Prior studies report that the business group structure and the associated intra-group capital flows are prone to conflicts of interest between controlling shareholders and minority investors. Yet business group is a prevalent and stable structure around the globe, particularly where capital markets are underdeveloped. Using data from China, this paper empirically studies the trade-off between the negative and positive roles played by intra-group capital flows and tests the efficiency implications of such trade-off. We find that from the perspective of the (...) whole group, intra-group capital flows are most efficient when the groups are least subject to conflicts of interest between controlling shareholders and minority shareholders and when they face strong external financing constraints. (shrink)

Moral values in healthcare range widely between interest groups and are principally subjective. Disagreements diminish dialogue and marginalize alternative viewpoints. Extremely premature births exemplify how discord becomes unproductive when conflicts of interest, cultural misunderstanding, constrained evidence review, and peculiar hierarchy compete without the balance of objective standards of reason. Accepting uncertainty, distributing risk fairly, and humbly acknowledging therapeutic limits are honorable traits, not relativism, and especially crucial in our world of constrained resources. We think dialogics engender a mutual understanding that: (...) i) transitions beliefs beyond bias, ii) moves conflict toward pragmatism (i.e., the truth of any position is verified by subsequent experience), and iii) recognizes value pluralism (i.e., human values are irreducibly diverse, conflicting, and ultimately incommensurable). This article provides a clear and useful Point-Counterpoint of extreme prematurity controversies, an objective neurodevelopmental outcomes table, and a dialogics exemplar to cultivate shared empathetic comprehension, not to create sides from which to choose. It is our goal to bridge the understanding gap within and between physicians and bioethicists. Dialogics accept competing relational interests as human nature, recognizing that ultimate solutions satisfactory to all are illusory, because every choice has downside. Nurturing a collective consciousness via dialogics and pragmatism is congenial to integrating objective evidence review and subjective moral-cultural sentiments, and is that rarest of ethical constructs, a means and an end. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 149 Thomas Aquinas and Gabriel Biel: Interpretations of St. Thomas Aquinas in German Nominalism on the Eve of the Reformation. By JOHN L. FARTHING. Duke Monographs in Medieval and Renaissance Studies, 9. Durham: Duke University Press, 1988. Pp. x +265. $22.50 (cloth). In this hook, John Farthing examines the use made by the fifteenth· century theologian Gabriel Biel of the thought of Thomas Aquinas. Contemplating the various (...) aspects of what he calls the ' dialogue ' between Biel and Aquinas {see e.g., pp. ix, 58, 191), Farthing wants to determine the extent and quality of Biel's knowledge and appropriation of Thomas's thought. Biel was a major shaper of contemporary theological opinion, who stood in the Occamist tradition in theology. Yet, although he himself shared Occamist presuppositions in theology and usually came out in various theological disputes on the Occamist side (pp. 5, 6, 8, 13-14, 16, 28, 33, 56, 122), as has long been recognized Biel often made a determined effort in his analyses to become acquainted with, and to repor·t, the thought of significant non-Occamist theologians, including Thomas Aquinas. Farthing thus justifies the present study by asking how precisely Thomas figures in the ' theological enterprise' of Gabriel Biel: Farthing wants to know how Biel used Aquinas and what Biel learned from his reading of Aquinas (pp. ix, 68 ). While Biel's significance for late fifteenth-century thought in itself justifies a study of his theological project and method, Farthing also believes that this hook on Biel and Aquinas is warranted on other grounds as well. Martin Luther learned much about scholasticism through his mastery of Biel's corpus. Hence, by establishing the quality of Biel's study and reporting of Aquinas on various theological questions, Farthing prepares the way for a future study of Luther's knowledge of Aquinas, a task however that he will leave to others (pp. x, 5, 7). Thomas Aquinas and Gabriel Biel is divided into ten chapters. After a brief Preface in which he provides the rationale for this study and an opening chapter on Thomas Aquinas and the via moderna, Farthing looks in turn at Biel's reading of Aquinas in the subject areas "God and Creatures," "Christ and Mary," "The Human Condition," "Ethics," "Church, Ministry, and Worship," "Sacraments," "Justification," and "Eschatology; " the tenth chapter, entitled "Post Thomam," summarizes the principal results of Farthing's research. After listing in an early footnote the hooks on Aquinas which he has found especially useful on each subject, Farthing in each chapter examines Biel's citations of Aquinas on the topic at hand. As he pro- 150 BOOK REVIEWS ceeds through each chapter, Farthing is careful to indicate when Biel has misread or misquoted Aquinas, offering in these instances possible reasons for Biel's errors. The longest chapters are on ethics and on sacraments (Chapters Five and Seven), reflecting Biel's own greater interest in these aspects of Thomistic theology (pp. 103, 191). On the basis of this close study, Farthing offers the following general conclusions about Biel's reading of Thomas Aquinas. On the whole, Biel is accurate in his reporting of Thomas's thought on various questions : Farthing claims that " statistically speaking, it is exceedingly rare for Biel to lay himself open to the change of infidelity to Thomas's intention" (p. 193). Second, Biel exploits Thomas's expertise more on ' practical ' than on ' speculative ' matters; the greater number of Thomas citations in Biel have to do with ethics and practical issues associated with the sacraments (pp. 58, 94, 191, 195-96). Third, Biel holds Aquinas in esteem because he sees in Thomas a thinker who shares his interest in summarizing and reporting fairly the thought of other theologians. In this regard, Biel often uses Aquinas as one today would use a' theological encyclopedia' (the term, in fact, is Farthing's; see pp. 26, 132). Biel wants to provide for his own time as extensive as possible a spectrum of opinions on a given question ; to this end he takes over Aquinas's characterizations of different theological opinions on the question at hand. Fourth, while Aquinas's thought is usually fairly reported, Biel does occasionally misrepresent Thomas... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 887 could also be useful in a science course as an outside reading for those interested in expanding their intellectual horizons in an inter· disciplinary way. F. F. CENTORE St. Jerome's College U. of Waterloo, Ontario Die Metaphysik des Thomas von Aquin in historischer Perspektive, ILTeil. Salzburger Studien zur Philosophie, Band 17. By LEO J. ELDERS. Salzburg/Miinchen: Verlag Anton Pustet, 1987. Pp. 331. Paper, DM 54. This (...) is the second half of Elders' metaphysical study as promised in the prior volume (reviewed in THE THOMIST, 50 [1986], 463· 465) on common being. The present book centers on God, in contrast to ens commune. But it strongly renews {pp. 7, 24) the insistence that no Wolffian separation of ontology from philosophical theology is Summa theologiae in showing first that God's existence is not immedi· ately evident to us but needs to be demonstrated (pp. 28-88). It then presents the " five ways " for demonstrating the divine existence, with Latin text and German translation side by side {pp. 89-137). It re· duces other suggested " ways " to some one of the five, or else sets them aside in one manner or another (pp. 137-142). After that it treats the divine attributes according to the ways of negation, causality and eminence {pp. 143-187), and then the naming of God (pp. 189· 221), God's knowledge, life, truth, power and will (pp. 223-275), and :finally the divine action upon creatures (pp. 277-315). This treatment proceeds strictly in the order followed by the Summa theologiae. The book concludes (p. 317) that the philosophical theology of Aquinas is a coherent whole, based upon everyday experience yet for that very reason on principles that are metaphysically evident and ad· mitted by "common sense" (see also pp. 15, 200). The treatment is neatly addressed to the problems that have been under lively discussion during the past few decades, such as the " death of God." These are dealt with against an extensive and admirably detailed historical background stretching from the Greeks to the present day, with wide coverage of secondary literature, thoroughly justifying the book's designation of itself as a study pursued "in historical perspective." However, the advisability of the Summa's order of treatment for a work meant to explain the metaphysical thinking of Aquinas is open to question. Elders (p. 8, n. 3; p. 13, n. 4) is acquainted with the vigor· 338 BOOK REVIEWS ous protests of Gilson and Pegis against reading as philosophy what Aquinas wrote as theology. Yet Elders (p. 8) allows the stand that on the ground of its intrinsic rationality Aquinas would have adhered to the Summa's order even if he had been writing a purely philosophical theology. In the present case, one may strongly object, the result is a way of thinking that dulls sensitivity to the core position of existence in Aquinas' metaphysical thought. The long and checkered history of the notion " common sense " in western philosophy should be enough to dissociate that concept from Thomistic metaphysics, and here the appeal to " everyday experience " as a support calls first for careful analysis of the radically different ways in which existence and nature are originally attained by human cognition. The book finds (p. 101, n. 61), for instance, that in the demonstration of God's existence from motion Aquinas is employing without radical distinction the same principles as Aristotle but is applying them more strictly. The pro· foundly distinctive character of Aquinas' metaphysical acumen is thereby missed. This may be aptly illustrated by one example. The pointed assertion of the Summa contra gentiles (1.9.Inter) that without consideration of the proof for God's existence " omnis consideratio de rebus divinis necessario tollitur," is understood by Elders to mean "... ist jede philosophische Betrachtung des Seienden letztlich grundlos" (p. 89). Yet granting without hesitation that the proof of the divine existence is necessary for understanding metaphysically " that which exists " (das Seiende), one may, against Elders, take the statement of Aquinas at its face value as much more finely pointed. It means what it literally says, namely that things divine cannot be understood apart from consideration of the proof for God's... (shrink)

The doctrine of double effect (DOE) has its origins in Roman Catholic thought and has been held to have widespread applications in bioethics. Its applications range over issues of maternal-fetal conflict, organ donation and transplant, euthanasia, and resource allocation, among other controversial issues. Recently, Joseph Boyle, the foremost proponent of the DOE over the past few decades, has argued that the DOE is required by the absolutist context of the Catholic tradition, and, further, that anyone who rejects this particular (...) context is not entitled to use the doctrine. In this essay, I will focus exclusively on the intention condition of the DOE and its central distinction, i.e., intention/side effect. I will proceed by considering in turn (1) Boyle's argument that the absolutist moral framework of the Catholic tradition requires the intention/side effect distinction; (2) the ways in which that framework is made vulnerable by this requirement; and (3) just why the DOE should be viable even outside of the Catholic tradition if it turns out that a feature of (l) is correct and the challenges of (2) can be met. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 315-318 [Access article in PDF] Book Review Contemplation et Dialogue: Quelques Exemples de Dialogue Entre Spiritualitiés Après le Concile Vatican II The Ground We Share: Everyday Practice, Buddhist and Christian Contemplation et Dialogue: Quelques Exemples de Dialogue Entre Spiritualitiés Après le Concile Vatican II. By Katrin Amell. Studia Missionalia Upsaliensia LXX. Uppsala: The Swedish Institute of Missionary Research, 1998. 245 pp. ISBN 91-85424-50-1. The Ground (...) We Share: Everyday Practice, Buddhist and Christian. By Robert Aitken and David Steindl-Rast. Edited by Nelson Foster. Boston and London: Shambala, 1996. xviii + 233 pp. ISBN 1-57062-219-1. $15.00. Here are two meritorious and well-produced works devoted to the dialogue between Buddhism and Christianity. They also have in common a certain desultoriness which left me reflecting on the limits of the rhetoric of 'dialogue.' Having taken over from 'liberation' as a theological buzzword, 'dialogue' seems by now to have exhausted its usefulness. William James remarked that everything genuine will somewhere become a sham. Lip service to a vague ideal of dialogue becomes a substitute for the unmet challenge of Buddhist-Christian thought, and the less the dialogue is practiced the more its importance is verbally celebrated. The retention of the word 'dialogue' may even serve to keep the religious other at a comfortable distance: it is more reassuring to say, "Of course we are in dialogue with the Buddhists" than to say "We are facing up to the challenge Buddhist thought poses to Christian theology," for in the former statement the Buddhists remain conveniently located others, sitting across the table, rather than a troublesome, potentially subversive presence within our own intellectual world. [End Page 315]In their submission to the recent Roman synod of Asian bishops, the Japanese bishops made much of their commitment to interreligious dialogue, and this was acclaimed with enthusiasm. But the impression left by Karin Amell's book (a doctoral thesis in missiology) is that not very much is going on in this area in Japan, the country seen as "the promised land of dialogue" after Vatican II (p. 119). "One has the impression that it is an activity for a few specialists" (p. 145), leaving the ordinary faithful largely untouched. Amell apparently does not read Japanese, so there may be much that she has missed, yet for my part I can think of nothing to add to the factual content of her account. For the spiritual side of the encounter she focuses on three Japanese pioneers, now in their seventies (pp. 150-191): Kadowaki Kakichi, SJ, Okumura Ichiro, OCD, and Oshida Shigeto, OP. To what extent these men have succeeded in creating a widespread Catholic Zen culture remains unclear, but Amell believes the "dialogue of religious experience" is the most widespread form of Buddhist-Catholic interaction in Japan (p. 146). As to scholarship, which is not Amell's direct concern, one has the impression that everyone is too busy with church and university affairs to devote their time to this. The scholarly labors of Heinrich Dumoulin, for example, have not been continued by anyone else. Despite the work of a powerful Catholic foundation, the Nanzan Institute for Religion and Culture (p. 141), Buddhism does not seem to excite Catholic intellectuals in Japan. Japanese Catholics are a small community, numbering about half a million. But given the high number of theologians, clergy and religious (p. 137), one would expect a more intensive interaction with local religious traditions. Instead the focus of theological interest remains fixed on Western sources. It is not so much that the situation of a small church in the midst of secularized-polytheistic-Buddhist Japan fails to give food for thought as that people seem afraid to think out its implications. Those engaged in contemplative sharing with Buddhists seem to avoid intellectual issues. Amell is uneasy with the insistence on intuition and the latent anti-intellectualism she finds in the intermonastic dialogue (discussed in the first half... (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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People often choose intuitive rather than equally valid nonintuitive alternatives. The authors suggest that these intuitive biases arise because intuitions often spring to mind with subjective ease, and the subjective ease leads people to hold their intuitions with high confidence. An investigation of predictions against point spreads found that people predicted intuitive options more often than equally valid nonintuitive alternatives. Critically, though, this effect was largely determined by people's confidence in their intuitions. Across naturalistic, expert, and laboratory samples, against personally (...) determined point spreads, and even when intuitive confidence was manipulated by altering irrelevant aspects of the decision context, the authors found that decreasing intuitive confidence reduced or eliminated intuitive biases. These findings indicate that intuitive biases are not inevitable but rather predictably determined by contextual variables that affect intuitive confidence. (shrink)

This project explores the ethical obligations of food journalists. Using history, normative, and feminist theory, I argue that if specific media is going to be considered food journalism, then we should be able to identify its service to citizens. This project thus seeks a unified view for evaluating the democratic and caring potential of food journalism. I outline some of the contours of quality food journalism – its principles, practices and forms – through both historical and contemporary examples. I show (...) how both sets of food journalists adhere(d) to traditional notions of democracy-serving communication while also employing a more situated ethic of care. Ultimately, I argue that quality food journalists should adopt this care ethic addressing citizen-eaters, as this nourishes the relationships necessary for democratic worldmaking and gives us the best opportunity of collectively eating and living well. (shrink)

Susan D. McCammon and Nicole M. Piemonte offer a thoughtful and thorough commentary on our manuscript entitled “Expanding the use of Continuous Sedation Until Death.” In this reply we attempt to clarify and further defend our position. We show how continuous sedation until death is not a “first resort” but rather a legitimate option among many that should available to terminally ill patients whose life expectancy is less than six months. We also attempt to show that we do not equivocate (...) the meaning of palliative care as the commentators suggested. We argue that the traditional notion of palliative care should move beyond relief of “experienced suffering” to relief of potential suffering for those whose life expectancy is less than six months. Lastly, we challenge the commentator’s position that the realm of ordinary medicine” should be the guide to care, by showing how the notion of ordinary medicine has been successfully challenged in both bioethical scholarship and the courts in a way that shows ordinary medicine to be an evolving concept rather than a static, universal guide. (shrink)

In this paper, I argue that care ethics should be understood as a form of value pluralism. Writers on the ethics of care tend not explicitly to address issues in the theory of value, although much of what has been written about care ethics may be taken to suggest that it endorses some form of value monism. I argue against this conception of care ethics by showing that the practical reality of caregiving is more accurately represented by a pluralist account (...) of value. Practices of care are plausibly guided by a number of distinct and potentially conflicting values. These include quality of life, autonomy, dignity, personal development, and the value of nurturant relationships. Whilst caring takes each of these values to be important in its own right, they are not always jointly realisable, and carers are sometimes forced to promote one such value at the expense of another. The possibility of conflict between values is, of course, precisely what a pluralist conception of value tells us to expect. In this respect, then, value pluralism more faithfully reflects the reality of caregiving than does value monism, and care ethicists ought for this reason to endorse it. (shrink)

Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits (...) the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals. (shrink)

Lukas J. Meier et al. offer the promise of a pathway for resolving clinical bioethical problems using an artificial intelligence interface. The ultimate goal, we assume, is...

Self-confidence is associated with many positive outcomes, and training programs routinely seek to build participants’ self-efficacy. In this article, however, we consider whether self-confidence increases unethical behavior. In a series of studies, we explore the relationship between negotiator self-efficacy—an individual’s confidence in his or her negotiation ability—and the use of deception. We find that individuals high in negotiator self-efficacy are more likely to use deception than individuals low in negotiator self-efficacy. We also find that perceptions of the risk of deception (...) mediate this relationship. By identifying negotiator self-efficacy as an antecedent to unethical behavior, our findings offer important theoretical and empirical insights into the use of deception, the role of individual differences in ethical decision making, and the broader consequences of self-confidence in business and society. (shrink)

Filmmakers use continuity editing to engender a sense of situational continuity or discontinuity at editing boundaries. The goal of this study was to assess the impact of continuity editing on how people perceive the structure of events in a narrative film and to identify brain networks that are associated with the processing of different types of continuity editing boundaries. Participants viewed a commercially produced film and segmented it into meaningful events, while brain activity was recorded with functional magnetic resonance imaging (...) (MRI). We identified three degrees of continuity that can occur at editing locations: edits that are continuous in space, time, and action; edits that are discontinuous in space or time but continuous in action; and edits that are discontinuous in action as well as space or time. Discontinuities in action had the biggest impact on behavioral event segmentation, and discontinuities in space and time had minor effects. Edits were associated with large transient increases in early visual areas. Spatial-temporal changes and action changes produced strikingly different patterns of transient change, and they provided evidence that specialized mechanisms in higher order perceptual processing regions are engaged to maintain continuity of action in the face of spatiotemporal discontinuities. These results suggest that commercial film editing is shaped to support the comprehension of meaningful events that bridge breaks in low-level visual continuity, and even breaks in continuity of spatial and temporal location. (shrink)

Environmental philosophers tend to be particularly wary of the language of “transcendence.” From Heidegger to contemporary feminism, we find the idea that the failure to respect nature is grounded in Platonism and Abrahamic religion. The denial of earth began, we are told, with the separation of the intelligible form from the actual thing, or, even worse, of the creator from the created. From this point of view what we need is a restored pantheistic sense, a new and revitalized paganism. I (...) counter this assertion by a reading of Plato’s Phaedrus that shows that respect itself is grounded in the recognition of transcendence. With the Bookof Job, I maintain that the voice of the transcendent God is what enables Job not only to see past his sufferings but for the first time to encounter the beauty of nature. Overcoming anthropocentrism requires a relationship to transcendence as such. (shrink)

Some bioethicists have argued in favor of a sliding scale notion of competence, paternalistically requiring greater competence in relation to more significant risk. I argue against a sliding scale notion, taking issue with the positions of Allen E. Buchanan and Dan W. Brock, Ian Wilkes, and Joel Feinberg. Rejecting arguments that a sliding scale is supported by legal cases, by ordinary usage, and by fallible judgments about competence, I argue in favor of greater evidence of competence when risk is greater. (...) Two clinical cases are examined, both involving amputation, to show that my fixed concept of competence, with a requirement of clearer evidence of competence when risk is high, better accounts for good moral decisions in bioethics. (shrink)

According to agent-based approaches to virtue ethics, the rightness of an action is a function of the motives which prompted that action. If those motives were morally praiseworthy, then the action was right; if they were morally blameworthy, the action was wrong. Many critics find this approach problematically insensitive to an act’s consequences, and claim that agent-basing fails to preserve the intuitive distinction between agent- and act-evaluation. In this article I show how an agent-based account of right action can be (...) made sensitive to an act’s consequences. According to the approach which I defend, an action is right just in case it realizes an agent’s morally praiseworthy motive. Conversely, an action is wrong just in case it realizes a morally blameworthy motive. Specifying act-evaluation in terms of the realization, rather than the expression, of an agent’s motives allows an agent-based approach to distinguish between agent- and act-evaluation. This is because an agent may act from a morally praiseworthy motive, but fail to realize that motive. Her action will therefore not have been the right one, despite its being the expression of morally praiseworthy motives. (shrink)