Central to the legal positivism of the nineteenth and the first half of the twentieth century was the dogma of the Ideal Legislator. Legal materials were to be interpreted as the work of an omniscient, coherent, consistent legislator. We argue that this dogma persists in the different guise of the competent speaker model, on which legal materials are the work of a competent speaker, who follows all the pertinent semantic and pragmatic rules. We will first lay out the Ideal Legislator (...) dogma as applied in legal interpretation, arguing that this dogma does not limit interpretive discretion but rather amplifies it by hiding it under the veil of an inexistent, purely instrumental rationality. We will then turn to the competent speaker model, showing that, despite its apparent neutrality, it proves to be a reincarnation of the Ideal Legislator dogma, for it, too, amplifies interpretive discretion, only it hides it under the veil of an inexistent, purely linguistic rationality. Finally, we will inquire into the different types of rationality and their relations, arguing that there is always a choice and value judgment involved in ascribing rationality to legislators, and that these choices and judgments need to be carefully inspected and normatively justified. (shrink)

This paper argues for a fundamental overhaul of the current competence constellation in the EU, which is necessary to address the problem that the current arrangement does not respect the important values that it is supposed to uphold, namely those of democracy, subsidiarity and national diversity. While pretending otherwise, it effectively contains neither negative nor positive EU integration in areas of Member State competence. Furthermore, it enables European integration of these areas through even less accountable intergovernmental mechanisms. It (...) will be argued that the root cause of this problem is that demarcation of competences as a method to contain the EU does not work, because such an approach of ‘categorical federalism’ is bound to fail, especially in the EU context since it is incompatible with the functionality that is written in the legal order’s DNA. It is therefore proposed to dispose of demarcation as a way to contain EU action and instead to openly recognise the inevitable broadness of the EU’s powers while containing the exercise of these powers through a democratisation of the legislative process. The paper tables a number of proposals that on the one hand enhance the EU’s formal legislative powers, while on the other hand strengthen national parliaments in their powers politically to review proposed EU legislation. (shrink)

While some descriptive and normative theories of legislation account for an extensive role of legal interpretation in legislation, others see its legislative role as marginal. Yet in contemporary constitutional democracies, where legislation is limited and guided by constitutional norms, as well as international and supranational law, legal interpretation must play some role in legislation—even if all or most of legislative activity may not be adequately described and evaluated as legal interpretation. In this chapter, I aim to explore some (...) implications of recognizing the role of legal interpretation in legislation—notably, for the conceptualization and significance of legal expertise in the legislative process, as well as for determining the moral duties of legislative representatives. First, I argue that the role of legal interpretation in legislation calls for institutional reforms in legislatures in order to ensure that legal expertise is adequately channeled into the legislative process, including agenda-setting. Second, I argue that interpreting legal norms through legislation implies specific moral duties for legislative representatives, both in their relations to one another and in their relations vis-à-vis their constituents. I show that giving legal interpretation its due in a descriptive and normative account of legislative activity does not imply an elitist understanding of legislation, and it does not compromise our conception of legislatures as loci of political and moral disagreement and democratic representation. (shrink)

German legislation demands that decisions about the treatment of mentally incompetent patients require an ‘informed consent’. If this was not given by the patient him-/herself before he/she became incompetent, it has to be sought by the physician from a guardian, who has to be formally legitimized before. Additionally this surrogate has to seek the permission of a Court of Guardianship (Vormundschaftsgericht), if he/she intends to consent to interventions, which pose significant risks to the health or the life of the person (...) under his/her care. This includes ‘end-of-life decisions’. Deviations from this procedure are only allowed in acute emergencies or cases of ‘medical futility’. On the basis of epidemiological and demographical data it can be shown that the vast majority of surrogate decisions on incompetent patients in Germany is not covered by legally valid consent. Moreover, the data suggests that if consent were to be requested according to the legal regulations, both the legal and medical system could realistically never cope with the practical consequences of this. Additionally, empiric research has revealed serious deficits concerning medical ‘end of life-decisions’ and practical performance in palliative care. As a consequence a multidisciplinary discussion has developed in Germany about the reform of present legislation with respect to key-issues like• the assessment of mental competence• the options for exercising patient self-determination via advance directives and durable powers of attorney• the improvement of palliative care facilities,• the clarification of formal procedures for surrogate decision-making in health care and towards the end of life• and the possibilities and their limitations of controlling these decision-making processes ‘externally’ (e.g., by Guardianship Courts or committees).The authors discuss those proposals, which clearly dominate the present debate: They all aim to comply with the scientific basis of German law, jurisdiction and the European traditions of philosophy of health care and bioethics. (shrink)

We should now be able to come to some general conclusions about the main lines of Cuvier's development as a naturalist after his departure from Normandy. We have seen that Cuvier arrived in Paris aware of the importance of physiology in classification, yet without a fully worked out idea of how such an approach could organize a whole natural order. He was freshly receptive to the ideas of the new physiology developed by Xavier Bichat.Cuvier arrived in a Paris also torn (...) by many overlapping debates on the nature of classification, and in particular that between the natural and artificial systems. The very validity of the enterprise of classification was questioned in many quarters. Cuvier's achievement on his entry into the Parisian world of science was not simply to establish himself as a highly competent anatomist: far more important, he also began to use ideas from many different specialties to change completely the notion of what was involved in natural history.124 At the same time that he himself swung away from the guiding image of the field naturalist as the ideal of the specialty, he took ideas from the new physiology to answer questions about the order of the animal world, and from comparative anatomy to resurrect extinct creation — and to come to conclusions from that creation about the history of the forms of life and the manner of their succession. He showed himself able to alter the relationships between natural history and many other fields of study in a way that implied, rightly or wrongly, his own complete mastery over such a movement. Partly he was able to do this because the ideas he borrowed were not themselves logically articulated and thus could be easily adapted and refocused for many different specific purposes. The value of the heuristic possibilities inherent in the idea of life, for example, far outweighed its inability to generate full systems of classification. Cuvier also consistently refused to consider in science matters relating to the first causes of events. Freed from the consideration of first-order phenomena, he was able to use second-order explanations across a far wider field of applicability. Personal doubts about the validity of a theology that had used science in order to bolster its own claims were combined here with the strong influence of the Kantian critique of the limits of human reason.125Cuvier's characteristic mode of procedure was that of intellectual appropriation and a bold capacity for altering the relationships between different fields of knowledge, rather than, with the exception of taxonomy, the technique of expanding their subject matter. His claims to originality came, first, from this reappropriation and reorientation and, second, from the sheer scope of his work, which aimed at nothing less than the cataloging and classification of all animate objects.126 They rested also on his acute use of his assertion of a certain relationship with the past of his subject. Very often he would present this history in such a way as to obscure his own intellectual genealogy, and often too he would give differing accounts of the priority of use of an idea in order to distract attention from the questionable exactitude of his own claims to originality. Cuvier came to Paris at precisely the time when society and institutions were most profitably malleable for a newcomer; it was also a time when many scientific disciplines had reached a stage advanced in terms of their factual content, yet relatively inadequate in conceptual organization. They were ripe for takeover by large-scale organizing ideas such as the animal economy and the subordination of characteristics. Paleontology is a particularly good example of a specialty in this particular form of underdevelopment in 1795.Cuvier paid a high price for his initial success. His electic applications of large-scale organizing ideas tended to mean that little of his own work had complete coherence at all levels. Ideas, as we have seen, that proved capable of providing a complete reform of the larger groups of the animal kingdom were incapable of producing its detailed working-out in the taxonomy of smaller groups, which had to be supplied from observed analogical correlations. Further, his physiological approach to classification involved the breakdown of strict correspondence between organs and functions, which left the way open for workers such as Geoffroy St. Hilaire gradually to tilt the balance away from the study of the correlations of hierarchies of functions, and toward morphology as the basis of the order of nature. Cuvier's brilliant appropriations from physiology from the beginning, therefore, contained the seeds of conflict with Geoffroy.Cuvier's eclectic approach made it very nearly impossible for him to present a clear idea of the ways in which the life sciences could be said to be lawful. In spite of his efforts to assimilate them to the position of the physical sciences in this respect, he was forced in the end to accord only an ambiguous status as “laws” to observational correlations. From this area of failure came much of the attempt to give his own two laws — the correlation of parts and the subordination of characteristics — predictive qualities, particularly in relation to paleontological research.It is not surprising that Cuvier's title as the “legislator” of natural history should represent more a claim than a reality. How, then, was he able to emerge as the leading French naturalist of his day? First of all must be adduced the sheer scale of his undertakings. Then comes his expertise as a practical anatomist, and the range of different topics toward which he turned his interest. His collaborators cannot be given credit for his output nor, as we have seen, for slavish adherence to his ideas. Cuvier was able to successfully claim to have dominated the underdeveloped specialties, such as paleontology, and turned them into a major heuristic input into both geology and comparative anatomy; but in other fields, such as physiology, he appropriated concepts and encouraged research but made little impact on the field himself. His attempts in 1812 to head off, or neutralize and absorb the growth of morphological studies landed him in a dangerously rigid position, which despite his encouragement of the new physiological research under the Restoration made further elaboration of his own conceptual underpinnings almost impossible.Cuvier's authority in the scientific world would in any case have been great because of his substantive achievement in taxonomy, but the rest of his work had enough ambiguities and dislocations for it to need the support of his political and social power. Cuvier's detractors seized on a vital fragment of the truth when they accused him of finding the political dimension all-important: it obscured the disjunctions in his theories and at the same time gave him the authority to make new claims for the status of the observational sciences - and for their relations of power with their surrounding specialties. Cuvier's science both thrived on and was halted by the power games of intellectual appropriation, manipulation of the past to confirm the present, and continual claims for hegemony. (shrink)

The scope of European Union competence was central to the reform process that culminated in the Lisbon Treaty. The Lisbon Treaty competence provisions borrowed heavily from those in the Constitutional Treaty. Some provisions are contained in the Treaty on European Union (TEU), but the detailed schema is in the Treaty on the Functioning of the European Union (TFEU). Article 2 TFEU is the foundational provision, setting out the categories of competence and the consequences that flow from them. (...) Article 2(1) TFEU establishes the category of exclusive competence, which carries the consequence that only the Union can legislate and adopt legally binding acts. Article 2(2) TFEU defines shared competence. The treaty schema for competence in Article 2 TFEU is premised on the ascription of legal consequences for EU and member state power as the result of coming within a particular category. Article 5 TFEU is an exception in this respect. (shrink)

"In this paper I shall attempt to sketch a defense of the plain man's view that the job of the judge, qua judge is to apply the law." What seems to have lead to the other view is the pervasive role of policy and principle in the justification of judicial decisions. This is no argument, however, for the existence of discretion: "For while it must be admitted that judges are entitled to appeal to certain general policies and principles, this by (...) no means implies that they are entitled to exercise discretionary judgment in the formulation of such standards." With Dworkin, distinguishes weak and strong discretion: the former means merely final or controversial; the latter implying that judges are at some point free to reach decisions not controlled by authoritative standards. Agrees with Dworkin that non-rule standards are part of law. "Both Dworkin and I are in agreement that law is a system of entitlements, although, as we shall see, we differ as to what is their basis." "At any rate, we share the view that a litigant before a court of law is not in the position of one begging a favor from a potential benefactor, but rather in that of one demanding a particular decision as a matter of right, as something to which the law entitles him. Such a demand has two aspects: a claim that a right exists which the law recognizes; a claim that this right takes precedence over any competing legal rights or obligations involved. Let us refer to these two sorts of claims respectively as ones involving decisions as to recognition, and weight.:" Argues that we cannot distinguish between legal moral principles and non-legal moral principles without a rule of recognition. The same is true for the problem of establishing weight between various principles - here we have to consider how well a principle coheres with the institutional practice of a legal system. "[I]t is the distinctive feature of the institutionalized role of the judiciary, in contrast to the legislative, that it may not directly base decisions on substantive considerations of the value of competing social policies." "The theoretical possibility of the law being indeterminate with regard to what it requires...does not imply any correspondign indeterminacy with regard to what is required of the judge.". (shrink)

Competent patients who refuse life saving medical treatment present a dilemma for healthcare professionals. On one hand, respect for autonomy and liberty demand that physicians respect a patient’s decision to refuse treatment. However, it is often apparent that such patients are not fully competent. They may not adequately comprehend the benefits of medical care, be overly anxious about pain, or discount the value of their future state of health. Although most bioethicists are convinced that partial autonomy or marginal competence (...) of this kind demands the same respect as full autonomy, Israeli legislators created a mechanism to allow ethics committees to override patients’ informed refusal and treat them against their will. To do so, three conditions must be satisfied: physicians must make every effort to ensure the patient understands the risks of non-treatment, the treatment physicians propose must offer a realistic chance of significant improvement, and there are reasonable expectations that the patient will consent retroactively. Although not all of these conditions are equally cogent, they offer a way forward to assure care for certain classes of competent patients without abandoning the principle of autonomy altogether. These concerns reach past Israel and should engage healthcare professionals wary that respect for autonomy may sometimes cause avoidable harm. (shrink)

Supreme Audit Institutions (SAIs) investigate the regularity (conformity to legislation) and performance (economy, efficiency, and effectiveness) of central government policies and administration through the instrument of accountability. Both types of audit have their own research process and set of standards. This article deals with the question of whether this distinction inhibits a proper appraisal of policy and administration and investigates the possibilities for SAIs to attain more integrated assessment procedures. This question is of vital importance, not only to SAIs but (...) to any controlling and inspecting body, whether political or administrative. (shrink)

BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally (...) children of 11.2 years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (shrink)

Norms conferring public or private powers, i.e., the competence to issue other norms, play a very important rôle in law. But there is no agreement among legal philosophers about the nature of such norms. There are two main groups of theories, those that regard them as a kind of norms of conduct (either commands or permissions) and those that regard them as non-reducible to other types of norms. I try to show that reductionist theories are not quite acceptable; neither (...) the command-variety (Kelsen, Alf Ross inOn Law and Justice), nor the permission-variety (von Wright, Kanger, Lindahl) provide a satisfactory account of competence norms.Among the authors who maintain that competence norms are different from (and hence not reducible to) norms of conduct are Hart, Ross inDirectives and Norms, and Searle. Ross and Searle distinguish between regulative and constitutive rules as two radically different kinds of rules and classify competence norms among constitutive rules. This distinction runs parallel to von Wright's distinction between rules that are prescriptions and determinative rules. While the first regulate actions (by commanding, prohibiting, or permitting them), determinative rules define certain concepts. To view competence norms as (partial) definitions of certain legal concepts (like those of legislator, judge, etc.) seems to open interesting perspectives and to shed light on at least one aspect of these elusive norms. (shrink)

Objective: To assess the knowledge of four groups of individuals regarding who is legally authorised to consent to health care or research involving older patients.Design: A provincewide postal survey.Setting: Province of Quebec, Canada.Participants: Three hundred older adults, 434 informal caregivers of cognitively impaired individuals, 98 researchers in aging and 136 members of research ethics boards .Measurements: Knowledge was assessed through a pretested postal questionnaire comprising five vignettes that describe hypothetical situations involving an older adult who requires medical care or is (...) solicited for research. The respondent had to identify the person who is legally authorised to provide consent.Results: Nearly 80% of all respondents provided the correct answer when the hypothetical scenario depicted a person who was competent to consent or incompetent but legally represented. Knowledge was worse for the scenario describing a research situation that involved an incompetent adult without a legal guardian.Conclusion: The observed lack of knowledge raises doubts about the ability of current legislation to truly protect the rights of older adults with diminished decision making capacity. It points to the need for educational programmes aimed at increasing public awareness of the legislation put in place for those requiring special protection. (shrink)

The American states have demonstrated varying levels of support for animal rights legislation. The activities of interest groups, including pressures from competing groups, help to explain the presence or absence of ten pro-animal regulations and laws. This article analyzes and ranks each of the fifty states with regard to ten key areas of animal protection and welfare legislation. The analysis reveals that states with a more agricultural economic base are less likely to provide protection to animals. In addition, states with (...) a more traditional political culture are less likely to have pro-animal legislation in place. (shrink)

Many of the world’s mental health acts, including all Australian legislation, allow for the coercive detention and treatment of people with mental illnesses if they are deemed likely to harm themselves or others. Numerous authors have argued that legislated powers to impose coercive treatment in psychiatric illness should pivot on the presence or absence of capacity not likely harm, but no Australian act uses this criterion. In this paper, I add a novel element to these arguments by comparing the use (...) of the harm to others justification for coercive treatment in mental illness with its use in illness due to infectious disease, and suggest a double standard applies. People with mental illness are subjected to coercive treatments at levels of risk to others far, far lower than would precipitate coercive treatment in people with influenza. In effect, this element of mental health legislation represents an example of sanism—state-sanctioned discrimination against people with mental illnesses. (shrink)

Patient’s decision making competence is a widely discussed subject. Issues of competence, autonomy, well-being and protection of the patient come up every day. In this article we analyse what role PDMC plays in Dutch legislation and what dilemmas healthcare professionals may experience, notably in patients suffering from Korsakoff’s syndrome. Dilemmas emerge if professionals want to meet the requirements mentioned in Dutch law and the desires of their patients. The autonomy of the patient and the healthcare professionals’ duty to (...) take care of their patient’s best interests, create a tension and lead to uncomfortable situations. Healthcare professionals describe difficulty finding a balance between these issues and assessing the degree of mental competence still present. In long term care situations, quality of the relationship between healthcare professionals and their patients seems to be of much more importance in decision making on minor issues of competence than simply relying on legal or house rules. In being committed to their cases, professionals will be more sensitive to individuals habits, abilities, welfare and dignity, which will make it easier to decide on issues of competence, and to find creative solutions to their dilemmas. (shrink)

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within (...) health care practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested. (shrink)

The paper examines the ethical and legal challenges of making decisions for previously competent patients and the role of advance directives and legal representatives in light of the Oviedo Convention. The paper identifies gaps in the Convention that result in conflicting instructions in cases of a disagreement between the expressed prior wishes of a patient, and the legal representative. The authors also examine the legal and moral status of informally expressed prior wishes of patients unable to consent. The authors argue (...) that positivist legal reasoning is insufficient for a consistent interpretation of the relevant provisions of the Convention and argue that ethical argumentation is needed to provide guidance in such cases. Based on the ethical arguments, the authors propose a way of reconciling the apparent inconsistencies in the Oviedo Convention. They advance a culturally sensitive approach to the application of the Convention at the national level. This approach understands autonomy as a broader, relational consent and emphasizes the social and cultural embeddedness of the individual. Based on their approach, the authors argue that there exists a moral obligation to respect the prior wishes of the patient even in countries without advance directives. Yet it should be left to the national legislations to determine the extent of this obligation and its concrete forms. (shrink)

The paper examines the ethical and legal challenges of making decisions for previously competent patients and the role of advance directives and legal representatives in light of the Oviedo Convention. The paper identifies gaps in the Convention that result in conflicting instructions in cases of a disagreement between the expressed prior wishes of a patient, and the legal representative. The authors also examine the legal and moral status of informally expressed prior wishes of patients unable to consent. The authors argue (...) that positivist legal reasoning is insufficient for a consistent interpretation of the relevant provisions of the Convention and argue that ethical argumentation is needed to provide guidance in such cases. Based on the ethical arguments, the authors propose a way of reconciling the apparent inconsistencies in the Oviedo Convention. They advance a culturally sensitive approach to the application of the Convention at the national level. This approach understands autonomy as a broader, relational consent and emphasizes the social and cultural embeddedness of the individual. Based on their approach, the authors argue that there exists a moral obligation to respect the prior wishes of the patient even in countries without advance directives. Yet it should be left to the national legislations to determine the extent of this obligation and its concrete forms. (shrink)

The well-established pattern of Executive expansionism and limited oversight of Executive action in times of terrorism is problematic from the civil libertarian point of view. How to limit such action has been the subject of much scholarship, a large amount of which focuses on perceptions of institutional competence rather than effectiveness. For the authors, the effective control of security-focused state action is to be judged by the extent to which it consists only of action that is necessary and proportionate (...) and thereby strikes an appropriate balance between security exigencies and individual rights. This article, written and structured in dialectic form, presents competing perspectives on effective oversight mechanisms: on the one hand, an extra-constitutionalism perspective, proposing a limited role for the Judiciary and emphasizing the need for legislative and democratic controls; and on the other, an argument for judicial muscularity. (shrink)

Several US states are enacting 'right-to-die' laws, in the wake of the Karen Quinlan case. But the way such a law is drafted may cast doubt on a patient's existing common law right to control all aspects of his own treatment; it may give legal sanction to a lower standard of medical care that society at present expects from doctors; and it may lead to conflict between the patient's directive and his doctor's clinical judgement which cannot readily be resolved. The (...) laws themselves are categorised as a) legalising active killing or b) defining rights of patients to control treatment or c) assigning to others the rights to control treatment where the patient is not competent. The California law is discussed critically. The conclusion is that such legislation is not a satisfactory answer to the ethical problem of euthanasia. (shrink)

The Human Tissue Act 2004 presents a radical change to the legal regulation of the use of human material in England and Wales. The Act presents a broad regulatory framework but much in the practical operation of the legislation will depend upon regulations to be enacted and a new Code of Practice. This article examines 'appropriate consent' for the use of human tissue for research purposes in the context of the living competent adult. It examines the provision of information as (...) part of the consent process for the use of human materials for research purposes, the question of when consent can be withdrawn, and the controversial exception enabling the use without consent of anonymized material for research purposes where the research has been ethically approved. The paper concludes by highlighting some of the problems which may remain after the legislation comes into force. (shrink)

In an effort at ethical reform, Taiwan recently revised the Hospice Palliative Care Law authorising family members or physicians to make surrogate decisions to discontinue life-sustaining treatment if an incompetent terminally ill patient did not express their wishes while still competent. In particular, Article 7 of the new law authorises the palliative care team, namely the physicians, to act as sole decision-makers on behalf of the incompetent terminally ill patient's best interests if no family member is available. However, the law (...) fails to provide guidance as to what constitutes the patient's best interests or what specific procedures the treating physicians should follow, and so has raised constitutional concerns. It may be difficult to translate ethical reform into law but it is not impossible if essential requirements are carefully followed. First, there must be substantial nexus between the purpose of the statute and the measures provided under the statute. Second, advocates need to convince the public that futility or waste has amounted to a public health emergency so as to justify lower procedural requirements. Third, a remedy or compensation should be available if the surrogate decisions have not been appropriately made. Fourth, minimum procedural safeguards are necessary even though the statute is intended to reduce the procedural burdens of making surrogate decisions on behalf of incompetent patients who lack family members and did not express their wishes while still competent. (shrink)

This paper discusses how the general and abstract concept of legitimacy applies to international institutions, using the United Nations Security Council as an example. We argue that the evaluation of the Security Council’s legitimacy requires considering three significant and interrelated aspects: its purpose, competences, and procedural standards. We consider two possible interpretations of the Security Council’s purpose: on the one hand, maintaining peace and security, and, on the other, ensuring broader respect for human rights. Both of these purposes are minimally (...) morally acceptable for legitimacy. Second, we distinguish between three different competences of the UNSC: 1) the decision-making competence, 2) the quasi-legislative competence, and 3) the referral competence. On this basis, we argue that different procedural standards are required to legitimise these competences, which leads to a more differentiated understanding of the Security Council’s legitimacy. While maintaining that the membership structure of the Council is a severe problem for its legitimacy, we suggest other procedural standards that can help to improve its overall legitimacy, which include broad transparency, deliberation, and the revisability of the very terms of accountability themselves. (shrink)

BackgroundFollowing several landmark rulings and increasing public support for physician-assisted death, in 2016, Canada became one of a handful of countries legalising medical assistance in dying (MAiD) with Bill C-14. However, the revised Bill C-7 proposes the specific exclusion of MAiD where a mental disorder is the sole underlying medical condition (MAiD MD-SUMC).AimThis review explores how some persons with serious and persistent mental illness (SPMI) could meet sensible and just criteria for MAiD under the Canadian legislative framework.MethodsWe review the (...) proposed Bill C-7 criteria (capacity, voluntariness, irremediability and suffering) as well as the nuances involved in separating a well-reasoned request for assisted suicide from what might be solely a manifestation of a SPMI.FindingsIn this paper, we argue against the absolute exclusion of patients with SPMIs from accessing MAiD. Instead, we propose that in some circumstances, MAiD MD-SUMC may be justifiable while remaining the last resort. Conducting MAiD eligibility assessments removes the need to introduce diagnosis-specific language into MAiD legislation. Competent psychiatric patients who request MAiD should not be treated any differently from other eligible candidates. Many individuals with psychiatric disorders will be incapable of consenting to MAiD. The only ethical option is to assess eligibility for MAiD on an individual basis and include as legitimate candidates those who suffer solely from psychiatric illness who have the decisional capacity to consent to MAiD. (shrink)

Lawyers around the world roughly agree on the meaning of private law. Whatever their national origins, they will point to contract and tort and identify their roots in the national private law order. Understanding European private law requires clarification of each of the three composite elements which includes Europe is not a state but a quasi‐state with a multilevel governance structure, the law is not only private but also has a strong regulatory (public) dimension and law cannot be equated with (...) codified law but has a multifaceted character‐ranging from private regulation within a public regulatory frame to contract governance and self‐regulation. Constitutionalization of private law through the increasing use of fundamental rights and human rights ranks high on the political, judicial, and academic agendas. The Draft Common Frame of Reference (DCFR) is designed to operate in a framework based on conventional actors: individual private parties, judges, and the legislator. (shrink)

Whistle blowing programs have been central to numerous government, legislative, and regulatory reform efforts in recent years. To protect investors, corporate boards have instituted numerous measures to promote whistle blowing. Despite significant whistle blowing incentives, few individuals blow the whistle when presented with the opportunity. Instead, individuals often remain fallaciously silent and, in essence, become passive fraudsters themselves. Using the fraud triangle and models of moral behavior, we model and analyze fallacious silence and identify factors that may motivate an (...) individual to rationalize fallacious silence. We use a survey of graduate accounting students to test hypothesized factors that contribute to fallacious silence rationalizations in an academic setting. We find evidence that the ability to rationalize fallacious silence is related to community influences and personal traits such as awareness and moral competence. (shrink)

Mental competence, or ‘mental capacity’ as it is referred to in recent legislation in the UK, is a concept that is expanding rapidly as a common currency in health and social care services. Neelke Doorn’s “Anthropological Reflection on the Concept of Competence” makes for fascinating and highly relevant reading and the legal and ethical discussions she describes taking place in the Netherlands would appear to echo many of those that have occurred in the UK over the last 5 (...) to 10 years, but with some significant differences. However, Doorn’s new conceptualization of mental competence causes some concerns, particularly if it was to be applied in services currently provided to people where their mental capacity may be .. (shrink)

The aim of this article is to address the regulatory framework as one of the key factors determining the success of creation of single market for renewable energy. No one could possibly argue that non-discriminative and consistent legal regulation plays a big role in the creation of a single market. Therefore, the question of legal capability to create the single market for renewable energy and the overall quality of present regulatory framework is at the centre of this article. Our objective (...) is to analyse whether the single market for energy produced from renewable sources can be created under current legal regulation of the European Union Therefore, the first part of the article analyses the competence of the European Union to regulate the renewable energy sector and division of legislative powers between the Member States and the European Union. The goal of the first part is to answer the question whether the European Union has the competence to regulate renewable energy market. The second part of the article analyses the legal framework of measures for the promotion of renewable energy production used in each Member State. The goal of the second part of this article is to answer the question – whether all renewable energy producers are in equal competitive position, notwithstanding different legal frameworks of the Member States. (shrink)

Common sense morality and legislations around the world ascribe normative relevance to biological connections between parents and children. Procreators who meet a modest standard of parental competence are believed to have a right to rear the children they brought into the world. I explore various attempts to justify this belief and find most of these attempts lacking. I distinguish between two kinds of biological connections between parents and children: the genetic link and the gestational link. I argue that the (...) second can better justify a right to rear. (shrink)

The concept of guardianship, its associated principles, distinctions, and articulation of the legal needs of the elderly are introduced via a review of well-canvassed criticisms of Canadian guardianship legislation. Claims that the reformed legislation of Alberta, Quebec, and British Columbia represent models of adequate adult guardianship compared with traditional (archaic lunacy) law are examined. This paper argues that these renovated models exhibit a dubious normative advance over traditional legislation. Specifically, the normative presuppositions of the reformed legislation, such as, restriction to (...) an autonomy-paternalism framework, and the norms of the liberal individual and state, obscure important issues in at least two key areas which challenge the models' assumptions; namely, assessment and legal competence and assessment and need. The development of guardianship laws and of social arrangements that are more responsive to the life experiences of the elderly requires critical re-articulation of the nature of individuals and their communities. (shrink)

Nonadherence to treatment continues to be one of psychiatry's greatest challenges. To improve adherence and thus improve the care of patients, clinicians and patients' family members sometimes resort to hiding medication in food or drink, a practice referred to as covert/ surreptitious medication. The practice of covert drug administration in food and beverages is well known in the treatment of psychiatrically ill world-wide but no prevalence rates exist. Covert medication may seem like a minor matter, but it touches on legal (...) and ethical issues of a patient's competence, autonomy, and insight. Medicating patients without their knowledge is not justifiable solely as a shortcut for institutions or families wishing to calm a troublesome patient and thus alleviate some of the burdens of care giving. The paramount principle is ensuring the well-being of a patient who lacks the competence to give informed consent. Ethically, covert/surreptitious administration can be seen as a breach of trust by the doctor or by family members who administer the drugs. Covert medication contravenes contemporary ethical practice. Legally, treatment without consent is permissible only where common law or statute provides such authority. The practice of covert administration of medication is not specifically covered in the mental health legislation in developing countries. Many of the current dilemmas in this area have come to public attention because of two important developments in medical ethics and the law - the increasing importance accorded to respect for autonomy and loss of the parens patriae jurisdiction of the courts [parens patriae means 'parent of the country'; it permitted a court to consent or refuse treatment on behalf of an 'incapacity', or alternatively to appoint a guardian with such powers]. (shrink)

Historically associated with military service, conscientious objection has become a significant phenomenon in health care. Mark Wicclair offers a comprehensive ethical analysis of conscientious objection in three representative health care professions: medicine, nursing and pharmacy. He critically examines two extreme positions: the 'incompatibility thesis', that it is contrary to the professional obligations of practitioners to refuse provision of any service within the scope of their professional competence; and 'conscience absolutism', that they should be exempted from performing any action contrary (...) to their conscience. He argues for a compromise approach that accommodates conscience-based refusals within the limits of specified ethical constraints. He also explores conscientious objection by students in each of the three professions, discusses conscience protection legislation and conscience-based refusals by pharmacies and hospitals, and analyzes several cases. His book is a valuable resource for scholars, professionals, trainees, students, and anyone interested in this increasingly important aspect of health care. (shrink)

The question of toleration matters more than ever. The politics of the twenty-first century is replete with both the successes and, all too often, the failures of toleration. Yet a growing number of thinkers and practitioners have argued against toleration. Some believe that liberal democracies are better served by different principles, such as respect of, or recognition for, people's ways of life. Others argue that because the liberal state should be entirely neutral or indifferent towards people's ways of life, it (...) can no longer be tolerant - it has no grounds on which it can object, and so there is nothing left to tolerate.Respecting Toleration provides a new, original, and provocative take on the question of toleration and its application to the politics of contemporary diversity. The volume demonstrates how toleration - despite its critics - is essential to any liberal political order. Peter Balint argues that from a conceptual viewpoint, toleration is entirely compatible with liberal politics; and from a normative viewpoint, it is utterly essential. The volume argues that if one cares about people living divergent lives, then it is liberal toleration that should be respected by legislators and policy makers, and not people's differences. It is a book that will shape the debate and demand a response from all who are interested in which political structures most fairly accommodate the competing ways of life that characterise contemporary diversity.Key Features:Develops a new framework of political tolerationProvides a clear demonstration and analysis of complex concepts and argumentsProvides extensive practical and theoretical examples. (shrink)

European legislators must increasingly deal with issues related to fundamental rights. Religion is a frequent topic obliging them to do so. It is not directly part of the EU’s competences but is a source of values underlying policy choices and a tricky political object. Relying on the findings of a survey about what Members of the European Parliament believe and what they do with these beliefs, the article analyzes potential tensions created by religion in the implementation of human rights by (...) the EU. A first part shows how and to what extent European law meets religion, and how it leaves ample room for flexibility but also for divergent interpretations. A second part states that MEPs agree largely on the principle of separation between politics and religion, but may be divided when it comes to drawing boundaries between the two domains. The conclusion points out the limits of the rule of law to prevent conflicts and suggests that human rights may inspire support as well as cause resistance to Europeanization. (shrink)

A new culture of care -- Maximising capacity -- Assessing capacity -- Advocacy and empowerment -- Advance care planning -- Best interests -- Liberty and choice.

Human genetic enhancement, examined from the standpoint of the new field of political bioethics, displaces the age-old question of truth: What is human nature? This book displaces that question with another: What kind of human nature should humans want to create for themselves? To answer that question, this book answers two others: What constraints should limit the applications of rapidly developing biotechnologies? What could possibly form the basis for corresponding public policy in a democratic society? Benjamin Gregg focuses on the (...) distinctly political dimensions of human nature, where politics refers to competition among competing values on which to base public policy, legislation, and political culture. This book offers citizens of democratic communities a broad perspective on how they together might best approach urgent questions of how to deal with the socially and morally challenging potential for human genetic engineering. (shrink)

Background:Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress.Objectives:To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology.Research design:In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups.Participants and research context:Healthcare professionals at all paediatric oncology centres in Sweden were invited to participate. A total of (...) 278 healthcare professionals participated. The response rate was 89%.Ethical considerations:In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey.Findings:The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants.Discussion:Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings.Conclusion:The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care. (shrink)

Dual Use Research of Concern constitutes a major challenge for research practice and oversight on the local, national and international level. The situation in Germany is shaped by two partly competing suggestions of how to regulate security-related research: The German Ethics Council, as an independent political advisory body, recommended a series of measures, including national legislation on DURC. Competing with that, the German National Academy of Sciences and the German Research Foundation, as two major professional bodies, presented a strategy which (...) draws on the self-control of science and, inter alia, suggests expanding the scope of research ethics committees to an evaluation of DURC. This situation is taken as an occasion to further discuss the scope and limits of professional self-control with respect to security-related research. The role of RECs as professional bodies of science is particularly analyzed, referring to the theoretical backgrounds of professionalism. Two key sociological features of professionalism – ethical orientation and professional self-control – are discussed with respect to the practice of biomedical science. Both attributes are then analyzed with respect to the assessment of DURC by RECs. In conclusion, it is stated that issues of biosecurity transcend the boundaries of the scientific community and that a more comprehensive strategy should be implemented encompassing both professional self-control and legal oversight. (shrink)

We live in a liberal, pluralistic, largely secular society where, in theory, there is fundamental protection for freedom of conscience generally and freedom of religion in particular. There is, however, both in statute and common law, increasing pressure on religious believers and conscientious objectors to act in ways that violate their sincere, deeply held beliefs. This is particularly so in health care, where conscientious objection is coming under extreme pressure. I argue that freedom of religion and conscience need to be (...) put on a sounder footing both legislatively and by the courts, particularly in health care. I examine a number of important legal cases in the UK and US, where freedom of religion and conscience have come into conflict with government mandates or equality and anti-discrimination law. In these and other cases we find one of two results: either the conscientious objector loses out against competing rights, or the conscientious objector succeeds, but due to what I consider unsound judicial reasoning. In particular, cases involving cooperation in what the objector considers morally impermissible according to their beliefs have been wrongly understood by some American courts. I argue that a reasonable theory of cooperation incorporated into judicial thinking would enable more acceptable results that gave sufficient protection to conscientious objectors without risking a judicial backlash against objectors who wanted to take their freedoms too far. I also venture into broader, more controversial waters concerning what I call freedom of dissociation – the fundamental right to withdraw from associating with people, groups, and activities. It is no more than the converse of freedom of association, which all free societies recognise as a basic right. How far should freedom of dissociation go? What might society be like if freedom of dissociation were given more protection in law than it currently has? It would certainly give freedom of religion and conscience a substantial foundation, but it could also lead to discriminatory behaviour to which many people would object. I explore some of these issues, before going back to the narrower area of freedom of conscience and religion in health care, making some proposals about how the law could strengthen these basic pillars of a liberal, free society. (shrink)

Slurs are words with a well-known tendency to conjure up painful memories and experiences in members of their target communities. Owing to this tendency, it’s widely agreed that one ought to exercise considerable care when even mentioning a slur, so as to avoid needlessly inflicting distressing associations on members of the relevant group. This paper argues that this tendency to evoke distressing associations is precisely what makes slurs impactful verbal weapons. According to the ballistic theory, slurs make such potent insults (...) because they enable their users to maliciously inflict noxious associations on members of their target groups. To motivate this theory, I demonstrate its ability to explain a number of facts about slurs’ offensiveness that pose formidable difficulties for competing theories of slurs. I argue that the ballistic theory not only explains why slurs make such explosively impactful terms of abuse, but also why: uses of slurs can provoke offense even when they aren’t interpreted as expressions of the speaker’s racist attitudes; and why mentions of slurs are inoffensive in some contexts, but in other contexts, warrant a level of offense every bit as severe as that warranted by weaponized uses. I conclude with a brief discussion of a practical application of the ballistic theory. I demonstrate that the theory has an important consequence for legislative efforts to regulate and punish weaponized uses of slurs. (shrink)

In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal (...) code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator. (shrink)

We live in a liberal, pluralistic, largely secular society where, in theory, there is fundamental protection for freedom of conscience generally and freedom of religion in particular. There is, however, both in statute and common law, increasing pressure on religious believers and conscientious objectors (outside wartime) to act in ways that violate their sincere, deeply held beliefs. This is particularly so in health care, where conscientious objection is coming under extreme pressure. I argue that freedom of religion and conscience need (...) to be put on a sounder footing both legislatively and by the courts, particularly in health care. I examine a number of important legal cases in the UK and US, where freedom of religion and conscience have come into conflict with government mandates or equality and anti-discrimination law. In these and other cases we find one of two results: either the conscientious objector loses out against competing rights, or the conscientious objector succeeds, but due to what I consider unsound judicial reasoning. In particular, cases involving cooperation in what the objector considers morally impermissible according to their beliefs have been wrongly understood by some American courts. I argue that a reasonable theory of cooperation incorporated into judicial thinking would enable more acceptable results that gave sufficient protection to conscientious objectors without risking a judicial backlash against objectors who wanted to take their freedoms too far. -/- I also venture into broader, more controversial waters concerning what I call freedom of dissociation – the fundamental right to withdraw from associating with people, groups, and activities. It is no more than the converse of freedom of association, which all free societies recognise as a basic right. How far should freedom of dissociation go? What might society be like if freedom of dissociation were given more protection in law than it currently has? It would certainly give freedom of religion and conscience a substantial foundation, but it could also lead to discriminatory behaviour to which many people would object. I explore some of these issues, before going back to the narrower area of freedom of conscience and religion in health care, making some proposals about how the law could strengthen these basic pillars of a liberal, free society. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Thinking with Heidegger:Rethinking Environmental Theory and PracticeKevin Michael DeLuca (bio)Environmentalism is tired. It is a movement both institutionalized and insipid. The vast majority of Americans claim to be environmentalists while buying ever more SUVs, leaf-blowers, and uncountable plastic consumer goods. Indeed, environmentalism itself has become just another practice of consumerism, a matter of buying Audubon memberships, Ansel Adams calendars, and 'biodegradable' plastic bags with one's Sierra Club credit card. (...) As a practice of everyday life, environmentalism has devolved into another lifestyle choice.On the political front, carbon-copy blow-dried presidential candidates proclaim their allegiance to the environment, an allegiance that is more a sign of fealty to opinion polls than a concern with environmental issues. In the world of real-politic, environmental regulations are gutted as corporations write legislation for the politicians they have bought. Outspent and outmaneuvered, mainstream environmental groups preach at the altar of broken promises about the potential of lobbying and insider access while awaiting the blandishments of the next candidate. As [End Page 67] a political practice, mainstream environmentalism has degenerated into a marginal special-interest group.On the intellectual front, a confusing array of reform environmentalists, deep ecologists, social ecologists, ecofeminists, wilderness advocates, social justice activists, social constructionists, and Christian ecologists offer a cacophony of competing paradigms and programs while exchanging charges and countercharges of wrong-headedness and infidelity. If on the level of practice an exhausted environmentalism has achieved both institutionalism and irrelevance, intellectually environmentalism has reached several stasis points. This is crucial, for at a level that is unusual for social movements, environmentalism has always highlighted the importance of how we think about the environment, that ideas of nature are powerful because practices follow from ideas. In other words, how we think about nature guides how we act toward nature. In the midst of this melee I want to suggest we reconsider the work of Martin Heidegger.I want to think Heidegger in distress: in the distress of machination; in the distress of the technological enframing of the earth; in the distress of the environmental crisis. In rejecting a Heideggerian hermeneutics, a piety to textual exegesis, I hope to stress Heidegger in order to stress environmental theory. With few exceptions,1 two insufficient responses typify the reception of Heidegger in environmental thinking. One is to champion Heidegger as some proto-environmentalist. Certainly, quotes from such works as Being and Time, Contributions to Philosophy: From Enowning, "The Question Concerning Technology," "Building Dwelling Thinking," and "The Age of the World Picture" inspire such a reading. Such readings, however, present a simplified Heidegger. For example, a poor reading of an essay such as "The Question Concerning Technology" produces the conclusion that Heidegger was anti-technology.2 These misreadings are not merely accidental but a result of the goal of the citation. The challenge of Heidegger is not engaged to develop environmental theory; rather, Heidegger is cited to lend some borrowed legitimacy to the fledgling enterprise. The most prominent example of this move occurs in Devall and Sessions' Deep Ecology, wherein Heidegger joins a potpourri of thinkers, including Dogen, Job, St. Francis of Assisi, Giordano Bruno, Spinoza, Thoreau, Chief Seattle, Herman Melville, John Muir, Aldous Huxley, Gandhi, Rainer Maria Rilke, Aldo Leopold, Robinson Jeffers, Mary Austin, Rachel Carson, Barry Commoner, Stanley Diamond, and [End Page 68] David Brower from a host of traditions, including Taoism, Hinduism, Zen Buddhism, Christianity, Native American thought, Romanticism, and ecological science (1985, 79–108). The result is confusion, at best.On the other hand, in a second response Heidegger serves as a kind of bogeyman, a Nazi used to tar the more radical environmental groups. The syllogism is simple and simplistic: Deep Ecologists are bio/ecocentric; Deep Ecologists quote Heidegger; Heidegger was a Nazi; Therefore, Deep Ecologists are Nazis/fascists. (To push this thinking to its logical extreme, then, all nonanthropocentric thinking is fascist.) Both responses may be useful for polemics but serve to prevent a possibly productive exploration of Heidegger for the engagement of the difficult problems that have stumped environmentalism on multiple levels.Violating HeideggerAs a prefatory word, even a cursory glance at Heidegger's work reveals him to be a thinker who... (shrink)

Med hjemmel i de lovfestede spesielle god skikk-reglene har flere yrker utformet yrkesetiske regler med en lovmessig forankring. Denne artikkelen tar utgangspunkt i fem yrker og gir en juridisk analyse av god revisorskikk, god advokatskikk, god regnskapsføringsskikk, god meglerskikk og god landmålerskikk. Formålet er å sammenligne den rettslige betydningen av disse SGS-reglene. De sammenlignes ut fra hjemmelsgrunnlaget og hvilken bransjeorganisasjon som har utformet de yrkesetiske reglene, autorisasjonsordning og en hypotese om at de yrkesetiske reglene inneholder følgende elementer: profesjonsansvar, integritet, objektivitet, (...) taushetsplikt og kompetansekrav.Sammenligningen viser at lovfestede SGS-regler har ført til at de aktuelle bransjeorganisasjonene har tatt ansvar for å utforme de yrkesetiske reglene. Når det gjelder autorisasjonsordningen, har Finanstilsynet ansvaret for autorisasjonene til revisorer, regnskapsførere og eiendomsmeglere. For advokater har Tilsynsrådet for advokatvirksomhet ansvaret for å føre tilsyn med advokatbevillingene, mens landmålerne ikke er underlagt en autorisasjonsordning.Analysen viser at en finner de fem elementene både i god revisorskikk, god advokatskikk, god regnskapsføringsskikk og god landmålerskikk. God meglerskikk er derimot svært forskjellig fra de andre yrkesetiske reglene. Samlet viser analysene at de yrkesetiske reglene har en viss rettslig betydning, selv om den varierer.Nøkkelord: lovfestede god skikk-regler, yrkesetiske reglerEnglish summary: The significance of ethical rules based on legislated rules for Code of ConductIn accordance with statutory authority rules for Code of conduct, several professions have designed ethical rules with a legal foundation. This article is based on a legal analysis of CoC for auditors, lawyers, accountants, real estate agents and for land surveyors. The purpose of the article is to compare the legal significance of these rules for the CoC. The various rules for CoC are compared in terms of their legal basis, the professional organisation which has designed the professional ethical rules and the system of authorisation. The rules for CoC are also compared in a hypothesis about five elements. The hypothesis is that the ethical rules contain the following elements: professionalism, integrity, objectivity, confidentiality and competency.The comparison shows that legislated rules for CoC have enabled the relevant professional organisations to take responsibility for designing professional ethical rules. In the case of system of authorisation, the «Financial Supervisory Authority of Norway» is responsible for authorising auditors, accountants and real estate agents. For lawyers the «Supervisory Council For Legal Practice» is responsible for supervising their authorisation, whereas land surveyors are not subject to an authorisation system – either public or professional.The analysis shows that one can find all five elements in the CoC for auditors, lawyers, accountants, and land surveyors. The CoC for real estate agents, however, is different from the other ethical rules. Overall, the analysis shows that the ethical rules have a certain legal significance, although it varies. (shrink)

Medical assistance in dying (MAiD) in Canada is a complex, novel interprofessional practice governed by stringent legal criteria. Often, patients need assistance navigating the system, and MAiD providers/assessors struggle with the administrative challenges of MAiD. Resultantly, the role of the MAiD care coordinator has emerged across the country as a novel practice dedicated to supporting access to MAiD and ensuring compliance with regulatory requirements. However, variability in the roles and responsibilities of MAiD care coordinators across Canada has highlighted the need (...) for accountability and standardization for this practice. This manuscript constitutes a first attempt to describe this emerging role, through discussion of proposed standards of practice, as well as roles and responsibilities, and ethical duties of this emergent professional practice. We detail the core commitments of MAiD care coordinators to patients, providers/assessors and institutions involved in the MAiD process. We address the core competencies that inform the unique skillset required by MAiD care coordinators to facilitate high-quality care, while highlighting the moral and ethical considerations embedded in this work. To illustrate the complexity of the MAiD care coordinator role, case examples involving ethical dilemmas encountered in practice are included. Finally, a code of ethics is proposed to serve as a guide for appropriate professional practice and conduct. This manuscript is intended to illustrate the importance of transparency and accountability for this new role that provides service to vulnerable patients and families; this is especially critical as the ethical complexity of MAiD is likely to increase with future changes in legislation opening MAiD access to new populations. (shrink)

Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: (...) Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses. (shrink)

The principle of liberal neutrality requires governments to avoid acting to promote particular conceptions of the good life. Yet by determining who uses natural resources and how, environmental policy makers can affect the availability of resources needed by individuals to carry on meaningful lives and in doing so can effectively privilege some versions of the good life at the expense of others. A commitment to liberal neutrality by implication promotes environmental policy that accommodates competing activities in order to provide a (...) wide range of resources that can support diversity in individual lives. It also encourages caution with regard to legislation based on deep ecology, the intrinsic value of species, and the fear of impending environmental catastrophe. (shrink)

An individual’s right to refuse life-sustaining treatment is a fundamental expression of patient autonomy; however, supporting this right poses ethical dilemmas for healthcare providers when the patient has attempted suicide. Emergency physicians encounter patients who have attempted suicide and are likely among the first medical providers to face the dilemma of honoring the patient’s DNR or intervening to reverse the effects of potentially fatal actions. We illustrate this issue by introducing a case example in which the DNR of a terminally (...) ill woman was not honored because the cause of her cardiac arrest was suicide. We argue that although a terminal diagnosis should change the way health care providers respond to a suicide attempt, many of the theoretical underpinnings for how one should treat suicide attempts—especially the criterion of external reasonability, that is the action to withhold or withdraw life-sustaining measures is reasonable independent of the precipitating event—are common to all situations :3–12, 2013). The presumption that patients who attempt suicide lack capacity due to acute mental illness is flawed because it fails to account for a competent individual’s reasonable preference to not be forced to live in an unbearable, terminal condition. In states without legislation allowing physician aid in dying, patients and providers must grapple with these limitations on a case-by-case basis. In cases where the patient has a limited life expectancy and there is not concern for psychiatric illness as the primary cause of the suicidal action, we argue that the negative right to refuse life-sustaining treatment should prevail. (shrink)