *moral conflict* if G1 has a moral obligation and G2 has a moral obligation, such that these obligations cannot both be fulfilled. We study moral conflicts using a multi-agent deontic logic devised to represent reasoning about sentences like "In the interest of group F of agents, group G of agents ought to see to it that phi". We provide a formal language and a consequentialist semantics. An illustration of our semantics (...) with an analysis of the Prisoner’s Dilemma follows. Next, necessary and sufficient conditions are given for (1) the possibility that a single group of agents faces a moral conflict, for (2) the possibility that two groups of agents face a moral conflict within a single moral code, and for (3) the possibility that two groups of agents face a moral conflict. (shrink)

On Obligations was written by Cicero in late 44 BC after the assassination of Julius Caesar to provide principles of behaviour for aspiring politicians. It explores the apparent tensions between honourable conduct and expediency in public life, and the right and wrong ways of attaining political leadership. The principles of honourable behaviour are based on the Stoic virtues of wisdom, justice, magnanimity, and propriety; in Cicero's view the intrinsically useful is always identical with the honourable. Cicero's famous treatise has (...) played a seminal role in the formation of ethical values in western Christendom. Adopted by the fourth-century Christian humanists, it beame transmuted into the moral code of the high Middle Ages. Thereafter, in the Renaissance from the time of Petrarch, and in the Age of Enlightenment that followed, it was given central prominence in discussion of the government of states. Today, when corruption and conflict in political life are the focus of so much public attention, On Obligations is still the foremost guide to good conduct. (shrink)

ABSTRACT: So far in this book, we have examined algorithmic decision systems from three autonomy-based perspectives: in terms of what we owe autonomous agents (chapters 3 and 4), in terms of the conditions required for people to act autonomously (chapters 5 and 6), and in terms of the responsibilities of agents (chapter 7). -/- In this chapter we turn to the ways in which autonomy underwrites democratic governance. Political authority, which is to say the ability of a government to exercise (...) power, may be justifiable or not. Whether it is justified and how it can come to be justified is a question of political legitimacy. Political legitimacy is another way in which autonomy and responsibility are linked. This relationship is the basis of the current chapter, and it is important in understanding the moral salience of algorithmic systems. We will draw the connection as follows. We begin, in section 8.1, by describing two uses of technology: crime predicting technology used to drive policing practices and social media technology used to influence elections (including by Cambridge Analytica and by the Internet Research Agency). In section 8.2 we consider several views of legitimacy and argue for a hybrid version of normative legitimacy based on one recently offered by Fabienne Peter. In section 8.3 we will explain that the connection between political legitimacy and autonomy is that legitimacy is grounded in legitimating processes, which are in turn based on autonomy. Algorithmic systems—among them PredPol and the Cambridge Analytica-Facebook-Internet Research Agency amalgam—can hinder that legitimation process and conflict with democratic legitimacy, as we argue in section 8.4. We will conclude by returning to several cases that serve as through-lines to the book: Loomis, Wagner, and Houston Schools. -/- The link below is to an open-access copy of the chapter. (shrink)

Powerful emotion and pursuit of self-interest have many times led people to break the law with the belief that they are doing so with sound moral reasons. This study is a comprehensive philosophical and legal analysis of the gray area in which the foundations of law and morality clash. This objective book views these oblique circumstances from two perspectives: that of the person who faces a possible conflict between the claims of morality and law and must choose whether or not (...) to obey the penal code; and that of the people who make and uphold laws and must decide whether to treat someone with a moral claim to disobey differently from ordinary lawbreakers. In examining the extent of the obligations owed by citizens to their government, Greenawalt concentrates on the possible existence of a single source of obligation that reaches all citizens and all laws. He also discusses techniques of amelioration of punishment for conscientious lawbreakers, asking how far legal systems should go to accomodate individuals who break the law for reason of conscience. Drawing from numerous examples of conflicts between law and morality, Greenawalt illustrates in detail the positions and predicaments of potential lawbreakers and lawmakers alike. (shrink)

"Guanxi" involves interpersonal obligations, which may conflict with other obligations people have that are based on general or abstract moral considerations. In the West, the latter have been widely accepted as the general source of obligations, which is perhaps tied to social changes associated with the rise of capitalism. Recently, Western ethicists have started to reconsider the extent to which personal relationships may form a distinct basis for obligation. In administration and management, salient bases for decision-Making include (...) deontological, consequentialist and personalist ethics. The first may be reflected in a bureaucratic approach, the second in a price system, and the third in arrangements like "guanxi". Each has positive and negative aspects, but problems arise when they lead to conflicting obligations, as may occur for an office holder who has some obligations based in deontological considerations and others based in personal relationships. This is a type of conflict of interest. Such conflicts have been considered in the West, and remedies proposed. Problems arise especially in cases where it is not clear how to prioritise different obligations, and this has been noted as a difficulty in the Chinese legal system. Questions that need to be answered include not only questions about how to deal with conflicting obligations, but also questions about what institutions to accept as giving rise to obligations. Institutions themselves may be problematic not only because of their consequences for economic productivity, but because they are internally incoherent, and this may be manifested in frequent conflicts faced by office holders. (shrink)

The current proxy voting system in the United States has become the subject of considerable controversy. Because institutional investment managers have the authority to vote their clients’ proxies, they have a fiduciary obligation to those clients. Frequently, in an attempt to fulfill that obligation, these institutional investors employ proxy advisory services to manage the thousands of votes they must cast. However, many proxy advisory services have conflicts of interest that inhibit their utility to those seeking to discharge their fiduciary duties. (...) In this article, we describe the current proxy advisory network as an example of how current notions of conflicts of interest fall short when explaining the behavior of an interconnected set of market players whose remit is to act in the best interests of their investors. We discuss what participants in this system should do to bring transparency and accuracy to the proxy advice industry. (shrink)

Formalising deontic concepts, such as obligation, prohibition and permission, is normally carried out in a modal logic with a possible world semantics, in which some worlds are better than others. The main focus in these logics is on inferring logical consequences, for example inferring that the obligation O q is a logical consequence of the obligations O p and O. In this paper we propose a non-modal approach in which obligations are preferred ways of satisfying goals expressed in (...) first-order logic. To say that p is obligatory, but may be violated, resulting in a less than ideal situation s, means that the task is to satisfy the goal p ∨ s, and that models in which p is true are preferred to models in which s is true. Whereas, in modal logic, the preference relation between possible worlds is part of the semantics of the logic, in this non-modal approach, the preference relation between first-order models is external to the logic. Although our main focus is on satisfying goals, we also formulate a notion of logical consequence, which is comparable to the notion of logical consequence in modal deontic logic. In this formalisation, an obligation O p is a logical consequence of goals G, when p is true in all best models of G. We show how this non-modal approach to the treatment of deontic concepts deals with problems of contrary-to-duty obligations and normative conflicts, and argue that the approach is useful for many other applications, including abductive explanations, defeasible reasoning, combinatorial optimisation, and reactive systems of the production system variety. (shrink)

Many of the items that humans consume are produced in ways that involve serious harms to persons. Familiar examples include the harms involved in the extraction and trade of conflict minerals (e.g. coltan, diamonds), the acquisition and import of non- fair trade produce (e.g. coffee, chocolate, bananas, rice), and the manufacture of goods in sweatshops (e.g. clothing, sporting equipment). In addition, consumption of certain goods (significantly fossil fuels and the products of the agricultural industry) involves harm to the environment, to (...) future persons, and to current persons in low-lying and developing countries, by way of their impacts on climate change. When it comes to such large-scale harms, it's easy for the individual to feel helpless. Even if she sincerely wishes things were otherwise, she may wonder what she could possibly do to make them so. In this paper I briefly explore several promising avenues for generating duties in individuals to consume ethically, and develop one in particular: that an individual ought to signal her commitments to others, as a first step in collectivizing to act against unjust global labour practices. (shrink)

Studies of workers in health care and the care of older people disclose tensions that emerge partly from their conflicting obligations. They incur some obligations from the personal relationships they have with clients, but these can be at odds with organizational demands and resource constraints. One implication is the need for policies to recognize the importance of allowing workers some discretion in decison making. Another implication may be that sometimes care workers can meet their obligations to (...) clients only by taking collective action. (shrink)

BackgroundBesides balancing burdens and benefits of intensive care, ethical conflicts in the process of decision-making should also be recognised. This calls for an ethical analysis relevant to clinicians. The aim was to analyse ethically difficult situations in the process of deciding whether a patient is admitted to intensive care unit.MethodsAnalysis using the ‘Dilemma method’ and ‘wide reflective equilibrium’, on ethnographic data of 45 patient cases and 96 stakeholder interviews in six UK hospitals.Ethical analysisFour moral questions and associated value conflicts were (...) identified. Who should have the right to decide whether a patient needs to be reviewed? Conflicting perspectives on safety/security. Does the benefit to the patient of getting the decision right justify the cost to the patient of a delay in making the decision? Preventing longer-term suffering and understanding patient’s values conflicted with preventing short-term suffering and provision of security. To what extent should the intensivist gain others’ input? Professional independence versus a holistic approach to decision-making. Should the intensivist have an ongoing duty of care to patients not admitted to ICU? Short-term versus longer-term duty to protect patient safety. Safety and security were key values at stake in the ethical conflicts identified. The life-threatening nature of the situation meant that the principle of autonomy was overshadowed by the duty to protect patients from harm. The need to fairly balance obligations to the referred patient and to other patients was also recognised.ConclusionProactive decision-making including advance care planning and escalation of treatment decisions may support the inclusion of patient autonomy. However, our analysis invites binary choices, which may not sufficiently reflect reality. This calls for a complementary relational ethics analysis. (shrink)

As an employee, a sports doctor has obligations to their employer, but also professional and widely accepted obligations of a doctor to the patient . The conflict is evident when sports doctors are asked by an athlete to keep personal health information confidential from the coach and team management, and yet both doctor and athlete have employment contracts specifying that such information shall be shared. Recent research in New Zealand shows that despite the presence of an employment contract, (...) there appears to be a wide range of behaviours among sports doctors when an athlete requests that information about them be kept from team management. Many seem willing to honour requests to keep health information about the athlete confidential, thereby being in breach of the employment contract, while others insist on informing team management against the wishes of the athlete. There are a number of potential solutions to this dilemma from forcing doctors to meet their contractual obligations, to limiting the expectations of the employment contract. This paper suggests that at times it may be appropriate to do both, making the position of the doctor clearer and supporting the ability of this group to resist pressure by coaches and management through having a robust code of ethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Conflicts—and Consensus—about Conflicts of Interest in MedicineMatthew K. Wynia and Bette–Jane Crigger*This fascinating collection of essays about individual experiences of conflict of interest leaves little doubt that physicians remain divided about the importance, impact and meaning of conflicts of interest in their work. These essays offer differing views about what conflicts of interest look and feel like “on the ground” and about whether specific conflicts of interest are bad, (...) just a fact of life, or maybe even good.Conflict, Conflict EverywhereThese essays situate conflict of interest in a variety of contexts: the treatment recommendations a physician makes for an individual patient; the relationship between teaching physician and medical student or practicing physician and health care organization; the interaction between academic researchers and industry collaborators or professional bodies and industry supporters. In this, the narratives taken together reflect the scope of concern about conflict of interest in medicine familiar in the literature. In his classic 1993 essay, Dennis Thompson noted that concerns about conflict of interest encompass issues of physician self–referral, risk sharing between physicians and health care institutions, gifts from industry, hospital purchasing practices, as well as sponsored research and research with patients (Thompson 1993). To that list have subsequently been added relationships with industry in medical education at all levels, physicians’ service as consultants to industry or members of industry speakers bureau, and development of clinical practice guidelines (Lo & Fields 2009).That almost none of these essays draw attention to some widely publicized situations of conflict of interest—for example, gifts to physicians or the provision of drug samples—should, we think, be seen more as an artifact of the authors’ varied individual experiences than as a failure by the authors to engage key concerns in the ongoing professional and public debate. It could also be that the authors, asked to submit personal stories, assumed that yet another essay about the ‘traditional’ issues in the conflicts of interest literature would be seen as redundant, routine or even boring. Or, there is the tantalizing possibility that the absence of some of the more familiar conflicts from these narratives is the early fruit of efforts to address these traditional issues through policies governing interactions between physicians and industry promulgated by academic medical centers and health systems, medical specialty societies, and industry.One significant area of concern that has emerged in recent years is conflict of interest in the development of clinical practice guidelines. E.g., Choudry et al. 2002; Sniderrman & Furberg 2009; Guyatt et al. 2010. Although none of the essays in this [End Page 101] collection address it head on, Perlmutter touches on several key issues. His depiction of how an FDA committee process limited the input he was able to provide as an expert, undermined his potential to contribute to the professional dialogue, and raised concerns about the objectivity of the drug approval process echoes concerns about objectivity, the role of expert opinion, and the presence on guideline development panels of individuals with financial interests in the recommendations to be developed that have been explored at some length in the literature, most recently by the Institute of Medicine in reports on evidentiary standards (Eden et al 2011) and principles for guideline development (Graham et al. 2011).Conflict of Interest or Dual Agency?Several essays set out physicians’ experience in navigating situations of diverging expectations. Bierut, for example, reflects on the disjunction between the goals and products of academic researchers and commercial sponsors. She saw herself advancing basic knowledge and was forced to grapple with the reality of sponsors’ goals to advance commercial ends as well. Nagldinne and Mikulec each recall struggles to reconcile their obligation to exercise professional judgment on behalf of patients with the demands of health care organizations focussed also on the bottom line. Cruz–Flores attests to the challenge of making recommendations for care when one is both a practicing clinician and a clinical investigator engaged in research that might offer benefit to a patient for whom there are limited options.Thompson defined conflicts of interest as “a set of conditions in which professional judgment concerning a primary interest (such as a patient’s welfare or the validity of... (shrink)

Bernard Williams’ critique of the morality system, as illustrated in his reading of Aeschylus’ Agamemnon, is intended to show both that real moral conflicts can arise, and that a moral obligation is merely one reason among others and can be defeated by the thick concepts of a shared ethical life. In response, I want to advance two lines of argument. First, when Williams argues that a moral obligation can be the locus of moral conflict, a further step is required to (...) explain why one should feel regret for not acting on a defeated reason. Second, Williams presupposes that, when a conflict is resolved, the conclusive reason will be a thick ethical concept, but there is no compelling justification for that assumption. (shrink)

This chapter contains sections titled: Abortion and Mother‐Fetus Conflict Moral Obligations to the Unborn The Obstetrical Cases: Forced Cesareans Fetal Surgery Conclusion References Further reading.