It is a popular view thatpractical deliberation excludes foreknowledge of one's choice. Wolfgang Spohn and Isaac Levi have argued that not even a purely probabilistic self-predictionis available to thedeliberator, if one takes subjective probabilities to be conceptually linked to betting rates. It makes no sense to have a betting rate for an option, for one's willingness to bet on the option depends on the net gain from the bet, in combination with the option's antecedent utility, rather than on the (...) offered odds. And even apart from this consideration, assigning probabilities to the options among which one is choosing is futile since such probabilities could be of no possible use in choice. The paper subjects these arguments to critical examination and suggests that, appearances notwithstanding, practical deliberation need not crowd outself-prediction. (shrink)

Progress towards Universal Health Coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the WHO Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases and how should one adjudicate between them when their demands conflict? This paper by some (...) members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three principal dimensions of progress towards UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to pre-payment with pooling of funds. Our cases are simplified to highlight common trade-offs. While we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC. (shrink)

Abstract:John Dewey argued that for education to be democratic, it is important for students to be not merely spectators but also participants in learning. Teachers sometimes find personal computing devices to be distracting or to contribute to passivity rather than activity in the classroom. In this essay we examine the question of whether a student’s Google search on a subject matter discussed in class is participatory or passive. We argue that with proper guidance students’ use of online searches and related (...) tools can empower students democratically as sources of ideas, conceptualizations, information, and insight while emphasizing participation in deliberation and judgment in the classroom. We begin with a look at the criticisms and then defenses of using online tools in the classroom. Finally, we examine Dewey’s distinction between the spectator versus the participant models of learning to apply his insights to the use of online tools in the classroom. (shrink)

Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the (...) CARE model provides a substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings. (shrink)

An Integrative Model of Moral Deliberation suggests that the inadequacy of models of moral deliberation to deal effectively with contemporary moral complexity is a result of the lack of an inadequate theory of moral cognition. Drawing from work in neuroscience, evolutionary psychology, social theory, dual process cognitive theory, and the work of William James, this book develops a theory of moral cognition to be used as the basis for a model of moral (...) deliberation. This model portrays moral deliberation as a back and forth movement between intuitive and analytic cognitions, by which narrative scenarios are constructed and then assessed by aesthetic sensibilities. (shrink)

Many of us read Peter Singer ’ s work on our obligations to those in desperate need with our students. Famously, Singer argues that we have a moral obligation to give a significant portion of our assets to famine relief. If my own experience is not atypical, it is quite common for students, upon grasping the implications of Singer ’ s argument, to ask whether Singer gives to famine relief. In response it might be tempting to remind students of (...) the ad hominem fallacy of attacking the person advancing an argument rather than the argument itself. In this paper I argue that the “ ad hominem reply ” to students ’ request for information about Singer is misguided. First I show that biographical facts about the person advancing an argument can constitute indirect evidence for the soundness / unsoundness of the argument. Second, I argue that such facts are relevant because they may reveal that one can discard the argument without thereby incurring moral responsibility for failing to act on its conclusion even if the argument is sound. (shrink)

A qualitative study with an exploratory, descriptive and documentary design that was conducted with the objective of identifying the elements to constitute a method for the analysis of accusations of and proceedings for professional ethics infringements. The method is based on underlying elements identified inductively during analysis of professional ethics hearings judged by and filed in the archives of the Regional Nursing Board of Santa Catarina, Brazil, between 1999 and 2007. The strategies developed were based on the results of an (...) analysis of the findings of fact (occurrences/infractions, causes and outcomes) contained in the records of 128 professional ethics hearings and on the structural elements (statements, rules and practices) identified in five example professional ethics cases. The strategies suggested for evaluating accusations of ethics infringements and the procedures involved in deliberating on ethics hearings constitute a generic proposal that will require adaptation to the context of specific professional ethics accusations. (shrink)

The aim of this article is to show how intimately connected Beth J. Singer's theory of operative rights is with her understanding of the deliberative process. I thus argue against Cynthia Gayman's effort to set in contrast Singer's theory of rights and Dewey's characteristic emphasis on reflective morality. Since I take the value of Singer's approach to be most evident in its relevance to the abortion debate as an ongoing deliberation, I question whether Mary Magada‐Ward sufficiently appreciates the dialogical (...) and deliberative emphases of Singer's stance. My goal, however, is not so much to argue against either Gayman or Magada‐Ward as it is to argue for taking Singer's position even more seriously than either author does. In particular, I want to highlight the finely nuanced character of Singer's philosophical intervention in the debate regarding abortion, especially stressing certain features that Gayman and Magada‐Ward overlook. (shrink)

In Chapter 9 of The Practice of Moral Judgment and her later article Making Room for Character, Barbara Herman offers a distinctive response to a familiar set of concerns with the room left for character and personal relationships in Kantian ethics. She begins by acknowledging the shortcomings of her previous response on this issue and by distancing herself from a standard kind of indirect argument for the importance of personal commitments according to which these have moral weight in (...) virtue of their connection with the psychological health of individuals. Agreeing with an imagined critic’s concern that Kantian ethics must do more than merely tolerate motives of connection, she proposes that we adopt a deliberative field account of practical deliberation incorporating a developmental model of desire formation. I argue that, while this is a subtle and interesting account of desire development, it is not one that will satisfy the critic and should not satisfy the Kantian. I claim that the Kantian cannot forgo instrumental arguments for the importance of personal relationships and commitments and that they should not be shy of endorsing these arguments. (shrink)

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and (...) methodologies have emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry. (shrink)

Empirical research in the field of moral cognition is increasingly being used to draw conclusions in philosophical moral psychology, in particular regarding sentimentalist and rationalist accounts of moral judgment. This paper calls for a reassessment of both the empirical and philosophical conclusions being drawn from the moral cognition research. It is proposed that moral decision making is best understood as a species of Kahneman and Frederick's dual-process model of decision making. According to this model, emotional (...) intuition-generating processes and reflective processes operate in an integrated way in moral deliberation, and metacognition is assigned an essential role in the monitoring and shaping of moral intuitions. In combination with observations from philosophical moral psychology, this proposal cautions against endorsing simple sentimentalism or rejecting rationalist accounts on the basis of the moral cognition research. (shrink)

This essay develops a new account of the phenomenon of imaginative resistance. Imaginative resistance is best conceived of as a limited phenomenon. It occurs when we try to engage imaginatively with different moral worlds that are insufficiently articulated so that they do not allow us either to quarantine our imaginative engagement from our normal moral attitudes or to agree with the expressed moral judgment from the perspective of moral deliberation. Imaginative resistance thus reveals the central (...) epistemic importance that empathy plays for our understanding of rational agents in a context where we try to make sense of the moral appropriateness of their reasons for acting. Reflecting on the phenomenon of imaginative resistance allows us to recognize important features of the relationship between imaginative perspective taking and ordinary moral deliberation. (shrink)

The experience of the last thirty years has shown that whether the different methodologies used in clinical ethics work well or not depends on certain external factors, such as the mentality with which they are used. This article aims to analyze two of these mentalities: the “dilemmatic” and the “problematic.” The former uses preferably the decision-making theory, whilst the latter emphasizes above all the role of deliberation. The author considers that Clinical Ethics must be deliberationist, and that only in (...) this context the different methodologies can be used correctly. (shrink)

Many social trends are conspiring to drive the adoption of greater automation in society, and we will certainly see a greater offloading of human decisionmaking to robots in the future. Many of these decisions are morally salient, including decisions about how benefits and burdens are distributed. Roboticists and ethicists have begun to think carefully about the moral decision making apparatus for machines. Their concerns often center around the plausible claim that robots will lack many of the mental capacities that (...) are indispensable in human moral decision making, such as empathy. To the extent that robots may be robustly artificially intelligent, these concerns subside, but they give way to new worries about creating artificial agents to do our bidding, if those artificial agents have moral standing. We suggest that the question of AI consciousness poses a dilemma. Whether artificially intelligent agents will be conscious or not, we will face serious difficulties in programming them to reliably make moral decisions. (shrink)

This paper develops themes addressed in an article by Eric Wiland in the Journal of Medical Ethics 2000;26:466–8, where he aims to contribute to the debate concerning the moral status of abortion, and to emphasise the importance of analogies in moral argument. In the present paper I try to secure more firmly a novel understanding of why analogy is an essential component in the attempt to justify moral beliefs. I seek to show how analogical argument both encapsulates (...) and exercises the notions of rationality and imagination and that the construction, development, and comparison of analogies fundamentally underpins ethical argument. In so doing, it enables us to adopt imaginative and ethically illuminating perspectives but in a manner that does not relinquish any claims to intellectual rigour. I present a critique of a brand of “moral particularism” by showing how it cannot, if construed in a certain way, adequately conceive of how we use analogies and imaginary cases in ethics. Although such a particularism is thus impotent with regard to ethical debate, I show that the wider motivation behind particularism that can be extracted is of clear relevance and importance to medical practitioners. (shrink)

Many social trends are conspiring to drive the adoption of greater automation in society, and we will certainly see a greater offloading of human decisionmaking to robots in the future. Many of these decisions are morally salient, including decisions about how benefits and burdens are distributed. Roboticists and ethicists have begun to think carefully about the moral decision making apparatus for machines. Their concerns often center around the plausible claim that robots will lack many of the mental capacities that (...) are indispensable in human moral decision making, such as empathy. To the extent that robots may be robustly artificially intelligent, these concerns subside, but they give way to new worries about creating artificial agents to do our bidding, if those artificial agents have moral standing. We suggest that the question of AI consciousness poses a dilemma. Whether artificially intelligent agents will be conscious or not, we will face serious difficulties in programming them to reliably make moral decisions. (shrink)

In this article I offer an account of normative thought inspired by Plato's proposal in the Theaetetus that judgement is ‘speech spoken … silently.’ After arguing that force conventionalism is the speech act theory best suited for modeling dialogic inner speech, I close the article by sketching the picture of normative thought that results. Though I defend a particular theory of normative speech elsewhere, the core insights of this article can be used by other theorists as well. The arguments offered (...) here also serve as an important step forward for the more general program of using social speech to better understand thought. (shrink)

"Application of the possibilities for this renewal of temperance comes with an examination of how emotion will help moral deliberation in the clinical practice of medicine. Sir William Osler (1849-1919) and his doctrine of aequanimitas is greatly misunderstood to be the founder of emotional detachment in physician/patient relations. This book offers the most detailed look at aequanimitas in print and equates it with a normative view of temperance as a moral virtue." "For upper-level undergraduate and graduate-level students (...) interested in ethics, bioethics, and moral psychology; Oslerians; and students of Aristotle's and Aquinas' views of the moral virtues."--BOOK JACKET. (shrink)

This paper considers the question of whether predictions of wrongdoing are relevant to our moral obligations. After giving an analysis of ‘won’t’ claims (i.e., claims that an agent won’t Φ), the question is separated into two different issues: firstly, whether predictions of wrongdoing affect our objective moral obligations, and secondly, whether self-prediction of wrongdoing can be legitimately used in moral deliberation. I argue for an affirmative answer to both questions, although there are conditions that must be (...) met for self-prediction to be appropriate in deliberation. The discussion illuminates an interesting and significant tension between agency and prediction. (shrink)

This paper considers the question of whether predictions of wrongdoing are relevant to our moral obligations. After giving an analysis of 'won't' claims, the question is separated into two different issues: firstly, whether predictions of wrongdoing affect our objective moral obligations, and secondly, whether self-prediction of wrongdoing can be legitimately used in moral deliberation. I argue for an affirmative answer to both questions, although there are conditions that must be met for self-prediction to be appropriate in (...) deliberation. The discussion illuminates an interesting and significant tension between agency and prediction. (shrink)

My aim in this note is to shed light on ways of interpreting Kant’s Formula of Universal Law (FUL), by looking at relevant similarities and differences between Pauline Kleingeld and Mark Timmons. I identify both their readings as a formal interpretation of Kant’s FUL, in contrast to the substantive interpretations that favor a robust conception of rational agency as a necessary requirement for moral deliberation. I highlight the benefits that arise from Kleingled’s interpretation in showing the immediacy involved (...) in the volitional self-contradiction when universalizing a maxim. Alongside Timmons, I address a question as to whether Kleingeld’s interpretation is completely free from at least a minimal set of assumptions about practical deliberation more broadly, that seem to play a role in generating the volitational self-contradiction she is defending. I close by raising some skeptical worries about the capacity of this kind of contradiction to translate into a moral judgment triggering action. (shrink)

Despite all the attention given to Kant’s universalizability tests, one crucial aspect of Kant’s thought is often overlooked. Attention to this issue, I will argue, helps us resolve two serious problems for Kant’s ethics. Put briefly, the first problem is this: Kant, despite his stated intent to the contrary, doesn’t seem to use universalization in arguing for duties to oneself, and, anyway, it is not at all clear why duties to oneself should be grounded on a procedure that envisions a (...) world in which everyone wills the contrary of those duties. The second, more global problem is that if we follow Barbara Herman in holding that Kantian ethics can provide a structure for moral deliberation, we need an interpretation of the universalization procedure that unproblematically allows it to generate something like prima facie duties to guide that deliberation; but it is not at all clear that we have such an interpretation. I argue here that if we expand our limited way of thinking about universalization, we can solve the first problem and work towards a solution to the second. We can begin by recalling that Kant’s ‘Law of Nature’ formulation (FLN) of the Categorical Imperative obligates us to ‘act as if the maxim of your action were to become by your will a universal law of nature’ (G, 421). (shrink)

Pragmatism has been understood by bioethicists as yet another rival in the “methods wars,” as yet another theory of moral deliberation. This has led to criticism of pragmatic bioethics as both theoretically and practically inadequate. Pragmatists’ responses to these objections have focused mainly on misunderstandings of pragmatism’s epistemology. These responses are insufficient. Pragmatism’s commitment to radical empiricism gives it theoretical resources unappreciated by critics and defenders alike. Radical empiricism, unlike its more traditional ancestors, undercuts the gaps between theory (...) and practice, and subjective and objective accounts of experience, and in so doing provides the metaphysical and epistemological basis for a thoroughgoing empirical naturalism in ethics. Pragmatism’s strength as an approach to moral problems thus emerges as a result of a much wider array of resources than contemporary interpreters have acknowledged, which makes it a richer, deeper framework for understanding moral deliberation in general and bioethical decision making in particular. (shrink)

Together we can achieve things that we could never do on our own. In fact, there are sheer endless opportunities for producing morally desirable outcomes together with others. Unsurprisingly, scholars have been finding the idea of collective moral obligations intriguing. Yet, there is little agreement among scholars on the nature of such obligations and on the extent to which their existence might force us to adjust existing theories of moral obligation. What interests me in this paper is the (...) perspective of the moral deliberating agent who faces a collective action problem, i.e. the type of reasoning she employs when deciding how to act. I hope to show that agents have collective obligations precisely when they are required to employ ‘we-reasoning’, a type of reasoning that differs from I-mode, best response reasoning, as I shall explain below. More precisely, two (or more) individual agents have a collective moral obligation to do x if x is an option for action that is only collectively available (more on that later) and each has sufficient reason to rank x highest out of the options available to them. (shrink)

Sunstein represents moral heuristics as rigid rules that lead us to jump to moral conclusions, and contrasts them with reflective moral deliberation, which he represents as independent of heuristics and capable of supplanting them. Following John Dewey's psychology of moral judgment, I argue that successful moral deliberation does not supplant moral heuristics but uses them flexibly as inputs to deliberation. Many of the flaws in moral judgment that Sunstein attributes to (...) heuristics reflect instead the limitations of the deliberative context in which people are asked to render judgments. (shrink)

Recent advancements in therapeutic and diagnostic medicine, along with the creation of large biobanks and methods for monitoring health technologies, have improved the prospects for preventing, treating, and curing illness. These same advancements, however, give rise to a plethora of ethical questions concerning good decision-making and best action. These ethical questions engage policymakers, practitioners, scientists, and researchers from a variety of fields in different ways. Collaborations between professionals in the medical and health sciences and the social sciences and humanities often (...) take an asymmetrical form, as when social scientists use ethnographic approaches to study the moral issues and practices of physicians. The ethics laboratory described in this article is a cross-sectoral and inter-disciplinary forum for collaborative investigation on important moral topics. It offers an experimental way of unpacking implied assumptions, underlying values, and comparable notions from different professional healthcare fields. The aim of this article is to present the ethics laboratory’s methodology. The article offers a model and a hermeneutical framework that rests on a dialogical approach to ethical questions. The model and the framework derive from a Danish research project, _Personalized Medicine in the Welfare State_. This article uses personalized medicine as a point of reference, though it offers an argument for the applicability of the model more broadly. (shrink)

This article argues that congregations should be seen as grassroots public moral agents, on the ground working to bring what they discern as God's preferred future into being. Deliberations among congregations of all social backgrounds are a way of doing ethics "polycentrically," without a dominant center. Because cultural and social boundaries are permeable and people in various social groups can imaginatively enter the worlds of people unlike themselves, they can engage those perspectives morally on an equal footing. The essay (...) addresses ethicists' participation in congregations' moral deliberation and action, and concludes with a plea for theological ethicists to consider congregations in their work. (shrink)

The use of Scripture for deliberation and justification in making moral judgments is a crucial and neglected function of the Bible in Christian ethics.

A research project by the Schools of Theology and Psychology of Australia’s Charles Sturt University surveyed a large sample of Salvation Army officers. This article considers survey responses to two questions relating to end-of-life care: the use of pain medications that may shorten life, and the cessation of fluid and food intake. The results of the analyses are evaluated in terms of Michael Banner’s proposal that moral theology should more assiduously converse with ‘patient ethnographic study’, which the survey instantiates (...) to some extent. Banner’s proposal and the results of the survey are contrasted to Peter Singer’s analytical moral philosophical dictums on end-of-life care. The results are also compared to a metastudy by Andrea Rodríguez-Prat and Evert van Leeuwen of 14 ethnographic studies of those who wish to hasten death at the end of life. We conclude that respondents exemplify a form of moral reasoning that is embedded within Christian spirituality; counters the assumptions of Singer’s approach; contrasts the diminishment of ‘meaning’ at the end of life, as seen in Rodríguez-Prat and van Leeuwen; and deserves further respectful ethnographic study. (shrink)

It is widely accepted in psychology and cognitive science that there are two “systems” in the mind: one system is characterized as quick, intuitive, perceptive, and perhaps more primitive, while the other is described as slower, more deliberative, and responsible for our higher-order cognition. I use the term “reflectivism” to capture the view that conscious reflection—in the “System 2” sense—is a necessary feature of good moral judgment and decision-making. This is not to suggest that System 2 must operate alone (...) in forming our moral decisions, but that it plays a normatively ineliminable role. In this paper, I discuss arguments that have been offered in defense of reflectivism. These arguments fit into two broad categories; let us think of them as two sides of a coin. On the first side are arguments about the efficaciousness of conscious reasoning—for example, without conscious deliberation we will make bad moral judgments and decisions. On the other side of the coin are arguments about the centrality of conscious deliberation to normative actions—for example, without conscious deliberation we are no more agential than animals or automatons. Despite their attractiveness, I argue that these arguments do not successfully establish that reflection is a necessary component of good moral judgment and decision-making. If I am right, the idea that good moral judgment and decision-making can result from entirely automatic and subconscious processes gains traction. My goal in this paper is to show that reflectivism fails to include the full range of cases of moral decision-making and that a theory of automaticity may do a better job. I briefly discuss at the end of the paper how an account of successful automatic moral judgment and decision-making might begin to take shape. (shrink)

There is an increased focus on fostering integrity in research by through creating an open culture where research integrity dilemmas can be discussed. We describe a pilot intervention study that used Moral Case Deliberation (MCD), a method that originated in clinical ethics support, to discuss research integrity dilemmas with researchers. Our research question was: can moral case deliberation in research groups help to navigate research integrity dilemmas? We performed 10 MCDs with 19 researchers who worked in (...) three different research groups from three different disciplinary fields at a university in the Netherlands. We analyzed the dilemmas and values discussed, sent out a survey questionnaire to assess self-perceived moral competencies, and conducted in-depth interviews. We found research integrity dilemmas pertained to authorship disputes, supervision of junior co-workers, and questionable handling of data. Participants perceived the majority of moral competencies to a higher degree during the MCD when compared to perceiving them in daily practice afterward. Interviewees told us that they felt most comfortable discussing dilemmas among peers with whom they were not closely affiliated. We conclude that MCD sessions could be relevant in navigating research integrity dilemmas, but that revisions to ensure commitment and safety are required. (shrink)