Christopher Meyers attempts a utilitarian defense of the deception of patients when the purported harms of truthful disclosure outweigh its benefits. He suggests that honesty i...

Allowing algorithms to guide or determine decision-making in ethically complex situations, and eventually satisfying the need for good clinical ethics consultation work, is a philosophically intere...

In this article, I argue that there is a moral difference between deactivating an implantable cardioverter defibrillator and turning off a cardiac pacemaker. It is, at least in most cases, morally permissible to deactivate an ICD. It is not, at least in most cases, morally permissible to turn off a pacemaker in a fully or significantly pacemaker-dependent patient. After describing the relevant medical technologies—pacemakers and ICDs—I continue with contrasting perspectives on the issue of deactivation from practitioners involved with these devices: (...) physicians, nurses, and allied professionals. Next, I offer a few possible analyses of the situation, relying on recent work in medical ethics. Considerations of intention, responsibility, and replacement support my distinguishing between ICDs and CPs. I conclude by recommending a change in policy of one of the leading cardiac societies. (shrink)

In their thoughtful and well-supported target article, Andrew Garland, Stephanie Morain, Jeremy Sugarman (2023) argue that clinicians have a duty to participate in pragmatic clinical trials. This d...

In this paper, I argue that distinctions between traditional and contemporary accounts of conscience protections, such as the account offered by Aulisio and Arora, fail. These accounts fail because they require an impoverished conception of our moral lives. This failure is due to unnoticed assumptions about the distinction between the traditional and contemporary articulations of conscience protection. My argument proceeds as follows: First, I highlight crucial assumptions in Aulisio and Arora’s argument. Next, I argue that respecting maximal play in values, (...) though a fine goal in our liberal democratic society, raises a key issue in exactly the situations that matter in these cases. Finally, I argue that too much weight is given to a too narrow conception of values. There are differences between appeals to conscience that are appropriately categorized as traditional or contemporary, and a way to make sense of conscience in the contemporary medical landscape is needed. However, the normative implications drawn by Aulisio and Arora do not follow from this distinction without much further argument. I conclude that their paper is a helpful illustration the complexity of this issue and of a common view about conscience, but insofar as their view fails to account for the richness of our moral life, they fail to resolve the issue at hand. (shrink)

In this paper, I consider the role of conscience in medical practice. If the conscientious practice of individual practitioners cannot be defended or is incoherent or unreasonable on its own merits, then there is little reason to support conscience protection and to argue about its place in the current medical landscape. If this is the case, conscience protection should be abandoned. To the contrary, I argue that conscience protection should not be abandoned. My argument takes the form of an analysis (...) of an essential feature of the conscience dissenter’s argument, the role of disagreement within “the medical profession.” Conscience dissenters make certain assumptions within their arguments about the profession, disagreements within the professions, and how such disagreement should be adjudicated. If it is the case that these assumptions are accurate reflections of the current medical landscape, then the advocate of conscience protection has one less leg to stand on. I aim to show that this is not the case and that the assumptions of the conscience dissenter are not only mistaken but are mistakes of significant magnitude, so significant as to raise serious questions about the merit of their position. If the argument in this paper is sound, then, at the very least, the conversation over conscience protection in medicine, in particular, and health care, in general, must continue. (shrink)

This essay serves as an introduction to this issue of the Journal of Medicine and Philosophy. The five articles in this issue address a range of topics from the human embryo and substantial change to conceptions of disability. They engage claims of moral status, defense of our humanity, and argue for an accurate and just classification of persons of different communities within a healthcare system. I argue in this essay that though their concerns are diverse, the authors in this issue (...) help to answer a common question: “Who counts as one of us?” Reading these articles through the lens of membership and the themes of dignity illustrates this commonality and bears fruit for further reflection on many of the challenging issues addressed in the subsequent papers. (shrink)

In “IRBs and The Protection Inclusion Dilemma: Finding a Balance,” Friesen et al. (2023) argue that IRBs ought to attend more, and better, to the need for the inclusion of under-researched populati...

We applaud Sedlakova and Trachsel’s work and their description of conversational artificial intelligence (CAI) as possessing a hybrid nature with features of both a tool and an agent (Sedlakova and...

Understanding what sorts of things one might be responsible for is an important component of understanding what one should do in situations where the administration of artificial hydration and nutrition are required to sustain the life of a patient. Relying on work done in the philosophy of action and on moral responsibility, I consider the implications of omitting the administration of artificial hydration and nutrition and instances in which the omitting agent would and would not be responsible for the death (...) of the patient. I am primarily interested in arguing against those who wish to seat responsibility for the death of a patient in an underlying pathology, even when the underlying pathology is not the cause of the patient’s death. (shrink)

The proper role of conscience in healthcare continues to be a topic of deep interest for bioethicists, healthcare professionals, and health policy experts. This issue of HEC Forum brings together a collection of articles about features of these ongoing discussions of conscience, advancing the conversations about conscience in healthcare from a variety of perspectives and on a variety of fronts. Some articles in this issue take up particularly challenging cases of conscientious objection in practice, such as Fleming, Frith, and Ramsayer’s (...) contextually rich piece on midwives in Scotland or Harter’s professionally grounded analysis; others engage the changing institutional landscapes which impact considerations of conscience, such as Cummins’ work on the role of employers in institutional policies about conscience and Ben Moshe’s discussion of publicity and institutional committees. Pieces by Howard and Pilkington both raise conceptual considerations about how we think about the role of conscience in medicine, questioning the use of “conscientious objection” in these discussions, and Byrnes pushes back on the most influential work in this area by Mark Wicclair. The issue concludes with a piece by Wicclair, which engages each of these distinct offerings, further extending the discussions of conscience in healthcare and helpfully connecting key themes discussed by authors in this issue to his contributions and to the longer tradition of discussions of conscience in medicine. This issue challenges readers to engage different arguments from different perspectives and asks them—in some cases—to be open to revising how they think about the role of conscience and the existence of and justification for conscientious objection in the dynamic, interdisciplinary fields of healthcare. (shrink)

One of the perplexing features of an infectious disease is the damage it causes, not only to physical health, but to mental health and to social relationships. This tension between the separation that is required for safety and the human need for contact is especially felt by institutions of higher education. Many such institutions not only educate students but seek to foster the kinds of communities which have thrived on personal interaction and shared physical space. Different institutions have responded to (...) COVID-19 and its impacts on their members differently. Given that the spring semester will begin months before COVID-19 vaccines are widely available, we offer seven recommendations and argue that for a university, college, or other similarly situated educational institution to ethically respond to the pandemic, it must follow these recommendations. These recommendations are grounded in both scientific research and ethical analysis. Proper ethical analysis, which is necessary for the implementation of good policies, cannot be accomplished without an evidence-based grounding. After describing features of the virus and the situation that faces higher education institutions, in general, we turn to a detailed discussion of transmission. We discuss interventions available to institutions, including masking, hygiene, barriers, and testing and surveillance. Our recommendations are supported by an ethical analysis reliant on four themes: expertise, planning, stewardship, and dignity. (shrink)

J Med Philos, 2020; 45: 28–41; doi:_ 10.1093/jmp/jhz031 _.

In their compelling argument for the use of role morality as a means to aid physicians in navigating potential conflicts of interest, Doernberg and Truog (2023) posit the existence of distinct sphe...

Discussions of the proper role of conscience and practitioner judgement within medicine have increased of late, and with good reason. The cost of allowing practitioners the space to exercise their best judgement and act according to their conscience is significant. Misuse of such protections carve out societal space in which abuse, discrimination, abandonment of patients, and simple malpractice might occur. These concerns are offered amid a backdrop of increased societal polarization and are about a profession which has historically fought for (...) such privileged space. There is a great deal that has been and might yet be said about these topics, but in this paper I aim to address one recent thread of this discussion: justification of conscience protection rooted in autonomy. In particular, I respond to an argument from Greenblum and Kasperbaur and clarify a critique I offered of an autonomy-based conscience protection argument which Greenblum and Kasperbaur seek to improve and defend. To this end, I briefly recap the central contention of that argument, briefly describe Greenblum and Kasperbaur’s analysis of autonomy and of my critique, and correct what appears to be a mistake in interpretation of both my work and of autonomy-based defenses of conscience protection in general. (shrink)

Discussions of the proper role of conscience and practitioner judgement within medicine have increased of late, and with good reason. The cost of allowing practitioners the space to exercise their best judgement and act according to their conscience is significant. Misuse of such protections carve out societal space in which abuse, discrimination, abandonment of patients, and simple malpractice might occur. These concerns are offered amid a backdrop of increased societal polarization and are about a profession which has historically fought for (...) such privileged space. There is a great deal that has been and might yet be said about these topics, but in this paper I aim to address one recent thread of this discussion: justification of conscience protection rooted in autonomy. In particular, I respond to an argument from Greenblum and Kasperbaur and clarify a critique I offered of an autonomy-based conscience protection argument which Greenblum and Kasperbaur seek to improve and defend. To this end, I briefly recap the central contention of that argument, briefly describe Greenblum and Kasperbaur’s analysis of autonomy and of my critique, and correct what appears to be a mistake in interpretation of both my work and of autonomy-based defenses of conscience protection in general. (shrink)

Discussions of the proper role of conscience and practitioner judgement within medicine have increased of late, and with good reason. The cost of allowing practitioners the space to exercise their best judgement and act according to their conscience is significant. Misuse of such protections carve out societal space in which abuse, discrimination, abandonment of patients, and simple malpractice might occur. These concerns are offered amid a backdrop of increased societal polarization and are about a profession which has historically fought for (...) such privileged space. There is a great deal that has been and might yet be said about these topics, but in this paper I aim to address one recent thread of this discussion: justification of conscience protection rooted in autonomy. In particular, I respond to an argument from Greenblum and Kasperbaur and clarify a critique I offered of an autonomy-based conscience protection argument which Greenblum and Kasperbaur seek to improve and defend. To this end, I briefly recap the central contention of that argument, briefly describe Greenblum and Kasperbaur’s analysis of autonomy and of my critique, and correct what appears to be a mistake in interpretation of both my work and of autonomy-based defenses of conscience protection in general. (shrink)

The question of whether nursing ethics is a distinct entity within bioethics is an important and thought-provoking one. Though fundamental bioethical principles are appreciated and applied within the practice of nursing ethics, there exist distinct considerations which make nursing ethics a unique subfield of bioethics. In this article, we focus on the importance of relationships as a distinguishing feature of the foundation of nursing ethics, evidenced in its education, practice, and science. Next, we consider two objections to our claim of (...) distinctiveness: first, that nursing ethics is merely an application of bioethical principles; second, that many bioethical subfields emphasize relationships. We respond by highlighting that throughout nursing education and generally in every career path that follows, the creation and nurturing of relationships is emphasized. Compassion and respect for the dignity of every patient is the framework upon which these therapeutic relationships are built. Much of the focus of nursing science rests on creating meaningful interpersonal experiences and human connection. After responding to each objection, we turn to the implications of this distinctiveness on clinical ethics practice, arguing that the strengths of our approach outweigh the limitations. The deep emphasis on creating meaningful interpersonal experiences and human connection supports a greater integration of relationships and social contexts into the evaluation of whether an action is ethically permissible, which is an important benefit in addressing the challenging human situations that patients face. Moreover, this perspective allows nurse ethicists to account for diverse and complex social structures and their influence in making ethical determinations. These strengths outweigh the limitations of potential inconsistencies between nurse and non-nurse clinical ethicists on the same service, a result we attribute to nursing ethics—and, in turn, the practice of the nurse ethicist—being framed by relationships to a larger extent than other bioethical subfields. (shrink)

We applaud Shen et al. (2024) for offering a framework to address how to return research results from digital phenotyping within the discipline of psychiatry. However, given the value-laden nature...

The authors, one a trained geneticist and the other a trained ethicist, designed and team-taught a bioethics course where nineteen third- and fourth-year undergraduate students were enrolled at Aquinas College in Grand Rapids, Michigan, during the fall 2016 semester. The syllabus, including democratically-chosen ethical debate topics, peer-led student working groups, and varied assessment methods were novel aspects of the course. The students, being either philosophy or biology majors or minors, successfully completed the course and indicated being highly satisfied with the (...) course at its completion. Although there were limitations to a course such as this one, educators at similar small liberal arts institutions could offer a bioethics course by following our suggestions, including collaborative teaching and assessment and incorporating students’ preferences into the scheduled curriculum. (shrink)

In the piece, “What Should ChatGPT Mean for Bioethics?” Professor Cohen proposes that the introduction of AI generally, and generative AI specifically, requires that patients be informed of, and co...

Chat Generative Pre-Trained Transformer (ChatGPT) has been a growing point of interest in medical education yet has not been assessed in the field of bioethics. This study evaluated the accuracy of ChatGPT-3.5 (April 2023 version) in answering text-based, multiple choice bioethics questions at the level of US third-year and fourth-year medical students. A total of 114 bioethical questions were identified from the widely utilised question banks UWorld and AMBOSS. Accuracy, bioethical categories, difficulty levels, specialty data, error analysis and character count (...) were analysed. We found that ChatGPT had an accuracy of 59.6%, with greater accuracy in topics surrounding death and patient–physician relationships and performed poorly on questions pertaining to informed consent. Of all the specialties, it performed best in paediatrics. Yet, certain specialties and bioethical categories were under-represented. Among the errors made, it tended towards content errors and application errors. There were no significant associations between character count and accuracy. Nevertheless, this investigation contributes to the ongoing dialogue on artificial intelligence’s (AI) role in healthcare and medical education, advocating for further research to fully understand AI systems’ capabilities and constraints in the nuanced field of medical bioethics. (shrink)

In a recent article for this journal, Bryan Pilkington makes a number of critical observations about one of our arguments for non-traditional medical conscientious objectors’ duty to refer. Non-traditional conscientious objectors are those professionals who object to indirectly performing actions—like, say, referring to a physician who will perform an abortion. In our response here, we discuss his central objection and clarify our position on the role of value conflicts in non-traditional conscientious objection.

Pointing the way toward a revitalized future for the study of literature, Reconstruction in Literary Studies draws on philosophical pragmatism to justify the academic study of literature. In turn, Vescio connects the changing field to its social function as an institution.

Overzicht van de ideeën van de Oostenrijks-Engelse wijsgeer (geb. 1902) over de wetenschap en de maatschappij.

In a brilliant and explosively controversial work, the author attacks modern science for destroying our spiritual sense of self. What is the role of science in present-day society? Should we be as dazzled as we are by the innovations, the insights, and the miraculous improvements in material life that science has wrought? Or is there a darker, more pernicious side to our scientific success? Renowned British science columnist Bryan Appleyard thoroughly explores each of these provocative topics in a book (...) that has incited the ire of the scientific community. He points out that while scientists have shaped our lives and our beliefs, they have consistently failed to explain human consciousness, the soul, or the meaning of life. From Galileo to Darwin, from Copernicus to Oppenheimer, countless scientists have proclaimed a universe in which human beings are only an accidental presence. The unwitting result is that science has cast humankind adrift, paralyzing us with fear and cutting us off from personal or religious truth. In Appleyard's view, science has done us "appalling spiritual damage." These startling conclusions have prompted strong counterattacks from the scientific establishment. Yet regardless of where one falls in the debate, Understanding the Present forces readers to re-examine society's blind faith in the benevolence of modern science. "An exposition that is dazzling for its concrete illustrations and examples."--The New York Times "A withering indictment of modern science . . . This should crack a few test tubes."--Kirkus Reviews. (shrink)

Semantics for Reasons is a book about what we mean when we talk about reasons. It not only brings together the theory of reasons and natural language semantics in original ways but also sketches out a litany of implications for metaethics and the philosophy of normativity. In their account of how the language of reasons works, Bryan R. Weaver and Kevin Scharp propose and defend a view called Question Under Discussion Reasons Contextualism. They use this view to argue for (...) a series of novel positions on the ontology of reasons, indexical facts, the reasons-to-be-rational debate, moral reasons, and the reasons-first approach. (shrink)

This article proposes an approach to educational distribution that attempts to minimise enduring tensions among conflicting values. At the foundation of this approach is a threshold of educational adequacy based on what is needed for citizens to participate in a democratic society. This threshold is justified because it minimises conflict with parental rights and because it better manages ‘the bottomless pit’ problem of educational distribution. This threshold is then modified to stipulate that, after the threshold has been reached, public resources (...) should be distributed equally across students from all backgrounds. While this modification is essential to sending messages of equal citizenship, it also leaves a ‘moral residue’ because it allows wealthy parents to invest greater private resources in their children, thus preserving their children's competitive advantage. Minimising this harm requires policy mechanisms outside of schools that more aggressively break the link between educational outcomes, success in market competition, and social goods. Something ‘external’ to educational institutions is necessary, then, for the achievement of educational justice. (shrink)

This article deals with the question of what time reversal means. It begins with a presentation of the standard account of time reversal, with plenty of examples, followed by a popular non-standard account. I argue that, in spite of recent commentary to the contrary, the standard approach to the meaning of time reversal is the only one that is philosophically and physically viable. The article concludes with a few open research problems about time reversal.

According to a widely credited model in the business ethics literature, ethical decisions are a function of two kinds of factors, personal(individual) and situational, and these factors interact with each other. According to a contrary view of decision making that is widely held in some areas of business research, individuals’ decisions about ethical issues (and subsequent actions) are purely a function of their self-interest.The laboratory experiment reported in this paper provides a test of the person-situation interactionist model, using the general (...) theoretical and experimental framework used in the experimental economics literature. One individual and two situational factors relating to moral intensity were examined which may influence decisions to misrepresent information in the course of business activities.The individual and one situational variable were significantly related to participants’ actions. The interactions among individual andsituation variables were not individually significant, although the model including interactions had a much higher level of statistical significance. Gender was significant, both directly and in interaction with moral development, suggesting that it may be worthy of further examination. (shrink)

There are two dominant approaches to quantification: the Fregean and the Tarskian. While the Tarskian approach is standard and familiar, deep conceptual objections have been pressed against its employment of variables as genuine syntactic and semantic units. Because they do not explicitly rely on variables, Fregean approaches are held to avoid these worries. The apparent result is that the Fregean can deliver something that the Tarskian is unable to, namely a compositional semantic treatment of quantification centered on truth and reference. (...) We argue that the Fregean approach faces the same choice: abandon compositionality or abandon the centrality of truth and reference to semantic theory. Indeed, we argue that developing a fully compositional semantics in the tradition of Frege leads to a typographic variant of the most radical of Tarskian views: variabilism, the view that names should be modeled as Tarskian variables. We conclude with the consequences of this result for Frege's distinction between sense and reference. (shrink)

A controversy rages over the question of how should controversial topics be taught. Recent work has advanced the “epistemic criterion” as the resolution to this controversy. According to the epistemic criterion, a matter should be taught as controversial when contrary views can be entertained on the matter without the views being contrary to reason. When an issue is noncontroversial, according to the epistemic criterion, the correct position can be taught “directively,” with the teacher endorsing that position. When there is a (...) legitimate controversy, the view should be taught “nondirectively,” with the teacher remaining neutral. In response, Bryan Warnick and Spencer Smith argue that the proponents of the epistemic criterion fail to recognize the multidimensional nature of what it means to learn to be rational. Recognizing this complexity undermines the link between the epistemic status of the controversy and directiveness of one's teaching, suggesting more flexibility in how teachers approach controversial issues. It also implies the need for a new category of teaching, which Warnick and Smith call “soft-directive” teaching. (shrink)

In his 1923 play R.U.R.: Rossum s Universal Robots, Karel Capek coined In 1993, we began a humanoid robotics project aimed at constructing a robot for use in exploring theories of human intelligence. In this article, we describe three aspects of our research methodology that distinguish our work from other humanoid projects. First, our humanoid robots are designed to act autonomously and safely in natural workspaces with people. Second, our robots are designed to interact socially with people by exploiting natural (...) human social cues. Third, we believe that robotics offers a unique tool for testing models of human intelligence drawn from developmental psychology and cognitive science. (shrink)

We argue that once a normative claim is developed, there is an imperative to effect changes based on this norm. As such, ethicists should adopt an “implementation mindset” when formulating...

According to a widely credited model in the business ethics literature, ethical decisions are a function of two kinds of factors, personal(individual) and situational, and these factors interact with each other. According to a contrary view of decision making that is widely held in some areas of business research, individuals’ decisions about ethical issues (and subsequent actions) are purely a function of their self-interest.The laboratory experiment reported in this paper provides a test of the person-situation interactionist model, using the general (...) theoretical and experimental framework used in the experimental economics literature. One individual and two situational factors relating to moral intensity were examined which may influence decisions to misrepresent information in the course of business activities.The individual and one situational variable were significantly related to participants’ actions. The interactions among individual andsituation variables were not individually significant, although the model including interactions had a much higher level of statistical significance. Gender was significant, both directly and in interaction with moral development, suggesting that it may be worthy of further examination. (shrink)

Aristotle thinks that happiness is an activity---it consists in doing something---rather than a feeling. It is the best activity of which humans are capable and is spread out over the course of a life. But what kind of activity is it? Some of his remarks indicate that it is a single best kind of activity, intellectual contemplation. Other evidence suggests that it is an overarching activity that has various virtuous activities, ethical and intellectual, as parts. At stake are questions about (...) how we should live and the correct balance of theoretical and practical activity. Numerous interpreters have sharply disagreed about Aristotle's answers to such questions. This book offers a fundamentally new approach to determining what kind of activity Aristotle thinks happiness is, one that challenges widespread assumptions that have until now prevented a dialectically satisfactory interpretation. This approach displays the boldness and systematicity of Aristotle's practical philosophy. (shrink)

We link the corporate governance literature in financial economics to the agency cost perspective of corporate social responsibility to derive theoretical predictions about the relationship between corporate governance and the existence of executive compensation incentives for CSR. We test our predictions using novel executive compensation contract data, and find that firms with more shareholder-friendly corporate governance are more likely to provide compensation to executives linked to firm social performance outcomes. Also, providing executives with direct incentives for CSR is an effective (...) tool to increase firm social performance. The findings provide evidence identifying corporate governance as a determinant of managerial incentives for social performance, and suggest that CSR activities are more likely to be beneficial to shareholders, as opposed to an agency cost. (shrink)