Background: This study attempts to understand if medical providers beliefs about the moral permissibility of honoring patient-directed refusals of life-sustaining treatment (LST) are tied to their beliefs about the patient’s decision-making capacity. The study aims to answer: 1) does concern about a patient’s treatment decision-making capacity relate to beliefs about whether it is morally acceptable to honor a refusal of LST, 2) are there differences between provider types in assessments of decision-making capacity and the moral permissibility to refuse LST, and (...) 3) do provider demographics impact beliefs about decision-making capacity and the moral permissibility to refuse LST. Methods: A mixed-methods survey using Likert assessment and vignette-based questions was administered to medical providers within a single health system in the upper Midwest (N = 714) to assess their perspectives on the moral acceptance and decision-making capacity in cases of withholding and withdrawing treatment and suicide. Results: Behavioral health providers report accepting of the moral permissibility of suicide (91.2%) more than either medical providers (77.2%) or surgeons (74.4%) (n = 283). Decision-making capacity was questioned more in the vignettes of the patients refusing life-saving surgery (36%) and voluntarily starvation (40.8%) than in the vignette of the patient requesting to deactivate a pacemaker (13%) (n = 283). Behavioral health providers were more concerned about the capacity to refuse life-saving surgery (55.9%) than medical providers (33.8%) or surgeons (23.1%) (n = 283). Conclusions: Respondents endorse the moral permissibility of persons to withhold or withdraw from treatment regardless of motive. Clinical concerns about a patient’s treatment decision-making capacity do not strongly correlate to views about the moral permissibility of honoring refusals of LST. Different provider types appear to have different thresholds for when to question treatment decision-making capacity. Behavioral health providers tend to question treatment decision-making capacity to refuse LST more than non-behavioral health providers. (shrink)

The question of whether clinical ethics consultants may engage in patient advocacy in the course of consultation has not been addressed, but it highlights for the field that consultants? allegiances, and the boundaries of appropriate professional practice, must be better understood. I consider arguments for and against patient advocacy in clinical ethics consultation, which demonstrate that patient advocacy is permissible, but not central to the practice of consultation. I then offer four recommendations for consultants who engage in patient advocacy, and (...) consider the implications of this issue for the field.1. (shrink)

Philosophers of time say that if presentism is true (i.e. if reality is comprised solely of presently existing things), then a complete description of reality must contain tensed terms, such as ‘was’, ‘presently is’ and ‘will be’. I counter this viewpoint by explaining how the presentist may de-tense our talk about times. I argue, furthermore, that, since the A-theory of time denies the success of any such de-tensing strategy, presentism is not a version of the A-theory – contrary to the (...) popular opinion. (shrink)

Theists typically think the freedom to choose between right and wrong is a great good . Yet, they also typically think that the very best being—God—and inhabitants of the very best place—heaven—lack this kind of freedom. The question arises: if freedom to choose evil is so good, then why is it absent from the best being and the best place? I discuss articulations of this question in the literature and point out drawbacks of answers that have been proposed. I then (...) propose a new answer by showing how freedom to do evil could result in certain good situations even if it does not contribute to the intrinsic greatness of a certain being or place. (shrink)

“Chiaroscuro” is a art technique that makes use of light and shade to suggest depth and solidity on a flat surface. I argue that the standards regarding accountability in the second edition of the Core Competencies for Healthcare Ethics Consultation , are chiaroscuro, because, despite the offered lists of competencies, it is very difficult to imagine how consultants might be held accountable to such standards. It is not clear to which of the many suggested standards a consultant should be held (...) accountable, and even if one stipulates that only the tabulated competencies are meant as standards, the vague wording makes it hard to know how a consultant might fail to meet the standards or perform excellently. In addition, because terms such as “ethics” and “ethical” are not defined in the document, we are left with no way to determine whether consultants have made appropriate recommendations. The document is useful as a point of discussion, but not yet ready to serve as a tool for holding practitioners accountable. (shrink)

Beginning with a reference to the concept of the political and the idea of stability, the essay turns to an examination of populism from an historical and a normative point of view. While historically populism can be traced to its Roman origins, from a normative perspective, populism rests on a binary opposition between ‘elites’ and the ‘people’. As such, it undercuts its moral claim to universal representation by taking the part for the whole. In the end, this essay argues that (...) populism cannot provide a moral justification for political stability. (shrink)

When facing a choice between saving one person and saving many, some people have argued that fairness requires us to decide without aggregating numbers; rather we should decide by coin toss or some form of lottery, or alternatively we should straightforwardly save the greater number but justify this in a non-aggregating contractualist way. This paper expands the debate beyond well-known number cases to previously under-considered probability cases, in which not (only) the numbers of people, but (also) the probabilities of success (...) for saving people vary. It is shown that, in these latter cases, both the coin toss and the lottery lead to what is called an awkward conclusion, which makes probabilities count in a problematic way. Attempts to avoid this conclusion are shown to lead into difficulties as well. Finally, it is shown that while the greater number method cannot be justified on contractualist grounds for probability cases, it may be replaced by another decision method which is so justified. This decision method is extensionally equivalent to maximising expected value and seems to be the least problematic way of dealing with probability cases in a non-aggregating manner. (shrink)

Plural quantification, often used to evade Russell paradoxes, will lead back to them, given certain assumptions about propositions. This chapter provides a more generalized version of the path to paradox by showing that any theory that makes possible the construction of an appropriate packaging relation falls prey to a Russell paradox. It gives examples of widely-held metaphysical theories that require such a relation. It shows that the paradoxes that can result from plural quantification are more widely damaging, and harder to (...) tame, than has been recognized. It also displays formal requirements that any metaphysical framework with a packaging relation must meet if it is to have a chance of escaping self-contradiction. The chapter first gives the general paradox-generating setup, and then shows how three families of metaphysical assumptions allow one to instantiate it. It concludes by assessing the aftermath of the arguments presented. (shrink)

An important question raised in the Molinist debate is, ‘Given God's access to counterfactual knowledge, could God create a world in which free creatures always refrain from evil?’ An affirmative answer suggests that God cannot possess counterfactual knowledge since such knowledge would allow God to create seemingly more desirable worlds than the actual world. However, Alvin Plantinga has argued that it is at least possible that every possible person is transworld depraved – meaning that each person would perform some wrong (...) actions if any world in which that person is morally free were actualized. I argue that, given an infinite number of possible persons, the probability that everyone is transworld depraved is exceedingly low. In addition, I investigate whether there are enough possible persons vis-à-vis the number of moral choices per person so that God could create worlds like the actual world, except lacking in moral evil. (shrink)

The field of nanoscience and nanotechnology is expanding rapidly, promising great benefits for society in the form of better medicine, more efficient energy production, new types of materials, etc. Naturally, in order for the science and technology to live up to these promises, it is important to continue scientific research and development, but equally important is the ethical dimension. Giving attention to the social, ethical and legal aspects of the field, among others, will help in developing a fully responsible—and thereby (...) capable—science and technology. Nanoethics has emerged as a field concerned with such ethical issues related to nanoscience and nanotechnology. Even though this field is relatively new, a significant amount of literature has already been published. This paper focuses on three of the major issues which are discussed in the literature of nanoethics, and also points to a certain bias in this literature. Each quite different in nature, these issues are: (1) The naming and (2) the timing of and approach to the field, as well as (3) the issue of safety. As will be seen, these issues are almost exclusively discussed by ethicists, (throughout the article, the term’ethicist’ is used in a broad definition covering philosophers, social and political scientists as well as philosophers of science) thus having no direct influence on the work being carried out by scientists. One can argue, therefore, that this bias creates a distortion of the ethical debate, making it insufficient and misleading. Ultimately, this bias is caused by the lack of communication and collaboration between ethicists on the one hand, and nanoscientists on the other. Thus, an argument is made for the different disciplines to begin collaborating, so as to more effectively and responsibly develop the field of nanoscience. (shrink)

International criminal law is dedicated to the battle against impunity. However, the concept of impunity lacks clarity. Providing that clarity also reveals challenges for the current state and future prospects of the project of ICL, which this article frames in cosmopolitan terms. The ‘impunity norm’ of ICL is generally presented in a deontic form. It holds that impunity for perpetrators of international crimes is a wrong so profound that states and international bodies have a pro tanto duty to prosecute and (...) punish perpetrators, a duty that cannot be overridden by considerations of cost, including the costs of infringing on the traditionally understood legal sovereignty of states. This deontic reading of the impunity norm is difficult to justify, a fact linked to the waning fortunes of ICL over the past several years. If ICL is to reverse this trend, the impunity norm’s strongly deontic reading should be replaced by a version derived from deliberative principles. (shrink)

This book will attempt to achieve a constructive and positive correla tion between mythic-symbolic language and philosophical anthropolo gy. It is intended as a reflection on the philosophical accomplishment of Paul Ricoeur. The term mythic-symbolic language in this context means the language of the multivalent symbol given in the myth with its psychological and poetic counterparts. The term symbol is not con ceived as an abstract sign as it is used in symbolic logic, but rather as a concrete phenomenon - (...) religious, psychological, and poetic. The task inherent in this correlation is monumental when one considers the dual dilemma of problematic and possibility which is at its heart. The prob lematic arises out of the apparent difficulty presented by the so-called challenge of modernity which seems to require the elimination of my thic-symbolic language as an intelligible mode of communication. Mythic-symbolic language is sometimes eliminated because in a world molded by abstract conceptualizations conceptUalizations of science, such a language is thought to be unintelligible. The claim is that its "primitive" explana tions have been transcended by our modernity. Others believe that the problem of mythic-symbolic language is the problem of the myth. If the mythic forms of language could be eliminated, the truth of such language could be preserved through its translation into an intelligible mode of discourse. The problematic is heightened further by the relation of consider ations of language to philosophical anthropology. (shrink)

Volume 19, Issue 9, September 2019, Page 44-45.

There was a time, in the late 1970s and 1980s, when great feats were expected of recombinant DNA biotechnology, some verging on the miraculous. According to both business enthusiasts and sober analysts like the U.S. Congressional Office of Technology Assessment, the new techniques of gene splicing would not only lift the drug industry out of its deep scientific and economic rut (characterized by long-declining introduction rates of genuinely novel medicines), but rejuvenate the American manufacturing sector (Chase 1979; Chemical Week 1987; (...) OTA 1984). Once freed by policy interventions to promote academic-industry collaboration, such as the 1980 Bayh-Dole Act, lifesaving drugs locked up in ivory towers would .. (shrink)

This essay examines the relationship between human choice and Rand's ethical standard for moral goodness and obligation. It shows that the neo-Aristotclian interpretation of Rand's ethics—an interpretation that does not accept the doctrine of "premoral choice" but instead claims that flourishing as a rational animal is the telos of human life and choice—is crucial to the viability of her ethical theory. The defenders of premoral choice confuse the conceptual order with the real and, despite their intentions, make Rand's ethics into (...) a voluntarist ethics, that is, an ethics in which reason is subordinate to will. (shrink)

The research enterprise depends on trust, especially trust in data reliability and ethical conduct of research. This trust is accomplished via systems, or “architectures,” that do the work of ensuring trustworthiness in research when individuals are not able to assess it for themselves. In the United States and many other countries, national laws or regulations constitute the research ethics trust architecture. But new research methods, such as citizen science, DIY biology, biohacking, or corporate research, avoid such regulations because they draw (...) on new means of funding, disseminating, and conducting research. This challenges the sufficiency of the traditional approach and requires us to revisit how we generate trust in the research enterprise. In this article, I discuss how new research challenges the existing trust architecture, offer some necessary elements of trust architecture in general, and use citizen science as a case study to illustrate how new, ethically meaningful trust architectures could be built. (shrink)

This essay is a comparative analysis of results reported in this volume from studies in mainland China, the United States, Iran, and Hong Kong regarding organ donation incentives. They reveal widespread (but not unanimous) support for honorary incentives (such as notes or ceremonies of gratitude) and significant support for familist incentives (offering a donor’s family members priority should they need an organ transplant in the future). Opinions on financial incentives were much more mixed, with significant worries expressed regarding potential exploitation (...) and unfairness. These interviews also reinforce the importance of culturally appropriate constructions of any steps to increase organ donation rates. And, in addition to their comments on various types of incentive, interviewees in these chapters also offer insight into other measures that could be taken to increase organ donation. (shrink)

Before we commit significant resources of time and energy to clinical ethics consultation (CEC) certification, education, and the like, one of the questions we ought to be able to answer is how to...

In this essay I deal with two conceptions of the political—one that entails a clash of civilizations associated with an Schmittian critique of liberalism, and a second that envisions the political as an emerging domain in relationship to the idea of overlapping consensus. The discovery of the emerging domain of the political in the later work of John Rawls separates the comprehensive from the political in a way that breaks the link between modernization and secularization. In so doing Rawls accommodates (...) the rise of religion that has become a major issue in the twenty-first century. I follow Rawls's development from…. (shrink)

Bastiat claims that the individual rights to life, liberty, and property are natural rights. Further, he claims that these natural rights are a matter of natural law and are not mere conventions. However, he never offers a detailed account of the connection between natural law and natural rights. By outlining a neo-Aristotelian theory of natural law that consists of two poles—an individualized vision of human flourishing and a conception of individual rights as metanormative principles—it is argued that Bastiat’s core insight (...) is correct. Individual rights are the proper political expression of a natural law approach to ethics. They determine the ultimate purpose of human law.Bastiat affirme que les droits individuels à la vie, à la liberté et à la propriété sont des droits naturels. De plus, il envisage ces droits naturels comme relevant du Droit Naturel plutôt qu’étant de simples conventions. Cependant, il n’offre nulle part une explication détaillée des liens entre le Droit Naturel et les droits naturels. En mettant en avant une théorie néo-aristotélicienne du Droit Naturel composée de deux pôles — une version individualisée de l’épanouissement humain et une conception des droits individuels en tant que principes métanormatifs — cet article soutient que l’idée centrale de Bastiat est juste. Les droits individuels sont l’expression politique adéquate d’une approche de l’éthique en termes de Droit Naturel. Ils déterminent la finalité ultime de la loi humaine. (shrink)

This essay explores the conversion of various Christianities to an “Earth-honoring” faith with a moral universe different from the one presently at home in most heads, hearts, and practices. Such reborn faith and morality would be new cloth, new wineskins.

Benjamin Lipscomb (The Women Are Up to Something) and Clare Mac Cumhaill and Rachel Wiseman (Metaphysical Animals) have written books discussing the same four women philosophers—Elizabeth Anscombe, Philippa Foot, Mary Midgley, and Iris Murdoch—and their rise to prominence in the almost exclusively male-dominated academies of Oxford and Cambridge universities. This review focuses on these philosophers’ intellectual contributions, with special attention given to the Aristotelian character of their views in the face of an opposing philosophical regimen. We conclude with a brief (...) reflection on Ayn Rand’s moral philosophy in light of the contributions made by these four women philosophers. (shrink)