Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.

Some properties are discussed of regular polygons that may result from angular homeostatic processes in stable orbit. To characterize these homeostatic polygons we need to discuss the winding number, the sidedness (integer, fractional and irrational), multiplicity, envelopes, and density. A regular (i.e., equilateral, equiangular) polygon may be closed in one revolution about its unique center, in multiple revolutions, or not at all. A homeostatic polygon can be generated only if all vertices are included in a single polygon, which occurs if (...) and only if the number of vertices and the number of revolutions required to complete the polygon are relatively prime. For the homeostatic polygon to have a finite number of sides (without repeating itself) the angle subtended by any two successive vertices at the center must be a rational multiple of 2. Biological implications of these properties are illustrated. (shrink)

The present study investigates the importance of emotional disclosure and vulnerability in the production of hegemonic masculinities. Of particular interest is the role that silence and invisibility play in how men talk about recent stressful life events. One-on-one interviews with men who experienced a stressful life event in the past year illustrate how men often talk about these events in simultaneously visible and invisible ways. We use the term “cloudy visibility” to describe this engagement, identified both in terms of what (...) men articulate in relation to their past stressful experiences and how they articulate these experiences within the present moment of the interview. The conversational consequences of these linguistic devices are analyzed to illustrate how men obscure their inner emotional lives, thus reproducing hegemonic masculine ideals of staying strong and stoic in the face of adversity, while they also seek to make aspects of their inner lives seen and heard to an interviewer. (shrink)

The arts of rule cover the exercise of power by princes and popular sovereigns, but they range beyond the domain of government itself, extending to civil associations, political parties, and religious institutions. Making full use of political philosophy from a range of backgrounds, this festschrift for Harvey Mansfield recognizes that although the arts of rule are comprehensive, the best government is a limited one.

Berger (2019) argues effectively that “representativeness is more aptly understood as a variable that is multidimensional and continuous based on relational moral authority,” and also makes some useful suggestions about how taking this observation seriously might require changes in current patterns of practice regarding surrogates. But the essay raises additional important questions about how the Best Interest Standard (BIS) should be used among unrepresented patients and other patients as well because many surrogates besides those who “have no actionable knowledge (...) of a patient’s preferences” find themselves in positions in which they need to determine, with the physician, what is in the patient’s best interests. In this commentary, we therefore provide support for the ethical superiority of BIS judgments made by a multi-stakeholder process (rather than solo decision-makers), and sketch a process by which such judgments might be made. (shrink)

In this paper, I argue that, even when disability rights activists are most clearly acting as activists, they can advance the scholarly activity of disability bioethics. In particular, I will argue that even engaging in non-violent direct action, including civil disobedience, is an important way in which disability rights activists directly support the efforts of disability bioethics scholars. I will begin by drawing upon Hilde Lindemann’s work on relational narrative identity to describe how certain damaging master narratives about disability hinder (...) the uptake of arguments from disability bioethics. Then, I will argue that disability activism, especially non-violent direct action and civil disobedience, provides an effective counterstory to some of the worst of these master narratives, thereby laying the groundwork for the scholarly argument s of disability bioethicists to be given more serious consideration. Ultimately, I conclude that the field of bioethics is improved when it abandons the gross grained, generalizations about who disabled people are and how they act put forth by oppressive master narratives in favor of the more nuanced self-descriptions offered by the counterstories being offered by disabled people themselves. So it is that, by challenging these oppressive master narratives that constrain and distort the social meaning of disability, disability activism can improve mainstream bioethics. (shrink)

One debate that occupied Pratyabhijñā philosophers and their Buddhist interlocutors was the question of the reality of _sambandha_, or relation. A central treaty on the topic is Utpaladeva’s (∼10th c.) _Sambandhasiddhi_ [SS] (‘_Proof of Relation_’), a response to Dharmakīrti’s (∼7th c.) _Sambandhaparīkṣā_ [SP] (‘_Analysis of Relation_’). As the contrasting titles suggest, Dharmakīrti held that relations are merely conceptual constructions (_kalpanā_), inferred _post hoc_ from discrete perceptual cognitions (_pratyakṣa_)—and thus ultimately _unreal_. Utpaladeva, on the other hand, attempted to ‘prove’ (_siddhi_) the (...) truth (_satya_) of relation as a genuine ‘division-non-division,’ or ‘unity-in-diversity’ (_bhedābheda_). In this article, I reconstruct Utpala’s ‘proof’ as a pragmatic argument to the effect that Dharmakīrti, in virtue of his nominalist metaphysics, mistakenly treats the general form of relation as an inferential _concept_, rather than the mode of ‘intentional’ _action_ (_śakti_) manifest in reflexive judgment (_vimarśa_). In doing so, Utpala suggests that Dharmakīrti inadvertently renders the relational conditions for the recognition of determinate intentional content unintelligible. (shrink)

The deeply entrenched, sometimes heated conflict between the disability movement and the profession of bioethics is well known and well documented. Critiques of prenatal diagnosis and selective abortion are probably the most salient and most sophisticated of disability studies scholars’ engagements with bioethics, but there are many other topics over which disability activists and scholars have encountered the field of bioethics in an adversarial way, including health care rationing, growth-attenuation interventions, assisted reproduction technology, and physician-assisted suicide. The tension between the (...) analyses of the disabilities studies scholars and mainstream bioethics is not merely a conflict between two insular political groups, however; it is, rather, also an encounter between those who have experienced disability and those who have not. This paper explores that idea. I maintain that it is a mistake to think of this conflict as arising just from a difference in ideology or political commitments because it represents a much deeper difference—one rooted in variations in how human beings perceive and reason about moral problems. These are what I will refer to as variations of moral psychology. The lived experiences of disability produce variations in moral psychology that are at the heart of the moral conflict between the disability movement and mainstream bioethics. I will illustrate this point by exploring how the disability movement and mainstream bioethics come into conflict when perceiving and analyzing the moral problem of physician-assisted suicide via the lens of the principle of respect for autonomy. To reconcile its contemporary and historical conflict with the disability movement, the field of bioethics must engage with and fully consider the two groups’ differences in moral perception and reasoning, not just the explicit moral and political arguments of the disability movement. (shrink)

The authors identify the challenge of holding contemporary business leaders accountable for enhancing the intangible strategic asset of integrity capacity in organizations. After defining integrity capacity and framing it as part of a strategic resource model of sustainable global competitive advantage, the stakeholder costs of integrity capacity neglect are delineated. To address this neglect issue, the authors focus on the cultivation of judgment integrity to handle behavioral, moral and hypothesized economic complexities as key dimensions of integrity capacity. Finally, the authors (...) recommend two leadership practices to build competence in business leaders to enhance integrity capacity as an organizational strategic asset. (shrink)

In academic philosophy and popular culture alike, pity is often framed as a virtue or the emotional underpinnings of virtue. Yet, people who are the most marginalized and, hence, most often on the receiving end of pity, assert that it is anything but an altruism. How can we explain this disconnect between an understanding of pity as a virtuous emotion versus a social harm? My paper answers this question by showing how pity is not only an emotion, but also a (...) power relation. Using the ideas of Sartre’s Anti-Semite and Jew, I explain how pity is understood as harmful by the one pitied because he is acutely aware of how it obscures his unequal power relation to the pitier and denies the pitier’s role in creating this domination. This is all done with an eye toward what I see as the quintessential class of people who are harmed by pity: people with disabilities. (shrink)

Bracken synthesizes Polanyi’s notion of morphogentic field and Whitehead’s notion of societies of actual occasions. These comments emphasize the implications of the metaphors involved in these notions. The rnetaphor of plants growing in afield lies beyond the concept of a morphogenetic field, and the metaphor of a society of interacting persons lies behind the concept of a society of actual occasions. I suggest that one of the implications of this metaphor is that there is not, as Bracken argues, a problem (...) of continuity in Whitehead’s metaphysics of events. (shrink)

Management Ethics: Integrity at Work redefines what it means for a manager to function with integrity in the private and public sectorsùdomestically and globally. It integrates the latest theoretical work in both descriptive and normative ethics, and incorporates legal, communication, quality, and organizational theories into a conceptual framework that improves managerial judgment in the handling of moral complexity at work. The authors use their organizational ethics consulting and academic research experience to provide practical assessment and decision-making tools that convert ethics (...) theories into sound action steps. The book examines three key dimensions of management integrityùjudgment, process, and developmental dimensionsùand applies them to individual chapters devoted to the subprocesses of ethical planning, organizing, leading, and controlling. The authors focus their theories and tools on 28 ethics minicases related to each management function in seven allied management application clusters: accounting, auditing management; finance, investment management; marketing, advertising management; business management, business law, human resource management; technology, quality operations, organizational behavior management; public, nonprofit, health care management; and international, environmental, public policy management. Management Ethics: Integrity at Work builds management integrity by linking and enhancing both ethics and management competence in responsible planning, organizing, leading, and controlling for use by professionals and students in the private and public sectorsùdomestically and globally. (shrink)

Volume 20, Issue 3, March 2020, Page 44-46.

In academic philosophy and popular culture alike, pity is often framed as a virtue or the emotional underpinnings of virtue. Yet, people who are the most marginalized and, hence, most often on the receiving end of pity, assert that it is anything but an altruism. How can we explain this disconnect between an understanding of pity as a virtuous emotion versus a social harm? My paper answers this question by showing how pity is not only an emotion, but also a (...) power relation. Using the ideas of Sartre’s Anti-Semite and Jew, I explain how pity is understood as harmful by the one pitied because he is acutely aware of how it obscures his unequal power relation to the pitier and denies the pitier’s role in creating this domination. This is all done with an eye toward what I see as the quintessential class of people who are harmed by pity: people with disabilities. (shrink)

The deeply entrenched, sometimes heated conflict between the disability movement and the profession of bioethics is well known and well documented. Critiques of prenatal diagnosis and selective abortion are probably the most salient and most sophisticated of disability studies scholars’ engagements with bioethics, but there are many other topics over which disability activists and scholars have encountered the field of bioethics in an adversarial way, including health care rationing, growth-attenuation interventions, assisted reproduction technology, and physician-assisted suicide. -/- The tension between (...) the analyses of the disabilities studies scholars and mainstream bioethics is not merely a conflict between two insular political groups, however; it is, rather, also an encounter between those who have experienced disability and those who have not. This paper explores that idea. I maintain that it is a mistake to think of this conflict as arising just from a difference in ideology or political commitments because it represents a much deeper difference—one rooted in variations in how human beings perceive and reason about moral problems. These are what I will refer to as variations of moral psychology. The lived experiences of disability produce variations in moral psychology that are at the heart of the moral conflict between the disability movement and mainstream bioethics. I will illustrate this point by exploring how the disability movement and mainstream bioethics come into conflict when perceiving and analyzing the moral problem of physician-assisted suicide via the lens of the principle of respect for autonomy. To reconcile its contemporary and historical conflict with the disability movement, the field of bioethics must engage with and fully consider the two groups’ differences in moral perception and reasoning, not just the explicit moral and political arguments of the disability movement. (shrink)

Professional associations, like the Academy of Management, exist to foster and promote scholarship, exchange among faculty, and an environment conducive to member professional ethics development. However, this last purpose of such organizations has received the least amount of attention. Moreover, previous research has demonstrated that there are differences in perceived needs for professional ethics development between tenured and untenured faculty. In the current research 260 Academy of Management members were surveyed. The research identified differences between tenured and untenured management faculty (...) with respect to expectations for the Academy of Management to provide ethics education and research with respect to the professional code of conduct. Implications of the findings are discussed from a developmental perspective. Directions for future research are provided. (shrink)

“A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes” is a major contribution linking comparative psychology with clinical developmental neuropsychopathology. In this commentary, I place some critical remarks concerning the theory's explanation of sleep problems, inhibition, error monitoring, and motor control.

Both mainstream and disability bioethics sometimes contend that the self-assessment of disabled people about their own well-being is distorted by adaptive preferences that are only held because other, better options are unavailable. I will argue that both of the most common ways of understanding adaptive preferences—the autonomy-based account and the well-being account—would reject blanket claims that disabled people’s QOL self-assessment has been distorted, whether those claims come from mainstream bioethicists or from disability bioethicists. However, rejecting these generalizations for a more (...) nuanced view still has dramatic implications for the status quo in both health policy and clinical ethics. (shrink)

It is sometimes argued that medical professionals should protect a future child's rights by prohibiting disabled parents from using technology to deliberately have a disabled child because disability is taken as an inevitable, severe threat to a child's otherwise “open” future. I will first argue that the open future that allegedly protects a child's future autonomy is precluded by the very conditions needed to develop that future autonomy. Any child's future will be narrowed as they are socialized in a way (...) that gives them the capacity for autonomous choice. However, oppressive master narratives can diminish a future child's autonomy by distorting their narrative identity and constricting their agency. In fact, the open future argument does just this by advancing one of the most damaging master narratives about disability: that disability inevitably and severely restricts a person's autonomy and closes their future. (shrink)

As a result of numerous, highly publicized, ethical breaches, firms and their agents are under ongoing scrutiny. In an attempt to improve both their image and their ethical performance, some firms have adopted ethical codes of conduct. Past research investigating the effects of ethical codes of conduct on behavior and ethical attitudes has yielded mixed results. In this study, we again take up the question of the effect of ethical codes on ethical attitudes and find strong evidence to suggest that (...) business professionals employed at firms with ethical codes of conduct are significantly less accepting of ethically questionable behavior toward most stakeholders. One notable exception relates to ethical actions toward customers. (shrink)

It may seem obvious that causing disability in another person is morally problematic in a way that removing or preventing a disability is not. This suggests that there is a moral asymmetry between causing disability and causing non-disability. This chapter investigates whether there are any differences between these two types of actions that might explain the existence of a general moral asymmetry. After setting aside the possibility that having a disability is almost always bad or harmful for a person (a (...) view that we have critiqued at length elsewhere), seven putative differences are considered. Ultimately, it is concluded that none of these seven factors can ground a general moral asymmetry between causing disability and causing non-disability, though each factor can provide some moral reason to avoid causing disability in certain particular cases. (shrink)

The authors delineate the nature and neglect of integrity capacity and global business citizenship by world business leaders. They discuss how the philosophical analysis of moral and economic complexity enhances judgment integrity capacity and global business citizenship. Finally, the authors recommend positive action steps to improve global business citizenship and leadership integrity capacity through a balanced and inclusive pluralistic economic philosophy.

During the Middle Ages, philosophers and theologians argued over the extramental reality of universal forms or essences. In the early modern period, the relation between subjectivity and objectivity, the individual self and knowledge of the outside world, was a rich subject of debate. Today, there is considerable argument about the relation between spontaneity and determinism within the evolutionary process, whether a principle of spontaneous self-organization as well as natural selection is at work in the aggregation of molecules into cells and (...) the development of primitive forms of life into complex organisms. In _Subjectivity, Objectivity and Intersubjectivity_, Joseph A. Bracken proposes that what is ultimately at stake here is the age-old problem of the relationship between the One and the Many, universality and particularity on different levels of existence and activity within nature. Bracken rejects traditional models of this relationship, wherein either the One or the Many is presupposed to have priority over the other. He instead suggests that a new social ontology—one that is grounded in a theory of universal intersubjectivity—protects both the concrete particularity of individual entities in their specific relations to one another and their enduring corporate reality as a stable community or environment within Nature. What emerges is a bold reimagining of the sometimes strained relationship between religion and science. Bracken's clear writing, sophisticated philosophical analysis, and exemplary scholarship will lend this new work an enthusiastic appreciation by readers with deep interests in philosophy and philosophical theology. (shrink)

The Johns Hopkins-Fogarty African Bioethics Training Program (FABTP) has offered a fully-funded, one-year, non-degree training opportunity in research ethics to health professionals, ethics committee members, scholars, journalists and scientists from countries across sub-Saharan Africa. In the first 9 years of operation, 28 trainees from 13 African countries have trained with FABTP. Any capacity building investment requires periodic critical evaluation of the impact that training dollars produce. In this paper we describe and evaluate FABTP and the efforts of its trainees.Our data (...) show that since 2001, the 28 former FABTP trainees have authored or co-authored 105 new bioethics-related publications; were awarded 33 bioethics-related grants; played key roles on 78 bioethics-related research studies; and participated in 198 bioethics workshops or conferences. Over the past nine years, trainees have collectively taught 48 separate courses related to bioethics and have given 170 presentations on various topics in the field. Many former trainees have pursued and completed doctoral degrees in bioethics; some have become editorial board members for bioethics journals. Female trainees were, on average, less experienced at matriculation and produced fewer post-training outputs than their male counterparts. More comprehensive studies are needed to determine the relationships between age, sex, previous experience and training program outputs. (shrink)

In “Bioethics and the Moral Authority of Experience,” Nelson et al. explore what they refer to as “The Paradox of Experience.” The authors characterize this paradox formally as follows:(A) Personal...

Of the many far-reaching implications of Fincher & Thornhill's (F&T's) theory, we focus on the consequences of parasite stress for mating strategies, marriage, and the differing roles and restrictions for men and women. In particular, we explain how examination of cultures of honor can provide a theoretical bridge between effects of parasite stress and disproportionate emphasis on female purity.

In this paper, I make three arguments regarding Crisis Standards of Care developed during the COVID-19 pandemic. First, I argue against the consideration of third person quality of life judgments that deprioritize disabled or chronically ill people on a basis other than their survival, even if protocols use the language of health to justify maintaining the supposedly higher well-being of non-disabled people. Second, while it may be unavoidable that some disabled people are deprioritized by triage protocols that must consider the (...) likelihood that someone will survive intensive treatment, Crisis Standards of Care should not consider the amount or duration of treatment someone may need to survive. Finally, I argue that, rather than parsing who should be denied treatment to maximize lives saved, professional bioethicists should have put our energy into reducing the need for such choices at all by resisting the systemic injustices that drive the need for triage. (shrink)

The author identifies the major micro-, meso-, and macro-level financial risk shifting factors that contributed to the Great Global Recession and how the absence of a compelling moral vision of responsible financial risk management perpetuated the economic crisis and undermined the recovery by blind reliance upon insufficiently accountable bailouts. The author offers a new theoretical model of Sustainable Stakeholder Capitalism by exercising moral imagination which inclusively and moderately balances four multi-level factors: types of capitalism, moral theories, human nature drives, and (...) credit risk profiles. Finally, the author recommends micro-, meso-, and macro-level practical reforms to prevent a recurrence of the current economic freefall, to re-create systemic global financial institution integrity, and to promote responsible risk management for sustainable global prosperity for current and future generations. (shrink)

The authors propose the integrity capacity construct with its four dimensions (process, judgment, development and system dimensions) as a framework for analyzing and resolving behavioral, moral and legal complexity in business ethics' issues at the individual and collective levels. They claim that moral progress in business comes about through the increase in stakeholders who regularly handle moral complexity by demonstrating process, judgment, developmental and system integrity capacity domestically and globally.

Disability activists have sometimes claimed their disability has actually increased their well-being. Some even say they would reject a cure to keep these gains. Yet, these same activists often simultaneously propose improvements to the quality and accessibility of assistive technology. However, for any argument favoring assistive over curative technology to work, there must be a coherent distinction between the two. This line is already vague and will become even less clear with the emergence of novel technologies. This paper asks and (...) tries to answer the question: what is it about the paradigmatic examples of curative and assistive technologies that make them paradigmatic and how can these defining features help us clarify the hard cases? This analysis will begin with an argument that, while the common views of this distinction adequately explain the paradigmatic cases, they fail to accurately pick out the relevant features of those technologies that make them paradigmatic and to provide adequate guidance for parsing the hard cases. Instead, it will be claimed that these categories of curative or assistive technologies are defined by the role the technologies play in establishing a person’s relational narrative identity as a member of one of two social groups: disabled people or non-disabled people. (shrink)

Patients who are imminently dying sometimes experience symptoms refractory to traditional palliative interventions, and in rare cases, continuous sedation is offered. Samuel H. LiPuma, in a recent article in this Journal, argues that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia based on a higher brain neocortical definition of death. We contest his position that continuous sedation involves killing and offer four objections to the equivalency thesis. First, sedation practices are proportional in a way that physician-assisted suicide/euthanasia is not. (...) Second, continuous sedation may not entirely abolish consciousness. Third, LiPuma’s particular version of higher brain neocortical death relies on an implausibly weak construal of irreversibility—a position that is especially problematic in the case of continuous sedation. Finally, we explain why continuous sedation until death is not functionally equivalent to neocortical death and, hence, physician-assisted suicide/euthanasia. Concluding remarks review the differences between these two end-of-life practices. (shrink)