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

Tragic choices arise during the COVID-19 pandemic when the limited resources made available in acute medical settings cannot be accessed by all patients who need them. In these circumstances, healthcare rationing is unavoidable. It is important in any healthcare rationing process that the interests of the community are recognised, and that decision-making upholds these interests through a fair and consistent process of decision-making. Responding to recent calls (1) to safeguard individuals’ legal rights in decision-making in intensive care, and (2) (...) for new authoritative national guidance for decision-making, this paper seeks to clarify what consistency and fairness demand in healthcare rationing during the COVID-19 pandemic, from both a legal and ethical standpoint. The paper begins with a brief review of UK law concerning healthcare resource allocation, considering how community interests and individual rights have been marshalled in judicial deliberation about the use of limited health resources within the National Health Service (NHS). It is then argued that an important distinction needs to be drawn between procedural and outcome consistency, and that a procedurally consistent decision-making process ought to be favoured. Congruent with the position that UK courts have adopted for resource allocation decision-making in the NHS more generally, specific requirements for a procedural framework and substantive triage criteria to be applied within that framework during the COVID-19 pandemic are considered in detail. (shrink)

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

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

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

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

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

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

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

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

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

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

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

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

Breaking with the orthodoxy, Compassionate Conservationists have taken issue with the way that individual wild animals are routinely sacrificed for the sake of species preservation or for the good of the ecosystem. Though explicitly aligning themselves with virtue ethics, there has been some confusion about what this means in practice. How is the perfectly compassionate person to act when the choice is between intentionally harming animals and protecting biodiversity? And what if the choice is between direct and indirect harm to (...) animals? Some critics suggest that when faced with these kinds of conflicts of value, Compassionate Conservationists will invariably base their choices either on the arbitrary feelings an action elicits in them, or else revert back to the decision-making procedures that characterize Traditional Conservation. In response, I argue (first) that these critics fail to appre- ciate that compassion often plays an essential role in moral deliberation. Second, that being compassionate matters even if it does not end up having a discernable effect on what one chooses to do. When one is faced with a tragic predicament in which harming individual animals is unavoidable, for instance, it matters here that one respond with an appropriate compassion. Third, that even when a situa- tion’s difficulty requires one to appeal to the impersonal norms of justice, here too it is required that one proceed with compassion. I end by illustrating these points through the close consideration of a case study: New Zealand’s controversial preda- tor extermination campaign. (shrink)

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

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

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

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

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

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

Le mosche del capitale [The Flies of Capital] is Volponi’s last novel, and it is inspired by autobiographical events, which are depicted at a historical level. The end of a progressist industrial paradigm entails the end of social conflicts (i.e., the end of the working class) and the passage from manufactured capital to financial capital. The pervasiveness reached by capital is criticized through some formal choices that ridicule the language of power and the subjugation of the managers to it. (...) The main objective of this paper is to show how Volponi depicts a double breakdown: on the one hand, and in dramatic forms, the breakdown of the working class; on the other hand, and in comic forms, the breakdown of industry. (shrink)

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

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

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

This reply to Giles Scofield's critique of the authors' article in the June 2008 issue of the Kennedy Institute of Ethics Journal highlights two main topics. First, contrary to what Scofield suggests, using the terms "ethics" and "morality" interchangeably constitutes an oversimplification that blurs important distinctions. Second, in a representative democracy, ethical expertise and consultation need not generate a "tragic choice" of the kind Scofield has in mind.

The purpose of this paper is to examine whether randomized clinical trial (RCT) methods are necessarily morally problematic. If they are intrinsically problematic, then there may be a dilemma such that tragic choices might have to be made between this socially very useful method for making medical progress on the one hand, and patients' rights and welfare, or physicans' duties on the other. It is argued that the dilemma may be avoided if RCTs can sometimes be viewed as an (...) honorable and cooperative venture between investigators and subjects. Another dilemma may take shape, however, if too few people are willing to cooperate to maintain the structural integrity of many important RCTs. Given their importance, does this method justify easing some of the consent requirements? It is argued that RCT methods are not so ideal that special consideration should be given to them regarding consent requirements. To examine the compatibility of current consent requirements and frequently used RCT schemas, seven RCT designs are discussed. It is found that some, but not all, RCTs, are intrinsically problematic but that sufficient reason has not been found to hold all RCT schemas as intrinsically morally troubling. Keywords: randomized clinical trials, informed consent, randomization CiteULike Connotea Del.icio.us What's this? (shrink)

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

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

The following essay involves a discussion of four theories about lying and their application to a specific circumstance, the Nazi-Jew situation, as found in Kant, Aquinas, Pruss, and Guervin. By examining their thoughts on this particular situation, we may draw out, by the use of “right reason,” ways to handle everyday situations that causes us to face the tragic choice between two goods that lying presents. The argument is that, if approached in a certain way, the tragic choice lying presents (...) may be avoided. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Philosophy of Isaiah Berlin by Johnny LyonsMario ClemensThe Philosophy of Isaiah Berlin, by Johnny Lyons; 276 pp. London: Bloomsbury Academic, 2020.A well-established Isaiah Berlin scholar recently pointed out, "Berlin gets us interested in value pluralism, but he leaves us with many questions."1 Therefore, is it really the case—as value pluralism holds—that human life in general and politics in particular are characterized by potentially conflicting values that cannot (...) be brought into a hierarchy, thus leaving us with tough and sometimes tragic choices? Does pluralism, thus understood, not lead to moral relativism? And what are the political implications of value pluralism?In the Philosophy of Isaiah Berlin, an encompassing study of Berlin's extensive oeuvre, Johnny Lyons makes an original suggestion for how to address these sustained riddles of Berlin scholarship. For Lyons, the key to understanding Berlin's political theory is his particular notion of philosophy. The author seeks to show "that it is only by unearthing Berlin's conception of philosophy that we can make sense of his political theory" (p. xv).Lyons—who taught philosophy for six years, then abandoned academia in the late 1990s to work in corporate communications, and now has reentered the philosophical debate with this study on Berlin's philosophy—is highly skeptical of the mainstream way of doing philosophy. Lyons sees much of anglophone moral and political philosophy engaged in a "self-styled scientific enterprise" (p. 213), where philosophy is "identifying itself too closely with science or at the very least with a severely naturalistic mindset" (p. 219). This has led to "weirdly formal and systematic moral theorizing" (p. 214), resulting in "predominantly formal, abstruse and largely unreadable work" (p. 213), which moreover ignores the insights of the "the historical turn" (p. 154, emphasis in the original). According to Lyons, this "current state of largely sterile detachment and ossifying specialization is neither inevitable nor useful" (p. 218).What Berlin had, and what, according to Lyons, contemporary anglophone philosophy lacks, is the awareness of more than one legitimate way of describing and understanding the world. Notwithstanding the crucial achievements of the natural sciences, this philosophy's positivist methods are not the only possible approaches to genuine insights.For Lyons, the primary task of philosophy is "to make sense of the world we live in" and to help "us to determine how best to live our lives within that world" (p. 215). And in the light of such a definition of philosophy, Berlin's approach appears preferable to the mainstream analytic tradition.The claim that scientific explanations do not exhaust the possibilities of rational insight is, of course, not new. Lyons himself points to the parallels between Berlin's "humanistic philosophy" (p. 214) and "the twentieth-century phenomenological turn to capture the Lifeworld or Lebenswelt, the intelligible field of our common subjective experience" (p. 221). Moreover, there is an [End Page 472] obvious parallel to the hermeneutic tradition (from Friedrich Schleiermacher, via Wilhelm Dilthey, to Hans-Georg Gadamer), which emphasizes understanding (Verstehen) as opposed to explaining (Erklären).Innovative, then, is not Lyons's claim that he has found a philosopher with a more human-centered way of doing philosophy. Instead, what is noteworthy is his suggestion that the themes Berlin scholars grapple with will appear in a new light once we pay sufficient attention to Berlin's particular understanding of philosophy.The book consists of five parts. In his "general introduction," Lyons introduces readers, especially those unfamiliar with Berlin, to his political philosophy. Lyons also addresses some of the likely objections against treating Berlin as a political philosopher (as opposed to a historian of ideas or "mere" essayist).In part two, Lyons explores Berlin's particular understanding of philosophy. For Lyons, two insights set Berlin apart from the dominant analytic tradition. First, Berlin adopts Immanuel Kant's claims that we see the world through concepts and categories of our own making. Second, Berlin takes on board two of Giambattista Vico's observations: we cannot look at the world from outside history, only through historical perspectives; and we nevertheless do have access to the outlooks of past epochs and their thinkers because our shared humanity enables... (shrink)

Resource development takes place through the transformation of social institutions. The moral dimension is of crucial importance in the evolution of associated management regimes. More than just a code of ethics, moralities are predicated on what is understood to be ‘the good’. Recognition of the good requires a rhetoric beyond those of power and interest. This paper proposes a rhetoric of love. Within this conception of morality, the management of human relationships becomes understood as an unfolding cycle of choice among (...) tragic choices and management of the non‐human environment is accomplished through the realisation of the gift relationship. (shrink)

This book uses real world examples, case studies, and commentary from practitioners to reveal the many and varied strategies American and English lawyers use to protect truth. It shows how they tackle their conflicting duties, and highlights the 'tragic choices' lawyers everywhere routinely make through their 'power of decision'. What emerges are new ways of understanding the critical role lawyers play in society - and their professional responsibilities. 'Truth is so precious it should always be protected by a bodyguard (...) of lies.' Churchill said this about wartime deception plans, but lawyers' clients may think their truth is so precious it too should be protected. Lawyers are 'bodyguards of lies' when they use so-called 'tricks of the trade' not only to keep clients' secrets but to construct a reality that is far from real. But should they? Lawyers have a divided loyalty. The book presents an account of what happens when lawyers' duties to clients conflict with their duties to the legal system, and looks at the ethical codes and laws that regulate their conduct. (shrink)

In Patterns of Moral Complexity, Charles Larmore describes three related ways in which moral and political theory are more complex than is often allowed. He objects to three parallel simplifications: that moral decision making largely consists in the application of rules to particular situations; that the ideals by which we are guided in our personal lives should also do service as political ideals, a simplification which he calls “expressivism”; and that there is but a single source of moral value. Against (...) these simplifications he argues in a sort of Aristotelian way for the centrality of judgment in moral reasoning; for the liberal principle that the state should not strive to express our highest personal ideal; and for the, I suppose eclectic, view that partiality, deontological reasons, and consequentialist reasons all have a place in moral reasoning and that therefore the moral person may well be caught in conflicts that present him or her with tragic choices. These are the three “patterns of moral complexity” that the title of the book refers to. (shrink)

Human population growth, along with technological development and levels of consumption, is a key driver of our devastating impact on the environment. This must be acknowledged as a matter of urgency. Otherwise, we risk bequeathing future generations a tragic choice between introducing explicitly impermissible coercive population policies, becoming incapable of securing even basic human rights, and worsening climate change and other environmental damage. However, this chapter warns against approaching questions of population from too narrow an environmental ethics viewpoint. If this (...) debate is conducted in isolation from considerations of global justice, there is a real danger of advocating policies that are plausible on the surface but impermissible when assessed in terms of their implicit impact on individual human lives. (shrink)

The essays in this volume are illustrative of the variety of issues that arise when thinking about moral responsibility. From metaphysical concerns about free will and determinism to normative interest in the nature of our social practices, the philosophy of moral responsibility seems to have something to offer philosophers of nearly any taste or temperament. It is, in part, this pervasive and diverse significance that sparked and has sustained my own interest in the topic. I hope the essays in this (...) volume have similar effects on readers.The volume begins with an essay by Justin Capes, examining blameworthiness in the context of tragic choices. It is natural to think that freely and knowingly doing wrong, despite the awareness that one could do right, is a sufficient condition of blameworthiness. But some have recently argued that there are counterexamples to this claim. Suppose that Ann is faced with the difficult choice of saving a few strangers from certain death or preventing her c .. (shrink)

How much by way of economic reward is due to health care providers?Although this problem usually presents itself as a practical matter of policy, it has buried within it a number of philosophical issues, for it can be regarded as a question in the theory of economic justice. The formal principle of justice is that we should render persons what is due to them. But on what consideration in the case of health care providers can we make an assessment of (...) what is due?The answer we give to this question has significant implications for the ethical appraisal of the allocation of resources in the health care system. Some of the most difficult issues of ethical appraisal emerge when we consider the problems of allocating potentially life-saving resources between different groups of patients. Many of the most significant current issues in medical ethics—the role of QALYs, the meaning of equality and the economic evaluation of life—find their point of reference in the ‘tragic choices’ that are created when there are insufficient resources to meet apparently legitimate medical need. Yet, as Robert Evans has pointed out, it is a simple matter of accounting identity that health care expenditures must equal health providers' incomes. So, in asking how we limit or allocate costly health care resources, we are implicitly offering an answer to the question of how much we should pay providers. I hope by seeking an answer explicitly to that question to throw light on the problems that are raised when considering ethically the allocation of health care resources. (shrink)

BackgroundAs the range of therapeutic options in the field of oncology increases, so too does the strain on health care budgets. The imbalance between what is medically possible and financially feasible is frequently rendered as an issue of tragic choices, giving rise to public controversies around health care rationing.Main bodyWe analyse the Norwegian media discourse on expensive cancer drugs and identify four underlying premises: (1) Cancer drugs are de facto expensive, and one does not and should not question why. (...) (2) Cancer drugs have an indubitable efficacy. (3) Any lifetime gained for a cancer patient is an absolute good, and (4) cancer patients and doctors own the truth about cancer. Applying a principle-based approach, we argue that these premises should be challenged on moral grounds. Within the Norwegian public discourse, however, the premises largely remain unchallenged due to what we find to be unjustified claims of moral superiority. We therefore explore alternative framings of the issue of expensive cancer drugs and discuss their potential to escape the predicament of tragic choices.ConclusionsIn a media discourse that has seemingly stagnated, awareness of the framings within it is necessary in order to challenge the current tragic choices predicament the discourse finds itself in. In order to allow for a discourse not solely concerned with the issue of tragic choices, the premises that underlie it must be subjected to critical examination. As the field of oncology advances rapidly, we depend on a discussion of its opportunities and challenges that is meaningful, and that soberly addresses the future of cancer care—both its potential and its limits. (shrink)

If we accept the premise that some sort of rationing of access to health care resources is necessary to contain escalating health care costs effectively, then we need to ask how that rationing might be accomplished most fairly. Calabresi and Bobbitt have argued in their book Tragic Choices that there is no 'perfectly fair' or even 'reasonably fair' way to bring this about.

Resource development takes place through the transformation of social institutions. The moral dimension is of crucial importance in the evolution of associated management regimes. More than just a code of ethics, moralities are predicated on what is understood to be 'the good'. Recognition of the good requires a rhetoric beyond those of power and interest. This paper proposes a rhetoric of love. Within this conception of morality, the management of human relationships becomes understood as an unfolding cycle of choice among (...) tragic choices and management of the non-human environment is accomplished through the realisation of the gift relationship. (shrink)

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

A collection of 17 essays on Kantian moral theory and practical ethics, including papers on autonomy, human dignity, utopian thinking, O'Neill and Rawls on constructivism, tragic choices, philanthropy, conscientious object, suicide, respect, self-respect, and an ideal attitude of appreciation beyond art, nature, and gratitude. TABLE OF CONTENTS Abbreviations for Kant’s Works INTRODUCTION PART II: KANT AND KANTIAN PERSPECTIVES (1) The Groundwork (2) Kant on Imperfect Duties to Oneself (3) Kantian Autonomy and Contemporary Ideas of Autonomy (4) Rüdiger Bittner on (...) Autonomy (5) Kantian Perspectives on the Rational Basis of Human Dignity (6) In Defense of Human Dignity (7) The Kingdom of Ends as an Ideal and Constraint on Legislation (8) Kantian Ethics and Utopian Thinking (9) Varieties of Constructivism PART II: PRACTICAL ETHICS (10) Human Dignity and Tragic Choices (11) Duties and Choices in Philanthropic Giving: A Kantian Perspective (12) Killing Ourselves (13) Conscientious Conviction and Conscience (14) Stability, A Sense of Justice, and Self-Respect (15) Two Conceptions of Virtue (16) Beyond Respect and Beneficence: An Ideal of Appreciation (17) Ideals of Appreciation and Expressions of Respect REFERENCES INDEX . (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)