There is a concern that the widespread deployment of autonomous machines will open up a number of ‘responsibility gaps’ throughout society. Various articulations of such techno-responsibility gaps have been proposed over the years, along with several potential solutions. Most of these solutions focus on ‘plugging’ or ‘dissolving’ the gaps. This paper offers an alternative perspective. It argues that techno-responsibility gaps are, sometimes, to be welcomed and that one of the advantages of autonomous machines is that they enable us to embrace (...) certain kinds of responsibility gap. The argument is based on the idea that human morality is often tragic. We frequently confront situations in which competing moral considerations pull in different directions and it is impossible to perfectly balance these considerations. This heightens the burden of responsibility associated with our choices. We cope with the tragedy of moral choice in different ways. Sometimes we delude ourselves into thinking the choices we make were not tragic ; sometimes we delegate the tragic choice to others ; sometimes we make the choice ourselves and bear the psychological consequences. Each of these strategies has its benefits and costs. One potential advantage of autonomous machines is that they enable a reduced cost form of delegation. However, we only gain the advantage of this reduced cost if we accept that some techno-responsibility gaps are virtuous. (shrink)

Tragic choices arise during the COVID-19 pandemic when the limited resources made available in acute medical settings cannot be accessed by all patients who need them. In these circumstances, healthcare rationing is unavoidable. It is important in any healthcare rationing process that the interests of the community are recognised, and that decision-making upholds these interests through a fair and consistent process of decision-making. Responding to recent calls to safeguard individuals’ legal rights in decision-making in intensive care, and for (...) new authoritative national guidance for decision-making, this paper seeks to clarify what consistency and fairness demand in healthcare rationing during the COVID-19 pandemic, from both a legal and ethical standpoint. The paper begins with a brief review of UK law concerning healthcare resource allocation, considering how community interests and individual rights have been marshalled in judicial deliberation about the use of limited health resources within the National Health Service. It is then argued that an important distinction needs to be drawn between procedural and outcome consistency, and that a procedurally consistent decision-making process ought to be favoured. Congruent with the position that UK courts have adopted for resource allocation decision-making in the NHS more generally, specific requirements for a procedural framework and substantive triage criteria to be applied within that framework during the COVID-19 pandemic are considered in detail. (shrink)

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices. We offer recommendations to clinical teams and aid (...) organizations for preparing and supporting frontline clinicians in their efforts to determine the least-worst option, and in their responsibility for making such choices. (shrink)

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices. We offer recommendations to clinical teams and aid (...) organizations for preparing and supporting frontline clinicians in their efforts to determine the least-worst option, and in their responsibility for making such choices. (shrink)

Early in the COVID-19 pandemic in the United States, concern that there could be a shortage of ventilators raised the possibility of rationing care. Denying patients life-saving care captures our moral imagination, prompting the demand for a defensible framework of ethical principles for determining who will live and who will die. Behind the moral dilemma posed by the shortage of a particular medical good lies a broad moral geography encompassing important and often unarticulated societal values, as well as assumptions about (...) the nature and purpose of health care and the consequences of long-standing choices about health care as a social good. This article explores what COVID-19 has exposed concerning values and choices around health care in the United States. Employing the lens of Catholic Social Thought, it argues for an approach to rationing that is grounded in respect for human dignity, committed to distributing social goods in light of the common good, and self-conscious about the construction of vulnerability to illness and death. (shrink)

In this paper, I make three arguments regarding Crisis Standards of Care developed during the COVID-19 pandemic. First, I argue against the consideration of third person quality of life judgments that deprioritize disabled or chronically ill people on a basis other than their survival, even if protocols use the language of health to justify maintaining the supposedly higher well-being of non-disabled people. Second, while it may be unavoidable that some disabled people are deprioritized by triage protocols that must consider the (...) likelihood that someone will survive intensive treatment, Crisis Standards of Care should not consider the amount or duration of treatment someone may need to survive. Finally, I argue that, rather than parsing who should be denied treatment to maximize lives saved, professional bioethicists should have put our energy into reducing the need for such choices at all by resisting the systemic injustices that drive the need for triage. (shrink)

Events over the last decade have returned the issue of interrogational torture to one of immediate and urgent concern, as governments attempt to circumvent the constraints of the UN Convention against Torture. Philosophers still favor variants of the ‘ticking bomb’ scenario and view with suspicion, if not incomprehension, any absolutist prohibition of torture. In this paper, I reiterate and develop an absolutist position against interrogational torture, arguing that ‘ticking bomb’ scenarios are ill-considered and offer not what they purport to offer. (...) I further make the case that assumptions behind the pro-torture position, particularly based on positive consequences of interrogational torture, are by no means as clear as apparently imagined, and that such practices challenge the very foundations of our moral lives in their attacks on notions of agency and responsibility. In any such extreme choice like the ones that torture presents, we must weigh what we might gain against what we might lose, and we always lose too much. (shrink)

Events over the last decade have returned the issue of interrogational torture to one of immediate and urgent concern, as governments attempt to circumvent the constraints of the UN Convention against Torture. Philosophers still favor variants of the ‘ticking bomb’ scenario and view with suspicion, if not incomprehension, any absolutist prohibition of torture. In this paper, I reiterate and develop an absolutist position against interrogational torture, arguing that ‘ticking bomb’ scenarios are ill-considered and offer not what they purport to offer. (...) I further make the case that assumptions behind the pro-torture position, particularly based on positive consequences of interrogational torture, are by no means as clear as apparently imagined, and that such practices challenge the very foundations of our moral lives in their attacks on notions of agency and responsibility. In any such extreme choice like the ones that torture presents, we must weigh what we might gain against what we might lose, and we always lose too much. (shrink)

In this article I explore a kind of tragic choice that has not received due attention, one in which you have to save only one of two persons but the probability of saving is not equal (and all other things are equal). Different proposals are assessed, taking as models proposals for a much more discussed tragic choice situation: saving different numbers of persons. I hold that cases in which (only) numbers are different are structurally similar to cases in (...) which (only) probabilities are different. After a brief defense of this claim, I conclude that some version of consequentialism seems more promising for offering a plausible solution to the probability case. (shrink)

However far we are from either in practice, basic global and intergenerational justice, including climate change mitigation, are taken to be theoretically compatible. If population grows as predicted, this could cease to be the case. This paper asks whether that tragic legacy can now be averted without hard or even tragic choices on population policy. Current generations must navigate between: a high-stakes gamble on undeveloped technology; violating human rights; demanding unbearable sacrifices of the already badly off; institutional (...) unfairness across adults; institutional unfairness across children; failing to protect children’s basic interests; and threatening the autonomy of the family. We are not yet forced to choose between bequeathing a tragic choice and making one, by adopting basically unjust measures. However, even the remaining options present a morally hard choice. The fact we face it is yet another damning indictment on the combined actions and collective failures of the global elite. (shrink)

However far we are from either in practice, basic global and intergenerational justice, including climate change mitigation, are taken to be theoretically compatible. If population grows as predicted, this could cease to be the case. This paper asks whether that tragic legacy can now be averted without hard or even tragic choices on population policy. Current generations must navigate between: a high-stakes gamble on undeveloped technology; violating human rights; demanding unbearable sacrifices of the already badly off; institutional (...) unfairness across adults; institutional unfairness across children; failing to protect children’s basic interests; and threatening the autonomy of the family. We are not yet forced to choose between bequeathing a tragic choice and making one, by adopting basically unjust measures. However, even the remaining options present a morally hard choice. The fact we face it is yet another damning indictment on the combined actions and collective failures of the global elite. (shrink)

A democratic society does not embody a permanent and internally consistent set of values but attempts to accommodate disagreement between incommensurable values. One of the purposes of the law is to manage such disagreement by ensuring that disputes are settled in a way that advances the interests of stability without foreclosing options. In this respect the function of the formal dissenting judgment has been neglected in the English literature. By contrast there is a rich US literature which reveals an ambivalent (...) attitude to the practice of dissent. The article discusses the nature of the disagreements that are predominant in dissenting judgments. It claims that the practise of dissent follows the development of democracy and that the majority of dissents in courts of last resort raise legitimate disagreement about fundamental incommensurable values. These concern disagreements between deontological and consequentialist values, between different conceptions of the legislative powers of the judiciary and between principle and pragmatism. Because the outcome of an appeal is contingent, the dissent may be as important as the majority in identifying the choices to be made and signalling the principles that are immanent in the law. The legal and political basis of the right to publish a dissent is discussed and arguments for and against the publication of dissents considered with the conclusion that constraints on the right to dissent would be self-defeating. (shrink)

Historically, cognitivists considered moral choices to be determined by analytic processes. Recent theories, however, have emphasized the role of intuitive processes in determining moral choices. We propose that the engagement of analytic and intuitive processes is contingent on the type of tradeoff being considered. Specifically, when a tradeoff necessarily violates a moral principle no matter what choice is made, as in tragic tradeoffs, its resolution should result in greater moral conflict and less confidence in choice than when (...) the tradeoff offers a moral escape route, as in taboo tradeoffs. We manipulated tradeoff type in between subjects design and confirmed the prediction that tragic tradeoffs prompt more conflict and less confidence than taboo tradeoffs. The findings further revealed that moral conflict mediated the effect of tradeoff type on confidence. The study sheds light on the manner in which human minds resolve moral problems involving social agents. (shrink)

_A moving meditation on recent geopolitical crises, viewed through the lens of ancient and modern tragedy__ “Spare, elegant and poignant.... If there is a single contemporary book that should be pressed into the hands of those who decide issues of war and peace, this is it.”—John Gray, _New Statesman_ “It is tragic that Robert D. Kaplan’s luminous _The Tragic Mind_ is so urgently needed.”—George F. Will_ Some books emerge from a lifetime of hard-won knowledge. Robert D. Kaplan has (...) learned, from a career spent reporting on wars, revolutions, and international politics in Europe, the Middle East, and East Asia, that the essence of geopolitics is tragedy. In _The Tragic Mind_, he employs the works of ancient Greek dramatists, Shakespeare, German philosophers, and the modern classics to explore the central subjects of international politics: order, disorder, rebellion, ambition, loyalty to family and state, violence, and the mistakes of power. The great dilemmas of international politics, he argues, are not posed by good versus evil—a clear and easy choice—but by contests of good versus good, where the choices are often searing, incompatible, and fraught with consequences. A deeply learned and deeply felt meditation on the importance of lived experience in conducting international relations, this is a book for everyone who wants a profound understanding of the tragic politics of our time. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 26.2 (2002) 260-272 [Access article in PDF] Tragic Conflict and Greatness of Character Ariel Meira IT IS A SURPRISING FACT that some of our best literary examples of greatness of character are of persons acting in a way that involves them in a terrible burden of guilt. As spectators we perceive Oedipus, in Sophocles's Oedipus the King, 1 as one who upon discovering the identity (...) of his father and mother affirms that he bears guilt for killing the former and committing incest with the latter, and we typically concur in some vague way with his affirmation. 2 We do not, after all, think that his affirmation is merely the consequence of some confusion about morals on his part, and that he would have been more justified in treating his discovery with a light conscience. Furthermore, it seems that our conception of his greatness is intimately bound up with our being acquainted with him as someone who acted so as to render himself profoundly guilty in this way. What is paradoxical is that moral taint would be expected to reduce our admiration for a character and our attribution of greatness to it. Why then should noteworthy paradigms of greatness of character be morally tainted characters? Can we make sense of the idea that some kinds of guiltiness might be constitutive of greatness of character?As it is well-known, Aristotle says that in order for a tragedy best to achieve its desired effect, it should portray a protagonist "who is not pre-eminent in moral virtue, who passes to bad fortune not through vice or wickedness, but because of some hamartia...." 3 The term "hamartia" is variously translated as "piece of ignorance," "miscalculation," and "error of judgment," but as O. B. Hardison notes, it must be treated as designating a moral flaw, because it renders the protagonist [End Page 260] less than "pre-eminent in moral virtue." 4 However, even if the term is interpreted as covering what I have described as the moral taint associated with greatness of character, it should be clear that Aristotle does not provide here an answer to my question. At best he can be viewed as explaining why morally tainted characters of this sort are crucial to achieving tragic effect. He is not explaining how it is that such characters can be viewed as paradigms of greatness.I propose not to treat this paradox in its most general form, but rather by confining my attention to an interesting subclass of cases. What I have in mind are cases in which a protagonist finds himself or herself in what I shall call circumstances of tragic conflict. Such circumstances determine that a choice must be made between two (or perhaps more) courses of action, even though each of the courses involves the violation of an important moral claim, or the destruction of a crucial value. As spectators or readers, we typically perceive the protagonist as emerging with a heavy burden of guilt (much in the way noted above regarding Oedipus), and we recognize that he or she was bound to emerge guilty, no matter which course of action would have been chosen. Cases such as that of Agamemnon (bearing guilt for the sacrifice of his daughter Iphigenia in Aeschylus's Agamemnon), 5 of Jephthah (again bearing guilt for the sacrifice of his daughter, in Judges 11), 6 and of Orestes (bearing guilt for the murder of his mother Clytemnestra in Euripides's Orestes) 7 belong quite uncontroversially to this subclass. 8These protagonists make difficult choices, and carry them out with courage and resolution, qualities which explain to some extent our perception of them as possessing greatness of character. But in making their choice, they necessarily render themselves guilty, whether or not they have made the correct choice (assuming there is a correct choice in the circumstances). And we sense that suffering the peculiarly poignant pain which accompanies their guilty action is at least partly constitutive of their greatness. Clearly, we are faced again with the paradox of the association of guilt with greatness of character.In... (shrink)

Although the self is distinct from identity, this essay offers some insight into how identity is maintained—in the processes by which a self is formed, and through the actual content of the schemata that compose the self-concept. The author explains how in the 1920s utopian representations of a “new man” indicate the blank space where an aesthetic for the self can appear long before a theory of choice and commitment can exist in reality. Far from being a dramaturgical plan of (...) action, such utopian representations disorient the elements of discourse in order to prepare the way for the appearance of something inconceivable or inexpressible within this discourse. The theatricality produced in this oppositional public sphere—like that of Max Reinhardt, Bertolt Brecht, Ernst Toller, and later by Jean-Paul Sartre and Albert Camus—can thus be read as expressions of unfulfilled desire resisting the limitations of the present system and breaking beyond with self-defined narratives not yet realized in our everyday lives. (shrink)

The standard response to engineering disasters like the Deepwater Horizon case is to ascribe full moral responsibility to individuals and to collectives treated as individuals. However, this approach is inappropriate since concrete action and experience in engineering contexts seldom meets the criteria of our traditional moral theories. Technological action is often distributed rather than individual or collective, we lack full control of the technology and its consequences, and we lack knowledge and are uncertain about these consequences. In this paper, I (...) analyse these problems by employing Kierkegaardian notions of tragedy and moral responsibility in order to account for experiences of the tragic in technological action. I argue that ascription of responsibility in engineering contexts should be sensitive to personal experiences of lack of control, uncertainty, role conflicts, social dependence, and tragic choice. I conclude that this does not justify evading individual and corporate responsibility, but inspires practices of responsibility ascription that are less ‘harsh’ on those directly involved in technological action, that listen to their personal experiences, and that encourage them to gain more knowledge about what they are doing. (shrink)

Wisdom is almost always associated with doing the right thing in the right way under right circumstances in order to achieve the common good. In this paper, however, we propose that wisdom is more associated with deciding between better and worse wrongs; a winless situation we define as tragic. We suggest that addressing the tragic question is something that leaders and managers generally avoid when focusing on business decisions and choices. Yet, raising and confronting the tragic (...) question is important for three main reasons. Firstly, it emphasises that wisdom is about recognising that doing the ethically responsible thing can sometimes lead to acting in ways that violate different ethical norms and values. Secondly, it foregrounds the issue of emotional perception in ethical decision-making. We argue that emotions are salient in directing attention to the tragic question and recognising morally ambiguous situations. Thirdly, the tragic question has important consequences for moral learning, accepting moral culpability for wrongdoing and organisational commitment to righting the wrong. We illustrate our arguments by drawing on three mini-cases: Arjuna’s dilemma in the Mahabharata, Gioia’s deliberations about his role in the Ford Pinto fires and the production of the abortion pill by French company Roussel-Uclaf. (shrink)

ABSTRACT The purpose of this article is to show how William James's thought can help to construct a critical approach to the conceptualization of unexpected destructive events and suggest modes of conceptualization that reduce social injustice. I draw on several interrelated themes in James's thought, including, but not limited to: metaphysical and moral relationalism, the tragedy of choice, and the psychology of selective attention. Specifically, I argue that James provides resources for mounting a criticism of a kind of essentialist thinking (...) about unexpected events; for showing how this essentialism can create social injustice by obfuscating social choices and causing marginalized groups to bear a disproportionate share of social costs; for helping to construct a pluralistic approach to unexpected events that makes transparent the tragic choices laying behind them; and for putting this approach to use in ways that mitigate social injustice. (shrink)

In the context of abortion stigma, most abortion stories remain untold. The stories we do tell of abortion are often told to morally recuperate the status of the woman who has an abortion through a recourse to tragedy. Tragedy frames experiences where every choice produces some suffering, so decisions are geared toward maintaining individual integrity rather than adherence to absolute moral truths. This article argues that one dominant tragic abortion narrative, that of the disabled fetus, works to recuperate the (...) moral status of “fit” mothers while actively constructing disabled lives as unlivable and undesirable. The option to stigmatize disability in recuperating the moral status of the woman who has an abortion relies on eugenic logics that also construct a variety of women as illegitimate reproductive subjects. The article analyzes narratives of Sherri Finkbine's 1962 abortion in relation to contemporary narratives of late‐term abortions involving nonviable fetuses to expose how investment in medical judgments of good births enables particular women to make use of tragic narratives to maintain their status as moral mothers without disturbing broader abortion stigma or eugenic logics. (shrink)

Most commentators have focused on ethical dilemmas and the idea that they were core to the actions of and decisions by Jewish doctors in SS concentration camps and ghettos during the Holocaust. While I recognize Jewish doctors did face ethical dilemmas, in this article, I shift my attention to include two other significant factors: choiceless choices, defined by the eminent Holocaust historian Lawrence Langer as “crucial decisions [that] did not reflect options between life and death, but between one form (...) of abnormal response and another, both imposed by a situation that was in no way of the victim’s own choosing,” and the human condition, whereby decisions and actions were triggered by personal traits and past experiences in response to particular situations and circumstances. Inherent in all three factors is the tenaciousness of reality and how the abhorrent conditions, immorality, inhumanity and evilness cast a shadow over every moment of the Jewish doctor’s life. My thesis is that decision-making was not one-dimensional but multi-dimensional. For the Jewish doctor every incident became a source of dread and tragedy. They were often not trained to treat some diseases or perform surgery and lacked experience to work in such conditions and cope emotionally and psychologically. I will attempt to show that how a person responds to an ethical dilemma is based on his or her own experiences and reasoning, and how they reacted to sudden and inexplicable incidents that threatened life or impacted survival induced abnormal actions and decisions. As Jewish doctors they were driven to be healers, to be normal, but they were forced by circumstances to kill or become perpetrators, acting abnormally. Tragically the abnormal became the norm. The Jewish doctors were professionally trained and culturally socialized to continue their roles as doctors. Nevertheless, they were human and were driven by the innate will to live. (shrink)

_This study investigates how domestic violence and abuse have been portrayed in Bina Shah’s Slum Child. The study analyzes how women’s portrayal construes domestic violence, abuse, marginalization, and victimization. The study employs Thematic Roles given by Andrew and Radford, as cited in Saeed to explore the linguistic choices which are significant in reflecting the underlying ideology of the author. Research shows that the beats, mourns, screams, and shouts of the female characters as portrayed in the novel represent the distress, (...) restraint, and implicit horrendous recollections. This study has contended that the selected novel features the complex relationship of females with space and researched how the female characters swaying among private and public spaces find the metropolitan space afraid for them. This study suggests that the academia through literature must commend voice following the troubles of the declined women whosoever are tragically collided together by the perpetrators._. (shrink)

If we set aside personal edification, what reasons remain for a philosopher of science to study the intellectual biography of a famous (or infamous) scientist? This question raises familiar and perhaps tired arguments about the relationship between history of science and philosophy of science, but it is also practical: why take the time to digest almost 600 pages devoted to the controversial German zoologist Ernst Haeckel? A preliminary answer is the author. The historical investigations of Robert Richards have been of (...) ongoing interest to philosophers, whether it be evolutionary explanations of mind and behavior in the nineteenth century (Dennett 1989) or his contentious claims—reinvigorated in the present volume—about Darwin’s commitment to embryonic recapitulation (Lennox 1994). Richards has a knack for unearthing details germane to conceptual reflection, in no small part because of his own philosophical predilections (e.g., a selection model of scientific theory development). Here I entertain three more reasons to follow the injunction tolle lege: the prescient synthesis exemplified in Haeckel’s evolutionary theorizing, the impact of model organism choice, and the critical role of pictures in scientific reasoning accented by Haeckel’s artistic proclivities. (shrink)

In this paper, we apply the capabilities approach—with the addition of capability ceilings—to energy justice. We argue that, to ensure energy justice, energy policies and scenarios should consider enabling not only minimal capability thresholds but also maximum capability ceilings. It is permissible, perhaps even morally required, to limit the capabilities of those above the threshold if it is necessary for enabling those below the threshold to reach the level required by justice. We make a distinction between tragic and non- (...) class='Hi'>tragic conflicts of capabilities: tragic conflicts are instances when one cannot raise an agent’s capabilities above the threshold that justice requires without pushing someone else below the threshold or restricting someone from reaching the threshold. In contrast, a non-tragic choice is when increasing someone above the threshold required by justice does not entail pushing someone else’s capabilities below the threshold. We utilise this framework to discuss energy justice and emissions of greenhouse gases. Drawing on the relation between points on the human development index and levels of energy consumption, we conclude that non-tragic mitigation policies now are highly preferable to tragic policies later. (shrink)

How should UNOS deal with the presence of scientific controversies on the risk factors for organ rejection when designing its allocation policies? The answer I defend in this paper is that the more undesirable the consequences of making a mistake in accepting a scientific hypothesis, the higher the degree of confirmation required for its acceptance. I argue that the application of this principle should lead to the rejection of the hypothesis that ‘less than perfect’ Human Leucocyte Antigen (HLA) matches are (...) an important determinant of kidney graft survival. The scientific community has been divided all along on the significance of partial antigen matches. Yet reliance on partial matches has emerged as one of the primary factors leading blacks to spend a much longer time than whites on the waiting list for kidneys, thereby potentially impacting the justice of the kidney allocation policy. My case study illustrates one of the legitimate roles non-epistemic values can play in science and calls into question the ideal of a value-free science. (shrink)

An underexamined insight of W. E. B. Du Bois’s John Brown is that John Brown worked for much of his life to cultivate democratic relationships with the Black Americans with and for whom he worked. Brown did so through practicing deference and deliberation, and by seeking authorization. However, Brown’s commitment to these practices faltered at a crucial moment in decision making: when he raided Harpers Ferry absent widespread support. Examining this aspect of John Brown brings into relief an overlooked (...) class='Hi'>tragic choice Brown made: To act in accordance with his own substantive vision of what justice required, Brown eschewed democratic ideals and practices that grounded the distinctive relations of equality he had cultivated with the Black communities with and for whom he worked. (shrink)

The current ethical-legal consensus — prohibiting assisted suicide and euthanasia, but (1) allowing patients to forgo all life-saving treatment, and (2) permitting pain relief that increases the risk of death — is a means of having it both ways. This is how we often make “tragic choices.”.

Covid‐19 confronts us with tragic choices, in which every option is unacceptable. On the New York State Task Force on Life and the Law, I worked on guidelines for such situations. We did not envision the scale or character of Covid‐19. To minimize fear that the decisions made in these situations might be unfair, we all must know what guidelines or mandates inform them. Only with transparency about how decisions will be made, by whom, and according to what (...) requirements can we have confidence that fairness prevails. We now face many related questions about process, goals, leadership, and trust. For example, how might ethical guidelines evolve as scientific understanding advances? Should guidelines vary with different venues? And if, as I have argued, judgment is necessary even with the best of guidelines, how can we prepare clinicians to make good judgments? Are there implications for better training of personnel in nonemergency times for what they might face in the worst of times? (shrink)

In a recent article, Steinkamp, Gordijn, and ten Have discussed a new way of thinking about the ethics consultant's ethical expertise. After critiquing their model of ethical expertise, along with the notion that discourse can and will enable ethicists to consult without over-reaching, this essay suggests that the debate about ethical expertise is intractable because it constitutes a 'tragic choice'.

Divided Staffs, Divided Selves offers a case-centered approach to the teaching of health care ethics to a wide range of students and clinicians. The book provides both clinical case material and a method for engaging in a dialogue regarding difficult decisions in the mental health care field that have potentially tragic choices. The essays that introduce the volume place the ethical problems of treating mentally ill people in the context of the health care ethics movement and traditions of (...) ethical decision making. The individual cases are real, derived from actual clinical and consultative experiences. (shrink)

This paper examines parents experiences of medical decision-making and coping with having a critically ill baby in the Neonatal Intensive Care Unit (NICU) from a cross-cultural perspective (France vs. U.S.A.). Though parents experiences in the NICU were very similar despite cultural and institutional differences, each system addresses their needs in a different way. Interviews with parents show that French parents expressed overall higher satisfaction with the care of their babies and were better able to cope with the loss of their (...) child than American parents. Central to the French parents perception of autonomy and their sense of satisfaction were the strong doctor–patient relationship, the emphasis on medical certainty in prognosis versus uncertainty in the American context, and the sentimental work" provided by the team. The American setting, characterized by respect for parental autonomy, did not necessarily translate into full parental involvement in decision-making, and it limited the rapport between doctors and parents to the extent of parental isolation. This empirical comparative approach fosters a much-needed critique of philosophical principles by underscoring, from the parents perspective, the lack of emotional work" involved in the practice of autonomy in the American unit compared to the paternalistic European context. Beyond theoretical and ethical arguments, we must reconsider the practice of autonomy in particularly stressful situations by providing more specific means to cope, translating the impersonal language of rights" and decision-making into trusting, caring relationships, and sharing the responsibility for making tragic choices. (shrink)