As a result of the coronavirus (COVID‐19) pandemic, health professionals are faced with situations they have not previously encountered and are being forced to make difficult ethical decisions. As the first group to experience challenges of caring for patients with coronavirus, Chinese nurses endure heartbreak and face stressful moral dilemmas. In this opinion piece, we examine three related critical questions: Whether society has the right to require health professionals to risk their lives caring for patients; whether health professionals have the (...) right to refuse to care for patients during the coronavirus pandemic; and what obligations there are to protect health professionals? Value of care, community expectations, legal obligations, professional and codes of practice may compel health professionals to put themselves at risks in emergency situations. The bioethical principles of autonomy, justice, beneficence and non‐maleficence, as well as public health ethics, guide nurses to justify their decisions as to whether they are entitled to refuse to treat COVID‐19 patients during the pandemic. We hope that the open discussion would support the international society in addressing similar ethical challenges in their respective situations during this public health crisis. (shrink)

Clarke A. Chambers interviews Marcia Eaton, professor in the Department of Philosophy.

Gideon Rosen (2014) has drawn our attention to cases of duress of a particularly interesting sort: the person's ‘mind is not flooded with pain or fear’, she knows exactly what she is doing, and she makes a clear-headed choice to act in, as Rosen says, ‘awful ways’. The explanation of why we excuse such actions cannot be that the action was not voluntary. In addition, although some duress cases could also be viewed as necessity cases and thus as justified, Rosen (...) wisely sets aside that complicating factor by zeroing in on those cases where the action clearly is not justified. So why do we excuse in these cases, where the action is not justified and the agent acted voluntarily?Rosen thinks the key lies in the ‘ill will’ condition, ‘the idea that an act is blameworthy only if it manifests insufficient concern or regard for those affected’. He says this is relatively uncontroversial; much of my paper is taken up with calling the ‘ill will’ condition into question. I also take issue with Rosen on just how justifications and excuses differ. I argue in favour of understanding justifications (in a context where we are asking how justifications and excuses differ) as not requiring truth, but only reasonable belief. (shrink)

The emphasis on duly in Kant's ethics is widely held to constitute a defect. Marcia W. Baron develops and assesses the criticism, which she sees as comprising two objections: that duty plays too large a role, leaving no room for the supererogatory, and that Kant places too much value on acting from duty. Clearly written and cogently argued, Kantian Ethics Almost without Apology takes on the most philosophically intriguing objections to Kant's ethics and subjects them to a rigorous yet (...) sympathetic assessment. (shrink)

Goldberg notes that the relationship is a component of Conflicts of Interests. Networks of relationships and the simultaneous presence of several interests are not negative per se but become so when they generate a conflict that undermines impartiality. The solution to the problem of COIs, therefore, cannot be to abolish relationships and the interests that they necessarily express but rather to verify whether those relationships are such as to unduly affect an individual’s judgement. The evolution of an Italian legislation about (...) COIs is eloquent in this regard. (shrink)

To "look good" and to "be good" have traditionally been considered two very different notions. Indeed, philosophers have seen aesthetic and ethical values as fundamentally separate. Now, at the crossroads of a new wave of aesthetic theory, Marcia Muelder Eaton introduces this groundbreaking work, in which a bold new concept of merit where being good and looking good are integrated into one.

During the past decade ethical theory has been in a lively state of development, and three basic approaches to ethics - Kantian ethics, consequentialism, and virtue ethics - have assumed positions of particular prominence.

La disolución de la noción de sujeto, que atraviesa el siglo XX, ampliamente conseguida hoy, ha hecho necesario, para una parte del pensamiento contemporáneo, impulsar la interrogación reconstructiva hasta su dispositivo preformativo originario: la persona. Merleau-Ponty se sitúa con pleno derecho en este espacio teórico, elaborando una reflexión que, superando tal noción, desplaza la mirada hacia el nivel impersonal y anónima, infra-corporal y pre-individual, más acá de la persona, al cual ésta permanece indisolublemente vinculada. Una reflexión que, por lo tanto, (...) rompiendo al mismo tiempo los bordes del perímetro fenomenológico, no sólo corta de raíz las categorías tradicionales de «yo» e «individuo», de «cuerpo propio» y «subjetividad constituyente», sino que implica una apertura a una nueva antropología y a preguntas tan urgentes como penetrantes a propósito de los derechos humanos.  . (shrink)

American doctors in the 1990s are being asked to serve as "double agents," weighing competing allegiances to patients' medical needs against the monetary costs to society. This situation is a reaction to rapid cost increases for medical services, themselves the result of the haphazard development since the 1920s of an inherently inflationary, open-ended system for funding and delivering health care. The answer to an inefficient system, however, is not to stint on care, but rather to restructure the system to remove (...) the inflationary pressures. As long as we are spending enormous resources on an inherently inefficient and inflationary system we cannot justify asking doctors to withhold beneficial care to save money for third-party payers. Doing so serves a largely political agenda and endangers the patient-centered ethic that is central to medicine. (shrink)

Cavell elaborates the view, traceable from Wittgenstein to Davidson, that there is no thought, and thus no meaning, without language, and shows how this concurs ...

The present narrative review addresses issues concerning the defining criteria and conceptual underpinnings of pain catastrophizing. To date, the concept of pain catastrophizing has been extensively used in many clinical and experimental contexts and it is considered as one of the most important psychological correlate of pain chronicity and disability. Although its extensive use, we are still facing important problems related to its defining criteria and conceptual understanding. At present, there is no general theoretical agreement of what catastrophizing really is. (...) The lack of a consensus on its definition and conceptual issues has important consequences on the choice of the pain management approaches, defining and identifying problems, and promoting novel research. Clinical and research work in absence of a common theoretical ground is often trivial. It is very surprising that clinical and experimental work has grown extensively in the past years, without a common ground in the form of a clear definition of pain catastrophizing and overview of its conceptual basis. Improving the efficacy and efficiency of pan catastrophizing related treatments requires an understanding of the theoretical construct. So far, most interventions have only demonstrated modest effects in reducing pain catastrophizing. Therefore, clarifying the construct may be an important precursor for developing more targeted and effective interventions, thereby easing some of the burden related to this aspect of pain. In our review, we have extracted and de-constructed common elements that emerge from different theoretical models with the aim to understand the concept of catastrophizing, which components can be modulated by psychological interventions, and the general role in pain processing. The analysis of the literature has indicated essential key elements to explain pain catastrophizing: emotional regulation, catastrophic worry, rumination, behavioral inhibition and behavioral activation systems, and interoceptive sensitivity. The present paper attempts to integrate these key elements with the aim to re-compose and unify the concept within a modern biopsychosocial interpretation of catastrophizing. (shrink)

...believe that his theory asks too much, demanding total devotion to morality and treating everything worth doing (and perhaps more) as a duty. But, despite their differences, the two sets of...

When successful and ethical managers are alerted to possible organizational wrongdoing, they take corrective action before the problems become crises. However, recent research [e.g., Rynes et al. (2007, Academy of Management Journal50(5), 987–1008)] indicates that many organizations fail to implement evidence-based practices (i.e., practices that are consistent with research findings), in many aspects of human resource management. In this paper, we draw from years of research on whistle-blowing by social scientists and legal scholars and offer concrete suggestions to managers who (...) are interested in encouraging internal reporting of problems requiring attention, and to observers of questionable activity who are considering reporting it. We also identify ways that research suggests policy-makers can have a more positive influence. We hope that these suggestions will help foster evidence-based practice regarding whistle-blowing. (shrink)

1. Stoicism in classical Latin literature -- 2. Stoicism in Christian Latin thought through the sixth century.

this essay analyzes Vladimir Jankélévitch’s work on death pointing out, in the vast thought of the twentieth century, its original and sharply problematic contribution. if death is generally seen as the perimeter that provides life with sense and autenticity (Heidegger, Lévinas), or more traditionally as the threshold that leads to a salvific other world, Jankélévitch first of all dismantles any reassuring strategy and underlines the elusiveness of death itself, its constituting a “totally other order” that escapes every human category. As (...) a consequence, if on the one hand the philosopher shows how every life has an “own death” that makes every life totally unique, on the other hand he highlights how the elusiveness of death delivers life, any life, to an unavoidable impropriety, which breaks through its individual and personal dimension. (shrink)

Marcia Cavell draws on philosophy, psychoanalysis, and the sciences of the mind in a fascinating and original investigation of human subjectivity. A "subject" is a creature, we may say, who recognizes herself as an "I," taking in the world from a subjective perspective; an agent, doing things for reasons, sometimes self-reflective, and able to assume responsibility for herself and some of her actions. If this is an ideal, how does a person become a subject, and what might stand in (...) the way? One of Marcia Cavell's guiding premises is that philosophical investigation into the specifically human way of being in the world cannot separate itself from investigations of a more empirical sort. Cavell brings together for the first time reflections in philosophy, findings in neuroscience, studies in infant development, psychoanalytic theory, and clinical vignettes from her own psychoanalytic practice. (shrink)

Justifications and excuses are defenses that exculpate. They are therefore much more like each other than like such defenses as diplomatic immunity, which does not exculpate. But they exculpate in different ways, and it has proven difficult to agree on just what that difference consists in. In this paper I take a step back from justification and excuse as concepts in criminal law, and look at the concepts as they arise in everyday life. To keep the task manageable, I focus (...) primarily on excuses and excusing activities, distinguishing them from justifications as well as from other close relatives, in particular, forgiving and pardoning. I draw upon J.L. Austin’s classic A Plea for Excuses, but expand on his account, suggesting that we offer excuses for reasons besides those he mentions. My hope is that my examination of excuses and excusing activities will help us rethink our views on just how justifications and excuses differ, views which often are worked out without much attention to how these concepts function in everyday life and to the connection between offers of excuses and justifications and the rules of civility. (shrink)

Anniversaries and funding crises prompt periodic calls to reevaluate the mission and public perceptions of the U.S. Land-Grant University system. One such call was issued by the Kellogg Commission on the Future of State Colleges and Land Grant Universities in their 1999 report, “Returning to Our Roots: the Engaged Institution.” Written by leaders of state universities and land-grant colleges, this report urges these institutions to engage more authentically and equitably in two-way relationships with their local constituents. Twenty years later, Land-Grant (...) Universities continue to struggle with building widespread public support for their missions and equitable involvement in research, teaching, and extension functions across diverse constituencies. While largely discounted by the Kellogg Commission, a fresh look at the role originally envisioned for the extension arm of the trifold land-grant mandate suggests that we may be conceiving of this system too narrowly. The establishment of statewide extension systems was once seen as a way to ensure that Land-Grant Universities would be accessible and responsive to all of a state’s residents. Extension systems continue to offer a front-door to a major public university in almost every county of the United States, but they tend to be viewed primarily as a way to translate science or distribute information from the university to the public. This discussion uses a historical and modern lens to reimagine the role that Extension could potentially play in catalyzing reciprocal, co-learning relationships between Land-Grant Universities and their diverse local constituencies. (shrink)

The American Journal of Bioethics, Volume 12, Issue 1, Page 37-38, January 2012.

Translational research is a main focus of current health policy (Albani and Prakken 2009; PLoS Medicine 2008). Translation of biomedical research knowledge to effective clinical treatment is essential to the public good (Lavis et al. 2003). Only 5% of basic science studies showing significant therapeutic promise are successfully translated into clinical application (Contopoulos-Ioannidis, Ntzani, and Ionannidis 2003; FDA 2004). As Hall (2001) observes, this is a problem: "When too many important discoveries lie dormant, the public good suffers" (p. G1127). Recent (...) health policy initiatives intended to foster the translation of basic science into clinical advances must consider the unique bioethical issues raised by .. (shrink)

In this essay I rethink a view that I developed in my Kantian Ethics Almost Without Apology , concerning how ethical theory should handle the phenomena that are standardly classified as supererogatory acts. The view I elaborated rejects the standard contemporary picture, according to which ethics needs to draw a line separating duty from what is "beyond duty"--the supererogatory. On the Kantian picture, beneficent acts are not beyond duty, for we are required to help others, but we are not required (...) to help whenever possible, and so it is not the case that each individual beneficent act is required by duty. Helping is required; helping here and now is not. After contrasting this view with the standard picture and explaining that much of what contemporary philosophers wanted to capture with the notion of the supererogatory can be captured with the Kantian notion of imperfect duties together with attention to the agent's character, I raise some problems for my view and try to address them. First, what about heroic actions that are not in character? Don't we need the notion of supererogatory acts to recognize their greatness? Second, isn't virtue doing all the conceptual work? Is there even any need to appeal to the notion of imperfect duties? Third, although I claimed in my book that it is an advantage of the Kantian view that moral excellence comes in many varieties, arguably it is too pluralistic. In dem Beitrag überdenke ich eine Auffassung, die ich in meinem Buch Kantian Ethics Almost Without Apology entwickelt habe. Sie betrifft die Frage, wie ethische Theorien das Phänomen behandeln sollen, das üblicherweise als "Supererogation" bezeichnet wird. Die von mir ausgearbeitete Auffassung verwirft das heute gängige Bild, nach dem Ethik abgrenzen muß zwischen dem, was Pflicht ist, und dem, was "jenseits der Pflicht" steht -- dem Supererogatorischen. Nach Kants Vorstellung sind wohltätige Handlungen nicht jenseits der Pflicht, da wir verpflichtet sind, anderen zu helfen. Wir müssen jedoch nicht in jeder möglichen Situation helfen, und daher ist es nicht der Fall, daß jede einzelne wohltätige Handlung Pflicht ist. Hilfe zu leisten , ist geboten; Hilfe hier und jetzt zu leisten, nicht. In einer Gegenüberstellung dieser Auffassung mit der gängigen Vorstellung zeige ich, daß vieles von dem, was moderne Philosophen mit dem Begriff des Supererogatorischen erklären wollen, auch mit Kants Begriff der unvollkommenen Pflichten, verbunden mit einem Blick auf den Charakter des Handelnden, erklärt werden kann. Danach werfe ich einige Probleme auf, die sich meiner Auffassung stellen, und versuche, Antworten zu geben. Erstens: Wie steht es mit heldenhaften Handlungen, die nicht dem Charakter des Handelnden entsprechen? Brauchen wir nicht den Begriff des supererogatorischen Handelns, um ihre Größe zu erkennen? Zweitens: Genügt nicht der Begriff der Tugend? Besteht irgendeine Notwendigkeit, auf den Begriff der unvollkommenen Pflicht zurückzugreifen? Drittens: Obwohl ich in meinem Buch behaupte, es sei ein Vorteil der Kantischen Sicht, daß moralische Vortrefflichkeit viele Gesichter hat, ist Kants Auffassung doch vielleicht zu pluralistisch. (shrink)

In this article, we describe the social and economic changes that have contributed to contemporary problems of work—family conflict, gender inequality, and risks to children's healthy development. We draw on feminist welfare state scholarship to outline an institutional arrangement that would support an earner—carer society—a social arrangement in which women and men engage symmetrically in paid work and unpaid caregiving and where young children have ample time with their parents. We present a blueprint for work—family reconciliation policies in three areas—paid (...) family-leave provisions, working-time regulations, and early childhood education and care—and we identify key policy design principles. We describe and assess these work—family reconciliation policies as they operate in six European countries widely considered to be policy exemplars: Denmark, Finland, Norway, Sweden, Belgium, and France. We close with an analysis of potential objections to these policies. (shrink)

PurposeThe aim of this paper is to assess the complex issue of responsibility in clinical practice. The paper focuses mainly on the relationship between personal- and medical-professional responsibility of practitioners and clinical guidelines.MethodsAfter a theoretical review of the different definitions of responsibility in selected bioethical and biojuridical literature, two recent juridical proceedings concerning medical responsibility from Italian Courts are discussed. Subsequently, a theoretical analysis of the definition of clinical practice guidelines is proposed in order to show their feasibility to assess (...) personal- and medical-professional responsibility.ResultsThe definitions of responsibility and the two Italian cases show the theoretical and practical difficulties of shared assessments of both personal-professional and medical-professional responsibility in clinical practice. Clinical practice guidelines cannot be assumed as an objective code of action stating exactly a rule of conduct in all situations, but as a tool suggesting how to decide what to do in different conditions.ConclusionsResponsibility in clinical practice is such a complex issue to deserve a special ethical assessment. The clinician’s personal-professional responsibility cannot be replaced or reduced by clinical practice guidelines, because medicine is as such a relationship focused on the expertize of practitioners. Nonetheless, a shared approach to different clinical conditions is needed in order to avoid a relativist outcome and protect patients’ and even clinicians’ rights. Formal guidelines (that describe not exactly what to do but how to decide what to do) are proposed as potential useful tool to achieve this aim. (shrink)