Suppose that one is at least a minimal realist about a given domain, in that one thinks that that domain contains truths that are not in any interesting sense of our own making. Given such an understanding, what can be said for and against the method of reflective equilibrium as a procedure for investigating the domain? One fact that lends this question some interest is that many philosophers do combine commitments to minimal realism and a reflective equilibrium methodology. Here, for (...) example, is David Lewis on philosophy: Our “intuitions” are simply opinions: our philosophical theories are the same. Some are commonsensical, some are sophisticated; some are particular; some general; some are more firmly held, some less. But they are all opinions, and a reasonable goal for a philosopher is to bring them into equilibrium. Our common task it to find out what equilibria there are that can withstand examination, but it remains for each of us to come to rest at one or another of them… Once the menu of well-worked out theories is before us, philosophy is a matter of opinion. Is that to say that there is no truth to be had? Or that the truth is of our own making, and different ones of us can make it differently? Not at all! If you say flatly that there is no god, and I say that there are countless gods but none of them are our worldmates, then it may be that neither of us is making any mistake of method. We may each be bringing our opinions to equilibrium in the most careful possible way, taking account of all the arguments, distinctions, and counterexamples. But one of us, at least, is making a mistake of fact. Which one is wrong depends on what there is (1983: x-xi). In addition to philosophy in general, the method of reflective equilibrium has also been endorsed as the appropriate procedure for investigating various other subject.. (shrink)

Many agents have failed to comply with their responsibilities to take the action needed to avoid dangerous anthropogenic climate change. This pervasive noncompliance raises two questions of nonideal political theory. First, it raises the question of what agents should do when others do not discharge their climate responsibilities. (the Responsibility Question) In this paper I put forward four principles that we need to employ to answer the Responsibility Question (Sections II-V). I then illustrate my account, by outlining four kinds of (...) action that should be undertaken (Section VI). Pervasive noncompliance also raises a second question: Given the lack of progress in combating climate change, should existing governance structures be maintained or changed (and if they should be changed, in what ways)? (the Governance Question). The paper briefly outlines a methodology for addressing this question and outlines what a nonideal response to the existing institutional structures would be (Section VII). It does so with reference to the Paris Agreement, and in particular the creation of a "global stocktake" (Article 14, Paris Agreement) and the "facilitative dialogue" (paragraph 20 of the ‘Adoption of the Paris Agreement’). The aim, then, is to set out an account of a nonideal theory of climate justice. (shrink)

In moral epistemology, the method of reflective equilibrium is often characterized in terms of intuitions or understood as a method for justifying intuitions. An analysis of reflective equilibrium and current theories of moral intuitions reveals that this picture is problematic. Reflective equilibrium cannot be adequately characterized in terms of intuitions. Although the method presupposes that we have initially credible commitments, it does not presuppose that they are intuitions. Nonetheless, intuitions can enter the process of developing a reflective equilibrium and, if (...) the process is successful, be justified. Since the method of reflective equilibrium does not essentially involve intuitions, it does not constitute a form of intuitionism in any substantial sense. It may be classified as intuitionist only in the minimal sense of not reducing justification to a matter of inference relations alone. (shrink)

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)

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. (...) This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist. (shrink)

Arriving at a moral judgment is not a straightforward or linear process in which ethical theories are simply applied to cases. Instead it is a process in which the formulation of the moral problem, the formulation of possible “solutions”, and the ethical judging of these solutions go hand in hand. This messy character of moral problems, however, does not rule out a systematic approach. In this article, we describe a systematic approach to problem solving that does justice to the complex (...) nature of moral problems and ethical judgment: the ethical cycle. Our goal is to provide a structured and disciplined method of addressing moral problems, which helps to guide a sound analysis of these problems. We will illustrate the usefulness of this cycle with an example. Further, we will discuss two general issues in applied ethics in relation to the proposed ethical cycle: the role of ethical theories and the place of individual judgment versus collective deliberation. (shrink)

How are we to appraise new technological developments that may bring revolutionary social changes? Currently this is often done by trying to predict or anticipate social consequences and to use these as a basis for moral and regulatory appraisal. Such an approach can, however, not deal with the uncertainties and unknowns that are inherent in social changes induced by technological development. An alternative approach is proposed that conceives of the introduction of new technologies into society as a social experiment. An (...) ethical framework for the acceptability of such experiments is developed based on the bioethical principles for experiments with human subjects: non-maleficence, beneficence, respect for autonomy, and justice. This provides a handle for the moral and regulatory assessment of new technologies and their impact on society. (shrink)

Various theories have been put forward in an attempt to explain what makes moral judgments justifiable. One of the main theories currently advocated in bioethics is a form of coherentism known as wide reflective equilibrium. In this paper, I argue that wide reflective equilibrium is not a satisfactory approach for justifying moral beliefs and propositions. A long-standing theoretical problem for reflective equilibrium has not been adequately resolved, and, as a result, the main arguments for wide reflective equilibrium are unsuccessful. Moreover, (...) practical problems that arise in using the method of wide reflective equilibrium undermine the idea that it is a viable approach for justifying moral judgments about cases and policies. Given that wide reflective equilibrium is the most prominent version of coherentism, these considerations call into question the coherentist approach to justification in bioethics. (shrink)

Speculation about the evolutionary origins of morality has yet to show how a biologically based capacity for morality might be connected to moral reasoning. Applying an evolutionary approach to three kinds of cases where partiality may or may not be morally reasonable, this paper explores a possible connection between a psychological capacity for morality and processes of wide reflective moral equilibrium. The central hypothesis is that while we might expect a capacity for morality to include aspects of partiality, we might (...) also expect these same aspects of the capacity to produce systemic forms of performance-based error. Understanding these errors helps point the way toward a theory of moral competence that includes aspects of both partiality and impartiality. (shrink)

In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...) analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)

Interactive technology assessment is a novel approach to evaluating (health) technology, which philosophically draws from the works of Rawls and Habermas. That is, it seeks to organise a practical setting for discursive ethics in order to find a legitimate basis for policy to be pursued when the technology under scrutiny features a moral controversy. Interactive technology assessment involves a cycle of interviews with all stakeholders, who are explicitly asked to respond (anonymously) to the concerns and issues raised by other participants. (...) This cycle is completed repeatedly, so that a process of vicarious learning develops. This process aims at identifying issues agreed and disagreed upon, on the basis of which widely endorsed policy recommendations can be formulated. This chapter involves an interactive technology assessment of paediatric cochlear implantation. The rationale, the design, and the results are explained, as well as the main ethical aspects of the procedure. (shrink)

A key concern of global ethics is the equitable distribution of benefits and burdens amongst persons belonging to different populations. Until recently, the philosophical literature on global distribution was dominated by the question of how benefits and burdens should be divided amongst contemporaries. Recent years, however, have seen an increase in research on the scope and content of our duties to future generations. This has led to a number of innovative attempts to extend principles of distribution across time while retaining (...) a focus on the entitlements of the existing poor. In this article, I examine a key aspect of intergenerational justice, namely, the appropriate 'pattern' of well-being that should be obtained across generations. With the aid of research into the impacts of global climate change, I evaluate a number of rival accounts of the pattern of justice and go on to explore the merits of a 'global sufficientarian' ethic, which holds that as many persons as possible should enjoy a satisfactory level of well-being regardless of when or where they live. (shrink)

So-called 'realists' have argued that political philosophers should engage with real politics, but that mainstream 'non-realist' political philosophers fail to do so. Perhaps surprisingly, many of the discussions between realists and their critics have not drawn much on debates in metaethics. In this paper, I argue that this is an oversight. There are important connections between the realism/non-realism debate and certain controversies in metaethics. Both realism and non-realism come with metaethical baggage. By considering several arguments that could be made for (...) and against both positions, each of which rests on contested views about the metaphysics and epistemology of value, I outline exactly which metaethical claims realists and nonrealists must defend in order to make their position tenable. (shrink)

The realities of human agency and decision making pose serious challenges for research ethics. This article explores six major challenges that require more attention in the ethics education of students and scientists and in the research on ethical conduct in science. The first of them is the routinization of action, which makes the detection of ethical issues difficult. The social governance of action creates ethical problems related to power. The heuristic nature of human decision making implies the risk of ethical (...) bias. The moral disengagement mechanisms represent a human tendency to evade personal responsibility. The greatest challenge of all might be the situational variation in people’s ethical behaviour. Even minor situational factors have a surprisingly strong influence on our actions. Furthermore, finally, the nature of ethics itself also causes problems: instead of clear answers, we receive a multitude of theories and intuitions that may sometimes be contradictory. All these features of action and ethics represent significant risks for ethical conduct in science. I claim that they have to be managed within the everyday practices of science and addressed explicitly in research ethics education. I analyse them and suggest some ways in which their risks can be alleviated. (shrink)

Carson Strong has recently argued that wide reflective equilibrium (WRE) is an unacceptable method of justification in bioethics. In its place, Strong recommends a methodology in which certain foundational moral judgments play a central role in the justification of moral beliefs, and coherence plays a limited justificatory role in that the rest of our judgments are made to cohere with these foundational judgments. In this paper, I argue that Strong’s chief criticisms of WRE are unsuccessful and that his proposed alternative (...) is in fact just another version of WRE. In the course of doing so, I specify which theses are central to WRE and which are not, and thus, provide a response to an additional objection, advanced by Peter Singer, that WRE is vacuous. I conclude by arguing that there may be better prospects for advancing the debate regarding methodology in bioethics if we focus on restricted epistemic and methodological theses rather than broad approaches, such as WRE, that come in many different varieties. (shrink)

Rationale, aims and objectives: Bioethics and professionalism are standard subjects in medical training programmes, and these curricula reflect particular representations of meaning and practice. It is important that these curricula cohere with the actual concerns of practicing clinicians so that students are prepared for real-world practice. We aimed to identify ethical and professional concerns that do not appear to be adequately addressed in standard curricula by comparing ethics curricula with themes that emerged from a qualitative study of medical practitioners. Method: (...) Curriculum analysis: Thirty-two prominent ethics and professionalism curricula were identified through a database search and were analysed thematically. Qualitative study: In-depth, semi-structured interviews were conducted with 20 medical practitioners. Participants were invited to reflect upon their perceptions of the ways in which values matter in their practices and their educational experiences. The themes emerging from the two studies were compared and contrasted. Results: While representations of meaning and value in ethics and professionalism curricula overlap with the preoccupations of practicing clinicians, there are significant aspects of ‘real-world’ clinical practice that are largely ignored. These fell into two broad domains: ‘sociological’ concerns about enculturation, bureaucracy, intra-professional relationships, and public perceptions of medicine; and epistemic concerns about making good decisions, balancing different kinds of knowledge, and practising within the bounds of professional protocols. Conclusions: Our findings support the view that philosophy and sociology should be included in medical school and specialty training curricula. Curricula should be reframed to introduce students to habits of thought that recognize the need for critical reflection on the social processes in which they are embedded, and on the philosophical assumptions that underpin their practice. (shrink)

Alternative allocations of a fixed bundle of healthcare resources often involve significantly different indirect, non-health effects. The question arises whether these effects must figure in accounts of the conditions under which a distribution of healthcare resources is morally justifiable. In this article we defend a Scanlonian, affirmative answer to this question: healthcare resource managers should sometimes select an allocation which has worse direct, health-related effects but better indirect, nonhealth effects; they should do this when the interests served by such a (...) policy are more urgent than the healthcare interests better served by an alternative allocation. We note that there is a prima facie case for the claim that such benefits (and costs) are relevant—i.e. they are real benefits, and in other contexts our decisions can permissibly be guided by them. We then proceed to rebut three lines of argument that might be thought to defeat this prima facie case: they appeal to fairness, the Kantian Formula of Humanity as an End in Itself, and the equal moral worth of persons, respectively. (shrink)

To be able to understand the history of bioethics, it is necessary to provide an overview of the mainstreams in philosophy which influenced them. That way one can clarify the theoretical origins of several ways of thought in bioethics as well as pinpoint certain problems within the field of bioethics. This paper will give a brief overview of moral theories in the history of philosophy and the way the have influenced ethical thought on biotechnology.

In this paper, I argue that addressing the medical needs of older persons warrants expanding the array of insured services as described by the Canada Health Act to include home care. The growing importance of chronic care supports my call for federally regulated home care services as the nature of disease management has changed significantly in the last decades. In addition, if the values of equity, fairness and solidarity, which are the keystone values of the CHA, are to be upheld (...) within the current social and demographic context, then Canada’s health care system should adapt accordingly. I focus my argument on the services provided to older persons for two main reasons. First, the changing nature of disease management is best seen in this population. If it is to be successfully argued that the transformations in medicine warrant an expansion of insured services covered by the CHA, it will be best illustrated by looking at the needs of older persons. Second, with the demographic shift looming large in the policy agenda, an exploration of this issue is not only crucial but timely. (shrink)

In order to secure ethical relevance for phenomenology, Peter Dabrock proposes a synthesis with a Kantian rational ethic. The theological question thus arises concerning the tenability of such a synthesis and the acceptability of the corresponding translation of Protestant anthropology into the language of philosophy. Dabrock argues that man's character as an image of god, understood in the context of a theology of justification, can be translated into the philosophical concept of incarnate reason. Even if the concept of incarnate reason (...) sounds plausible in view of foundational theology and anthropology, its contribution to a foundation for material ethics is very limited because the body itself however has no normative impact when it comes to deciding about the ethical acceptability of concrete medical interventions. Thus, the constitutive significance of our being embodied becomes ethically relevant only insofar as that significance is integrated into a moral philosophical or theological ethical framework theory. (shrink)

Most management researchers pause at the threshold of objective right and wrong. Their hesitation is understandable. Values imply a “subjective,” personal dimension, one that can invite religious and moral interference in research. The dominant epistemological camps of positivism and subjectivism in management stumble over the notion of moral objectivity. Empirical research can study values in human behavior, but hard-headed scientists should not assume that one value can be objectively better than another. In this article, we invite management researchers to rethink (...) this presumption. We show how accepting at least a limited form of moral objectivity, namely, an epistemic orientation that seeks objective moral reasons, can benefit management research by 1. guiding research practice; 2. using patterns of moral objectivity as clues for formulating empirical hypotheses for psychological explanations; and 3. adding prescriptive power to empirical theories. (shrink)

A Moorean fact, in the words of the late David Lewis, is ‘one of those things that we know better than we know the premises of any philosophical argument to the contrary’. Lewis opens his seminal paper ‘Elusive Knowledge’ with the following declaration.

Rule consequentialism (RC) holds that the rightness and wrongness of actions is determined by an ideal moral code, i.e., the set of rules whose internalization would have the best consequences. But just how many moral codes are there supposed to be? Absolute RC holds that there is a single morally ideal code for everyone, while Relative RC holds that there are different codes for different groups or individuals. I argue that Relative RC better meets the test of reflective equilibrium than (...) Absolute RC. In particular, I contend that Relative RC is superior because it accommodates our convictions about costless benefits. Some have charged that Relative RC threatens our convictions about the generality of moral codes and that it leads inevitably to what Brad Hooker calls “runaway relativism.” I argue that Relative RC has principled reasons for stopping this imagined slide down the slippery slope. (shrink)

In this article, I argue that Powers and Faden’s non-ideal, comprehensive theory of justice cannot keep in line with the proposed moderateness of their essentialist approach. My argument is as follows: Powers and Faden’s comprehensive theory of justice contravenes the thrust of moderate essentialism, in claiming that their theory values health for its own sake. Why do they define their conception of justice as valuing health for its own sake when it is likely to be incongruous with their essentialist approach? (...) To understand this, we should examine their sufficientarian proposal. There are two requirements for plausible sufficientarianism. The first requirement is to specify the threshold below which people are seriously deprived and must be urgently benefited in a non-arbitrary manner. The second requirement is that sufficientarianism should be sensitive to certain inequalities above the threshold. Powers and Faden’s approach convincingly meets the first requirement. However, the non-ideal aspect of their approach, which is key to meeting the second requirement, makes it explicit that at least one of the listed dimensions of well-being must be valued for their own sake. This is not reconcilable with their own characterization of moderate essentialism. For this reason, we should conclude that Powers and Faden fail to argue for moderate essentialism. (shrink)

Jeff McMahan appeals to what he calls the “Time-relative Interest Account of the Wrongness of Killing ” to explain the wrongness of killing individuals who are conscious but not autonomous. On this account, the wrongness of such killing depends on the victim’s interest in his or her future, and this interest, in turn, depends on two things: the goods that would have accrued to the victim in the future; and the strength of the prudential relations obtaining between the victim at (...) the time of the killing and at the times these goods would have accrued to him or her. More precisely, when assessing this interest, future goods should be discounted to reflect reductions in the strength of such relations. Against McMahan’s account I argue that it relies on an implausible “actualist” view of the moral importance of interests according to which satisfactions of future interests only have moral significance if they are satisfactions of actual interests. More precisely, I aim to show that the Time-relative Interest Account does not have the implications for the morality of killing that McMahan takes it to have, and implies, implausibly, that certain interest satisfactions which seem to be morally significant are morally insignificant because they are not satisfactions of actual interests. (shrink)

In this paper it is argued that functional role semantics can be saved from criticisms, such as those raised by Putnam and Fodor and Lepore, by indicating which beliefs and inferences are more constitutive in determining mental content. The Scylla is not to use vague expressions; the Charybdis is not to endorse the analytic/synthetic distinction. The core idea is to use reflective equilibrium as a strategy to pinpoint which are the beliefs and the inferences that constitute the content of a (...) mental state. The beliefs and the inferences that are constitutive are those that are in reflective equilibrium in the process of attributing mental states to others. (shrink)

ABSTRACT Does genetic relatedness define who is a mother or father and who incurs obligations towards or entitlements over children? While once the answer to this question may have been obvious, advances in reproductive technologies have complicated our understanding of what makes a parent. In a recent publication Bayne and Kolers argue for a pluralistic account of parenthood on the basis that genetic derivation, gestation, extended custody and sometimes intention to parent are sufficient (but not necessary) grounds for parenthood.1 Bayne (...) and Kolers further suggest that definitions of parenthood are underpinned by the assumption that ‘being causally implicated in the creation of a child is the key basis for being its parent’.2 This paper examines the claim that genetic relatedness is sufficient grounds for parenthood based on a causal connection between genetic parents and their offspring. I argue that parental obligations are about moral responsibility and not causal responsibility because we are not morally accountable for every consequence to which we causally contribute. My account includes the conditions generally held to apply to moral responsibility, i.e. freedom and foreseeability. I argue that parental responsibilities are generated whenever the birth of a child is a reasonably foreseeable consequence of voluntary actions. I consider the implications of this account for third parties involved in reproductive technologies. I argue that under some conditions the obligations generated by freely and foreseeably causing a child to exist can be justifiably transferred to others. (shrink)

Imagine that an anthropologist returns from her study of a group of people and reports the following:They refuse to kill one person even to avert the death of all involved—including that one person;They won’t directly push someone to his death to save the lives of five others, but they will push a lever to kill him to save five others;They punish transgressors because it feels right, even when they expect the punishment to cause far more harm than good—and even when (...) the harm done by the punishment exceeds the harm done by the transgression being punished.The anthropologist’s report might lead us to conclude that these people are at least confused, and perhaps even dangerous.Here’s some bad news. Those people are us. Or so suggests recent research in experimental psychology and the neurosciences. This research indicates that our moral intuitions have a vaguely deontological character and they prompt us to make any number of judgments that appear arbitrary or otherwise unjustified, such ... -/- I contend that Greene partly misunderstands the practical implications of his own principles. If our ordinary moral judgments are to do the strategic work Greene wants them to do, he needs to endorse fullfledged Sidgwickian self-effacement for at least some areas of micro-level decision making. By the lights of some of Greene’s own arguments, people must accept the correctness—and not simply the usefulness—of the relevant intuitions in their personal conduct to satisfy utilitarian standards. I argue that removing utilitarian reasoning from micro-level decision making is consistent with Greene’s preferred strategy of using utilitarianism as a Bcommon currency^ for resolving moral conflict at the institutional level. To clarify upfront: the aim of this paper is to offer an internal criticism rather than to defend (e.g.,) the relevant empirical research, utilitarianism, self-effacement, and so on. I’m making an argument about where Greene’s own psychological and philosophical commitments should take him. (shrink)

Liberal societies are characterized by respect for a fundamental value pluralism; i.e., respect for individuals’ rights to live by their own conception of the good. Still, the state must make decisions that privilege some values at the cost of others. When public ethics committees give substantial ethical advice on policy related issues, it is therefore important that this advice is well justified. The use of explicit tools for ethical assessment can contribute to justifying advice. In this article, I will discuss (...) one approach to ethical assessment, the ethical matrix method. This method is a variant of intuitionist balancing. Intuitionism is characterized by stressing the existence of several (at least two) fundamental prima facie moral principles, between which there is no given rank order. For some intuitionist approaches, coherentism has been proposed as a model of justification. This article will discuss justification of ethical advice and evaluate the appropriateness of coherentism as a justificatory approach to intuitionist tools. (shrink)

The anti-counterfeiting trade agreement was originally meant to harmonise and enforce intellectual property rights provisions in existing trade agreements within a wider group of countries. This was commendable in itself, so ACTA’s failure was all the more disappointing. In this article, I wish to contribute to the post-ACTA debate by proposing a specific analysis of the ethical reasons why ACTA failed, and what we can learn from them. I argue that five kinds of objections—namely, secret negotiations, lack of consultation, vagueness (...) of formulation, negotiations outside any international body, and the creation of a new governing body outside already existing forums—had only indirect ethical implications. This takes nothing away from their seriousness but it does make them less compelling, because agreements should be evaluated, ethically, for what they are, rather than for the alleged reasons why they are being proposed. I then argue that ACTA would have caused three ethical problems: an excessive and misplaced kind of responsibility, a radical decrease in freedom of expression, and a severe reduction in information privacy. I conclude by indicating three lessons that can help us in shaping a potential ACTA 2.0. First, we should acknowledge the increasingly vital importance of the framework of implicit expectations, attitudes, and practices that can facilitate and promote morally good decisions and actions. ACTA failed to perceive that it would have undermined the very framework that it was supposed to foster, namely one promoting some of the best and most successful aspects of our information society. Second, we should realise that, in advanced information societies, any regulation affecting how people deal with information is now bound to influence the whole ‘onlife’ habitat within which they live. So enforcing IPR becomes an environmental problem. Third, since legal documents, such as ACTA, emerge from within the infosphere that they affect, we should apply to the process itself, which one day may lead to a post-ACTA treaty, the very framework and ethical values that we would like to see promoted by it. (shrink)

The phenomenon of distributed knowledge is well-known in epistemic logic. In this paper, a similar phenomenon in ethics, somewhat neglected so far, is investigated, namely distributed morality. The article explains the nature of distributed morality, as a feature of moral agency, and explores the implications of its occurrence in advanced information societies. In the course of the analysis, the concept of infraethics is introduced, in order to refer to the ensemble of moral enablers, which, although morally neutral per se, can (...) significantly facilitate or hinder both positive and negative moral behaviours. (shrink)

The UK’s Cancer Drugs Fund was introduced in 2010 following the Conservative Party’s promise to address the fact that numerous efficacious cancer drugs were not available because of their cost ineffectiveness, as deduced by the National Institute of Health and Care Excellence. While, at face value, this policy appears only to promote the UK’s public welfare, a deeper analysis reveals the ethically unjustifiable inconsistencies that the CDF introduces; where is the analogous fund for other equally severe diseases? Have the patients (...) without cancer been neglected simply due to the fear-inducing advertising and particularly ferocious speech which surrounds cancer? The CDF is unjustifiable when challenged by such questions. However, it is troubling to think that the CDF might be repealed in order to abolish these ethical concerns. Intuitively, one feels uncomfortable stripping the cancer patient of their benefits just so that they might be on an equally pessimistic footing with others. In the present essay, I argue that, although there are no ethically justifiable grounds for the CDF’s introduction, its removal would be inappropriate. Following this realisation, I investigate whether the procedural steps of the CDF itself—theoretically removed from the context of resource distribution for all disease types—represent an ethically justifiable system. I believe that the answer is yes, given the CDF’s conformity to accountability for reasonableness, a robust framework of procedural justice, which continuously improves the ethical and epistemological standards of the policies to which it is applied. (shrink)

In A Theory of Justice (1971), John Rawls introduces the concept of “reflective equilibrium.” Although there are innumerable references to and discussions of this concept in the literature, there is, to the present author's knowledge, no discussion of the most important question: Why reflective equilibrium? In particular, the question arises: Is the method of reflective equilibrium applicable to the choice of this method itself? Rawls's drawing of parallels between Kant's moral theory and his own suggests that his concept of “reflective (...) equilibrium” is on a par with Kant's concept of “transcendental deduction.” Treating these two approaches to justification as paradigmatic, I consider their respective merits in meeting the reflexive challenge, i.e., in offering a justification for choice of mode of justification. My enquiry into this topic comprises three parts. In this first part, I raise the issue of the reflexivity of justification and question whether the reflexive challenge can be met within the framework of A Theory of Justice. (shrink)

In A Theory of Justice (1971), John Rawls introduces the concept of “reflective equilibrium.” Although there are innumerable references to and discussions of this concept in the literature, there is, to the present author's knowledge, no discussion of the most important question: Why reflective equilibrium? In particular, the question arises: Is the method of reflective equilibrium applicable to the choice of this method itself? Rawls's drawing of parallels between Kant's moral theory and his own suggests that his concept of “reflective (...) equilibrium” is on a par with Kant's concept of “transcendental deduction.” Treating these two approaches to justification as paradigmatic, I consider their respective merits in meeting the reflexive challenge, i.e., in offering a justification for choice of mode of justification. In the first part of this enquiry (Eng 2014a), I raised the issue of the reflexivity of justification and questioned whether the reflexive challenge can be met within the framework of A Theory of Justice. In the second part (Eng 2014b), I outlined a Kantian approach that represents a paradigmatic alternative to Rawls. In this third and final part, I shall argue that Rawls's reflective equilibrium cannot justify the choice of itself and that in the broader perspective thus necessitated, we cannot escape the metaphysical issues integral to the Kantian approach. (shrink)

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the (...) ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations. (shrink)

This paper is concerned with the practical importance of different forms of paternalism for educational theory and practice. Contrary to the traditional treatment of paternalism as a sometimes necessary and rather messy aspect of educational practices, I demonstrate that paternalism is to be regarded as an “indigenous concept” of educational theory and as the ‘indigenous model of justification’ that underlies the structure of educational practices. Based on an analysis of the intricate nexus between autonomy-oriented forms of paternalism and educational forms (...) of autonomy-based perfectionism I furthermore argue that a perfectionistically structured conception of autonomy provides a more adequate evaluative framework for justifying autonomy as an educational aim than alternative educational regimes of autonomy can deliver. Finally, I discuss some major theoretical problems of bridging the gap between general ethical principles and their application in practical fields. (shrink)

Soft regulatory measures are often promoted as an alternative for existing regulatory regimes for nanotechnologies. The call for new regulatory approaches stems from several challenges that traditional approaches have difficulties dealing with. These challenges relate to general problems of governability, tensions between public interests, but also (and maybe particularly) to almost complete lack of certainty about the implications of nanotechnologies. At the same time, the field of nanotechnology can be characterized by a high level of diversity. In this paper, we (...) discuss and compare two models for framing public policy in relation to technology regulation: the first is a deliberative model based on foresight knowledge and the second the wide reflective equilibrium model, developed by political philosopher John Rawls. In both models, the aim is to find consensus on (a framework for) policy measures and regulation. On the basis of a critical discussion of the strengths and weaknesses of both models, some tentative conclusions are drawn for effective policy making and implementation based on soft law. (shrink)

Due to their non-hierarchical structure, socio-technical networks are prone to the occurrence of the problem of many hands. In the present paper an approach is introduced in which people’s opinions on responsibility are empirically traced. The approach is based on the Rawlsian concept of Wide Reflective Equilibrium (WRE) in which people’s considered judgments on a case are reflectively weighed against moral principles and background theories, ideally leading to a state of equilibrium. Application of the method to a hypothetical case with (...) an artificially constructed network showed that it is possible to uncover the relevant data to assess a consensus amongst people in terms of their individual WRE. It appeared that the moral background theories people endorse are not predictive for their actual distribution of responsibilities but that they indicate ways of reasoning and justifying outcomes. Two ways of ascribing responsibilities were discerned, corresponding to two requirements of a desirable responsibility distribution: fairness and completeness. Applying the method triggered learning effects, both with regard to conceptual clarification and moral considerations, and in the sense that it led to some convergence of opinions. It is recommended to apply the method to a real engineering case in order to see whether this approach leads to an overlapping consensus on a responsibility distribution which is justifiable to all and in which no responsibilities are left unfulfilled, therewith trying to contribute to the solution of the problem of many hands. (shrink)

Insights from social science are increasingly used in the field of applied ethics. However, recent insights have shown that the empirical branch of business ethics lacks thorough theoretical grounding. This article discusses the use of the Rawlsian methods of wide reflective equilibrium and overlapping consensus in the field of applied ethics. Instead of focussing on one single comprehensive ethical doctrine to provide adequate guidance for resolving moral dilemmas, these Rawlsian methods seek to find a balance between considered judgments and intuitions (...) concerning particular cases on the one hand and general principles and theories on the other. In business ethics this approach is promissing because it enables decision-making in a pluralist context with different stakeholders who often endorse different or even conflicting cultural and moral frameworks without giving priority to any of them. Moreover, the method is well founded in political theory. A taxonomy of different kinds of applications is developed, and classified according to the purpose, the content, and the type of justification. On the basis of this taxonomy an inventory of 12 recent applications is made. In terms of the purpose and content of the method the applications are rather diverse. Two conceptual obstacles for applying Rawlsian methods are identified, viz. inclusiveness and the communitarian objection that people have to become detached from their personal life. It is found that methodological questions, such as the question how to retrieve the relevant empirical data, are scarcely addressed in the literature. To advance the use of empirical approaches in general, and that of Rawlsian approaches in particular, it is important not only to use empirical data but to use methodological insights from social sciences in order to further advance the field of empirical ethics. It is recommended that stakeholders be given a more active role in the assessment and justification of these methods. (shrink)

People tend to contribute more—and think they have stronger obligations to contribute more—to rescuing an identified victim rather than a statistical one. Indeed, they are often disposed to contribute more to rescuing a single identified victim than a greater number of statistical ones. By an “identified victim,” I mean Terry Q., lying injured in the passenger seat of the wrecked automobile on the corner of Main Street and Broadway, or Jessica McClure, the child who fell into the Texas well in (...) 1987 and whose family was sent $700,000 in donations for her. We need not know their names, however, and we can accept a very minimal form of identification. By a “statistical victim,” I mean the person who, extrapolating from traffic records, will be in a similar, serious car accident tomorrow (and may then be identified), or the children who will fall into wells next year if we do not cap them better than we did the well that trapped Jessica. Does this disposition (or perceived obligation) have any normative force? I initially thought there could be no such normative force, but consequentialist and nonconsequentialist arguments, pro and con, have convinced me that reasonable people can disagree with each other. This disagreement poses a problem for political philosophy: how should policy choices take such disagreement into account? (shrink)

The ArgumentSome have claimed that negative genetic interventions are morally permissible while positive ones are not, but the distinction cannot be used to draw this moral boundary. Underlying the negative/positive distinction is a distinction between treatment and enhancement. The treatment/enhancement distinction at best provides an imperfect guide to which health care services we are obliged to provide and which we are not. It offers only some “warning flags” to help us think about what is permissible or not.

The arguments advanced in this paper are the following. Firstly, that just as Trevarthen’s three subjective/intersubjective levels, primary, secondary, and tertiary, mapped out different modes of access, so too response is similarly structured, from direct primordial responsiveness, to that informed by shared pragmatic concerns and narrative contexts, to that which demands the distantiation afforded by representation. Secondly, I propose that empathy is an essential mode of intentionality, integral to the primary level of subjectivity/intersubjectivity, which is crucial to our survival as (...) individuals and as a species. Further to this last point, I argue that empathy is not derived on the basis of intersubjectivity, nor does it merely disclose intersubjectivity, rather it is constitutive of intersubjectivity at the primary level. Empathy is a direct, irreducible intentionality separable in thought from the other primary intentional modes of perception, rationality, memory and imagination, but co-arising with these. In regard to the inter-personal level, the concrete relations with others, primary empathy is both the ground for the possibility of the secondary manifestations—pity, sympathy, perspective taking, etc., and motivates them. Thirdly, it is the movement in the core of subjectivity initially generated by shifting attention between the ‘I’ and ‘we’ perspectives and later ‘solidified’ through affect to become shifting identification, which opens up the intersubjective domain. So we can affirm that we are not only born into sociality but our sociality goes to the roots of our being as Husserl, Heidegger and Merleau-Ponty have claimed. (shrink)

L'hypothèse qui guide le présent article est que les méthodes et techniques de dérivation ou de modélisation utilisées en éthique contemporaine, ont une incidence sur les contenus proprement moraux de la théorie morale ; vues comme de simples outils à l'usage du philosophe moral, elles agissent en fait comme des sources de normativité morale. Cette hypothèse n'est pas une simple reformulation de l'idée voulant qu'il existe, au sein de la théorie morale, un rapport entre explication et justification ou entre méta-éthique (...) et éthique. Pour le montrer, je m'appuierai d'abord sur une caractéristisation générale de ces composantes de la théorie morale et des rapports qu'elles entretiennent entre elles. Dans un deuxième temps j'arguerai que l'usage d'outils méthodologiques particuliers peut avoir une incidence sur les contenus moraux proprement dits. Pour caractériser cette incidence et en décrire les mécanismes, je ferai d'abord appel à une approche pragmatique de l'explication, puis je donnerai deux exemples, tirés de la philosophie morale contemporaine, et illustrant le fait que certains contenus moraux ainsi introduits échappent de fait à une justification en bonne et due forme.The central claim made in this article is that the various methodological devices used by contemporary moral philosophers in order to represent or derive moral principles affect the very moral content of their theory; seen by them as mere tools for philosophers, they in fact are sources of moral normativity. This claim is not a mere reformulation of the idea that there is within moral theory a connection between explanation and justification or between metaethics and ethics. To show that this is so, I first give a general characterization of the various components of moral theory and of their relationships. I then argue that the use of particular methodological devices affect the very moral content of the theory. To characterize such incidence and its mechanisms, I first appeal to a pragmatic conception of explanation and, finally, I discuss two examples from contemporary moral theory showing that substantive moral claims so introduced, in fact fail to be justified. (shrink)

Abstract: In this article the author develops the view, held by some, that political constructivism is best interpreted as a pragmatic enterprise aiming to solve political problems. He argues that this interpretation's structure of justification is best conceived in terms of two separate investigations—one develops a normative solution to a particular political problem by working up into a coherent whole certain moral conceptions of persons and society; and the other is an empirically based analysis of the political problem. The author (...) argues that the empirically based analysis can generate criteria for assessing whether the normative theory successfully works out a solution, thereby developing a functionalist structure of justification. He further argues that this interpretation overcomes a longstanding criticism of constructivism, namely, that the use of substantive moral concepts in the hypothetical choice procedure biases the defense of principles in a particular direction and therefore begs important philosophical questions. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

In this commentary, I critically discuss the respective views of Gert and Beauchamp–Childress on the nature of so-called common morality and its promise for enriching ethical reflection within the field of bioethics. Although I endorse Beauchamp and Childress’ shift from an emphasis on ethical theory as the source of moral norms to an emphasis on common morality, I question whether rouging up common morality to make it look like some sort of ultimate and universal foundation for morality, untouched by the (...) dialectics of time and reflective equilibrium, was an equally good move. As for Gert’s magisterial conception of common morality, I conclude that certain elements of his system are controversial at best and woefully inadequate at worst. He has a tendency to find in common morality what he himself put there, and his highly restricted conception of duties of assistance strikes this reader as ad hoc, inadequately defended, and unworthy of a project whose goal is to lessen the amount of misery in the world. (shrink)

In his recent book, The Dimensions of Consequentialism, Martin Peterson puts forward a new version of consequentialism that he dubs ‘multidimensional consequentialism’. The defining thesis of the new theory is that there are irreducible moral aspects that jointly determine the deontic status of an act. In defending his particular version of multidimensional consequentialism, Peterson advocates the thesis—he calls it DEGREE—that if two or more moral aspects clash, the act under consideration is right to some non-extreme degree. This goes against the (...) orthodoxy according to which—Peterson calls this RESOLUTION—each act is always either entirely right or entirely wrong. The argument against RESOLUTION appeals to the existence of so-called deontic leaps: the idea is that endorsing RESOLUTION would not give each relevant moral aspect its due in the final analysis. Our paper argues that, contrary to Peterson, all moral aspects remain visible in what can properly be called the final analysis of a moral theory that involves RESOLUTION, moral aspects do not have to remain visible in judgements of all-things-considered rightness or wrongness, respectively, introduction of what Peterson calls verdictive reasons does not change the overall picture in favour of DEGREE. We conclude that multi-dimensional consequentialists should accept RESOLUTION rather than DEGREE. (shrink)

This issue provides readers the opportunity to broaden understanding of methods used in applied ethics. We hope you will be inspired to decide on which method, or a combination of different ones, to use towards achieving reflective balance that can enhance understanding of all considerations relevant to deciding what should be done. Like tools, methods are used because they are well suited to the task we seek to accomplish.