The practice of transplantation of vital organs from “brain-dead” donors is in a state of theoretical disarray. Although the law and prevailing medical ethics treat patients diagnosed as having irreversible total brain failure as dead, scholars have increasingly challenged the established rationale for regarding these patients as dead. To understand the ethical situation that we now face, it is helpful to revisit the writings of the philosopher Hans Jonas, who forcefully challenged the emerging effort to redefine death in the (...) late 1960s. (shrink)

The prelims comprise: Introduction Historical Background The Role of Health Research in Promoting Social Justice Justice in Setting Research Priorities Justice Concerns within the Research Context Case Study: The Investigation of Alternative Lead Abatement Procedures by the Kennedy Krieger Institute Conclusion Note References.

In our 2018 paper, “Hypocrisy and the Standing to Blame,” we offer an argument justifying the Nonhypocrisy Condition on the standing to blame. Benjamin Rossi (2018) has recently offered several criticisms of this view. We defend our account from Rossi’s criticisms and emphasize our account’s unique advantage: explaining why hypocritical blamers lack the standing to blame.

Male provisioning ability may have evolved as a “good dad” indicator through sexual selection, whereas male creativity may have evolved partly as a “good genes” indicator. If so, women near peak fertility (midcycle) should prefer creativity over wealth, especially in short-term mating. Forty-one normally cycling women read vignettes describing creative but poor men vs. uncreative but rich men. Women’s estimated fertility predicted their short-term (but not long-term) preference for creativity over wealth, in both their desirability ratings of individual men (r=.40, (...) p<.01) and their forced-choice decisions between men (r=.46, p<.01). These preliminary results are consistent with the view that creativity evolved at least partly as a good genes indicator through mate choice. (shrink)

Floridi and Sanders, seminal work, “On the morality of artificial agents” has catalyzed attention around the moral status of computer systems that perform tasks for humans, effectively acting as “artificial agents.” Floridi and Sanders argue that the class of entities considered moral agents can be expanded to include computers if we adopt the appropriate level of abstraction. In this paper we argue that the move to distinguish levels of abstraction is far from decisive on this issue. We also argue that (...) adopting certain levels of abstraction out of context can be dangerous when the level of abstraction obscures the humans who constitute computer systems. We arrive at this critique of Floridi and Sanders by examining the debate over the moral status of computer systems using the notion of interpretive flexibility. We frame the debate as a struggle over the meaning and significance of computer systems that behave independently, and not as a debate about the ‘true’ status of autonomous systems. Our analysis leads to the conclusion that while levels of abstraction are useful for particular purposes, when it comes to agency and responsibility, computer systems should be conceptualized and identified in ways that keep them tethered to the humans who create and deploy them. (shrink)

ABSTRACTConventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life‐sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life‐sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two practices (...) is based on a series of moral fictions – motivated false beliefs that erroneously characterize withdrawing life‐sustaining treatment in order to bring accepted end‐of‐life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end‐of‐life decisions is radically mistaken. (shrink)

Sometimes it is not one’s place to blame or forgive. This phenomenon is captured under the philosophical notion of standing. However, there is an asymmetry to be explained here. One can successfully blame, even if one lacks the standing to do so. Yet, one cannot successfully forgive if one lacks the standing to do so. In this article we explain this asymmetry. We argue that a complete explanation depends on not only a difference in the natures of the standing to (...) blame and forgive but also a difference in the natures of blame and forgiveness themselves. (shrink)

It is widely agreed that hypocrisy can undermine one’s moral standing to blame. According to the Nonhypocrisy Condition on standing, R has the standing to blame some other agent S for a violation of some norm N only if R is not hypocritical with respect to blame for violations of N. Yet this condition is seldom argued for. Macalester Bell points out that the fact that hypocrisy is a moral fault does not yet explain why hypocritical blame is standingless blame. (...) She raises a challenge: one must explain what is distinct about hypocritical blame such that the hypocritical blamer lacks the standing to blame, even if the arrogant or petty blamer does not. Of those writing on hypocrisy, only we offer a direct response to Bell’s challenge. Recently, however, our account has come under criticism. We argue here that (1) our account can handle these criticisms and that (2) no other rival account adequately addresses Bell’s challenge of explaining what is uniquely objectionable about hypocritical blame. Because answering Bell’s challenge is a necessary component of any plausible account of the relationship between hypocrisy and standing, our account remains the best on offer. (shrink)

The first topic of concern is anonymity, specifically the anonymity that is available in communications on the Internet. An earlier paper argues that anonymity in electronic communication is problematic because: it makes law enforcement difficult ; it frees individuals to behave in socially undesirable and harmful ways ; it diminishes the integrity of information since one can't be sure who information is coming from, whether it has been altered on the way, etc.; and all three of the above contribute to (...) an environment of diminished trust which is not conducive to certain uses of computer communication. Counterbalancing these problems are some important benefits. Anonymity can facilitate some socially desirable and beneficial behavior. For example, it can eliminate the fear of repercussions for behavior in contexts in which repercussions would diminish the availability or reliability of information, e.g., voting, personal relationships between consenting adults, and the like. Furthermore, anonymity can be used constructively to reduce the effect of prejudices on communications. Negative aspects of anonymity all seem to point to a tension between accountability and anonymity. They suggest that accountability and anonymity are not compatible, and they even seem to suggest that since accountability is a good thing, it would be good to eliminate anonymity. In other words, the problems with anonymity suggest that individuals are more likely to behave in socially desirable ways when they are held accountable for their behavior, and they are more likely to engage in socially undesirable behavior when they are not held accountable. I am not going to take issue with the correlation between accountability and anonymity, but rather with the claim that accountability is good. To examine this problem, let's look at a continuum that stretches from total anonymity at one end, and no anonymity at all at the other end. At the opposite extreme of anonymity is a panopticon society. The panopticon is the prison environment described by Foucault in which prison cells are arranged in a large circle with the side facing the inside of the circle open to view. The guard tower is placed in the middle of the circle so that guards can see everything that goes on in every cell. In a recent article on privacy, Jeffrey Reiman, reflecting on the new intelligent highway systems, suggests that we are moving closer and closer to a panopticon society. When we contemplate all the electronic data that is now gathered about each one of us as we move through our everyday lives- intelligent highway systems, consumer transactions, traffic patterns on the internet, medical records, financial records, and so on- we see the trend that Reiman identifies. Electronic behavior is recorded and the information is retained. While actions/transactions in separate domains are not necessarily combined, it seems obvious that the potential exists for combining data into a complete portfolio of an individual's day to day life. So it would seem that as more and more activities and domains are moved into a IT-based medium, the closer we will come to a panopticon society. A panopticon society gives us the ultimate in accountability. Everything an individual does is observable and therefore available to those to whom we are accountable. Of course, in doing this, it puts us, in effect, in prison. The prison parallel is appropriate here because what anonymity allows us is freedom; prison is the ultimate in lack of freedom. In this way the arguments for a free society become arguments for anonymity. Only when individuals are free will they experiment, try new ideas, take risks, and learn by doing so. Only in an environment that tolerates making mistakes will individuals develop the active habits that are so essential for democracy. In a world without information technology, individuals have levels or degrees and various kinds of anonymity and consequently different levels and kinds of freedom. Degrees and kinds of anonymity vary with the domain: small town social life versus urban social life, voting, commercial exchanges, banking, automobile travel, airplane travel, telephone communication, education, and so on. Drawing from our experience before IT-based institutions, we might believe that what we need is varying levels or degrees and kinds of anonymity. This seems a good starting place because it suggests an attempt to re-create the mixture that we have in the physical, non-IT-based world. Nevertheless, there is a danger. If we think in terms of levels and degrees of anonymity, we may not see the forest from the trees. We may not acknowledge that in an electronic medium, levels and kinds of anonymity mean, in an important sense, no anonymity. If there are domains in which we can be anonymous but those domains are part of a global communication infrastructure in which there is no anonymity at the entry point, then it will always be possible to trace someone's identity. We delude ourselves when we think we have anonymity on-line or off-line. Rather, what we have both places is situations in which it is more and less difficult to identify individuals. We have a continuum of situations in which it is easy and difficult to link behavior to other behavior and histories of behaviors. In the physical world, we can go places and do things where others don't know us by name and have no history with us, though they see our bodies, clothes, and behavior. If we do nothing unusual, we may be forgotten. On the other hand, if we do something illegal, authorities may attempt to track us down and figure out who we are. For example, law enforcement officials, collection agencies, those who want to sue us may take an active interest in removing our anonymity, ex post facto. Think of Timothy McVeigh and Terry Nichols-the men who apparently bombed the federal building in Oklahoma City. Much of what they did, they did anonymously, but then law enforcement officials set out to find out who had done various things, e.g., rented a car, bought explosives, etc. The shrouds of anonymity under which McVeigh and Nichols had acted were slowly removed. Is this any different than behavior on the internet? Is there a significant difference in the kind or degree of anonymity we have in the physical world versus what we have in an IT-based world? The character of the trail we leave is different; in the one case, its an electronic trail; while in the other it involves human memories, photographs, and paper and ink. What law enforcement officials had to do to track down McVeigh is quite different from tracking down an electronic law breaker. Also, the cost of electronic information gathering, both in time and money, can be dramatically lower than the cost of talking to people, gathering physical evidence, and the other minutia required by traditional detective work. We should acknowledge that we do not and are never likely to have anonymity on the Internet. We would do better to think of different levels or kinds of identity. There are important moral and social issues arising as a result of these varying degrees and kinds of identity. Perhaps the most important matter is assuring that individuals are informed about the conditions in which they are interacting. Perhaps, even more important is that individuals have a choice about the conditions under which they are communicating. In the rest of this paper we explore a few examples of levels and kinds of identity that are practical on the Internet. We discuss the advantages and disadvantages that we see for these "styles" of identity for individuals, and we examine the costs and benefits of these styles for society as a whole. (shrink)

Hypocrites, we are told, lack the moral standing to blame. But what is this standing to blame? Why would hypocrisy undermine it? Do any other conditions compromise standing to blame? Kasper Lippert-Rasmussen’s The Beam and the Mote offers the first book-length treatment on such complex questions. Yet the book admirably pushes even further, extending the scope of standing into other normative domains, such as praise, forgiveness, and encouragement. In our review, we critically engage with four of the book’s central topics: (...) (1) the nature and scope of the moral standing to blame, (2) why hypocrisy undermines standing to blame, (3) what other conditions undermine standing to blame, and (4) standing in other normative domains. Although we argue that Lippert-Rasmussen’s views on (2) and (4) require further development, his expansion of standing into underexplored domains is praiseworthy. (shrink)

Traditionally, those writing on blame have been concerned with blaming others, including when one has the standing to blame others. Yet some alleged problems for such accounts of standing arise when we focus on self-blame. First, if hypocrites lack the standing to blame others, it might seem that they also lack the standing to blame themselves. But this would lead to a bootstrapping problem, wherein hypocrites can only regain standing by doing that which they lack the standing to do. Second, (...) in addition to hypocrites, there may be hypercrites, who blame themselves more severely than others. Leading accounts for why hypocrites lack standing to blame others would also seem to imply that hypercrites lack the standing to blame others, but some may find this counterintuitive. We argue that neither of these problems from self-blame poses a unique threat to leading accounts of standing. (shrink)

Electronic communication and commerce facilitate the collection of information about individual use of the Internet. Focusing on the case of Comet Systems Inc. and its data gathering practices, this paper explores the technical details of gathering personal information in databases in general and the special character of the privacy issue raised by 'anonymous' information about individual behavior on the Internet. The case analysis suggests new insights for our understanding of privacy and frames a discussion of policy alternatives with respect to (...) the privacy of Internet communication. (shrink)

The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting (...) Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes (...) in the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

: Bioethicists have failed to understand the pervasively paternalistic character of research ethics. Not only is the overall structure of research review and regulation paternalistic in some sense; even the way informed consent is sought may imply paternalism. Paternalism has limits, however. Getting clear on the paternalism of research ethics may mean some kinds of prohibited research should be reassessed.

Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two practices (...) is based on a series of moral fictions – motivated false beliefs that erroneously characterize withdrawing life-sustaining treatment in order to bring accepted end-of-life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end-of-life decisions is radically mistaken. (shrink)

A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of the common morality to medicine or whether some of these norms are internal or proper to medicine. In this article we describe and defend an evolutionary perspective on the internal morality of medicine that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these (...) goals. This perspective is developed by means of a critical examination of the essentialist conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp. (shrink)

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. (...) Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

The differential aging effect is shown to be valid in any physically reasonable extension of the special theory of relativity which includes a description of accelerating observers. Einstein's controversial assumption—the clock hypothesis—is avoided. Instead, it is sufficient to assume accessibility—that it is possible to travel from one inertial observer to another and then return to the first in a reasonable manner. Since Minkowski space-time displays this accessibility property, there must be an error in Sachs's quaternion development of general relativity. No (...) assumptions concerning measurements—proper time—of accelerating observers are necessary, nor are assumptions concerning special features of their motion—uniform acceleration. (shrink)

Accepted medical practice already violates the dead donor rule. Explicitly jettisoning the rule—allowing vital organs to be extracted, under certain conditions, from living patients—is a radical change only at the conceptual level. But it would expand the pools of eligible organ donors.

The following article examines critically Robert Veaten's argument that respect for patient autonomy invalidates the concept of medically indicated treatment. I contend that when judgments of medically indicated treatment are distinguished from what ought to be done in a given case, all things considered, they are compatible with patient autonomy. Yet there remains a significant danger, which needs to be guarded against, that physicians will use these judgments to dominate their interactions with patients. Medicine would be impoverished, however, if physicians (...) were barred from using clinical judgment to recommend medically indicated treatment. Keywords: clinical judgment, doctor's orders, medically indicated, physician-patient relationship CiteULike Connotea Del.icio.us What's this? (shrink)

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)