Educators and policy makers confront challenging questions of ethics, justice, and equity on a regular basis. Should teachers retain a struggling student if it means she will most certainly drop out? Should an assignment plan favor middle-class families if it means strengthening the school system for all? These everyday dilemmas are both utterly ordinary and immensely challenging, yet there are few opportunities and resources to help educators think through the ethical issues at stake. Drawing on research and methods developed in (...) the Justice in Schools project at the Harvard Graduate School of Education,_ Dilemmas of Educational Ethics_ introduces a new interdisciplinary approach to achieving practical wisdom in education, one that honors the complexities inherent in educational decision making and encourages open discussion of the values and principles we should collectively be trying to realize in educational policy and practice. At the heart of the book are six richly described, realistic accounts of ethical dilemmas that have arisen in education in recent years, paired with responses written by noted philosophers, empirical researchers, policy makers, and practitioners, including Pedro Noguera, Howard Gardner, Mary Pattillo, Andres A. Alonso, Jamie Ahlberg, Toby N. Romer, and Michael J. Petrilli. The editors illustrate how readers can use and adapt these cases and commentaries in schools and other settings in order to reach a difficult decision, deepen their own understanding, or to build teams around shared values. (shrink)

_Teaching in a democracy is challenging and filled with dilemmas that have no easy answers._ For example, how do educators meet their responsibilities of teaching civic norms and dispositions while remaining nonpartisan? _Democratic Discord in Schools_ features eight normative cases of complex dilemmas drawn from real events designed to help educators practice the type of collaborative problem solving and civil discourse needed to meet these challenges of democratic education. Each of the cases also features a set of six commentaries written (...) by a diverse array of scholars, educators, policy makers, students, and activists with a range of political views to spark reflection and conversation. Drawing on research and methods developed in the Justice in Schools project at the Harvard Graduate School of Education (HGSE), _Democratic Discord in Schools_ provides the tools that allow educators and others to practice the deliberative skills they need in order to find reasonable solutions to common ethical dilemmas in politically fraught times. (shrink)

A chronicler who recites events without distinguishing between major and minor ones acts in accordance with the following truth: nothing that has ever happened should be regarded as lost for history."Few areas of American public life have received as much attention with as little actual on-the-ground study as citizen deliberation," Lawrence R. Jacobs, Fay Lomax Cook, and Michael X. Delli Carpini argue. "Whether and how real citizens engage in discursive participation; the nature, settings, and impact of this public talk; and (...) when and if 'talk' ever rises to the level of 'democratic deliberation'—each of these is ignored or, at best, occasionally introduced by way of illustration or anecdote" (2009, 20-21).This is .. (shrink)

Measuring the effectiveness of medical interventions faces three epistemological challenges: the choice of good measuring instruments, the use of appropriate analytic measures, and the use of a reliable method of extrapolating measures from an experimental context to a more general context. In practice each of these challenges contributes to overestimating the effectiveness of medical interventions. These challenges suggest the need for corrective normative principles. The instruments employed in clinical research should measure patient-relevant and disease-specific parameters, and should not be sensitive (...) to parameters that are only indirectly relevant. Effectiveness always should be measured and reported in absolute terms (using measures such as 'absolute risk reduction'), and only sometimes should effectiveness also be measured and reported in relative terms (using measures such as 'relative risk reduction')-employment of relative measures promotes an informal fallacy akin to the base-rate fallacy, which can be exploited to exaggerate claims of effectiveness. Finally, extrapolating from research settings to clinical settings should more rigorously take into account possible ways in which the intervention in question can fail to be effective in a target population. (shrink)

Robustness arguments hold that hypotheses are more likely to be true when they are confirmed by diverse kinds of evidence. Robustness arguments require the confirming evidence to be independent. We identify two kinds of independence appealed to in robustness arguments: ontic independence —when the multiple lines of evidence depend on different materials, assumptions, or theories—and probabilistic independence. Many assume that OI is sufficient for a robustness argument to be warranted. However, we argue that, as typically construed, OI is not a (...) sufficient independence condition for warranting robustness arguments. We show that OI evidence can collectively confirm a hypothesis to a lower degree than individual lines of evidence, contrary to the standard assumption undergirding usual robustness arguments. We employ Bayesian networks to represent the ideal empirical scenario for a robustness argument and a variety of ways in which empirical scenarios can fall short of this ideal. (shrink)

The value-free ideal for science holds that values should not influence the core features of scientific reasoning. We defend the difference-to-inference model of value-permeation, which holds that value-permeation in science is problematic when values make a difference to the inferences made about a hypothesis. This view of value-permeation is superior to existing views, and it suggests a corresponding maxim—namely, that scientists should strive to eliminate differences to inference. This maxim is the basis of a novel value-free ideal for science. -/- (...) . (shrink)

It has been suggested that iconic graphical signs evolve into symbolic graphical signs through repeated usage. This article reports a series of interactive graphical communication experiments using a ‘pictionary’ task to establish the conditions under which the evolution might occur. Experiment 1 rules out a simple repetition based account in favor of an account that requires feedback and interaction between communicators. Experiment 2 shows how the degree of interaction affects the evolution of signs according to a process of grounding. Experiment (...) 3 confirms the prediction that those not involved directly in the interaction have trouble interpreting the graphical signs produced in Experiment 1. On the basis of these results, this article argues that icons evolve into symbols as a consequence of the systematic shift in the locus of information from the sign to the users' memory of the sign's usage supported by an interactive grounding process. (shrink)

Medicalisation is a social phenomenon in which conditions that were once under legal, religious, personal or other jurisdictions are brought into the domain of medical authority. Low sexual desire in females has been medicalised, pathologised as a disease, and intervened upon with a range of pharmaceuticals. There are two polarised positions on the medicalisation of low female sexual desire: I call these the mainstream view and the critical view. I assess the central arguments for both positions. Dividing the two positions (...) are opposing models of the aetiology of low female sexual desire. I conclude by suggesting that the balance of arguments supports a modest defence of the critical view regarding the medicalisation of low female sexual desire. (shrink)

The phenomenon of disagreement has recently been brought into focus by the debate between contextualists and relativist invariantists about epistemic expressions such as ‘might’, ‘probably’, indicative conditionals, and the deontic ‘ought’. Against the orthodox contextualist view, it has been argued that an invariantist account can better explain apparent disagreements across contexts by appeal to the incompatibility of the propositions expressed in those contexts. This paper introduces an important and underappreciated phenomenon associated with epistemic expressions — a phenomenon that we call (...) reversibility. We argue that the invariantist account of disagreement is incompatible with reversibility, and we go on to show that reversible sentences cast doubt on the putative data about disagreement, even without assuming invariantism. Our argument therefore undermines much of the motivation for invariantism, and provides a new source for constraints on the proper explanation of purported data about disagreement. (shrink)

Panpsychism is a solution to the mind-body problem that presumes that consciousness is a fundamental aspect of reality instead of a product or consequence of physical processes (i.e., brain activity). Panpsychism is an elegant solution to the mind-body problem: it effectively rids itself of the explanatory gap materialist theories of consciousness suffer from. However, many theorists and experimentalists doubt panpsychism can ever be successful as a scientific theory, as it cannot be empirically verified or falsified. In this paper, I present (...) a panpsychist model based on the controversial idea that consciousness may be a so called higher physical dimension. Although this notion seems outrageous, I show that the idea has surprising explanatory power, even though the model (as most models) is most likely wrong. Most importantly, though, it results in a panpsychist model that yields predictions that can be empirically verified or falsified. As such, the model's main purpose is to serve as an example how a metaphysical model of consciousness can be specified in such a way that they can be tested in a scientifically rigorous way. (shrink)

The animal agriculture industry causes animals a tremendous amount of pain and suffering. Many ethical vegans argue that we therefore have an obligation to abstain from animal products in order to reduce this suffering. But this argument faces a challenge: thanks to the size and structure of the animal agriculture industry, any individual’s dietary choices are overwhelmingly unlikely to make a difference. In this paper, we criticize common replies to this challenge and develop an alternative argument for ethical veganism. Specifically, (...) we argue that individuals should abstain from animal products because vegans, as a group, successfully reduce animal suffering, and individuals are obligated to participate in, rather than free ride on, this collective endeavor. Or, at the very least, individuals have strong reasons to purchase fewer inhumanely raised animal products—even if they are not obligated to go vegan per se. (shrink)

Harms of medical interventions are systematically underestimated in clinical research. Numerous factors—conceptual, methodological, and social—contribute to this underestimation. I articulate the depth of such underestimation by describing these factors at the various stages of clinical research. Before any evidence is gathered, the ways harms are operationalized in clinical research contributes to their underestimation. Medical interventions are first tested in phase 1 ‘first in human’ trials, but evidence from these trials is rarely published, despite the fact that such trials provide the (...) foundation for assessing the harm profile of medical interventions. If a medical intervention is deemed safe in a phase 1 trial, it is tested in larger phase 2 and 3 clinical trials. One way to think about the problem of underestimating harms is in terms of the statistical ‘power’ of a clinical trial—the ability of a trial to detect a difference of a certain effect size between the experimental group and the control group. Power is normally thought to be pertinent to detecting benefits of medical interventions. It is important, though, to distinguish between the ability of a trial to detect benefits and the ability of a trial to detect harms. I refer to the former as power-B and the latter as power-H. I identify several factors that maximize power-B by sacrificing powerH in phase 3 clinical trials. If a medical intervention is approved for general use, it is evaluated by phase 4 post-market surveillance. Phase 4 surveillance of harms further contributes to underestimating the harm profile of medical interventions. At every stage of clinical research the hunt for harms is shrouded in secrecy, which further contributes to the underestimation of the harm profiles of medical interventions. (shrink)

Consensus conferences are social techniques which involve bringing together a group of scientific experts, and sometimes also non-experts, in order to increase the public role in science and related policy, to amalgamate diverse and often contradictory evidence for a hypothesis of interest, and to achieve scientific consensus or at least the appearance of consensus among scientists. For consensus conferences that set out to amalgamate evidence, I propose three desiderata: Inclusivity, Constraint, and Evidential Complexity. Two examples suggest that consensus conferences can (...) readily satisfy Inclusivity and Evidential Complexity, but consensus conferences do not as easily satisfy Constraint. I end by discussing the relation between social inclusivity and the three desiderata. (shrink)

Drug regulation is fraught with inductive risk. Regulators must make a prediction about whether or not an experimental pharmaceutical will be effective and relatively safe when used by typical patients, and such predictions are based on a complex, indeterminate, and incomplete evidential basis. Such inductive risk has important practical consequences. If regulators reject an experimental drug when it in fact has a favourable benefit/harm profile, then a valuable intervention is denied to the public and a company’s material interests are needlessly (...) thwarted. Conversely, if regulators approve an experimental drug when it in fact has an unfavourable benefit/harm profile, then resources are wasted, people are needlessly harmed, and other potentially more effective treatments are underutilized. Given that such regulatory decisions have these practical consequences, non-epistemic values about the relative importance of these consequences impact the way such regulatory decisions are made (similar to the analysis of laboratory studies on the toxic effects of dioxins presented in Douglas [2000]). To balance the competing demands of the pertinent non-epistemic values, regulators must perform what I call an “inductive risk calculus.” At least in the American context this inductive risk calculus is not well-managed. (shrink)

If scientists violate principles and practices of routine science to quickly develop interventions against catastrophic threats, they are engaged in what I call fast science. The magnitude, imminence, and plausibility of a threat justify engaging in and acting on fast science. Yet, that justification is incomplete. I defend two principles to assess fast science, which say: fast science should satisfy as much as possible the reliability-enhancing features of routine science, and the fast science developing an intervention against a threat should (...) not depend on the same problematic assumptions as the fast science which estimates the magnitude, imminence, and plausibility of the threat. (shrink)

This article summarizes some of the results of the BIOMED II project “Basic Ethical Principles in European Bioethics and Biolaw” connected to a research project of the Danish Research Councils “Bioethics and Law”. The BIOMED project was based on cooperation between 22 partners in most EU countries. The aim of the project was to identify the ethical principles of respect for autonomy, dignity, integrity and vulnerability as four important ideas or values for a European bioethics and biolaw. The research concluded (...) that the basic ethical principles cannot be understood as universal everlasting ideas or transcendental truths but they rather function reflective guidelines and important values in European culture. The method of the research was conceptual, philosophical analysis of the cultural background of the four values or normative ideas that people use and find important in their existence. Moreover, this was combined with analysis of empirical legal material and policy documents. Also, a number of qualitative interviews with relevant experts were carried out. Another important result of the BIOMED project was the partner's Policy Proposals to the European Commission, the Barcelona Declaration, unique as a philosophical and political agreement between experts in bioethics and biolaw from many different countries. The Policy Proposals are reprinted here at the end of the article. (shrink)

Ideal theorists aim to describe the ideally just society. Problem solvers aim to identify concrete changes to actual societies that would make them more just. The relation between these two sorts of theorizing is highly contested. According to the benchmark view, ideal theory is prior to problem solving because a conception of the ideally just society serves as an indispensable benchmark for evaluating societies in terms of how far they deviate from it. In this paper, I clarify the benchmark view, (...) argue that existing criticisms of it are unsuccessful, and develop a novel redundancy objection to the benchmark view and the claim of priority it allegedly entails. I then consider the extent to which ideal theory might facilitate problem solving without being prior to it and argue that it can only play a modest role in this regard. The upshot is that ideal theory is neither required for nor especially relevant to problem solving—but it is not completely irrelevant either. It facilitates problem solving to some limited degree, but no more, say, than theorizing about dystopia. (shrink)

I defend a novel account of scientific progress centred around justification. Science progresses, on this account, where there is a change in justification. I consider three options for explicating this notion of change in justification. This account of scientific progress dispels with a condition for scientific progress that requires accumulation of truth or truthlikeness, and it emphasises the social nature of scientific justification.

This article argues that Epictetus employs the terms orexis and hormê in the same manner as the older Stoics. It then shows, on the basis of this claim, that the older Stoics recognized a distinction between dispositional and occurrent forms of motivation. On this account of Stoic theory, intentional action is in each instance the product of two forms of cognition: a value ascription that attributes goodness or badness to some object, conceiving of its possession as beneficial or harmful to (...) the agent, together with a situational judgment about appropriate action. The resulting interpretation suggests that the Stoic theory of motivation as a whole — and not merely the Stoic analysis of the pathê — has the basic shape of a practical syllogism, with more psychological depth than commentators have recognized. (shrink)

Many jurisdictions prohibit or severely restrict the use of evidence about a defendant’s character to prove legal culpability. Situationists, who argue that conduct is largely determined by situational features rather than by character, can easily defend this prohibition. According to situationism, character evidence is misleading or paltry. -/- Proscriptions on character evidence seem harder to justify, however, on virtue ethical accounts. It appears that excluding character evidence either denies the centrality of character for explaining conduct—the situationist position—or omits probative evidence. (...) Situationism is, after all, presented as antithetical to virtue ethics. -/- This essay provides a virtue ethical defense of character evidence exclusion rules. We show that existing virtue ethical rebuttals to situationism themselves support prohibitions on character evidence; even if behavior arises from stable character traits, character evidence should be prohibited. In building our case, we provide a taxonomy of kinds of character judgment and reconcile the ubiquity and reasonableness of character judgments in ordinary life with the epistemic legitimacy of character evidence prohibitions in law. (shrink)

Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life as a result of their depressive symptoms when similarly situated (...) incapacitated patients without such depressive symptoms would have their previous wishes honoured via substituted judgment. This commentary argues for reconsidering this approach and for using a substituted judgment standard for a subset of EMP/LQL patients seeking death. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in (...) recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

Reasons transmit. If one has a reason to attain an end, then one has a reason to effect means for that end: reasons are transmitted from end to means. I argue that the likelihood ratio (LR) is a compelling measure of reason transmission from ends to means. The LR measure is superior to other measures, can be used to construct a condition specifying precisely when reasons transmit, and satisfies intuitions regarding end-means reason transmission in a broad array of cases.

This study investigates factors impacting perceptions of ethical conduct of peers of 293 students in four US universities. Self-reported ethical behavior and recognition of emotions in others (a dimension of emotional intelligence) impacted perception of ethical behavior of peers. None of the other dimensions of emotional intelligence were significant. Age, Race, Sex, GPA, or type of major (business versus nonbusiness) did not impact perception of ethical behavior of peers. Implications of the results of the study for business schools and industry (...) professionals are discussed. (shrink)

A consequence relation \ is monotonic iff for premise sets \ and conclusion \, if \, \, then \; and non-monotonic if this fails in some instance. More plainly, a consequence relation is monotonic when whatever is entailed by a premise set remains entailed by any of its supersets. From the High Middle Ages through the Early Modern period, consequence in theology is assumed to be monotonic. Concomitantly, to the degree the argument formulated by Anselm at Proslogion 2–4 is taken (...) up by later commentators, it is accepted or rejected in accordance with a monotonic notion of consequence. Examining Anselm’s use of parallelism in the Proslogion, I show Anselm embeds his famous argument in Proslogion 2–4 in a non-monotonic context. The results here presented challenge some deeply ingrained ideas governing the historiography of the long twelfth century, particularly concerning how the theology of the later eleventh through the twelfth century relates to the scholasticism of the thirteenth. (shrink)

This paper reports on the results of an experiment conducted with experienced corporate directors. The study findings indicate that directors employ prospective rationality cognition, and they sometimes make decisions that emphasize legal defensibility at the expense of personal ethics and social responsibility. Directors recognize the ethical and social implications of their decisions, but they believe that current corporate law requires them to pursue legal courses of action that maximize shareholder value. The results suggest that additional ethics education will have little (...) influence on the decisions of many business leaders because their decisions are driven by corporate law, rather than personal ethics. (shrink)

This paper reports laboratory data for games that are played only once. These games span the standard categories: static and dynamic games with complete and incomplete information. For each game, the treasure is a treatment in which behavior conforms nicely to predictions of the Nash equilibrium or relevant refinement. In each case, however, a change in the payoff structure produces a large inconsistency between theoretical predictions and observed behavior. These contradictions are generally consistent with simple intuition based on the interaction (...) of payoff asymmetries and noisy introspection about others’ decisions. (shrink)

One of the great Jewish intellectuals of the twentieth century, Taubes published only this one book during his life, and here the English translation finally becomes available.

It is argued that claims about personal obligation (of the form "s ought to 0") cannot be reduced to claims about impersonal obligation (of the form "it ought to be the case that p"). The most common attempts at such a reduction are shown to have unacceptable implications in cases involving a plurality of agents. It is then argued that similar problems will face any attempt to reduce personal obligation to impersonal obligation.

Physicians expressing opinions on medical matters that run contrary to the consensus of experts pose a challenge to licensing bodies and regulatory authorities. While the right to express contrarian views feeds a robust marketplace of ideas that is essential for scientific progress, physicians advocating ineffective or dangerous cures, or actively opposing public health measures, pose a grave threat to societal welfare. Increasingly, a distinction has been made between professional speech that occurs during the physician-patient encounter and public speech that transpires (...) beyond the clinical setting, with physicians being afforded wide latitude to voice empirically false claims outside the context of patient care. This paper argues that such a bifurcated model does not sufficiently address the challenges of an age when mass communications and social media allow dissenting physicians to offer misleading medical advice to the general public on a mass scale. Instead, a three-tiered model that distinguishes between citizen speech, physician speech and clinical speech would best serve authorities when regulating physician expression. (shrink)

Priority for solid organ transplant generally does not consider the underlying cause of the need for transplantation. This paper argues that a distinctive set of factors justify assigning lower priority to willfully unvaccinated individuals who require transplant as a result of suffering from COVID‐19. These factors include the personal responsibility of the patients for their own condition and the public outrage likely to ensue if willfully unvaccinated patients receive organs at the expense of vaccinated ones. The paper then proposes a (...) three‐prong test for similar deviations from the current allocation standard that incorporates patient responsibility, foreseeability and avoidability, and the frequency of the occurrence. (shrink)

The integrity of the patient–physician relationship depends on maintaining professional boundaries. While ethicists and professional organisations have devoted significant consideration to the subject of sexual boundary transgressions, the subject of non-sexual boundaries, especially outside the mental health setting, has been largely neglected. While professional organisations may offer guidance on specific subjects, such as accepting gifts or treating relatives, as well as general guidance on transparency and conflict of interest, what is missing is a principle-based method that providers can use to (...) assess non-sexual interactions with patients that transcend norms of practice. This paper attempts to offer an operational model for such assessment that considers not only the traditional emphasis on beneficence, but also incorporates concerns over entanglement and concordance. (shrink)

Abstract: Laudan (1984) distinguishes between two senses of success for scientific theories: (i) that a particular theory is successful, and (ii) that the methods for picking out approximately true theories are successful. These two senses of success are reflected in two different ways that the no miracles argument for scientific realism (NMA) may be set out. First, I set out a (traditional) version of NMA that considers the success of particular theories. I then consider a more recent formulation of NMA (...) (Psillos, 1999). This version of NMA is aimed at making us believe that our methods for picking out approximately true theories are reliable. I shall argue that the success of the latter argument is dependent on the success of the first. Therefore, even though Psillos presents a new formulation of NMA, the evidential support for it is no stronger than the evidential support for the original version. (shrink)

Recent research indicates that compensation structure can be used by firms to discourage their employees from whistleblowing. We extend the ethics literature by examining how compensation structures and financial rewards work together to influence managers’ decisions to blow the whistle. Results from an experiment indicate that compensation with restricted stock, relative to stock payments that lack restrictions, can enhance the likelihood that managers will blow the whistle when large rewards are available. However, restricted stock can also threaten the effectiveness of (...) whistleblowing systems without the presence of large financial rewards for whistleblowing. Thus, the large potential rewards for whistleblowing enacted by the Dodd–Frank Act appear timely as firms are moving toward compensation agreements that include greater proportions of restricted stock. (shrink)

On Zeno Beach there are infinitely many grains of sand, each half the size of the last. Supposing Aristotle denied the possibility of Zeno Beach, did he have a good argument for the denial? Three arguments, each of ancient origin, are examined: the beach would be infinitely large; the beach would be impossible to walk across; the beach would contain a part equal to the whole, whereas parts must be lesser. It is attempted to show that none of these arguments (...) was Aristotle’s. Indeed, perhaps Aristotle’s finitism applied to magnitude only, not plurality. (shrink)

A speaker wishes to persuade a listener to take a certain action. The conditions under which the request is justified, from the listener’s point of view, depend on the state of the world, which is known only to the speaker. Each state is characterized by a set of statements from which the speaker chooses. A persuasion rule specifies which statements the listener finds persuasive. We study persuasion rules that maximize the probability that the listener accepts the request if and only (...) if it is justified, given that the speaker maximizes the probability that his request is accepted. We prove that there always exists a persuasion rule involving no randomization and that all optimal persuasion rules are ex-post optimal. We relate our analysis to the field of pragmatics. (shrink)

As conceptual and theoretical discussions on environmental valuation approaches have advanced there is growing interest in the impact that valuation has on decision making. The perceived legitimacy of the outputs of valuation studies is seen as one factor influencing their impact on policy decisions. One element of this is ensuring that participants of valuation processes see the results as legitimate and would be willing to accept decisions based on these findings. Here, we test the perceived legitimacy to participants of two (...) approaches to deliberative monetary valuation, deliberated preferences and Deliberative Democratic Monetary Valuation, in the context of marine planning in the Clyde estuary in Scotland. We compare and contrast deliberated preference and deliberative democratic monetary valuation and track their emergence as responses to critiques of conventional stated preference approaches. We then present the results of our case study where we found that deliberative democratic monetary valuation produced valuations that were perceived as more legitimate that deliberated preference as the basis for decision making by those involved in the valuation process. (shrink)

The “Goldwater rule,” a policy adopted by the American Psychiatry Association in 1973, prohibits organization members from diagnosing or offering professional opinions regarding the mental health of public figures without both first-hand evaluation and authorization. Initially developed in response to a controversial survey of APA members during the 1964 Presidential election campaign, the ethics rule faced few large scale challenges until the election of Donald Trump in 2016. Since that time, a significant number of psychiatrists have either violated or criticized (...) the rule openly. This paper argues that whatever the initial merits of the rule, the prohibition has since been rendered obsolete by the combined lack of professional consensus supporting the policy, absence of a meaningful enforcement mechanism, and the credible statements of non-APA members in the mental health professions regarding public figures. (shrink)

Since several landmark legal decisions in the 1970s and 1980s, substituted judgment has become widely accepted as an approach to decision‐making for incapacitated patients that incorporates their autonomy and interests. Two notable exceptions have been cases involving minors and those involving cognitively or psychiatrically impaired individuals who never previously possessed the ability to contemplate the medical decisions involved in their care. While a best interest standard may have universal merit in pediatric cases, this paper argues that substituted judgement has been (...) rejected too broadly for “never‐capacitated” patients. It then lays out a three‐condition test for using substituted judgment in these cases. For a subset of “never‐capacitated” patients who belong to distinctive religious or cultural communities with clear medical values and have an appropriate surrogate, these values may prove helpful in vindicating the interests of the never‐capacitated and should not be blanketly dismissed. (shrink)