Volume 20, Issue 7, July 2020, Page 153-155.

During the Covid‐19 pandemic, as resources dwindled, clinicians, health care institutions, and policymakers have expressed concern about potential legal liability for following crisis standards of care (CSC) plans. Although there is no robust empirical research to demonstrate that liability protections actually influence physician behavior, we argue that limited liability protections for health care professionals who follow established CSC plans may instead be justified by reliance on the principle of reciprocity. Expecting physicians to do something they know will harm their patients (...) causes moral distress and suffering that may leave lasting scars. Limited liability shields are both appropriate and proportionate to the risk physicians are being asked to take in such circumstances. Under certain narrow circumstances, it remains unclear that the standard of care is sufficiently flexible to protect physicians from liability. Given this uncertainty, the likelihood that physicians would be sued for such an act, and their desire for such immunity, this limited protection is morally legitimate. (shrink)

Ten years ago, Megan Shinal sought the care of neurosurgeon Steven Toms for the surgical treatment of a recurrent nonmalignant tumor in the pituitary region of her brain. In their twenty-minute meeting, Shinal did not make a final decision about which surgical approach she wished to pursue. Subsequently, she spoke with Tom's physician assistant once by phone and once in person, when she signed the consent form, which did not appear to designate which surgical approach she had chosen. During the (...) operation—a total resection—Toms perforated Shinal's carotid artery, resulting in hemorrhage, stroke, brain injury, and partial blindness. The jury found that Toms had fulfilled his informed-consent obligations prior to performing the resection; however, in June 2017, the Supreme Court of Pennsylvania overturned the decision, relying on the Pennsylvania Medical Care Availability and Reduction of Error Act. The court found that the language of the act is unambiguous in its requirement that “a physician's duty to provide information to a patient sufficient to obtain her informed consent is non-delegable.” Presumably, this rule of nondelegation applies beyond the surgical theater to other major treatment decisions. And it is unclear whether it applies to other professionals in a subordinate position to the treating physician, such as residents and fellows. (shrink)

American history has been rife with human subjects research scandals, particularly those that involve “vulnerable” populations. State and federal laws and regulations often do not provide any special oversight mechanisms or protections to ensure the ethical and safe inclusion of cognitively impaired adults in research. At the New York State level, repeated efforts have been made to regulate research involving individuals who lack consent capacity. In January 2014, the New York State Task Force on Life and the Law released its (...) Report and Recommendations for Research with Human Subjects Who Lack Consent Capacity, which represents the most recent step in a decades-long process in the state to develop oversight mechanisms that are appropriately sensitive to the fine line between protecting a vulnerable population and impeding the advancement of research. These recommendations may serve as a model for research policy in other states and at the federal level, particularly in light of shifting societal concerns and changing political winds. (shrink)

Despite existing federal and state law and regulation, new human subjects research scandals involving “vulnerable” populations continue to surface. Although existing oversight mechanisms were enacted to ensure voluntary informed consent for participants and institutional review board oversight of HSR, these laws and regulations do not provide any special oversight mechanisms or protections to ensure the ethical and safe inclusion of cognitively impaired adults. The absence of rules to ensure consistently ethical conduct of research involving adults who lack consent capacity may (...) either lead to exploitation of this vulnerable population or the dearth of important research into the broad range of diseases that impair cognition. In other words, while some institutions and investigators are conducting research with this group without guidance, others are taking an extremely conservative approach and are excluding these individuals from research. Without safeguards that are adequate and robust but not overly burdensome, conducting research involving this population is ethically and legally challenging. (shrink)

Genetic testing has led to the establishment of the concept of the “previvor”: someone who is not yet sick, but who has a genetic predisposition to disease. The previvor experience demonstrates how the practice of medicine and medical decision making is evolving to render current law and policy increasingly inapplicable to modern medical practice. The introduction of previvorship to the medical landscape raises special issues for the physician-patient relationship and the legal doctrine of informed consent. It challenges some of the (...) most basic assumptions underlying the doctrine, is representative of the doctrine’s declining utility, and is illustrative of the need to transition to a shared decision-making model. Thus, we should begin to envision a legal doctrine that supports a robust shared decision-making approach to address individual preferences and values, the increasing complexity of risk/benefit assessment, and inherent (and sometimes irreducible) uncertainty. Such an approach should emphasize a new, more expansive, and inclusive model of illness. (shrink)

Morain and colleagues (2019) advocate rethinking the rather dogmatic guidance from both regulatory authorities and professional associations cautioning physician-investigators against obtaining inf...

In Saks v. Franklin Covey Co., the Court of Appeals for the Second Circuit held that the American with Disabilities Act, Title VII of Civil Rights Act of 1964, the Pregnancy Discrimination Act, and New York state law do not proscribe an employer's self-insured employee health plan from excluding surgical impregnation procedures from its coverage. Although the court found that infertility qualifies as a disability under the ADA, it restricted required coverage of certain infedty treatments.Title I of the ADA prohibits (...) an employer from discriminating on the basis of disability “in regard to … fringe benefits available by virtue of employment, whether or not administered by the covered entity.” The ADA defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities.” In Bragdon v. Abbott, the U.S. Supreme Court found that reproduction was a major life activity under the ADA. (shrink)

In Saks v. Franklin Covey Co., the Court of Appeals for the Second Circuit held that the American with Disabilities Act, Title VII of Civil Rights Act of 1964, the Pregnancy Discrimination Act, and New York state law do not proscribe an employer's self-insured employee health plan from excluding surgical impregnation procedures from its coverage. Although the court found that infertility qualifies as a disability under the ADA, it restricted required coverage of certain infedty treatments.Title I of the ADA prohibits (...) an employer from discriminating on the basis of disability “in regard to … fringe benefits available by virtue of employment, whether or not administered by the covered entity.” The ADA defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities.” In Bragdon v. Abbott, the U.S. Supreme Court found that reproduction was a major life activity under the ADA. (shrink)

In Kentucky Association of Health Plans, Inc. v. Miller,, the Supreme Court unanimously held that states’ “any willing provider” laws are not preempted by the Employee Retirement Income Security Act of 1974. The Court ruled that states can regulate their health maintenance organizations, and thus upheld a Kentucky law that requires insurers to reimburse services of any health care provider who is willing and able to meet established criteria. The Supreme Court has heard several cases related to ERISA in the (...) last few years, and other such cases are working their way through the court system. Coupled with this most recent decision in Miller, the Supreme Court may significantly alter the shape of the insurance industry. (shrink)

In Kentucky Association of Health Plans, Inc. v. Miller,, the Supreme Court unanimously held that states’ “any willing provider” laws are not preempted by the Employee Retirement Income Security Act of 1974. The Court ruled that states can regulate their health maintenance organizations, and thus upheld a Kentucky law that requires insurers to reimburse services of any health care provider who is willing and able to meet established criteria. The Supreme Court has heard several cases related to ERISA in the (...) last few years, and other such cases are working their way through the court system. Coupled with this most recent decision in Miller, the Supreme Court may significantly alter the shape of the insurance industry. (shrink)

Effective November 1, 2002, the federal Department of Health and Human Services reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program. By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal policy has defined childhood as beginning (...) at conception.”In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children. (shrink)

Effective November 1, 2002, the federal Department of Health and Human Services reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program. By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal policy has defined childhood as beginning (...) at conception.”In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children. (shrink)

The authors offer ways to encourage and educate Americans to participate in the public deliberations that make democracy work and lay out the principles of..

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A philosopher argues that state-sponsored cyberattacks against central military or civilian targets are always acts of war. What is this philosopher doing? According to conceptual analysts, the philosopher is making a claim about our concept of war. According to philosophical realists, the philosopher is making a claim about war per se. In a quickly developing literature, a third option is being explored: the philosopher is engineering the concept of war. On this view, the philosopher is making a proposal about which (...) concept we should have – even if it deviates from the extant concept, and even if it does not capture ‘what war really is’. The activity or method of proposing such revisionary definitions, as well as the metaphilosophical reflection on it, has become known as conceptual engineering. (shrink)

Conceptual engineers aim to revise rather than describe our concepts. But what are concepts? And how does one engineer them? Answering these questions is of central importance for implementing and theorizing about conceptual engineering. This paper discusses and criticizes two influential views of this issue: semanticism, according to which conceptual engineers aim to change linguistic meanings, and psychologism, according to which conceptual engineers aim to change psychological structures. I argue that neither of these accounts can give us the full story. (...) Instead, I propose and defend the Dual Content View of Conceptual Engineering. On this view, conceptual engineering targets concepts, where concepts are understood as having two kinds of contents: referential content and cognitive content. I show that this view is independently plausible and that it gives us a comprehensive account of conceptual engineering that helps to make progress on some of the most difficult problems surrounding conceptual engineering. (shrink)

The first study, along with edition and translation, of Chrysostomus Javelli’s epitome of the _Liber de bona fortuna_ (1531), a work permitting insight into the early modern understanding of fortune, fate, and free will.

This book develops a comprehensive framework for ethics in the helping professions based on bioethicist Bernard Gert's theory of common morality. The prevailing model of ethics education is built upon adherence to codes of ethics applied largely through the use of decision-making trees. While a firm understanding of a professions code of ethics and all relevant laws is essential to responsible practice, this approach to teaching ethics excludes the opportunity for students to acquire a holistic, and grounded understanding of moral (...) action. The framework proposed in this text moves beyond codes of ethics, and allows students to develop a cohesive sense of ethical reasoning that both validates their moral intuition and challenges moral assumptions. The theory of a common morality uses a systematic, step-by-step approach that readers and practitioners can apply to all questions of moral action and behaviour. While there is no such thing as a single right answer to any ethical question, by following this approach practitioners can confidently eliminate the bad decisions, allowing them to feel more secure in their decision and practice. (shrink)

To what extent should we focus on implicit bias in order to eradicate persistent social injustice? Structural prioritizers argue that we should focus less on individual minds than on unjust social structures, while equal prioritizers think that both are equally important. This article introduces the framework of transactive memory into the debate to defend the equal priority view. The transactive memory framework helps us see how structure can emerge from individual interactions as an irreducibly social product. If this is right, (...) then debiasing interventions are structural interventions. One upshot is that the utility of the individual versus structural distinction is not apparent for the purposes of intervention. (shrink)

This book focuses on some of the most pressing methodological, ethical, and technique-philosophical questions that are connected with the concept of artificial autonomous systems. (Series: Hermeneutics and Anthropology / Hermeneutik und ...

Social problems such as racism, sexism, and inequality are often cited as structural rather than individual in nature. What does it mean to invoke a social structural explanation, and how do such explanations relate to individualistic ones? This article explores recent philosophical debates concerning the nature and usages of social structural explanation. I distinguish between two central kinds of social structural explanation: those that are autonomous from psychology, and those that are not. This distinction will help clarify the explanatory power (...) that each type of SSE has, points of convergence with methodological traditions such as critical theory and rational choice theory, and the difficulties that each type of SSE faces. (shrink)

In this paper, I discuss the view defended by Manuel Rebuschi, Maxime Amblard, and Michel Musiol that schizophrenia is not entirely irrational but that the rationality of disordered discourse can be accounted for from the first-person point of view—which, by their account, is not wholly introspective but is rather defined by a certain use of the charity principle, by contrast with what they call third-person approaches. I argue in favor of the idea of continuity between the two points of view: (...) ordinary and schizophrenic. On the basis of this claim, I propose a hypothesis for understanding what Rebuschi et al. call the interactional deficiency of schizophrenic conversations, and I make further exploratory suggestions of ways of understanding the so-called rationality of schizophrenic discourse, notably in relation to the complex notions of “context” and “meaning”. (shrink)

La philosophie de l’action wittgensteinienne, par sa clarification conceptuelle, permet une critique radicale de la métaphysique dualiste impliquée par la psychologie empirique. Si le psychologique est constitué concrètement par nos pratiques, une philosophie wittgensteinienne de l’action peut aider la psychologie à sortir des impasses dues à ses confusions sur la nature de son objet, en substituant à la notion réductrice de comportement le concept d’action.

In this paper, I explore the difference between expression of intention and expression of emotion through a discussion of a passage from G.E.M. Anscombe’s Intention, where she claims that expression of intention, unlike expression of emotion, is “purely conventional”. I argue that this claim is grounded on the fact that, although emotions can be described, expressions of emotion are not descriptions at all. Similarly, expressions of intention are not descriptions of a present state of mind but are rather the expression (...) of a special sort of foreknowledge of a purported action. They are, in this respect, distinct from expression of emotion, since they are a description of some future happening. Now, the centrally descriptive character of expressions of intention is what makes them “purely conventional”. But of course, Anscombe argues, one can have an intention without expressing it. And having an intention does not amount to having some description in mind. (shrink)

Intuitively, there is a difference between knowledge and mere belief. Contemporary philosophical work on the nature of this difference has focused on scenarios known as “Gettier cases.” Designed as counterexamples to the classical theory that knowledge is justified true belief, these cases feature agents who arrive at true beliefs in ways which seem reasonable or justified, while nevertheless seeming to lack knowledge. Prior empirical investigation of these cases has raised questions about whether lay people generally share philosophers’ intuitions about these (...) cases, or whether lay intuitions vary depending on individual factors (e.g. ethnicity) or factors related to specific types of Gettier cases (e.g. cases that include apparent evidence). We report an experiment on lay attributions of knowledge and justification for a wide range of Gettier Cases and for a related class of controversial cases known as Skeptical Pressure cases, which are also thought by philosophers to elicit intuitive denials of knowledge. Although participants rated true beliefs in Gettier and Skeptical Pressure cases as being justified, they were significantly less likely to attribute knowledge for these cases than for matched true belief cases. This pattern of response was consistent across different variations of Gettier cases and did not vary by ethnicity or gender, although attributions of justification were found to be positively related to measures of empathy. These findings therefore suggest that across demographic groups, laypeople share similar epistemic concepts with philosophers, recognizing a difference between knowledge and justified true belief. (shrink)

Carl Henrik Koch har i denne bog samlet en række af sine artikler om fremtrædende danske filosoffer. Med start ved Holberg i 1700-tallet arbejder Koch sig op gennem den danske filosofihistorie og strejfer blandt andre Eilchov, Sibbern, A.P. Adler, Brøchner og naturligvis mastodonterne Søren Kierkegaard og Georg Brandes. Bogen giver en hurtig, men spændende indførsel i en vigtig del af den danske kulturhistorie, som gennem de sidste 250 år har haft stor indflydelse både herhjemme og i udlandet.

Most studies investigating the relationship between cultural constructs and ethical perception have focused on individual- and societal-level values without much attention to other type of cultural constructs such as social beliefs. In addition, we need to better understand how social beliefs are linked to ethical perception and the level of analysis at which social beliefs may best predict ethical perceptions. This research contributes to the cross-cultural ethical perception literature by examining the relationship of individual-level social cynicism belief, one of five (...) universally endorsed social beliefs, together with individual social dominance orientation and the perception of unethical behavior. By means of two studies, we examine these relationships across societies that significantly differ on societal-level social cynicism belief. Using 371 business students from Russia and the U.S. in Study 1 and 268 professionals from Portugal and the U.S. in Study 2, we found that individual-level social cynicism belief was positively associated with social dominance orientation. Social dominance orientation, in turn, mediated the relationship between individual social cynicism belief and the perception of unethical behavior. Although we found significant societal-level differences in social cynicism belief in both studies, the relationships between individual-level social cynicism belief, social dominance orientation, and the perception of unethical behavior were structurally equivalent across societies in both studies, suggesting that societal-level differences did not significantly affect these relationships. Implications for cross-cultural business ethics research and practice are discussed. (shrink)