This book addresses the concepts of sovereignty, justice and justification in relation to western warfare. It argues that ontological assumptions about human life underpin these concepts. This book focuses on these assumptions and shifts our attention away from the question of our right to kill and towards the question of the construction of life.

Voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical (...) climate. In this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient’s life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics.

Voluntary active euthanasia and physician-assisted suicide remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical climate. In (...) this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

: The philosophical import of the chariot images found in the Katha Upanishad and the Phaedrus is considered here. It is claimed that the resemblance in the accounts provided in these disparate texts is not merely incidental. Rather, each chariot-image should be read as contributing to a careful answer to the same thorny philosophical problem: the identification and justification of the best life for the individual. It is argued that each serves to illuminate an internal and complex account (...) of the self, which grounds and supports an effective rejection of the life spent in pursuit of the satisfaction of bodily desires in favor of the life spent in pursuit of wisdom. (shrink)

The philosophical import of the chariot images found in the Katha Upanishad and the Phaedrus is considered here. It is claimed that the resemblance in the accounts provided in these disparate texts is not merely incidental. Rather, each chariot-image should be read as contributing to a careful answer to the same thorny philosophical problem: the identification and justification of the best life for the individual. It is argued that each serves to illuminate an internal and complex account of (...) the self, which grounds and supports an effective rejection of the life spent in pursuit of the satisfaction of bodily desires in favor of the life spent in pursuit of wisdom. (shrink)

The philosophical import of the chariot images found in the Katha Upanishad and the Phaedrus is considered here. It is claimed that the resemblance in the accounts provided in these disparate texts is not merely incidental. Rather, each chariot-image should be read as contributing to a careful answer to the same thorny philosophical problem: the identification and justification of the best life for the individual. It is argued that each serves to illuminate an internal and complex account of (...) the self, which grounds and supports an effective rejection of the life spent in pursuit of the satisfaction of bodily desires in favor of the life spent in pursuit of wisdom. (shrink)

Part of Robert Kane’s response to the contemporary cultural condition of pluralism is to attempt to ground morality in the _search_ for wisdom about how to live. With regard to the right, Kane argues, roughly, that a new principle capturing what all morally permissible actions have in common warrants belief on the part of all inquirers, even in the face of reasonable uncertainty, because it is justified as an essential means to ascertaining wisdom. Upon embarking for wisdom, one quickly discovers (...) an important chunk of it about right action, namely, that wisdom will not be found unless one treats others in a particular kind of way. Although, as I discuss, this rationale has some similarities with transcendental arguments to be found in the literature, it is novel and merits careful attention from meta-ethicists. In this critical notice, I focus largely on Kane’s interesting justification of a principle of right action, paying somewhat less attention to the content of this principle, which is akin to Kant’s Formula of Humanity, and the not-merely-mental account of the good that Kane also advances; however, these elements of Kane’s intricate worldview about how to live should also be of interest to normative ethicists. (shrink)

Is the capital punishment a solution? Can a basis for rejecting or justifying it be established? How should and how can a criminal be punished? Can the capital punishment be replaced by another type of punishment? Is this really a cruel, violent and unusual punishment? Questions like the previous ones, to which, of course, many others can be added, cannot be avoided once the still controversial issue of capital punishment has been addressed, being considered a major infringement of human rights. (...) Uncomfortable and complex, sensitive and profound, it appears, first and foremost, as a fundamental theme for philosophical reflection and not only, being of a special significance to the applied ethics, as it is a point of contention that concerns life itself. The importance of this theme is conferred in particular by the fact that it deals with different aspects regarding the suppression of a person's life in a legal, deliberate and justified way, an obvious importance by the very purpose of this punishment. From a compositional point of view, we have structured the present study in such a way as to include, using the critical dimension, the highlighting of some of the relevant philosophical perspectives that are subsumed to the topic, and which can still be an argument, at least an ethical one, against the application of capital punishment. At the end of the study, we sketched some current distinctive reflections, pointing out an argument in favour of one's own choice on the subject of the study, not necessarily considering that this is not a solution, but also that an ultimate basis cannot be established to support it. (shrink)

People who suffer from eating disorders often have to be treated against their will, perhaps by being detained, perhaps by being forced to eat. In this paper it is argued that whilst forcing compliance is generally acceptable, there may be circumstances under which a sufferer's refusal of consent to treatment should be respected. This argument will hinge upon whether someone in the grip of an eating disorder can actually make competent decisions about their quality of life. If so, then (...) the decision to refuse therapy may be on a par with other decisions to refuse life‐prolonging therapy made by sufferers of debilitating chronic, or acute onset terminal illness. In such cases, palliation might justifiably replace aggressive therapy. The argument will also draw heavily on the distinction between competent refusal of therapy and passive euthanasia, and the distinction between incompetent and irrational decisions. Both distinctions will then be applied to decisions to refuse food. The extent to which sufferers from anorexia nervosa can be categorised as either incompetent or irrational will be examined. It is against this background that it will be argued that at least some of those who suffer from eating disorders should have their refusals respected, even if they may die as a result. (shrink)

As a preliminary to the justification of equal opportunity, we require a few words on the concept. An opportunity is a chance to attain some goal or obtain some benefit. More precisely, it is the lack of some obstacle or obstacles to the attainment of some goal(s) or benefit(s). Opportunities are equal in some specified or understood sense when persons face roughly the same obstacles or obstacles of roughly the same difficulty of some specified or understood sort. In different (...) contexts we might have different sorts of benefits or obstacles in mind. But in the current social context, and in the context of this discussion, we refer to educational and occupational opportunities, chances to attain the benefits of higher education and of socially and economically desirable positions, benefits assumed to be desired by many or most individuals, other things being equal. And we generally divide obstacles into two broad classes: those imposed by the social system or by other persons in the society, for example, the hardships of life in the lower economic classes or barriers from prejudices based on race, sex, or ethnic background; and those imposed by natural disabilities, for example, low intelligence or lack of talents.The initial question is whether a moral society is obligated to create equality in opportunities in the senses just defined. I shall assume here initially that there is some such obligation on the part of society or the state, although I shall specify its nature and limits more precisely below. With the exception of certain libertarians, almost everyone, liberal and conservative alike, agrees in this assumption. (shrink)

There seems to be a broad agreement that curiosity is important in education. However, current research often seeks to answer the question of how best to nurture curiosity and fails to ask the normative question of why this should be done. A closer look reveals that the reasons for justifying the importance of curiosity vary, with some theorists pointing to its role in cognitive development as a starting point for learning, and others praising it as an element of democracy and (...) a child’s right to participation. Most of these approaches understand curiosity as an individual urge or desire for knowledge. In contrast, this article will examine a relational understanding of the concept by focussing on social curiosity. Instead of following a cognitive developmentalist, intellectual virtue or emancipatory approach to valuing curiosity, I will employ relational ethical theory. The argument then explores a possible analogy between social curiosity and the concept of sovereign expressions of life, as developed by the Danish philosopher and theologian K.E. Løgstrup. By drawing on his relational ethics, the article aims to expand the theoretical grounds on which curiosity can be normatively legitimised in education. With children spending longer and longer hours in educational, structured and adult-led settings, I conclude with a twofold normative claim: Social curiosity should be a part of all relations in education and its absence should lead to an ethical demand. In addition, an awareness of the actual deeds through which social curiosity is realised is also a topic that must be addressed by educators. (shrink)

When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of (...) well-being. I present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. (shrink)

The health of newborns has always been subject to the natural lottery. When in the past a severely disabled baby was born, nature provided the “solution,” and the child did not survive. Medical technology has brought about a change; fetuses who would have died during pregnancy or newborns who once would have had little chance to survive are now kept alive. Although these technological advances do benefit many children, the dark side is that more severely handicapped babies are surviving.When a (...) severely disabled baby is born, all persons concerned are faced with emotional difficulties as well as moral and legal dilemmas. Questions that arise include whether it is acceptable, morally and legally, to allow the severely handicapped newborn to die by forgoing treatment or by direct intervention. (shrink)

This paper argues that Immanuel Kant’s practical philosophy contains a coherent, albeit implicit, defense of the legitimacy of capital punishment, one that refutes the most important objections leveled against it. I first show that Kant is consistent in his application of the ius talionis. I then explain how Kant can respond to the claim that death penalty violates the inviolable right to life. To address the most significant objection – the claim that execution violates human dignity – I argue (...) that motives of honor, as Kant conceives it, require a rational person to will her own execution, were she to commit murder. (shrink)

The focus of the study is the problem of “entry” or “penetration” of pre-revolutionary philosophy into Soviet philosophy. On the example of the oeuvre of E.K. Gertsyk, the au­thor of “Memoirs” on the philosophers and writers of the religious and philosophical re­vival at the turn of the 19th–20th centuries, the translator of the works of F. Nietzsche, J. Huysmans, F. von Baader and others, the thinker who created her own version of the philosophy of life, it is shown how (...) a representative of the culture of the Silver Age managed to reconcile with the Soviet reality. The article traces Gertsyk’s creative evolu­tion from the philosophy of the phenomenon, presented in her dissertation essay on the problem of the real world in the Kant’s philosophy (1904), to the philosophy of life; her interpretation of Kant’s epistemology is considered; the concept of a path (a key one in Gertsyk’s work) was analyzed on the basis of works written in the early Soviet years (the hagiographic treatise “On the Ways” (1917–1918), the essay “Edgar Poe” (1918–1927)); the influences of decisive importance for Gertsyk’s philosophical searches are considered (I. Kant, F. Nietzsche, L. Shestov, N. Berdyaev, V. Ivanov, A. Bergson and etc). The article focuses on the transitional stage of Gertsyk’s oeuvre, when there was an increase in religiosity and apocalyptic moods in her mindset, which in the 1930s was replaced by a departure from Christianity as a stronghold of the old culture and old values, justification and apologia for the new social reality, demonstrated by Gertsyk in the well-known letters “from there”, i.e. from the Soviet Russia, published on the pages of the Parisian journal “Sovremennye zapiski” and caused a mixed reaction in the emigrant community. The article shows what ideological attitudes allowed the par­ticipant of the decadent meetings and the interlocutor of Russian religious philosophers to accept the Soviet reality. (shrink)

Almost everybody has a conscience, though it may not play a dominating or even very prominent role in his life. To have a conscience is to classify some kinds of action as morally right and others as morally wrong, and to be disposed to do the former and avoid doing the latter. To judge an action as morally right or wrong is not to judge it as advantageous or disadvantageous to the agent; the motive for acting conscientiously cannot be (...) pure self-interest. It is a mark of my thinking an action morally right that I am disposed to do it even though doing it will involve me in a net loss of enjoyment or a net surplus of suffering. A man who is only disposed to do such things as he thinks will increase his happiness in the long run has no conscience. Conscience presents itself to a person as a kind of constraint which he cannot evade on the ground that it will be inconvenient to comply with it. (shrink)

Transmission of justification across inference is a valuable and indeed ubiquitous epistemic phenomenon in everyday life and science. It is thanks to the phenomenon of epistemic transmission that inferential reasoning is a means for substantiating predictions of future events and, more generally, for expanding the sphere of our justified beliefs or reinforcing the justification of beliefs that we already entertain. However, transmission of justification is not without exceptions. As a few epistemologists have come to realise, more (...) or less trivial forms of circularity can prevent justification from transmitting from p to q even if one has justification for p and one is aware of the inferential link from p to q. In interesting cases this happens because one can acquire justification for p only if one has independent justification for q. In this case the justification for q cannot depend on the justification for p and the inferential link from p to q, as genuine transmission would require. The phenomenon of transmission failure seems to shed light on philosophical puzzles, such as Moore's proof of a material world and McKinsey's paradox, and it plays a central role in various philosophical debates. For this reason it is being granted continued and increasing attention. (shrink)

Surrogacy as a practice is supported by science, technology, morality and legality. It follows that the issues concerning it cut across all facets of life. And different arguments have being advanced for and against this practice. The belief espouse in this paper is that one cannot discuss successfully the moral, the science or the legality of surrogacy without delving into the cultural question of who is a mother. In other words, it is possible to have simple scientific and legal (...) understandings of the practice and still disagree on the cultural level because of its stronger emotional appeal. The purpose of this work is to expose the Yoruba-African religio-cultural beliefs that have bearing on the understanding of motherhood or ownership of a child. This will be done through a critical analysis of Yoruba cultural beliefs about personhood and the metaphysical underpinning between birth and the ontology of life itself. Theargument here is that given some Yoruba ontological belief about life, motherhood and personhood it may be difficult for the products of surrogacy to fit-in into the society in terms of personal and social development. This work goes further to recommend that cultural beliefs should be taking into consideration when making laws to guide surrogacy in order to avoid conflict between the mothers and the child. (shrink)

This paper offers a novel interpretation of Hans Jonas’ analysis of metabolism, the centrepiece of Jonas’ philosophy of organism, in relation to recent controversies regarding the phenomenological dimension of life-mind continuity as understood within ‘autopoietic’ enactivism (AE). Jonas’ philosophy of organism chiefly inspired AE’s development of what we might call ‘the phenomenological life-mind continuity thesis’ (PLMCT), the claim that certain phenomenological features of human experience are central to a proper scientific understanding of both life and mind, and (...) as such central features of all living organisms. After discussing the understanding of PLMCT within AE, and recent criticisms thereof, I develop a reading of Jonas’ analysis of metabolism, in light of previous commentators, which emphasizes its systematicity and transcendental flavour. The central thought is that, for Jonas, the attribution of certain phenomenological features is a necessary precondition for our understanding of the possibility of metabolism, rather than being derivable from metabolism itself. I argue that my interpretation strengthens Jonas’ contribution to AE’s justification for ascribing certain phenomenological features to life across the board. However, it also emphasises the need to complement Jonas’ analysis with an explanatory account of organic identity in order to vindicate these phenomenological ascriptions in a scientific context. (shrink)

Qualitative research carried out within human science must provide justification for its findings. However, the justification of empirical claims concerning human meanings has to be approached in new ways: Quantitative procedures of validation or the use of experimental control are inappropriate. Many researchers have attempted to follow Schutz's ''postulate of adequacy," which lays down as a condition of acceptability of a scientific account of human action that it be understandable by the actor in terms of commonsense interpretation of (...) everyday life. For instance, Harré suggests "validating" descriptions by ensuring that subjects of the research approve them. Against this approach, it is insisted that human science research is essentially an interpersonal process, and that therefore research activities cannot avoid such Goffmanesque features of self-presentation as resistance to being understood and eager acceptance of understanding, which are both pervasive possibilities of all social interaction. Thus, the research participant's agreement or disagreement cannot be taken as evidence as to the adequacy of a qualitative research description or interpretation. (shrink)

Some have argued that specifically moral demands or norms are justified by the constraints of rationality. On this view, any agent who comes to doubt, challenge, or reject the authority of moral demands does so on penalty of irrationality. According to this view, the agent who asks the question Why be moral? can be given a rational justification for the demands that morality makes on her, regardless of her individual reasons and motives. ;I consider amoralism as a test case. (...) Could a proposed justification of morality answer to the amoralist? I develop two characterizations of amoralism: the principled objector and the amoralist from indifference. I argue that normal moral agents may adopt or succumb to either type of amoralism without forfeiting their claim to rationality, and further, that such amoralists are not best understood as demanding a justification of morality. ;Some philosophers have objected that the notion of amoralism is conceptually mistaken or incoherent. I address three forms of this argument. First, I argue that the inverted-commas argument attributed to R. M. Hare fails to show that purported amoralists cannot really make or understand value judgments. Second, I argue that Michael Smith's internalist argument against amoralism is unconvincing. Third, I consider Christine Korsgaard's argument in The Sources of Normativity that the very nature of rational action entails moral obligation. ;I conclude by discussing the way in which a justification of moral demands can only be made internal to a particular moral outlook or way of life. To attempt to respond to amoralists who are radically dissatisfied with, or dissociated from, a moral perspective with a wholesale rational justification of morality is to misunderstand the nature of their disaffection as well as to misunderstand the project of moral philosophy. However, acknowledging the limited role of justification in moral theory and argument does not entail that moral philosophy's primary enterprise is merely the explanation of moral phenomena. Moral normativity is a function of our capacity for reflection. Thus, the work of moral philosophy lies in making reflective recommendations for which norms to adopt, how to obligate oneself and others, and how to live. (shrink)

ABSTRACT A disagreement about the nature of Nietzsche's “aesthetic justification of existence” has recently emerged in the literature. In this essay, I argue that the disagreement stems from a common but mistaken assumption that Nietzsche focuses on works of art to justify life. Instead, in the Untimely Meditations, Nietzsche shifts to the beauty of exemplary individuals to justify life. Through an examination of the Kantian practical arguments in the Untimely Meditations, I show how the scholarly debate can (...) be overcome and suggest that Nietzsche's early period views can illuminate the basis of some of his late period ideals, such as the overman and philosopher of the future. (shrink)

Recent defenders of Philippa Foot, such as Michael Thompson and John Hacker-Wright, have argued that it is a mistake to think that Ft aims to justify a substantive conception of human soundness and defect. instead, she relies on the acceptance of certain groundless moral norms to underwrite her views about what is characteristically human. I maintain that this is a weakness and that the Footian-style proponent of natural normativity needs to provide a story about how we might achieve justified self-confidence (...) regarding moral norms. In this paper, I offer a coherentist model for doing so, thereby addressing the justification gap. (shrink)

Ethics and Qualities of Life looks at what enters into ethical judgment and choice. Interpretation of a case and of what the options are is always a factor, as is a sense of the possible values at stake. Intuitions also enter in, but often are unreliable. For a long time it seemed only fair that oldest sons inherited, and struck few people as unfair that women were not allowed to attend universities. A moral judgment is putatively part of a (...) moral order in a society that any reasonable person would accept. But what counts as "reasonable" is generally contestable. The unreliability of intuitions leads naturally to ethical theory. Kantian, contractualist, and consequentialist theories all have some important truth in them, but not the whole truth. Contractualism lacks the resources required for a fully determinate account of what counts as "reasonable". Broad general rules are important to Kant and are at the center of everyday morality. But can Kantian ethics explain why they have to have this central role? Our evolving social contract now contains elements that once would have seemed counter-intuitive to most people. But could consequentialists have predicted with entire confidence the consequences of social changes that we now think were desirable? The last part of this book contains a double argument. One is that ethical theory is employed by humans in a state of semi-ignorance of relevant factors, grasping at likely truths and evolved intuitions. The other is that consequentialist considerations have a major role at the fundamental level, but much more in justification or criticism than in ethical discovery. (shrink)

The author analyzes the lessons for ethics consultants presented by McCrary and colleagues in their case, “Elective Delivery Before 39 Weeks’ Gestation: Reconciling Maternal, Fetal, and Family Interests in Challenging Circumstances.” Clinical ethics cases that involve different specialists representing the best interests of different parties in a case, such as this case involving neonatologists and perinatologists, are complex and time-consuming. The author concludes that ethics must insure the interests of the fetus and future person are not subsumed to the interests (...) of those with a voice, without deliberate reflection and strong ethical justification. (shrink)

ABSTRACT This paper explores one of the most politically sensitive and intellectually neglected issues in bioethics – the interface between the history of contemporary end‐of‐life ethics and the economics of life and death. It suggests that contrary to general belief, economic impulses have increasingly become part of the conditions in which contemporary end‐of‐life ethics continues to evolve. Although this conclusion does not refute the philosophical justifications provided by the ethics for itself, it may cast new light upon (...) its social role. (shrink)

Low opportunity cost, weak influence of quality of life in the face of death, the social value of life extension to others, shifting psychological reference points, and hope have been proposed as factors to explain why people apparently perceive marginal life extension at the end of life to have disproportionately greater value than its length. Such value may help to explain why medical spending to extend life at the end of life is as high (...) as it is, and the various factors behind this value might provide normative rationale for that spending. Upon critical analysis, however, most of these factors turn out to be questionable or incompletely conceived; this includes hope, which is examined here in special detail. These factors help to explain complexity and nuance in the normative issues, but they do not provide adequate justification for spending as high as it often is. In any case, two additional factors must be added to the descriptive explanation of high spending, and they throw its normative justification into further doubt: the “insurance effect” and provider-created demand. Overall, the perception of especially high value of life at the end of life provides some normative justification for high spending, but seldom strong justification, and not for spending as high as it often is. (shrink)

The Contours of Christian Philosophy series will consist of short introductory-level textbooks in the various fields of philosophy. These books will introduce readers to major problems and alternative ways of dealing with those problems. These books, however, will differ from most in that they will evaluate alternative viewpoints not only with regard to their general strength, but also with regard to their value in the construction of a Christian world and life view. Thus, the books will explore the implications (...) of the various views for Christian theology as well as the implications that Christian convictions might have for the philosophical issues discussed. It is crucial that Christians attain a greater degree of philosophical awareness in order to improve the quality of general scholarship and evangelical theology. (shrink)

In this paper, we consider three arguments for the irrelevance of the doctrine of double effect in end-of-life decision making. The third argument is our own and, to that extent, we seek to defend it. The first argument is that end-of-life decisions do not in fact shorten lives and that therefore there is no need for the doctrine in justification of these decisions. We reject this argument; some end-of-life decisions clearly shorten lives. The second is that (...) the doctrine of double effect is not recognized in UK law ; therefore, clinicians cannot use it as the basis for justification of their decisions. Against this we suggest that while the doctrine might have dubious legal grounds, it could be of relevance in some ways, e.g. in marking the boundary between acceptable and unacceptable practice in relation to the clinician's duty to relieve pain and suffering. The third is that the doctrine is irrelevant because it requires there to be a bad effect that needs justification. This is not the case in end-of-life care for patients diagnosed as dying. Here, bringing about a satisfactory dying process for a patient is a good effect, not a bad one. What matters is that patients die without pain and suffering. This marks a crucial departure from the double-effect doctrine; if the patient's death is not a bad effect then the doctrine is clearly irrelevant. A diagnosis of dying allows clinicians to focus on good dying and not to worry about whether their intervention affects the time of death. For a patient diagnosed as dying, time of death is rarely important. In our conclusion we suggest that acceptance of our argument might be problematic for opponents of physician-assisted death. We suggest one way in which these opponents might argue for a distinction between such practice and palliative care; this relies on the double-effect doctrine's distinction between foresight and intention. (shrink)

Background: Clinical ethics support services have been advocated in recent decades. In clinical practice, clinical ethics support services are often requested for difficult decisions near the end of life. However, their contribution to improving healthcare has been questioned and demands for evaluation have been put forward. Research indicates that there are considerable challenges associated with defining adequate outcomes for clinical ethics support services. In this systematic review, we report findings of qualitative studies and surveys, which have been conducted to (...) evaluate clinical ethics support services near the end of life. Methods: Electronic databases and other sources were queried from 1970 to May 2018. Two authors screened studies independently. Methodological quality of studies was assessed. For each arm of the review, an individual synthesis was performed. Prospero ID: CRD42016036241. Ethical Considerations: Ethical approval is not needed as it is a systematic review of published literature. Results: In all, 2088 hits on surveys and 2786 on qualitative studies were found. After screening, nine surveys and four qualitative studies were included. Survey studies report overall positive findings using a very wide and heterogeneous range of outcomes. Negative results were reported only occasionally. However, methodological quality and conceptual justification of used outcomes was often weak and limits generalizability of results. Conclusion: Evidence points to positive outcomes of clinical ethics support services. However, methodological quality needs to be improved. Further qualitative or mixed-method research on evaluating clinical ethics support services may contribute to the development of evaluating outcomes of clinical ethics support services by means of broaden the range of appropriate (process-oriented) outcomes of (different types of) clinical ethics support services. (shrink)