This paper reviews the ethical literature on conflicts between health professionals and parents about medical decision-making for children. We present the results of a systematic review which addressed the question ‘when health professionals and parents disagree about the appropriate course of medical treatment for a child, under what circumstances is the health professional ethically justified in overriding the parents’ wishes?’ We identified nine different ethical frameworks that were put forward by their authors as applicable across various ages and clinical (...) scenarios. Each of these frameworks centred on a different key moral concept including harm, constrained parental autonomy, best interests, medically reasonable alternatives, responsible thinking and rationality. (shrink)

In this paper, I argue that those moral theorists who wish to accommodate agent-centered options and supererogatory acts must accept both that the reason an agent has to promote her own interests is a nonmoral reason and that this nonmoral reason can prevent the moral reason she has to sacrifice those interests for the sake of doing more to promote the interests of others from generating a moral requirement to do so. These theorists must, then, deny that moral reasons morally (...) override nonmoral reasons, such that even the weakest moral reason trumps the strongest nonmoral reason in the determination of an act’s moral status (e.g., morally permissible or impermissible). If this is right, then it seems that these theorists have their work cut out for them. It will not be enough for them to provide a criterion of rightness that accommodates agent-centered options and supererogatory acts, for, in doing so, they incur a debt. As I will show, in accommodating agent-centered options, they commit themselves to the view that moral reasons are not morally overriding, and so they owe us an account of how both moral reasons and nonmoral reasons come together to determine an act’s moral status. (shrink)

Cognitive scientists distinguish between automatic and controlled mental processes. Automatic processes are either innately involuntary or become automatized through extensive practice. For example, reading words is a purportedly automatic process for proficient readers and the Stroop effect is consequently considered the “gold standard” of automated performance. Although the question of whether it is possible to regain control over an automatic process is mostly unasked, we provide compelling data showing that posthypnotic suggestion reduced and even removed Stroop interference in highly hypnotizable (...) individuals. Drawing on a large sample of highly hypnotizable participants, we examined the effects of suggestion on Stroop performance both with and without a posthypnotic suggestion to perceive the input stream as meaningless symbols. We show that suggestion administered to highly hypnotizable persons significantly reduced Stroop interference and derailed a seemingly automatic process. (shrink)

If you focus your charitable giving on global causes where it will do the most good, how should you feel about passing by the local soup kitchen? Would the ideally virtuous agent have their (local) empathy still activated, but simply overridden by the recognition that distant others are in even greater need, leaving the agent feeling torn? Or would their empathetic impulses be wholeheartedly redirected towards the greatest needs? This chapter suggests a way to revise an outdated conception of moral (...) virtue to better meet the demands of a cosmopolitan moral outlook. (shrink)

Cognitive scientists routinely distinguish between controlled and automatic mental processes. Through learning, practice, and exposure, controlled processes can become automatic; however, whether automatic processes can become deautomatized – recuperated under the purview of control – remains unclear. Here we show that a suggestion derails a deeply ingrained process involving involuntary audiovisual integration. We compared the performance of highly versus less hypnotically suggestible individuals in a classic McGurk paradigm – a perceptual illusion task demonstrating the influence of visual facial movements on (...) auditory speech percepts. Following a posthypnotic suggestion to prioritize auditory input, HSIs but not LSIs manifested fewer illusory auditory perceptions and correctly identified more auditory percepts. Our findings demonstrate that a suggestion deautomatized a ballistic audiovisual process in HSIs. In addition to guiding our knowledge regarding theories and mechanisms of automaticity, the present findings pave the road to a more scientific understanding of top-down effects and multisensory integration. (shrink)

Adolescents are routinely treated differently to adults, even when they possess similar capacities. In this article, we explore the justification for one case of differential treatment of adolescents. We attempt to make philosophical sense of the concurrent consents doctrine in law: adolescents found to have decision-making capacity have the power to consent to—and thereby, all else being equal, permit—their own medical treatment, but they lack the power always to refuse treatment and so render it impermissible. Other parties, that is, individuals (...) who exercise parental responsibility or a court, retain the authority to consent on an adolescent’s behalf. We explore four defences of the doctrine. We reject two attempts to defend the asymmetry in the power to consent to and refuse medical treatment by reference to transitional paternalism. We then consider and reject a stage of life justification. Finally, we articulate a justification based on the distinctiveness of adolescent well-being. (shrink)

Dewi Z. Phillips has argued that moral considerations must override other considerations. The author distinguishes ‘evidential’ from ‘verdictive’ moral considerations, arguing that only the latter are in any sense overriding.

When should doctors seek protective custody to override a parent’s refusal of potentially lifesaving treatment for their child? The answer to this question seemingly has different answers for different subspecialties of pediatrics. This paper specifically looks at different thresholds for physicians overriding parental refusals of life-sustaining treatment between neonatology, cardiology, and oncology. The threshold for mandating treatment of premature babies seems to be a survival rate of 25–50%. This is not the case when the treatment in question is open (...) heart surgery for a child with congenital heart disease. Most cardiologists would not pursue legal action when parents refuse treatment, unless the anticipated survival rate after surgery is above 90%. In pediatric oncology, there are case reports of physicians requesting and obtaining protective custody for cancer treatment when the reported mortality rates are 40–50%. Such differences might be attributed to differences in care, a reasonable prioritization of quality of life over survival, or the role uncertainty plays on prognoses, especially for the extremely young. Nonetheless, other, non-medical factors may have a significant effect on inconsistencies in care across these pediatric subspecialties and require further examinations. (shrink)

This article addresses the following meta-ethical question: do moral values have a special position among other values? According to Robert Adams, moral values do have a special position and are of overriding importance. I argue that the "overridingness" thesis is inconsistent with Adams’s value theory that only God has value in himself and all other things are valuable to the extent that they resemble God. I consider some possible ways of integrating the overridingness thesis that are latent in Adams’s (...) work and argue that none succeeds. My main contribution is to propose a solution to the inconsistency in Adams’s theory. I argue that a theological account of beauty gives us reason to reject the overridingness thesis. Morality overrides some other concerns, but not all other concerns. (shrink)

As an important step towards a comprehensive model of challenges and defeat- ers, it is here argued that securing a previously held epistemic status for a belief in the face of an overriding challenge does not require us to reach a higher epistemic standard than the one the belief originally reached. In the course of the investigation, criteria for when the epistemic status of beliefs are challenged and defeated are suggested. At the end of the paper, these results are (...) then more briefly applied to shed some light on the problem of misleading evidence. (shrink)

ABSTRACTHumans are cognitive misers because their basic tendency is to default to processing mechanisms of low computational expense. Such a tendency leads to suboptimal outcomes in certain types of hostile environments. The theoretical inferences made from correct and incorrect responding on heuristics and biases tasks have been overly simplified, however. The framework developed here traces the complexities inherent in these tasks by identifying five processing states that are possible in most heuristics and biases tasks. The framework also identifies three possible (...) processing defects: inadequately learned mindware; failure to detect the necessity of overriding the miserly response; and failure to sustain the override process once initiated. An important insight gained from using the framework is that degree of mindware instantiation is strongly related to the probability of successful detection and override. Thus, errors on such tasks cannot be unambiguously attributed to miserly processing – and corre... (shrink)

Natural selection favors not only more adaptive structural features but also more effective behavioral programs. Crucial for the prospering and very survival of an extremely sophisticated social species like homo sapiens is the biological/psychological program that might be conveniently labeled the human sense of fairness: a feeling often referred to in societies featuring supernaturalized explanations as one's "God given conscience." The sense of fairness and related programs derive a measure of their effectiveness from the fact that, in addition to the (...) pleasure/pain mechanisms reinforcing their implementation, we are programmed to want to want the goals they introduce and to experience repugnance in the face of goals that strongly conflict. (shrink)

Health care workers or others may wish to override parental decisions because of their impact on the health or safetySafety of a child or others. Justification of such an action requires two types of principle: an authorityAuthority principle that designates the process for reversal, and anPrincipal, interventionintervention principleIntervention principle that specifies the grounds for reversal. It is generally accepted that states may overruleOverruleparentsParents’ decisions for good cause. I argue that the role of the state is to provide sufficient protection against (...) parental malfeasance. Parental malfeasance can be construed as either exposing a child to harmHarm or as insufficient defense of the child’s interestsChild's interests. I propose a test to determine what sorts of parental decisions might trigger intervention. I also propose constraints on government action to minimize government unfairness in applying the test. I show how this plays out in application. (shrink)

The paper examines one implication of pluralism, the view that all values are conditional and none are overriding. This implication is that since scientific knowledge is one of the conditional values, there are circumstances in which the pursuit of even the most basic scientific knowledge is legitimately curtailed. These circumstances occur when the pursuit of scientific knowledge conflicts with moral and political values which, in that context, are more important than it. The argument focuses on the case for and (...) against space exploration in search of intelligent extraterrestrial life. The widely held supposition that search for pure scientific knowledge cannot be reasonably curtailed is identified as the fallacy of overriding values. (shrink)

Birchley9s critique of the harm threshold for overriding parental decisions is successful in demonstrating that the harm threshold, like the best interests standard, suffers from the problem of indeterminacy. However, his focus on critiquing empirical rather than normative arguments for the harm threshold means that his broad conclusion that it is ‘ill-judged’ is not justified. Advocates of the harm threshold can accept that the concept of harm to a child is indeterminate, yet still invoke strong normative arguments for this (...) way of responding to parental decisions that conflict with medical recommendations. I suggest that Birchley9s discussion, rather than showing that the harm threshold is mistaken, instead highlights the importance of developing a comprehensive account of children9s interests, for proponents of a best interests approach and for advocates of the harm threshold. (shrink)

I argue that any theory of moral obligation must be able to explain two things: why we cannot be thrust into a moral dilemma through no fault of our own, and why we can get into a moral dilemma through our own negligence. The most intuitive theory of moral obligation cannot do so. However, I offer a theory of moral obligation that satisfies both of these criteria, one that is founded on the principle that if you are required to do (...) something, then you would be blameworthy for failing to do it. I conclude by relating these results to the current literature on moral dilemmas. (shrink)

The European Union Data Protection Regulation will have profound implications for public health, health services research and statistics in Europe. The EU Commission's Proposal was a breakthrough in balancing privacy rights and rights to health and healthcare. The European Parliament, however, has proposed extensive amendments. This paper reviews the amendments proposed by the European Parliament Committee on Civil Liberties, Justice and Home Affairs and their implications for health research and statistics. The amendments eliminate most innovations brought by the Proposal. Notably, (...) derogation to the general prohibition of processing sensitive data shall be allowed for public interests such as the management of healthcare services, but not health research, monitoring, surveillance and governance. The processing of personal health data for historical, statistical or scientific purposes shall be allowed only with the consent of the data subject or if the processing serves an exceptionally high public interest, cannot be performed otherwise and is legally authorised. Research, be it academic, government, corporate or market research, falls under the same rule. The proposed amendments will make difficult or render impossible research and statistics involving the linkage and analysis of the wealth of data from clinical, administrative, insurance and survey sources, which have contributed to improving health outcomes and health systems performance and governance; and may illegitimise efforts that have been made in some European countries to enable privacy-respectful data use for research and statistical purposes. If the amendments stand as written, the right to privacy is likely to override the right to health and healthcare in Europe. (shrink)

Respect for patients’ autonomy has taken a central place in the practice of medicine. Received wisdom holds that respect for autonomy allows overriding a patient’s treatment preferences only if the patient has been found to lack capacity. This understanding of respect for autonomy requires a dichotomous approach to assessing capacity, whereby a patient must be found either to have full capacity to make some particular treatment decision or must be found to lack capacity to make that decision. However, clinical (...) reality is more complicated, and, in borderline cases, different physicians may arrive at disparate judgments of capacity. In such cases, when capacity-determination protocols fail to achieve consensus, physicians would benefit from guidance regarding the clinical decision-making process necessary to elucidate the most ethically sound course of action. This article considers one such case and argues that, in a limited number of cases, respect for autonomy may require overriding a patient’s stated treatment preference when a capacity determination is equivocal, even though the patient has not clearly demonstrated a lack of capacity. (shrink)

Selective conscientious objection, a refusal to participate in a specific war due to reasons of conscience, has recently gained attention. A combatant confronted with such a decision needs guidance to help decide whether and how to object. Furthermore, those judging a combatant’s objection or failure to object need guidance. After introducing the prima facie duty override criteria, I will apply the criteria to the case of selective conscientious objection. Ultimately, I argue that the jus ad bellum criteria rebranded as the (...) prima facie duty override criteria can help provide guidance regarding selective conscientious objection. (shrink)

While it is often thought that pluralism is best accommodated by a liberal state, John Kekes has recently argued that pluralism and liberalism involve inconsistent commitments. He maintains that liberalism is committed to the idea that one or more of the “liberal values” must override all other values, while pluralism is committed to the idea that there are no overriding values whatsoever. In this paper I challenge Kekes' position by arguing that ethical pluralism does not require an absence of (...) overriding values, and that liberalism does not require that one or more of the liberal values must override all others. (shrink)

This paper attempts to distinguish the aesthetic approach to environmental protection from the practical approach. The practical approach has a definite goal—the protection of present and future generations of human beings from harm and destruction. Protection of the environment is therefore only a means to an end—this means that if there were alternative and less painful ways to achieve the same goal, then we might opt for those other ways to preserve humankind. The aesthetic approach, on the other hand, treats (...) environmental protection as an end in itself. This is because certain aesthetic moods, feelings, or mental states can only be created by the objects we attend to; these objects are therefore unique, and their destruction must mean that we can no longer enjoy that peculiar feeling which it will evoke. (shrink)

Parker’s article is a welcome attempt to address the importance of environmental sustainability in the realm of clinical ethics.1 We support the recent movement to seriously consider the environmental impact of healthcare institutions in bioethics.2 3 Still, we find two partly linked weaknesses of Parker’s analysis and guideline suggestion. These relate to a need in ‘green’ bioethics to see beyond the normal healthcare ethical focus on health-related values related to individual patients, and to primarily adopt institutional ways of framing central (...) decision problems. Traditional bioethics applies a restricted scope of values to assess clinical decisions: primarily health-related patient well-being (including life) and patient autonomy. If a decision improves (or, as in Parker’s inhaler case, maintains) a patient’s health-related well-being, this supports it. However, if a decision improves a patient’s non health-related well-being, say, winning a beauty contest or securing a job by having cosmetic surgery, it is not supported. And so on. This idea of healthcare as, in Michael Walzer’s classic terminology, a separate ‘sphere of justice’ has two interrelated limitations: it reflects a bias towards individual patients over other people, and it restricts the scope of values allowed to influence healthcare ethical judgements. These limitations appear once we see that the issue addressed by Parker can be framed either as prescription decisions taken by individual doctors against the background of …. (shrink)

We present new probabilistic generalizations of Pearl’s entailment in System Z and Lehmann’s lexicographic entailment, called Zλ- and lexλ-entailment, which are parameterized through a value λ ∈ [0,1] that describes the strength of the inheritance of purely probabilistic knowledge. In the special cases of λ = 0 and λ = 1, the notions of Zλ- and lexλ-entailment coincide with probabilistic generalizations of Pearl’s entailment in System Z and Lehmann’s lexicographic entailment that have been recently introduced by the author. We show (...) that the notions of Zλ- and lexλ-entailment have similar properties as their classical counterparts. In particular, they both satisfy the rationality postulates of System P and the property of Rational Monotonicity. Moreover, Zλ-entailment is weaker than lexλ-entailment, and both Zλ- and lexλ-entailment are proper generalizations of their classical counterparts. (shrink)

Douglas Diekema influentially argues that interference with parental decisions is not in fact guided by the child’s best interests, but rather by a more permissive standard, which he calls the harm principle. This article first seeks to clarify this alternative position and defend it against certain existing criticisms, before offering a new criticism and alternative. This ‘harm principle’ has been criticized for (i) lack of adequate moral grounding, and (ii) being as indeterminate as the best interest standard that it seeks (...) to replace. I argue that these are not serious problems. I take Diekema’s negative point to be right—our actual standard for intervention is not literally the best interests of the child—but I disagree with his proposed replacement. First, Diekema’s proposed harm threshold should be more carefully distinguished from Mill’s harm principle. Second, there is no reason to assume that the standard for permissible intervention coincides with the threshold for harm (or serious harm). Thus, I propose that the best alternative to the best interests standard is not a harm principle, but rather a sufficiency threshold between adequate (or ‘good enough’) and inadequate (or ‘substandard’) parenting. (shrink)

The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death (...) based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A [2015] EWHC 443. Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions. We argue that: the tests of brainstem function were not properly undertaken in this case; the two conjunctive clinical criteria set forth in the code of practice cannot be reliably confirmed by these tests in any event; and absent authentication of the clinical criteria of death, the code of practice wrongly invokes a secular definition of death based on the loss of personhood. Consequently, the moral obligation of a pluralistic society to honor and respect diverse religious convictions to the greatest extent possible is being violated. Re A is contrasted with the US case of Jahi McMath in which the court accommodated parental religious objection to the determination of neurological death codified in the Uniform Determination of Death Act. We conclude that the legal system in the United Kingdom should not favour a secular definition of death over a definition of death that is respectful of religious values about the inviolability and sanctity of life. We recommend the legal recognition of religious accommodation in death determination to facilitate cultural sensitivity and compassionate care to patients and families in a pluralistic society. (shrink)

The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death (...) based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A [2015] EWHC 443. Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions. We argue that: the tests of brainstem function were not properly undertaken in this case; the two conjunctive clinical criteria set forth in the code of practice cannot be reliably confirmed by these tests in any event; and absent authentication of the clinical criteria of death, the code of practice wrongly invokes a secular definition of death based on the loss of personhood. Consequently, the moral obligation of a pluralistic society to honor and respect diverse religious convictions to the greatest extent possible is being violated. Re A is contrasted with the US case of Jahi McMath in which the court accommodated parental religious objection to the determination of neurological death codified in the Uniform Determination of Death Act. We conclude that the legal system in the United Kingdom should not favour a secular definition of death over a definition of death that is respectful of religious values about the inviolability and sanctity of life. We recommend the legal recognition of religious accommodation in death determination to facilitate cultural sensitivity and compassionate care to patients and families in a pluralistic society. (shrink)