This essay contends that individual liberty, understood as the permissibility of making choices about one’s own health care in support of one’s own good and the good of one’s family utilizing private resources, is central to the moral foundations of a health care system. Such individual freedoms are important not only because they often support more efficient and effective health care services, but because they permit individuals to fulfill important moral duties. A comparative study of the health care systems in (...) Hong Kong and mainland China is utilized to illustrate the conceptual and moral concerns at stake. Both regions have implemented two-tier health care systems with a public tier of basic health care services together with a second tier of privately purchased health care. As we document, Hong Kong permits patients and doctors significantly greater opportunities to choose private health care of typically higher medical quality than their mainland counterparts. As a result, individuals are able to obtain higher quality health care while also fulfilling important moral duties for themselves and their families. In this sense, Hong Kong’s health care system is morally superior to mainland China’s. In each case, Confucianism’s concerns regarding equality are partly satisfied through the provision of public health care services on the basic tier, while appropriate use of private resources in support of oneself and one’s family is permissibly exercised on the private tier. Although it is true that inequalities in health care access and outcome are inevitable within a system that permits such individual freedoms, we argue that such inequalities are morally justifiable in terms of Confucian ethical thought. (shrink)

In short, the anticipated harm (death) to Ms. A of telling her about her child greatly outweighs the harm she will experience by being lied to. Also, the latter harm can be ameliorated; the former can not.

In celebration of the fortieth anniversary of the publication of Beauchamp and Childress’s Principles of Biomedical Ethics, a review is undertaken to compare the lists of principles in various bioethical theories to determine the extent to which the various lists can be reconciled. Included are the single principle theories of utilitarianism, libertarianism, Hippocratism, and the theories of Pellegrino, Engelhardt, The Belmont Report, Beauchamp and Childress, Ross, Veatch, and Gert. We find theories all offering lists of principles numbering from one to (...) ten. Many of the differences can be reconciled, but some critical differences remain. (shrink)

The origins of professional ethical codes and oaths are explored. Their legitimacy and usefulness within the profession are questioned and an alternative ethical source is suggested. This source relies on a commonly shared, naturally knowable set of principles known as common morality.

This essay concerns itself with the methodology of practical ethics. There are a variety of methods employed in ethics. Although none have been firmly established as dominant, it is generally agreed that casuistry, or the case-based method, is one important strategy commonly used for resolving ethical issues. Casuists compare the case under consideration to a relevantly similar precedent case in which judgements have already been made, and they use these earlier judgements to determine the proper resolution of the present case. (...) In this article, I try to provide a better understanding of the nature of contemporary casuistry. To accomplish this, I explain the basic features of casuistic reasoning. The second section focuses on the logic of casuistry. By assessing casuistic reasoning from the logical viewpoint, casuistry can be reconstructed as a logically correct method of reasoning. The third section looks at casuistry from the epistemic point of view and investigates the justificatory force of casuistic reasoning. Finally, in the fourth section, I show the usefulness of formal casuistry. (shrink)

Ethical principles are fundamental for the exercise of any profession. Portuguese psychologists have waited for 30 years for professional validation. This paper will define the Portuguese psychologists’ ethical principles, with a universal view as a starting point and then an adaptation to the cultural and professional reality in Portugal. The level of acceptability of these principles will be ascertained in a later paper.

The use of case-based reasoning in teaching professional ethics has come of age. The fields of medicine, engineering, and business all have incorporated ethics case studies into leading textbooks and journal articles, as well as undergraduate and graduate professional ethics courses. The most recent guidelines from the National Institutes of Health recognize case studies and face-to-face discussion as best practices to be included in training programs for the Responsible Conduct of Research. While there is a general consensus that case studies (...) play a central role in the teaching of professional ethics, there is still much to be learned regarding how professionals learn ethics using case-based reasoning. Cases take many forms, and there are a variety of ways to write them and use them in teaching. This paper reports the results of a study designed to investigate one of the issues in teaching case-based ethics: the role of one’s professional knowledge in learning methods of moral reasoning. Using a novel assessment instrument, we compared case studies written and analyzed by three groups of students whom we classified as: Experts in a research domain in bioengineering. Novices in a research domain in bioengineering. The non-research group—students using an engineering domain in which they were interested but had no in-depth knowledge. This study demonstrates that a student’s level of understanding of a professional knowledge domain plays a significant role in learning moral reasoning skills. (shrink)

Cognitive semantics has made important empirical findings about human conceptualization. In this paper some findings concerning moral concepts are analyzed and their implications for medical ethics discussed. The key idea is that morality has to do with metaphors and imagination rather than with well-defined concepts and deduction. It is argued that normative medical ethics to be psychologically realistic should take these findings seriously. This means that an imaginative casuistry is to be preferred compared to principlism and to other forms of (...) casuistry. Furthermore, the metaphorical character of central principles in medical ethics such as autonomy, utility, justice, and integrity is indicated. Such principles are interpreted as rules of thumb summarizing the collective wisdom concerning prototype cases. (shrink)

The current crisis has come at a cost not only for big business but also for business schools. Business schools have been deemed largely responsible for developing and teaching socially dysfunctional curricula that, if anything, has served to promote and accelerate the kind of ruthless behavior and lack of self-restraint and social irresponsibility among top executives that have been seen as causing the crisis. As a result, many calls have been made for business schools to accept their responsibilities as social (...) institutions and to work toward becoming more socially embedded and better attuned to public interests. In this paper, however, we point to some of the barriers there may be in the way of business schools developing into responsible organizational citizens proper. We argue that there are lines of resistance against responsibilization operating at epistemological, institutional, and organization levels and that we need to take account of barriers on all these levels in order to properly capture the challenges that are involved in making the modern business school amenable to demands for more social responsibility. In terms of working toward overcoming such barriers, we discuss how business education can become more socially embedded via the inclusion of ethical reflection and critical thinking. (shrink)

Accustomed as many of us have become in the era of clinical bioethics to the idea of a “hospital philosopher”, on reflection the historical novelty of the role is astonishing, as are its ambiguities. As a result of considering my own experience I found myself writing this miniature intellectual autobiography. In the course of this essay I raise two specific questions: what can the Western philosophical tradition contribute to the clinical setting; and (a question that is rarely asked), what are (...) the implications of this experience for that tradition? (shrink)

This essay reflects on 25 years since Christian Bioethics began publication and, in somewhat autobiographical fashion, engages two core concerns. First, although “non-ecumenism” may often appear a pretext for contention and division, I suggest that a respectful non-ecumenism may provide the opportunity for dialogue and the occasion for employing certain tools from religious studies. Second, although many are skeptical about the possibilities of identifying a “common morality,” a defense of that notion provides a plausible explanation for the development of limited (...) consensus on some issues in bioethics. (shrink)

In a spirit of critical appreciation, this essay challenges several core aspects of the critique of secular morality and the defense of Orthodox Christianity offered by H. Tristram Engelhardt in After God. First, I argue that his procedurally driven approach to a binding morality based solely on a principle of permission leaves morality without any substantive definition in general terms, in ways that are both conceptually problematic and also at odds with Engelhardt’s long-standing distinction between non-malevolence and beneficence. Second, I (...) question the accuracy or adequacy of Engelhardt’s critique of the Enlightenment project for his unwarranted privileging of a particular version of Enlightenment thinking at the expense of other Enlightenment perspectives less amenable to Engelhardt’s working generalizations. Third, I challenge the theoretical cogency of Engelhardt’s insistence on the ubiquity and intractability of moral controversies and his depiction of moral strangers and moral friends as, in effect, mutually exclusive terms. Finally, I question Engelhardt’s embrace of a divine command model of ethics as the appropriate resolution of Euthyphro’s dilemma and suggest that there may be intermediate approaches to the usual starkly drawn contrasts between divine command and naturalist accounts. (shrink)

There have been many attempts during the history of applied ethics that have tried to develop a theory of moral reasoning. The goal of this paper is to explicate one aspect of the debate between various attempts of offering a specific method for resolving moral dilemmas. We contrast two kinds of deliberative methods: deliberative methods whose goal is decision-making and deliberative methods that are aimed at gaining edifying perspectives. The decision-making methods assessed include the traditional moral theories like utilitarianism and (...) Kantianism, as well as second order principles, such as principlism and specified principlism. In light of this assessment, we suggest taking a closer look at two perceptive models, casuistry and particularism. These models are used for dealing with moral dilemmas that provide for edifying perspectives rather than decision-making. These perceptive models, though less scientific and not as good at prescribing an action, are more human in the sense that they enrich our moral sensibilities and enhance our understanding of the meaning of the situation. (shrink)

The ArgumentEmergency medicine, a new medical specialty in the United States, is an ethical practice that has developed through its interaction with the spaces in which it is situated. We discuss this claim in two steps followed by a demonstration. First we examine the historical evolution of the hospital, to provide the background for a lengthier account of the historical transformation of the emergency room. We then introduce Foucault's approach to ethics, to explain the sense in which emergency medicine is (...) an ethical practice constituted, in part, by its space of operation. The preliminaries of the application of our historico-ethical framework to emergency medicine, are presented, focusing on cardiopulmonary resuscitation. Our intention is to provide a framework for the newest clinical specialty as an ethical practice in order to understand how to individuate its emerging ethical problems. The emphasis on space throughout enables us to integrate the historical development of emergency medicine with its present concrete setting, and to establish a basis for analyzing emergency medicine that does not rely uncritically on either a preferred ethical perspective or the perspective of its practitioners. (shrink)

This paper examines the ethical pitfalls and challenges that non-ethicists, such as researchers and programmers in the fields of computer science, artificial intelligence and robotics, face when building moral machines. Whether ethics is “computable” depends on how programmers understand ethics in the first place and on the adequacy of their understanding of the ethical problems and methodological challenges in these fields. Researchers and programmers face at least two types of problems due to their general lack of ethical knowledge or expertise. (...) The first type is so-called rookie mistakes, which could be addressed by providing these people with the necessary ethical knowledge. The second, more difficult methodological issue concerns areas of peer disagreement in ethics, where no easy solutions are currently available. This paper examines several existing approaches to highlight the ethical pitfalls and challenges involved. Familiarity with these and similar problems can help programmers to avoid pitfalls and build better moral machines. The paper concludes that ethical decisions regarding moral robots should be based on avoiding what is immoral in combination with a pluralistic ethical method of solving moral problems, rather than relying on a particular ethical approach, so as to avoid a normative bias. (shrink)

In order to discuss the normative aspects of euthanasia one has to clarify what is meant by active and passive euthanasia. Many philosophers deny the possibility of distinguishing the two by purely descriptive means, e.g. on the basis of theories of action or the differences between acting and omitting to act. Against this, such a purely descriptive distinction will be defended in this paper by discussing and refining the theory developed by Dieter Birnbacher in his “Tun und Unterlassen”. On this (...) basis I will suggest a new definition of active and passive euthanasia. (shrink)

Many bioethical arguments rely implicitly on the assumption that the concept of “human part” is one on which everyone must agree, because it is unambiguous. But various parties interpret this “unambiguous” term in incompatible ways, leading to contention. This article is an informal presentation of a topomereological system on whose preferred interpretation several distinct but related meanings of “human part” can be isolated: part of a human body, part of the completion of a human body, and part of a human (...) being. A case is analyzed (the first total artificial heart (TAH) implantation), demonstrating in the process much of the apparatus of the system. By means of a casuistic methodology, the analysis is translated into recommendations for the ethical conduct of future TAH research. The more general conclusion, however, is that formal methods may provide useful tools for clarifying thought processes and organizing arguments in debates over bioethical issues. (shrink)

Ruiping Fan; The Memoirs of a Pagan Sojourning in the Ruins of Christendom, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 5, Issue 3.

We argue that the current ethical and regulatory framework for permissible risk levels in pediatric research can be helpfully understood in terms of children’s moral right to adequate protection from harm. Our analysis provides a rationale for what we propose as the highest level of permissible risk in pediatric research without the prospect of direct benefit: what we call “relatively minor” risk. We clarify the justification behind the usual standards of “minimal risk” and “a minor increase over minimal risk” and (...) explain why it is permissible to impose any risks at all on child participants who do not stand to benefit directly from enrollment in research. Finally, we illuminate some aspects of the concept of “best interests.”. (shrink)

Reproductive counseling includes counseling of prospective parents by obstetricians, clinical geneticists, and genetic counselors regarding, for example, the use of assisted reproductive technologies, prenatal testing, and preimplantation genetic diagnosis. Two different views on wisdom and the goal of reproductive counseling are analyzed. According to the first view, the goal of reproductive counseling is to help prospective parents reach a wise decision. A specific course of action is recommended by the counselor in contrast to other possible alternatives. According to the second (...) view, the goal of reproductive counseling is not to help prospective parents reach a wise decision but to help them reach their own decision wisely. It is the prospective parents who should make the decision, and it is their value commitments that should be decisive. It is argued that the second approach is to be preferred to the first. It combines respect for autonomy with a recognition of the need for assistance in decision-making. Both the first and second views relate the goal of reproductive counseling to wisdom. A problem is, however, what wisdom more precisely means — there are many different views. A casuistic view of wisdom is investigated. This view roughly defines wisdom as practical prudence in dealing with particular cases. What characterizes a casuistic decision-making method is elaborated in more detail. Applied to the second view, a casuistic view of wisdom implies that the counselor should encourage prospective parents to take into consideration the nature of the particular problem at hand, the context of the problem, their own individual identities, their personal value commitments, and various alternative perspectives, values and arguments. (shrink)

According to G. E. Moore, moral expertise requires abilities of several kinds: the ability to factor judgments of right and wrong into (a) judgments of good and bad and (b) judgments of cause and effect, (2) the ability to use intuition to make the requisite judgments of good and bad, and (3) the ability to use empirical investigation to make the requisite judgments of cause and effect. Moore’s conception of moral expertise is thus extremely demanding, but he supplements it with (...) some very simple practical guidance. (shrink)