Informal political representation can be a political lifeline, particularly for oppressed and marginalized groups. Such representation can give these groups some say, however mediate, partial, and imperfect, in how things go for them. Coeval with the political goods such representation offers these groups are its particular dangers to them. Mindful of these dangers, skeptics challenge the practice for being, inter alia, unaccountable, unauthorized, inegalitarian, and oppressive. These challenges provide strong pro tanto reasons to think the practice morally impermissible. This paper (...) considers the question: On what conditions is the informal political representation of oppressed and marginalized groups permissible? By responding to skeptics’ challenges, I develop a systematic account of moral constraints that, if adopted, would make such representation permissible. The account that emerges shows that informal political representatives (IPRs) must aim to fulfill two sets of sometimes conflicting duties to the represented: democracy within duties, which concern how the representative treats and relates to the represented, and justice without duties, which concern how the representative’s actions advance the aims of the representation. (shrink)

Background: The theoretical framework of Jϋrgen Habermas suggests that effective communication requires competent participants with an objective attitude that complies with the rules and worlds designated as objective, social and subjective. This situation determines communicative action, which stimulates the search for mutual understanding and results in a process of interaction that promotes self-determination. Objectives: In this study, the discharge letters of patients with myocardial infarction were explored regarding the provision of information. The patient’s right to information and the duty (...) of informing were analysed according to the perspective of Jϋrgen Habermas. Research design: This was a cross-sectional analysis (from a broader longitudinal study) of all discharge letters that were directly related to nursing interventions regarding the provision of information to 106 patients. In this major study, the difficulties faced by patients who experienced a myocardial infarction and the changes in their lifestyles were analysed based on the type of information received. Ethical considerations: The hospital Ethics Committee approved the study, which complied with ethical principles and required informed consent. Findings: In the nursing letters, interventions related to the provision of information were conducted at an average of 3.59 interventions per patient. For 8.5% of the patients, however, no interventions related to the provision of information were performed. The most common area of information during hospitalisation was related to the management of signs and symptoms and applied to 90.6% patients. Discussion: The nursing interventions did not cover patient education, transition processes or awareness of the disease. Thus, the right to information can be questioned. Conclusion: Information is a right, and communication is extremely important. Health professionals should be aware of this importance regarding both care management and the satisfaction guarantee. The sharing of information by health professionals based on their competency is essential for patients to exercise their right to self-determination and decision-making. (shrink)

In this paper, a critique will be developed and an alternative proposed to Luciano Floridi’s approach to Information Ethics (IE). IE is a macroethical theory that is to both serve as a foundation for computer ethics and to guide our overall moral attitude towards the world. The central claims of IE are that everything that exists can be described as an information object, and that all information objects, qua information objects, have intrinsic value and are therefore deserving of moral respect. (...) In my critique of IE, I will argue that Floridi has presented no convincing arguments that everything that exists has some minimal amount of intrinsic value. I will argue, however, that his theory could be salvaged in large part if it were modified from a value-based into a respect-based theory, according to which many (but not all) inanimate things in the world deserve moral respect, not because of intrinsic value, but because of their (potential) extrinsic, instrumental or emotional value for persons. (shrink)

The rule that a patient should give a free, fully-informed consent to any therapeutic intervention is traditionally thought to express merely a right of the patient against the physician, and a duty of the physician towards the patient. On this view, the patient may waive that right with impugnity, a fact sometimes expressed in the notion of a right not to know. This paper argues that the rule also expresses a duty of the patient towards the physician and (...) a right of the physician against the patient. The argument turns, first, on the truism that a physician has no obligation to commit a battery, or unauthorized touching, and, second, on the thesis that a patient necessarily cannot consent to something that is unknown to him. The conclusion is drawn that a patient is not free to receive treatment voluntarily without knowledgeably authorizing it. CiteULike Connotea Del.icio.us What's this? (shrink)

Suppose a woman chooses to carry a pregnancy to term. What duties should she be understood to have with respect to the fetus? If she is informed that a vaginal delivery will pose significant risks to its life or health, for example, is she obligated to submit to a caesarean section procedure on its behalf?

Conjoined with the claim that there is a moral right to privacy, each of the major contemporary accounts of privacy implies a duty of ignorance for those against whom the right is held. In this paper I consider and respond to a compelling argument that challenges these accounts (or the claim about a right to privacy) in the light of this implication. A crucial premise of the argument is that we cannot ever be morally obligated to become ignorant of (...) information we currently know. The plausibility of this premise, I suggest, derives from the thought that there are no epistemically ways in which we can cause ourselves to become ignorant of what we already know. Drawing on some recent work in the epistemology and psychology of self-deception and forgetting, I seek to undermine this thought, and thus provide a defense against the challenging argument, by arguing that there are indeed such ways. (shrink)

Duty and Healing positions ethical issues commonly encountered in clinical situations within Jewish law. The concept of duty is significant in exploring bioethical issues, and this book presents an authentic and non-parochial Jewish approach to bioethics, while it includes critiques of both current secular and Jewish literatures. Among the issues the book explores are the role of family in medical decision-making, the question of informed consent as a personal religious duty, and the responsibilities of caretakers. The exploration (...) of contemporary ethical problems in healthcare through the lens of traditional sources in Jewish law is an indispensable guide of moral knowledge. (shrink)

The societal benefits derived from competitive markets certainly depend upon participants conforming to generally accepted notions of moral duty. These notions include negative duties such as those against fraud, deception, and coercion and also positive duties such as those that favor beneficence but with limits. This investigation examines the extent that product, capital, and internal-labor markets are capable of imposing conformance to society’s expectations of duty through both formally and informally organized boycotts. A categorization of classic and recent (...) boycotts into those motivated by (i) establishing new norms, or (ii) enforcing existing generally accepted norms is provided. This categorization helps to explain why some boycotts are successful, and others not. Through this exploration, a contribution to the resolution of the so called “Adam Smith problem” concerning the morality-enforcing capability of the invisible hand is offered. (shrink)

This paper argues that patients' duties are derivable from the idea which typically grounds the idea of patients' rights: patient autonomy. The autonomous patient, joined in partnership with the health care professional, has self-regarding obligations and obligations to others, including health care professionals. Patients' duties include, but are not limited to: a duty to be honest about why the patient seeks care; a duty to collect information on available treatments and likely side-effects; a duty for a patient (...) who has an infectious condition to act on that information which can best prevent further transmission. Keywords: autonomy, duty, paternalism, patient, rights, self-care CiteULike Connotea Del.icio.us What's this? (shrink)

Legal standards of disclosure in a variety of jurisdictions require physicians to inform patients about the likely consequences of treatment, as a condition for obtaining the patient’s consent. Such a duty to inform is special insofar as extensive disclosure of risks and potential benefits is not usually a condition for obtaining consent in non-medical transactions. -/- What could morally justify the physician’s special legal duty to inform? I argue that existing justifications have tried but failed (...) to ground such special duties directly in basic and general rights, such as autonomy rights. As an alternative to such direct justifications, I develop an indirect justification of physicians’ special duties from an argument in Kant’s political philosophy. Kant argues that pre- legal rights to freedom are the source of a duty to form a state. The state has the authority to conclusively determine what counts as “consent” in various kinds of transactions. The Kantian account can subsequently indirectly justify at least one legal standard imposing a duty to inform, the reasonable person standard, but rules out one interpretation of a competitor, the subjective standard. (shrink)

The last several years have been marked by a seemingly increasing numbers of individuals with homosexual inclinations. There are consequences to society-wide increases in disordered dispositions, and this paper presents one such consequence. Patients often enter the physician–patient relationship basedon the physician’s “sexual preference.” In order to avoid sexual misconduct from a physician, patients often choose physicians that are not inclined to be sexually attracted to the patient. It is often assumed that a patient can infer a physician’s sexual inclinations (...) by his or her gender, but this is not the case. Due to the inability to determine a health care professional’s “sexual preference” by their gender, a physician has a duty to disclose this information prior to care. National Catholic Bioethics Quarterly 13.3 (Autumn 2013): 445–450. (shrink)

Rather than approaching Kant's moral theory in the normal way through a consideration of The Groundwork of the Metaphysics of Morals and The Critique of Practical Reason, I do so from the perspective of an extended analysis of other aspects of his work that bear on his moral philosophy . Consideration of the Doctrine of Right suggests that the universal principle of Right Kant identifies is a restricted version of the CI applied to the limited domain of relations between persons (...) at issue in this context. Given that duties of Right deriving from this principle are also regarded as perfect ethical duties, an analysis of the nature and scope of the universal principle of Right can, I argue, be expected to be informative with respect to our understanding of perfect duties and the contradiction in conception from which these are said to derive. Allowing for the more limited scope of merely external duties of Right, analysis of these duties suggests that ethical duties of Right are obligations concerned with ensuring the capacity of rational agents to govern themselves on the basis of reason . This kind of analysis, I argue, is both confirmed and clarified by Kant's subsequent discussion of perfect and imperfect duties of virtue we owe to ourselves under the rubric of concerns with our moral health and moral prosperity. ;The resulting view is, I claim, a promising one that allows us to integrate the different treatments of duties in these two works and accommodate the various duties Kant discusses. In particular, understood in terms of the notions of moral health and prosperity, the concerns engendered here require careful consideration of the particular nature and psychology of human agency and yield a much more subtle and interesting account of duty and of the moral life than those typically associated with Kant. (shrink)

This issue’s “Legal Briefing” column, one product of a Greenwall Foundation grant, reviews recent developments concerning compulsory reporting duties.1 Most licensed clinicians in the United States are “mandated reporters.” When these clinicians discover certain threats to the safety of patients or the public, they are legally required to report that information to specified government officials. Over the past year, several states have legislatively expanded the scope of these reporting duties. In other states, new court cases illustrate the vigorous enforcement of (...) already existing duties. I have organized all these legal developments into the following eight categories: 1. Overview of Mandatory Reporting Duties 2. Controversy over the Benefits of Mandatory Reporting 3. New and Expanded Duties to Report 4. Criminal Penalties for Failing to Report 5. Civil Liability for Failing to Report 6. Disciplinary Penalties for Failing to Report 7. Legal Immunity for Good-Faith Reporting 8. Protection against Employers’ Retaliation. (shrink)

Lithuania was one of the first states in Europe to approve a comprehensive list of patients’ duties under a special Law on the Rights of Patients of 2010. The approval of the catalogue of patients’ duties at the level of a law is based on the restatement of the principle of equal rights of the parties participating in health care relations, and the prevention of consumerism in these relations. The paper distinguishes between general and special patients’ duties. The general duties (...) include the duty to exercise the patient’s rights in good faith, the ban to abuse them, the duties of cooperation and looking after one’s health, as well as the duty of treatment with due respect. The norms that entrench duties of ethical nature should serve to prevent any inappropriate behaviour of patients in health care institutions. Nevertheless, legal application of these provisions and proving the infringements in practice is likely to be complicated. The special duties include: the duty to familiarise oneself against signature with the internal regulations of the health care institution as presented to him or her, other documents prescribed by the health care institution; the duty to present the documents confirming identity; the duty upon receiving information about the health care services prescribed for him or her to confirm in writing his or her consent or refusal with regard to the provision of such health care services in the cases specified by the law; the duty to provide health care professionals with any information about one’s health, to follow the prescriptions and recommendations of health care professionals, to inform health care professionals about any deviations from the prescriptions or the prescribed treatment regime which he or she has accepted. The legal analysis of the contents of the duties has revealed certain unsubstantial obscurities. The analysis of the provision that enables to take sanctions against the patient infringing their duties has revealed that the health care institution may only terminate provision of health care services to the patient if one of the two alternative conditions is fulfilled. I.e. if a person violates his or her duties and thereby causes danger to their own and other patients’ health and life, or prevents them from receiving high quality health care services. The conclusions show that application of this provision may be problematic: first, due to the juridical technique of the wording of the norm; second – due to complicated substantiating that the patient prevented or prevents other patients from receiving high quality health care services; third – due to the conflict of this provision with the provision of the Law of the Republic of Lithuania on Medical Practice, which provides that a doctor may refuse provision of health care services in cases of real threat to his or her own life; and fourth – the norm does not provide for the right to terminate the provision of services in cases of threat to health and/or life of health care workers (non-specialists). (shrink)

This qualitative study describes midwives’ experiences in relation to termination of pregnancy for fetal abnormalities, and their corresponding professional and ethical position. Thirteen midwives working in a university clinic were interviewed about their problems in this respect. The information gathered was evaluated by using qualitative content analysis. The study focused on the emotional experience of the midwives, their professional position, and ethical conflict. In this situation, midwives are faced with a conflict between the woman’s right to self-determination on one hand (...) and the right to life of the child on the other. This conflict causes a high level of emotional stress and, subsequently, professional identity problems. Although questions concerning the child’s right to life are generally suppressed, the ethical principle of the woman’s right to self-determination is rationalized. Although this process of rationalization seems to present a false ethical decision, it enables midwives to continue with their daily professional duties. As far as orientating midwives to the value of these women’s right to self-determination is concerned, it must be assumed that they have made an ethical decision to which they have given insufficient thought. This problem is exacerbated by the fact that midwives are largely excluded from the decision-making process of the parents in question. They cannot therefore help in this process in a valuable and responsible way by providing clear information and proposing objective criteria. In relation to the tasks they are expected to fulfil, these midwives revealed that they were in a state of professional confusion. (shrink)

Patients are usually granted autonomy rights, including the right to consent to or refuse treatment. These rights are commonly attributed to patients if they fulfil certain conditions. For example, a patient must sufficiently understand the information given to them before making a treatment decision. On the one hand, there is a large group of patients who meet these conditions. On the other hand, there is a group that clearly does not meet these conditions, including comatose patients or patients in the (...) late stages of Alzheimer’s disease. Then there is a group of patients who fall into the range in between. At the lower end of this range are so-called ‘marginal agents,’ which include young children and patients in the middle stages of Alzheimer’s disease. They also do not meet the typical requirements for autonomy, which is why they are usually granted fewer autonomy rights. However, some of them are capable of ‘pre-forms’ of autonomy that express what is important to them. These pre-forms differ from mere desires and reflect the identification/authenticity condition of autonomy. They have something in common with autonomous attitudes, choices, and actions – namely, they express the _value_ of autonomy. As I will argue, autonomy is a value worthy of protection and promotion – even in its non-reflexive forms. Against this background, it becomes clear _why_ we have autonomy duties, more precisely positive, autonomy-enabling duties, towards marginal agents and why we should give them as much attention as autonomy duties towards competent patients. (shrink)

Genetic and other biotechnologies are starting to impact significantly upon society and individuals within it. Rose and Novas draw on an analysis of many patient groups to sketch out the broad notion of biocitizenship as a device for describing how the empowered and informed individual, group or network can engage with bioscience. In this paper, we examine critically the notion of biocitizenship, drawing on both sociological fieldwork that grounds the debate in the views of a large and varied group of (...) concerned actors. Using work within green politics, we identify shortcomings in the concept of biocitizenship as it has so far been explicated. The value assumptions lying behind an account of biocitizenship, and its tendency to see issues through a reductive lens, are examined. Alternative views of values and goals, which may undermine any alleged rights and duties, are explored using interviews and other ethnographic data that illustrates the complexity of the terrain. The reductive lens of biocitizenship is explored through contrast with the wider scope of concerns emanating from various sources, including many within green politics. If such complexities are not recognised, there is a danger that a concept of biocitizenship may serve to create and amplify inequalities. Problems with identity issues are key: the construction of identity is complex and many groups are explicitly rejecting the ‘biological’ label. We discuss the multiple relations of citizens with the biotech and pharmaceutical industries. Arguably, existing inequalities in power relationships, exploitation, commodification and ownership patterns are being perpetuated in novel ways through the new biosciences. We pose the question of whether it is possible to construct a concept of biocitizenship that overcomes these problems. (shrink)

Background: Due to the aging society the number of informal caregivers is growing. Most informal caregivers are women working as nurses within a health organization and they have a high risk of developing mental and physical exhaustion. Until now little research attention has been paid to the expectations and needs of double duty caregivers and the role of self-management in managing private-work balance.Objective: The overall aim of this study was to investigate the expectations and needs of double duty (...) caregivers in Netherlands, and to examine the meaning of self-management in managing work-life balance.Method: Different research methods have been applied in this exploratory study. Firstly, a scoping review has been conducted on the topics self-management and sustainable employability of double-duty caregivers using the search engines: CINAHL, MEDLINE, PubMed, and Google Scholar. Furthermore, a qualitative study has been conducted through focus groups with double duty caregivers.Results: Twenty studies that met the inclusion criteria could be identified. We found that double duty caregivers have different motivations for being a double duty caregiver based on internal and external expectations. Double duty caregiving causes a lot of mental and physical pressure for the caregiver. To be able to combine both duty’s, double duty caregivers need flexibility and understanding from the workplace. Through two focus groups we found that social support from the workplace is not enough to be able to manage the situation. Self-management skills are important to be able to communicate effectively with the workplace and community care organizations about the kind of support needed. Also, health care organizations should offer the same support to double duty caregivers as any other informal caregiver.Discussion: Double-duty caregivers are at high risk of developing symptoms of overload and risk of reduced self-management quality and employability levels across time. Health care organizations and the double duty caregiver often wait too long to act instead of taking more preventive measures. Furthermore, community care organizations should dialog with double duty caregivers about their wishes concerning the division of caring tasks. This finding calls for special attention, with long-term solutions at both macro, organizational, and employee level. (shrink)

Background: Adolescents’ health choices have been widely researched, but the ethical basis of these choices, namely their rights, duties, and responsibilities, have been disregarded and scale is required to measure these. Objective: To describe the development of a scale that measures adolescents’ rights, duties, and responsibilities in relation to health choices and document the preliminary scale testing. Research design: A multi-phase development method was used to construct the Health Rights Duties and Responsibilities ( HealthRDR) scale. The concepts and content were (...) defined through document analysis, a systematic literature review, and focus groups. The content validity and clarity of the items were evaluated by expert panel of 23 adolescents, school nurses, and researchers. We calculated the content validity index and the content validity ratio at on item and scale levels. Preliminary testing was conducted with 200 adolescents aged 15–16 years. Descriptive statistics, Cronbach’s alpha correlation, and statistics for the item-analysis were calculated. Ethical considerations: Ethical approval and permission were obtained according to national legislation and responsible research practice was followed. Informed consent was obtained from the participants and the parents were informed about the study. Findings: The Health Rights Duties and Responsibilities scale comprises of four sub-scales with 148 items: 15 on health choices, 36 on rights, 47 on duties, and 50 on responsibilities. The items had a 0.93 content validity index and a 0.85 content validity ratio. Cronbach’s alpha correlation coefficient was 0.99 for the total scale and the individual sub-scales scores were health choices (0.93), rights (0.97), responsibilities (0.99), and duties (0.98). Discussion: The findings are discussed in light of the ethical concepts and validity and reliability of the developed scale. Conclusion: The Health Rights Duties and Responsibilities scale defines and understands adolescents’ rights, duties, and responsibilities in relation to health choices and has good content validity. Further testing and refinement of the concepts are needed. (shrink)

Doctors have an ethical and legal duty to respect patient confidentiality. We consider the basis for this duty, looking particularly at the meaning and value of autonomy in health care. Enabling patients to decide how information about them is disclosed is an important element in autonomy and helps patients engage as active partners in their care.Good quality data is, however, essential for research, education, public health monitoring, and for many other activities essential to provision of health care. We (...) discuss whether it is necessary to choose between individual rights and the wider public interest and conclude that this should only rarely be necessary. The paper makes some recommendations on practical steps which could help ensure that good quality information is available for work which benefits society and the public health, while still enabling patients’ autonomy to be respected. (shrink)

Are positive duties to help others in need mere informal duties of virtue or can they also be enforceable duties of justice? In this paper I defend the claim that some positive duties (which I call basic positive duties) can be duties of justice against one of the most important prin- cipled objections to it. This is the libertarian challenge, according to which only negative duties to avoid harming others can be duties of justice, whereas positive duties (basic or nonbasic) (...) must be seen, at best, as informal moral requirements or recommendations. I focus on the contractarian version of the libertarian challenge as recently presented by Jan Narveson. I claim that Narveson’s contractarian construal of libertarianism is not only intuitively weak, but is also subject to decisive internal problems. I argue, in particular, that it does not pro- vide a clear rationale for distinguishing between informal duties of virtue and enforceable duties of justice, that it can neither successfully justify libertarianism’s protection of negative rights nor its denial of positive ones, and that it fails to undermine the claim that basic positive duties are duties of global justice. -/- . (shrink)

This paper addresses the problem of ‘premature consent’. The term ‘premature consent’ denotes patient decisions that are: formulated prior to discussion with the appropriate healthcare professional ; based on information from unreliable sources ; and resolutely maintained despite the HCP having provided alternative reliable information. HCPs are not obliged to respect premature consent patients’ demands for unindicated treatments. But why? What is it that premature consent patients do or get wrong? Davis has argued that premature consent patients are incompetent and (...) misinformed. We argue that this view is not sustainable. A more plausible position asserts that premature consent threatens the integrity of the medical profession. We argue that this gives rise to a negative patient duty which premature consent patients fail to honour. We argue for a further positive duty of good faith engagement in shared decision-making. This implies willingness to potentially revise or justify one’s evaluative bases. Fundamentally, the problem with premature consent patients is that certain of their evaluative bases are not open to revision. They therefore fail in their duty to participate faithfully in the shared decision-making process. (shrink)

Role modelling communicates a standard of behavior to another person. Silent role modelling occurs when this standard can be communicated without articulating reasons for the action; articulate role modelling occurs when it is necessary to articulate reasons in order to effectively role model the standard of behavior, and to avoid misinterpretation. Nurses are role models in virtue of the respect and admiration given to the nursing profession. As such, nurses have role model obligations. This paper examines nurses' role model obligations (...) for healthy behaviors and pandemic precautions. Research often identifies nurses as role models for healthy behavior, despite the fact that nurses are typically no healthier than the general population. This paper argues that nurses do not have a duty to role model healthy behaviors. The ability to adopt healthy behaviors is affected by numerous personal and individual factors. For a nurse to share their struggles to adopt healthy behaviors as articulate ‘imperfect’ role models violates their right to privacy. By contrast, nurses do have a moral duty to role model pandemic precautions during the COVID-19 pandemic, such as correctly wearing appropriate masks, maintaining social distancing, avoiding gatherings of multiple households when pandemic precautions are not being taken, and staying up to date on vaccination. Nurses’ duty to role model pandemic precautions does not involve sharing any personal information. Nurses have a duty to be silent role models when the risk of misinterpretation is low, and a duty to be articulate role models, who explicitly communicate reasons for the role modelled behavior, when necessary to ensure they are not misinterpreted. When articulate role modelling goes beyond the minimal role modelling duty, and imposes a comparative cost to the nurse, articulate role modelling is not obligatory, but supererogatory. (shrink)

Like the ownership of physical property, the issues computer software ownership raises can be understood as concerns over how various rights and duties over software are shared between owners and users. The powers of software owners are defined in software licenses, the legal agreements defining what users can and cannot do with a particular program. To help clarify how these licenses permit and restrict users’ actions, here I present a conceptual framework of software rights and duties that is inspired by (...) the terms of various proprietary, open source, and free software licenses. To clarify the relationships defined by these rights and duties, this framework distinguishes between software creators (the original developer), custodians (those who can control its use), and users (those who utilise the software). I define the various rights and duties that can be shared between these parties and how these rights and duties relate to each other. I conclude with a brief example of how this framework can be used by defining the concepts of free software and copyleft in terms of rights and duties. (shrink)

Tad Brennan explains how to live the Stoic life--and why we might want to. Stoicism has been one of the main currents of thought in Western civilization for two thousand years: Brennan offers a fascinating guide through the ethical ideas of the original Stoic philosophers, and shows how valuable these ideas remain today, both intellectually and in practice. He writes in a lively informal style which will bring Stoicism to life for readers who are new to ancient philosophy. The Stoic (...) Life will also be of great interest to philosophers and classicists seeking a full understanding of the intellectual legacy of the Stoics. (shrink)

Vermeulen et al. suggest a moral duty exists for physicians to inform patients of “relevant opportunities” for Expanded Access. Such a duty is likely both too broad, leading to important practical challenges, and too narrow, without further steps to promote patient access. However, physicians should be expected to be aware of the EA pathway, disclose it to eligible patients, and support the pursuit of EA options reasonably likely to help.

A former Prime Minister of Israel is alleged to have said that her country would never ascend to the status of authentic statehood until it possessed certain well-known social attributes — organized crime, prostitution, and corruption. These features, while obviously undesirable, were she felt, reliable indices of societal maturation. This anecdote is suggestive in understanding current events pertaining to the field of applied ethics.Philosophers have produced a massive body of opinion and argument on a diverse range of subjects under the (...) rubric of applied ethics. Moreover, they have assumed positions on various panels, commissions, governmental bodies and committees in the hope of making an informed contribution to the formulation of institutional and public policy. These accomplishments have begun to elicit the kinds of attributes commonly associated with philosophical maturation — exposées, debunkings, refutations, and ideologically informed critiques. (shrink)

Ignorance of current events is ordinarily treated as a moral failing. In this article, I argue that much of this ire is misplaced. The disengaged are no less positioned to do good or dispense beneficence, no more arrogant or complicit than those glued to the headlines. Nonetheless, I contend that citizens do have moral reason to remain informed – they ought not be indifferent to others. This, I show, provides a standing reason to pay attention to distant strangers: by bearing (...) witness, we avoid indifference. It follows that we should reconsider our media diet and our critiques of the disengaged. (shrink)

Scholarly inquiry into medical ethics should inform and guide those involved in making challenging ethical decisions.1 It should strive to be integral to the work of health care professionals and health care institutions2 and clinical relevance seems essential for this to happen. To acknowledge the importance of clinical relevance for medical ethics, the Journal of Medical Ethics has introduced a regular Clinical Ethics section at the beginning of each issue. Papers that we think are likely to be of particular (...) interest and relevance to clinicians will be placed in this section of the journal. One way in which a paper can be framed for a more clinical audience is by organising it around a scenario that healthcare professions might face. The paper published in this issue’s Clinical Ethics section considers a dilemma about whether an egg donor should be contacted to help diagnose a condition that the resulting child might have.3 While egg donation has become more common, the complexities presented by this scenario might appear removed from those which most health professionals face. However, the way in which genomics is becoming incorporated into healthcare means that the issues this scenario raises are relevant to all healthcare professionals. The spread of genomics into practice means that the …. (shrink)

In 1991, the CDC recommended that health care workers (HCWs) infectedwith HIV or HBV (HbeAg positive) should be reviewed by an expert paneland should inform patients of their serologic status before engaging inexposure-prone procedures. The CDC, in light of the existing scientificuncertainty about the risk of transmission, issued cautiousrecommendations. However, considerable evidence has emerged since 1991suggesting that we should reform national policy. The data demonstratesthat risks of transmission of infection in the health care setting areexceedingly low. Current policy, moreover, (...) does not improve patientsafety. At the same time, implementation of current national policy atthe local level poses significant human rights burdens on HCWs.Consequently, national policy should be changed to ensure patient safetywhile protecting the human rights of HCWs. This article proposes a newnational policy, including: (1) a program to prevent bloodborne pathogentransmission; (2) a responsibility placed on infected HCWs to promotetheir own health and well-being and to assure patient safety; (3) adiscontinuation of expert review panels and special restrictions forexposure-prone procedures; (4) a discontinuation of mandatorydisclosure of a HCW's inflection status; and (5) the imposition ofpractice restrictions if a HCW is unable to practice safely because of aphysical or mental impairment or failure to follow careful infectioncontrol techniques. A new national policy, focused on management of theworkplace environment and injury prevention, would achieve high levelsof patient safety without discrimination and invasion of privacy. (shrink)

This paper develops an interpretation of the relationship between Kant's various formulations of the categorical imperative in the Groundwork that steers a middle course between the formal and substantive poles of the interpretive spectrum, represented by John Rawls and Barbara Herman, respectively. Accepting and rejecting key aspects of both Rawls's and Herman's interpretations, I argue that the first formulation, understood correctly, does suffice to determine all Kantian moral duties, but only if duties are regarded as situation-specific rather than standing obligations. (...) I also argue, however, that the second and third formulations provide information that is necessary for understanding and applying the first formulation to determine one's duty correctly, and that the formulations are in a sense equivalent even though each plays a distinctive and important role. (shrink)

The relationship between intimacy and honesty seems a paradoxical one. While intimate relationships would seem to demand a high level of honesty, this same intimacy might make us more likely to shield the other or protect ourselves through benevolent lying or the withholding of information. It would seem that honesty may not always be the best policy in intimate relationships. The purpose of this article is to examine the tension between honesty and intimacy in Kant’s duty of friendship, and (...) it will highlight the limitations of Kant’s expectations of friendship. At the same time I will use Kant’s own appeal to the autonomy of moral agents to delineate an appropriate role for the obligations of honesty and self disclosure in friendship. (shrink)

Do individuals have moral duties to fulfil all the demands of their jobs? In this paper, we discuss how to understand such ‘occupational duties’ and their normative bases, with a specific focus on duties that go beyond contractually agreed upon duties. Against views that reduce occupational duties to contractual duties, we argue that they often have greater moral weight, based on skills, roles, and the duty of social cooperation. We discuss what it would take to make sure that individuals (...) are not unfairly overburdened by such occupational duties, distinguishing between choice conditions (voluntariness, availability of alternatives, full information) and conditions concerning the role and the social structures within which such duties are embedded (feasible role design, existence of support structures, employee voice). These conditions, however, are not fulfilled for many existing jobs, especially for jobs typically occupied by structurally disadvantaged groups such as women or ethnic minorities. This leads to a dilemma between the claims of those who depend on the occupational duties to be fulfilled, and the rights of those who hold these occupations and are unfairly overburdened. We conclude by arguing for the need for structural reform to dissolve this dilemma. (shrink)

Universally, the idea of needs arises from the limited nature of man. Arising from this limitation, the desires involved in being human are such that man is trapped in a world of needs, which are biological, psychological, social, political, economic and so on. But the understanding that defines and directs these needs depends on the context and culture where the human being functions. This chapter sets out to articulate the key issues that define the idea of needs in African thought. (...) To do this, it applies the instance of the idea of needs in Igbo thought as an illustration of meaning assigned to needs and the understanding that informs reactions to needs in African thought. It translates needs into three components, namely Required necessity, Required necessity that could be provided through an agent and Required necessity that should be provided by an agent. It then maps out Igbo proverbs on Lack, Care and Duty, and applies them to articulate the idea of needs in African thought. It will also articulate the social and political imperatives implied by this understanding. (shrink)

The most plausible line of anti-doping argumentation starts with the fact that performance enhancing substances are harmful and put at considerable risk the health and the life of those who indulge in the overwhelming promises these substances hold. From a liberal point of view, however, this is not a strong reason neither to morally reject doping altogether, nor to put a blanket ban on it; on the contrary, allowing adult, competent and informed athletes to have access to performance enhancement drugs (...) is often showcased as a liberty-related right of noninterference. In this article I will first discuss doping from the liberal point of view, especially in the light of the harm principle as it was introduced by Mill and elaborated by his successors, most notably by Joel Feinberg. Then I will examine whether – and to what degree – one’s decision to receive performance enhancement drugs would mean to use humanity in one’s own person only as a means, which would be self-defeating in the light of Kantian ethics. From this I will move one step backwards to what I consider as the core question concerning the ethics of doping, the one that is logically prior to any other in my view, and concerns the consistency of the thesis that doping may be compatible with sport. I will argue that there is an inherent logical antinomy between doing sport and using performance enhancement drugs, one that presents any argumentation in favor of doping as essentially self-contradictory. (shrink)

To fulfill a perfect duty an agent must avoid vice, yet when an agent refrains from acting on a prohibited maxim she still must do something. I argue that the setting of morally required ends ought to consistently inform an agent's judgment regarding what is to be done beyond compliance with perfect, negative duties. Kant's assertion of a puzzling version of latitude of choice within his discussion of perfect duties motivates and complicates the case I make for a (...) more expansive interpretation of the duty to pursue virtue. (shrink)

Mental health clinicians and evaluators of a person's mental health for legal purposes must address highly nuanced and possibly conflicting goals that arise in their work. Forensic Neuropsychiatric Ethics reviews real-life dilemmas facing practitioners who work in the field of mental health. The first two chapters ground the reader in the modern history and evolution of forensic ethics. Subsequent chapters provide practical direction on a range of important topics, including maintaining robust professionalism, writing an ethical report, testifying ethically, participating in (...) capital cases, managing bias and subjectivity, incorporating testing into one's opinion, and working in leadership roles. Other topics include providing informed consent; violating confidentiality; considering advance directives and physician assistance in dying; fulfilling the Tarasoff duty to protect; ethical considerations related to assisted outpatient treatment; the assessment and potential removal of firearms; the termination of pregnancy and decisional capacity; recognition of structural and implicit bias in violence risk assessments; and implications for the use of neuroscience and artificial intelligence in the courtroom. The book is written for all clinicians, forensic evaluators, educators, administrators, lawyers, and judges. (shrink)

This monograph opens with an examination of the aid industry and the claims of leading practitioners that the industry is experiencing a crisis of confidence due to an absence of clear moral guidelines. The book then undertakes a critical review of the leading philosophical accounts of the duty to aid, including the narrow, instructive accounts in the writings of John Rawls and Peter Singer, and broad, disruptive accounts in the writings of Onora O’Neill and Amartya Sen. Through an elaboration (...) of the elements of interconnection, responsible action, inclusive engagement, and accumulative duties, the comparative approach developed in the book has the potential to overcome the philosophical tensions between the accounts and provide guidance to aid practitioners, donors and recipients in the complex contemporary circumstances of assistance. Informed by real world examples, this book grapples with complex and multi-dimensional questions concerning practices and the ethics of aid. The author judiciously guides us through the debate between deontological and consequentialist moral theories to arrive at a sophisticated consequentialist account that does justice to the complexity of the problems and facilitates our deliberation in discharging our duty to aid, without yielding, as it should not, a determinate answer for each specific situation. Researchers, students, and practitioners of international aid will all find this book rewarding. Win-chiat Lee, Professor and Chair, Department of Philosophy, Wake Forest University Susan Murphy’s book offers us a sophisticated exploration of the philosophical basis for aid. It is grounded in a full understanding of the complexities and pitfalls of the aid industry, but its particular strength lies, mainly through an extensive discussion of Singer, Rawls, O’Neill and Sen, in a comparison of consequentialist and duty-based approaches, eventually endorsing a broad non-idealised, situated consequentialist account in what she calls an interconnected ethical approach to the practice of assistance. For anyone wanting to think carefully about why we should give aid, this book has much to offer. Dr Nigel Dower Honorary Senior Lecturer, University of Aberdeen Author of World Ethics – the New Agenda. (shrink)

This paper considers the development and judicial application of the Public Sector Equality Duty now found in section 149 Equality Act 2010, previously in a variety of forms in the Race Relations Act 1976, the Disability Discrimination Act 1995 and the Sex Discrimination Act 1975. It identifies a number of emerging themes in the jurisprudence concerned, in particular, with the relationship between the PSED and Wednesbury review, the extent of the information-gathering obligation it imposes, the delegability of PSED decision-making (...) and the timing of PSED challenge. It then considers the uncertainties which remain including, in particular, the application of the duty to various categories of decision-making, and concludes by assessing the impact of the PSED on challenges to ‘cuts’ cases arising from the reductions to public sector funding, and on domestic equality jurisprudence. (shrink)

The nocebo effect, a phenomenon whereby learning about the possible side effects of a medical treatment increases the likelihood that one will suffer these side effects, continues to challenge physicians and ethicists. If a physician fully informs her patient as to the potential side effects of a medicine that may produce nocebogenic effects, which is usually conceived of as being a requirement associated with the duty to respect autonomy, she risks increasing the likelihood that her patient will experience these (...) side effects and therefore suffer (unnecessary) harm, a violation of the duty of nonmaleficence. If, on the other hand, she intentionally withholds side effect information in an effort to protect her patient from suffering unnecessary harm from side effects, which is consistent with the duty of nonmaleficence, she violates the duty to respect patient autonomy. In this paper, the author discusses several previous attempts to deal with the nocebo effect and explains their weaknesses. He then proposes a means of managing the nocebo effect and argues that it does not share the weaknesses found in previous approaches. He concludes with a discussion of a simple, yet practical tool that might help clinicians manage the tension resulting from the nocebo effect. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

ABSTRACT:The oft-cited privacy paradox is the perceived disconnect between individuals’ stated privacy expectations, as captured in surveys, and consumer market behavior in going online: individuals purport to value privacy yet still disclose information to firms. The goal of this paper is to empirically examine the conceptualization of privacy postdisclosure assumed in the privacy paradox. Contrary to the privacy paradox, the results here suggest consumers retain strong privacy expectations even after disclosing information. Privacy violations are valued akin to security violations in (...) creating distrust in firms and in consumer willingness to engage with firms. This paper broadens the scope of corporate responsibility to suggest firms have a positive obligation to identify reasonable expectations of privacy of consumers. In addition, research perpetuating the privacy paradox, through the mistaken framing of disclosure as proof of anti-privacy behavior, gives license to firms to act contrary to the interests of consumers. (shrink)

Technology has outpaced the capacity of researchers performing research on human participants to interpret all data generated and handle those data responsibly. This poses a critical challenge to existing rules governing human subjects research. The technologies used in research to generate images, scans, and data can now produce so much information that there is significant potential for incidental findings, findings generated in the course of research but beyond the aims of the study. Neuroimaging scans may visualize the entire brain and (...) even the entire head; computed tomography colonography research may visualize the entire torso, from the base of the lungs to the pubis; genetics studies may reveal “extra” and sometimes unwanted information about the family, such as misattributed paternity and undisclosed adoption; and genomic microarray research increasingly involves whole-genome analysis revealing an individual’s complete genotype, with enormous potential for uncovering unexpected information about an individual’s genetics and risks of developing future conditions. (shrink)

ABSTRACT How should physicians act when faced with corporal punishment, such as amputation, or torture? In most cases, the answer is clear: international law, UN resolutions and universal codes of medical ethics absolutely forbid physicians from countenancing torture and corporal punishment in any form. An acute problem arises, however, in decent societies, but not necessarily liberal states, that are, nonetheless, welcome in the world community. The decent society is often governed, in whole or in part, by religious laws, and while (...) these states abridge various human rights they are peace loving, generally tolerant, and offer their citizens wide avenues for political participation. Under these circumstances the prohibition against corporal punishment and torture weakens, often compelling physicians to participate. This is true in two cases. In Rawls’ hypothetical nation of Kazanistan, Islamic law is the order of the day, and amputations and corporal punishment play an integral part in the execution of traditional Islamic justice. In Israel, torture is sometimes used to elicit the information needed to thwart impending terror attacks. In each case, a physician's participation is essential. In light of the near universal condemnation that accompanies torture and corporal punishment, physicians can only appeal to norms anchored in collective well‐being and concern for life that override respect for human dignity in these societies. Western societies have consistently rejected this reasoning, but it is part and parcel of life in the decent society. (shrink)

Journalists seldom consider the layers of those affected by their actions; third parties such as families, children, and even people unlucky enough to be in the wrong place at the wrong time. This article argues for consideration of the broader group, considering a range of options available for doing their duty to inform the public while also minimizing harm to others. Journalists might compare themselves with other professions that have similar roles, such as anthropologists, on such issues as (...) confidentiality and disclosure. A broader lesson is the value of applying different views, theoretical frameworks, and starting points to the ethical issues in any profession. (shrink)

Although disproportionate housework and care responsibilities ascribed to mothers and wives have been found to greatly impact women’s self-employment, less is known about how family-level labor structures may shape daughters’ entrepreneurship. Family business scholarship has shed partial light on this question by showing that household hierarchies and gender norms impede daughters’ recognition and inheritance within family firms in the United States. Drawing on interviews with 32 women microenterprise owners in Zacatecas, Mexico, this article builds on previous research by suggesting that (...) gendered mechanisms and labor structures may in fact position daughters to inherit businesses or business-related resources such as skills, financial capital, and property from their parents. Daughters acquire these assets by virtue of contributing to their parents’ enterprises as part of their childhood chores and maintaining a continued attachment to these businesses into adulthood. Daughters’ job prospects aside from inheritance were found to further shape their perceptions of business succession and inform their decision about whether to take over the family enterprise. Such acquisitions can be said to comprise instances of “gendered inheritance,” in which gendered institutions largely understood as disadvantaging women also may position them to attain valuable assets. (shrink)

The decline of empirical research on ethical decision-making based on ethical theories might imply a tacit consensus has been reached. However, the exclusion of virtue ethics, one of the three main normative ethical theories, from this stream of literature calls this potential consensus into question. This article investigates the role of all three normative ethical theories—deontology, utilitarianism and virtue ethics—in ethical decision-making of corporate executives. It uses virtue ethics as a dependent variable thus studying the interconnectivity of all three normative (...) ethical theories in specific circumstances. We find that managers use different ethical theories in different circumstances (business vs. private life, formal vs informal ethical leadership, etc.). A predictive model of ethical decision-making, however, cannot be established. We also find that only a limited number of variables influence the choice of ethical theory, which leans business ethics towards postmodern management paradigm. We suggest that moral pragmatism could provide the answer to ethical decision-making. (shrink)

In recent years, increasing pressures have been brought to bear upon nurses and others more closely to inform, involve and support the rights of parents or guardians when crucial ‘life and death’ ethical decisions are made on behalf of their seriously ill child. Such decisions can be very painful for all involved, and may easily become deadlocked when there is an apparent clash of moral ideals or values between the medical team and the parents or guardians. This article examines (...) a growing number of such cases in New Zealand and analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. The article concludes with a recommendation that nurses should be recognized as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations. (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)