Marshall et al. (2024) raise questions regarding patient refusals of care. In this commentary we address refusals of care from the lens of patient autonomy and provide suggestions for patient cente...

Virtuousness refers to the pursuit of the highest aspirations in the human condition. It is characterized by human impact, moral goodness, and unconditional societal betterment. Several writers have recently argued that corporations, in addition to being concerned with ethics, should also emphasize an ethos of virtuousness in corporate action. Virtuousness emphasizes actions that go beyond the “do no harm” assumption embedded in most ethical codes of conduct. Instead, it emphasizes the highest and best of the human condition. This research empirically (...) examines the buffering and amplifying effects of virtuousness in organizations. The study hypothesizes that virtuousness has a positive effect on organizations because amplifying dynamics make subsequent virtuous action more likely, and buffering dynamics reduce the harmful effects of downsizing. The study reveals that two types of virtuousness – tonic and phasic – are associated with these effects. (shrink)

Retaliation against whistleblowers is a well-recognized problem, yet there is little explanation for why uninvolved peers choose to retaliate through ostracism. We conduct two experiments in which participants take the role of a peer third-party observer of theft and subsequent whistleblowing. We manipulate injunctive norms and descriptive norms. Both experiments support the core of our theoretical model, based on social intuitionist theory, such that moral judgments of the acts of wrongdoing and whistleblowing influence the perceived likeability of each actor and (...) ultimately influence intention to ostracize each actor and indicate more willingness to ostracize the whistleblower than the wrongdoer. When we vary norms for the wrongdoing in Experiment 1, we find that descriptive and injunctive norms indirectly influence intentions to ostracize both the wrongdoer and whistleblower. These relationships are serially mediated by the observers’ moral judgments of the act and likeability of the actor. When we vary norms for whistleblowing in Experiment 2, the injunctive norm manipulation affected moral judgment of the action of whistleblowing, and we do not observe any other significant effects of the norm manipulations on moral judgments of the actions of wrongdoing or whistleblowing. (shrink)

Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics (...) and public health ethics. The goal of this paper is to begin to consider what it might mean to combine systems thinking with public health ethics to solve public health challenges. We argue that there is a role for ethics in systems thinking in public health as a means of elucidating implicit assumptions and facilitating ethics debate and dialogue with key stakeholders. (shrink)

Gender dysphoria is a clinically significant incongruence between expressed gender and assigned gender, with rapidly growing prevalence among children. The UK High Court recently conducted a judicial review regarding the service provision at a youth-focussed gender identity clinic in Tavistock. The high court adjudged it ‘highly unlikely’ that under-13s, and ‘doubtful’ that 14–15 years old, can be competent to consent to puberty blocker therapy for GD. They based their reasoning on the limited evidence regarding efficacy, the likelihood of progressing to (...) cross-sex hormone therapy and the ‘life-changing consequences’ of puberty blockers. In this article, I offer two concurrent arguments to dispute their reasoning. First, I argue that minors can be competent to consent to puberty blockers for GD, because the decision to undergo puberty blocker therapy is no more complex or far-reaching than other medical decisions that we accept a child should be able to make. Second, I argue that—irrespective of competence—such legal restriction for all children fundamentally contradicts the central ethical tenet of child healthcare: best interests. For these two reasons, the high court should not restrict access to puberty blockers for competent GD children. (shrink)

In The Norm of Belief, John Gibbons claims that there is a “natural reaction” to the general idea that one can be normatively required to Ø when that requirement is in some sense outside of one’s first person perspective or inaccessible to one. The reaction amounts to the claim that this is not possible. Whether this is a natural or intuitive idea or not, it is difficult to articulate exactly why we might think it is correct. To do so, we (...) need a view about the relationship between agents’ capacities to accord with normative requirements and the conditions under which those normative requirements obtain. I offer an account of the epistemic dimension of this relationship. The goal is to provide enough of a story about the natural reaction to make accounting for it look like an important desideratum for any theory of the nature of normative requirements—whether these are moral or epistemic. To focus the discussion, I use Timothy Williamson’s knowledge-first view of evidence as an example of a view in epistemology that generates the natural reaction. One upshot of the discussion, then, is a detailed account of what is troubling about Williamson’s influential but controversial view of evidence. (shrink)

BackgroundResponsive neurostimulation has been utilized as a treatment for intractable epilepsy. The RNS System delivers stimulation in response to detected abnormal activity, via leads covering the seizure foci, in response to detections of predefined epileptiform activity with the goal of decreasing seizure frequency and severity. While thalamic leads are often implanted in combination with cortical strip leads, implantation and stimulation with bilateral thalamic leads alone is less common, and the ability to detect electrographic seizures using RNS System thalamic leads is (...) uncertain.ObjectiveThe present study retrospectively evaluated fourteen patients with RNS System depth leads implanted in the thalamus, with or without concomitant implantation of cortical strip leads, to determine the ability to detect electrographic seizures in the thalamus. Detailed patient presentations and lead trajectories were reviewed alongside electroencephalographic analyses.ResultsAnterior nucleus thalamic leads, whether bilateral or unilateral and combined with a cortical strip lead, successfully detected and terminated epileptiform activity, as demonstrated by Cases 2 and 3. Similarly, bilateral centromedian thalamic leads or a combination of one centromedian thalamic alongside a cortical strip lead also demonstrated the ability to detect electrographic seizures as seen in Cases 6 and 9. Bilateral pulvinar leads likewise produced reliable seizure detection in Patient 14. Detections of electrographic seizures in thalamic nuclei did not appear to be affected by whether the patient was pediatric or adult at the time of RNS System implantation. Sole thalamic leads paralleled the combination of thalamic and cortical strip leads in terms of preventing the propagation of electrographic seizures.ConclusionThalamic nuclei present a promising target for detection and stimulation via the RNS System for seizures with multifocal or generalized onsets. These areas provide a modifiable, reversible therapeutic option for patients who are not candidates for surgical resection or ablation. (shrink)

Paul Sheehy has argued that the modal realist cannot satisfactorily allow for the necessity of God’s existence. In this short paper I show that she can, and that Sheehy only sees a problem because he has failed to appreciate all the resources available to the modal realist. God may be an abstract existent outside spacetime or He may not be: but either way, there is no problem for the modal realist to admit that He exists at every concrete possible world.

In De Anima 2.4, Aristotle claims that nutritive soul encompasses two distinct biological functions: nutrition and reproduction. We challenge a pervasive interpretation which posits ‘nutrients’ as the correlative object of the nutritive capacity. Instead, the shared object of nutrition and reproduction is that which is nourished and reproduced: the ensouled body, qua ensouled. Both functions aim at preserving this object, and thus at preserving the form, life, and being of the individual organism. In each case, we show how Aristotle’s detailed (...) biological analysis supports this ontological argument. (shrink)

ABSTRACT:Deliberative democratic theory, commonly used to explore questions of “political” corporate social responsibility, has become prominent in the literature. This theory has been challenged previously for being overly sanguine about firm profit imperatives, but left unexamined is whether corporate contexts are appropriate contexts for deliberative theory in the first place. We explore this question using the case of Starbucks’ “Race Together” campaign to show that significant challenges exist to corporate deliberation, even in cases featuring genuinely committed firms. We return to (...) the underlying social theory to show that this is not an isolated case: for-profit firms are predictably hostile contexts for deliberation, and significant normative and strategic problems can be expected should deliberative theory be imported uncritically to corporate contexts. We close with recent advances in deliberative democratic theory that might help update the PCSR project, and accommodate the application of deliberation to the corporate context, albeit with significant alterations. (shrink)

When a person at risk of having a child with a genetic illness or disease wishes to have an unaffected child, this can involve difficult choices. If the pregnancy is established by sexual intercourse, the fetus can be tested early in pregnancy, and if affected a decision can be made to abort in the hope that a future pregnancy with an unaffected fetus ensures. Alternatively, preimplantation genetic diagnosis can be used after in vitro fertilisation to select and implant an unaffected (...) embryo that hopefully will proceed to term and produce a healthy baby. We are aware that many individuals at risk regard the latter as ethically more acceptable than the former, and examine whether there is an ethical difference between these options. We conclude that PGD and implantation of an unaffected embryo is a more acceptable choice ethically than prenatal diagnosis followed by abortion for the following reasons: Choice after PGD is seen as ethically neutral because a positive result balances a negative result simultaneously . While there is usually the intention to establish a healthy pregnancy after an abortion, this is not simultaneous; A woman sees abortion as a personal physical violation of her integrity, and as the pregnancy proceeds she increasingly identifies with and gives ethical status to the embryo/fetus as it develops in utero and not in the laboratory; Many people see aborting a fetus as “killing”, whereas in the case of PGD the spare embryos are “allowed to die”. We argue that this difference of opinion gives further weight to our conclusion, but note that this has been addressed and debated at length by others. (shrink)

Anthony Brueckner has argued that claims about underdetermination of evidence are suppressed in closure-based scepticism (“The Structure of the Skeptical Argument”, Philosophy and Phenomenological Research 54:4, 1994). He also argues that these claims about underdetermination themselves lead to a paradoxical sceptical argument—the underdetermination argument—which is more fundamental than the closure argument. If Brueckner is right, the status quo focus of some predominant anti-sceptical strategies may be misguided. In this paper I focus specifically on the relationship between these two arguments. I (...) provide support for Brueckner’s claim that the underdetermination argument is the more fundamental sceptical argument. I do so by responding to a challenge to this claim put forward by Stewart Cohen (“Two Kinds of Skeptical Argument”, Philosophy and Phenomenological Research 58:1, 1998). Cohen invokes an alternative epistemic principle which he thinks can be used to challenge Brueckner. Cohen’s principle raises interesting questions about the relationship between evidential considerations and explanatory considerations in the context of scepticism about our knowledge of the external world. I explore these questions in my defence of Brueckner. (shrink)

Recent Developments Content Type Journal Article DOI 10.1007/s11673-010-9256-0 Authors Cameron Stewart, Centre of Health Governance, Law and Ethics, Sydney Law School, University of Sydney, Sydney, NSW Australia Bernadette Richards, Faculty of Law, University of Adelaide, Adelaide, South Australia Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529.

Decades of research conducted in Western, Educated, Industrialized, Rich, & Democratic (WEIRD) societies have led many scholars to conclude that the use of mental states in moral judgment is a human cognitive universal, perhaps an adaptive strategy for selecting optimal social partners from a large pool of candidates. However, recent work from a more diverse array of societies suggests there may be important variation in how much people rely on mental states, with people in some societies judging accidental harms just (...) as harshly as intentional ones. To explain this variation, we develop and test a novel cultural evolutionary theory proposing that the intensity of kin-based institutions will favor less attention to mental states when judging moral violations. First, to better illuminate the historical distribution of the use of intentions in moral judgment, we code and analyze anthropological observations from the Human Area Relations Files. This analysis shows that notions of strict liability—wherein the role for mental states is reduced—were common across diverse societies around the globe. Then, by expanding an existing vignette-based experimental dataset containing observations from 321 people in a diverse sample of 10 societies, we show that the intensity of a society's kin-based institutions can explain a substantial portion of the population-level variation in people's reliance on intentions in three different kinds of moral judgments. Together, these lines of evidence suggest that people's use of mental states has coevolved culturally to fit their local kin-based institutions. We suggest that although reliance on mental states has likely been a feature of moral judgment in human communities over historical and evolutionary time, the relational fluidity and weak kin ties of today's WEIRD societies position these populations' psychology at the extreme end of the global and historical spectrum. (shrink)

Whether there is a general moral obligation to obey the law, often referred to as ‘political obligation’, is an enduring question in contemporary legal and political philosophy. Theories are continually being formulated, criticized, and reformulated as theorists attempt to settle this issue. However, there yet remains no general consensus as to whether any theory successfully answers this question in either the affirmative or the negative. I propose the legal doctrine of quasi-contract as a candidate for making sense of this persistent (...) issue. While the duty to reciprocate and the principle of reasonable expectations each falls short when independently advanced as a theory of political obligation, quasi-contract, which combines reciprocity, reasonable expectations, and additional moral considerations, is able to establish a satisfactory account of political obligation. (shrink)

I argue that using a traditional biological account of parenthood causes problems for determining who counts as a parent for the purposes of filial obligations in alternative family structures. I then argue that a better way to understand parenthood is as a role. People who fill the role of parents are parents, regardless of their biological ties to a child. Next, I argue that children can have more than two parents and so can have filial obligations to more than two (...) people. I then demonstrate that understanding parenthood as a role allows us to correctly account for who should be a parent in cases of adoption, surrogacy, and extended families. In the final section I discuss three related worries about allowing a child to have more than two parents. (shrink)

For the first time in English, this anthology offers a comprehensive selection of primary sources in the history of philosophy of language. Beginning with a detailed introduction contextualizing the subject, the editors draw out recurring themes, including the origin of language, the role of nature and convention in fixing form and meaning, language acquisition, ideal languages, varieties of meanings, language as a tool, and the nexus of language and thought, linking them to representative texts. The handbook moves on to offer (...) seminal contributions from philosophers ranging from the pre-Socratics up to John Stuart Mill, preceding each major historical section with its own introductory assessment. With all of the most relevant primary texts on the philosophy of language included, covering well over two millennia, this judicious, and generous, selection of source material will be an indispensable research tool for historians of philosophy, as well as for philosophers of language, in the twenty-first century. A vital tool for researchers and contemporary philosophers, it will be a touchstone for much further research, with coverage of a long and varied tradition that will benefit today's scholars and enhance their awareness of earlier contributions to the field. (shrink)

Rarely have missiologists explored the overlapping space where community development work intersects the formation and multiplication of new, vibrant churches in ‘least reached’ settings. Drawing on professional practice and field experience in both community development and missiology the authors propose initial expressions of a missiology that explores this intersection, identifying key principles appropriate for this space. Understanding the Kingdom of God is foundational; understanding how people enter it deeply affects how we go about ministry. Ethical and professional concerns as well (...) as demands for transparency cause us to avoid any hint of coercion or utilitarian approaches that would create a ‘platform’ of community development work merely as a base to accomplish a different goal. At the same time, the love and professional skill of community development workers may help open doors and win a hearing for the gospel among the least reached. (shrink)

The logical empiricists held that an analogical hypothesis does not gain any acceptability from the analogy on which it is founded. On this view, the acceptability of a hypothesis cannot be discounted by criticizing the foundational analogy. Yet scientists commonly appear to level exactly this sort of criticism. If scientists are able to discount the acceptability of analogical hypotheses in this way, then the logical empiricist view is mistaken. I analyze four forms of analogy counterargument, disanalogy, misanalogy, counteranalogy, and false (...) analogy, with examples from the debate over the asteroid impact hypothesis. These counterarguments do address the acceptability of analogical hypotheses, indicating that analogies can confer acceptability, confirmation notwithstanding. 1 Introduction 2 The asteroid impact hypothesis 3 Analogy counterarguments 3.1 Disanalogy 3.2 Misanalogy 3.3 Counteranalogy 3.4 False analogy 4 Acceptability 5 Conclusions. (shrink)

Biographical studies have shown that visual mental imagery plays a significant role in the conduct of scientific research, particularly in the generation of hypotheses. But the nature of visual mental imagery and its participation in abductive inference is not systematically understood. This paper discusses examples of visual abductive reasoning by archaeologists, analyzing them according to the visual information and the process of inference employed. This work supports the conclusion that visual abduction is useful to scientists under certain conditions and that (...) it is amenable to detailed study. (shrink)

Is the world internally connected by a web of necessary connections or is everything loose and independent? Followers of David Hume accept the latter by upholding Hume’s Dictum, according to which there are no necessary connections between distinct existences. Roughly put, anything can coexist with anything else, and anything can fail to coexist with anything else. Hume put it like this: “There is no object which implies the existence of any other if we consider these objects in themselves.” Since Hume’s (...) day, Hume’s Dictum has played a major role in philosophy, especially in contemporary metaphysics. In ruling out necessary connections, Hume’s Dictum implies that causal relations and the laws of nature are contingent. It makes other demands on our metaphysics of science as well; for example, it places restrictions on our metaphysics of counterfactuals, dispositions, and explanation. The principle has applications in other areas too. Hume’s Dictum places constraints on our theories of abstract objects and moral properties. For example, Hume’s Dictum rules out the view that moral properties are distinct from, but necessarily connected to, non-moral properties. While Hume’s Dictum is a prominent principle in metaphysics, few Humeans have defended the principle at length. It is assumed more often than it is argued for. As a result, Hume’s Dictum no longer enjoys the reputation it once did. It’s common to hear complaints about the lack of arguments in support of Hume’s Dictum. Moreover, philosophers are increasingly willing to defend views that are at odds with Hume’s Dictum. A striking example of this is the recent explosion of interest in views that take causal relations and the laws of nature to be necessary. Humeans can no longer afford to be complacent. An extended defense of Hume’s Dictum is called for, and that’s what this dissertation aims to offer. This dissertation has three parts. In the first part, I lay out some preliminaries and offer a precise formulation of Hume’s Dictum. In the second part, I develop three arguments in favor of Hume’s Dictum. In the final part, I defend Hume’s Dictum against objections. (shrink)

Recent Developments Content Type Journal Article DOI 10.1007/s11673-010-9256-0 Authors Cameron Stewart, Centre of Health Governance, Law and Ethics, Sydney Law School, University of Sydney, Sydney, NSW Australia Bernadette Richards, Faculty of Law, University of Adelaide, Adelaide, South Australia Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529.

This article revolves around the debate surrounding the lack of a coherent definition for corporate social responsibility (CSR). I make use of Jacques Derrida’s theorizing on contested meaning to argue that CSR’s ambiguity is actually necessary in light of its functional role as a “supplement” to corporate profit-seeking. As a discourse that refuses to conclusively resolve the tension between profit-seeking and prosociality, CSR expresses an important critical perspective which demands that firms act responsibly, while retaining the overall corporate frame of (...) shareholder supremacy. CSR does this by ambivalently affirming both profit-seeking and prosociality, a necessary contradiction. Attempts to reduce CSR’s ambiguity can thus only succeed by undermining its viability as a normative discourse that captures how certain elements of society understand how firms should act. The analysis suggests that greater scholarly attention is needed with regard to the material discursive environments within which discourses such as CSR are deployed. A discursive approach to research could thus benefit future practitioners, who have to act according to fluid standards of responsibility that cannot be authoritatively defined, but which can be better understood than they are at present. (shrink)