Background: Previous research has identified a link between the loss of a significant person, grief complications, and substance abuse. People with substance use disorder are more vulnerable to complicated grieving symptoms following loss. From sociocognitive theories, the model of coping with stress assumes that substance use is one of the responses used to cope with traumatic life events. The main objective of this study is to identify the coping strategies of people with SUD and to analyze their relationship to complicated (...) grief.Methods: A sample of 196 bereaved drug-dependent patients was assessed, after providing written consent, in sociodemographic variables, drug and bereavement related characteristics, CG symptomatology and coping strategies.Results: There are differences in relation to the coping strategies used among patients with CG, using more those focused on emotional expression, social withdrawal, wishful thinking, and self-criticism.Conclusion: We can conclude that, in general, CG in patients with SUD is more associated with the use of less adaptive coping strategies. This data can contribute to a better understanding of the different variables involved in the grieving process among people with SUD. It is important to point out the clinical implications of addressing what the coping strategies associated with improved grief outcomes among people with addiction problems are. (shrink)

The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to “mental privacy.” In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are—at least for now—no different from those raised by other well-understood data collection (...) technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum’s “contextual integrity” theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts—healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy. (shrink)

BackgroundEthics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribute to underutilization.MethodsThis was a cross-sectional single-health system, anonymous written online survey, which was developed by the UCSD Health Clinical Ethics Committee and distributed by Survey Monkey. We compare responses between physicians, APPs, and nurses using standard parametric and non-parametric statistical (...) methods. Satisfaction with ethics consult and likelihood of calling Ethics service again were assessed using a 0–100 scale using a 5-likert response structured (0 being “not helpful at all” to 100 being “extremely helpful”) and results presented using box plots and interquartile ranges (IQR).ResultsFrom January to July 2019, approximately 3800 surveys were sent to all physicians, APPs and nurses with a return rate of 5.5—10%. Although the majority of respondents had encountered an ethical dilemma (85–92.1%) only approximately half had ever requested an Ethics consult. The primary reason for physicians never having requested a consult was that they never felt the need for help (41%). For APPs the primary reasons were not knowing an Ethics consult service was available (33.3%) or not knowing how to contact Ethics (27.8%). For nurses, it was not knowing how to contact the Ethics consult service (30.8%) or not feeling the need for help (26.2%). The median satisfaction score (IQR) for Ethics consult services rated on a 0–100 scale, from physicians was 76 (29), for AAPs 89 (49), and nurses 70 (40) (p = 0.62). The median (IQR) of likelihood of consulting Ethics in the future also on a 0–100 scale was 71 (47) for physicians, 69 (45) for APPs, and 61 (45) for nurses (p = 0.79). APP’s and nurses were significantly more likely than physicians to believe that the team did not act on the Ethics consult’s recommendations.ConclusionsBased on the results presented, we were able to identify actionable steps to better engage healthcare providers—and in particular APPs and nurses—and scale up institutional educational efforts to increase awareness of the role of the Ethics consult service at our institution. Actionable steps included implementing a system of ongoing feedback that is critical for the sustainability of the Ethics service role. We hope this project can serve as a blueprint for other hospital-based Ethics consult services to improve the quality of their programs. (shrink)

Children acquire complex concepts like DOG earlier than simple concepts like BROWN, even though our best neuroscientific theories suggest that learning the former is harder than learning the latter and, thus, should take more time (Werning 2010). This is the Complex- First Paradox. We present a novel solution to the Complex-First Paradox. Our solution builds on a generalization of Xu and Tenenbaum’s (2007) Bayesian model of word learning. By focusing on a rational theory of concept learning, we show that it (...) is easier to infer the meaning of complex concepts than that of simple concepts. (shrink)

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both (...) distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19. (shrink)

Die Debatte genießt in liberalen Demokratien einen hohen Stellenwert. Das gilt nicht nur für den öffentlichen Raum, sondern auch für den Schulunterricht, der Heranwachsende auf die Teilnahme an dieser Praxis vorbereiten soll. Wie kontrovers soll und darf es im Klassenzimmer selbst aber zugehen? Wie steht es etwa mit antidemokratischen oder illiberalen Positionen? Sollen auch sie kontrovers diskutiert werden, oder sollen die Lernenden hier vielmehr von vornherein zur Übernahme der als legitim vorausgesetzten Position gebracht werden? Wenn ja, auf welche Weise? Diese (...) Fragen werden in der Bildungsphilosophie intensiv diskutiert. Der Beitrag befasst sich mit der sogenannten Kontroverse um Kontroversitätsgebote. Konkret widmet er sich Johannes Drerups Versuch, den Raum der Kontroverse im Klassenzimmer zu eröffnen und zugleich zu begrenzen. Zunächst wird betrachtet, wie er die Grenzen des Diskurses zieht und inwieweit er diese Grenzziehung überzeugend begründet. Dann werden die unterrichtspraktischen Konsequenzen, die er selbst daraus ableitet, und das Konzept eines „direktiven Unterrichtens“ im Kontext ethischer Debatten beleuchtet. Schließlich wird eine alternative Herangehensweise angedeutet: Statt zu versuchen, den Lernenden anhand kontroverser Themen top down einen fixen Wertekanon zu vermitteln, können Lehrpersonen solche Kontroversen auch zum Anlass nehmen, die Wertvorstellungen der Schüler:innen gemeinsam mit ihnen aufzudecken, zu explizieren und kritisch zu durchdenken. Eine solche Praxis dialogischer Wertebildung ist zwar für alle Beteiligten herausfordernder, scheint aber besser zur Idee der Demokratiebildung zu passen. (shrink)

ABSTRACTThis article studies multi-stakeholder initiatives as spaces for both deliberation and contestation between constituencies with competing discourses and disputed values, beliefs, and preferences. We review different theoretical perspectives on MSIs, which see them mainly as spaces to find solutions to market problems, as spaces of conflict and bargaining, or as spaces of consensus. In contrast, we build on a contestatory deliberative perspective, which gives equal value to both contestation and consensus. We identify four types of internal contestation which can be (...) present in MSIs—procedural, inclusiveness, epistemic, and ultimate-goal—and argue that embracing contestation and engaging in ongoing revision of provisional agreements, criteria, and goals can enhance the democratic quality of MSIs. Finally, we explore the implications of this perspective for theorizing about the democratic quality in MSIs and about the role of corporations in transnational governance. (shrink)

Much is being made of local food. It is at once a social movement, a diet, and an economic strategy—a popular solution—to a global food system in great distress. Yet, despite its popularity or perhaps because of it, local food (especially in the US) is also something of a chimera if not a tool of the status quo. This paper reflects on and contrasts aspects of current local food rhetoric with Dalhberg’s notion of a regenerative food system. It identifies three (...) problematic emphases—the locavore emphasis, the Wal-Mart emphasis, and the Pollan emphasis—and argues that they are shifting local food (as a concept and a social movement) away from the deeper concerns of equity, citizenship, place-building, and sustainability. It is suggested that local food activists and advocates might consider the use of multiple methodologies and forms of expression to explore the integration and reintegration of local food into diverse and redundant place-based practice. A short case study of a low-income, urban neighborhood in Lansing, Michigan, illustrates the value of contextual analysis for more fully enabling the local food movement and a regenerative food system. (shrink)

Over the last decade, Corporate Social Responsibility (CSR) has been defined first as a concept whereby companies decide voluntarily to contribute to a better society and cleaner environment and, second, as a process by which companies manage their relationship␣with stakeholders (European Commission, 2001. Nowadays, CSR has become a priority issue on governments’ agendas. This has changed governments’ capacity to act and impact on social and environmental issues in their relationship with companies, but has also affected the framework in which CSR (...) public policies are designed: governments are incorporating multi-stakeholder strategies. This article analyzes the CSR public policies in European advanced democracies, and more specifically the EU-15 countries, and provides explanatory keys on how governments have understood, designed and implemented their CSR public policies. The analysis has entailed the classification of CSR public policies taking into consideration the actor to which the governments’ policies were addressed. This approach to the analysis of CSR public policies in the EU-15 countries leads us to observe coinciding lines of action among the different countries analyzed, which has enabled us to propose a ‹four ideal’ typology model for governmental action on CSR in Europe: Partnership, Business in the Community, Sustainability, and Citizenship, and Agora. The main contribution of this article is to propose an analytical framework to analyze CSR public policies, which provide a perspective on the relationships between governments, businesses, and civil society stakeholders, and enable us to incorporate the analysis of CSR public policies into a broader approach focused on social governance. (shrink)

Trust is a core feature of the physician-patient relationship, and risk is central to trust. Patients take risks when they trust their providers to care for them effectively and appropriately. Not all patients take these risks: some medical relationships are marked by mistrust and suspicion. Empirical evidence suggests that some patients and families of color in the United States may be more likely to mistrust their providers and to be suspicious of specific medical practices and institutions. Given both historical and (...) ongoing oppression and injustice in American medical institutions, such mistrust can be apt. Yet it can also frustrate patient care, leading to family and provider distress. In this paper, I propose one way that providers might work to reestablish trust by taking risks in signaling their own trustworthiness. This interpersonal step is not meant to replace efforts to remedy systemic injustice, but is an immediate measure for addressing mistrust in occurrent cases. (shrink)

This paper begins with the lived accounts of emergency and critical care medical interventions in which an unhoused person is brought to the emergency department in cardiac arrest. The case is a dramatised representation of the extent to which biopolitical forces via reduction to bare life through biopolitical and necropolitical operations are prominent influences in nursing and medical care. This paper draws on the scholarship of Michel Foucault, Giorgio Agamben, and Achille Mbembe to offer a theoretical analysis of the power (...) dynamics that influence the health care and death care of patients who are caught in the auspices of a neoliberal capitalist healthcare apparatus. This paper offers analysis of the overt displays of biopower over those individuals cast aside as generally unworthy of access to healthcare in a postcolonial capitalist system, in addition to the ways in which humans are reduced to ‘bare life’ in their dying days. We analyse this case study through Agamben's description of thanatopolitics, a ‘regime of death’, and the technologies that accompany the dying process, particularly in that of the homo sacer. Additionally, this paper illustrates the ways in which necropolitics and biopower are integral to understanding how the most advanced and expensive medical interventions make visible the political values of the healthcare system and how nurses and healthcare functions in these deathworlds. The purpose of this paper is to develop a greater understanding of biopolitical and necropolitical operations in acute and critical care environments, and to offer guidance to nurses in these spaces as they work to uphold ethical duties in a system that increasingly dehumanises. (shrink)

The aim of the chapter is to discuss and evaluate the epistemic role of emotions in participatory sense-making, assuming 4Ecognition as background. I first ask why could emotions be beneficial for the collective processes of knowledge, especially discussing Battaly and arguing for a conceptualisation of emotions as socially extended motivations in virtue epistemology; then, I discuss participatory sense-making, both conceptually and phenomenologically, arguing for a fundamental role played by emotions in boosting epistemic cooperation and determining the quality of social bonds. (...) I advocate their specific function in epistemic cooperation. Epistemic cooperation is what brings about the generation of a shared meaning in participatory sense-making and thus, since emotions function as socially extended motivations, they boost the relationships among the agents, bonding them to the aims of their epistemic community. (shrink)

As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive (...) alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual‐ or gender‐minority groups who likewise seek to pursue parenthood. We examine the history of access to current family‐building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual‐ or gender‐minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice. (shrink)

The challenge that confronts corporate decision-makers in connection with global labor conditions is often in identifying the standardsby which they should govern themselves. In an effort to provide greater direction in the face of possible global cultural conflicts, ethicistsThomas Donaldson and Thomas Dunfee draw on social contract theory to develop a method for identifying basic human rights: Integrated Social Contract Theory (ISCT). In this paper, we apply ISCT to the challenge of global labor standards, attempting to identify labor rights that (...) could serve as guides for corporations producing or outsourcing outside of their home country. In addition to identifying areas of universal agreement, we also examine whether ISCT is, in fact, a sufficient basis for determining worker rights; we seek to define the parameters of the “sweatshop” problem; we include the application and results of our ISCT analysis as applied to labor standards: the global labor rights hypernorms; and conclude that ISCT is sufficient only for rights that are universal. We also discuss whether market-driven decisions can identify the boundaries of labor rights, or at least assure that market outcomes are compatible with maintaining labor rights, in order to respond to the shortcomings of ISCT. We conclude with some comments on directions of analysis for labor rights determination. (shrink)

The aim of this article is to contribute to understanding the changing role of government in promoting corporate social responsibility (CSR). Over the last decade, governments have joined other stakeholders in assuming a relevant role as drivers of CSR, working together with intergovernmental organizations and recognizing that public policies are key in encouraging a greater sense of CSR. This paper focuses on the analysis of the new strategies adopted by governments in order to promote, and encourage businesses to adopt, CSR (...) values and strategies. The research is based on the analysis of an explanatory framework, related to the development of a relational analytical framework, which tries to analyze the vision, values, strategies and roles adopted by governments, and the integration of new partnerships that governments establish in the CSR area with the private sector and social organizations. The research compares CSR initiatives and public policies in three European countries: Italy, Norway and the United Kingdom, and focuses on governmental drivers and responses. The preliminary results demonstrate that governments are incorporating a common statement and discourse on CSR, working in partnership with the private and social sectors. For governments, CSR implies the need to manage a complex set of relationships in order to develop a win–win situation between business and social organizations. However, the research also focuses on the differences between the three governments when applying CSR public policies. These divergences are based on the previous cultural and political framework, such as the welfare state typology, the organizational structures and the business and social and cultural background in each country. (shrink)

Recent work at the junction of epistemology and political theory focuses on the notion of epistemic injustice, the injustice of being wronged as a knower. Miranda Fricker (2007) identifies two kinds of epistemic injustice. I focus here on hermeneutical injustice in an attempt to identify a difficulty for Fricker's account. In particular, I consider the significance of background social conditions and suggest that an epistemic injustice should not rely on other forms of disadvantage to achieve its status as an injustice. (...) Thus reformulated, the notion of epistemic injustice can help us to achieve an even deeper understanding of the relationship between knowledge and privilege. (shrink)

Taking Arthur Fine’s The Shaky Game as my inspiration, and the recent 25th anniversary of the publication of that work as the occasion to exercise that inspiration, I sketch an alternative to the “Naturalism” prevalent among philosophers of physics. Naturalism is a methodology eventuating in a metaphysics. The methodology is to seek the deep framework assumptions that make the best sense of science; the metaphysics is furnished by those assumptions and supported by their own support of science. The alternative presented (...) here, which I call “Locavoracity,” shares Naturalism’s commitment to making sense of science, but alters Naturalism’s methodology. The Locavore’s sense-making projects are piecemeal, rather than sweeping. The Locavore’s hypothesis is that the collection of local sense-making projects fails to issue a single overarching unifying framework deserving of the title “the metaphysics that makes the best sense of science.” I muster some examples supporting the Locavore hypothesis from the interpretation of quantum field theories. (shrink)

Lack of specificity around stakeholder identity remains a serious obstacle to the further development of stakeholder theory andits adoption in actual practice by business managers. Nowhere is this shortcoming more evident than in stakeholder theory’s treatment of the constituency known as “community.”In this paper we attempt to set forth what we call “the Problem of Community” as indicative of the definitional problems of stakeholdertheory. We then begin the process of gaining greater specificity around our notions of community and the role (...) of community in stakeholder theory and management. In doing so, we identify the emergence of two fairly new forms of community that we believe are particularly relevant to the stakeholder theorist and practicing manager. These two new variants of community—the virtual advocacy group and the community of practice—extend the notion of community in new directions, which have strikingly different implications for stakeholder theory and practice. (shrink)

Background: Moral decision-making consists of a complex process requiring individuals to evaluate potential consequences of personal and social decisions, including applied organizational contexts.Methods: This research aims to investigate the behavioral (offer responses and reaction times, RTs) and electrophysiological (EEG) correlates underlying moral decision-making during three different choice conditions (professional fit, company fit, and social fit) and offers (fair, unfair, and neutral).Results: An increase of delta and theta frontal activity (related to emotional behavior and processes) and beta frontal and central activity (...) (linked to cognitive and attentional processes) was found. A left beta, delta, and theta frontal activity was observed for fair offers in professional fit conditions, while increased right frontal delta and theta activity was found in response to unfair offers in company fit conditions. Also, an increase of left delta and theta parietal activity for unfair offers in social fit condition was detected. Finally, higher accepted responses were found for fair and neutral offers in professional and social fit conditions, with increased RTs for unfair offers suggesting decisions’ cognitive load and complexity.Conclusions: By revealing a greater involvement of left and right frontal areas in decision-making processes based on choices and offers, personal interest evaluations and emotional values, and of parietal areas in more prosocial and altruistic moral behavior, current findings provide information about the neural and behavioral correlates underlying company moral behavior. (shrink)

The aim of this chapter is to discuss the relevance that emotions can play in our epistemic life considering the state of the art of the philosophical debate on emotions. The strategy is the one of focusing on the three main models on emotions as evaluative judgements, bodily feelings, and perceptions, following the fil rouge of emotion intentionality for rising questions about their epistemic functions. From this examination, a major challenge to mainstream epistemology arises, the one that asks to provide (...) prominence to the epistemic agent and to her affects. This chapter discusses these implications, also providing an overview of the many alternatives available nowadays in epistemology, arguing for an open, comprehensive, and interdisciplinary approach to emotions in knowledge. (shrink)

The 2006 outbreak of E. coli O157:H7, traced to bagged spinach from California, illustrates a number of contradictions. The solutions sought by many politicians and popular food analysts have been to create a centralized federal agency and a uniform set of production standards modeled after those of the animal industry. Such an approach would disproportionately harm smaller-scale producers, whose operations were not responsible for the epidemic, as well as reduce the agroecological diversity that is essential for maintaining healthy human beings (...) and ecosystems. Why should responses that only reinforce the problem be proffered? We use the framework of accumulation and legitimation to suggest corporate and government motives for concealing underlying problems and reinforcing powerful ideologies of individualism, scientism, and centralizing authority. Food safety (or the illusion of safety) is being positioned to secure capital rather than public welfare. We propose implementing the principle of subsidiarity as a more democratic and decentralized alternative. Because full implementation of this principle will be resisted by powerful interests, some promising intermediate steps include peer production or mass collaboration as currently applied to disease prevention and surveillance, as well as studying nascent movements resisting current food safety regulations. (shrink)

This article examines the methodology of a core branch of contemporary political theory or philosophy: “analytic” political theory. After distinguishing political theory from related fields, such as political science, moral philosophy, and legal theory, the article discusses the analysis of political concepts. It then turns to the notions of principles and theories, as distinct from concepts, and reviews the methods of assessing such principles and theories, for the purpose of justifying or criticizing them. Finally, it looks at a recent debate (...) on how abstract and idealized political theory should be, and assesses the significance of disagreement in political theory. The discussion is carried out from an angle inspired by the philosophy of science. (shrink)

Positive Psychology has turned its attention to the study of emotions in a scientific and rigorous way. Particularly, to how emotions influence people’s health, performance, or their overall life satisfaction. Within this trend, Flow theory has established a theoretical framework that helps to promote the Flow experience. Flow state, or optimal experience, is a mental state of high concentration and enjoyment that, due to its characteristics, has been considered desirable for the development of the performing activity of performing musicians. Musicians (...) are a population prone to health problems, both psychological and physical, owing to different stressors of their training and professional activity. One of the most common problems is Musical Performance Anxiety. In this investigation, an electronic intervention program was carried out for the development of psychological self-regulation skills whose main objective was to trigger the Flow response in performing musicians and the coping mechanism for Musical Performance Anxiety. A quasi-experimental design was used with a control group in which pre- and post-measures of Flow State, Musical Performance Anxiety and, also, Social Skills were taken. Sixty-two performing musicians from different music colleges in Spain participated in the program. Results indicated that the intervention significantly improved Flow State, and Sense of Control, and decreased Music Performance Anxiety, and self-consciousness of the participants in the EG but not CG. The changes in the EG after the program showed the inverse relationship between Flow and Anxiety. Two important theoretical factors of both variables, such as worry and the feeling of lack of control, could be involved. The results are under discussion and future lines of research are proposed. (shrink)

Previous research has underlined the significance of practical wisdom pertaining to corporate sustainability. Recent studies, however, have identified managing opposing but interlocked tensions related to environmental, social, and economic aspects as one of the most crucial future challenges in CS. Therefore, we apply the established link between wisdom and sustainability to the pressing topic of managing tensions in CS. We commence with a literature overview of tensions in sustainability management, which manifests our basic work assumption concerning the need for practical (...) wisdom in CS. We then discuss the threefold, mutual interconnectedness between practical wisdom and tension management in CS, which we illustrate in a conceptual model. Thereafter, we develop a set of propositions on how a practical wisdom approach influences CS in practice and how it differs from a business-case approach. In recognition of the conceptual character of our paper, we conclude by outlining potential practical applications and theoretical implications of the model and of the propositions. Limitations and avenues for further research are discussed. (shrink)

While no one seems to believe that business schools or their faculties bear entire responsibility for the ethical decision-making processes of their students, these same institutions do have some burden of accountability for educating students surrounding these skills. To that end, the standards promulgated by the Association to Advance Collegiate School of Business, their global accrediting body, require that students learn ethics as part of a business degree. However, since the AACSB does not require the inclusion of a specific course (...) to achieve this objective, it may be satisfied by establishing a stand-alone course in ethical decision-making, by integrating ethical decision-making into the existing curricula, by some combination of the two strategies, or through some alternative mechanism. Notwithstanding the choice of delivery process, though, the institution must ensure that it is able to demonstrate the students' achievement of learning with regard to ethics, a bar that was raised, or arguably simply modified, in 2003. With learning objectives designed precisely to measure the student delta based on content, process and engagement in a particular class, those programs that have opted for stand-alone ethics courses may be more prepared to respond to assessment-related inquiries regarding their programs or satisfaction of the standards. The relevance of the AACSB standards modification to the current efforts at ethics integration in business programs is instead a re-examination of how to create a program of integration that is designed to ensure the most effective learning results possible, while responding to the challenges presented by the integrated approach. The purpose of this article is to explore some of those challenges that may be somewhat universal to business school programs implementing the integrated approach, and to share one large university's response to those challenges, along with lessons learned. (shrink)

Se trata de la reseña bibliográfica del libro de Emmanuel Biset et. al., Sujeto, una categoría en disputa.

Health policymakers employ utility measures to inform resource allocation decisions. They often rely on a conceptual tool called the quality-adjusted life year that discounts the value of years lived in a state of disability relative to years lived in full health. A representative sample of the general public is asked to place values on hypothetical health states as part of a standard gamble or time trade-off task. Policymakers use the resulting values to calculate the number of QALYs gained through particular (...) interventions. Utilitarian reasoning mandates that policymakers maximize QALYs gained per unit cost.Although many scholars have explored the problems of distributive justice that arise from this system... (shrink)

In Constructing the World, Chalmers seeks to articulate and defend an important epistemic accessibility thesis, the Scrutability of Truth, which is crucial to Chalmers’ rationalist approach to meaning and modality. Chapters 3 and 4 of the book are devoted to persuading us that the move from weaker to stronger forms of Scrutability is intuitively plausible. In these comments, I want to question this move. The plausibility of strong forms of Scrutability hinges on controversial views about epistemic norms for answering ‘what (...) is x?’ questions that semantic externalists have good reason to reject. (shrink)

Background Self-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefits and risks of SBDs, few data on stakeholder perspectives on SBDs are available. Aims The aim of the study was to identify opportunities and challenges of SBDs perceived by stakeholders (...) who have personal or professional experience with legally enforceable SBDs. Methods Data collection was carried out in the Netherlands from February 2020 to October 2021 by means of semi-structured interviews. Participants were selected through purposive sampling and snowball methods. Interviews were conducted with mental health service users (n = 7), professionals (n = 13), and an expert on SBD policy (n = 1), resulting in a total number of 21 interviews. The data were analyzed thematically. Results Perceived benefits of SBDs included increased autonomy, improvement of the therapeutic relationship, possibility of early intervention and prevention of harm, prevention of compulsory care, reduction of the duration of compulsory care and recovery, mitigation of negative experiences around compulsory care, and guidance for professionals in providing compulsory care. Perceived risks included infeasibility of SBD instructions, difficulty in decision-making around SBD activation, limited accessibility of SBDs, disappointment of service users due to non-compliance with SBDs, and limited evaluation and updating of SBD content. Barriers to SBD completion included lack of knowledge of SBDs among professionals, lack of motivation or insight among service users, and lack of professional support for SBD completion. Facilitators of SBD completion and activation included support for SBD completion, involvement of relatives and peer experts, specification of SBD content, and evaluation of compulsory care and SBD content. The new legal framework was regarded as having both positive and negative effects on SBD implementation. Conclusions Stakeholders who have personal or professional experience with legally enforceable SBDs perceive SBDs as having important benefits and tend not to articulate the fundamental ethical concerns about SBDs which can be found in the ethics and legal literature. Instead, they perceive ethical and practical challenges that can be addressed through the implementation of suitable safeguards. (shrink)

Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying (...) ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia. (shrink)

ABSTRACT A widespread thesis in contemporary philosophy of language is that certain speech constitutes, rather than merely causes, harm. McGowan develops a prescriptive account of harm constitution, according to which harm-constituting speech enacts norms that prescribe harm. Ordinary verbal bigotry, she claims, is harmful in this sense. We submit that the norms enacted by ordinary racist (or otherwise bigoted) utterances are not prescriptive. In our view, ordinary verbal bigotry enacts ‘non-neutrally’ permissive norms rendering harmful behaviours locally permitted—and indeed preferred over (...) non-harmful options. We conclude by arguing that, although ordinary verbal bigotry enacts non-prescriptive norms, it can still constitute harm. (shrink)

Bioethics is a field in which innovation is required to help prevent and respond to zoonotic diseases with the potential to cause epidemics and pandemics. Some of the developments necessary to fight pandemics, such as COVID-19 vaccines, require public debate on the benefits and risks of individual choice versus responsibility to society. While these debates are necessary, a more fundamental ethical innovation to rebalance human, animal, and environmental interests is also needed. One Health (OH) can be characterized as a strategy (...) that recognizes and promotes the synergy between human, animal, and environmental health. Yet, despite the recognition that these entities are interdependent, there is a pronounced inequality in the power relations between human, non-human animal, and the environmental interests which threatens the well-being of all. Until OH can ensure the moral status of animals and the environment and thereby the equal consideration of these interests, it will struggle to protect non-human interests and, as a result, human health. To create a sustainable health system requires a renewed concept of justice that is ecocentric in nature and an application of OH that is flexible and responsive to different ethical interests (e.g., person-centred care and physician responsibilities). Ultimately, to save themselves, humans must now think beyond themselves. Bioethics must assume a key role in supporting the developments required to create and maintain relationships able to sustain environmental and human health. (shrink)

This paper examines faculty perceptions regarding ethical behavior among colleagues and students, and faculty practices with regard to teaching ethics in three institutions over a 4-year period. Faculty reported an uneven pattern of unethical behavior among colleagues over the period. A majority of business courses included ethics, however as both a specific topic on the syllabus and within course discussions. The percentage of courses with ethics discussions increased in 2006, however, the time allocated to these discussions decreased. These results suggest (...) that faculty are approaching ethics instruction less formally, raising concerns over the success of curriculum integration. (shrink)

The covert administration of medication occurs with incapacitated patients without their knowledge, involving some form of deliberate deception in disguising or hiding the medication. Covert medication in food is a relatively common practice globally, including in institutional and homecare contexts. Until recently, it has received little attention in the bioethics literature, and there are few laws or rules governing the practice. In this paper, we discuss significant, but often overlooked, ethical issues related to covert medication in food. We emphasise the (...) variety of ways in which eating has ethical importance, highlighting what is at risk if covert administration of medication in food is discovered. For example, losing trust in feeders and food due to covert medication may risk important opportunities for identity maintenance in contexts where identity is already unstable. Since therapeutic relationships may be jeopardised by a patient’s discovery that caregivers had secretly put medications in their food, this practice can result in an ongoing deception loop. While there may be circumstances in which covert medication is ethically justified, given a lack of suitable alternatives, we argue that in any particular case this practice should be continually re-evaluated in light of the building moral costs to the relational agent over time. (shrink)

Late in life, Foucault identified with “the critical tradition of Kant,” encouraging us to read both thinkers in new ways. Kant’s “Copernican” strategy of grounding knowledge in the limits of human reason proved to stabilize political, social-scientific, and medical expertise as well as philosophical discourse. These inevitable limits were made concrete in historical structures such as the asylum, the prison, and the sexual or racial human body. Such institutions built upon and shaped the aesthetic judgment of those considered “normal.” Following (...) Kant through all of Foucault’s major works, this book shows how bodies functioned as “problematic objects” in which the limits of post-Enlightenment European power and discourse were imaginatively figured and unified. It suggests ways that readers in a neoliberal political order can detach from the imaginative schemes vested in their bodies and experiment normatively with their own security needs. (shrink)

The following address considers the relevance of business ethics education to our students. Is our concept of ethics one of practiceand application? And, if so, are we accountable to our students, our institutions and ourselves, for the practical impact that we haveor, conversely, that we do not have? Aren’t we responsible in part if one of our students ventures forth and does not act in an ethicalmanner? Though a positive response to this query may not be popular, what is the (...) alternative? If we are not responsible for the impact(or lack thereof) that we have on our students, then what is our purpose? The discussion further explores the nature of this impact andthe process by which we can amplify the results. (shrink)

M. Laura Gemelli Marciano ist Titularprofessorin für Klassische Philologie an der Universität Zürich.

Zusammenfassung Hintergrund Stigmatisierung hat einen erheblichen Einfluss auf die Gesundheit verschiedener gesellschaftlicher Gruppen und trägt zu Ungleichheiten im Gesundheitswesen bei. Sexarbeit ist mit erheblichem sozialem Stigma verbunden, das sich nachteilig auf den Zugang von Sexarbeiter*innen zur Gesundheitsversorgung auswirkt. Die vorliegende explorative Studie gibt erste Einblicke in die Sichtweisen von Sexarbeiter*innen und Berater*innen in Deutschland auf den Zugang, die Bedürfnisse und die Barrieren von Sexarbeiter*innen in Bezug auf die Gesundheitsversorgung. Dabei lag der Fokus auf einem etablierten Netzwerk von Gesundheitsangeboten für Sexarbeiter*innen (...) in Bochum. Methoden Leitfadengestützte Interviews wurden mit 4 Berater*innen durchgeführt, die soziale und medizinische Beratung für Sexarbeiter*innen anbieten, sowie mit 3 Sexarbeiter*innen, die diese Angebote nutzen. Die Interviews wurden mittels qualitativer Inhaltsanalyse nach Kuckartz ausgewertet. Ergebnisse Es zeigten sich verschiedene Hürden bei der Inanspruchnahme von Gesundheitsversorgung, insbesondere aufgrund unzureichender Krankenversicherung oder fehlendem Wissen über den eigenen Krankenversicherungsstatus, Sprachbarrieren, Bürokratie, Mobilität und Diskriminierung in der Gesundheitsversorgung. Diskriminierung aufgrund von Sexarbeit überschnitt sich mit anderen Diskriminierungsformen, wie beispielsweise antislawischem Rassismus oder der Stigmatisierung von Schwangerschaftsabbrüchen. Spezifische Bedürfnisse und Barrieren wurden hinsichtlich psychischer Gesundheit angegeben, die sich als wichtiges Thema für Sexarbeiter*innen erwies. Die bestehenden kostenlosen, anonymen und zugänglichen Angebote für Sexarbeiter*innen, insbesondere aufsuchende Angebote, wurden als hilfreich beschrieben. Sexarbeiter*innen und Berater*innen wiesen auf einen Mangel an Angeboten für unterschiedliche Bedürfnisse von Sexarbeiter*innen hin, die über Tests auf sexuell übertragbare Infektionen und deren Behandlung hinausgehen, z. B. im Bereich der psychischen Gesundheit. Schlussfolgerung Nach wie vor bestehen Barrieren für den Zugang zur Gesundheitsversorgung, von denen viele besonders Sexarbeiter*innen mit Migrationsgeschichten aus osteuropäischen Ländern betreffen. Die Studie zeigt, dass die Etablierung antidiskriminierender Gesundheitsangebote für Sexarbeiter*innen notwendig ist. Bei der Entwicklung solcher Angebote sollten die Perspektiven von Sexarbeiter*innen eine zentrale Rolle einnehmen. (shrink)

The American Assembly of Collegiate Schools of Business has called for stronger ethics programs. There are two problems with this battle cry. First, the AACSB rejects, with weak arguments, the single best way to get ethics into the curriculum. Second, the AACSB can only vaguely describe some unpromising alternatives to that strategy. A number of leading business ethicists have challenged the AACSB to defend and clarify its views, to little avail. The proposed Procedures and Standards cannot by themselves bring about (...) any significant change in the teaching of business ethics. There is a gap between the AACSB’s professed objectives and the means for achieving the objectives and determining whether they are being achieved. The Statement about Curriculum Content gives great prominence to the teaching of business ethics, but the interpretation of the statement, especially in the standards for measuring achievement, shows how improbable it is that the proposed Procedures and Standards will have the desired impact. We must recognize the constraints on the AACSB as we consider current standards and the controversy over a free-standing course versus an integrated curricular approach. The evident conclusion is a call, not only to the AACSB but to all business school educators, to set the stage for strengthened ethics education rather than to have standards imposed on us from outside. (shrink)

Laura D'Olimpio argues that aesthetic education ought to be a compulsory part of education for all students, from pre-primary through to high school, as it is essential that young people have the opportunity to make art, experience and understand art and be informed as to the artistic history and aesthetic theories that have shaped their own culture and others. The book defends arts education on the basis of art's distinctive value and centrality to human experience. It also engages with (...) topics such as the art teacher's role in the classroom, curricula concerns and gleaning moral meanings from artworks. (shrink)

Background While the theoretical benefits and harms of Artificial Intelligence (AI) have been widely discussed in academic literature, empirical evidence remains elusive regarding the practical ethical challenges of developing AI for healthcare. Bridging the gap between theory and practice is an essential step in understanding how to ethically align AI for healthcare. Therefore, this research examines the concerns and challenges perceived by experts in developing ethical AI that addresses the healthcare context and needs. Methods We conducted semi-structured interviews with 41 (...) AI experts and analyzed the data using reflective thematic analysis. Results We developed three themes that expressed the considerations perceived by experts as essential for ensuring AI aligns with ethical practices within healthcare. The first theme explores the ethical significance of introducing AI with a clear and purposeful objective. The second theme focuses on how experts are concerned about the tension that exists between economic incentives and the importance of prioritizing the interests of doctors and patients. The third theme illustrates the need to develop context-sensitive AI for healthcare that is informed by its underlying theoretical foundations. Conclusions The three themes collectively emphasized that beyond being innovative, AI must genuinely benefit healthcare and its stakeholders, meaning AI also aligns with intricate and context-specific healthcare practices. Our findings signal that instead of narrow product-specific AI guidance, ethical AI development may need a systemic, proactive perspective that includes the ethical considerations (objectives, actors, and context) and focuses on healthcare applications. Ethically developing AI involves a complex interplay between AI, ethics, healthcare, and multiple stakeholders. (shrink)