End-of-life decision-making is controversial. There are different views about when it is appropriate to limit life-sustaining treatment, and about what palliative options are permissible. One approach to decisions of this nature sees consensus as crucial. Decisions to limit treatment are made only if all or a majority of caregivers agree. We argue, however, that it is a mistake to require professional consensus in end-of-life decisions. In the first part of the article we explore practical, ethical, and legal factors that support (...) agreement. We analyse subjective and objective accounts of moral reasoning: accord is neither necessary nor sufficient for decisions. We propose an alternative norm for decisions – that of ‘professional dissensus’. In the final part of the article we address the role of agreement in end-of-life policy. Such guidelines can ethically be based on dissensus rather than consensus. Disagreement is not always a bad thing. (shrink)

Adjustments of everyday life in order to prevent disease or treat illness afflict partly unconscious preferences and cultural expectations that are often difficult to change. How should one, in medical contexts, talk with patients about everyday life in ways that might penetrate this blurred complexity, and help people find goals and make decisions that are both compatible with a good life and possible to accomplish? In this article we pursue the question by discussing how Habermas’ theory of communicative action can (...) be implemented in decision-making processes in general practice. The theory of deliberative decision-making offers practical guidelines for what to talk about and how to do it. For a decision to be rooted in patients’ everyday life it has to take into consideration the patient’s practical circumstances, emotions and preferences, and what he or she perceives as ethically right behaviour towards other people. The aim is a balanced conversation, demonstrating respect, consistency and sincerity, as well as offering information and clarifying reasons. Verbalising reasons for one’s preferences may increase awareness of values and norms, which can then be reflected upon, producing decisions rooted in what the patient perceives as good and right behaviour. The asymmetry of medical encounters is both a resource and a challenge, demanding patient-centred medical leadership, characterised by empathy and ability to take the patient’s perspective. The implementation and adjustments of Habermas’ theory in general practice is illustrated by a case story. Finally, applications of the theory are discussed. (shrink)

This long-awaited book sets out the implications of Habermas's theory of communicative action for moral theory. "Discourse ethics" attempts to reconstruct a moral point of view from which normative claims can be impartially judged. The theory of justice it develops replaces Kant's categorical imperative with a procedure of justification based on reasoned agreement among participants in practical discourse.Habermas connects communicative ethics to the theory of social action via an examination of research in the social psychology of moral and interpersonal development. (...) He aims to show that our basic moral intuitions spring from something deeper and more universal than contingent features of our tradition, namely from normative presuppositions of social interaction that belong to the repertoire of competent agents in any society. Jürgen Habermas is Professor of Philosophy at the University of Frankfurt. (shrink)

This long-awaited book sets out the implications of Habermas's theory of communicative action for moral theory. "Discourse ethics" attempts to reconstruct a moral point of view from which normative claims can be impartially judged. The theory of justice it develops replaces Kant's categorical imperative with a procedure of justification based on reasoned agreement among participants in practical discourse.Habermas connects communicative ethics to the theory of social action via an examination of research in the social psychology of moral and interpersonal development. (...) He aims to show that our basic moral intuitions spring from something deeper and more universal than contingent features of our tradition, namely from normative presuppositions of social interaction that belong to the repertoire of competent agents in any society. Jürgen Habermas is Professor of Philosophy at the University of Frankfurt. (shrink)

The concept of consensus is often appealed to in discussions of biomedical ethics and applied ethics, and it plays an important role in many influential ethical theories. Consensus is an especially influential notion among theorists who reject ethical realism and who frame ethics as a practice of discourse rather than a body of objective knowledge. It is also a practically important notion when moral decision making is subject to bureaucratic organization and oversight, as is increasingly becoming the case in medicine. (...) Two models of consensus are examined and criticized: pluralistic consensus and overlapping consensus. As an alternative to these models, the paper argues that consensus refers to the dialogic aspects of a broader normative conception of democratic moral agency. When the preconditions for that dialogic democratic practice are met, consensus has a justificatory role in ethics; when they are not, consensus, as distinct from mere agreement, does not emerge and can have no moral authority. Keywords: applied ethics, bioethics, consensus, contract theory, democracy, discourse ethics, liberalism CiteULike Connotea Del.icio.us What's this? (shrink)

OBJECTIVES: To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN: Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analysis. SETTING: Five departments of internal medicine at Danish hospitals. SAMPLE: Seven discussion groups. MAIN MEASUREMENTS: Ethical content of statements, style of statements, time used by each participant. RESULTS: Danish physicians (...) and nurses do not differ in the kind of ethical reasoning they use, but physicians use more of the discussion time than nurses, they use a more assertive style of argumentation, and the solutions chosen are usually first put forward by physicians. CONCLUSION: The results and informal comparisons with similar data from long qualitative interviews indicate that groups of this kind are a useful tool for gathering data on ethical reasoning. (shrink)

OBJECTIVES: To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN: Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analysis. SETTING: Five departments of internal medicine at Danish hospitals. SAMPLE: Seven discussion groups. MAIN MEASUREMENTS: Ethical content of statements, style of statements, time used by each participant. RESULTS: Danish physicians (...) and nurses do not differ in the kind of ethical reasoning they use, but physicians use more of the discussion time than nurses, they use a more assertive style of argumentation, and the solutions chosen are usually first put forward by physicians. CONCLUSION: The results and informal comparisons with similar data from long qualitative interviews indicate that groups of this kind are a useful tool for gathering data on ethical reasoning. (shrink)

Abstract:In this paper I explore the topic of moral compromise in institutional settings and highlight how moral compromise may affirm, rather than undermine, personal integrity. Central to this relationship between moral compromise and integrity is a view of the self that is responsive to multiple commitments and grounded in an ethic of responsibility. I elaborate a number of virtues that are related to this notion of the self and highlight how these virtues may support the development of individuals who are (...) responsive and reasonable in moral discourse and discerning in establishing moral limits on compromise. I look at how moral regret is closely connected to moral compromise and emphasize its significance for reinforcing personal integrity. The paper closes with a discussion of the relevance of these topics to the field of business ethics. (shrink)

The first section of this paper asks why the notion of consensus has recently come to the fore in the medical humanities, and suggests that the answer is a function of growing technological and professional complexity. The next two sections examine the concept of consensus analytically, citing some of the recent philosophical literature. The fourth section looks at committee deliberations and their desirable outcomes, and questions the degree to which consensus serves those outcomes. In the fifth and last section it (...) is suggested that if I am to subscribe to a consensual outcome responsibly I must be personally committed to it, and that this requires a form of knowledge I call ‘fiduciary’, in this case knowledge of the competence and trustworthiness of other participants in deliberation whose expertise may have influenced my agreement. (shrink)

Libertarian paternalism is a concept derived from cognitive psychology and behavioural science. It is behind policies that frame information in such a way as to encourage individuals to make choices which are in their best interests, while maintaining their freedom of choice. Clinicians may view their clinical consultations as far removed from the realms of cognitive psychology but on closer examination there are a number of striking similarities.

Here, for the first time in English, is volume one of Jurgen Habermas's long-awaited magnum opus: The Theory of Communicative Action. This pathbreaking work is guided by three interrelated concerns: to develop a concept of communicative rationality that is no longer tied to the subjective and individualistic premises of modern social and political theory; to construct a two-level concept of society that integrates the 'lifeworld' and 'system' paradigms; and to sketch out a critical theory of modernity that explains its sociopathologies (...) in a new way. Habermas approaches these tasks through a combination of conceptual analyses, systematic reflections, and critical reconstructions of such predecessors as Marx and Weber, Durkheim and Mead, Horkheimer and Adorno, Schutz and Parsons. Reason and the Rationalization of Society develops a sociological theory of action that stresses not its means-ends or teleological aspect, but the need to coordinate action socially via communication. In the introductory chapter Habermas sets out a powerful series of arguments on such foundational issues as cultural and historical relativism, the methodology of Verstehen, the inseparabilty of interpretation from critique. In addition to clarifying the normative foundations of critical social inquiry, this sets the stage for a systematic appropriation of Weber's theory of rationalization and its Marxist reception by Lukacs, Horkheimer and Adorno. This is an important book for degree students of philosophy, sociology and related subjects. (shrink)

Postmodernism has evoked great controversy and it continues to do so today, as it disseminates into general discourse. Some see its principles, such as its fundamental resistance to metanarratives, as frighteningly disruptive, while a growing number are reaping the benefits of its innovative perspective. In Political Theory and Postmodernism, Stephen K. White outlines a path through the postmodern problematic by distinguishing two distinct ways of thinking about the meaning of responsibility, one prevalent in modern and the other in postmodern perspectives. (...) Using this as a guide, White explores the work of Heidegger, Foucault, Derrida, Lyotard, and Habermas, as well as 'difference' feminists, with the goal of showing how postmodernism can inform contemporary ethical-political reflection. In his concluding chapter, White examines how this revisioned postmodern perspective might bear on our thinking about justice. (shrink)

Ethics and Law for the Health Professions is a cross-disciplinary medico-legal book whose previouseditions have been widely used in the medical world. This new 3rd edition is fully revised with all ethics and law topics updated to reflect recent developments. New chapters include dealing specifically with children, health care and the environment, infectious diseases, public health, and ethics and chronic disease. All law sections have been extensively re-visited by Dr Cameron Stewart. Its special features are its focus on a clinically (...) relevant approach, and its recognition that health care professionals are often confronted by legal issues and ethical issues at the same time. Health professionals have to satisfy both, and their legal advisers need to be aware of the dilemmas this can present. This book is careful to distinguish between ethics and law. Its chapters take account of all the health professions, and their differing responsibilities, and cover a very wide range of the issues they face. (shrink)

Respecting the autonomy of disabled people is an important ethical issue for providers of long-term care. In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in this setting, where ethical conflict, dilemma and tragedy are inescapable. He argues that liberal accounts of autonomy and individual rights are insufficient, and offers an account of autonomy that matches the realities of long-term care. The book therefore offers a framework for carers to develop an ethic (...) of long-term care within the complex environment in which many dependent and aged people find themselves. Previously published as Autonomy and Long-term Care, this revised edition, in paperback for the first time, takes account of recent work and develops the author's views of what autonomy means in the real world. It will have wide appeal among bioethicists and health care professionals. (shrink)

The New Social Disease is about how we personalize our computers and associated technologies while depersonalizing others and ourselves.

This paperback edition contains a new greatly expanded bibliography of Habermas's work.

In Between Facts and Norms, Jürgen Habermas works out the legal and political implications of his Theory of Communicative Action (1981), bringing to fruition the project announced with his publication of The Structural Transformation of the Public Sphere in 1962. This new work is a major contribution to recent debates on the rule of law and the possibilities of democracy in postindustrial societies, but it is much more. The introduction by William Rehg succinctly captures the special nature of the work, (...) noting that it offers a sweeping, sociologically informed conceptualization of law and basic rights, a normative account of the rule of law and the constitutional state, an attempt to bridge normative and empirical approaches to democracy, and an account of the social context required for democracy. Finally, the work frames and caps these arguments with a bold proposal for a new paradigm of law that goes beyond the dichotomies that have afflicted modern political theory from its inception and that still underlie current controversies between so-called liberals and civic republicans. The book includes a postscript written in 1994, which restates the argument in light of its initial reception, and two appendixes, which cover key developments that preceded the book. Habermas himself was actively involved in the translation, adapting the text as necessary to make it more accessible to English-speaking readers. (shrink)

Habermas's 1971 Gauss Lectures, plus two additional essays, outlining an intersubjective approach to social theory.

This chapter seeks to provide an understanding of philosophical ethics sufficient for reading other chapters and for appreciating the relevance of philosophical investigations for epidemiologic ethics. Some central concepts and methods of biomedical ethics are explained. In the section on Social Morality and Professional Morality, several questions about the nature of morality and moral responsibility are discussed. In the Section on Problems and Methods in Moral Philosophy, several problems and methods in moral philosophy are discussed, and, in the final section, (...) some ethical theories of importance for biomedical ethics are investigated. (shrink)