This paper discusses the vast continuum between the letter of the law (legality) and the spirit of the law (ethics or morality). Further, the authors review the fiduciary duties owed by the firm to its various publics. These aspects must be considered in developing a corporate code of ethics. The underlying qualitative characteristics of a code include clarity, comprehensiveness and enforceability. While ethics is indigenous to a society, every code of ethics will necessarily reflect the corporate culture from which that (...) code stems and be responsive to the innumerable situations for which it was created. Several examples have been provided to illustrate the ease of applicability of these concepts. (shrink)

This is the conundrum that gives rise to the issue of tax avoidance: Although governments always seem to lack sufficient funds to support the needs of society, tax codes are often written that offer “a way out” of paying taxes for some but not all constituents. The ways out are referred to as loopholes that allow taxpayers to avoid taxes. This paper first defines the basic terms of tax avoidance and tax evasion and then offers an ethical review of the (...) morality of aggressive tax avoidance. Aggressive tax avoidance is then addressed in relationship a corporate entity’s tone at the top. The conclusion is drawn that use of the letter of the law to avoid payment of taxes sorely needed by governments for the good faith provision of public goods and services is ethically unacceptable. Several suggestions for change are provided, including a new financial statement disclosure and the possibility of a published corporate ethics report. (shrink)

Within their value chains of suppliers through customers, many businesses are becoming more aware of the environmental aspects and impacts of their organizations. Viewed as a continuum of behavior, business environmentalism can range from simply complying with the law to accepting and pursuing a goal of sustainable development. The point on the continuum at which an organization chooses to operate is reflected in its environmental mission, policies, and actions. Attributes of the various levels of behavior and classification of some organizational (...) mission statements are examined in this paper. (shrink)

The international economy is changing at a rapid rate. The alteration and reduction of both geographical and political borders, coupled with the growing interdependence of socially, politically, economically, and legally diverse countries, have caused multinational corporate entities to revise various policies. These revisions include revisions in marketing strategies, strategic alliances, product and service strategies and, perhaps most importantly as it affects all strategies, a MNC's approach to ethical systems. The truly global company must come to grips with the legal and (...) moral atmosphere in which it operates. The concept of moral rights, those transcending legal or political rights, drives us to review four international codes of conduct and to attempt to develop one international uniform code that might be applicable to any business, in any country or culture. (shrink)

Total quality management (TQM) has become a basic business practice in organizations throughout the world. Implementation of TQM in these organizations has been driven by the desire to increase profits in the highly competitive business world. Total quality management techniques are designed to improve performance.Concurrently, organizations are striving to eradicate the concept that the termbusiness ethics is an oxymoron. Corporate codes of conduct have been developed to indicate the outside boundaries of acceptable organizational behavior and companies are espousing and enforcing (...) the ideals contained within these codes. (shrink)

This article focuses on the ethics of payday lending. We present information about the payday lending industry, a range of legal and best practices guidelines for the industry, and finally our own presentation of the most appropriate practices to be used to satisfy both legal and ethical edicts. This effort is made with the hope that business people in general, professionals in the payday lending industry, lawmakers, educators, and even potential consumers may benefit by understanding the driving economic, legal, and (...) social guidelines that can make payday lending services a positive and efficacious addition to our lending industries. (shrink)

First-person reports of Major Depressive Disorder reveal that when an individual becomes depressed a profound change or ‘shift’ to one’s conscious experience occurs. The depressed person reports that something fundamental to their experience has been disturbed or shifted; a change associated with the common but elusive claim that when depressed one finds oneself in a ‘different world’ detached from reality and other people. Existing attempts to utilise these phenomenological observations in a psychiatric context are challenged by the fact that this (...) experiential ‘shift’ characteristic of depression appears mysterious and resists analysis in scientific terms. This paper offers a way out of this predicament. The hypothesis proposed is that when an individual becomes depressed, the individual departs from a state of ordinary wakeful consciousness and enters a distinctive global state of consciousness akin to dreaming and the psychedelic state. After unpacking and motivating this hypothesis in the context of research in consciousness science, I outline two of its important implications for the neurobiology of depression and psychedelic psychiatry. The upshot is a promising and conceptually well-motivated hypothesis about depression which is apt for empirical uptake and development. (shrink)

Aphantasia is a recently discovered disorder characterised by the total incapacity to generate visual forms of mental imagery. This paper proposes that aphantasia raises important theoretical concerns for the ongoing debate in the philosophy and science of consciousness over the nature of dreams. Recent studies of aphantasia and its neurobehavioral correlates reveal that the majority of aphantasics, whilst unable to produce visual imagery while awake, nevertheless retain the capacity to experience rich visual dreams. This finding constitutes a novel explanandum for (...) theories of dreaming. Specifically, I argue that the recent dream reports of aphantasics constitute an empirical challenge to the emerging family of views which claim that dreams are essentially imaginative experiences, constitutively involving the kinds of mental imagery which aphantasics, ex-hypothesi, lack. After presenting this challenge in the context of Jonathan Ichikawa’s recent arguments for this view, I argue that this empirical challenge may be overcome if the imagination theorist abandons Ichikawa’s account of dreaming in favour of a modified version. This involves the claim that dreams are essentially inactive and constitutively involve non voluntary forms of imagination. I conclude with a suggestion for further research which can test the viability of this alternative hypothesis, and move the debate forward. (shrink)

Moral certainty refers to those aspects of morality- moral acting, feeling, and thinking-that are beyond doubt, explanation, and justification. The essays in this book explore the concept of moral certainty and its application and usefulness in contemporary moral debates. The notion of moral certainty, which is inspired by the philosophy of Ludwig Wittgenstein, is emerging as a key reference point in contemporary moral philosophy. An investigation of the implications of moral certainty is called for, given that so many discussions in (...) moral philosophy concern the possibility of justifying our moral beliefs. The concept of moral certainty also feeds directly into the emerging field of hinge epistemolo,gy. The chapters in this volume tackle the following issues: meta-questions around whether and how we can make sense of the concept of moral certainty; the role of moral certainty in contemporary debates on gender, racism, bias and historically unjust practices; ways in which radical change in society engendered by new technologies might affect moral certainties; the role of the notion of moral certainty in the debates on free will and moral responsibility. Philosophical Perspectives on Moral Certainty will appeal to researchers and advanced students working on ethics and moral philosophy, epistemology, philosophy of technology, and Wittgenstein. (shrink)

Purpose – The aim of this study is to study the implementation of G2B initiatives for small- and medium-sized enterprises in Hong Kong, focusing on the underlying importance, benefits and challenges. Design/methodology/approach – The context of this study was initially established based on comparisons with B2B initiatives. However, it is also learned from the literature that the transformational aspect of e-Government development has not been materialized, whereas the extended web assessment method, the three-ring model and DeLone and McLean’s IS success (...) model were therefore identified to derive and build the theoretical G2B success model, thereby developing the online survey instrument of this study. Specifically, a positivist paradigm was adopted to investigate the impact of each G2B success factor on the overall satisfaction with using the G2B systems under examination from the perspective of SMEs, rather than simply placing emphasis on the number of electronic services provided and the investments spent. Findings – The research findings were compiled based on both the multiple regression analysis and EWAM analysis results, thus making the necessary improvements in the appropriate service aspects of the G2B systems concerned. Originality/value – The main study concluded that prevalent G2B initiatives in Hong Kong have been largely connected to pursuing conservative paradigms in public service provision. The new e-Government strategic agenda is therefore laid out for increasing the overall transparency of new public management based on the provision of resilient-based public services, thereby advancing the democratic empowerment of all the G2B stakeholders involved and also maximizing the multifold effects of value creations. (shrink)

Background Home-based care workers mainly work alone in the patient’s home. They encounter a diverse patient population with complex health issues. This inevitably leads to several ethical challenges. Aim The aim is to gain insight into ethical challenges related to patient autonomy in home-based care and how home-based care staff handle such challenges. Research design The study is based on a 9-month fieldwork, including participant observation and interviews in home-based care. Data were analysed with a thematic analysis approach. Participants and (...) research context The study took place within home-based care in three municipalities in Eastern Norway, with six staff members as key informants. Ethical considerations The Norwegian Agency for Shared Services in Education and Research evaluated the study. All participants were competent to consent and signed an informed consent form. Findings A main challenge was that staff found it difficult to respect the patient’s autonomy while at the same time practicing appropriate care. We found two main themes: Autonomy and risk in tension; and strategies to balance autonomy and risk. These were explicated in four sub-themes: Refusing and resisting care; when choosing to live at home becomes risky; sweet-talking and coaxing; and building trust over time. Staff’s threshold for considering the use of coercion appeared to be high. Conclusions Arguably, home-based care staff need improved knowledge of coercion and the legislation regulating it. There is also a need for arenas for ethics reflection and building of competence in balancing ethical values in recurrent ethical problems. (shrink)

In the wake of modernity, women's sexuality was positioned in a way that created a beauty/narcissism double bind that is still with us today. My concern in this article is that the subject position of “fashion model” serves as a constant reminder of this split, which is directed at all women and weakens the generalized woman's political agency. Fashion models themselves experience harassment and humiliation as well as pleasure and desire in their work as fashion models. However, the small portion (...) of feminist work that has engaged explicitly with the fashion-model business sees it mainly as an enterprise that is alienating and hostile to women. Although I do not entirely disagree with this analysis, it neglects the meaning of beauty and what beauty does to us with regard to creativity and pleasure. I wish to explore how some of the work experience of fashion models intersects with and challenges the beauty/narcissism double bind. I suggest that rather than grounding our understanding of the subject position “fashion model” and the fashion business solely in their reinforcement of the beauty/narcissism double bind, we should pay attention to the importance of what beauty and aspects of narcissism may mean. (shrink)

In the state of Victoria, Australia in the late 1950s and early 1960s, restorative treatment was introduced into the state‐subsidised benevolent homes, and they were reclassified as geriatric hospitals. In the process, the nursing care of incapacitated old people was identified in terms of particular skills and knowledge, and specific forms of training were established for nurses at two levels of training: nurses’ aides and supervisory nurses with a postbasic qualification. These institutional changes were complemented by the introduction of a (...) nursing role into the body responsible for overseeing care for the aged in Victoria. Little was made of this opportunity to establish a leading role for nurses in the field of care for the aged. However, this episode raises fertile questions for further research into the development of nursing in Australia, as a set of practices divided along the lines of acute and chronic illness. (shrink)

The performance artists Florian Feigl and Fjóla Gautadóttir engage with production conditions of artistic work through their ways of managing time in performances. Informed by Marxist and feminist theories on affective and reproductive work, and with references to the history of performance art, I demonstrate how, contrary to myths of inspiration and virtuosity, production conditions co-create artistic authorship. Thereby, I reexamine what traditionally is termed as the aesthetics of production. An aesthetics of production is, I suggest, not about natural talent (...) and originality of the soloist artist genius but is founded on the interdependency of life and work, and what enables the artist to do work. Feigl and Gautadóttir’s performances include what has been excluded as disturbances by idealist aesthetics of production: the sociality, temporality and economy of the artistic work. By proposing a feminist-materialist aesthetics of production, I claim that the artist’s work is not only working by the numbers of the present production conditions, but is also performing and intervening within the infrastructures of art. (shrink)

Understanding the biological basis of consciousness is one of the central challenges for modern science. Is a mature scientific explanation really possible, and if so, how should consciousness science be organized so as to achieve this? This thesis is a collection of four papers which approach these questions via an account of the natural categories or ‘kinds’, drawn from philosophy of science, to which paradigmatic mental phenomena like consciousness belong. The central claims defended in the thesis are twofold. Firstly, that (...) to facilitate a mature science of consciousness it is crucial to explicitly introduce a new organizing concept of consciousness modelled on the kinds of concepts which underpin previous successful explanations of other natural phenomena – that of a natural kind concept of consciousness. This draws on the general observation that some concepts are better suited to scientific theorizing about the world than others, and thus that progress in scientific and philosophical domains can be (and indeed, has often been) made by working to refine our existing conceptual schemes to reflect this. Secondly, that a mature science of consciousness will be one which recognizes the reality and explanatory importance of a particular category of mental phenomena called ‘global states of consciousness’ which includes dreaming and wakefulness. Examination of this latter claim leads to a third idea explored and motivated in the thesis which brings consciousness science into closer connection with psychiatry. This is the hypothesis that Major Depressive Disorder involves a change to a subject’s global state of consciousness, marking a change from a state of ordinary wakeful consciousness to an altered ‘depressive state’ of consciousness akin to a dream or psychedelic state. (shrink)

What drives moral revolutions like the legal abolition of slavery and women’s right to vote? The importance of having an answer to this question lies in the hope of it being able to help us create moral progress in the future. This can be changing harmful practices and traditions like honour killing, child marriage, genital mutilation and political corruption. Furthermore, a wrong or insufficient picture of the dynamics of change, held by e.g. politicians or NGOs and incorporated into laws and (...) institutions, can lead to misfired inventions, wasted resources and possibly human harm. If we lack conceptual clarity and empirical insights, we will have trouble making good decisions. However, before answering the above question we need to consider what answering it entails. This article therefore discusses which form an understanding of the dynamics of moral revolutions should take in order to best help us create progress. I do so by critically investigating one currently dominant way of approaching this issue, namely the idea that we should produce a general explanatory theory of the fundamental dynamics of change. In order to expose the problems in this approach, I engage with a contemporary example of it, namely Appiah’s work on moral revolutions, and demonstrate that honour codes cannot have the explanatory role, which Appiah claims for them. The article concludes by pointing to alternative models of understanding the dynamics of moral revolutions and changes. (shrink)

A prominent trend in moral philosophy today is the interest in the rich textures of actual human practices and lives. This has prompted engagements with other disciplines, such as anthropology, history, literature, law and empirical science, which have produced various forms ofcontextual ethics. These engagements motivate reflections on why and how context is important ethically, and such metaethical reflection is what this article undertakes. Inspired by the work of the later Wittgenstein and the Danish theologian K.E. Løgstrup, I first describe (...) one of the ways in which context plays a central role with regard to ethical meaning and normativity. I then examine how ‘context’ is to be defined, and finally I discuss some of the questions which arise when giving context prominence in ethics – namely, how to delimit the scope of relevant context, the relevant traits of a particular context and what ‘the ethical’ is. (shrink)

A prominent trend in moral philosophy today is the interest in the rich textures of actual human practices and lives. This has prompted engagements with other disciplines, such as anthropology, history, literature, law and empirical science, which have produced various forms of contextual ethics. These engagements motivate reflections on why and how context is important ethically, and such metaethical reflection is what this article undertakes. Inspired by the work of the later Wittgenstein and the Danish theologian K.E. Løgstrup, I first (...) describe one of the ways in which context plays a central role with regard to ethical meaning and normativity. I then examine how ‘context’ is to be defined, and finally I discuss some of the questions which arise when giving context prominence in ethics – namely, how to delimit the scope of relevant context, the relevant traits of a particular context and what ‘the ethical’ is. (shrink)

“Don’t think, but look!” (Wittgenstein 2009: § 66). This insistient advice has served as methodological inspiration for several influential thinkers in the broad range of ‘empirically informed’ philosophy, which has flourished over the last decades. There is, however, a worrisome tension between Wittgenstein’s work and these turns to practices, history, science, field work, and everyday life: Wittgenstein is in general doing something different from what the thinkers who claim to be inspired by him are doing. An argument for the legitimacy (...) of the move from Wittgenstein to empirically informed philosophy is so far missing in the literature. This article shows how this move can be justifiable within a Wittgensteinian frame, philosophically beneficial, and at times even necessary. (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds in (...) philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

Informed consent is considered by many to be a moral imperative in medical research. However, it is increasingly acknowledged that in many actual instances of consent to participation in medical research, participants do not employ the provided information in their decision to consent, but rather consent based on the trust they hold in the researcher or research enterprise. In this article we explore whether trust-based consent is morally inferior to information-based consent. We analyse the moral values essential to valid consent (...) – autonomy, voluntariness, non-manipulation, and non-exploitation – and assess whether these values are less protected and promoted by consent based on trust than they are by consent based on information. We find that this is not the case, and thus conclude that trust-based consent if not morally inferior to information-based consent. (shrink)

Legitimacy challenges are part of human societies. Whenever we recognise a person, law, ideal or institution as authoritative, questions can be raised about their legitimacy. Why follow this law? Why strive to honour this moral ideal? If such questions are repeatedly raised, they pose an undermining threat to the authorities in question. This is good if the challenged law or ideal is harmful, but problematic, if it is beneficial. Where the first kind of legitimacy challenges are raised by ethical pioneers (...) and moral critics, the last kind are posed by cynics, who disregard the demands of law and morality when they conflict with their interests. The threat to human society caused by cynicism is part of the reason why philosophers since Plato have sought to address and rid society of it.This article discusses how philosophy can deal with cynicism. It does so by firstly looking at how Anthony Holiday defends a moral realist theory and disproves ‘the theory of cynicism’ as well as tries to subvert real life cynics. Secondly, the work of the later Wittgenstein is used to discuss Holiday’s approach, finding it to some extent wanting in both its theoretical and practical aims.Lastly, inspired by Stanley Cavell’s thinking it is suggested that cynicism calls for not only problem solving and problem dissolving, but also something we might call reconciliation. (shrink)

The theme of change is one of the most prominent traits of Wittgenstein’s later work, and his writings have inspired many contemporary thinkers’ discussions of changes in e.g. concepts, ‘aspect-seeing’, practices, worldviews, and forms of life. However, Wittgenstein’s conception of the dynamics of change has not been investigated in its own right. The aim of this paper is to investigate which understanding of the dynamics of changes can be found in the later Wittgenstein’s work. I will argue that what emerges (...) is a rich and complex picture that has the potential to aid our thinking in politics and elsewhere when developing strategies for creating changes. It can do so both as source of inspiration and by countering tempting, yet ultimately problematic ways of conceptualizing change like the hope for transforming harmful traditions and social practices with the help of a general explanatory theory of the fundamental dynamics of changes. (shrink)

The idea of moral certainties is venerable, highly contentious, and nevertheless alive. What I call “hinge ethics” (in analogy to hinge epistemology) combines three currents – meta-ethical concerns about the scope and limits of moral knowledge and objectivity, the idea of limits of doubt as articulated in On Certainty, and sympathies for Wittgensteinian ideas about ethics. This essay critically assesses hinge ethics, focusing on Nigel Pleasants’ work. My main objection is not that Wittgensteinian ideas about certainty cannot be transferred from (...) the domain of physical phenomena to the moral domain. Nor shall I nail my colours to the mast of moral relativism. Instead my main tack will be as follows: Several of the views hinge ethicists detect in or derive from On Certainty are intriguing and ingenious, yet either unwarranted and/or not echt Wittgensteinian. Purported moral certainties like the wrongness of killing are neither ineffable, nor non-propositional, nor quasi-transcendental preconditions of moral thought and action. In so far as morality has scaffolding foundations, it is not certainties but capacities. At least some of these capacities are cognitive, a matter of social cognition. (shrink)

Background: Individual, comprehensive, and written informed consent is broadly considered an ethical obligation in research involving the sampling of human material. In developing countries, however, local conditions, such as widespread illiteracy, low levels of education, and hierarchical social structures, complicate compliance with these standards. As a result, researchers may modify the consent process to secure participation. To evaluate the ethical status of such modified consent strategies it is necessary to assess the extent to which local practices accord with the values (...) underlying informed consent. Methods: Over a 2-week period in April 2014 we conducted semistructured interviews with researchers from a genetic research institute in rural Pakistan and families who had given blood samples for their research. Interviews with researchers focused on the institute’s requirements for consent, and the researchers’ strategies for and experiences with obtaining consent in the field. Interviews with donors focused on their motivation for donating samples, their experience of consent and donation, and what factors were central in their decisions to give consent. Results: Researchers often reported modifications to consent procedures suited to the local context, standardly employing oral and elder consent, and tailoring information to the social education level of donor families. Central themes in donors’ accounts of their decision to consent were the hope of getting something out of their participation and their remarkably high levels of trust in the researchers. Several donor accounts indicated a degree of confusion about participation and diagnosis, resulting in misconceived expectations of therapeutic benefits. Conclusions: We argue that while building and maintaining trusting relationships in research is important—not least in developing countries—strategies that serve this endeavor should be supplemented with efforts to ensure proper provision and understanding of relevant information, specifically about the nature of research and measures for individual consent and opt-out. (shrink)

"We shall become more Scandinavian." This sentence was pronounced in 2013 by French President François Hollande's entourage.1 It was the starting point for new legislation, notably on transparency, along with a general attempt to diminish the gap between the ruling class and ordinary people. Hollande was seemingly trying to transform "French political culture, a Latin culture, into a Scandinavian culture."2Hollande was not alone in this attempt. During the 2017 presidential campaign, Emmanuel Macron stated that his political project was "exactly like (...) the Scandinavian model," adding that this Scandinavian model "works much better than ours."3 He also pointed out that he saw the "moralization" of public life as one... (shrink)

Societies change over time. Chattel slavery and foot-binding have been abolished, democracy has become increasingly widespread, gay rights have become established in some countries, and the animal rights movement continues to gain momentum. Do these changes count as moral progress? Is there such a thing? If so, how should we understand it? These questions have been receiving increasing attention from philosophers, psychologists, biologists, and sociologists in recent decades. This survey provides a systematic account of recent developments in the understanding of (...) moral progress. We outline the concept of moral progress and describe the different types of moral progress identified in the literature. We review the normative criteria that have been used in judging whether various developments count as morally progressive or not. We discuss the prospects of moral progress in the face of challenges that claim that moral progress is not psychologically possible for human beings, and we explore the metaethical implications of moral progress. (shrink)

Person‐specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self‐determination method with people with various long‐term health conditions. It explains the mechanisms of mobilizing relational capacity by including person‐specific evidence in shared decision‐making. Person‐specific self‐insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self‐management challenges. This step paved the way for sharing these insights and (...) challenges in a relationship with a supportive health professional, who could then rely on person‐specific evidence instead of assumptions or a narrow disease perspective for shared decision‐making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person‐specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self‐insights in daily life with other people, decreasing loneliness they experienced in self‐management. Relational capacity, the core of the theory, is mobilized in both people with long‐term health conditions and healthcare professionals. Further research on person‐specific evidence and relational capacity in healthcare is recommended. (shrink)

The power of technology to transform religions, science, and political institutions has often been presented as nothing short of revolutionary. Does technology have a similarly transformative influence on societies’ morality? Scholars have not rigorously investigated the role of technology in moral revolutions, even though existing research on technomoral change suggests that this role may be considerable. In this paper, we explore what the role of technology in moral revolutions, understood as processes of radical group-level moral change, amounts to. We do (...) so by investigating four historical episodes of radical moral change in which technology plays a noteworthy role. Our case-studies illustrate the plurality of mechanisms involved in technomoral revolutions, but also suggest general patterns of technomoral change, such as technology’s capacity to stabilize and destabilize moral systems, and to make morally salient phenomena visible or invisible. We find several leads to expand and refine conceptual tools for analysing moral change, specifically by crystallizing the notions of ‘technomoral niche construction’ and ‘moral payoff mechanisms’. Coming to terms with the role of technology in radical moral change, we argue, enriches our understanding of moral revolutions, and alerts us to the depths of which technology can change our societies in wanted and unwanted ways. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion (...) between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

Obtaining human genetic samples is vital for many biobank research purposes, yet, the ethics of obtainment seems to many fraught with difficulties. One key issue is consent: it is by many considered ethically vital that consent must be fully informed (at least ideally speaking) in order to be legitimate. In this paper, we argue for a more liberal approach to consent: a donor need not know all the specifics of future uses of the sample. We argue that blanket consent is (...) ethically defensible, and that this is buttressed by considerations of (justified) trust-relations. Given robust institutional oversight, blanket consent is a permissible form of consent in the bio-banking context. (shrink)