The increasing life expectancy of terminally-ill people has raised many public policy concerns about end-of-life care. Due to increased longevity and the lack of cures for illnesses like cancer and heart disease, palliative care, particularly pain management, has become an important mode OF medical therapy. Palliative care providers feel that “[h]ealth care professionals have a moral duty to provide adequate palliative care and pain relief, even if such care shortens the patient’s life.” Practitioners of forensic medicine grapple with determining when (...) to classify the death of a person formerly receiving palliative care as a non-natural death. Such classification may be paramount in the enforcement of new statutes that aim at preventing assisted suicide or monitoring the quality of health care, but it potentially places forensic medicine and palliative medicine in adversarial roles. (shrink)

Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits (...) the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals. (shrink)

Some bioethicists have argued in favor of a sliding scale notion of competence, paternalistically requiring greater competence in relation to more significant risk. I argue against a sliding scale notion, taking issue with the positions of Allen E. Buchanan and Dan W. Brock, Ian Wilkes, and Joel Feinberg. Rejecting arguments that a sliding scale is supported by legal cases, by ordinary usage, and by fallible judgments about competence, I argue in favor of greater evidence of competence when risk is greater. (...) Two clinical cases are examined, both involving amputation, to show that my fixed concept of competence, with a requirement of clearer evidence of competence when risk is high, better accounts for good moral decisions in bioethics. (shrink)

Researchers designing a clinical trial may be aware of disputed evidence of serious risks from previous studies. These researchers must decide whether and how to describe these risks in their model informed consent document. They have an ethical obligation to provide fully informed consent, but does this obligation include notice of controversial evidence? With ACCORD as an example, we describe a framework and criteria that make clear the conditions requiring inclusion of important controversial risks. The ACCORD model consent document did (...) not include notice of prior trials with excess death. We develop and explain a new standard labeled risk in equipoise. We argue that our approach provides an optimal level of integrity to protect the informational needs of the reasonable volunteers who agree to participate in clinical trials. We suggest language to be used in a model consent document and the informed consent discussion when such controversial evidence exists. (shrink)

People often choose intuitive rather than equally valid nonintuitive alternatives. The authors suggest that these intuitive biases arise because intuitions often spring to mind with subjective ease, and the subjective ease leads people to hold their intuitions with high confidence. An investigation of predictions against point spreads found that people predicted intuitive options more often than equally valid nonintuitive alternatives. Critically, though, this effect was largely determined by people's confidence in their intuitions. Across naturalistic, expert, and laboratory samples, against personally (...) determined point spreads, and even when intuitive confidence was manipulated by altering irrelevant aspects of the decision context, the authors found that decreasing intuitive confidence reduced or eliminated intuitive biases. These findings indicate that intuitive biases are not inevitable but rather predictably determined by contextual variables that affect intuitive confidence. (shrink)

Ground-breaking research by leading international researchers on the nature, functions and characteristics of social motivation.

This project explores the ethical obligations of food journalists. Using history, normative, and feminist theory, I argue that if specific media is going to be considered food journalism, then we should be able to identify its service to citizens. This project thus seeks a unified view for evaluating the democratic and caring potential of food journalism. I outline some of the contours of quality food journalism – its principles, practices and forms – through both historical and contemporary examples. I show (...) how both sets of food journalists adhere(d) to traditional notions of democracy-serving communication while also employing a more situated ethic of care. Ultimately, I argue that quality food journalists should adopt this care ethic addressing citizen-eaters, as this nourishes the relationships necessary for democratic worldmaking and gives us the best opportunity of collectively eating and living well. (shrink)

Lukas J. Meier et al. offer the promise of a pathway for resolving clinical bioethical problems using an artificial intelligence interface. The ultimate goal, we assume, is...

Clinical ethics consultants should show bold moral courage in discharging their duties to patients, families, and healthcare providers. Given the corrosive impact on trust, and on the appropriate d...

The metaphysics of presence has led not only to the closure of rationalized systems that define modernity, but also to what can appear as its opposite, the freely flowing movement of information (and of capital) characteristic of the post-modern “de-centered” world. Ideas, after all, require a depth dimension that ultimately proves irreconcilable with the one-dimensionality of the purely present. It is for this reason that the rejection of metaphysics (which is only the final consequence of the metaphysics of presence) fails (...) to solve our dilemma. An alternative strategy is to attempt the recovery of the living heart of metaphysics, its open and ecstatic gaze, rather than its final consequence, the constrictive will to closure, determination, and power. This is the genuinely Socratic possibility, a metaphysics not of presence but of radical transcendence. To clarify that possibility, it is necessary to show how Socrates himself was characterized less by practical and political concerns than by a metaphysical vision directed not to presence but to the unknowable region that opens with death. Socrates’ irony and courage have the same source, what I call a metaphysics of “silence.”. (shrink)

The objective of this article is to examine the nature of individual and social responses to the nuclear threat from psychological and sociological perspectives on ignorance. It is argued that a constructed and managed ignorance concerning the nuclear threat serves many functions, structuring an individual and social reality which is reassuring, meaningful, and both individually and collectively self-serving. A sociology of ignorance framework is employed to articulate the possible benefits of “not knowing about” and collaboratively “not dealing with” the nuclear (...) threat, as well as to define the longer-term costs of ignoring this threat. The distinctive roles played by various kinds of ignorance regarding this important issue are investigated, and the conventional wisdom that knowledge of the consequences of a nuclear war is the only way to prevent its occurrence is challenged. (shrink)

In Socrates among Strangers, Joseph P. Lawrence reclaims the enigmatic sage from those who have seen him either as a prophet of science, seeking the security of knowledge, or as a wily actor who shed light on the dangerous world of politics while maintaining a prudent distance from it. The Socrates Lawrence seeks is the imprudent one, the man who knew how to die. The institutionalization of philosophy in the modern world has come at the cost of its most (...) vital concern: the achievement of life wisdom. Those who have ceased to grow (those who think they know) close their ears to the wisdom of strangers—and Socrates, who stood face to face with death, is the archetypal stranger. His avowal of ignorance, Lawrence suggests, is more needed than ever in an age defined by technical mastery and expert knowledge. (shrink)

Moral distress has been the subject of extensive research and debate in the nursing ethics literature since the mid-1980s, but the concept has received comparatively little attention from those working outside of applied ethics. In this article, I defend a care ethical account of moral distress, according to which the phenomenon is the product of an agent’s inability to live up to one of her caring commitments. This account has a number of attractions. First, it places a greater emphasis on (...) the importance of the relationship between the caregiver and her cared-for than that found in previous accounts. Second, it does not make problematic assumptions about the correctness of a caregiver’s moral judgments, as has been claimed in relation to previous accounts of moral distress. Finally, my account allows for a clear conceptual distinction to be drawn between moral distress and other forms of negative moral emotion such as guilt and regret. Earlier accounts draw this distinction by appealing to the causal aetiology of moral distress, but as I show here, such appeals are ultimately unsuccessful unless they are made from an explicitly care ethical starting point. One of the implications of my account is that moral distress has the potential to occur in the context of any caregiving relationship. This claim is explored in the final section of the paper, in relation to student-teacher and parent-child caregiving. (shrink)

In order for a moral theory to support application it must be able to provide determinate answers to actual moral problems or, at the least, to significantly narrow acceptable options. It must also support the development of a genuine consensus, one that is disinterested, reasonable, and unbiased. I argue that theories concentrating on principles, or on rules, or on particular cases fail to meet these standards. A full coherence theory, taking into account principles, rules, practices, and judgments holds the greatest (...) promise for successful application. I present a detailed outline of a full coherence theory that is principled, pluralistic, and comprehensive. This coherence theory includes three basic principles (expressed both negatively and positively), but binds these, in terms of their explication and application, to rules and practices. This theory respects current practices but also directs us to change practices and institutions and even the interpretation of basic moral principles. The theory includes ways to determine which aspect of moral experience should take precedence in given circumstances, ways to determine who has particular obligations, and how — by means of a mutuality principle — value may be enhanced under conditions of value conflict. (shrink)

This book offers a comprehensive approach to moral experience. It respects the many dimensions of our moral life which elude the traditional philosophical theories that deal exclusively with principles, consequences, virtues, or some other single dimension. Working from a critique of such traditions, the book shows how to integrate their values in a dynamic coherence. Thus, it is not just another ethical theory, but a new level of philosophizing in ethics which rewards the reader with an enlarged and enriched vision (...) of our complexity as moral beings. (shrink)