This essay provides a framework of concepts and principles suitable for systematic discussion of issues surrounding expertise. Expertise creates inequality. Its multiple benefits and the creativity of technology lead to a society replete with expertises. The basic binds of expertise derive from the desire of non-experts to be able to both enjoy what expertise offers and insure that it is exercised in the social interest. This involves trusting the exercise of expertise, involuntarily or voluntarily. A healthy society provides various means (...) to move trust from involuntary to voluntary. The social means for achieving this are laid out. The purpose of this short essay is to briefly lay out a conceptual framework within which to construct, clarify, evaluate and apply expertises. It is not to promote some particular notion of expertise over others, or to review the vast literatures, such as that on trust in science, that make up the domain. A few notes on one work towards this essay’s close may indicate what a major, and expert, process this would be. (shrink)

Suicide has long been the subject of philosophical, literary, theological and cultural–historical inquiry. But despite the diversity of disciplinary and methodological approaches that have been brought to bear in the study of suicide, we argue that the formal study of suicide, that is, suicidology, is characterized by intellectual, organizational and professional values that distinguish it from other ways of thinking and knowing. Further, we suggest that considering suicidology as a “social practice” offers ways to usefully conceptualize its epistemological, philosophical and (...) practical norms. This study develops the idea of suicidology as a social practice and considers the implications for research, practice and public discourse. (shrink)

This article offers a critique and reformulation of the concept of empathy as it is currently used in the context of medicine and medical care. My argument is three pronged. First, that the instrumentalised notion of empathy that has been common within medicine erases the term’s rich epistemological history as a special form of understanding, even a vehicle of social inquiry, and has instead substituted an account unsustainably structured according to the polarisations of modernity. I suggest that understanding empathy by (...) examining its origins within the phenomenological tradition, as a mode of intersubjective understanding, offers a different and profitable approach. Secondly, I argue that the appropriation of empathy in medicine means that, ironically, empathy can function as a technique of pastoral power, in which virtue, knowledge and authority remain with the doctor. And thirdly, empathy is in danger of being resourced as a substitute for equity and funding within health systems. I conclude however with hope for the productive possibilities for empathy. (shrink)

Little and colleagues’ paper describing a key aspect of cancer patients’ experience, that of “liminality,” is remarkable for giving articulation to a very common and yet mostly overlooked aspect of patient experience. Little et. al. offered a formulation of liminality that deliberately set aside the concept’s more common use in analysing social rituals, in order to grasp at the interior experience that arises when failing bodily function and awareness of mortality are forced into someone’s consciousness, as occurs with a diagnosis (...) of cancer. We set out the reasons as to why this analysis was so significant in 1998—but we also consider how the “liminality” described by Little and colleagues was a feature of modernity, founded on what we term “the mirage of settlement.” We argue that this mirage is impossible to sustain in 2022 amid the many forms of un-settling that have characterized late modernity, including climate change and COVID-19. We argue that many people in developed nations now experience liminality as a result of the being forced into the consciousness of living in a continued state of coloniality. We thus rejoin the social aspects of liminality to the interior, Existential form described by Little et. al. (shrink)

In this analysis of the ethical dimensions of doctors’ participation in macroallocation we set out to understand the skills they use, how they are acquired, and how they influence performance of the role. Using the principles of grounded moral analysis, we conducted a semi-structured interview study with Australian doctors engaged in macroallocation. We found that they performed expertise as argument, bringing together phronetic and rhetorical skills founded on communication, strategic thinking, finance, and health data. They had made significant, purposeful efforts (...) to gain skills for the role. Our findings challenge common assumptions about doctors’ preferences in argumentation, and reveal an unexpected commitment to practical reason. Using the ethics of Paul Ricoeur in our analysis enabled us to identify the moral meaning of doctors’ skills and learning. We concluded that Ricoeur’s ethics offers an empirically grounded matrix for ethical analysis of the doctor’s role in macroallocation that may help to establish norms for procedure. (shrink)

In most socialised health systems there are formal processes that manage resource scarcity and determine the allocation of funds to health services in accordance with their priority. In this analysis, part of a larger qualitative study examining the ethical issues entailed in doctors’ participation as technical experts in priority setting, we describe the values and ethical commitments of doctors who engage in priority setting and make an empirically derived contribution towards the identification of an ethical framework for doctors’ macroallocation work. (...) We conducted semi-structured interviews with 20 doctors, each of whom participated in macroallocation at one or more levels of the Australian health system. Our sampling, data-collection, and analysis strategies were closely modelled on grounded moral analysis, an iterative empirical bioethics methodology that employs contemporaneous interchange between the ethical and empirical to support normative claims grounded in practice. The values held in common by the doctors in our sample related to the domains of personal ethics, justice, and practices of argumentation. Applying the principles of grounded moral analysis, we identified that our participants’ ideas of the good in macroallocation and their normative insights into the practice were strongly aligned with the three levels of Paul Ricoeur’s ‘little ethics’: ‘aiming at the “good life” lived with and for others in just institutions’. Our findings suggest new ways of understanding how doctors’ values might have procedural and substantive impacts on macroallocation, and challenge the prevailing assumption that doctors in this milieu are motivated primarily by deontological considerations. Our empirical bioethics approach enabled us to identify an ethical framework for medical work in macroallocation that was grounded in the values and ethical intuitions of doctors engaged in actions of distributive justice. The concordance between Ricoeur’s ‘little ethics’ and macroallocation practitioners’ experiences, and its embrace of mutuality, suggest that it has the potential to guide practice, support ethical reflection, and harmonise deliberative practices amongst actors in macroallocation generally. (shrink)

Critiques of the dehumanising aspects of contemporary medical practice have generated increasing interest in the ways in which health care can foster a holistic sense of wellbeing. We examine the relationship between two areas of this humanistic endeavour: narrative and dignity. This paper makes two simple arguments that are intuitive but have not yet been explored in detail: that narrative competence of carers is required for maintaining or recreating dignity, and that dignity promotion in health care practice is primarily narrative (...) in form. The multiple meanings that dignity has in a person’s life are what give the concept power and can only be captured by narrative. This has implications for health care practice where narrative work will be increasingly required to support patient dignity in under-resourced and over-subscribed health care systems. (shrink)

In the paper “An archeology of corruption in medicine”, Miles Little, Wendy Lipworth, and Ian Kerridge present an account of corruption and describe its prevalent forms in medicine. In presenting an individual-focused account of corruption found within “social entities”, Little et al. argue that these entities are corruptible by nature and that certain individuals are prone to take advantage of the corruptibility of social entities to pursue their own ends. The authors state that this is not preventable, so the way (...) to remedy corruption is via management and, where necessary, punishment. This commentary will briefly lay out the key features and functions of corruption as presented by Little et al., before providing a critical discussion that will focus on whether corruptibility is a necessary feature of social entities. I will propose that it is not a necessary feature, though it may frequently arise where individualistic values are unchecked. Corruption can be prevented within social entities by enhancing structures that direct toward virtue and which promote and reward cooperation instead of competition. (shrink)

This article explores the consequences of failure to communicate early, as recommended in risk communication scholarship, during the first stage of the COVID-19 pandemic in Australia and the United Kingdom. We begin by observing that the principles of risk communication are regarded as basic best practices rather than as moral rules. We argue firstly, that they nonetheless encapsulate value commitments, and secondly, that these values should more explicitly underpin communication practices in a pandemic. Our focus is to explore the values (...) associated with the principle of communicating early and often and how use of this principle can signal respect for people’s self-determination whilst also conveying other values relevant to the circumstances. We suggest that doing this requires communication that explicitly acknowledges and addresses with empathy those who will be most directly impacted by any disease-control measures. We suggest further that communication in a pandemic should be more explicit about how values are expressed in response strategies and that doing so may improve the appraisal of new information as it becomes available. (shrink)

Testimonial injustice occurs when bias against the credibility of certain social identities results in discounting of their contributions to deliberations. In this analysis, we describe testimonial injustice against women and how it figures in macroallocation procedure. We show how it harms women as deliberators, undermines the objective of inclusivity in macroallocation and affects the justice of resource distributions. We suggest that remedial action is warranted in order to limit the effects of testimonial injustice in this context, especially on marginalised and (...) disadvantaged groups, and propose three areas for action, whose implementation might feasibly be achieved by those immediately involved in macroallocation. (shrink)

This paper starts by juxtaposing the normative ethics in the final part of Parfit's final book, On What Matters, vol. 3, with the normative ethics in his earlier books, Reasons and Persons and On What Matters, vol. 1. The paper then addresses three questions. The first is, where does the reflective-equilibrium methodology that Parfit endorsed in the first volume of On What Matters lead? The second is, is the Act-involving Act Consequentialism that Parfit considers in the final volume of On (...) What Matters as plausible as Rossian deontology? The third is, how is the new argument that Parfit puts forward for Rule Consequentialism supposed to work? (shrink)

Incoherence is usually regarded as a bad thing. Incoherence suggests irrationality, confusion, paradox. Incoherentism disagrees: incoherence is not always a bad thing, sometimes we ought to be incoherent. If correct, Incoherentism has important and controversial implications. It implies that rationality does not always require coherence. Dilemmism and Incoherentism both embrace conflict in epistemology. After identifying some important differences between these two ways of embracing conflict, I offer some reasons to prefer Incoherentism over Dilemmism. Namely, that Incoherentism allows us to deliberate (...) about what we ought to believe using ordinary epistemology, and it does a better job of accommodating the positive features of incoherence. (shrink)

Theories of individual well‐being fall into three main categories: hedonism, the desire‐fulfilment theory, and the list theory (which maintains that there are some things that can benefit a person without increasing the person's pleasure or desire‐fulfilment). The paper briefly explains the answers that hedonism and the desire‐fulfilment theory give to the question of whether being virtuous constitutes a benefit to the agent. Most of the paper is about the list theory's answer.

Developing Deontology consists of six new essays in ethicaltheory by leading contemporary moral philosophers. Each essayconsiders concepts prominent in the development of deontologicalapproaches to ethics, and these essays offer an invaluablecontribution to that development. Essays are contributed by Michael Smith, Philip Stratton-Lake,Ralph Wedgewood, David Owens, Peter Vallentyne, and ElizabethHarman - all leading contemporary moral philosophers Each essay offers an original and previously unpublishedcontribution to the subject A significant addition to the field for anyone with an interestin the development of deontology (...) The collection is edited by a leading philosophicalscholar. (shrink)

This paper starts by characterising moral requirements and everyday thought. Then ways in which moral requirements shape everyday thought are identified, including the way internalised moral requirements prevent some possible actions from even being considered. The paper then explains that everyday moral thought might be structured by dispositions to which there are corresponding principles even if these principles do not usually appear in the conscious thoughts of agents while they are engaged in everyday moral decision-making. Nevertheless, especially when conflicts between (...) moral considerations arise, alternative possible resolutions are typically framed in terms of principles. The paper pushes on to discuss how everyday moral thought is pushed to consider principles, engage in moral theorising, and even consider abstract moral theories. (shrink)

Elgar Advanced Introductions are stimulating and thoughtful introductions to major fields in the social sciences, business and law, expertly written by the world's leading scholars. Designed to be accessible yet rigorous, they offer concise and lucid surveys of the substantive and policy issues associated with discrete subject areas. This concise and engaging Advanced Introduction provides the conceptual tools necessary to make ethical decisions in today's business world. John Hooker provides an objective and closely-reasoned analysis of ethical issues based on (...) a unified conceptual framework that distils the best of ethical thought into three clearly articulated principles: the generalization, utilitarian, and autonomy principles. Key features include: examples and case studies that illustrate ethical reasoning in complex business dilemmas exploration of business ethics in relation to environmental, social, and financial sustainability factors coverage of cross-cultural business ethics, technological unemployment, and the ethics of artificial intelligence and machine learning. This Advanced Introduction will be a valuable resource for academics and advanced students of business ethics and trust, business leadership, and corporate social responsibility. It will also be beneficial for business managers who wish to build an ethical organization, as well as technical personnel who incorporate ethics into automated systems. (shrink)

This paper considers the question of whether impartiality and predictability are illusory to the extent that every consequentialist ethical theory must be hopeless.

In recent decades, a new scientific approach to understand, explain, and predict many features of religion has emerged. The cognitive science of religion has amassed research on the forces that shape the tendency for humans to be religious and on what forms belief takes. It suggests that religion, like language or music, naturally emerges in humans with tractable similarities. This new approach has profound implications for how we understand religion, including why it appears so easily, and why people are willing (...) to fight-and die for it. Yet it is not without its critics, and some fear that scholars are explaining the ineffable mystery of religion away, or by showing that religion is natural proves or disproves the existence of God. An Introduction to the Cognitive Science of Religion offers students and general readers an accessible introduction to the approach, providing an overview of key findings and the debates that shape it. The volume includes a glossary of key terms, and each chapter includes suggestions for further thought and further reading as well as chapter summaries highlighting key points. This book is an indispensable resource for introductory courses on religion and a much-needed option for advanced courses. (shrink)

This book develops an intellectual framework for analyzing ethical dilemmas that is both grounded in theory and versatile enough to deal rigorously with real-world issues. It sees ethics as a necessary foundation for the social infrastructure that makes modern life possible, much as engineering is a foundation for physical infrastructure. It is not wedded to any particular ethical philosophy but draws from several traditions to construct a unified and principled approach to ethical reasoning. Rather than follow the common academic practice (...) of seeking a reflective equilibrium of moral intuitions and principles, it builds on a few bedrock principles of rational thought that serve as criteria for valid argumentation. It develops the ideas from the ground up, without presupposing any background in ethics or philosophy. Epistemologically, the book views ethics as parallel to mathematics, in that it relies on generally accepted proof techniques to establish results. Whereas mathematics rests on such proof paradigms as mathematical induction and proof by contradiction, ethics can be seen as relying on proof by applying consistency tests, such as generalizability and respect for autonomy. Utilitarianism also plays a key role, but it is reconceived as a deontological criterion. This approach obviously requires that these criteria be formulated more rigorously than is normally the case. To accomplish this, the book begins with the classical idea that an action is distinguishable from mere behavior by virtue of its having a coherent rationale, where coherence requires passing certain consistency tests such as generalizability. An action is therefore inseparable from its rationale, and generalizability is defined in terms of consistency with the rationale. A utilitarian criterion receives a similar treatment with respect to a means-end rationale. Respect for autonomy is grounded in a carefully developed action theory that takes into account such concepts as joint autonomy, implied consent, and the permissibility of interference with unethical behavior. It provides an account of responsibility that is both practical and theoretically satisfying, and it yields a novel solution of the much-discussed trolley car dilemmas. The book is written for a general audience and strives to be as readable and engaging as possible, while maintaining rigor. It begins by dispelling a raft of misconceptions that trivialize ethics and block its development as an essential tool of modern life, such as the notion that ethics is just a matter of opinion without rational foundation. After presenting the ethical principles just described, along with many examples, it provides several chapters that analyze real-life dilemmas, many obtained from the author's students and professional workshop participants. One cannot understand physics or chemistry without seeing how their principles are applied to real problems, and the same is true of ethics. These chapters demonstrate that a unified normative theory can deal with a wide range of real cases while achieving a reasonable level of objectivity and rigor. (shrink)

An unrepentant Nazi, Carl Schmitt remains one of the most divisive figures in twentieth century political thought. In recent years, his ideas have attracted a new and growing audience. This book seeks to cut through the controversy surrounding Schmitt to analyse his ideas on world order. In so doing, it takes on board Schmitt's critique of the condition of order in late modernity, and considers Schmitt's continued relevance. Consideration is given to the two devices Schmitt deploys, the Grossraum and the (...) Partisan, and argues that neither concept lives up to its claim to transcend or reform Schmitt's pessimistic history of the state. The author concludes that Schmitt's continuing value lies in his provocative historical critique, rather than his conceptual innovation"--Provided by publisher. (shrink)

Is logic normative for belief? A standard approach to answering this question has been to investigate bridge principles relating claims of logical consequence to norms for belief. Although the question is naturally an epistemic one, bridge principles have typically been investigated in isolation from epistemic debates over the correct norms for belief. In this paper we tackle the question of whether logic is normative for belief by proposing a Kripkean model theory accounting for the interaction between logical, doxastic, epistemic and (...) deontic notions and using this model theory to show which bridge principles are implied by epistemic norms that we have independent reason to accept, for example, the knowledge norm and the truth norm. We propose a preliminary theory of the interaction between logical, doxastic, epistemic and deontic notions that has among its commitments bridge principles expressing how logic is normative for belief. We also show how our framework suggests that logic is exceptionally normative. (shrink)

Virtue ethics is normally taken to be an alternative to consequentialist and Kantian moral theories. I shall discuss what I think is the most interesting version of virtue ethics – Rosalind Hursthouse's. I shall then argue that her version is inadequate in ways that suggest revision in the direction of a kind of rule-consequentialism.

The Expanse does not provide an easy answer to the vexing question on making a decision when competing, but considering conflicts of values on the show can help us reason about tough choices in real life. Sometimes, scientific progress conflicts with the prudential value of self‐preservation. This chapter explains three ways of understanding value conflicts: as situations in which every option is forbidden, situations in which every option is permissible, or situations in which some options are obligatory and some options (...) are forbidden. The idea that all these different kinds of value can be traded with a common currency is tempting. But contra Keats, beauty is not truth; and it certainly is not goodness, as Tolstoy says. Epistemic, moral, prudential, and aesthetic values are very different. (shrink)

Physician assistants (PAs), nurse practitioners (NPs), and medical residents constitute an increasingly significant part of the American health care workforce, yet patient assent to be seen by nonphysicians is only presumed and seldom sought. In order to assess the willingness of patients to receive medical care provided by nonphysicians, we administered provider preference surveys to a random sample of patients attending three emergency departments (EDs). Concurrently, a survey was sent to a random selection of ED residents and PAs. All respondents (...) were to assume the role of patient when presented with hypothetical clinical scenarios and standardized provider definitions. Despite presumptions to the contrary, ED patients are generally unwilling to be seen by PAs, NPs, and residents. While seldom asked in practice, 79.5% of patients fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider. Patients are more willing to see residents than nonphysicians. (shrink)