Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of (...) nudges in this context is morally problematic. It is disrespectful of people's autonomy to take advantage of their cognitive biases since doing so involves bypassing, not engaging, their rational capacities. We conclude that while mandated active choice policies are not problem free—they are coercive, after all—voluntary active choice, opt-in, and opt-out policies are potentially less respectful of people's autonomy since their use of nudges could significantly affect people's decision making. (shrink)

An effective method to increase the number of potential cadaveric organ donors is to make people donors by default with the option to opt out. This non-coercive public policy tool to influence people’s choices is often justified on the basis of the as-judged-by-themselves principle: people are nudged into choosing what they themselves truly want. We review three often hypothesized reasons for why defaults work and argue that the as-judged-by-themselves principle may hold only in two of these cases. We specify further (...) conditions for when the principle can hold in these cases and show that whether those conditions are met is often unclear. We recommend ways to expand nationwide surveys to identify the actual reasons for why defaults work and discuss mandated choice policy as a viable solution to many arising conundrums. (shrink)

Background In the wake of mandates for biomedical research to increase participation by members of historically underrepresented populations, community engagement (CE) has emerged as a key intervention to help achieve this goal.Methods Using interviews, observations, and document analysis, we examine how stakeholders in precision medicine research understand and seek to put into practice ideas about who to engage, how engagement should be conducted, and what engagement is for.Results We find that ad hoc, opportunistic, and instrumental approaches to CE exacted significant (...) consequences for the time and resources devoted to engagement and the ultimate impacts it has on research. Critical differences emerged when engagement and research decisionmaking were integrated with each other versus occurring in parallel, separate parts of the study organization, and whether community members had the ability to determine which issues would be brought to them for consideration or to revise or even veto proposals made upstream based on criteria that mattered to them. CE was understood to have a range of purposes, from instrumentally facilitating recruitment and data collection, to advancing community priorities and concerns, to furthering long-term investments in relationships with and changes in communities. These choices about who to engage, what engagement activities to support, how to solicit and integrate community input into the workflow of the study, and what CE was for were often conditioned upon preexisting perceptions and upstream decisions about study goals, competing priorities, and resource availability.Conclusions Upstream choices about CE and constraints of time and resources cascade into tradeoffs that often culminated in “pantomime community engagement.” This approach can create downstream costs when engagement is experienced as improvised and sporadic. Transformations are needed for CE to be seen as a necessary scientific investment and part of the scientific process. (shrink)

Carol Pateman has said that the public/private distinction is what feminism is all about. I tend to be sceptical about categorical pronouncements of this sort, but this book is a work of feminist political philosophy and the public/private distinction is what it is all about. It is motivated by the belief that we lack a philosophical conception of privacy suitable for a democracy; that feminism has exposed this lack; and that by combining feminist analysis with recent developments in political philosophy, (...) we can meet the philosophical and political need for a distinctively democratic conception of privacy. This book then, is an effort to sketch and defend such a conception of privacy. It aims to show that while some conceptions of privacy are inconsistent with democracy, others are not. Indeed, the book asserts, the belief that privacy can be valuable and that it can justify basic legal rights, is implicit in a democratic conception of persons as free and equal beings, and a democratic conception of politics as the self-governing, or regulating, activity of such individuals. Just as we can and should reject undemocratic conceptions of the suffrage in favour of democratic ones, so the book maintains, we can and must reject undemocratic conceptions of privacy in favour of ones that reflect the moral equality of men and women, and a commitment to democratic forms of government. Democracy is often described as government by and for the people. On such a view, democracy is a political regime which can be contrasted with monarchies or aristocracies on the one hand, or with theocracies and despotisms on the other. By contrast with the former, it is a form of government that views individuals as citizens and as equal members of the agency which authorizes the use of political power. By contrast with the latter, it is a form of government whose purposes and aims are established by the common interests of individuals, conceived as free and equal citizens. It is my contention that there is a plausible and attractive conception of privacy implicit in this view of democracy. Hence, I show that individuals have fundamental interests in privacy because privacy enables them to participate in politics freely and as the equal of others and, beyond that, to lead lives that they can each affirm to be reasonable, valuable and right. As I think that the ideal of democratic government is properly associated with this latter and broader goal, as well as with the former one, I call my account of privacy a democratic conception of privacy to signal its connection to a particular ideal of politics, and to the conception of persons that makes this ideal a convincing and inspiring one. As this is a work of political philosophy, however, no effort is made to address the legal merits of competing accounts of the right to privacy, or to resolve legal dispute about the content and justification of particular constitutional rights in the United States. Thus, while I use Supreme Court decisions and works of legal theory to illustrate and support my arguments, my use of these materials is governed by philosophical concerns and my conclusions, therefore, are strictly of a philosophical, not a legal, nature. The book is divided into four chapters, moving from feminist criticisms of privacy to an engagement with the philosophical literature on privacy and an account of the right to privacy in a democratic society. It proceeds as follows. In Chapter 1, I examine feminist concerns about privacy, through a close reading of the work of Catherine MacKinnon. I argue that MacKinnon persuasively shows that protection for privacy has frequently licensed the coercion and subjection of women, and that her arguments are supported both by feminist scholarship, key Supreme Court decisions, and by familiar conceptions of privacy and equality. However, I argue, these criticisms do not imply that privacy, like slavery, can never be democratic, because wholly inconsistent with the equality of individuals. Rather, feminist criticisms of privacy suggest that privacy, like the suffrage, can be necessary to the equality of women and can have a legitimate and important place in a democratic society. In Chapter 2, I examine the philosophical literature on privacy in light of the need to distinguish democratic from undemocratic accounts of its nature and value. This literature, I show, can help us to provide an account of privacy that is sensitive both to its inegalitarian aspects and to its importance for a democratic commitment to the freedom and equality of women. However, I argue, we cannot embrace current philosophical accounts of privacy uncritically, because to a striking extent they are, themselves, indifferent to the ways that privacy has licensed sexual inequality. Thus, in Chapter 2, I set about interpreting privacy as a moral and political value, in light of the strengths and weaknesses of the philosophical literature on privacy. Their strength is that they show that there are many reasons for caring about privacy, or many ways in which we might define it as a democratic value. Their weakness is that they tend to assume that we must choose amongst these different conceptions of privacy, in order to provide a philosophically cogent account of privacy. This, I show, is a mistake and one that can be remedied by remembering that a commitment to the equality of individuals requires us to acknowledge the reasonable differences in value and interest that may characterize their relations in a democracy. When we do so, I show, it is possible to define privacy in terms of its protection for self-definition, intimacy and confidentiality, without having to choose between the three of them. For individuals may legitimately disagree about the differences between privacy and other values, even while holding that privacy is a distinctive and important democratic good; and they may also disagree about the importance of privacy compared to other goods, such as equality, without denying that self-definition, intimacy and confidentiality can be morally and politically desirable in a democracy. In Chapter 2, therefore, I show that we can provide a philosophically adequate account of what privacy is and why it is valuable without supposing that privacy is always sexually egalitarian, or denying that it has a distinctive place in a democratic conception of value. Chapter 3 then extends this account of privacy, by considering the justification for a legal right to privacy. Just as we cannot provide a democratic conception of privacy without attending to the different, though equally valid, concerns that individuals may have so, I show, we cannot provide a democratic account of privacy rights if we forget that individuals can, quite reasonably, differ in the importance that they attach to privacy. The result, I argue, is that we can distinguish two main reasons for protecting privacy by right in a democracy, the one personal and the other political. Whereas the former emphasizes the importance of self-definition, intimacy and confidentiality to the personal freedom and equality of individuals, the latter emphasizes their importance to their prospects for voluntary and equal participation in the processes of collective choice and deliberation that define a democratic government. These two justifications of privacy rights reflect the fact that in a democracy the personal can be political, as feminists have insisted, but need not be in order to merit protection by right. Indeed, I argue, we can distinguish democratic from undemocratic accounts of the right to privacy in this way: for whilst the former acknowledge the variety of individuals’ interests in personal and collective choice, the latter either collapse the political into the personal, or assume that the legitimate claims of individuals are merely a function of collective needs, interests and values. Neither of these is consistent with familiar assumptions about the nature and justification of democratic institutions and rights, nor can they be reconciled with a commitment to sexual equality. Thus, I conclude, though the fact that there are different justifications for privacy rights in a democracy means that individuals may legitimately disagree over the content and justification of basic rights, it is wrong to confuse democratic debate with moral or conceptual confusion and so, arbitrarily, to truncate our accounts of privacy, equality and democracy. Finally, in Chapter 4, I test and develop these claims by examining the justification for abortion rights in a democracy. I argue that women have legitimate interests in abortion, as well as in bearing children, because they have fundamental, and legitimate, interests in privacy and equality. Although safe and legal abortion is necessary to sexual equality, as feminists claim, I show that we can provide a convincing and democratic account of women’s claims to abortion only if we recognize women’s interests in self-definition, intimacy and confidentiality. This is because women have both personal and political interests in abortion and we will be unable adequately to identify these if we overlook their interests in privacy. Indeed, I show, the difference between democratic and undemocratic solutions to conflict over abortion lies precisely in this: that whereas the former acknowledge the importance of privacy to the personal and political equality of women, the latter overlook or deny this. As a result, the latter license both mandated abortions, although women have legitimate interests in bearing and raising children, and prohibitions on abortion that cannot be reconciled with the freedom and equality of women. That is not to say that abortion is not a politically significant matter, or that we can resolve moral conflict over abortion simply by giving women a legal right to abortion. Neither is the case. However, the chapter shows, in a democracy individuals are entitled to make morally and politically controversial decisions for themselves not simply because this is expedient or useful, but because this is right. To overlook this feature of democracy, I argue, is to make moral and political conflict utterly intractable by democratic means. Thus, while controversy over abortion has been held to show that privacy is an incoherent and undemocratic right, this chapter argues that it shows the reverse: for controversy over abortion makes clear that privacy is essential to democracy, and why this should be so. This overview of the book, I hope, makes clear that its concerns are methodological as well as substantive, and moral as well as political. Thus, its central methodological claim is that we cannot reconcile privacy with the equality of individuals unless we make a deliberate effort to do so. Its central moral and political claims are that privacy is compatible with the equality of individuals, and sufficiently important to the latter that, in a democracy, the privacy of individuals merits legal protection by right. However, this summary of the book also exposes its limitations. Chief amongst these, I fear, is that it provides no sustained discussion of the place of property on a democratic conception of privacy, and that the latter, itself, is rather a broad preliminary sketch than a polished and detailed portrait. I regard these limits on the scope and arguments of the book as limitations, albeit ones that I hope to be able to remedy before too long.However, limited though the book clearly is, I believe that it lays out the essential components of a democratic conception of privacy and that, by analysing and synthesizing several diverse bodies of literature, it may help those who are interested in the relations between privacy, equality and democracy. (shrink)

Presumed consent to organ donation looks increasingly unlikely to be a palatable option for increasing organ procurement in the UK following the publication of the report into events at Alder Hey and elsewhere. Yet, given that the alternative to increasing the number of cadaveric organs available is either to accept a greater number of live donations, or accept that people will continue to die for the want of an organ, public policy makers remain obliged to consider other means of increasing (...) the procurement rate.In this paper, we meet the main objections to mandated choice . We have modified the traditional approach to mandated choice to take into account the force of the objection that mandated donation is preferable, by accepting that people can and do make bad decisions about organ donation and proposing that all accompanying public education and information about cadaveric donation should be directed in favour of donation. (shrink)

This article critically evaluates current developments in marketing fair trade labelled products and "no sweat" manufactured goods, and argues that both the fair trade and ethical trade movements increasingly rely on strategies for bottom-up change, converting consumers "one cup at a time". This individualistic approach, which we call "shopping for a better world", must, we argue, be augmented by more collectivist approaches to affect transformative change. Specifically, we look at the concept of mission-driven organizations pursuing leadership roles in developing affinity (...) relationships to promote fair and ethical trade and developing ethical spaces. Increasingly, a range of organizations are restructuring their operations, so that their mission is reflected in ethical practices throughout their operations, including product sourcing and product sales. First, ethical purchasing policies operated by non-profits and public agencies represent markets through which fair/ethical products reach end consumers. The efforts discussed to create ethical spaces through direct democracy and electoral mandate build on a broad-based affinity with the principles of fair and ethical trade. Second, we explore the potential for "mission-driven" non-profit organiza- tions, such as zoos and aquaria for merging their mission of conservation education with their marketing activities through the operation of their shops and cafes. Interesting initiatives to link the conservation message to food choices is being undertaken by a number of zoos and aquaria, while there is scope for increased linkages in the giftware sold in their shops. (shrink)

While we primarily love individual persons, we also love our work, our homes, our activities and causes. To love is to be engaged in an active concern for the objective well-being—the thriving—of whom and what we love. True love mandates discovering in what that well-being consists and to be engaged in the details of promoting it. Since our loves are diverse, we are often conflicted about the priorities among the obligations they bring. Loving requires constant contextual improvisatory adjustment of (...) priorities among our commitments. Besides delighting in—and being enhanced by—the presence and existence of another person, love requires extended reflection and work. (shrink)

A number of authors criticise opt-out (or ‘deemed consent’) systems for failing to secure valid consent to organ donation. Further, several suggest that mandated choice offers a more ethical alternative. This article responds to criticisms that opt-out does not secure informed consent. If we assume current (low) levels of public awareness, then the explicit consent secured under mandated choice will not be informed either. Conversely, a mandated choice policy might be justifiable if accompanied by (...) a significant public education campaign. However, if this entitles us to assume that members of the public are informed, then an opt-out system would also be justified in the same circumstances. The alleged advantages of mandated choice seem to rest on an unfair comparison, between mandated choice with a public education campaign and an opt-out system without one. While it may be that some countries with opt-out systems should do more to inform their publics, I see no reason to assume that this cannot be done. Indeed, advocates of mandated choice seem committed to thinking it possible to raise awareness. If opt-out systems adopt the same methods, such as writing to every individual, this should also address concerns about whether consent is informed. (shrink)

On January 18, 2011, President Obama signed Executive Order 13563, Improving Regulation and Regulatory Review, which instructs federal regulators to do the following: coordinate their agencies activities to simplify and harmonize rules that may be overlapping, inconsistent, or redundant; determine whether the present and future benefits of a proposed regulation justify its potential costs (including taking into account both quantitative and qualitative factors); increase participation of industry, experts, and the public (“stakeholders”) in the formal rule‐making process; encourage the use of (...) warnings, default rules, disclosure requirements, and provisions of information to the public as an alternative to traditional “command‐and‐control” rule‐making restricting consumer choice; and mandate a government‐wide review of all existing administrative rules to remove outdated regulations. Executive Order 13563 includes a qualitative “values” provision to be considered in the required cost–benefit analysis, which can potentially counteract the alleged regulatory reform rationale of President Obama. Furthermore, in Executive Order 13563, President Obama established a deadline of May 18, 2011, for all executive branch agencies to submit their plans to streamline their rulemaking operations and repeal those “overlapping, inconsistent, or redundant” rules. These two issues, along with complementary regulatory review proposals being discussed in the U.S. Congress, are evaluated in this essay. (shrink)

This paper offers an explanation for subjects’ lack of confidence in vaccines’ safety, which in turn is widely recognized as one of the main determinants of vaccine hesitancy. I argue that among the psychological roots of this lack of confidence there is a kind of intuitive thinking that can be traced back to a specific superstitious belief: the belief that “it is bad luck to tempt fate”. Under certain conditions, subjects perceive the choice to undergo vaccinations as an action (...) that “tempts fate”, and this leads them to overestimate its risks. When an action is perceived as “tempting fate”, indeed, its possible negative outcomes are anticipated as highly aversive, and as such they capture subjects’ imagination, thereby feeling more subjectively probable. This has important consequences for practical pro-vaccine interventions. Part of what makes an action perceived as “tempting fate” is its being free, arbitrary, and departing from one’s typical behavior: insofar as vaccine hesitancy is driven by beliefs about tempting fate, then, we can predict the success of interventions that make vaccinations nearly mandatory, or build vaccination opportunities into health care routines as opt-out, rather than opt-in options, making them closer to something that subjects passively accept rather actively seek. (shrink)

Choice over home care has become an important pillar in the provision of publicly financed long-term care for people of all ages. In many European welfare states, cash-for-care schemes give care recipients greater choice over home care arrangements by allowing them to pay for care provided by acquaintances, friends and even family members. Paying for such informal care, however, is increasingly contested due to growing care needs, rising costs and the perceived need to tighten access to publicly funded (...) care. Citizens in paid care-giving roles are thus pressured to continue their care unpaid or re-divide their care-giving responsibilities with lay ?citizen-carers?. On the basis of a Dutch case study, this article examines how paid family care-givers experience this call for greater self-sufficiency in providing care. An analysis of 25 interviews and 21 letters of complaint revealed that care-givers felt trapped between their desire to derive social status from paid work and their inability to reject or re-divide previously paid care responsibilities. In a society where all citizens are expected to work, care-givers feel that their previously paid care-giving is devalued from a public to a private matter, despite the government's attempts to reframe care as an act of good citizenship. (shrink)

Approximately 62,000 people in this country await organ transplants. Ten years ago the waiting list numbered 16,000. The line gets longer every day. Up to 30% of those waiting in line will die waiting. We face a chronic shortage of organs. While demand for organs steadily increases, the number of cadaveric organ donors remains relatively constant: approximately 4,000 in 1988, and approximately 5,500 in 1997. In response to this environment of scarcity, policymakers have considered initiatives in a number of domains.

In this study, we examine investor and firm response to the California Transparency in Supply Chains Act of 2010. The CTSCA requires large retail and manufacturing firms to disclose efforts to eradicate slavery and human trafficking from their supply chains and is a rare example of mandated corporate social responsibility disclosure. Based on a sample of 105 retail companies subject to the CTSCA, we find a significant negative market reaction to the passing of the CTSCA. Furthermore, we find that (...) the reaction is significantly more negative for larger firms and companies facing greater supply chain risks, suggesting that investors place a negative value on exposure to legitimacy threats in the social domain. With respect to company disclosure response, we document relatively high compliance with the legislation, although we also find that the disclosure response appeared to be more symbolic than substantive in nature. Finally, our analysis indicates that both disclosure choice and disclosure extensiveness were significantly higher for the high-supply chain risk companies, suggesting that the response was influenced by concerns with strategic legitimation. Overall, the limited quality of disclosure suggests that, without additional rules and guidance, mandates alone may not lead to meaningful social disclosure. (shrink)

Recent arguments over whether certain public health interventions should be mandatory raise questions about what counts as a "mandate." A mandate is not the same as a mere recommendation or the standard of practice. At minimum, a mandate should require an active opt-out and there should be some penalty for refusing to abide by it. Over-loose use of the term "mandate" and the easing of opt-out provisions could eventually pose a risk to the gains that truly mandatory public health (...) interventions, such as childhood vaccines, have provided over the last 50 years. Already, confusion about what counts as a mandate, and about what criteria should be used to determine when a public health intervention should be implemented as a mandate, has led to some inappropriate public policy decisions. For instance, by any reasonable criteria, the yearly influenza vaccine should be mandatory for health care workers. To enforce this mandate, those who refuse vaccination should be required to sign a waiver, and patients - especially those at high risk from flu - should be informed when they receive care from unvaccinated practitioners. (shrink)

Organ transplant shortages are ubiquitous in healthcare systems around the world. In response, several commentators have argued for the adoption of an opt-out policy for organ transplantation, whereby individuals would by default be registered as organ donors unless they informed authorities of their desire to opt-out. This may potentially lead to an increase in donation rates. An opt-out system, however, presumes consent even when it is evident that a significant minority are resistant to organ donation. In this article, we defend (...) a mandated choice framework for consent to deceased organ donation. A mandated choice framework, coupled with good public education, would likely increase donation rates. More importantly, however, a mandated choice framework would respect the autonomous preferences of people who do not wish to donate. We focus in particular on the Australian healthcare context, and consider how a mandated choice system could function as an ethical means to increase the organ donation rate in Australia. We make the novel proposal that all individuals who vote at an Australian federal election be required to state their organ donation preferences when voting. (shrink)

Background: Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma. Methods: This qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using (...) a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis. Results: We first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: respecting the patient’s pace and perceived coercion; patient health needs to be first priority; clarity in roles and responsibilities; and the art of communication – between transparency and unchecked information sharing. Discussion: Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings. (shrink)

I critically examine a common liberal egalitarian view about the justification for, and proper content of, mandatory health insurance. This view holds that a mandate is justified because it is the best way to ensure that those in poor health gain health insurance on equitable terms. It also holds that a government should mandate what a representative prudent individual would purchase for themselves if they were placed in fair conditions of choice. I argue that this common justification for a (...) mandate is incomplete. A further reason for mandated insurance is that it helps secure social egalitarian public goods that would be underprovided if insurance were optional. I also argue that rather than mandating what a representative individual would choose for themselves, we should design the mandatory package by appealing to a pluralistic egalitarian view, which cares about improving people’s well-being, reducing unfair inequality, and maintaining egalitarian social relations. (shrink)

Approximately one in three American adults has executed a living will or healthcare declaration stating personal preferences regarding medical treatment in the event that he or she becomes terminally ill and unable to communicate. This figure stands in striking contrast to the 90% of Americans who, when asked, express specific wishes regarding their choice of care under such circumstances. Congress attempted to increase the number of Americans with advance directives when it passed the Patient Self Determination Act in 1990, (...) billed at the time as the “Miranda Warning” of medicine, which requires hospitals and nursing homes receiving federal funds both to inform patients of their right to refuse life-sustaining care and to record all written directive in patients’ charts. (shrink)

This article argues that the Supreme Court should not require a religious exemption from vaccine mandates. For children, who cannot yet make autonomous religious decision, religious exemptions would allow parents to make a choice that puts the child at risk and makes the shared environment of the school unsafe — risking other people’s children. For adults, there are still good reasons not to require a religious exemption, since vaccines mandates are adopted for public health reasons, not to target religion, (...) are an area where free riding is a real risk, no religion actually prohibits vaccinating under a mandate, and policing religious exemptions is very difficult. (shrink)

Many philosophers maintain that there is a distinction between acts that the agent plays an active role in producing, and acts that issue from the agent in a more passive fashion. According to the standard account, we can make sense of this distinction by maintaining that reflective or deliberative acts are paradigmatic cases of an agent’s playing an active role in the production of action. This chapter argues that this standard account is mistaken. Reflective or deliberative actions will (...) seem to be active only if we conflate three claims: that choice causes action, that motives do not determine choice, and that reflection suspends the effects of motives. The chapter argues that while and are true, is false. Further, is needed to support the claim that reflective acts are active. Given the falsity of, the chapter shows that reflective acts are not necessarily more active than unreflective ones. The chapter closes by suggesting a new model of agential activity. (shrink)

Contemporary discussions of the positive relation between rational choice and moral theory are a special case of a much older tradition that seeks to show that mutual agreement upon certain moral rules works to the mutual advantage, or in the interests, of those who so agree. I make a few remarks about the history of discussions of the connection between morality and self-interest, after which I argue that the modern theory of rational choice can be naturally understood as (...) a continuation of this older tradition. I then go on to argue for a controversial three-fold thesis: (1) that grounding a theory of morality in terms of rational self-interest is the only epistemologically respectable way to proceed with the justification of moral principles; (2) that despite this, most of the contemporary explorations of rational choice foundations for moral principles do not work—that the models of rational choice to which they appeal yield less than the substantial results that they are intended to yield; but (3) that if one rethinks just what it means to be rational, one can find in fact a promising way to connect the two—specifically through the development of a theory of genuinely cooperative activity. (shrink)

What is citizenship? -- What are choices? -- Choosing to think for yourself -- Choosing to say no -- Choosing to be friendly -- Choosing to be fair -- Choosing what to eat -- Choosing to spend or save money -- Choosing entertainment -- Choosing to be active -- Choosing to follow the rules -- Choosing to tell the truth -- Making choices and happiness.

This paper explores the relationship of various trait emotions to the ethical choices of 189 college students who completed a managerial decision-making task as part of an in-basket exercise in a laboratory setting. Prior research regarding emotion influences on ethical decision-making and linkages between emotions and cognition informed hypotheses about how different types of emotions impact ethical choices. Findings supported our expectations that positive and negative emotions classified as active would be more strongly related to interpersonally-directed ethical choices than (...) to organizationally-directed ones, and that passive emotions would be less related to ethical choices than active emotions. Implications for ethical decision-making research and organizational practices are discussed. (shrink)

In a task requiring speeded bidirectional responses to arrow symbols , “free choice” responses to interspersed bidirectional stimuli are influenced by masked directional primes . By varying stimulus–response compatibility, we tested whether this priming effect is mediated by the conscious instructional set, or instead by pre-existing directional associations to the symbols. In two experiments, one group of participants was instructed to respond with the hand consistent with the implied direction of the arrow symbols, while another group was instructed to (...) make the spatially opposite responses. Both groups showed priming of “free choice” responses. However, such priming was always biased according to the instructional set rather than pre-existing associations. Subliminal priming of “free choice” responses therefore depends on conscious task goals. (shrink)

Learner Voice, Learner Choice offers fresh, forward-thinking supports for teachers creating an empowered, student-centered classroom. Learner agency is a major topic in today's schools, but what does it mean in practice, and how do these practices give students skills and opportunities they will need to thrive as citizens, parents, and workers in our ever-shifting climate? Showcasing authentic activities and classrooms, this book is full of diverse instructional experiences that will motivate your students to take an agile, adaptable role in (...) their own learning. This wealth of pedagogical ideas-from specific to open-ended, low-tech to digital, self-expressive to collaborative, creative to critical-will help you discover the transformative effects of providing students with ownership, agency, and choice in their learning journeys. (shrink)

Health ethics can justify the use of vaccination mandates. However, policies that pressurize parents to vaccinate their children can undermine traditional clinical ethics standards. The aim of this paper is to argue that the ethical impact of vaccination mandates can only be determined in the context of the clinical encounter. Public debate on the topic tends to be general in nature and, as a result, issues that require clarification to help sustain the trust of service users are underexamined. In addition, (...) ethical debates are hampered by a toxic dichotomy in the public sphere between those who claim a move away from parental choice is necessarily a serious ethical violation; and others who neglect serious consideration of ethical issues. This predicament permits flawed ethical claims to be made, and to remain unchallenged. Despite this, ethical concerns – including those relating to trust and individual freedom – are fundamental to sustaining confidence in vaccination. This has recently been highlighted by the Covid-19 pandemic which made accessing childhood vaccinations harder, leading to a further decline in uptake. The pandemic has also revealed the strength of public feeling towards infection control measures that restrict peoples’ freedoms. In this paper I argue that to minimize the ethical disruption associated with the use of vaccination mandates, it is essential to focus more attention on their impact in the clinic and to accurately identify the drivers of such tensions. (shrink)

It is customary to think that Objective List (“OL), Desire-Satisfaction (“D-S”) and Hedonistic (“HED”) theories of prudential value pretty much cover the waterfront, and that those of the three that are “subjective” are naturalistic (in the sense attacked by Moore, Ross and Ewing), while those that are “objective” must be Platonic, Aristotelian or commit the naturalist fallacy. I here argue for a theory that is both naturalistic (because voluntaristic) and objective but neither Platonic, Aristotelian, nor (I hope) fallacious. In addition, (...) this proposal, called “CHOICE,” is an example of neither an OL, D-S, nor HED theory. It is a theory according to which uncoerced choosings create objective values that we (even everyone) may be wrong about, because valuations are conative rather than epistemic activities. On this view, intrinsic prudential goods necessarily involve likely (pursuant to lawlike regularities) net increases in successful free choosings . (shrink)

The emergence of personal assistants in the form of smart speakers has begun to significantly alter people’s everyday experiences with technology. The rate at which household Intelligent Personal Assistants such as Amazon’s Echo and Google Home emerged in household spaces has been rapid. They have begun to move human–computer interaction from text-based to voice-activated input, offering a multiplicity of features through speech. The supporting infrastructure connects with artificial intelligence and the internet of things, allowing digital interfaces with domestic appliances, lighting (...) systems, thermostats, media devices and more. Yet this also constitutes a significant new production of situated and sensitive data. This study focuses on how users negotiate and make choices about household Intelligent Personal Assistant use in connection with their data. This study is based on empirical research in Europe with early adopters in Germany and potential users in the Netherlands. This examination of users’ early stage technology acceptance considerations highlights particular practices and choices of users to either preserve their privacy or determine what is acceptable use for their data. Drawing on a simplified version of Unified Theory of Acceptance and Use of Technology 2, a quantitative model for technology acceptance, we demonstrate how acceptance of a household Intelligent Personal Assistants does not imply access to all household data, how users see usefulness in relation to a proliferation of devices, and note the recognition by users regarding the efforts needed for full use and acceptance. The study highlights the complexity of data production at a household level and how these devices produce myopic views of users for platforms. (shrink)

This paper contributes to the semantic typology of dependent indefinites, by accounting for the distribution and interpretation of the Romanian indefinite vreun. It is shown that its occurrences are restricted to negative polarity and a subset of modal contexts. More specifically, the study of its behavior in intensional environments reveals that vreun is systematically incompatible with non-epistemic operators, a restriction we capture by proposing a novel empirical generalization (‘the epistemic constraint’). To account for the observed pattern, we adopt the unitary (...) approach to polarity in Chierchia (Logic in Grammar: polarity, free choice and intervention, 2013a; in: Fălăuş (ed.) Alternatives in semantics, 2013b) and derive the properties of vreun from its obligatory association with alternatives. Its distributional restrictions are argued to follow from the interplay between the types of alternatives it activates (scalar and subdomain alternatives), the way these alternatives are factored into meaning (via an independently motivated mechanism of exhaustification) and the lexical semantics of the operators in the context of occurrence. We propose that the epistemic constraint arises from the lexicalization of an inference (anti-total variation) that non-epistemic operators can never satisfy. (shrink)

This Ideas and Opinions article revisits an argument from Judith Jarvis Thomson in her essay “A Defense of Abortion” that abortion can be an ethical choice even if we assume that fetuses have full moral personhood and moral rights. The authors examine the implications of laws that require a pregnant person to care for another with their body and what other impositions states may also require of citizens to care for others.

The problem of free will lies at the heart of modern scientific studies of consciousness. An influential series of experiments by Libet has suggested that conscious intentions arise as a result of brain activity. This contrasts with traditional concepts of free will, in which the mind controls the body. A more recent study by Haggard and Eimer has further examined the relation between intention and brain processes, concluding that conscious awareness of intention is linked to the choice or selection (...) of a specific action, and not to the earliest initiation of action processes. The exchange of views in this paper further explores the relation between conscious intention and brain activity. (shrink)

The Catholic Church proscribes methods of birth control other than sexual abstinence. Although the U.S. Food and Drug Administration (FDA) recognizes abstinence as an acceptable method of birth control in research studies, some pharmaceutical companies mandate the use of artificial contraceptive techniques to avoid pregnancy as a condition for participation in their studies. These requirements are unacceptable at Catholic health care institutions, leading to conflicts among institutional review boards, clinical investigators, and sponsors. Subjects may feel coerced by such mandates to (...) adopt contraceptive techniques inconsistent with their personal situation and beliefs; women committed to celibacy or who engage exclusively in non-heterosexual activities are negatively impacted. We propose principles to insure informed consent to safeguard the rights of research subjects at Catholic institutions while mitigating this ethical conflict. At the same time, our proposal respects the interests of pharmaceutical research agencies and Catholic moral precepts, and fully abides by regulatory guidance. (shrink)

This article examines field studies of nursing work published in the English language between 1993 and 2003 as the first step towards an empirically based reformulation of the nursing mandate. A decade of ethnographic research reveals that, contrary to contemporary theories which promote an image of nursing work centred on individualised unmediated caring relationships, in real‐life practice the core nursing contribution is that of the healthcare mediator. Eight bundles of activity that comprise this intermediary role are described utilising evidence from (...) the literature. The mismatch between nursing's culture and ideals and the structure and constraints of the work setting is a chronic source of practitioner dissatisfaction. It is argued that the profession has little to gain by pursuing an agenda of holistic patient care centred on emotional intimacy and that an alternative occupational mandate focused on the healthcare mediator function might make for more humane health services and a more viable professional future. (shrink)

There is a long-standing philosophical discussion about the relationship between love and choice. The most simplistic versions see love as something one “falls” into, without any choice at all. A more sophisticated account of love would accommodate some degree of indirect choice: I feel an initial interest, and choose to seek her out more. I can also choose to create and sustain the conditions that support love, for example, by avoiding infidelity and long commutes. However, such indirect (...) choices are relatively discrete or time-limited. In contrast, I want to explore a more temporally extended kind of choice, which starts when I take responsibility for the other. This is an attitude involving a prospective commitment, an achievement of the imagination, and an active concern. I argue that one essential requirement of longer-term adult romantic and friendly love is precisely that the lover takes responsibility for meeting the beloved’s unpredictable and possibly onerous needs in the future. (shrink)

Background Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. -/- Purpose To attend to the activity and dispositions of the public health staff who provide “waiver education”. -/- Method This study reports results of focus group interviews (...) with 39 of Michigan's vaccine waiver educators (37 nurses), conducted during 2016 and 2017, and analyzed in 2018. -/- Findings Four themes emerged from analysis of the transcripts of these interviews: Participants had (1) complex and nuanced observations and evaluations of parents' judgments and feelings about vaccines and vaccine education; (2) sympathetic attitudes about alternative vaccine schedules; (3) critical and supportive evaluations of institutional policies and the background political context of immunization education; and (4) consistent commitments to respect parents, affirm their values, and protect their rights. Discussion These results show that public health nurses are sensitive to the burdens mandatory immunization education places on families, the motivations for parents' requests for nonmedical exemptions, and the values implicated by personal immunization decisions and government immunization policies. In light of the unique training, experiences, and public reputation of nurses, there is good reason for additional investigation into the roles that nurses can play in immunization education and in vaccine mandate policies, more generally. (shrink)

Representing moral choice as a function of rational choice is carried out by formalizing moral evaluation into a functional mechanism called "Moral Choice Function" whose domain is information on a state of affairs and range is a moral judgment, and upon which formal and substantive requirements are imposed. The notions such as impartiality, universalizability, proportionality, and informational invariance are employed for the issue of how to solve conflict of values faced by an individual as well as collective (...) moral agent. By utilizing the structural affinity with post-Arrovian social choice theory, it is shown that inter-attribute commensurability is indispensable for any serious moral agent who wants to solve conflict of values through pluralistic maximizing. It is also shown that once the morally relevant attributes are identified, formal requirements are powerful enough to qualify the function to behave in a certain way such that the formulas for pluralistic maximizing vary with the modes of inter-attribute commensurability. It is also shown how it is still possible to manage conflict of values rationally without value commensurability by interpreting John Rawls's theory of justice as neo-Kantian in dealing with conflicting desiderata from Kantian deontology and utilitarian consequentialism. The metaethical tenets for the project are also argued for such that it is neutral about the ontological status of morality; but it is anti-Humean with its supervenience thesis, anti-Moorean with its reducibility thesis, and anti-naturalist with its syntheticity thesis. It is also argued that behind the project there lies a fundamental metaphysical conception of an entity as a bundle of properties conjoined with epistemic foundationalism, which is evidenced not only in moral evaluation but also in other kinds of cognitive activity. (shrink)

This study provides evidence on the governance of CSR policies and activities by Indian central government-owned companies [i.e. Central Public Sector Enterprises ] within a unique mandatory regulatory setting. We utilise the multi-level ‘Logic of governance’ conceptual framework and draw upon interview data collected from 25 senior managers in 21 CPSEs to assess the dynamics of CSR implementation within CPSEs. Our findings indicate most managers believe that a mandatory policy has enhanced the accountability and commitment of governing boards and senior (...) management to CSR. However, CSR policy implementation within Indian CPSEs is still nascent, fraught with bureaucratic hurdles, insufficient human and knowledge resources, limited stakeholder analysis and over-emphasis on CSR budget utilisation as an outcome. Several key areas for improvements include the need for better translation of national CSR policy goals to firm-level strategies, more formal assessment of stakeholder needs, clearer communication lines with external service providers, such as NGOs and local government agencies, and the better evaluation of CSR outcomes. The findings of this study have implications for both theory and policy development. (shrink)

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric‐driven competency‐based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper‐focus on “figuring out” the teacher (...) with minimal focus on the act of writing. Students used a form of behavioral “code‐switching” to maximize their grade while considering how their “valuing” of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment. (shrink)

Many “anti-vaxxers” oppose COVID-19 vaccination mandates on the grounds that they wrongfully infringe on bodily autonomy. Their view has been expressed with the slogan “My Body, My Choice,” co-opted from the pro-choice abortion rights movement. Yet, many of those same people are pro-life and support abortion restrictions that are effectively a kind of gestation mandate. Both vaccine and gestation mandates impose restrictions on bodily autonomy in order to prevent serious harms. This article evaluates the defensibility of the anti-vax (...) pro-life position. We argue that the case for opposing gestation mandates on grounds of bodily autonomy is much stronger than the case for opposing vaccine mandates—even if fetuses have full moral status. Thus, there is a deep tension in being a pro-life, COVID anti-vaxxer concerned with bodily autonomy. (shrink)

The increasingly wide spread use of RCM, rational choice modeling, and RCT, rational choice theory, in disciplines like economics, law, ethics, psychology, sociology, political science, management facilitates interdisciplinary exchange. This is a great achievement. Yet it nurtures the hope that a unified account of rational active choice making might arise from ‘reason’ in terms of intuitively appealing axioms. Such ‘rationalist’ characterizations of rational choice neglect real human practices and empirical accounts of those practices. This is (...) theoretically misleading and practically dangerous. Searching for a wide reflective equilibrium, WRE, on RCT in evidence-oriented ways can explicate ‘rational’ without rationalism. (shrink)

In this paper a new interactionistic model of mental causation is developed. By analysing the results of physics and neuroscience it is shown that the macroscopic cerebral activity and the resulting behavioural output is not strictly determined. This opens up the possibility that a non-physical mind can influence which of the physically allowed brain states is realised. Most models of mental causation postulate that there are coherent quantum states in the brain which could be influenced by a local mind-brain interaction. (...) Due to environmental decoherence, however, it is questionable whether coherent quantum states can exist in the warm and wet brain. The here presented `creative choice theory' solves the problem of environmental decoherence by including the environment. The whole universe is considered as a quantum system that is in superposition of alternative realities. It is then assumed that a universal mind collapses the universal wave-function whilst individual minds interact with individual brains. This leads to a holistic model of reality that could also provide an explanation for ESP-phenomena and mystical experiences. (shrink)

Current models of cortical speech and language processing include multiple regions within the temporal lobe of both hemispheres. Human communication, by necessity, involves complex interactions between regions subserving speech and language processing with those involved in more general cognitive functions. To assess these interactions, we utilized an ecologically salient conversation-based approach. This approach mandates that we first clarify activity patterns at the earliest stages of cortical speech processing. Therefore, we examined high gamma (70-150 Hz) responses within the electrocorticogram (ECoG) recorded (...) simultaneously from Heschl’s gyrus (HG) and lateral surface of the superior temporal gyrus (STG). Subjects were neurosurgical patients undergoing evaluation for treatment of medically intractable epilepsy. They performed an expanded version of the Mini-mental state examination (MMSE), which included additional spelling, naming, and memory-based tasks. ECoG was recorded from HG and the STG using multicontact depth and subdural electrode arrays, respectively. Differences in high gamma activity during listening to the interviewer and the subject's self-generated verbal responses were quantified for each recording site and across sites within HG and STG. The expanded MMSE produced widespread activation in auditory cortex of both hemispheres. No significant difference was found between activity during listening to the interviewer's questions and the subject's answers in posteromedial HG (auditory core cortex). A different pattern was observed throughout anterolateral HG and posterior and middle portions of lateral STG (non-core auditory cortical areas), where activity was significantly greater during listening compared to speaking. No systematic task-specific differences in the degree of suppression during speaking relative to listening were found in posterior and middle STG. Individual sites could, however, exhibit task-related variability in the degree of suppression during speaking compared to listening. The current study demonstrates that ECoG recordings can be acquired in time-efficient dialog-based paradigms, permitting examination of language and cognition in an ecologically salient manner. The results obtained from auditory cortex serve as a foundation for future studies addressing patterns of activity beyond auditory cortex that subserve human communication. (shrink)