BackgroundThe amount of research utilizing health information has increased dramatically over the last ten years. Many institutions have extensive biobank holdings collected over a number of years for clinical and teaching purposes, but are uncertain as to the proper circumstances in which to permit research uses of these samples. Research Ethics Boards (REBs) in Canada and elsewhere in the world are grappling with these issues, but lack clear guidance regarding their role in the creation of and access to registries and (...) biobanks.MethodsChairs of 34 REBS and/or REB Administrators affiliated with Faculties of Medicine in Canadian universities were interviewed. Interviews consisted of structured questions dealing with diabetes-related scenarios, with open-ended responses and probing for rationales. The two scenarios involved the development of a diabetes registry using clinical encounter data across several physicians' practices, and the addition of biological samples to the registry to create a biobank.ResultsThere was a wide range of responses given for the questions raised in the scenarios, indicating a lack of clarity about the role of REBs in registries and biobanks. With respect to the creation of a registry, a minority of sites felt that consent was not required for the information to be entered into the registry. Whether patient consent was required for information to be entered into the registry and the duration for which the consent would be operative differed across sites. With respect to the creation of a biobank linked to the registry, a majority of sites viewed biobank information as qualitatively different from other types of personal health information. All respondents agreed that patient consent was needed for blood samples to be placed in the biobank but the duration of consent again varied.ConclusionParticipants were more attuned to issues surrounding biobanks as compared to registries and demonstrated a higher level of concern regarding biobanks. As registries and biobanks expand, there is a need for critical analysis of suitable roles for REBs and subsequent guidance on these topics. The authors conclude by recommending REB participation in the creation of registries and biobanks and the eventual drafting of comprehensive legislation. (shrink)

ABSTRACT This article is a response to Nani Ranken's paper ‘Morality in business: disharmony and its consequences’ . There she attacked the analogy sometimes made between businesses and persons, and concluded that businesses cannot be regarded as moral agents. Her thesis relies centrally on a very strict notion of a person's ‘true good’. By exploring and expanding the concepts of ‘true good’ and ‘moral agency’ we are able to recover a sense in which businesses are indeed members of the moral (...) community. Moreover, admitting businesses to the moral community also provides a working framework to examine the claim that what is good for business is in harmony with the dictates of morality. (shrink)

The notion of role morality suggests individuals may adopt a different morality depending on the roles they undertake. Investigating role morality is important, since the mentality of role morality may allow agents to believe they can abdicate moral responsibility when acting in a role. This is particularly significant in the literature dealing with professional morality where professionals, because of their special status, may find themselves at odds with their best moral judgments. Here I tell four stories and draw out some (...) distinctions. I conclude that role morality is a genuine and useful distinction. However, I suggest that the purported distinction between role morality and professional morality is over‐determined. Therefore, alleged conflicts between the demands of role and profession (such as the different pressures on Pinto designers as employees and as engineers) are not conflicts between different kinds of demands, but rather conflicts arising from divergent roles that most workers will encounter regularly. Another analytical perspective is to look at moral choices at work in terms of power and the ability to bring about change. Finally, I draw the implication that we should stress moral awareness at a fairly abstract level for all employees and reinforce the moral primacy of individual choice. (shrink)

In this lively undergraduate textbook, Kevin Gibson explores the relationship between ethics and the world of business, and how we can serve the interests of both. He builds a philosophical groundwork that can be applied to a wide range of issues in ethics and business, and shows readers how to assess dilemmas critically and work to resolve them on a principled basis. Using case studies drawn from around the world, he examines topics including stakeholder responsibilities, sustainability, corporate social (...) responsibility, and women and business. Because business can no longer be isolated from its effects on communities and the environment, these concerns are brought to the forefront. The book also captures the dynamic nature of business ethics in the era of globalization where jobs can be outsourced, products are made of components from scores of countries and sweatshops often provide the cheap goods the public demands. (shrink)

I believe that corporations should be held responsible for their actions. Traditional discussions about the moral responsibility of an organization have relied on a model of criminal intent. Demonstrating intent demands that we find a moral agent capable of intending, and this has led to problems. Here I replace the analysis based on criminal law by one based on tort law. Under this framework I suggest that corporations can be held responsible for the harms caused by their activities even if (...) no person or persons in their decision making structure had formed malicious intent, since the sheer fact that the corporate environment encouraged or allowed negligence will be sufficient. (shrink)

Models of moral responsibility rely on foundational views about moral agency. Many scholars believe that only humans can be moral agents, and therefore business needs to create models that foster greater receptivity to others through ethical dialog. This view leads to a difficulty if no specific person is the sole causal agent for an act, or if something comes about through aggregated action in a corporate setting. An alternate approach suggests that corporations are moral agents sufficiently like humans to be (...) treated as persons, which leads to questions of intentionality and the organizational structure required to support the claim. In this article, I make an intermediate claim combining Goodpaster and Matthews' (60:132–141, 1982 ) view that a corporation may have a moral culture which affects subjective choices, with those of Painter-Morland (17(3):515–534, 2007 ) who points out that we should move from a model that posits discrete persons acting on each other to one where morality comes about through shared experience between agents who participate in each other’s lives. I argue that the discussion has been trapped in traditional dichotomies, and is better served by language that more accurately represents the dynamic interplay between organization and individual. I underwrite this claim by looking at recent changes in British and American legal approaches to corporate responsibility. These provide greater incentives for owners and business leaders to encourage employees to discuss the reflexive nature of legal and moral responsibility in business, facilitate workers to voice their moral concerns, and create structures and processes that allow those concerns to be heard. (shrink)

Neutrality is held to be the touchstone of good mediation. True neutrality is elusive, however, and probably not even desirable, at least when applied to patient‐provider disputes over medical care. In this context, mediators should not posture as “neutrals”; they should strive instead to protect their clients’ autonomy.

Many commentators have dismissed Wittgenstein’s numbering system in the Tractatus as either incoherent or a joke. In this paper I offer a way to rehabilitate the system along the lines of Wittgenstein’s own instructions. Reading the Tractatus in this way not only offers a way to make sense of the numbering, but also offers a significant improvement in examining the meaning of the text.

Many commentators have dismissed Wittgenstein’s numbering system in the Tractatus as either incoherent or a joke. In this paper I offer a way to rehabilitate the system along the lines of Wittgenstein’s own instructions. Reading the Tractatus in this way not only offers a way to make sense of the numbering, but also offers a significant improvement in examining the meaning of the text.

Abstract:Business negotiations often involve cooperative arrangements. Sometimes one party will renege on a cooperative enterprise for short-term opportunistic gain. There is a common assumption that such behavior necessarily leads to a spiral of mutual antagonism. We use some of the philosophical literature to frame general research questions and identify relevant variables in dealing with defection. We then describe an experimental approach for examining the possibility of reconciliation and discuss the results of one such experiment where participants were the victims of (...) defection. In contrast to the initial assumptions we found that many participants were willing to reconcile, and that penance conditions, when demanded, were less stringent than expected. We suggest that these findings warrant further study and have implications for business dealings.Very little can be learnt about [retribution] from Aristotle’sPoliticsor his three ethics. In modern ethico-political concepts of justice (in Hobbes, Rousseau and Hegel), the problem of retribution appears in conjunction with other problems and is not of central importance.—Agnes Heller. (shrink)

In this paper I will point to some of the common themes that have emerged when we ask whether engineering ethics is just business ethics I will then reflect on some of the implications of the approaches suggested by Michael Davis, Vivian Weil, and Rachelle Hollander.

Dees and Cramton have argued that we should take a deontological stand to make negotiations more ethical (“Promoting Honesty in Negotiation: An Exercise in Practical Ethics” BEQ, Vol. 3, #3). I suggest that their analysis is overdetermined, and that one can, in fact, reach the same conclusions through a Hobbesian approach to negotiation. I suggest that an equally valid way to develop ethical negotiation is through the consequentialist “Harmony Thesis” which posits that moral behavior is coextensive with beneficial results.

ABSTRACTThis article suggests that corporate responsibility should be interpreted to include concern about resources that cannot easily be treated as commodities. Heritage Sites are places of historical and cultural importance. Given the primacy of contingent valuation methods in creating policy, these sites are often at risk from development or tourism since there is pressure to treat them as revenue centers. The article moves to looking at the status of sites in terms of property rights, drawing on Locke's original formulation. The (...) article concludes that there is a normative justification for treating these sites as collective property that may warrant maintenance, preservation and restricted access. (shrink)

Here I look at the views of Mackie about the transitivity of causal statements. Mackie suggests that we replace total transitivity with a calculation which assigns a proportional value to partial causes; this allows us to work out an overall proportion of a single event in a causal chain. I marry the philosophical discussion with a sketch of tort law by means of an unusual hypothetical. I suggest that Mackie’s proportional analysis could be have a useful practical application since current (...) tort law regards causality as transitive and that total responsibility may be placed on the originator of connected but distinct events. (shrink)

Here I look at the views of Mackie about the transitivity of causal statements. Mackie suggests that we replace total transitivity with a calculation which assigns a proportional value to partial causes; this allows us to work out an overall proportion of a single event in a causal chain. I marry the philosophical discussion with a sketch of tort law by means of an unusual hypothetical. I suggest that Mackie’s proportional analysis could be have a useful practical application since current (...) tort law regards causality as transitive and that total responsibility may be placed on the originator of connected but distinct events. (shrink)

The Ontology for Biomedical Investigations (OBI) is an ontology that provides terms with precisely defined meanings to describe all aspects of how investigations in the biological and medical domains are conducted. OBI re-uses ontologies that provide a representation of biomedical knowledge from the Open Biological and Biomedical Ontologies (OBO) project and adds the ability to describe how this knowledge was derived. We here describe the state of OBI and several applications that are using it, such as adding semantic expressivity to (...) existing databases, building data entry forms, and enabling interoperability between knowledge resources. OBI covers all phases of the investigation process, such as planning, execution and reporting. It represents information and material entities that participate in these processes, as well as roles and functions. Prior to OBI, it was not possible to use a single internally consistent resource that could be applied to multiple types of experiments for these applications. OBI has made this possible by creating terms for entities involved in biological and medical investigations and by importing parts of other biomedical ontologies such as GO, Chemical Entities of Biological Interest (ChEBI) and Phenotype Attribute and Trait Ontology (PATO) without altering their meaning. OBI is being used in a wide range of projects covering genomics, multi-omics, immunology, and catalogs of services. OBI has also spawned other ontologies (Information Artifact Ontology) and methods for importing parts of ontologies (Minimum information to reference an external ontology term (MIREOT)). The OBI project is an open cross-disciplinary collaborative effort, encompassing multiple research communities from around the globe. To date, OBI has created 2366 classes and 40 relations along with textual and formal definitions. The OBI Consortium maintains a web resource providing details on the people, policies, and issues being addressed in association with OBI. (shrink)

The so-called "Prisoner''s Dilemma" is often referred to in business ethics, but probably not well understood. This article has three parts: (1) I claim that models derived from game theory are significant in the field for discussions of prudential ethics and the practical decisions managers make; (2) I discuss using them as a practical pedagogical exercise and some of the lessons generated; (3) more speculatively, I suggest that they are useful in discussions of corporate personhood.

This conceptual article has three parts: In the first, I discuss the shortcomings of treating the environment as a stakeholder and conclude that doing so is theoretically vague and lacks prescriptive force. In the second part, I recommend moving from broad notions of preserving nature and appeals to beauty to a more concrete analytic framework provided by the idea of human sustainability. Using sustainability as the focus of concern is significant as it provides us with a more tenable and quantifiable (...) standard for action, as in the case of carbon offsets and development of measures such as the United Nations Sustainability Indicators. In the final section, I draw on notions of stewardship to suggest that stakeholder management has a positive responsibility to promote sustainability. (shrink)

There are two competing conceptions of the nature and domain of ecological science in the popular and academic literature, an orthodox conception and a more expansive conception. The orthodox conception conceives ecology as a natural biological science distinct from the human social sciences. The more expansive conception views ecology as a science whose domain properly spans both the natural and social sciences. On the more expansive conception, non-traditional ecological disciplines such as ecological psychology , ecological anthropology and ecological economics may (...) legitimately be regarded as sub-disciplines of ecology, and the practitioners of such disciplines as ecologists. The orthodox-expansionist issue is significant both for the practice of ecology and for the self-identity of the philosophy of ecology. I argue in favour of the expansionist conception of ecology on general conceptual grounds, and by developing the case for one particular non-traditional ecological discipline, ecological psychology. (shrink)

Major Depressive Disorder (MDD) is a serious condition with a large disease burden. It is often claimed that MDD is a “brain disease.” What would it mean for MDD to be a brain disease? I argue that the best interpretation of this claim is as offering a substantive empirical hypothesis about the causes of the syndrome of depression. This syndrome-causal conception of disease, combined with the idea that MDD is a disease of the brain, commits the brain disease conception of (...) MDD to the claim that brain dysfunction causes the symptoms of MDD. I argue that this consequence of the brain disease conception of MDD is false. It incorrectly rules out genuine instances of content-sensitive causation between adverse conditions in the world and the characteristic symptoms of MDD. Empirical evidence shows that the major causes of depression are genuinely psychological causes of the symptoms of MDD. This rules out, in many cases, the “brute” causation required by the brain disease conception. The existence of cases of MDD with non-brute causes supports the reinstatement of the old nosological distinction between endogenous and exogenous depression. (shrink)

It is a mistake to think that any philosophical contribution to the study of psychopathology is otiose. I identify three non-exhaustive roles that philosophy can and does occupy in the study of mental disorder, which I call the agenda-setting role, the synthetic role, and the regulative role. The three roles are illustrated via consideration of the importance of Jaspers' notion of understanding and its application to specific examples of mental disorder, including delusions of reference, Capgras delusion and other monothematic delusions, (...) and clinical depression. Together the three roles assign to philosophy of psychopathology the task of determining how to situate the varieties of mental disorder within the system of interpretive and evaluative concepts that partially make up the dynamic but indispensable manifest image. (shrink)

Rudolf Eucken on the meaning and value of life: the anthropotheistic standpoint of religious idealism.--The alleged revolutionism of Eucken's philosophy.--Activism and adolescence.--The religion of the spirit.--The principle of fruition.--Religion and morality.--Fruition and action.--The passion of love.--Pragmatism and religious idealism.--Universalism and the problem of evil.

This book is the first major study of the theme of misanthropy, its history, arguments both for and against it, and its significance for us today. Misanthropy is not strictly a philosophy. It is an inconsistent thought, and so has often been mocked. But from Timon of Athens to Motörhead it has had a very long life, vast historical purchase and is seemingly indomitable and unignorable. Human beings have always nursed a profound distrust of who and what they are. This (...) book does not seek to rationalize that distrust, but asks how far misanthropy might have a reason on its side, if a confused reason. There are obvious arguments against misanthropy. It is often born of a hatred of physical being. It can be historically explained. It particularly appears in undemocratic cultures. But what of the misanthropy of terminally defeated and disempowered peoples? Or born of progressivisms? Or the misanthropy that quarrels with specious or easy positivities (from Pelagius to Leibniz to the corporate cheer of contemporary `total capital`)? From the Greek Cynics to Roman satire, St Augustine to Jacobean drama, the misanthropy of the French Ancien Regime to Swift, Smollett and Johnson, Hobbes, Schopenhauer and Rousseau, from the Irish and American misanthropic traditions to modern women`s misanthropy, the book explores such questions. It ends with a debate about contemporary culture that ranges from the `dark radicalisms`, queer misanthropy, posthumanism and eco-misanthropy to Houellebecq, punk rock and gangsta rap. (shrink)

It is a mistake to think that any philosophical contribution to the study of psychopathology is otiose. I identify three non-exhaustive roles that philosophy can and does occupy in the study of mental disorder, which I call the agenda-setting role, the synthetic role, and the regulative role. The three roles are illustrated via consideration of the importance of Jaspers’ notion of understanding and its application to specific examples of mental disorder, including delusions of reference, Capgras delusion and other monothematic delusions, (...) and clinical depression. Together the three roles assign to philosophy of psychopathology the task of determining how to situate the varieties of mental disorder within the system of interpretive and evaluative concepts that partially make up the dynamic but indispensable manifest image. (shrink)

Despite how he begins, suggesting that it is somehow a problem for me that I think "there is such a thing as philosophy, which could then be useful for psychopathology," ultimately it is clear that the possibility of philosophy is not the issue for Ghaemi. Rather, his issue is with academic philosophy of psychiatry, as he sees it, and with my failure to ask what underlying assumptions typically operate in it.I do not dispute that someone like Jaspers would want to (...) ask such a question, nor do I dispute that it is, in general, a perfectly good question. But Ghaemi thinks that my paper is missing out on something by not posing it. The reason he thinks this is because he thinks my paper is an instance of a pattern in the discipline against which he evidently has an axe to grind. In particular, he thinks philosophy in general should be more attendant to the ways in which Diagnostic and Statistical Manual of Mental Disorders (DSM) categories are (problematically) socially constructed. The fact that philosophers have failed to critically point this out allegedly shows philosophy of psychiatry's— and my—unexamined sympathy with the postmodern tendencies—understood as tendencies toward "relativism about truth" and "skepticism about science"—of psychiatry itself. This is odd for a number of reasons, especially in the present context. Firstly, I am not presently in a position to exhaustively defend all of philosophy of psychiatry on the charge of 'postmodernism,' or on the charge of failure to critically engage with the DSM, but it is worth simply stating that I find these to be rather patently unsubstantiated charges. Prominent works that falsify the latter and easily come to mind are by Tsou (2011), Cooper (2004, 2007), Horwitz and Wakefield (2007), Murphy (2006), Poland and von Eckhardt (2013), and Lalumera (2016). Of these, only Lalumera is interested in defending a DSM-style descriptivism (which perhaps Ghaemi would call a kind of "social constructionism"), but even she limits her defense of DSM categories to their role as reference-fixing representations. It is also true that Tsou's paper is an argument that the practical considerations which go into shaping the DSM categories sometimes represent values that permissibly operate in psychiatry. Perhaps this could be construed as a kind of social constructionism as well, and presumably Ghaemi would disagree with it, but no one here is guilty of a failure to engage critically with the DSM and its history. Further, whichever position is taken by these theorists on whether the DSM does, or even one day could, cut nature at its joints, or whether some of the values that shape its construction do so permissibly or impermissibly, one's acceptance or rejection of relativism about truth is an entirely logically independent matter. (shrink)

As biological organisms, we age and, eventually, die. However, age’s deteriorating effects may not be universal. Some theoretical entities, due to their synthetic composition, could exist independently from aging—artificial general intelligence (AGI). With adequate resource access, an AGI could theoretically be ageless and would be, in some sense, immortal. Yet, this need not be inevitable. Designers could imbue AGIs with artificial mortality via an internal shut-off point. The question, though, is, should they? Should researchers curtail an AGI’s potentially endless lifespan (...) by deliberately making it mortal? It is this question that this article explores. First, it considers what type of AGI is under discussion before outlining how such beings could be ageless. Then, after clarifying the type of immortality under discussion and arguing that imbuing an AGI with synthetic aging would be person-affecting, the article explores four core conundrums: (i) deliberately causing a morally significant being’s death; (ii) immortality’s associated harms; (iii) concerns about immortality’s unequal assignment; and (iv) the danger of immortal AGI overlords. The article concludes that while prudence requires we create an aging AGI, in the face of the material harm such an action would constitute, this is an insufficient reason to justify doing so. (shrink)

Although several important methodologies implicitly assume the truth of epistemic conservatism, the view that holding a belief confers some measure of justification on the belief, recent criticisms have led some to conclude that epistemic conservatism is an implausible view. That conclusion is mistaken. In this article, I propose a new formulation of epistemic conservatism that is not susceptible to the criticisms leveled at earlier formulations of epistemic conservatism. In addition to withstanding these criticisms, this formulation of epistemic conservatism has several (...) benefits. First, this formulation has the benefits of earlier formulations of epistemic conservatism, that is to say it makes sense of our intuitions about justification in regard to both memory beliefs and beliefs for which we have forgotten our evidence. Second, it provides a good way of responding to the skeptic’s challenge concerning the possibility of possessing knowledge of the external world posed by the Alternative Hypotheses argument. Third, it provides responses to both forms of a new skeptical problem plaguing basic knowledge structure theories, the Problem of Easy Knowledge formulated by Stewart Cohen. I argue that given the many benefits of this formulation of epistemic conservatism and the fact that it is not vulnerable to the criticisms that undermine earlier formulations of epistemic conservatism, this formulation of epistemic conservatism is a plausible view to maintain. (shrink)

It is a commonplace that liberalism and religious belief conflict. Liberalism, its proponents and critics maintain, requires the privatization of religious belief, since liberals often argue that citizens of faith must repress their fundamental commitments when participating in public life. Critics of liberalism complain that privatization is objectionable because it requires citizens of faith to violate their integrity. The liberal political tradition has always sought to carve out social space for individuals to live by their own lights. If liberalism requires (...) citizens to violate their integrity, liberals have cause for concern. I seek to rebut this integrity objection to liberalism. I focus on the dominant form of philosophical liberalism: public reason liberalism. I argue that the integrity objection undermines the mainstream conception of public reason liberalism, but not public reason liberalism itself. The paper opens by outlining the structure of public reason liberalism and the integrity objection (§§2 and 3). It then analyses two versions of the objection and argues that the second version is successful against the mainstream conception of public reason (§4). I argue in response that public reason liberalism need not endorse principles of restraint—the civic restrictions on religious expression typically associated with it. I then sketch a conception of public reason liberalism that eschews principles of restraint (§5). This alternative promises to reconcile public reason liberals and their faith-friendly critics by putting the integrity objection to rest. (shrink)

This volume explores evidentialism, a major theory of epistemic justification. It contains more than 20 papers that examine its nuances, its challenges, as well as its future directions. Written by leading and up-and-coming epistemologists, the papers cover a wide array of topics related to evidentialism. The contributors present both sides of the theory: some are advocates of evidentialism, while others are critics. This provides readers with a comprehensive, and cutting-edge, understanding of this epistemic theory. Overall, the book is organized into (...) six parts: The Nature of Evidence, Understanding Evidentialism, Problems for Evidentialism, Evidentialism and Social Epistemology, New Directions for Evidentialism, and Explanationist Evidentialism. Readers will find insightful discussion on such issues as the ontology of evidence, phenomenal dogmatism, how experiences yield evidence, the new evil demon problem, probability, norms of credibility, intellectual virtues, wisdom, epistemic justification, and more. This title provides authoritative coverage of evidentialism, from the latest developments to the most recent philosophical criticisms. It will appeal to researchers and graduate students searching for more information on this prominent epistemological theory. (shrink)

Introduction: religion and politics as human universals -- Catholic integralism and the integralists -- History --Symmetry -- Transition -- Stability -- Justice -- Confucian and Islamic anti-liberalisms -- Epilogue: reconciliation.

Matthew McGrath has recently challenged all theories that allow for immediate perceptual justification. This challenge comes by way of arguing for what he calls the “Looks View” of visual justification, which entails that our visual beliefs that are allegedly immediately justified are in fact mediately justified based on our independent beliefs about the looks of things. This paper shows that McGrath’s arguments are unsound or, at the very least, that they do not cause genuine concern for the species of dogmatism (...) called “Phenomenal Explanationism”, recently introduced and defended by Kevin McCain and Luca Moretti. (shrink)

This chapter explores the metaphysical views about higher-order logic held by two individuals responsible for introducing it to philosophy: Gottlob Frege (1848–1925) and Bertrand Russell (1872–1970). Frege understood a function at first as the remainder of the content of a proposition when one component was taken out or seen as replaceable by others, and later as a mapping between objects. His logic employed second-order quantifiers ranging over such functions, and he saw a deep division in nature between objects and functions. (...) Russell understood propositional functions as what is obtained when constituents of propositions are replaced by variables, but eventually denied that they were entities in their own right. Both encountered contradictions when supposing there to exist as many objects as functions, and both adopted views about the meaningfulness of higher-order discourse that were difficult to state from within their own strictures. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)