This paper explores the relationship of various trait emotions to the ethical choices of 189 college students who completed a managerial decision-making task as part of an in-basket exercise in a laboratory setting. Prior research regarding emotion influences on ethical decision-making and linkages between emotions and cognition informed hypotheses about how different types of emotions impact ethical choices. Findings supported our expectations that positive and negative emotions classified as active would be more strongly related to (...) interpersonally-directed ethical choices than to organizationally-directed ones, and that passive emotions would be less related to ethical choices than active emotions. Implications for ethical decision-making research and organizational practices are discussed. (shrink)

Ideal for students with little or no background in philosophy, Ethical Choices: An Introduction to Moral Philosophy with Cases provides a concise, balanced, and highly accessible introduction to ethics. Featuring an especially lucid and engaging writing style, the text surveys a wide range of ethical theories and perspectives including consequentialist ethics, deontological ethics, natural and virtue ethics, the ethics of care, and ethics and religion.Each chapter of Ethical Choices also includes compelling case studies that are (...) carefully matched with the theoretical material. Many of these cases address issues that students can relate directly to their own lives: the drinking age, student credit card debt, zero tolerance policies, grade inflation, and video games. Other cases discuss current topics like living wills, obesity, human trafficking, torture "lite," universal health care, and just-war theory. The cases provide students with practice in addressing real-life moral choices, as well as opportunities to evaluate the usefulness and applicability of each ethical theory. Every case study concludes with a set of Thought Questions to guide students as they reflect upon the issues raised by that case.Ethical Choices is enhanced by several pedagogical features. These include summaries at the end of each section, lists of key terms, questions For Reflection and Discussion at the end of each chapter, Guidelines for a Case Study Analysis, and suggestions For Further Reading that include Internet sources. Starred sections indicate more advanced material that may be included at the instructor's discretion. A companion website at www.oup.com/us/burnor contains additional resources for both students and instructors: chapter outlines, flashcards of key terms, sets of Helpful Hints to further aid students in mastering the material, and an additional chapter on our Moral Obligations Towards the Future. (shrink)

Ideal for students with little or no background in philosophy, Ethical Choices: An Introduction to Moral Philosophy with Cases provides a concise, balanced, and highly accessible introduction to ethics. Featuring an especially lucid and engaging writing style, the text surveys a wide range of ethical theories and perspectives including consequentialist ethics, deontological ethics, natural and virtue ethics, the ethics of care, and ethics and religion. Each chapter of Ethical Choices also includes compelling case studies that (...) are carefully matched with the theoretical material. Many of these cases address issues that students can relate directly to their own lives: the drinking age, student credit card debt, zero tolerance policies, grade inflation, and video games. Other cases discuss current topics like living wills, obesity, human trafficking, torture "lite," universal health care, and just-war theory. The cases provide students with practice in addressing real-life moral choices, as well as opportunities to evaluate the usefulness and applicability of each ethical theory. Every case study concludes with a set of Thought Questions to guide students as they reflect upon the issues raised by that case. Ethical Choices is enhanced by several pedagogical features. These include summaries at the end of each section, lists of key terms, questions For Reflection and Discussion at the end of each chapter, Guidelines for a Case Study Analysis, and suggestions For Further Reading that include Internet sources. Starred sections indicate more advanced material that may be included at the instructor's discretion. A companion website at www.oup.com/us/burnor contains additional resources for both students and instructors: chapter outlines, flashcards of key terms, sets of Helpful Hints to further aid students in mastering the material, and an additional chapter on our Moral Obligations Towards the Future. (shrink)

As health care costs continue to escalate, cost control measures will likely become unavoidable and painful. One approach is to engage external forces to allocate resources - for example, through managed care or outright rationing. Another approach is to engage consumers to make their own allocation decisions, through "self-rationing," wherein they are given greater awareness, control, and hence responsibility for their health care spending. Steadily gaining popularity in this context is the concept of "consumer directed health care" (CDHC), which (...) is envisioned to both control cost and enhance choice, by combining financial incentives with information to help consumers make more informed health care decisions and to appreciate the economic trade-offs of those decisions. While CDHC is gaining attention in the popular press, business publications, and academic journals, it is not without controversy about its relative merits and demerits. CDHC raises questions regarding the ethical limits of consumer responsibility for their choices. While the emphasis on consumer choice implies that autonomy is the ruling ethical principle in CDHC, it must be tempered by justice and beneficence. Justice must temper autonomy to protect disadvantaged populations from further widening disparities in health care access and outcomes that could arise from health care reform efforts. Beneficence must temper autonomy to protect consumers from unintended consequences of uninformed decisions. Thoughtful paternalism suggests that CDHC plans offer choices that are comprehensible to lay consumers, limited in their range of options, and carefully structured with default rules that minimize potential error costs. (shrink)

In organ transplantation, there is a lack of ethical discussion about the recipient’s right not to receive a transplant. Using the current situation of living organ transplantation and deceased organ transplantation in Japan as an example, we prospectively discussed to what extent the recipient’s right not to receive a transplant is ethically acceptable. In directed transplantation from a living donor, a recipient may refuse organ donation from a particular donor. It is preferable that a recipient’s request for organ (...) donation from a donor occurs as part of a transparent process. In nondirected transplantation from a deceased donor, refusal of transplantation from a particular type of donor appears potentially justifiable. There are both moral and pragmatic considerations. Certain refusals based solely on belief are morally unacceptable, and refusal to transplant a recipient based on the donor’s age jeopardizes the entire transplant system. When religious beliefs affect mental and physical health, individualized measures are required for transplant rejection. We also deductively developed a prospective argument based on the current status of donor–recipient communication in living organ transplantation in Japan and the 2010 amendment of the law allowing relatives to be given priority in organ transplantation from deceased donors. (shrink)

With vast new scientific and technological powers, we face unprecedented choices for which traditional ethics provide little direct guidance. What role can the religious community play in addressing the ethical and theological issues that even science now acknowledges as urgent?Chapman's work forges a method for integrating ethical reasoning with scientific data, focusing on four issues -- cloning, genetic engineering, patenting of life, and environmental alteration. For each, she reviews the work of religious thinkers, assesses the roles of (...) the religious community, considers relevant confessional differences, determines how traditional theological and ethical concepts can be clarified, reformulated, and "operationalized" to meet the questions, and finally she formulates helpful methodological options. She calls for a scientifically informed religious ethics built dialogically from concepts in both science and theology. (shrink)

Targeted modifications of the human epigenome, epigenome editing (EE), are around the corner. For EE, techniques similar to genome editing (GE) techniques are used. While in GE the genetic information is changed by directly modifying DNA, intervening in the epigenome requires modifying the configuration of DNA, for example, how it is folded. This does not come with alterations in the base sequence (‘genetic code’). To date, there is almost no ethical debate about EE, whereas the discussions about GE are (...) voluminous. Our article introduces EE into bioethics by translating knowledge from science to ethics and by comparing the risks of EE with those of GE. We, first (I), make the case that a broader ethical debate on EE is due, provide scientific background on EE, compile potential use-cases and recap previous debates. We then (II) compare EE and GE and suggest that the severity of risks of novel gene technologies depends on three factors: (i) the choice of an ex vivo versus an in vivo editing approach, (ii) the time of intervention and intervention windows and (iii) the targeted diseases. Moreover, we show why germline EE is not effective and reject the position of strong epigenetic determinism. We conclude that EE is not always ethically preferable to GE in terms of risks, and end with suggestions for next steps in the current ethical debate on EE by briefly introducing ethical challenges of new areas of preventive applications of EE (III). (shrink)

The book aims to revitalise the interdisciplinary debate about evolutionary ethics and substantiate the idea that evolution science can provide a rational and robust framework for understanding morality. It also traces pathways for knowledge-based choices to be made about directions for future long-term biological evolution and cultural development in view of adaptation to the expected, probable and possible future and the ecological sustainability of our planetary environment The authors discuss ethical challenges associated with the major biosocial sources of (...) human variation: individual variation, inter-personal variation, inter-group variation, and inter-generational variation. This book approaches the long-term challenges of the human species in a holistic way. Researchers will find an extensive discussion of the key theoretical scientific aspects of the relationship between evolution and morality. Policy makers will find information that can help them better understand from where we are coming and inspire them to make choices and take actions in a longer-term perspective. The general public will find food for thoughts. (shrink)

The lack of consistency between people’s engagement in ethical issues and their food choices has received considerable attention. Consumption as “choice” dominates this discourse, understood as decision-making at the point of purchase. But ideas concentrating on individual choice are problematic when trying to understand how social and ethical issues emerge and are dealt with in the practices of buying and eating food. I argue in this paper that “consumer choice” is better understood as a political ideology addressing (...) a particular way in which everyday practices can be directed so as to solve social problems. It is a way that makes questions of power particularly challenging. Some assume consumer sovereignty, emphasizing consumer choice as a reflection of neoliberal deregulation and commercialization. Others worry that ongoing changes increase consumers’ powerlessness. None of these seem to capture that there is active regulation, where public as well as commercial and civil actors are making strong efforts to make people do the right thing—voluntarily. Labeling is the key measure. In practice, the individualized and rationalized model of responsibility depends not only on market opportunities, but even political and social expectations and trust. People may lack concrete capabilities and power to follow up on moral calls, but they may also have a different understanding of who is responsible and what is a “good deed,” or their actions may, in a Foucauldian sense, represent resistance. The paper will, with examples from European empirical studies, discuss how mobilization as well as inertia and disinterest emerge within specific political constellations and practical contexts. (shrink)

The influence of direct-to-consumer advertising and physician promotions are examined in this study. We further examine some of the ethical issues which may arise when physicians accept promotional products from pharmaceutical companies. The data revealed that direct-to-consumer advertising is likely to increase the request rates of both the drug category and the drug brand choices, as well as the likelihood that those drugs will be prescribed by physicians. The data further revealed that the majority of responding physicians were (...) either neutral or did not feel that accepting some types of gifts from pharmaceutical companies affected their ethical behaviors. (shrink)

Since the concept of the living wills emerged nearly 50 years ago, there have been practical challenges in translating the concept of an advance directive into documents that are clinically useful across various healthcare settings and among different patient populations and cultures. Especially, challenging has been the reliance in most ADs on pre-selected “choices” about specific interventions which either revolve around broad themes or whether or not to utilize particular interventions, both of which about most laypersons know little and, (...) more importantly, lacking context, prove to be of limited meaningfulness. Moreover, whether by foundational frame, decade-long misunderstanding in medicine and bioethics, or different societal customs, these ADs present decision-making responsibility for initiating, continuing, or withdrawing medical interventions as a patient responsibility—creating a burden for which most patients are unprepared—and hence reducing healthcare providers’ responsibility to mere technical application or customer service. At our institution, significant efforts have focused on embracing the unique and complementary responsibilities of patients and physicians for enabling appropriate plans of care. This includes re-structuring our AD form to more accurately represent patient’s values as the frame within which physicians are responsible for determining appropriate care. Rather than specifying interventions, the AD makes patients responsible for specifying what matters to them as well as what they value in terms of function, interaction, and level of acceptable burden, thus providing clear goals for clinicians to pursue—or when goals are not reachable by available medical interventions, to acknowledge and allow for logical shifts to what may be achieved, including, in end of life contexts, care focused on respect and dignity. (shrink)

In New Zealand an advance directive can be either an oral statement or a written document. Such directives give individuals the opportunity to make choices about future medical treatment in the event they are cognitively impaired or otherwise unable to make their preferences known. All consumers of health care have the right to make an advance directive in accordance with the common law. When we consider New Zealand's rapidly ageing population, the fact that more people now live with and (...) die of chronic rather than acute conditions, the importance given to respecting autonomous decision-making, increasing numbers of individuals who require long-term residential care, and financial pressures in the allocation of medical resources, there would seem to be a number of compelling reasons to encourage individuals to write or verbalise an advance directive. Indeed the promotion of advance directives is encouraged. However, caution should be exercised in promoting advance directives to older people, especially in light of several factors: ageist attitudes and stereotypes towards them, challenges in the primary healthcare setting, and the way in which advance directives are currently focused and formulated. This paper considers some of the specific challenges that need to be addressed if the promotion of advance directives are to improve outcomes of patient treatment and care near the end of life. (shrink)

In an interesting response to an article I published in CQ that questions the ability of advance directives to reflect autonomy, Christopher Tollefsen raises a number of issues that deserve greater attention. Tollefsen offers several examples to illustrate how the critique of advance directives I offer would also threaten other choices that most people would consider autonomous. Importantly, I largely agree that the examples Tollefsen offers should be captured as autonomous. Where I disagree, however, is whether these examples reflect (...) the particular type of second order decision strategy that I categorize advance directives as, and so whether the critique of advance directives I offer, if accepted, would commit us to an unreasonably narrow conception of autonomy. (shrink)

A psychiatric advance directive (PAD) is a communication tool that promotes patients’ autonomy and gives capacitated adults who live with serious mental illnesses the ability to record their preferences for care and designate a proxy decision maker before a healthcare crisis. Despite a high degree of interest by patients and previous studies that recommend that clinicians facilitate the completion of PADs, the rate of implementation of PADs remains low. Research indicates that many clinicians lack the necessary experience to facilitate the (...) completion of PADs and to use them, and, as a consequence, do not effectively engage patients about PADs. This study developed practical recommendations for clinicians to improve their ability to communicate and facilitate PADs. We (1) thematically analyze definitions of PADs published in 118 articles across disciplines, and (2) present our recommendations for enhanced communication in clinical practice that emphasize patient-centeredness, usefulness, and clarity, aligned with evidence-based practices that put patients’ autonomy and understanding first. While there is no one-sizefits- all script to engage patients in complex conversations, our recommended strategies include an emphasis on patients’ autonomy, the adaptation of word choices, the use of metaphor not simile, and checking for patients’ understanding as effective methods of clinical communication. (shrink)

One of the most commonly referenced ethical principles when it comes to the management of dying patients is the doctrine of double effect (DDE). The DDE affirms that it is acceptable to cause side effects (e.g. respiratory depression) as a consequence of symptom‐focused treatment. Much discussion of the ethics of end of life care focuses on the question of whether actions (or omissions) would hasten (or cause) death, and whether that is permissible. However, there is a separate question about (...) the permissibility of hastening or causing unconsciousness in dying patients. Some authors have argued that the DDE would not permit end of life care that directly aims to render the patient unconscious. The claim is that consciousness is an objective human good and therefore doctors should not intentionally (and permanently) suppress it. Three types of end of life care (EOLC) practices will be explored in this article. The first is symptom‐based management (e.g. analgesia); the second is proportional terminal sedation as a means of relieving suffering (also referred to as palliative sedation or continuous deep sedation); and finally, deliberate and rapid sedation to unconsciousness until death (a practice we call terminal anaesthesia in this paper). After examining the common arguments for the various types of symptom‐based management and sedation, we apply the DDE to the latter two types of EOLC practices. We argue that aiming at unconsciousness, contrary to some claims, can be morally good or at least morally neutral in some dying patients. (shrink)

Arguments for and against direct-to-consumer drug advertising (DTCA) center on two issues: (1) the epistemic effects on patients through access to information provided by the ads; and (2) the effects of such information on patients’ abilities to make good choices in the healthcare marketplace. Advocates argue that DTCA provides useful information for patients as consumers, including information connecting symptoms to particular medical conditions, information about new drug therapies for those conditions. Opponents of DTCA point out substantial omissions in information (...) provided by the ads and argue that the framing of the ads may mislead patients about the indications, uses, and effectiveness of the drugs advertised. They also suggest that DTCA has a number of potentially negative effects on the doctor–patient relationship. The standard arguments appear to assume a simplistic correlation—more information means more agency for patients. However, empirical studies on medical decision making suggest that this relationship is much more complex and nuanced. I examine recent research on ways in which patients are vulnerable with respect to DTCA. In order to address the complex issues of information acquisition and consumer decision-making in the health care marketplace, the focus should not be simply on what information patients need in order to make medical decisions, but also on the conditions under which patients actually are able to make medical decisions requiring complex medication information. This requires examining both the cognitive limitations of patients with respect to drug information and investigating patients’ preferences and needs in a variety of medical contexts. (shrink)

This paper explores sustainable fashion choices from a Stoic philosophical perspective. Ancient Stoic teachings can help us reexamine our relationship with clothes in the 21st century and provide direction for the considerable number of people that are influenced by contemporary Stoicism. Stoicism provides a clear justification for sustainable living, given its call to live in harmony with Nature. Given the environmental facts, contemporary Stoics would do well to reduce the size of their wardrobe to what is necessary and functional. (...) They should mindfully select clothing made of organic natural fibers, which are of sufficient quality as to reduce wasteful practices. (shrink)

Approximately one in three American adults has executed a living will or healthcare declaration stating personal preferences regarding medical treatment in the event that he or she becomes terminally ill and unable to communicate. This figure stands in striking contrast to the 90% of Americans who, when asked, express specific wishes regarding their choice of care under such circumstances. Congress attempted to increase the number of Americans with advance directives when it passed the Patient Self Determination Act in 1990, billed (...) at the time as the “Miranda Warning” of medicine, which requires hospitals and nursing homes receiving federal funds both to inform patients of their right to refuse life-sustaining care and to record all written directive in patients’ charts. (shrink)

The past four decades of research in the social sciences have shed light on two important phenomena. One is that human decision-making is full of predicable errors and biases that often lead individuals to make choices that defeat their own ends (i.e., the bad choice phenomenon), and the other is that individuals’ decisions and behaviors are powerfully shaped by their environment (i.e., the influence phenomenon). Some have argued that it is ethically defensible that the influence phenomenon be utilized to (...) address the bad choice phenomenon. They propose that “choice architects” learn about the various ways in which choices can be influenced and directed by the environment, and then work to design environments, broadly construed, that influence individuals towards choices that make them better off. Those who advocate intentionally creating choice environments that lead people to better choices believe that doing so is ethically permissible because (1) it makes people better off, and (2) it does so in a way that is entirely compatible with individual liberty. The evaluation of these two claims is the main focus of this paper. (shrink)

In spite of an increasing number of studies on ethical climate, little is known about the antecedents of ethical climate and the moderators of the relationship between ethical climate and work outcomes. The present study conducted firm-level analyses regarding the relationship between chief executive officer (CEO) ethical leadership and ethical climate, and the moderating effect of climate strength (i.e., agreement in climate perceptions) on the relationship between ethical climate and collective organizational citizenship behavior (OCB). (...) Self-report data were collected from 223 CEOs and 6,021 employees in South Korea. The results supported all study hypotheses. As predicted, CEOs' self-rated ethical leadership was positively associated with employees' aggregated perceptions of the ethical climate of the firm. The relationship between ethical climate and firm-level collective OCB was moderated by climate strength. More specifically, the relationships between ethical climate and interpersonally directed collective OCB and between ethical climate and organizationally directed collective OCB were more pronounced when climate strength was high than when it was low. Theoretical and practical implications of these findings are addressed herein. (shrink)

Marketing Ethics addresses head-on the ethical questions, misunderstandings and challenges that marketing raises while defining marketing as a moral activity. A substantial introduction to the ethics of marketing, exploring the integral relations of marketing and morality Identifies and discusses a series of ethical tools and the marketing framework they constitute that are required for moral marketing Considers broader meanings and background assumptions of marketing infrequently included in other marketing literature Adds direction and meaning to problems in marketing ethics (...) through reflection on concepts such as individual choice, freedom and responsibility, desire satisfaction, noncoercive exchanges, and instrumental efficiency. (shrink)

When talking about personal identity in the context of medical ethics, ethicists tend to borrow haphazardly from different philosophical notions of personal identity, or to abjure these abstract metaphysical concerns as having nothing to do with practical questions in medical ethics. In fact, however, part of the moral authority for respecting a patient’s self-regarding decisions can only be made sense of if we make certain assumptions that are central to a particular, psychological picture of personal identity, namely, that patients will (...) remain psychologically connected to a certain degree with their future selves. I draw this out, show problems with approaches in medical ethics based on alternate theories of personal identity that do not recognise this, and explore some important implications. Namely, I show how this recognition can better explain the circumstances under which we should respect advance directives and why, and how it can better make sense of patient fears that they will not "survive" personality-altering deep brain stimulation procedures, and provide guidance on approaching patient decisions concerning this type of procedure in a manner that captures and addresses such concerns. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.1 (2004) 47-54 [Access article in PDF] Ethical Guidelines for Human Embryonic Stem Cell Research*(A Recommended Manuscript) Adopted on 16 October 2001Revised on 20 August 2002 Ethics Committee of the Chinese National Human Genome Center at Shanghai, Shanghai 201203 Human embryonic stem cell (ES) research is a great project in the frontier of biomedical science for the twenty-first century. Be- cause the research (...) involves the use of human embryos, it triggers serious debate on ethical issues. Opponents consider the embryo to be an early form of human life that should be respected and not destroyed. However, the majority of scientists support embryonic stem cell research, believing that it offers good prospects for the treatment of diseases that have remained incurable until now and so will benefit humankind. The Ethics Committee of the Department of Ethical, Legal, and Social Implications of the Chinese National Human Genome Center at Shanghai seriously discussed the ethical debate initiated by embryonic stem cell research. We concluded that we should support the scientists of our country in actively carrying out human embryonic stem cell research for the noble cause of "medicine being a beneficent art." For the healthy and orderly development of human embryonic stem cell research in our country, we put forward the following recommended Ethical Guidelines for Human Embryonic Stem Cell Research as a reference for leaders, administrative departments, and related scientists. Preface Article 1. Human embryonic stem cells are the primitive cells that play the main role in the growth and development of a human body. These [End Page 47] primitive cells have the potential for infinite proliferation, self-renewal, and multi-directional differentiation. If scientists can discover the mechanism of differentiation of human embryonic stem cells, it will be possible to induce differentiation of human embryonic stem cells to form various types of human cells for clinical cell therapy. If human embryonic stem cell research can be integrated with modern biomedical engineering techniques, it also will be possible to make repair and replacement of human tissues and organs a reality. Article 2. There are two ways to classify human embryonic stem cells. One way is to classify them according to their potential for differentiation. There could be three kinds of stem cells: totipotent stem cells, pluripotent stem cells, and unipotent stem cells.A totipotent stem cell has the potential to develop into a whole individual. It can differentiate into the more than 200 cell types in the whole body, construct any tissue or organ of the body, and finally develop into a whole individual. The fertilized egg and the cleavage cells at the very early stage of embryonic development are totipotent stem cells.A pluripotent stem cell has the potential to differentiate into many cell types derived from the three embryonic layers. However, it has lost the capacity to develop into a complete organism.A unipotent stem cell is derived from the further differentiation of the pluripotent stem cell. It can differentiate only into one cell type such as a hematopoietic stem cell, neural stem cell, and others.The other way is to classify human stem cells according to their source. There could be two kinds of human stem cells: embryonic stem cells and tissue stem cells (also called adult stem cells). The former involves experimentation with embryos, which has serious ethical implications. Ethical issues associated with the latter are mainly expressed in the various opinions regarding the allocation of health resources. Article 3. Human embryonic stem cells are the group of cells called the blastocyst inner cell mass during the early stage of embryonic development. They are the main source of totipotent stem cells, and hence the focal and hot point in stem cell research. Studies on the clinical application of embryonic stem cells probably will involve use of the somatic cell nucleus transfer (SCNT) technique, which destroys the early human embryo. At present, the ethical and moral debate is very serious in human embryonic stem cell research regarding whether the research will develop... (shrink)

In The Harm Principle, Personal Identity and Identity-Relative Paternalism,1 Wilkinson offers a thoughtful argument about medical decision-making and Derek Parfit’s reductionist account of personal identity. I agree that Parfit’s account can contribute to the ethical analysis of patients’ choices. My own work in this area emphasises challenges the reductionist account presents to conventional understanding of advance treatment directives, particularly in cases involving people with dementia.2 I have also urged people making directives to consider the harm their directives could (...) impose on future selves with dementia.3 But as Wilkinson points out, Parfit’s account has implications in other medical contexts as well. Wilkinson presents examples of people making medical decisions that could impose serious harm on their future selves. These examples consider decisions made before a health crisis. Another kind of case involves people in the midst of illness who face a series of ongoing care choices. As people in this situation adjust to their …. (shrink)

This thesis is comprised of four papers that explore the nature and practical implications of moral doubt. It starts from the observation that the appropriate way to understand and handle moral doubt will depend on the nature of our moral judgements themselves. The first and second papers take a cognitivist view of moral judgements and analyse moral doubt in terms of partial degrees of belief in moral propositions. The first, The Relevance of Belief: Subjective Norms Under Empirical and Moral Uncertainty, (...) argues that this form of moral uncertainty is relevant to our choices and that the norms most directly relevant to choice under moral uncertainty are the action-guiding subjective norms of instrumental rationality. The second, Preference and Commitment Under Moral Uncertainty, proposes a particular way of accommodating moral uncertainty within a decision theoretic model of rational choice, and shows that this has substantial advantages over existing alternatives. The third paper, Attitudinal Ambivalence: Moral Uncertainty for Non-cognitivists, provides an account of moral doubt that is consistent with non-cognitivism, by analysing the phenomenon in terms of ambivalence in one’s moral attitudes. The fourth and final paper, The Balance and Weight of Reasons, draws out some implications of ambivalence, by exploring the way in which the overall weight of reasons are reflected in the preferences of rational agents. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

Nondirectiveness is widely regarded as an important principle of genetic counseling. However, numerous studies have indicated that the use of this principle and its content itself are subject to controversies. The present study aimed to verify how the nondirectiveness principle is defined by Polish geneticists, the extent to which it is considered the main principle in clinical practice, and the situations in which geneticists see the positive value of the directive action. Using quantitative and qualitative methods, the study compared the (...) abstract declarations of the directiveness validity and the scope of this principle with the declaration of action in situations close to reality (case scenarios). The results showed that the high rank assigned to the nondirectiveness principle does not translate into the conviction about the absolute obligation to use it in clinical practice. Polish geneticists are inclined to restrict the scope of patients’ choices when these are outside of their definition of medical standard. Strong medical paternalism manifests itself particularly in invasive prenatal diagnostics, where geneticists play the role of gatekeepers. In this study, we offer hypotheses about the sources of these attitudes by analyzing the current cultural and legal context of Poland. (shrink)

Background On December 2017 the Italian Parliament approved law n. 219/2017 “Provisions for informed consent and advance directives” regarding challenging legal and bioethical issues related to healthcare decisions and end-of-life choices. The law does not contain an explicit reference to Ethics Committees (ECs), but they could still play a role in implementing the law. Methods A questionnaire-based survey was performed among the ECs of the Italian Institute for Research and Care belonging to the Network of neuroscience and neurorehabilitation, with (...) the aim of (1) knowing whether the ECs participated and, if so, how in the process of implementation of law n. 219/2017 in the referring institutes; (2) investigating the point of view of the ECs regarding their possible involvement in the process; (3) exploring the contribution ECs can provide to give effective implementation to the law principles and provisions. Results Seventeen ECs out of thirty took part in the survey; the characteristics of the responding and non-responding committees are similar, so the responding ECs can be regarded as representative of all ECs in the Network. Nine ECs did not discuss the law in anyway: the main reason for this is that the referring institutions (6) and the health care professionals (3) did not ask for an EC intervention. Nevertheless, the large majority of the ECs believe that their involvement in the implementation of the law as a whole is appropriate (8) or absolutely appropriate (6), while 3 of them are neutral. No EC believes that the involvement is inappropriate. The aspect of the law on which the 14 ECs converge in considering the EC involvement appropriate/absolutely appropriate is the one related to the health facilities obligation to guarantee the full and proper implementation of the principles of the law. Conclusions Our survey confirms that ECs believe they can play a role in the implementation of law n. 219/2017, although this does not entirely correspond to what the committees have actually done in reality. This role could be better exercised by ECs specifically established for clinical practice, which would have a composition, functioning and a mandate better suited to the purpose. This supports the call for a national regulation of ECs for clinical practice. (shrink)

Effects of globalization have amplified the magnitude and frequency of corporate abuses, particularly in developing economies where weak or absent rules undermine social norms and principles. Improving multinational enterprises’ (MNEs) ethical conduct is a factor of both the ability of firms to change behaviors in the direction of the moral good, and their willingness to do so. Constraints and enablers of a firm’s ability to act ethically emanate from the external environment, including the industry environment of which the firm (...) is a resident, and the host country environment in which it operates. A firm’s willingness to engage in ethical conduct is determined by the effective bundling of internal resources and the commitment of those resources to social ends. The interaction of external and internal conditions carves out categories of expected firm behaviors and suggests interventions that would push these behaviors in a more positive ethical direction. With reference to integrative social contracts theory (ISCT), these categories of firms are examined, and a conceptual model for analysis is developed to explain the drivers of corporate choices in the adoption and implementation of codes of conduct, and the relative power of relevant communities to the process. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of (...) advance directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

Aristotle's treatment of the choice between the political and contemplative lives (in EN I 5 and X 7-8) can seem awkward. To offer one explanation of this, I argue that when he invokes self-sufficience (autarkeia) as a criterion for this choice, he appeals to two different and incompatible specifications of "lacking nothing." On one specification, suitable to a human being living as a political animal and thus seeking to realize his end as an engaged citizen of a polis, a person (...) lacks nothing by possessing a wide range of goods that directly require other people. On the other, more suitable to a god or a beast, a person lacks nothing by having no need of goods that directly require other people. The ambiguity of this criterion renders the choice between the political and contemplative lives difficult. (shrink)

Effects of globalization have amplified the magnitude and frequency of corporate abuses, particularly in developing economies where weak or absent rules undermine social norms and principles. Improving multinational enterprises’ (MNEs) ethical conduct is a factor of both the ability of firms to change behaviors in the direction of the moral good, and their willingness to do so. Constraints and enablers of a firm’s ability to act ethically emanate from the external environment, including the industry environment of which the firm (...) is a resident, and the host country environment in which it operates. A firm’s willingness to engage in ethical conduct is determined by the effective bundling of internal resources and the commitment of those resources to social ends. The interaction of external and internal conditions carves out categories of expected firm behaviors and suggests interventions that would push these behaviors in a more positive ethical direction. With reference to integrative social contracts theory (ISCT), these categories of firms are examined, and a conceptual model for analysis is developed to explain the drivers of corporate choices in the adoption and implementation of codes of conduct, and the relative power of relevant communities to the process. (shrink)

This paper examines ethics in organizations in relation to the subjectivity of managers. Drawing on the work of Michel Foucault we seek to theorize ethics in terms of the meaning of being a manager who is an active ethical subject. Such a manager is so in relation to the organizational structures and norms that govern the conduct of ethics. Our approach locates ethics in the relation between individual morality and organizationally prescribed principles assumed to guide personal action. In (...) this way we see ethics as a practice that is powerfully intertwined in an individual’s freedom to make choices about what to do and who to be, and the organizational context in which those choices are situated, framed and governed. (shrink)

A study found that women participating in mammography screening were content with the programme and the paternalistic invitations that directly encourage participation and include a pre-specified time of appointment. We argue that this merely reflects that the information presented to the invited women is seriously biased in favour of participation. Women are not informed about the major harms of screening, and the decision to attend has already been made for them by a public authority. This short-circuits informed decision-making and the (...) legislation on informed consent, and violates the autonomy of the women. Screening invitations must present both benefits and harms in a balanced fashion, and should offer, not encourage, participation. It should be stated clearly that the choice not to participate is as sensible as the choice to do so. To allow this to happen, the responsibility for the screening programmes must be separated from the responsibility for the information material. (shrink)

While the ethics of technology is analyzed across disciplines from science and technology studies, engineering, computer science, critical management studies, and law, less attention is paid to the role that firms and managers play in the design, development, and dissemination of technology across communities and within their firm. Although firms play an important role in the development of technology, and make associated value judgments around its use, it remains open how we should understand the contours of what firms owe society (...) as the rate of technological development accelerates. We focus here on digital technologies: devices that rely on rapidly accelerating digital sensing, storage, and transmission capabilities to intervene in human processes. This symposium focuses on how firms should engage ethical choices in developing and deploying these technologies. In this introduction, we, first, identify themes the symposium articles share and discuss how the set of articles illuminate diverse facets of the intersection of technology and business ethics. Second, we use these themes to explore what business ethics offers to the study of technology and, third, what technology studies offers to the field of business ethics. Each field brings expertise that, together, improves our understanding of the ethical implications of technology. Finally we introduce each of the five papers, suggest future research directions, and interpret their implications for business ethics. (shrink)

This paper examines ethics in organizations in relation to the subjectivity of managers. Drawing on the work of Michel Foucault we seek to theorize ethics in terms of the meaning of being a manager who is an active ethical subject. Such a manager is so in relation to the organizational structures and norms that govern the conduct of ethics. Our approach locates ethics in the relation between individual morality and organizationally prescribed principles assumed to guide personal action. In (...) this way we see ethics as a practice that is powerfully intertwined in an individual’s freedom to make choices about what to do and who to be, and the organizational context in which those choices are situated, framed and governed. (shrink)

What reasons stand in favor of (or against) violent resistance to oppression? I distinguish two kinds of normative reasons that bear relevantly in such a practical deliberation. I argue that in addition to reasons of impartial morality, victims’ personal projects and relationships may also provide reasons for (or against) violent resistance. Moreover, there is no guarantee that conflicts will not occur between such reasons. Thus, some acts of violent resistance may arise from situations of radical choice in which impartial moral (...) reasons and personal reasons pull the agent in opposite directions. Regardless of what we ultimately think agents facing such decisions ought to do all things considered, recognizing such conflicts is crucial for understanding the circumstances that give rise to violence and for better sympathizing with victims who are pushed to such extreme modes of resistance. (shrink)

Our soft survey reveals that the assumption underlying much of the business ethics literature -- that the conduct of business can and ought to support the social good -- is not accepted within the workplace. This paper considers an apparent dichotomy, with companies investing in ethical programs whose worth their employees and managers question. We examine the relationship between work, bureaucracy and "the market" and conclude that employees often question the existence of business ethics because there is no good (...) and bad between which to choose. The choice is between success and failure. A common view of success and the "good life" is one determined by hard work in a well-organised company operating in a free market. Analysing the three aspects of this view (the free market, hard work, bureaucracy) we suggest these are mere fictions. A major problem we identify in business is that organisations are designed as profit making mechanisms and have no interest in the good of society. The challenge is to convince such organisations that a direct benefit accrues to them through their own ethical behaviour. In order to do this organisations must first be shown the importance of long termism. Executives, managers and other employees can be expected to attain high ethical standards only when they feel they are a integral part of an organisation and the organisation itself respects those standards. One of the keys to unravelling the undesirable situation of a perceived absence of ethics in business is in encouraging a greater identity community, company and workforce. We provide some examples of ways companies can meet the challenge of encouraging more ethical, long-sighted behaviour. In addition, we highlight ways in which the expectations of the organisations of the organisation can be communicated more strongly through corporate structures that foster ethical action that benefits the long term interests of the individual and the organisation. Overall implementing a successful ethical program is shown to parallel that of the implementation of a quality program. (shrink)

Almost all jurisdictions where physician-assisted death is legal require that the requesting individual be competent to make medical decisions at time of assistance. The requirement of contemporary competence is intended to ensure that PAD is limited to people who really want to die and have the cognitive ability to make a final choice of such enormous import. Along with terminal illness, defined as prognosis of death within six months, contemporary competence is regarded as an important safeguard against mistake and abuse, (...) arguably the strongest objections to legalizing PAD.The insistence on contemporary competence is problematic. It means that someone who has dementia is ruled out as a candidate for PAD, even if she is terminally ill and suffering terrible and unrelievable pain. It also rules out individuals with strong and unwavering desires not to end their life in dementia. (shrink)

Against a backdrop of an international trend to shift from a teacher-centred to a learner-centred education, this article explores a Confucian conception of education. Focusing on an ancient Chinese text Xueji, the essay examines its educational ideals and practices based on the principles of ‘choice’, ‘doing’ and ‘power relationship’. It is argued that the educational model in the Xueji does not fit the description of a learner-centred education as commonly understood in the Western literature. Rather, the Xueji advocates a ‘teacher- (...) class='Hi'>directed and learner-engaged’ approach by giving the teacher control over the curriculum and authority over the learners while encouraging the learners to participate actively in the learning process. In proposing a conception that is not exactly learner-centred, the Xueji challenges the assumption that ‘good’ education must necessarily be learner-centred. (shrink)

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is (...) unjustified. Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle. (shrink)

In decision-making based on multiple criteria, situations may arise where agents find their options to be neither better than, worse than nor equal to each other with respect to the relevant criteria. How, if at all, can a justified choice be made between such options? Are the options incomparable? This article explores a hypothetical case that illustrates how such a situation can arise in an environmental context; more specifically, it considers the deliberations of an imagined 'ethics committee' as it struggles (...) to decide whether or not a deep-sea mining project should be allowed to proceed. I argue that the case is best understood as involving options that are comparable in the sense of being 'on a par'. Working out from a discussion of Ruth Chang's 'self-governance' theory of choice in cases of parity, I suggest that, in the environmental context, the idea of choices expressing a moral identity may lead us in the direction of a plausible solution to these particularly challenging cases. (shrink)

In this paper, I argue that we have obligations not only to perform certain actions, but also to have certain attitudes (such as desires, beliefs, and intentions), and this despite the fact that we rarely, if ever, have direct voluntary control over our attitudes. Moreover, I argue that whatever obligations we have with respect to actions derive from our obligations with respect to attitudes. More specifically, I argue that an agent is obligated to perform an action if and only if (...) it’s the action that she would perform if she were to have the attitudes that she ought to have. This view, which I call attitudism, has three important implications. First, it implies that an adequate practical theory must not be exclusively act-orientated. That is, it must require more of us than just the performance of certain voluntary acts. Second, it implies that an adequate practical theory must be attitude-dependent. That is, it must hold that what we ought to do depends on what attitudes we ought to have. Third, it implies that no adequate practical theory can require us to perform acts that we would not perform even if we were to have the attitudes that we ought to have. I then show how these implications can help us both to address certain puzzling cases of rational choice and to understand why most typical practical theories (utilitarianism, rational egoism, virtue ethics, Rossian deontology, etc.) are mistaken. (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim (...) of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

Ethics, Aging and Society...is the first major work in ten years to critically address issues and methodologies in aging and ethics...This well-organized volume begins theoretically and offers new ways of thinking about ethics that can handle the complexities and realities of aging in particular social contexts."--Choice This new research-based book, by experts in the field of ethics, is excellent and much-needed...I challenge you to consider reading this book and seeing all the ways in which you might be forced to rethink (...) things that most of us take as given for ethics and aging. I know you will not be disappointed and I guarantee you will end up thinking long and hard about personal and professional decisions you may have made as well as your assumptions about aging in America."--CFLE Network Newsletter This is a book that should be required reading for all involved in the ethical provision of services to the aging on any level, as well as for policy makers and administrators in positions of influence over the lives of older patients."--PsycCRITIQUES...the authors' application of feminist ethics to frail elders rings true to both my clinical experience working with frail elders, and my research experience trying to understand their quality of life concerns...there were true gems of ideas [in this book] that illuminated the limitations of the dominant paradigm of autonomy in bioethics. [The authors] make a compelling critique of end-of-life care."--GeriPal: A Geriatrics and Palliative Care Blog This book presents second generation issues in ethics, aging, and society by presenting critical outcomes that arise when ethics is applied to the practical concerns that occur in day-to-day elder care. The first volume in over 10 years to address ethics and gerontology, it is unparalleled in its comprehensiveness and integration of well-developed philosophical arguments with empirical research, humanistic scholarship, and insights gained from practical experience. This book challenges the tried and true approaches to ethical issues in aging and opens avenues for creative problem-solving. The authors' diverse backgrounds bring the advantages of both interdisciplinary scholarship and practical experience to this comprehensive textbook. It is an essential resource for those interested in, and working with, older people, from upper-level undergraduate students and graduate-division students, to gerontology practitioners in training. Key Features: Presents the first major work in over 10 years to integrate the disciplines of ethics and aging Includes case studies derived from day-to-day practice Addresses individual/clinical ethics in health and long-term care and ethical issues raised by public policy, cultural norms and social attitudes Examines such critical issues as Alzheimer's disease, long-term care, ageism, public policy, anti-aging medicine, elder abuse, and natural disasters Explores new directions in ethical and social philosophy as they pertain to gerontology and care. (shrink)

In 2004, prenatal risk assessment (PRA) was implemented as a routine offer in Denmark, in order to give all pregnant women an informed choice about whether to undergo prenatal testing. PRA is a non-invasive intervention performed in the first trimester of pregnancy and measures the risk of a fetus having Down's syndrome or other chromosomal disorders. The risk figure provides the basis for action, i.e. the decision about whether or not to undergo invasive fetal testing via the maternal route (amniocentesis (...) or chorionic villus sampling), which, however, involves the risk of inducing a miscarriage. On the basis of ethnographic fieldwork in an ultrasound clinic in Denmark and interviews with pregnant women and their partners, this paper investigates how ideals such as autonomy and non-directiveness are practised in processes of decision-making. We view such ideals as forming social practice rather than neutral instruments to reach a certain goal. Focusing on one couple's trajectory through the clinical practices of PRA and the process through which a decision is reached, we call into question the assumption that more choice and more objective information is a source of empowerment and control. We make evident how decisions are made through a complicated process of meaning-making, which emerges through the relationship between professionals, the clinical setting and the social life of the couples. In the face of complex risk knowledge, PRA users are reluctant to make choices and seek to re-install authority in the health professionals. However, when assumptions about autonomy and self-determination are inscribed into the social practice of PRA, authority is transferred to the couple undergoing PRA and a new configuration of responsibility evolves between the couple and their relationship to the fetus. It is argued that PRA performs a form of government that works not through compulsion or persuasion but through choice. An ethic of a shared responsibility for PRA and its outcome between pregnant women and health professionals would be more in agreement with how decisions are actually made. (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of (...) this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)