Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.

Treating patients and their family members with respect and dignity is a broadly accepted goal of health care. The work presented in this article is part of a larger project aimed at better understanding what constitutes treatment with respect and dignity in the ICU to improve the care that patients and family members receive in this regard. Direct observation was selected as one of the methods to facilitate this understanding because it provides the opportunity to see and document what actually (...) occurs during encounters among patients, their families, and clinicians. This article reports seven major thematic domains and many subthemes that together create a detailed account of the interpersonal and environmental components of treatment with respect and dignity. Attention to these components might enhance the experience and treatment of patients and family members. (shrink)

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

Despite wide recognition of the importance of treating patients with respect and dignity, little is known about what constitutes treatment in this regard. The intensive care unit (ICU) is a unique setting that can pose specific threats to treatment with respect and dignity owing to the critical state of patients, stress and anxiety amongst patients and their family members, and the highly technical nature of the environment. In attempt to understand various stakeholders’ perspectives of treatment with respect and dignity, patients (...) and family members were interviewed, a wide range of health care professionals participated in focus groups, and third party observers took field notes of interactions in the ICU. This paper compares and contrasts the data that were generated using these different methods. Triangulating the data in this way contributes to a more complete and nuanced understanding of treatment with respect and dignity in the ICU. (shrink)

A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents’ personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum’s goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values as (...) they affect patient care. Content analysis of written reflections was guided by a tool developed to identify and assess the level of ethical reasoning in eight domains determined to be important aspects of ethical competence. Based on the assessment of narratives written at two times (12 to 16 months/apart) during their training, residents showed significant progress in two specific domains: use of professional values, and use of personal values. Residents did not show decline in ethical reasoning in any domain. This study demonstrates that content analysis of personal narratives may provide a useful method for assessment of developing ethical sensitivity and reasoning. (shrink)

Little is known about health care professionals’ perceptions regarding what it means to treat patients and families with respect and dignity in the intensive care unit (ICU) setting. To address this gap, we conducted nine focus groups with different types of health care professionals (attending physicians, residents/fellows, nurses, social workers, pastoral care, etc.) working in either a medical or surgical ICU within the same academic health system. We identified three major thematic domains, namely, intrapersonal (attitudes and beliefs), interpersonal (behaviors), and (...) system (contextual) factors that influence treatment with respect and dignity. Participants suggested strategies for improving treatment of patients and families in the ICU with respect and dignity, as well as the related need for enhancing respect among the multidisciplinary team of clinicians. Implementing these strategies will require innovative educational interventions and leadership. Future research should focus on the design and evaluation of such interventions on the quality of care. (shrink)

Respect and dignity are central to moral life, and have a particular importance in health care settings such as the intensive care unit (ICU). We conducted 15 semistructured interviews with 21 participants during an ICU admission to explore the definition of, and specific behaviors that demonstrate, respect and dignity during treatment in the ICU. We transcribed interviews and conducted thematic qualitative analysis. Seven themes emerged that focused on what it means to be treated with respect and/or dignity: treated as a (...) person; Golden Rule; acknowledgement; treated as family/friend; treated as an individual; treated as important/valuable; and treated as equal. Participants described particular behaviors or actions that were considered related to demonstrating treatment with respect and dignity: listening; honesty/giving information; attention to body/modesty/appearance; caring/bedside manner; patient and family as an information source; attention to pain; and responsiveness. These behaviors provide a framework for improving experiences with care in the ICU. (shrink)

Joseph Raz presents a penetrating exploration of the interdependence of value, reason, and the will. These essays illuminate a wide range of questions concerning fundamental aspects of human thought and action. Engaging Reason is a summation of many years of original, compelling, and influential work by a major contemporary philosopher.

In this book Joseph Heath brings Jürgen Habermas's theory of communicative action into dialogue with the most sophisticated articulation of the instrumental conception of practical rationality-modern rational choice theory. Heath begins with an overview of Habermas's action theory and his critique of decision and game theory. He then offers an alternative to Habermas's use of speech act theory to explain social order and outlines a multidimensional theory of rational action that includes norm-governed action as a specific type.In the second (...) part of the book Heath discusses the more philosophical dimension of Habermas's conception of practical rationality. He criticizes Habermas's attempt to introduce a universalization principle governing moral discourse, as well as his criteria for distinguishing between moral and ethical problems. Heath offers an alternative account of the level of convergence exhibited by moral argumentation, drawing on game-theoretic models to specify the burden of proof that the theory of communicative action and discourse must assume. (shrink)

In contemporary philosophical debates in the United States "redefining pragmatism" has become the conventional way to flag significant philosophical contests and to launch large conceptual and programmatic changes. This book analyzes the contributions of such developments in light of the classic formulations of Charles S. Peirce and John Dewey and the interaction between pragmatism and analytic philosophy. American pragmatism was revived quite unexpectedly in the 1970s by Richard Rorty's philosophical heterodoxy and his running dispute with Hilary Putnam, who, like Rorty, (...) is a professed Deweyan. Reinventing Pragmatism examines the force of the new pragmatisms, from the emergence of Rorty's and Putnam's basic disagreements of the 1970s until the turn of the century. Joseph Margolis considers the revival of a movement generally thought to have ended by the 1950s as both a surprise and a turn of great importance. The quarrel between Rorty and Putnam obliged American philosophers, and eventually Eurocentric philosophy as a whole, to reconsider the direction of American and European philosophy, for instance in terms of competing accounts of realism and naturalism. (shrink)

This book examines Aristotle's method in ethics from the vantage point of his broader conception of philosophy. Joseph Karbowski challenges longstanding dialectical orthodoxy and argues instead that, in his ethical treatises, Aristotle is seeking the first principles of a demonstrative ethical science, a science of human goodness, using an ethically adapted version of the method described in the second book of his Posterior Analytics. Part I of this volume develops a novel interpretation of Aristotle's conception of philosophy, which highlights (...) its ambition to scientific knowledge and its flexible approach to philosophical inquiry. Part II then demonstrates Aristotle's scientific and flexible approach to philosophy at work in his ethical treatises. The book shows how the aspiration to scientific knowledge is compatible with Aristotle's remarks about ethical precision, the practical aim of ethics, and the particular orientedness of phronēsis. (shrink)

The essence of who we are depends on our brains. They enable us to think, to feel joy and sorrow, communicate through speech, reflect on the moments of our lives, and to anticipate, plan for, and worry about our imagined futures. Although some of our abilities are comparatively new, key features of our behavior have deep roots that can be traced to the beginning of life. By following the story of behavior, step-by-step, over its roughly four-billion-year trajectory, we come to (...) understand both how similar we are to all organisms that have ever lived, and how different we are from even our closest animal relatives. We care about our differences because they are ours. But differences do not make us superior; they simply make us different. (shrink)

I propose to analyze the concept of basing beliefs on reasons. The concept is an important one in understanamg the so-called "inferential" or "indirect" knowledge. After briefly stating the causal analyses of this concept given by D.M. Armstrong and Marshall Swain I will present two cases which show these analyses to be too strong and too weak. Finally, I will propose an analysis which avoids these twin difficulties.

Joseph Grange's beautifully written book provides a unique synthesis of two major figures of world philosophy, John Dewey and Confucius, and points the way to a global philosophy based on American and Confucian values. Grange concentrates on the major themes of experience, felt intelligence, and culture to make the connections between these two giants of Western and Eastern thought. He explains why the Chinese called Dewey "A Second Confucius," and deepens our understanding of Confucius's concepts of the way (dao) (...) of human excellence (ren). The important dimensions of American and Chinese cultural philosophy are welded into an argument that calls for the liberation of what is finest in both traditions. The work gives a new appreciation of fundamental issues facing Chinese and American relations and brings the opportunities and dangers of globalization into focus. (shrink)

The inclusion of morally binding values such as religious—or in a broader sense, spiritual—values fundamentally alter organizational decision-making and ethical behavior. Family firms, being a particularly value-driven type of organization, provide ample room for religious beliefs to affect family, business, and individual decisions. The influence that the owning family is able to exert on value formation and preservation in the family business makes religious family firms an incubator for value-driven and faith-led decision-making and behavior. They represent a particularly rich and (...) relevant context to re-assess the relationship between ethical beliefs, decision-making processes and behaviors in business organizations at the interface between family and professional logics. This Special Issue is dedicated to deepening our understanding of the role religious values and spirituality play in the formation of organizational ethical practices in faith-led family firms and resulting organizational and family-related outcomes. In this editorial, we introduce the 10 papers included in this Special Issue, which investigate the relationship between religion or spirituality and family firm ethical behavior in various geographical, cultural and religious contexts, using a multitude of qualitative and quantitative methodologies. By focusing on the effects of religious or spiritual orientations on both the business and the family, as well as on the values, norms and goals present in the family business system, further research can gain a more nuanced understanding of the relationship between religious and spiritual believes, and sustainable ethical behavior in family firms. (shrink)

The swamping problem is to explain why knowledge is epistemically better than true belief despite being no more true, if truth is the sole fundamental epistemic value. But Carter and Jarvis argue that the swamping thesis at the heart of the problem ‘is problematic whether or not one thinks that truth is the sole epistemic good’. I offer a counterexample to this claim, in the form of a theory of epistemic value for which the swamping thesis is not problematic: evidence (...) monism. Then I argue that another kind of response to the swamping problem given by Sylvan 2018 does not escape the problem unscathed, because it is not only instrumentalism that gives rise to the swamping problem. The upshot is that, given a standard account of fundamental value, the swamping problem favours evidence monism over truth monism. (shrink)

John Stuart Mill is one of the hallowed figures of the liberal tradition, revered for his defense of liberal principles and expansive personal liberty. By examining Mill's arguments in On Liberty in light of his other writings, however, Joseph Hamburger reveals a Mill very different from the "saint of rationalism" so central to liberal thought. He shows that Mill, far from being an advocate of a maximum degree of liberty, was an advocate of liberty and control--indeed a degree of (...) control ultimately incompatible with liberal ideals.Hamburger offers this powerful challenge to conventional scholarship by presenting Mill's views on liberty in the context of his ideas about, in particular, religion and historical development. The book draws on the whole range of Mill's philosophical writings and on his correspondence with, among others, Harriet Taylor Mill, Auguste Comte, and Alexander Bain to show that Mill's underlying goal was to replace the traditional religious basis of society with a form of secular religion that would rest on moral authority, individual restraint, and social control. Hamburger argues that Mill was not self-contradictory in thus championing both control and liberty. Rather, liberty and control worked together in Mill's thought as part of a balanced, coherent program of social and moral reform that was neither liberal nor authoritarian.Based on a lifetime's study of nineteenth-century political thought, this clearly written and forcefully argued book is a major reinterpretation of Mill's ideas and intellectual legacy. (shrink)

In 1908, three years after Einstein first published his special theory of relativity, the mathematician Hermann Minkowski introduced his four-dimensional “spacetime” interpretation of the theory. Einstein initially dismissed Minkowski’s theory, remarking that “since the mathematicians have invaded the theory of relativity I do not understand it myself anymore.” Yet Minkowski’s theory soon found wide acceptance among physicists, including eventually Einstein himself, whose conversion to Minkowski’s way of thinking was engendered by the realization that he could profitably employ it for the (...) formulation of his new theory of gravity. The validity of Minkowski’s mathematical “merging” of space and time has rarely been questioned by either physicists or philosophers since Einstein incorporated it into his theory of gravity. Physicists often employ Minkowski spacetime with little regard to the whether it provides a true account of the physical world as opposed to a useful mathematical tool in the theory of relativity. Philosophers sometimes treat the philosophy of space and time as if it were a mere appendix to Minkowski’s theory. In this critical study, Joseph Cosgrove subjects the concept of spacetime to a comprehensive examination and concludes that Einstein’s initial assessment of Minkowksi was essentially correct. (shrink)

Various processes are often classified as both deterministic and random or chaotic. The main difficulty in analysing the randomness of such processes is the apparent tension between the notions of randomness and determinism: what type of randomness could exist in a deterministic process? Ergodic theory seems to offer a particularly promising theoretical tool for tackling this problem by positing a hierarchy, the so-called ‘ergodic hierarchy’, which is commonly assumed to provide a hierarchy of increasing degrees of randomness. However, that notion (...) of randomness requires clarification. The mathematical definition of EH does not make explicit appeal to randomness; nor does the usual way of presenting EH involve a specification of the notion of randomness that is supposed to underlie the hierarchy. In this paper we argue that EH is best understood as a hierarchy of random behaviour if randomness is explicated in terms of unpredictability. We then show that, contrary to common wisdom, EH is useful in characterising the behaviour of Hamiltonian dynamical systems. (shrink)

CONTEMPORARY ISSUES IN BUSINESS ETHICS, 6E introduces readers to business ethics by focusing on the influence of market mechanisms and social values on workplace norms. And because business is increasingly a global enterprise, this edition emphasizes the role of ethics both at home and abroad.

Analyzes Schelling's arguments for his idealism and pieces together a description of his theory of nature from among the large number of his writings in this area. It also traces the influence of Naturphilosophie on 19th-century science and connects it with recent System Theory.

Edmund Husserl EDMUND GUSTAVE ALBRECHT HUSSERL was born in Prossnitz, Moravia, on April 8, 1859. After receiving his secondary education in Vienna, ...

There is a need for empirically based research on social and ethical challenges related to informed consent processes, particularly in studies focusing on adolescent sexual and reproductive health. In a pilot study of a school-based pregnancy prevention intervention in rural Zambia, the majority of the guardians who were asked to consent to their daughters’ participation, refused. In this paper we explore the reasons behind the low participation in the pilot with particular attention to challenges related to the community engagement and (...) informed consent process. The pilot was implemented in two schools and examined the acceptability of a package of interventions including economic support to families to keep their girls in school, pocket money for girls, youth club meetings on reproductive health, and community meetings to sensitize the community. Focus group discussions were conducted with girls who participated in the pilot, boys in their class and with parents. Individual semi-structured interviews were conducted with teachers, peer educators and community health workers involved in the coordination of the intervention as well as with religious and traditional leaders. Data were analyzed through thematic analysis. The findings indicate that inadequate use of recognized community communication channels during the community engagement process and dissemination of information about the pilot resulted in limited understanding of the pilot concept by the community. This surfaced through uncertainty and fear that the intervention may result in loss of control over daughters, worries about why money was provided unconditionally to girls, and suspicion of links to satanism. The sense of insecurity appeared to be exacerbated by low literacy levels, poverty, fear of loss of bride wealth, perceived disregard for local perceptions of social status, and scanty trust in the actors implementing the pilot. Inadequate use of locally appropriate channels in the dissemination of information created room for interpretation and facilitated development of mistrust, undermining the conditions for community engagement and actual informed consent. A key lesson learnt is the importance of taking seriously the complexity of local values and structures that may impact people’s capability to consent or not consent to a study in an informed manner. (shrink)

Most causal discovery algorithms in the literature exploit an assumption usually referred to as the Causal Faithfulness or Stability Condition. In this paper, we highlight two components of the condition used in constraint-based algorithms, which we call “Adjacency-Faithfulness” and “Orientation- Faithfulness.” We point out that assuming Adjacency-Faithfulness is true, it is possible to test the validity of Orientation- Faithfulness. Motivated by this observation, we explore the consequence of making only the Adjacency-Faithfulness assumption. We show that the familiar PC algorithm has (...) to be modified to be correct under the weaker, Adjacency-Faithfulness assumption. The modified algorithm, called Conservative PC (CPC), checks whether Orientation- Faithfulness holds in the orientation phase, and if not, avoids drawing certain causal conclusions the PC algorithm would draw. Howtion: ever, if the stronger, standard causal Faith-. (shrink)

This study surveys the internal audit department of a large financial services organization. Respondents were challenged to recognize and evaluate ethical and unethical situations often encountered in practice. Four key demographic variables were investigated: gender, age, years of employment and peer group influence. For the most part, respondents view themselves as more ethical than their peers. There does appear to be a gender effect suggesting females' ability to identify ethical behavior better than their male counterparts. This study contributes to the (...) extant literature in that it has explored a previously unexplored profession, namely, the internal auditing profession. (shrink)

Henry Hansmann has claimed we have reached the “end of history” in corporate law, organized around the “widespread normative consensus that corporate managers should act exclusively in the economic interests of shareholders.” In this paper, I examine Hansmann’s own argument in support of this view, in order to draw out its implications for some of the traditional concerns of business ethicists about corporate social responsibility. The centerpiece of Hansmann’s argument is the claim that ownership of the firm is most naturally (...) exercised by the group able to achieve the lowest agency costs, and that homogeneity of interest within the ownership group is the most important factor in achieving lower costs. He defends this claim through a study of cooperatives, attempting to show that homogeneity is the source of the competitive advantage most often enjoyed by shareholders over other constituency groups, such as workers, suppliers and customers, when it comes to exercising control over the firm. Some business ethicists, impressed by this argument, have taken it to be a vindication of Milton Friedman’s claim that profit-maximization is the only “social responsibility” of management. I would like to suggest that this conclusion does not follow, and that the “Hansmann argument” lends itself to a less minimalist view, what I refer to as a “market failures” approach to business ethics. (shrink)

The debate concerning the role of intuitions in philosophy has been characterized by a fundamental disagreement between two main camps. The first, the autonomists, hold that, due to the use in philosophical investigation of appeals to intuition, most of the central questions of philosophy can in principle be answered by philosophical investigation and argument without relying on the sciences. The second, the naturalists, deny the possibility of a priori knowledge and are skeptical of the role of intuition in providing evidence (...) in philosophical inquiry. In spite of the seemingly stark and deep disagreement between the autonomist and the naturalist, in this paper I will attempt to suggest that there is a way to mount a partial defense of intuition-based philosophical practice on naturalist grounds. As will be seen, doing so will require a number of concessions that will satisfy few autonomists while simultaneously disappointing those naturalists who might have thought that all notions of the a priori had been successfully laid to rest. However, I will argue that the account proposed here will preserve those features of traditional philosophical practice that matter most and better explain the history of successes and failures of that practice, thus answering the worries of the autonomist, and that the rejection of the No A Priori Thesis attendant with the account presented here is indeed demanded by the current theories of our best scientific understanding of the mind, thus pacifying the rabid naturalistic critic of any version of apriorism. (shrink)

In two recent papers Perez Laraudogoitia has described a variety of supertasks involving elastic collisions in Newtonian systems containing a denumerably infinite set of particles. He maintains that these various supertasks give examples of systems in which energy is not conserved, particles at rest begin to move spontaneously, particles disappear from a system, and particles are created ex nihilo. An analysis of these supertasks suggests that they involve systems that do not satisfy the mathematical conditions required of Newtonian systems at (...) the time the supertask is due to be completed, or else they rely on the application of the time-reversal transformation to states which are not well-defined. Consequently, it is unjustified to conclude that the paradoxical results are arising from within the framework of Newtonian mechanics. In the last part of this article, we discuss various aspects of the physics of these supertasks. (shrink)

The idea of human-like robots with artificial intelligence (AI) engaging in sports has been considered in the light of robotics, technology and culture. However, robots with AI can also be used to clarify ethical questions in sports such as boxing with its inherent risks of brain injury and even death.This article develops an innovative way to assess the ethical issues in boxing by using a thought experiment, responding to recent medical data and overall concerns about harms and risks to boxers. (...) The thought experiment imagines a fight between a human and a robot. Critical issues about head trauma and brain injuries are then discussed. These can be summed up in two ethical questions: ‘why is it acceptable for a boxer to deliver concussive and recurrent subconcussive punches to a human head (skull and brain), powerful enough to achieve a knockout, or score more points, or to potentially inflict an injury immediately or eventually resulting in death?’, with the reciprocal question, ‘why is it acceptable to allow oneself to be injured in a like manner, possibly fatally, by an opponent?’The two questions are explored using the thought experiment in two matching perspectives: where the human boxer is attacking and the robot boxer is defending; and conversely, where the human boxer is on the receiving end of punches delivered by the robot. Each perspective opens with some general remarks, followed by an analysis of the boxing contest and eliciting some implications for future opportunities for the sport. (shrink)

Critical response to John Rawls's The Law of Peopleshas been surprisingly harsh) Most of the complaints centre on Rawls's claim that there are no obligations of distributive justice among nations. Many of Rawls's critics evidently had been hoping for a global application of the difference principle, so that wealthier nations would be bound to assign lexical priority to the development of the poorest nations, or perhaps the primary goods endowment of the poorest citizens of any nation. Their subsequent disappointment reveals (...) that, while the reception of Rawls's political philosophy has been very broad, it has not been especially deep. Rawls has very good reason for denying that there are obligations of distributive justice in an international context. (shrink)

The prevalence of white-collar crime casts a long shadow over discussions in business ethics. One of the effects that has been the development of a strong emphasis upon questions of moral motivation within the field. Often in business ethics, there is no real dispute about the content of our moral obligations, the question is rather how to motivate people to respect them. This is a question that has been studied quite extensively by criminologists as well, yet their research has had (...) little impact on the reflections of business ethicists. In this article, I attempt to show how a criminological perspective can help to illuminate some traditional questions in business ethics. I begin by explaining why criminologists reject three of the most popular folk theories of criminal motivation. I go on to discuss a more satisfactory theory, involving the so-called “techniques of neutralization,” and its implications for business ethics. (shrink)