The following article is a response to the position paper of the Hastings Center, "Ethical Challenges of Chronic Illness", a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical (...) survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. Keywords: acute, agent, autonomy, chronic, knowledge, obligations, rights CiteULike Connotea Del.icio.us What's this? (shrink)

Medicine needs our trust. We need to be able to rely on individual clinicians and researchers, and we need to be able to have confidence in hospitals and clinics. Yet the organization of our healthcare institutions is not designed to promote that trust. In fact, the structure of our medical institutions seems to undermine our faith.

As early as 1981 Gorlin and Zucker produced a film, AComplicatingFactor:Doctors'FeelingsasaFactorinMedicalCare and in a 1983 paper on the subject they described one of the important epiphenomena of the encounter between doctor and patient—namely, the reaction of the physician to the patient and how this affects both the physician and the quality of the relationship. At that time they were concerned with the physicians' ability to reckon with their own reactions to patients who presented with problems or personality traits that complicated (...) the doctor-patient relationship. Some patients were hateful or unlikable, some denied their disease state, some became unusually dependent on the physician, some were intimidating to the doctor. Their behavior evoked responses that tended to complicate the doctor-patient relationship with distancing, unusual identification, or hostility. That publication recognized and explained the problem and went on to suggest a process of achieving emotional awareness and mastery to help physicians maintain their appropriate role. (shrink)

A woman's right to know the contents of her own body, and to make a choice about whether to continue her pregnancy or not, should be defended against laws trying to stop prenatal sex selection, either in the developing world or in the developed world. Restrictions on women's reproductive freedom harm the interests of women and girls, and ignore myriad social policy solutions, such as education and income incentives to have girls and universal old age pensions, that provide better answers (...) to the strains of unbalanced sex ratios. The opponents of sex selection trumpet all accounts of increased discrimination against women resulting from unequal sex ratios while ignoring growing evidence of positive cultural change and women's empowerment fromwomen's enhanced marriage prospects. Opponents of sex selection reify a conservative heteronormative model of sexuality, gender roles and family structure, while arguing that unmarried men are social time bombs who can only be controlled by a wife. Eventually the social policy dilemma around sex selection will presumably be made moot since would-be parents will be able to use pre-conceptive technology to determine a conceptus's gender without abortion or in-vitro fertilization. But until the sex selection argument unravels before technological innovation, women's rights to control their bodies must be defended against laws banning - or requiring - prenatal ultrasound and abortion. (shrink)

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision‐making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found (...) in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision‐making. (shrink)

This essay challenges the dominance of the spherical earth model in fifteenth- and early-sixteenth-century Western European thought. It examines parallel strains of Latin and vernacular writing that cast doubt on the existence of the southern hemisphere. Three factors shaped the alternate accounts of the earth as a plane and disk put forward by these sources: the unsettling effects of maritime expansion on scientific thought; the revival of interest in early Christian criticism of the spherical earth; and a rigid empirical stance (...) toward entities too large to observe in their entirety, including the earth. Criticism of the spherical earth model faded in the decades after Magellan’s crew returned from circuiting the earth in 1522. (shrink)

Comparative environmental philosophy is valuable in many ways. Perhaps it is most valuable because it reveals some of the foundational assumptions that run so deep in the poles of comparison that they might otherwise have gone unnoticed. These revelations may invite us to challenge those assumptions that have led to the kind of thinking responsible for much of the environmental degradation that we see today. Japanese Environmental Philosophy gathers papers focused on the environmental problems of the twenty-first century. Drawing from (...) Japanese philosophical traditions they investigate our relationships with other humans, nonhuman animals, and the environment. The heart of the book consists of chapters written by fifteen top scholars from Japan, the United States, Europe, and Australia. The essays cover a broad range of topics drawn from various strains of Japanese thought—including Zen Buddhism, Shintoism, the Kyoto school, and Japanese philosophy of art and aesthetics—as well as from traditional Japanese culture and the contemporary science of planning for natural disasters. These articles demonstrate that Japanese scientific, philosophical, religious, and cultural traditions can provide meaningful insight to address the current global environmental crisis. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Kant's Religion within the Boundaries of Mere Reason is one of the great modern examinations of religion's meaning, function and impact on human affairs. In this volume, the first complete English-language commentary on the work, James J. DiCenso explains the historical context in which the book appeared, including the importance of Kant's conflict with state censorship. He shows how the Religion addresses crucial Kantian themes such as the relationship between freedom and morality, the human propensity to evil, the status (...) of historical traditions in relation to ethical principles, and the interface between individual ethics and social institutions. The major arguments are clearly and precisely explained, and the themes are highlighted and located within Kant's mature critical philosophy, especially his ethics. The commentary will be valuable for all who are interested in the continuing relevance of religion for contemporary inquiries into ethics, public institutions and religious traditions. (shrink)

This volume -- a companion to Thomas Reid: Selected Philosophical Writings (2012) -- makes available material from Thomas Reid's autograph manuscripts and student notes of his lectures. It includes an introductory essay by Nicholas Wolterstorff.

This is a book about how we see: the environment around us (its surfaces, their layout, and their colors and textures); where we are in the environment; whether or not we are moving and, if we are, where we are going; what things are good for; how to do things (to thread a needle or drive an automobile); or why things look as they do.The basic assumption is that vision depends on the eye which is connected to the brain. The (...) author suggests that natural vision depends on the eyes in the head on a body supported by the ground, the brain being only the central organ of a complete visual system. When no constraints are put on the visual system, people look around, walk up to something interesting and move around it so as to see it from all sides, and go from one vista to another. That is natural vision—and what this book is about. (shrink)

The alleged threats to human nature are at the root of many concerns about the use of nanotechnology to extend human health and capabilities. Bu the concept of human nature is illusory, selectively deployed, and does not impose any ethical constraint on human enhancement. Human nature is not only a meaningless concept, a product of our imperfect human cognition and a relic of the idea of a "soul," but, as it is deployed today against human enhancement technologies, it is also (...) a morally offensive, racist concept. The "human-racists" who deploy the concept of human nature are more inclusive than their forebears, but the make the same mistake of tying citizenship and value to biology. By setting aside the concept of human nature, we can affirm the value of the myriad aspects of human existence that we wish to preserve and extend using human enhancement technologies, including whatever genetic capacities and limits we may discover. Human enhancement technologies, such as those that may be enabled by nanotechnology and genetic engineering, enable us to define a new and more dynamic set of human capabilities, and to better achieve many moral virtues, regardless of whether they are part of "human nature" or not. (shrink)

Individuals and businesses make numerous payments every day. They sometimes have choices about what forms of payment to make or accept, and at other times are effectively forced to use a particular form. Often there is an asymmetric power relationship between payer and payee that raises the issue of whether one side unfairly exploits the other. Is it unethical exploitation for an employer to pay employees with a fee-laden payroll card over other more convenient forms of payment? Does the fee (...) structure of payment networks such as Visa and MasterCard unfairly exploit merchants? The bitcoin payment system is an ethical as well as technological evolution as it was designed to be an electronic payment system that does not rely upon trust. Can an entire payment system like bitcoin be “evil,” as charged by Krugman? Payment tools as such are ethically neutral, but can be used in an ethical or unethical manner. (shrink)

In 2000 Bill Joy proposed that the best way to prevent technological apocalypse was to "relinquish" emerging bio-, info- and nanotechnologies. His essay introduced many watchdog groups to the dangers that futurists had been warning of for decades. One such group, ETC, has called for a moratorium on all nanotechnological research until all safety issues can be investigated and social impacts ameliorated. In this essay I discuss the differences and similarities of regulating bio- and nanotechnological innovation to the efforts to (...) regulate nuclear and biological weapons of mass destruction. I then suggest the creation of a global technology regulatory regime to ensure the safe and equitable diffusion of genetic, molecular and information technologies, and point out the principal political obstacles to implementing such a regime. (shrink)

The term “biopolitics” has four distinct but overlapping meanings in modern scholarship. According to Lemke’s history of the term (Lemke 2011), political scientists used “biopolitics” in a variety of ways as early as the 1920s, and the Third Reich used it to describe their eugenic plans. But the term really found common usage first among 1960s political scientists interested in the relationship of evolutionary biology and politics (Caldwell 1964). Forming the Association for Politics and the Life Sciences (APLS) in 1981, (...) they defined “biopolitics” as any investigation of the effect of biology on politics, from the primate origins of hierarchy, to infectious disease impacts on warfare, to the influence of the health of leaders on their decision making (Somit and Peterson 1998). (shrink)

Recently there has been an outpouring of consumer frustration over rising food and energy prices. Many politicians railed against “speculators” who allegedly drove up the prices of key necessities. Is speculation unethical? This article reviews the traditional arguments against speculation. Many of the standard criticisms confuse speculation with gambling. In much the same way as ethicists now draw distinctions between usury and normal business interest, we draw a distinction between socially useful speculation and gambling. Gambling involves taking on risk with (...) no plausible expectation of making a profit. Gambling may provide entertainment value to some people, but like other addictive activities causes grave harm to a subset of users. Speculation involves taking on a business risk with a plausible expectation that a profit will result. Speculators provide an important risk bearing service by taking on risks that others do not want. They help markets to function better by helping to incorporate information into prices as well as providing liquidity. Speculators may actually reduce shortages by causing quicker price increases that motivate producers to increase production and consumers to conserve. But even socially useful speculation may have an ethical dark side. Does such speculation cause damage by adding excess volatility to prices? Speculators may contribute to price bubbles. At what point does legitimate speculation become odious “price gouging?” We also draw an ethical distinction between speculation, which seeks to benefit from changing prices, and manipulation, actions taken to push prices away from their economically appropriate levels. (shrink)

This authoritative volume provides a comprehensive road map of the important and rapidly growing field of emotion regulation.

This paper examines the ethics of contemporary managerial compensation in the context of executive stock options. Economic considerations would dictate that executive stock options should be adjusted to eliminate the effect of overall stock market movements which are beyond the control of the executive. However, in practice, most executive stock options are not adjusted to control for these outside factors. Agency considerations are the most likely culprit. Adjusting for the influence of outside factors, such as a generally rising stock market, (...) from executive stock options sets a higher bar for managers to reach. Furthermore, traditional accounting standards permitted firms that did not adjust options to avoid reporting options as expenses. This presents CEOs and boards of directors with a major ethical dilemma. On the one hand, their duty to their shareholders and stakeholders dictates that executive stock options should be adjusted to eliminate outside noise from unrelated movements in the overall stock market. However, financial statements are presented in the language of accounting. If the overwhelming majority of the users of a language define a particular item in one way, then to deviate from the norm implies that the recipient of such a deviant statement may not properly interpret the statement. Likewise, if the standard practice is for firms to use unadjusted options and thus under-report expenses, to deviate from this industry norm risks that users of financial statements would not properly interpret the financial statements, with perhaps negative consequences for the shareholders. In short, if "everyone else does it," then it could be wrong for an individual firm to deviate from the norm as that would harm the shareholders. (shrink)

Both the psychology of perception and the philosophy of perception seem to show a new face when the process is considered at its own level, distinct from that of sensation. Unfamiliar conceptions in physics, anatomy, physiology, psychology, and phenomenology are required to clarify the separation and make it plausible. But there have been so many dead ends in the effort to solve the theoretical problems of perception that radical proposals may now be acceptable. Scientists are often more conservative than philosophers (...) of science. I end, therefore, as I began, with a plea for help. (shrink)

The controversy over short selling has continued unabated from the introduction of modern equity trading in Amsterdam in 1610 to the present day. Nevertheless, the business ethics literature has not really addressed short selling. Short sellers not only profit from the misery of others, they also create it through their selling activities. However, they also provide a socially useful service by making prices better reflect true values, protecting other investors from purchasing overpriced securities. Short sellers can also help to provide (...) liquidity in the markets. Recently, there has been a hue and cry against so called "naked" short selling, which involves not delivering the shares that have been sold. This gives manipulators a tool for depressing stock prices and deprives purchasers of voting rights and potential stock lending revenue. Naked short selling creates ethical issues for short sellers, buyers, brokers, market makers, and regulators. Is it ethical to exploit a legal loophole that permits sellers to sell stock and delay delivering shares indefinitely? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Selected Letters by William, Henry JamesWilliam James EarleWilliam and Henry James. Selected Letters. Edited by Ignas K. Skrupskelis and Elizabeth M. Berkeley. Introduction by John J. McDermott. Charlottesville VA: University Press of Virginia, 1997. Pp. xxxi + 570. $ 39.95.Almost fifty years of letters to and from the very diversely brilliant James brothers: in this volume a generous, and probably ample, selection of 216 from (...) a total of 740 surviving letters or postcards, from an original total, according to the present editors, of twice as many. This volume of correspondence reflects the deep, unquestioned, unshakable familial (and virtually statutory) closeness of William and Henry who happened, as adults, to be seldom in the same place. There is, it must be said, very little explicit philosophy, narrowly or broadly defined, in these letters, but the philosophical reader will—or ought to—find much raw material for philosophical reflection. For example, a reasonable historicist thesis of how brotherhood, or family connection generally, plays itself out is supported by these documents. The nineteenth century is not the same as the twentieth. For example, here is William’s comment on the will of his sister, Alice, who left more to her companion and care-giver, Katherine Loring, a [End Page 479] women of extraordinary virtue and burden, than to her brother Robertson: “I can well sympathize with Alice’s desire to leave her something handsome; but I must say that her own consent (being apparently privy to the will) strikes me as tant soit peu lacking in delicacy. Surely no one of us would like to be in such a position in her family or any other” (271). This would be, in 1998, a rather unenlightened and ungenerous attitude, but is natural enough in 1892, even if not quite inevitable, not being shared by Alice herself. There is, incidentally, much discussion of wills and bequests, for the Jameses were of the genteel class, people with small family money and modest private incomes for whom the wherewithal to maintain homes with servants and to provide themselves with country houses and recuperative European vacations was always a faintly embarrassing, and occasionally a pressing, problem.It is probably also true that the much-discussed question of Henry’s homosexuality has, somehow, to be recast in historically relative terms. Here is an early report—1869—of Henry’s from Oxford: “As I walked along the river I saw hundreds of the mighty lads of England, clad in white flannel & blue, immense, fair-haired, magnificent in their youth, lounging down the stream in their punts or pulling in straining crews & rejoicing in their godlike strength” (41). This could not, the point is, be said by anyone, gay or straight, in 1998. Yet Henry is neither generally naive nor uncritically anglophile. He says of the Warwickshire scenery, which in a way he likes, that it is “too monotonously sweet & smooth—too comfortable, too ovine, too bovine, too English in a word.” And he adds, a little surprisingly: “It seems like a vast show region kept up at the expense of the poor” (41). This is only one of many appealing comments not sparsely scattered, but unpredictably, in letters of more ordinary news. Here’s one I liked occasioned by seeing theater in Paris: “We talk about it & write about it & criticize & dogmatize & analyse to the end of time: but those brave players stand forth & exemplify it & act—create—produce!” (66).Of course the “wit and wisdom” are not the monopoly of Henry. Here is William being wise: “We all learn sooner or later that we must gather ourselves up and more or less arbitrarily concentrate our interests, throw much overboard to save any” (55–56). Again: “It is a sweet world, in the interstices of its bedevilment & brutality” (321). And William being funny: “Boils are surely the most slowly evolving things in nature—Christian doctrine is nothing to them” (393). He is talking about his own boils and was subject, at every period, to ailments and infirmities: “Since writing to you, I have been swimming in deep seas of influenza, gout and Erysipelas of the face” (443). Or as he, in 1900, sums it up: “My... (shrink)

In September of 2008, the Congregation for the Doctrine of the Faith published Dignitas Personae, which addresses several newly emerging topics in thearea of biomedical ethics. One of these topics is genetic engineering, which we can define as the intentional manipulation of genetic material so as to produce some desired trait or characteristic. Genetic engineering is discussed in Dignitas Personae, but is done so relatively briefly. In this paper, I explore some of the metaphysical and ethical questions that are key (...) in assessing the morality of this practice by examining other Church documents as well as philosophical literature. Ultimately, I will argue that aside from some instrumental restrictions, questions about the moral permissibility of genetic engineering, the distinction between therapy and enhancement, and what it means to be human are not as easily answered from a Catholic perspective as one might think. (shrink)

Speakers often do not state requests directly but employ innuendos such as Would you like to see my etchings? Though such indirectness seems puzzlingly inefficient, it can be explained by a theory of the strategic speaker, who seeks plausible deniability when he or she is uncertain of whether the hearer is cooperative or antagonistic. A paradigm case is bribing a policeman who may be corrupt or honest: A veiled bribe may be accepted by the former and ignored by the latter. (...) Everyday social interactions can have a similar payoff structure (with emotional rather than legal penalties) whenever a request is implicitly forbidden by the relational model holding between speaker and hearer (e.g., bribing an honest maitre d’, where the reciprocity of the bribe clashes with his authority). Even when a hearer’s willingness is known, indirect speech offers higher-order plausible deniability by preempting certainty, gossip, and common knowledge of the request. In supporting experiments, participants judged the intentions and reactions of characters in scenarios that involved fraught requests varying in politeness and directness. (shrink)

This classic book by Theodor W. Adorno anticipates many of the themes that have since become common in contemporary philosophy: the critique of foundationalism, the illusions of idealism and the end of epistemology.

Modern emotion theories emphasise the adaptive value of emotions. Emotions are by no means always helpful, however. They often must be regulated. The study of emotion regulation has its origins in the psychoanalytic and stress and coping traditions. Recently, increased interest in emotion regulation has led to crucial boundary ambiguities that now threaten progress in this domain. It is argued that distinctions need to be made between (1) regulation of emotion and regulation by emotion; (2) emotion regulation in self and (...) emotion regulation in others; and (3) conscious and nonconscious emotion regulation. Using a process model of emotion generation, this review considers promising research on basic processes and individual differences in emotion regulation and poses five theoretical challenges. (shrink)

While electronic mail has enjoyed rapid growth in the workplace, many companies have failed to establish clear expectations among employees about their e-mail privacy rights. This has resulted in controversy and even lawsuits against employers where employees later learned that management personnel monitored or read their electronic communications. It has been speculated that most employees underestimate the legal right of their employer to engage in e-mail monitoring activities. However, this issue has been virtually unexplored from a research perspective. Consequently, the (...) purpose of this study is to assess individuals'' ethical beliefs and perceptions about electronic mail privacy. This study of more than 200 e-mail users reveals that there is significant resistance to e-mail monitoring, and that many individuals have a relatively poor understanding of their e-mail privacy rights. The results also suggest that companies need to develop and communicate a policy to employees that addresses this issue. Finally, this study suggests several possibilities for further research. Building a greater body of knowledge of this domain should assist business leaders and lawmakers as they work to formulate an effective response to this workplace challenge that will equitably balance the rights of employees and employers. (shrink)