BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Entrepreneurship is increasingly studied as a fundamental and foundational economic phenomenon. It has, however, received less attention as an ethical phenomenon. Much contemporary business ethics assumes its core application purposes to be (1) to stop predatory business practices and (2) to encourage philanthropy and charity by business. Certainly predation is immoral and charity has a place in ethics, neither should be the first concerns of ethics. Instead, business ethics should make fundamental the values and virtues of entrepreneurs - i.e., those (...) self-responsible and productive individuals who create value and trade with others to win-win advantage. (shrink)

This is the Dawes Hicks Lecture on Philosophy for 1967. Interestingly enough the previous year's Lecture, by G. J. Warnock, was also on Kant's moral theory. Körner is a bit more reverential toward his subject than Warnock, but not too much more. In particular, he criticizes Kant's exclusion of freedom from the realm of phenomena. This is a familiar criticism but Körner does not merely state it. He firms it up by offering a different account of the relation between (...) categoreal and phenomenal intelligibility. Kant regarded the latter as simply an expression, albeit confused, of the former: science, with an assist from transcendental logic, could be expected to recapitulate exhaustively the intelligibility of phenomenal experience in categoreal and, most importantly, deterministic terms. Körner's account of the relation between these two forms of intelligibility stresses, on the contrary, the logical discontinuity between the two. In the language of contemporary philosophy of science, the relation between experience and theory is instrumental. Körner has developed his basic argument more clearly and sophisticatedly in the last two chapters of his Experience and Theory, and his application in this lecture of its essentials to Kant, although certainly appropriate, is not very smooth. It is cluttered up with a lot of miscellaneous observations which could be harmonized in a longer study of Kant but only tend to distract here.--E. A. R. (shrink)

This Dawes Hicks Lecture on Philosophy for 1966 is concerned to exhibit the basis of Kant's deontological moral theory and primacy-warranting of practical over theoretical reason. One would have thought this had been done often enough, but Warnock has apparently not benefited from past attempts. For his effort to undermine both of Kant's contentions and push in a utilitarian direction is based on an unsympathetic and unprobing manipulating of the key terms in the theory: freedom, reason, virtue. For example, (...) Warnock cites the historical influence of Rousseau on Kant in the matter of stressing the primacy of practical reason but fails to note the deeper connection between Kant's deontologism and Rousseau's sentimentalism: the link emerges when we realize that aesthetic beauty, which is the norm that Rousseau presses toward in his sentimentalism, is, like Kantian virtue, an embodiment of the good which has no purpose beyond itself. Warnock also fails to see that Kant was more than dimly aware of the fact that Reason is realized Freedom; and consequently his disparaging reference to Kant's rationalism is ill-conceived.--E. A. R. (shrink)

This volume is designed as an anthology of shorter texts centered around some of the standard problems in natural theology. The first section contains readings pertaining to the theistic proofs; the section on the Ontological argument is particularly well-organized here. The inclusion of Braithwaite's paper, "Religious Statements as Ethically but not Factually Significant" and Hick's own paper on "Eschatological Verification" makes these papers available in an inexpensive form for the first time. Hick's own conviction that religion can at best assume (...) an attitude of indifference or armed neutrality towards philosophy is reflected in his introduction.—E. A. R. (shrink)

Shoemaker (1996) presenteda prioriarguments against the possibility of ‘self‐blindness’, or the inability of someone, otherwise intelligent and possessed of mental concepts, to introspect any of her concurrent attitude states. Ironically enough, this seems to be a position that Gopnik (1993) and Carruthers (2006, 2008, 2009a,b) have proposed as not only possible, but as the actual human condition generally! According to this ‘Objectivist’ view, supposed introspection of one's attitudes is not ‘direct’, but an ‘inference’ of precisely the sort we make about (...) the attitudes of others, an inference that has the advantage in our own case ofonlyour own sensory data and memories, our behavior, and of the context we are in; i.e. we are all substantially self‐ blind. After sorting out a number of methodological and verbal issues, I argue, first, that thea prioriarguments against Objectivism don't succeed, and that Gopnik and Carruthers are right to regard the issue as an empirical one. On the other hand, I think they seriously underestimate the difficulty of establishing Objectivism. It is unlikely there is an inferential procedure from the data of pure sensation, behavior and context to the relevant self‐attributions that would be as spectacularly reliable as people manifestly seem to be. Moreover, there is a simpler model: the mind very likely consists of a panoply of sub‐routines some of whose outputs are ‘tagged’ for their having been so processed, rather in the way that software ‘documents’ are on standard computers. Introspection plausibly consists in a person's simply attending to distinctive constellations of these tags, even though they may lack phenomenal feels. This draws attention to an important independent fact: that much of phenomenology (or ‘what it's like’ to be in a certain state) may be constituted by facts that are not phenomenal. (shrink)

This book is a timely new interpretation of the moral and political philosophy of Thomas Hobbes. Staying close to Hobbes's text and working from a careful examination of the actual substance of the account of natural law, R.E. Ewin argues that Hobbes well understood the importance of moral behavior to civilized society. This interpretation stands as a much-needed corrective to readings of Hobbes that emphasize the rationally calculated, self-interested nature of human behavior. It poses a significant challenge to currently fashionable (...) game theoretic reconstructions of Hobbesian logic. It is generally agreed that Hobbes applied what he took to be a geometrical method to political theory. But, as Ewin forcefully argues, modern readers have misconstrued Hobbes's geometric method, and this has led to a series of misunderstandings of Hobbes's view of the relationship between politics and morality. Important implications of Ewin's reading are that Hobbes never thought that "the war of each against all" was an empirical possibility for citizens; that his political theory actually presupposes moral agency; and that Hobbes's account of natural law forces us to the conclusion that Hobbes was a virtue theorist. This major contribution to Hobbes studies will be praised and criticized, welcomed and challenged, but it cannot be ignored. All philosophers, political theorists, and historians of ideas dealing with Hobbes will need to take account of it. (shrink)

Concepts, Kovesi argued in Moral Notions and elsewhere, are formed from a point of view; they express relevant needs, wants, interests, ideals, and attitudes, and are formed from a point of view that can be anybody’s. The point of view need not be everybody’s (not everybody is interested in chess, for example), but it is a point of view that can be taken by anybody. The point of view expresses our purpose in forming the concept (p. 48)1; it is the (...) point of view of somebody dealing with certain sorts of problems, and that determines which material elements will come under the concept. But Kovesi refuses to explain in any of his writings what the moral point of view is, and says that it is no part of his project to explain that (see especially pp. 105 ff). This is not a matter of his refusing to say whether he is taking a Utilitarian point of view or an Emotivist point of view of anything of that sort. His question is a much more basic one about the logical structure of moral concepts and their relationships to the problems morality is formed to deal with. His refusal to explain the moral point of view is puzzling. The moral point of view that Kovesi envisaged, I think, is the point of view of members of a species the members of which have to get on together, a species members of which have the qualities of character that enable them to get on together. (shrink)

: George Rupp's Beyond Existentialism and Zen, in its typological-structural analysis and model of religious pluralism, proffers an alternative to the dominant Kantian models (e.g., by John Hicks and Sarvepalli Radhakrish nan). The question for Rupp is not which religion is true and how to decide that issue—answered in the Kantian approach in terms of an unknowable Ding an sich that all religions, albeit imperfectly, try to approximate or conceptualize (i.e., God or the Transcendent)—but rather how do religions represent, (...) at least in principle, a structural possibility for salvation or human flourishing, however different and incompatible their distinct prima facie truth claims might be. Although the potential for a radically relativistic model is implicit in Rupp's approach, it is argued here that his Hegelian assumptions lead him to accept relativism only in a provisional ("critical") way; for Rupp, under ideal epistemic conditions (e.g., the Peircian "end of inquiry"), one final conceptualization of ultimate reality will emerge as absolute truth. In the final part of this essay a version of the relativistic model implicit in Rupp's approach is defended against both the Kantian model of Hicks et al. and Rupp's Hegelian-Peircian model, which, it is argued, is incompatible certainly with the spirit of his own typological-structural analysis, if not with the letter. In challenging what Rupp calls the truth of Zen, it is further argued that not only is more than one salvific structural possibility available to us through the different world religions but also that realizing these possibilities is principally a human responsibility, and that the cosmos is quite indifferent to and compatible with several possibilities, from the most destructive to the most conducive to human well being and flourishing. (shrink)

George Rupp's Beyond Existentialism and Zen, in its typological-structural analysis and model of religious pluralism, proffers an alternative to the dominant Kantian models (e.g., by John Hicks and Sarvepalli Radhakrish nan). The question for Rupp is not which religion is true and how to decide that issue-answered in the Kantian approach in terms of an unknowable Ding an sich that all religions, albeit imperfectly, try to approximate or conceptualize (i.e., God or the Transcendent)-but rather how do religions represent, at (...) least in principle, a structural possibility for salvation or human flourishing, however different and incompatible their distinct prima facie truth claims might be. Although the potential for a radically relativistic model is implicit in Rupp's approach, it is argued here that his Hegelian assumptions lead him to accept relativism only in a provisional ("critical") way; for Rupp, under ideal epistemic conditions (e.g., the Peircian "end of inquiry"), one final conceptualization of ultimate reality will emerge as absolute truth. In the final part of this essay a version of the relativistic model implicit in Rupp's approach is defended against both the Kantian model of Hicks et al. and Rupp's Hegelian-Peircian model, which, it is argued, is incompatible certainly with the spirit of his own typological-structural analysis, if not with the letter. In challenging what Rupp calls the truth of Zen, it is further argued that not only is more than one salvific structural possibility available to us through the different world religions but also that realizing these possibilities is principally a human responsibility, and that the cosmos is quite indifferent to and compatible with several possibilities, from the most destructive to the most conducive to human well being and flourishing. (shrink)

Awe and wonder are theorised to be distinct from other positive emotions, such as happiness. Yet little empirical or theoretical work has focused on these emotions. This investigation explored differences in language used to describe experiences of awe and wonder. Such analyses can provide insight into how people conceptualise these emotional experiences, and whether they conceptualise these emotions to be distinct from other positive emotions, and each other. Participants wrote narratives about experiences of awe, wonder and happiness. There were differences (...) in the language used to describe these positive emotional states, consistent with the theorised functions of each emotion. Awe was related to observing the world, reflected in greater use of perception words. Wonder was related to trying to understand the world, reflected in greater use of cognitive complexity and tentative words. Language use for both emotions reflected an environmental focus, whereas language use for happiness reflected a social/relationship focus. (shrink)

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and (...) should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. (shrink)

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the (...) field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

Rich with historical and cultural value, these works are published unaltered from the original University of Minnesota Press editions.

J. Krishnamurti (1895-1986) was thought by many to be a modern-day equivalent of the Buddha. In fact, he was once even considered to be the second coming of Christ. While many think it wonderful to live and work in close proximity with such a person, it's difficult to understand the depth of what this means and how challenging this might be. In Knocking at the Open Door, author R.E. Mark Lee provides an ordinary person view of what being close-up and (...) working together with such a man means, how it challenges one at every turn, and how it causes one to question ceaselessly, even more deeply than one ordinarily would. Lee offers an insightful, candid, and heartfelt narrative that reveals various unknown facets of the eminent world teacher J. Krishnamurti and highlights his distinctive vision for education worldwide. This comprehensive volume brings alive the practical and everyday interactions Lee had with Krishnamurti during a twenty-year period in India and the United Sates. Knocking at the Open Door shares a clear and honest account that demonstrates the challenges of working with Krishnamurti in running a school that is true to the teaching and yet able to function in the reality of modern parental, student, and educational establishment expectations. (shrink)

The thesis of this article is that there has never been any ground for the controversy between the doctrine of free will and determinism, that it is based upon a misapprehension, that the two assertions are entirely consistent, that one of them strictly implies the other, that they have been opposed only because of our natural want of the analytical imagination. In so saying I do not tamper with the meaning of either phrase. That would be unpardonable. I mean free (...) will in the natural and usual sense, in the fullest, the most absolute sense in which for the purposes of the personal and moral life the term is ever employed. I mean it as implying responsibility, merit and demerit, guilt and desert. I mean it as implying, after an act has been performed, that one " could have done otherwise " than one did. I mean it as conveying these things also, not in any subtly modified sense but in exactly the sense in which we conceive them in life and in law and in ethics. These two doctrines have been opposed because we have not realised that free will can be analysed without being destroyed, and that determinism is merely a feature of the analysis of it. And if we are tempted to take refuge in the thought of an "ultimate ", an "innermost" liberty that eludes the analysis, then we have implied a deterministic basis and constitution for this liberty as well. For such a basis and constitution lie in the idea of liberty. -/- The thesis is not, like that of Green or Bradley, that the contending opinions are reconciled if we adopt a certain metaphysic of the ego, as that it is timeless, and identifies itself with a desire by a " timeless act". This is to say that the two are irreconcilable, as they are popularly supposed to be, except by a theory that delivers us from the conflict by taking us out of time. Our view on the contrary is that from the natural and temporal point of view itself there never was any need of a reconciliation but only of a comprehension of the meaning of terms. (The metaphysical nature of the self and its identity through time is a problem for all who confront memory, anticipation, etc.; it has no peculiar difficulties arising from the present problem.) -/- I am not maintaining that determinism is true; only that it is true insofar as we have free will. That we are free in willing is, broadly speaking, a fact of experience. That broad fact is more assured than any philosophical analysis. It is therefore surer than the deterministic analysis of it, entirely adequate as that in the end appears to be. But it is not here affirmed that there are no small exceptions, no slight undetermined swervings, no ingredient of absolute chance. All that is here said is that such absence of determination, if and so far as it exists, is no gain to freedom, but sheer loss of it; no advantage to the moral life, but blank subtraction from it. -- When I speak below of "the indeterminist" I mean the libertarian indeterminist, that is, him who believes in free will and holds that it involves indetermination. (shrink)

Volume 20, Issue 4, May 2020, Page 71-73.

George Rupp's Beyond Existentialism and Zen, in its typological-structural analysis and model of religious pluralism, proffers an alternative to the dominant Kantian models (e.g., by John Hicks and Sarvepalli Radhakrish- nan). The question for Rupp is not which religion is true and how to decide that issue-answered in the Kantian approach in terms of an unknowable Ding an sich that all religions, albeit imperfectly, try to approximate or conceptualize (i.e., God or the Transcendent)-but rather how do religions represent, at (...) least in principle, a structural possibility for salvation or human flourishing, however different and incompatible their distinct prima facie truth claims might be. Although the potential for a radically relativistic model is implicit in Rupp's approach, it is argued here that his Hegelian assumptions lead him to accept relativism only in a provisional ("critical") way; for Rupp, under ideal epistemic conditions (e.g., the Peircian "end of inquiry"), one final conceptualization of ultimate reality will emerge as absolute truth. In the final part of this essay a version of the relativistic model implicit in Rupp's approach is defended against both the Kantian model of Hicks et al. and Rupp's Hegelian-Peircian model, which, it is argued, is incompatible certainly with the spirit of his own typological-structural analysis, if not with the letter. In challenging what Rupp calls the truth of Zen, it is further argued that not only is more than one salvific structural possibility available to us through the different world religions but also that realizing these possibilities is principally a human responsibility, and that the cosmos is quite indifferent to and compatible with several possibilities, from the most destructive to the most conducive to human well-being and flourishing. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

The overall aim of this article is to discuss the organization of limit setting in healthcare in terms of legitimacy. We argue there is a strong ethical demand that such processes should be arranged to provide adversely affected people well-justified reasons to confer legitimacy to the processes despite favouring a different decision-making outcome. Two increasingly popular approaches, Accountability for Reasonableness (A4R) and Multi-Criteria Decision Analysis (MCDA), can both be applied to support legitimate decision-making processes. However, the role played by ‘fair-minded (...) people’ in the A4R framework can be shown to undermine an adequate conceptualization of legitimacy according to the ethical demand. We discuss and specify conditions enabling A4R to meet this ethical demand when being implemented in a real-world setting without having to renounce the aim of striving for ‘reasonableness’ and impartiality. The methodological approach MCDA describes how to arrange for transparent resource allocation. This approach does not encompass any normative guidance on how to shape limit settings in terms of ‘reasonableness’; it basically promotes ‘rational’ decisions. We discuss how this practical methodology can be integrated with the theoretical A4R framework to meet the ethical demand while at the same time promoting politically required impartiality of healthcare limit setting. (shrink)