In late 2021, tennis star Chris Evert learned new genetic information about her sister, who died from ovarian cancer in January 2020. As Evert has explained in posts published by ESPN, her sister had a variant in the BRCA1 gene that was reclassified—upgraded—from a variant of uncertain significance (VUS) to pathogenic. Hearing about the variant’s reclassification likely saved Evert’s life. After getting genetic testing that showed she also carried the variant, Evert underwent prophylactic surgery. Clinical testing associated with the procedure (...) revealed she already had stage 1c ovarian cancer. The Wall Street Journal reported on a different variant reclassification story in 2019. Seven female relatives had prophylactic surgeries after cascade genetic testing indicated they each carried the same pathogenic variant in BRCA2. However, there was significant distress and confusion when one of the women received notice that the variant had been downgraded from pathogenic to a VUS. As these cases illustrate, reclassification of the clinical significance of genetic variants—which ranges from pathogenic, likely pathogenic, uncertain, likely benign and benign—can have profound impacts on individuals and families. Although genetic testing often provides valuable information, many identified variants are of uncertain significance, even in genes associated with disease. Many of these VUS will be reclassified as genomic data …. (shrink)

_Kant, Duty and Moral Worth _is a fascinating and original examination of Kant's account of moral worth. The complex debate at the heart of Kant's philosophy is over whether Kant said moral actions have worth only if they are carried out from duty, or whether actions carried out from mixed motives can be good. Philip Stratton-Lake offers a unique account of acting from duty, which utilizes the distinction between primary and secondary motives. He maintains that the moral law should (...) not be understood as a normative moral reason but as playing a transcendental role. Thus a Kantian account of moral worth is one where the virtuous agent may be responsive to concrete particular considerations, whilst preserving an essential role for universal moral principles. _Kant, Duty and Moral Worth _is a lucid examination of Kant's moral thought that will appeal to Kant scholars and anyone interested in moral theory. (shrink)

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see more patients per (...) unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so. (shrink)

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see more patients per (...) unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so. (shrink)

Background Escalating levels of obesity place enormous and growing demands on Health care provision in the (U.K.) United Kingdom. Resources are limited with increasing and competing demands upon them. Ethical considerations underpin clinical decision making generally, but there is limited evidence regarding the relationship between these variables particularly in terms of treating individuals with obesity. Research aim To investigate the views of National Health Service (NHS) clinicians on navigating the ethical challenges and decision making associated with obesity management in adults (...) with chronic illness. Research design A cross-sectional, multi-site survey distributed electronically. Participants A consensus sample of nurses, doctors, dietitians and final year students in two NHS Trusts and two Universities. Ethical considerations Ethical and governance approvals obtained from a National Ethics Committee (11NIR035), two universities and two teaching hospitals. Results Of the total ( n = 395) participants, the majority were nurses (48%), female (79%) and qualified clinicians (59%). Participants strongly considered the individual to have primary responsibility for a healthy weight and an obligation to attempt to maintain that healthy weight if they wish to access NHS care. Yet two thirds would not withhold treatment for patients with obesity. Discussion While clinicians were clear about patient responsibility and obligations, the majority prioritised their duty of care and would not invoke a utilitarian approach to decision making. This may reflect awareness of obesity as a multi-faceted entity, with responsibility for support and management shared amongst society in general. Conclusions The attitudes of this sample of clinicians complemented the concept of the health service as being built on a principle of community, with each treated according to their need. However limited resources challenge the concept of needs-based decisions consequently societal engagement is necessary to agree a pragmatic way forward. (shrink)

In Group Duties, Stephanie Collins proposes a ‘tripartite’ social ontology of groups as obligation-bearers. Producing a unified theory of group obligations that reflects our messy social reality is challenging and this ‘three-sizes-fit-all’ approach promises clarity but does not always keep that promise. I suggest considering the epistemic level as primary in determining collective obligations, allowing for more fluidity than the proposed tripartite ontology of collectives, coalitions and combinations.

This chapter focuses on the question of who has duties regarding poverty and what those duties demand, from within the perspective of contemporary analytic normative philosophy. The chapter is structured in three sections. Section 1 considers the duties of those living in poverty, which might be either self-regarding or other-regarding duties, and which must be tempered by concerns of overdemandingness. Section 2 considers the duties of affluent individuals. These are imperfect duties grounded in affluent (...) individuals’ relations to the structures that produce poverty: relations of contribution, benefit, and ability to change. Section 3 considers duties of collective agents – including states, for-profits, charities, and civil society groups. The poverty-related duties of these collective agents are sometimes perfect and sometimes imperfect, and include both primary and secondary duties, and both positive and negative duties. (shrink)

Background: The coronavirus disease 2019 pandemic is impacting the delivery of healthcare worldwide, creating dilemmas related to the duty to care. Although understanding the ethical dilemmas about the duty to care among nurses is necessary to allow effective preparation, few studies have explored these concerns. Aim: This study aimed to identify the ethical dilemmas among clinical nurses in Spain and Chile. It primarily aimed to identify nurses’ agreement with the duty to care despite high risks for themselves and/or their families, (...) describe nurses’ well-being and describe the associations between well-being and the duty to care. Research design: Cross-sectional self-reported anonymous data were collected between May and June 2020 via electronic survey distribution. Ethical considerations: The Institutional Ethical Review Committees in both countries approved the study. Findings: In total, 345 clinical nurses answered the primary question about the duty to care for the sick. Although in the total sample 77.4% agreed they have a duty to care for the sick, significant differences were found between the Spanish and Chilean samples. Overall, 53.6% of the nurses reported low levels of well-being; however, among those reporting low well-being, statistically significant differences were found between Spanish and Chilean nurses as 19.4% and 37.8%, respectively, disagreed with the statement regarding the duty to care. Discussion: Participants in both countries reported several ethical dilemmas, safety fears, consequent stress and low well-being. These results suggest that prompt actions are required to address nurses’ ethical concerns, as they might affect their willingness to work and psychological well-being. Conclusion: Our findings shed light on the ethical dilemmas nurses are facing related to the duty to care. Not only has the coronavirus disease 2019 pandemic given rise to ethical challenges, but it has also affected nurses’ well-being and willingness to work during a pandemic. (shrink)

Prichard's concern here is whether a person's obligation depends either on features of his or her situation or on features of his or her thoughts about that situation. Related to this contrast between the objective view and the subjective view is the issue of whether an obligation is an obligation to do some action. To the latter issue, Prichard responds that an obligation is not an obligation to do something, but an obligation to set ourselves to do something; as a (...) consequence, it is necessary to modify the terms of Prichard's primary concern. This modification diminishes the force of the objective view and does nothing to eliminate the central difficulty in the subjective view, namely, that the obligation to do some action is said to depend not on the character that the action would have, but on our belief that it would have that character. The belief that some general character picks out obligations derives from the mistaken habit of regarding the terms ‘right’ and ‘wrong’ as equivalent to ‘ought’ and ‘ought not’. Having highlighted this mistake, Prichard holds that in instances where we have considered the circumstances fully, our thoughts about the situation decide whether we ought to perform a given activity. (shrink)

This article examines the actions and testimonies of 14 nurses who killed psychiatric patients at the state hospital of Meseritz-Obrawalde in the Nazi 'euthanasia' program. The nurses provided various reasons for their decisions to participate in the killings. An ethical analysis of the testimonies demonstrates that a belief in the relief of suffering, the notion that the patients would 'benefit' from death, their selection by physicians for the 'treatment' of 'euthanasia', and a perceived duty to obey unquestioningly the orders of (...) physicians were the primary ethical reasons that were stated for their behavior. However, 20 years had elapsed between the killings and the trial, thus giving ample opportunity for the defendants to develop comfortable rationales for their actions and for their attorneys to have observed successful defenses of others accused of euthanasia. (shrink)

A contrary-to-duty obligation is an obligation telling us what ought to be the case if something that is wrong is true. For example: ‘If you have done something bad, you should make amends’. Doing something bad is wrong, but if it is true that you did do something bad, it ought to be the case that you make amends. Here are some other examples: ‘If he is guilty, he should confess’, ‘If you have hurt your friend, you should apologise to (...) her’, ‘If she will not keep her promise to him, she ought to call him’, ‘If the books are not returned by the due date, you must pay a fine’. Alternatively, we might say that a contrary-to-duty obligation is a conditional obligation where the condition (in the obligation) is forbidden, or where the condition is fulfilled only if a primary obligation is violated. In the first example, he should not be guilty; but if he is, he should confess. You should not have hurt your friend; but if you have, you should apologise. She should keep her promise to him; but if she will not, she ought to call him. The books ought to be returned by the due date; but if they are not, you must pay a fine. -/- Contrary-to-duty obligations are important in our moral and legal thinking. They turn up in discussions concerning guilt, blame, confession, restoration, reparation, punishment, repentance, retributive justice, compensation, apologies, damage control, and so forth. The rationale of a contrary-to-duty obligation is the fact that most of us do neglect our primary duties from time to time and yet it is reasonable to believe that we should make the best of a bad situation, or at least that it matters what we do when this is the case. -/- We want to find an adequate symbolisation of such obligations in some logical system. However, it has turned out to be difficult to do that. This is shown by the so-called contrary-to-duty (obligation) paradox, sometimes called the contrary-to-duty imperative paradox. The contrary-to-duty paradox arises when we try to formalise certain intuitively consistent sets of ordinary language sentences, sets that include at least one contrary-to-duty obligation sentence, by means of ordinary counterparts available in various monadic deontic logics, such as the so-called Standard Deontic Logic and similar systems. In many of these systems the resulting sets are inconsistent in the sense that it is possible to deduce contradictions from them, or else they violate some other intuitively plausible condition, for example that the members of the sets should be independent of each other. This article discusses this paradox and some solutions that have been suggested in the literature. -/- (Submitted: 2017-10-23; Published in 2022). (shrink)

A primary fiduciary bond, rarely examined, is that of neighbor. I distinguish this bond from others that may overlap it, those of fellow citizen or compatriot. I argue that the nature of moral identity and the nature of moral formation require moral agents to acknowledge the fiduciary duties of neighbor.

A primary fiduciary bond, rarely examined, is that of neighbor. I distinguish this bond from others that may overlap it, those of fellow citizen or compatriot. I argue that the nature of moral identity and the nature of moral formation require moral agents to acknowledge the fiduciary duties of neighbor.

Background:Nurses must balance their perceived duty to care against their perceived risk of harm to determine their willingness to report during disaster events, potentially creating an ethical dilemma and impacting patient care.Research aim:The purpose of this study was to investigate nurses’ perceived duty to care and whether there were differences in willingness to respond during disaster events based on perceived levels of duty to care.Research design:A cross-sectional survey research design was used in this study.Participants and research context:Using a convenience sample (...) with a snowball technique, data were collected from 289 nurses throughout the United States in 2017. Participants were recruited through host university websites, Facebook, and an American Nurses Association discussion board.Ethical considerations:Institutional review board approval was obtained from the University of Texas at Tyler and the University of Arkansas.Findings:Analysis of willingness to report to work based on levels of perceived duty to care resulted in the emergence of two groups: “lower level of perceived duty to care group” and “higher level of perceived duty to care group.” The most discriminating characteristics differentiating the groups included fear of abandonment by co-workers, reporting because it is morally the right thing to, and because of imperatives within the Nursing Code of Ethics.Discussion:The number of nurses in the lower level of perceived duty to care group causes concern. It is important for nursing management to develop strategies to advance nurses’ safety, minimize nurses’ risk, and promote nurses’ knowledge to confidently work during disaster situations.Conclusion:Level of perceived duty to care affects nurses’ willingness to report to work during disasters. Primary indicators of low perceived duty to care are amenable to actionable strategies, potentially increasing nurses’ perceived duty to provide care and willingness to report to work during disasters. (shrink)

Private law is generally formulated in terms of rightduty relation at all but on a or liability” relation. A primary-liability claim is not a claim arising from the breach of a strict-liability duty. The recognition of primary-liability claims does not involve skepticism about duties or rules or legal relations and it is consistent with the analysis of private law in terms of corrective justice.

We investigate under what conditions contrary-to-duty (CTD) structures lacking temporal and action elements can be given a coherent reading. We argue, contrary to some recent proposals, that CTD is not an instance of defeasible reasoning, and that methods of nonmonotonic logics are inadequate since they are unable to distinguish between defeasibility and violation of primary obligations. We propose a semantic framework based on the idea that primary and CTD obligations are obligations of different kinds: a CTD obligation pertains (...) to, or pre-supposes, a certain context in which a primary obligation is already violated. This framework is presented initially as an extension of Standard Deontic Logic (SDL), a normal modal logic of type KD, and is illustrated by application to a series of examples. The concluding section is concerned with some resemblances between CTD and defeasible reasoning. We show first that the SDL-based framework contains a flaw and must be adjusted. A discussion of possible adjustments, including an alternative treatment in terms of a preference-based semantics, reveals difficulties that are reminiscent of problems in defeasible reasoning and intensional accounts of defeasible conditionals. (shrink)

Many follow Kant in thinking that morally worthy actions must be carried out solely from the motive of duty. This outlook faces two challenges: (1) The One Feeling Too Few problem (actions that issue from, say, compassion also seem to have moral worth), and (2) The One Thought Too Many problem (some actions have moral worth precisely because they’re not motivated by duty). These challenges haven’t led Kantians to dispense with the motive of duty. Instead, they have proposed to push (...) it into the background. We should not (the thought goes) construe duty as a primary motive, a consideration that motivates the agent to act. Duty is best thought of as a secondary motive, a background concern that constrains her choice. Since it is consistent with acting from duty at the secondary level that one is motivated at the primary level by compassion, this move is thought to overcome both challenges. In this paper, I argue that secondary motive views don’t live up to their stated ambitions. Such proposals either fail to make progress on issues with which primary motive views continue to grapple, or they render the motive of duty ill-suited to underwrite a plausible account of moral worth. (shrink)

A contrary-to-duty obligation is an obligation that tells us what ought to be the case if something that is wrong or forbidden is true. Alternatively, we might say that a contrary-to-duty obligation is a conditional obligation where the condition is fulfilled only if a primary obligation is violated. Consider this example: “If you have hurt her feelings, you should make amends.” Since contrary-to-duty obligations play an important role in our moral and legal thinking, we want to find a good (...) analysis of this concept. However, it has turned out to be difficult to formalize various contrary-to-duty obligations. This is illustrated by the so-called contrary-to-duty paradox. This paradox is generated when we try to symbolize various scenarios that include at least one contrary-to-duty obligation in many formal deontic systems, such as Standard Deontic Logic. Such symbolizations are often inconsistent or entail some other problematic consequences. This entry is a brief introduction to this problem. (shrink)

Barbara Herman offers an interpretation of Kant's Groundwork on which an action has moral worth if the primary motive for the action is the motive of duty. She offers this approach in place of Richard Henson's sufficiency-based interpretation, according to which an action has moral worth when the motive of duty is sufficient by itself to generate the action. Noa Latham criticizes Herman's account and argues that we cannot make sense of the position that an agent can hold multiple (...) motives for action and yet be motivated by only one of them, concluding that we must accept a face-value interpretation of the Groundwork where morally worthy actions obtain only when the agent's sole motive is the motive of duty. This paper has two goals, one broad and one more constrained. The broader objective is to argue that interpretations of moral worth, as it is presented in the Groundwork, depend on interpretations of Kant's theory of freedom. I show that whether we can make sense of the inclusion of nonmoral motives in morally worthy actions depends on whether the 'always causal framework' is consistent with Kant's theory of freedom. The narrow goal is to show that if we adopt an 'always causal' framework for moral motivation, then Herman's position and her critique of the sufficiency-based approach fail. Furthermore, within this framework I will specify a criterion for judging whether an action is determined by the motive of duty, even in the presence of nonmoral motives. Thus, I argue Latham's conclusion that we must accept a face-value interpretation is incorrect. (shrink)

Richard Henson attempts to take the sting out of this view of Kant on moral worth by arguing (i) that attending to the phenomenon of the overdetermination of actions leads one to see that Kant might have had two distinct views of moral worth, only one of which requires the absence of cooperating inclinations, and (ii) that when Kant insists that there is moral worth only when an action is done from the motive of duty alone, he need not also (...) hold that such a state of affairs is morally better, all things considered, than one where supporting inclination is present. Henson's proposals seem to me both serious and plausible. I do not think that either of his models, in the end, can take on the role Kant assigns to moral worth in the argument of the Groundwork. But seeing the ways Henson's account diverges from Kant's makes clearer what Kant intended in his discussion of those actions he credits with moral worth. [...] An action has moral worth if it is required by duty and has as its primary motive the motive of duty. The motive of duty need not reflect the only interest the agent has in the action (or its effect); it must, however, be the interest that determines the agent's acting as he did. (shrink)

Even though it offers a compelling account of the responsibility-component in the negligence standard—arguably the Holy Grail of negligence theory—Professor John Gardner is mistaken in conceptualizing the duty of care in negligence as a duty to try to avert harm. My goal here is to explain why and to point to an alternative account of the responsibility component in negligence. The flaws in conceiving of the duty of care as a duty to try are: failing to comport with the legal (...) doctrine of negligence and failing as a revisionary account for the law; overly burdening autonomy and restricting the liberty of thought; adversely affecting the prevention of negligent harm—the essence of the negligence standard—; and, raising severe probative difficulties. Moreover, the duty of care also does not give rise to what I call a de facto duty to try. The duty of care is better construed to require only certain conduct and not trying. Returning to the primary appeal and motivation for exploring the validity of equating the duty of care with a duty to try—searching for the responsibility-component in the negligence standard—I argue that the responsibility-component in negligence does not take the form of an obligation to try but rather has a conditional form, manifested in the conditions of applicability of the negligence standard. In other words, the negligence standard comprises a conduct-based as opposed to a combined action-/intent-based duty (such as a duty to try) as its duty of care, a duty that only applies to actors who possess the capacity to intentionally or knowingly comply with it, or, put differently, possess the capacity to try. (shrink)

Recent discussions in the just war literature suggest that soldiers have a duty to assume certain risks in order to protect the lives of all innocent civilians. I challenge this principle of risk by arguing that it is justified neither as a principle that guides the conduct of combat soldiers, nor as a principle that guides commanders in the US military. I demonstrate that the principle of risk fails on the first account because it requires soldiers both to violate their (...) strict duty of obedience and loyalty and to exceed their special obligations to protect their fellow comrades, the state, the state's constituents and other protected civilians. I then illustrate that the principle of risk fails on the second account since it conflicts with the commander's primary obligation to protect and promote the welfare and lives of his or her soldiers. I conclude by arguing that we cannot reasonably expect soldiers and commanders to adhere to the principle of risk until there is a radical, institutional-level transformation of militaristic goals, values, strategies, policies, warrior codes and expectations of service members in the US Armed Forces. (shrink)

The view that agents are not obliged to do more than their initial fair shares when their fellow duty bearers fail to comply has prominent defenders, including Liam Murphy and David Miller. While Murphy thinks that asking agents to take up other agents’ slack would be unfair, Miller claims that slack-taking cannot be required because primary responsibility does not migrate from noncompliers to compliers. This paper argues, by contrast, that there are a number of circumstances in which there is (...) a duty to take up the slack even though it is unfair and even though responsibility stays where it is. The central claim is that what agents owe to third parties is a separate issue from how they relate to fellow duty bearers. This proposal also runs counter to familiar defenses of slack-taking that weigh its unfairness against the moral importance of the interests at stake for third parties. (shrink)

There exists a serious shortage of organs for transplantation in China, more so than in most Western countries. Confucianism has been commonly used as the cultural and ethical reason to explain the reluctance of Chinese and other East-Asian people to donate organs for medical purposes. It is asserted that the Confucian emphasis on xiao (filial piety) requires individuals to ensure body intactness at death. However, based on the original texts of classical Confucianism and other primary materials, we refute this (...) popular view. We base our position on the related Confucian norms of filial piety and ren (humaneness, humanity or benevolence), the tension between differentiated love and universal love, and belief in the goodness of human nature. In light of this, we argue that the Confucian ethical outlook actually calls for organ donation at an individual level, and supports an opt-out (presumed consent) system at the level of social policy. Furthermore, because the popular view is based on a number of dominant but misleading modes of thinking about cultural differences, our revisionist account of Confucian moral duties regarding organ donation has implications for developing a more adequate transcultural and global bioethics. These will be discussed and expanded upon. (shrink)

In his new book, The Grammar of Criminal Law: American, Comparative, and International, celebrated criminal law theorist George Fletcher excavates criminal law doctrine across a number of countries and cultures to reveal a small number of basic shared structures. Among these structures Fletcher argues that it is a criminal law justified by Kantian legal morality, in contrast to perfectionist or communitarian theories, that is legitimate. Thus, Fletcher proposes, along with legal positivists, that the validity of legal norms does not turn (...) on the moral claims that may underlie a perfectionist or virtue theory of law. Fletcher's claims about the shared structure of law do more than propose an analytical model of valid criminal law. Most importantly, Fletcher draws attention to the often under explored normative implications of proposed models of law in analytical jurisprudence. Virtue theories of law challenge Fletcher's view of legitimate criminal law by proposing a fundamentally different jurisprudential model of valid law. Rather than liberalism's commitment to preserving autonomy or the neutrality of the state as primary, virtue theories forward competing models of law grounded in preserving sound practical reason or the promotion of human flourishing. And while these models find a distinct and mediated role for morality to play in the determination of legitimate law, they ultimately deny Fletcher's claim that morality cannot be incorporated into law without being referenced by the law and that our political commitments must precede our moral commitments. This article places Fletcher's model of criminal law within the positivist jurisprudential landscape and connects that model of law to Kantian legal duties. The piece then explores the particular resources virtue theories of law forwarded by Lawrence Solum and Kyron Huigens have to address the role of political concerns within a virtue theory of law. It examines whether a sophisticated virtue theory finds a place for political concerns that are sufficient to defeat liberal philosophical critiques and undermine Fletcher's claims for criminal law. More importantly, rather than simply exploring the competing jurisprudential models, this article explores the important normative commitments that stem from competing jurisprudential models. Ultimately, the article concludes that understanding certain factors about the very nature of law generally and criminal law particularly leads one to affirm Fletcher's claims and limits the justification of law to our deontic duties. (shrink)

Philosophers who, in the light of these attacks, have attempted to vindicate the motive of duty have done so in a half-hearted way, by stressing the motive of duty’s function as a secondary or limiting motivation, or by denying “that acting from duty primarily concerns isolated actions.” I will defend duty as a primary motive with respect to isolated actions. Critics of acting from duty and philosophers who have attempted to respond to them have done little work spelling out (...) exactly what it is for an agent to act from duty. To act explicitly on moral principle is to act from a type of concern for persons that is no less morally good than concern expressed in direct emotional responses. Concern mediated by moral principles is, in certain ways, morally superior to that expressed in direct emotional responses, even when the object of concern is an intimate such as a friend or loved one. (shrink)

I aspire to answer two questions regarding the concept of a corrective duty. The first concerns what it means to wrong others, thus triggering a demand for corrections (the ground question). The second relates to the proper content of corrective duties. I first illustrate how three prominent accounts of corrective duties—the Aristotelian model of correlativity, the Kantian idea that wronging corresponds to the violation of others’ right to freedom, and the more recent continuity view—have failed to answer the (...) two questions satisfactorily. I then introduce my proposal, which holds that we wrong others when we fail to treat their status as moral agents as a source of stringent constraints on our action. I call it the moral neglect account. Once we have identified a common aim of corrective duties (counterbalancing moral neglect), we can fill their content in the various contexts in which wronging has occurred. I conclude by observing that it is not the primary role of corrective justice to assign responsibilities for damage reparations; in fact, requests for compensation make more sense if framed in distributive rather than corrective terms. (shrink)

This paper explores ethical concerns arising in healthcare integration. We argue that integration is necessary imperative for meeting contemporary and future healthcare challenges, a far stronger evidence base for the conditions of its effectiveness is required. In particular, given the increasing emphasis at the policy level for the entire healthcare infrastructure to become better integrated, our analysis of the ethical challenges that follow from the logic of integration itself is timely and important and has hitherto received insufficient attention. We evaluated (...) an educational intervention which aims to improve child health outcomes by making transitions between primary to secondary care more efficient, ensuring children and parents are better supported throughout. The programme provided skills for trainee paediatricians and general practitioners in co-designing integrated clinical services. The key ethical challenges of integrated care that arose from a clinical perspective are: professional identity and autonomy in an integrated working environment; the concomitant extent of professional responsibility in such an environment; and the urgent need for more evidence to be produced on which strategies for integrating at scale can be based. From our analysis we suggest a tentative way forward, viewed from a normative position broadly situated at the intersection of deontology and care ethics. We adopt this position because the primary clinical ethical issues in the context of integrated care concern: how to ensure that all duties of care to individual patients are met in a newly orientated working environment where clinical responsibility may be ambiguous; and the need to orientate care around the patient by foregrounding their autonomous preferences and ensuring good patient clinician relationships in clinical decision-making. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so the (...) steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

Supererogation has gained attention as a means of explaining the voluntary behaviours of individuals and organizations that are done for the benefit of others and which go above what is required of legislation and what may be expected by society. Whilst the emerging literature has made some significant headway in exploring supererogation as an ethical lens for the study of business there remain several important issues that require attention. These comprise, the lack of primary evidence upon which such examinations (...) have been made, attention has been given to only singular pro-social acts of organizations, and the focus has been upon the actions of large organizations. Furthermore, Heyd’s (Supererogation, Cambridge University Press, 1982) original taxonomy of six supererogatory acts, comprising Moral Heroism, Beneficence, Volunteering, Favour, Forgiveness and Forbearance, has been considered to be complete and other forms of supererogatory acts have not yet been explored. In order to address these gaps this study poses the research questions: First, it studies how a single, contemporary SME performs multiple supererogatory acts in its attempts to address its social and environmental goals that go beyond CSR. Second, it seeks to gain a deeper theoretical understanding of Heyd’s (Supererogation, Cambridge University Press, 1982) taxonomy of six forms of supererogation through the capture of primary data. This research makes a three-year case study examination of a single SME that has been formally recognized for its work in addressing social and environmental issues at local, national and global levels. Primary data are acquired of the supererogatory acts that it performs through a three-year participant observation case study, utilizing 61 interviews and 3 focus groups with internal and external stakeholders. In doing so, it addresses the empirical limitations of the extant research, substantiates each of the forms that supererogatory acts may take, and makes a contribution to the theory of supererogation by identifying a further class of act that is ‘Sharing’. (shrink)

A critical issue facing the criminal justice system today is how best to promote ethical behavior by public prosecutors. The legal profession has left much of a prosecutor’s day-to-day activity unregulated, in favor of a general, catch-all admonition to “seek justice.” In this article the author argues that professional norms are truly functional only if those working with a given ethical framework recognize the system’s implicit dependence on character. A code of professional conduct in which this dependence is not recognized (...) is both contentless and corrupting. Building on the ethics of Aristotle and modern philosophers Alasdair MacIntyre and Bernard Williams, the author argues that virtue theory can help bridge the gaps in prosecutorial ethics where other forms of moral reasoning fail. The author analyzes three especially difficult ethical problems frequently confronted by prosecutors in the field. He demonstrates not only that the Model Rules of Professional Conduct and the ABA Criminal Justice Standards fail to answer any of these complex questions, but also that future attempts to more closely regulate how prosecutors should act in any of these nuanced situations are unlikely to succeed. The author argues that honesty, fairness, courage, and prudence are the primary virtues that citizens have a right to expect of their public prosecutors. He then demonstrates how these four key virtues might provide important guidance to conscientious prosecutors striving to do what is right. The author concludes by offering several insights into how the field of virtue ethics might inform both the structure and organization of government law offices, and the manner in which individual prosecutors working within these offices might perceive and fulfill their professional roles. (shrink)

The Irish Teaching Council introduced a new model of school-based and National Induction Programme for Teachers (NIPT) called Droichead (meaning ‘bridge’ in Gaelic) in 2013/14. The Droichead process is an integrated professional induction framework for newly qualified teachers. It was designed to provide whole-school support for teacher induction in both primary and post-primary schools. This study explores the implementation of Droichead in a post-primary school, and to gain insights as to its effectiveness and the potential to bring (...) about improvements. The study found that NQTs are un-prepared to assume full teaching duties after initial teacher education (ITE), and can benefit greatly from having mentors from within the school to guide them through their first year of teaching. The benefits of the process include emotional support for NQTs, practical help in terms of learning new teaching strategies, the promotion of reflective practice and assisting the professional development of teachers. Droichead was found to promote peer observation and can help leaders change the culture of an organisation to better embrace and support peer observation and review. The programme also promoted and developed leadership skills among the mentors, who cited a renewed enthusiasm for teaching from their involvement in Droichead. There were conflicting views on the involvement of the senior leadership team in the programme, and it would seem that the success of their inclusion depends largely on the individual style of leadership. The negative aspects of the Droichead process related to the ‘Cluster meetings’ which are compulsory for NQTs and were seen as being too similar to their initial teacher education. (shrink)

The moral virtues are the normative foundations of peace. Building on this, thepaper argued that peaceful co-existence among religions and identities is possibleeven in a highly pluralized society. The study employed the philosophical-criticalmethod where factual and philosophical data are extrapolated from relevant literatures and are used to advance the main thesis via a rigorous philosophical dialectic. The study found that the moral virtues are the primary principles of thenatural law, which are naturally and spontaneously known through the practicalreason/conscience. In (...) as much as religions presuppose the existence of God, themoral virtues constitute God’s primary will for all men to accomplish and arethe first and highest duties of religions. Although, most religions, if not all, teachthe importance of the moral virtues, they are not given the highest position.Conflicts arise when religious laws, customs and traditions, which sometimesare contrary to the moral virtues, are given the highest priority. Thus, the paperargued that the moral virtues should be considered as the primary and overridingprinciples by which religious observance is judged as faithful or not. The paperconcluded that peace can be achieved when leaders of different religions anchortheir religious teachings, religious life, and the notion of religious fidelity mainlyor primarily on the moral virtues, and above all, love. Keywords: Philosophy of religion, peace, duties of religion, thin universalism, moralvirtues, natural law, Philippines. (shrink)

It is unclear that United States schools are doing sufficient work to identify and protect the interests of their LGB students this analysis, we rely on certain public-health research in social epidemiology to show that discrimination against LGB adolescents imposes morally significant harms to both adolescents and community. We apply "trust” and “social capital” to educational standards and practices as foundations for educational practices that work toward full equality of LGB students in regard to opportunity and other primary social (...) goods. (shrink)

Evidence based medicine has had an increasing impact on primary care over the last few years. In the UK it has influenced the development of guidelines and quality standards for clinical practice and the allocation of resources for drug treatments and other interventions. It has informed the thinking around patient involvement in decision making with the concept of evidence based patient choice. There are, however, concerns among primary care clinicians that evidence based medicine is not always relevant to (...) primary care and that undue emphasis placed on it can lead to conflict with a clinician’s duty of care and respect for patient autonomy. In this paper we consider the impact of evidence based medicine on primary care, and the ethical implications of its increasing prominence for clinicians and managers in primary care. (shrink)

Ethically challenging or controversial medical procedures have prompted increasing requests for the exercise of conscientious objection, and caused concerns about how and when it should be practised. This paper clarifies definitions, especially with regard to discrimination, and explores the restrictions, duties, and practical limitations, in order to suggest criteria for its practice. It also argues that a conscientious refusal to treat, where there is therapeutic doubt, is a valid form of conscientious objection. An email survey sent to General Practitioners (...) (GPs), explored the adherence to the suggested criteria, and assessed the outcomes, in terms of acceptability, impact, and difficulties experienced by the GPs, their colleagues and their patients. The results demonstrate high acceptability of conscientious objection, and better outcomes when the suggested criteria are adhered to. The GPs would support education to improve the practice of conscientious objection to a professional level, which could further improve outcomes and acceptability. (shrink)

The recent review by Monrad1 presents several issues about secondary vaccine trials. It lays out the case in which a vaccine has been tested through phases I–III and is being deployed. Subsequently, consideration is being given to conducting ‘trials for another vaccine for the pathogen’. Monrad states: ‘In summary, we may say that researchers have strong prima facie reasons not to conduct a secondary vaccine trial.’ Monrad discusses several factors meriting careful consideration about the need for developing and testing more (...) than one vaccine: relative efficacy, length of immunity, adverse reactions, ease of storage and administration, economic and logistical factors. What is not addressed are the ethical duties that exist when there are competing phase III vaccine candidates for COVID-19. We have serious concerns about potential ethical inadequacies about these ongoing trials and …. (shrink)

This article argues that congregations should be seen as grassroots public moral agents, on the ground working to bring what they discern as God's preferred future into being. Deliberations among congregations of all social backgrounds are a way of doing ethics "polycentrically," without a dominant center. Because cultural and social boundaries are permeable and people in various social groups can imaginatively enter the worlds of people unlike themselves, they can engage those perspectives morally on an equal footing. The essay addresses (...) ethicists' participation in congregations' moral deliberation and action, and concludes with a plea for theological ethicists to consider congregations in their work. (shrink)

It is the primary duty of business to satisfy consumer by providing quality goods and services at right place, right time, in right quantity at a fair price. The need for consumer protection is recognized by law makers in India since ancient times. It was very well realized that a consumer is prone to exploitation on the part of providers of goods and services. Therefore, the ancient Indian law codes regulated not only social conditions but also the economic life (...) of people by establishing human values and code of trade practices to protect the interests of buyers. This article is mainly based on the detailed study of ancient Indian literature, that is, Manu Smriti, Narada Smriti, Brihaspati Smriti and Arthshastra. (shrink)

Funeral Orations as Indicators of what a Good Life Ought to Be The central aim of this study was to uncover, based on funeral orations, what the Igbo of South-East Nigeria regard as the good life. Over two hundred and fifty funeral orations/tributes were investigated. These were classified into: tributes by spouses; by offspring; by close family members; by friends, associates and organizations. The study revealed that the notion of the good life among the Igbo was based on primary (...) duties and obligations at each of the four levels identified above and on related secondary duties and obligations. The good life was measured by the extent to which these duties and obligations were discharged and in the way their performance manifested in the provision of social amenities, help to educate members of the community and so on. What would ordinarily be regarded as virtues were considered desirable only in so far as they helped people fulfill their primary and secondary obligations, otherwise they were regarded as sterile or "bottled" virtues. (shrink)

Suppose we can save either a larger group of persons or a distinct, smaller group from some harm. Many people think that, all else equal, we ought to save the greater number. This article defends this view (with qualifications). But unlike earlier theories, it does not rely on the idea that several people's interests or claims receive greater aggregate weight. The argument starts from the idea that due to their stakes, the affected people have claims to have a say in (...) the rescue decision. As rescuers, our primary duty is to respect these procedural claims, which we must do by doing what these people would decide, in a process where each is given an equal vote on the matter. So in cases where each votes in their own self-interest, respect for their equal right to decide, or their autonomy, will lead us to save the greater number. The argument is explained in detail, with special attention to the questions of how, exactly, it avoids aggregation, and of why majority rule is superior to lottery procedures. The view has further advantages. Especially, it explains the “partial” relevance of numbers in cases involving unequal harms, and it does so in a way that dissolves the appearance of paradox that besets theories of “partial aggregation.”. (shrink)

While citizens of developed countries enjoy lives of unmatched affluence, over a billion people struggle to subsist on incomes of less than $1/day. Can't we conclude that their poverty constitutes a glaring injustice? The answer almost certainly is yes—but not because some countries are rich, nor because of inadequate levels of redistribution. Liberal political theory traditionally maintains that persons are rights-holders, and the primary duty owed them is noninterference. Corrupt and tyrannical governments flagrantly violate the liberty rights of their (...) captive populations. External governments conspicuously fail to respect noninterference, however, when they erect barriers to trade between foreign nationals and their own citizens, subsidize domestic industries, prevent innocent movement across borders by would-be workers, and when they tender assistance to abusive states (such as foreign aid that lines the pockets of kleptocrats and enhances their power). The theory advanced here is similar to that of Rawls in rejecting an international difference principle, but unlike Rawls it advances an account of international justice as continuous with domestic principles of justice. (shrink)

The combination of the issue of return of individual genetic results/incidental findings and paediatric biobanks is not much discussed in ethical literature. The traditional arguments pro and con return of such findings focus on principles such as respect for persons, autonomy and solidarity. Two dimensions have been distilled from the discussion on return of individual results in a genetic research context: the respect for a participant’s autonomy and the duty of the researcher. Concepts such as autonomy and solidarity do not (...) fit easily in the discussion when paediatric biobanks are concerned. Although parents may be allowed to enrol children in minimal risk genetic research on stored tissue samples, they should not be given the option to opt out of receiving important health information. Also, children have a right to an open future: parents do not have the right to access any genetic data that a biobank holds on their children. In this respect, the guidelines on genetic testing of minors are applicable. With regard to the duty of the researcher the question of whether researchers have a more stringent duty to return important health information when their research subjects are children is more difficult to answer. A researcher’s primary duty is to perform useful research, a policy to return individual results must not hamper this task. The fact that vulnerable children are concerned, is an additional factor that should be considered when a policy of returning results is laid down for a specific collection or research project. (shrink)

This work employs Elizabeth Cripps’ collectivist account of responsibility for climate change in order to ground an individual duty to reduce one’s GHG emissions. This is significant not only as a critique of Cripps, but also as an indication that even on some collectivist footings, individuals can be assigned primary duties to reduce their emissions. Following Cripps, this work holds the unstructured group of GHG emitters weakly collectively responsible for climate change harms. However, it argues against Cripps that (...) what follows from this is a corresponding collective duty to act qua group to bring about an end to the harm and a derivative duty for each emitter to promote the required organization of a group capable of this. Instead, this work argues that acts of GHG emission, to the extent that they are avoidable and performed with requisite knowledge, make one into a member of a group that is morally responsible for climate-related harms. Thus, individual emitters who can do otherwise should recognize themselves as members of a group that collectively harms. Subsequently, they should take all possible steps in order to renounce their membership (e.g. by reducing their GHG emissions). (shrink)

Clinicians and administrators have a professional obligation to contribute to improvement of healthcare quality. At the same time, participation in embedded research poses risks to healthcare institutions. Disclosure of an institution’s sensitive information could endanger relationships with patients and undermine its reputation. The existing ethical framework for learning healthcare systems does not address the conflict between the OTC and institutional interests. Ethical guidance and policy regulation are needed to create a safe environment for embedded research. In this article we analyse (...) the EF for LHSs and the concept of professionalism. We suggest that the EF should be supplemented with an obligation to protect provider’s legitimate interests. We define legitimate interests as those that enable providers to discharge their primary duties. We argue that both the OTC and the obligation to protect legitimate interests are grounded in the concept of medical professionalism and can be understood as a matter of contract between a democratic society and medical professionals. The proposed supplemented EF can be implemented into a regulatory system in three different ways: the self-regulating: where providers decide themselves how to balance the ethical claims, the centralised: where a governmental institution decides the right balance between providers’ interests and interests of a health system; and the mediating: where medical professionals, the state and patients negotiate their interests. Our article contributes to the discussion on ethical relevance of providers’ interests and the regulatory model for weighing opposite interests in LHSs. (shrink)

This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics—autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician–patient relationship is a deontological construct in which the physician’s primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological (...) Principlism. During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic. (shrink)