The COVID-19 pandemic that struck New York City in the spring of 2020 was a natural experiment for the clinical ethics services of NewYork-Presbyterian (NYP). Two distinct teams at NYP’s flagship academic medical centers—at NYP/ Columbia University Medical Center (Columbia) and NYP/ Weill Cornell Medical Center (Weill Cornell)—were faced with the same pandemic and operated under the same institutional rules. Each campus used time as an heuristic to analyze our collective response. The Columbia team compares consults during the pandemic with (...) the same period during the year prior. The Weill Cornell service describes the phases of the pandemic to depict its temporal evolution and subsequent ethical challenges. Both sites report that the predominant ethical challenges centered around end-of-life decision making, setting goals of care, and medical futility, all complicated by resource allocation questions and the ambiguity of state law under crisis standards of care. The Columbia campus saw a statistically significant increase in ethics consultations provided to Hispanic patients, perhaps reflective of the disproportionate burden of COVID-19 suffered by this demographic. While Weill Cornell and Columbia saw a surge in clinical ethics consultations, the two services assumed a more expansive role than one normally played in institutional life. Serving as intermediaries between frontline clinicians and senior hospital administrators, consultants provided critical intelligence to hospital leadership about the evolution of the pandemic, disseminated information to clinicians, and attended to the moral distress of colleagues who were asked to provide care under truly extraordinary circumstances. The COVID-19 surge in New York City revealed latent capabilities in ethics consultation that may prove useful to the broader clinical ethics community as it responds to the current pandemic and reconceptualizes its potential for future service. (shrink)

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

From mid-March through May 2020, New York City was the world’s epicenter of the COVID-19 pandemic, and its hospitals faced an unparalleled surge of patients who were critically ill with the virus. In addition to putting an enormous strain on medical resources, the pandemic presented many ethical issues to emotionally and physically stressed clinicians and hospital administrators. Analyses of the challenges faced by the ethics consultation services of the two campuses of New York Presbyterian Hospital, and how they assisted their (...) clinician and administrative colleagues, is the subject of the following four articles. (shrink)

We investigate the causal effects of religious service attendance on prosocial behaviours using longitudinal data from a nationally representative sample of 33,198 New Zealanders collected between 2018 and 2021. Our study innovates in three ways: (1) we use longitudinal rather than cross-sectional data; (2) we incorporate measures of help received alongside self-reported giving; and (3) our statistical models are designed to address causal questions, rather than simply to describe change over time. We model causal contrasts for three hypothetical interventions – (...) increasing, decreasing, or maintaining religious service attendance – and assess their effects on eight distinct prosocial domains. Study 1 focuses on self-reported charitable donations and volunteering. Studies 2 and 3 examine receiving help – both personal and financial – from family, friends, and the wider community. Across all analyses, we find that the causal effects of religious service attendance are notably smaller than cross-sectional correlations suggest. However, even modest increases in regular attendance would result in charitable donations equivalent to approximately 4% of the New Zealand Government’s annual spending – a considerable public benefit. By applying robust methods for causal inference to national-scale panel data, our study provides insights that can inform public policy about the social functions of religious participation and advances a methodological framework for investigating the social consequences of cultural practices. (shrink)

Behavior, language, development, identity, and science—all of these phenomena are commonly characterized as 'social' in nature. But what does it mean to be 'social'? Is there any intrinsic 'mark' of the social shared by these phenomena? In the first book to shed light on this foundational question, twelve distinguished philosophers and social scientists from several disciplines debate the mark of the social. Their varied answers will be of interest to sociologists, anthropologists, philosophers, psychologists, and anyone interested in the theoretical foundations (...) of the social sciences. (shrink)

Responding to volatile criticisms frequently leveled at Leo Strauss and those he influenced, the prominent contributors to this volume demonstrate the profound influence that Strauss and his students have exerted on American liberal democracy and contemporary political thought. By stressing the enduring vitality of classic books and by articulating the theoretical and practical flaws of relativism and historicism, the contributors argue that Strauss and the Straussians have identified fundamental crises of modernity and liberal democracy.

In response to national trends calling for increasing accountability and an emerging dialogue within bioethics, we describe an effort to credential clinical ethicists at a major academic medical center. This effort is placed within the historical context of prior calls for credentialing and certification and efforts currently underway within organized bioethics to engage this issue. The specific details, and conceptual rationale, behind the New York-Presbyterian Hospital’s graduated credentialing plan are shared as is their evolution and ratification within the context of (...) institutional policy. While other programs will design their credentialing schema consistent with their local context and demographics, the description of one such effort is offered to be instructive to others who want to bring additional standardization to the assessment of the readiness and credentials of those who will engage in the practice of clinical ethics case consultation. (shrink)

Joseph Raz’s theory of authority has become influential among moral, political, and legal philosophers. This article will provide an overview and accessible explanation of the theory, guiding those coming to it for the first time as to its theoretical ambitions within the wider issues of authority, and through its intricacies. I first situate the theory among philosophical examinations of authority, and then explain the theory itself in detail.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Moral leadership matters. As world politics enters a new and dangerous era, judgment, constancy, moral purpose, and a willingness to overcome partisan politicking are essential for America's leaders. Tempered Strength finds the alternative standard of leadership that Americans are seeking in the classical philosophy of prudence. Ethan Fishman's new work brings together leading American political scientists—including Ronald Beiner, Kenneth L. Deutsch, and George Anastaplo—to discuss the evolution of a standard of prudential leadership both reasonable in nature and practical in (...) scope. Section One studies the meaning of prudence and its evolution in the history of political science from Aristotelian phronesis to Xenophon, Thomas Aquinas, Edmund Burke, and Michael Oakeshott. Section Two demonstrates how the theory of prudential leadership can be applied to practical political issues. (shrink)

DIVA new look at Kenneth Arrow’s classic study of the economics of health care: is his formulation still relevant 40 years later?/div.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

In an earlier Dissecting Bioethics contribution, Debra J. H. Mathews, Joseph J. Fins, and Eric Racine challenge standard ways of thinking about the therapeutic misconception in the context of consent for research participation. They propose that instead of demanding “rational congruence” between how researchers and participants conceive of a given protocol, we should accept a less stringent standard of “reasonable coherence.” While Mathews, Fins, and Racine (MFR) provide some important insights, their proposal needs refinement. There is room for a (...) wide but not unlimited range of participant hopes and motivations. However, their model of reasonable coherence is too weak a standard for whether participants have adequate understanding of the scientific goals of a protocol. By the time participants are recruited for medical research, the goals of the protocol, having been set and agreed to through accepted scientific processes, are no longer open for alternate interpretations. This paper discusses this and other objections to MFR’s proposal. It then suggests that a concept of “deal breakers” might be useful in this context. (shrink)

The notion that Hegel repudiated epistemology has had dire consequences for our understanding of Hegel. By disregarding epistemology, Hegel’s expositors often disregarded the general issues central to epistemology of how one can establish or justify a philosophical view. If Hegel did address epistemological issues and tried to justify (not simply to expound) ‘absolute knowledge’, then that disregard would produce skewed interpretations of Hegel. Recent attention to Hegel’s epistemology (e.g., by Klaus Hartmann, Joseph Flay, Robert Pippin, Michael Forster, Terry Pinkard, (...) and Justus Hartnack) is salutary. However, I argue that most of these efforts founder by making key assumptions about epistemology that Hegel clearly rejects. Moreover, many of these efforts exhibit hermeneutic defects that Hegel scholars should consider carefully; most of these interpretations are long on interpretive promise but short on philosophical delivery. (shrink)

I show that conceptual philosophical anarchism, the claim that law cannot give reasons for action, is entailed by several popular theories about law. Reductionists about practical authority believe that all supposedly legitimate practical authority reduces to forms of theoretical authority. They tend to embrace anarchism, but some readers might not be clear why. Trigger theorists about reason-giving believe that all reason-giving merely activates pre-existing conditional reasons. Natural lawyers hold that all legal reasons are sourced in the natural law, which entails (...) that positive law cannot provide reasons for action. If you are attracted to any of these theories and still think that positive law creates new practical reasons, you might have to give up one or the other position. If anarchism is entailed by believing the normativity in law’s directives pre-dates the directive, only a few may be able to avoid it, Hans Kelsen, Mark Greenberg, and Joseph Raz being the most likely. (shrink)

Joseph Raz's famous theory of authority is grounded in three claims about the nature and justification of authority. According to the Preemption Thesis, authoritative directives purport to replace the subject's judgments about what she should do. According to the Dependence Thesis, authoritative directives should be based on reasons that actually apply to the subjects of the directive. According to the Normal Justification Thesis (NJT), authority is justified to the extent that subjects are more likely to comply with right reason (...) by following the authority's directives than by following their own judgments about what right reason requires.1In this article, I consider a number of ways in which NJT might be construed as a justification for authority. First, I evaluate NJT construed as a principle that would provide a practical justification for an individual to accept or recognize a particular person or persons as a preemptive authority. Second, I evaluate NJT construed as a principle that describes the conditions under which a state or legal system is morally legitimate. I argue that NJT is true under none of these interpretations.2. (shrink)