As case management is under development in France for elderly people, this study sets out to identify and analyse key situations responsible for ethical dilemmas for French case managers. We based our study on the analyses of individual interviews made with case managers and focus-group discussions, bringing together all case managers working in local organisations running for at least a year. We identified three situations giving rise to ethical dilemmas: in the order of importance, the refusals of care, the practicalities (...) of collecting and sharing personal data and the allocation of resources. These three situations can lead to conflict between the principle of beneficence and those of respect for autonomy, non-maleficence and justice. We describe here how French case managers practically deal with these situations. (shrink)

Several studies have explored differences between North American and European doctor patient relationships. They have focused primarily on differences in philosophical traditions and historic and socioeconomic factors between these two regions that might lead to differences in behaviour, as well as divergent concepts in and justifications of medical practice. However, few empirical intercultural studies have been carried out to identify in practice these cultural differences. This lack of standard comparative empirical studies led us to compare differences between France and the (...) USA regarding end-of-life decision-making. We tested certain assertions put forward by bioethicists concerning the impact of culture on the acceptance of advance directives in such decisions. In particular, we compared North American and French intensive care professional's attitudes toward: (1) advance directives, and (2) the role of the family in decisions to withhold or withdraw life-support. (shrink)

French healthcare networks aim to help healthcare workers to take care of patients by improving cooperation, coordination and the continuity of care. When applied to palliative care in the home, they facilitate overall care including medical, social and psychological aspects. French legislation in 2002 required that an information document explaining the functioning of the network should be given to patients when they enter a healthcare network. The law requires that this document be signed. Ethical issues arise from this legislation with (...) regard to the validity of the signature of dying patients. Signature of the consent form by a guardian or trustee, a designated person—the Person of Trust—transforms the doctor–patient relationship into a triangular doctor–patient–third-party relationship. (shrink)

The Inforare project aims to set up a system for the sharing of clinical and familial data, in order to study how genes are related to the severity of sickle cell disease. While the computerisation of clinical records represents a valuable research goal, an ethical framework is necessary to guarantee patients' protection and their rights in this developing field. Issues relating to patient information during the Inforare study were analysed by the steering committee. Several major concerns were discussed by the (...) committee and formalised in the patients' information letter: educating patients to aid the recruitment of family members, rules of confidentiality and the disclosure of aggregate, individual and unexpected research results. This paper presents the main issues addressed. (shrink)

Objective: To evaluate feasibility of the guidelines of the Groupe Francophone de Réanimation et Urgence Pédiatriques for limitation of treatments in the paediatric intensive care unit .Design: A 2-year prospective survey.Setting: A 12-bed PICU at the Hôpital Jeanne de Flandre, Lille, France.Patients: Were included when limitation of treatments was expected.Results: Of 967 children admitted, 55 were included with a 2-day median delay. They were younger than others , had a higher paediatric risk of mortality score , and a higher paediatric (...) overall performance category score at admission ; all p<0.002. 34 children died. A limitation decision was made without meeting for 7 children who died: 6 received do-not-resuscitate orders and 1 received withholding decision. Decision-making meetings were organised for 31 children, and the following decisions were made: 12 DNROs , 4 withholding , with 14 withdrawing and 1 continuing treatment . After limitation, 21 children died and 10 survived . 13 procedures were interrupted because of death and 11 because of clinical improvement . Parents’ opinions were obtained after 4 family conferences , 3 days after inclusion. The first meeting was planned for 6 days after inclusion and held on the 7th day after inclusion; 80% of parents were immediately informed of the decision, which was implemented after half a day.Conclusions: GFRUPs procedure was applicable in most cases. The main difficulties were anticipating the correct date for the meeting and involving nurses in the procedure. Children for whom the procedure was interrupted because of clinical improvement and who survived in poor condition without a formal decision pointed out the need for medical criteria for questioning, which should systematically lead to a formal decision-making process. (shrink)

Purpose The search for cause of death is important to improve knowledge and provide answers for the relatives of the deceased. Medical autopsy following unexplained death in hospital is one way to identify cause of death but is difficult to carry out routinely. Post mortem sampling (PMS) of tissues via thin biopsy needle or ‘mini incisions’ in the skin may be a useful alternative. A study was undertaken to assess how this approach is perceived by intensive care doctors and also (...) to evaluate how this practice is considered in ethical terms in France. Methods A study of PMS practices immediately after death in 10 intensive care departments was performed. The medical director of each centre was interviewed by telephone and asked to describe practices in their unit and to outline the questions raised by this practice. Results PMS is routinely performed in 70% of the units which responded, without systematically obtaining formal consent and without precise rules for communicating results. Approaches to PMS differed between centres, but all physicians felt that PMS is useful for the scientific information it gives and also for the information it provides for relatives. All physicians regret the lack of standards to structure PMS practices. Conclusion Information from post mortem examinations is important for society to inform about causes of death, for doctors to improve practices and for decision-makers responsible for organising care. Debate persists regarding the balance between individual rights and community interests. It is suggested that an approach for identifying cause of death could easily be integrated into the relationship between carers and relatives, provided full transparency is maintained. (shrink)

Breast cancer is a major public health challenge. Organized mammography screening (OS) is considered one way to reduce breast cancer mortality. EU recommendations prone mass deployment of OS, and back in 2004, France introduced a national OS programme for women aged 50–74 years. However, in 2012, participation rate was still just 52.7%, well short of the targeted 70% objective. In an effort to re-address the (in) efficiency of the programme, the French National Cancer Institute has drafted an expert-group review of (...) the ethical issues surrounding breast cancer mammography screening. (shrink)

Background Disclosure of obtaining informed consent from patients (ICP) and research ethics committee (REC) approval in published reports is sometimes omitted. To date, no disclosure data are available on surgical research. Objective Our aim was to assess whether REC approval and ICP were documented in surgical trials. Study design Overall, 657 randomised trials, published between 2005 and 2010 in 10 international journals, were included. We collected the report rate of REC approval and ICP and contacted the corresponding author when ethical (...) information was lacking. Results Among the 657 randomised controlled trials (RCT), 576 (87.7%) stated that an REC had approved the research, and 606 (92.2%) stated that ICP had been requested. Furthermore, 28 RCTs (4.3%) reported neither REC nor ICP. Conclusions The phase III randomised surgical trials that were analysed were shown to have respected fundamental ethical principles in approximately 90% of the cases examines. (shrink)

Hume's Reception in Early America: Expanded Edition brings together the original American responses to one of Britain's greatest men of letters, David Hume. Now available as a single volume paperback, this new edition includes updated further readings suggestions and dozens of additional primary sources gathered together in a completely new concluding section. From complete pamphlets and booklets, to poems, reviews, and letters, to extracts from newspapers, religious magazines and literary and political journals, this book's contents come from a wide variety (...) of sources published in colonial America and the early United States between 1758 and 1850. As well as classics by Thomas Jefferson, John Adams and Alexander Hamilton, it contains scores of unknown and hard-to-locate items, many of which have not been reprinted since their original publication. These responses are divided into four parts covering Hume's Essays; his Philosophical Writings; his History of England; and his Character and Death. Each of those parts has a separate introductory essay, and every selection is introduced by a short headnote that sets the piece in its historical context and provides bibliographical references. Packed with new insights into Hume and American thought and culture, Hume's Reception in Early America reveals the relevance and impact of Hume on American political, philosophical, historical, religious, and aesthetic debates. (shrink)

This is a welcome reprint of a book that continues to grow in importance.

We examine the role of religious identity in promoting strategic renewal in privately held founder family firms. Religious identity in these firms refers to their collective sense of being that reflects their founders’ and owner family members’ espoused religious values and beliefs, thereby distinguishing themselves from others in what is central, distinct, and enduring about their organization. We propose that such a religious identity determines family firms’ spiritual capital, which influences strategic renewal activities such as conflict resolution and resource allocation. (...) Specifically, we argue that spiritual capital can be a double-edged sword when family firms pursue strategic renewal. We discuss the implications of our work for future research. (shrink)

We examine the role of religious identity in promoting strategic renewal in privately held founder family firms. Religious identity in these firms refers to their collective sense of being that reflects their founders’ and owner family members’ espoused religious values and beliefs, thereby distinguishing themselves from others in what is central, distinct, and enduring about their organization. We propose that such a religious identity determines family firms’ spiritual capital, which influences strategic renewal activities such as conflict resolution and resource allocation. (...) Specifically, we argue that spiritual capital can be a double-edged sword when family firms pursue strategic renewal. We discuss the implications of our work for future research. (shrink)

Editor James Fetzer presents an analytical and historical introduction and a comprehensive bibliography together with selections of many of Carl G. Hempel's most important studies to give students and scholars an ideal opportunity to appreciate the enduring contributions of one of the most influential philosophers of science of the 20th century.

Ethics in business and economics is often attacked for being too superficial. By elaborating the conclusions of two such critics of business ethics and welfare economics respectively, this article will draw the attention to the ethics behind these apparently well-intended, but not always convincing constructions, by help of the fundamental ethics of Emmanuel Levinas. To Levinas, responsibility is more basic than language, and thus also more basic than all social constructions. Co-operation relations in organizations, markets and value networks are generated (...) from personal relations and personal responsibilities. It is not sufficient to integrate ethics in an impersonal, rational system, neither in business organizations nor in the world economy. Ethics has its source not in rationality, but in the personal. (shrink)

Fichte assigns ‘intellectual intuition’ a new meaning after Kant. But in 1799, his doctrine of intellectual intuition is publicly deemed indefensible by Kant and nihilistic by Jacobi. I propose to defend Fichte’s doctrine against these charges, leaving aside whether it captures what he calls the ‘spirit’ of transcendental idealism. I do so by articulating three problems that motivate Fichte’s redirection of intellectual intuition from being to acting: (1) the regress problem, which states that reflecting on empirical facts of consciousness leads (...) only to further facts and so cannot yield a first principle; (2) the rhapsody problem, which states that the categories form a haphazard set and so lack necessity unless they derive from a first principle; and (3) the nihilism problem, which states that a first principle cannot lie outside our cognition of it, lest it be the cause of our cognition and, being first, the cause of all our actions, reducing us to machines. Crucially, Fichte’s three motivating problems are in fact aspects of a single problem. Leaving any aspect unsolved spoils putative solutions to the other two. Consequently, Fichte requires a single unified solution to all three, which his doctrine of intellectual intuition provides. (shrink)

Levinas did not present any new ethical theories; he did not even give any normative recommendations. But his phenomenological investigations help us to understand how the idea of ethics emerges and how we try to cope with it. The purpose of this paper is to suggest some implications from a reading of Levinas on how ethical challenges are handled within a management perspective. The paper claims that management, both in theory and in practice, is necessarily egocentric and thus ethically biased. (...) Therefore, ethics, defined as the idea that it is possible to do otherwise than pursue one's own interest, must have its source outside the scope of management. Levinas identifies this source as the call for responsibility from the Other, beyond the reach of managerial control. He also suggests how this idea of ethics is put into practice, especially in economic life: the existence of money makes it both possible and necessary to compare unique and incomparable others. Management tools may be used in the service of always more justice, as it also may be used for the opposite purpose. Instead of trying to draw a normative conclusion from Levinas, we may distinguish between two ways of experiencing reality: one through language and knowledge, covering both descriptive and normative knowledge, including business ethics, and the other through the particular events of encounters, from where this knowledge is continuously questioned through the call for responsibility, and thereby may provide possibilities for continuous improvements towards always more justice. (shrink)

Levinas did not present any new ethical theories; he did not even give any normative recommendations. But his phenomenological investigations help us to understand how the idea of ethics emerges and how we try to cope with it. The purpose of this paper is to suggest some implications from a reading of Levinas on how ethical challenges are handled within a management perspective. The paper claims that management, both in theory and in practice, is necessarily egocentric and thus ethically biased. (...) Therefore, ethics, defined as the idea that it is possible to do otherwise than pursue one's own interest, must have its source outside the scope of management. Levinas identifies this source as the call for responsibility from the Other, beyond the reach of managerial control. He also suggests how this idea of ethics is put into practice, especially in economic life: the existence of money makes it both possible and necessary to compare unique and incomparable others. Management tools may be used in the service of always more justice, as it also may be used for the opposite purpose. Instead of trying to draw a normative conclusion from Levinas, we may distinguish between two ways of experiencing reality: one through language and knowledge, covering both descriptive and normative knowledge, including ‘business ethics’, and the other through the particular events of encounters, from where this knowledge is continuously questioned through the call for responsibility, and thereby may provide possibilities for continuous improvements towards always more justice. (shrink)

Two attitudes are possible: one, that the world is an absolute jungle and that the exercise of coercive power by rulers is only a manifestation of this; and the other, that it is both necessary and right that there should be this exercise of power, that through it the world is much less of a jungle than it could possibly be without it, so that one should in principle be glad of the existence of such power, and only take exception (...) to its unjust exercise. (shrink)

The familiar issue of corporate social responsibility takes on a new topic. Added to the list of concerns from affirmative action and environmental integrity is their growing contributions to education. At first glance, the efforts may appear to be ordinary gestures of communal good will in terms of providing computers, sponsoring book covers, and interactive materials provided by Scholastic Magazine. A closer view reveals a targeted market of student life who are vulnerable to commercials placed in these formats. Among the (...) most effective corporate intervention is Channel One News. It offers a newsworthy show but with mandatory commercial viewing. This increasing trend of corporations intervening to assist schools that need more money and/or equipment is disingenuous.In this essay, I present the background of this commercialization of education and demonstrate the violations against student autonomy and integrity. Although there may be utilitarian merits to some interventions, I argue that these infringe upon the moral value of personhood. Advertising in schools in its current practice is immoral on deontological grounds. (shrink)

1. The present paper is a continuation of my “Self-Ownership, World Ownership, and Equality,” which began with a description of the political philosophy of Robert Nozick. I contended in that essay that the foundational claim of Nozick's philosophy is the thesis of self-ownership, which says that each person is the morally rightful owner of his own person and powers, and, consequently, that each is free to use those powers as he wishes, provided that he does not deploy them aggressively against (...) others. To be sure, he may not harm others, and he may, if necessary, be forced not to harm them, but he should never be forced to help them, as people are in fact forced to help others, according to Nozick, by redistributive taxation. (shrink)

Throughout his career, Schelling assigns knowledge of the absolute first principle of philosophy to intellectual intuition. Schelling's doctrine of intellectual intuition raises two important questions for interpreters. First, given that his doctrine undergoes several changes before and after his identity philosophy, to what extent can he be said to “hold onto” the same “sense” of it by the 1830s, as he claims? Second, given that his doctrine of intellectual intuition restricts absolute idealism to what he calls a “science of reason”, (...) which he says cannot prove the absolute’s existence, what other doctrine does he require in order to prove this? I will answer these questions by tracing the shifts in Schelling’s doctrine of intellectual intuition from the 1790s to the 1830s and drawing out its evolving methodological role within his science of intelligibility. (shrink)