Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than (...) generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)

The most recent restatements of stakeholder theory formulate that approach in terms of the distribution of value: “A stakeholder approach to business is about creating as much value as possible for stakeholders, without resorting to tradeoffs” (Freeman et al. 2010: 28). This formulation marks a shift from earlier work, which included a procedural dimension—a requirement that stakeholders participate in organization decision making. The present paper pushes back against this shift: it argues that orienting the stakeholder approach around the participation requirement (...) provides for a different moral logic, one not available to (now) conventional stakeholder theorizing (without that requirement), and one that may be more compelling to many. This argument requires critical re-examination of the moral arguments offered in the most recent restatements of the stakeholder approach. (shrink)

This paper addresses the tactical question of how we ought to proceed in teachingbusiness ethics, taking as a starting point that business ethics should be concerned with cooperative,mutually beneficial outcomes, and in particular with fostering behavior that contributes to thoseoutcomes. This paper suggests that focus on moral reasoning as a tactical outcome—as a way ofachieving behavior in support of cooperative outcomes—is misplaced. Instead, we ought to focuson cultivating empathetic experiences. Intuitively, the problem we need to address in business ethicsis not (...) that our students (and that we ourselves) sometimes reason poorly, or that moral decisionmakingis subject to characteristic kinds of errors. The problem is that our students (and—again—we ourselves) do not always care enough, we do not modify our behavior consistently enough. (shrink)

Why do physicians have financial conflicts of interest? They arise because society expects physicians to act in their patients’ interest, while simultaneously, financial incentives encourage physicians to practice medicine in ways that promote their own interests or those of third parties. Because physicians’ clinical choices, referrals, and prescriptions affect the fortune of third parties, these third parties may offer physicians financial incentives to make income-driven clinical choices. In the past, physicians and scholars typically conceived of conflicts of interest as an (...) ethical issue to be resolved according to individual judgment or professional and organizational norms. However, society can mitigate or eliminate conflicts of interest by changing financial and organizational arrangements in medicine. Conflicts of interest, therefore, are as much matters of public policy and management as individual choices or social norms. (shrink)

This paper argues that Rawls’ principles of justice provide a normative foundation for stakeholder theory. The principles articulate (at an abstract level) citizens’ rights; these rights create interests across all aspects of society, including in the space of economic activity; and therefore, stakeholders – as citizens – have legitimate interests in the space of economic activity. This approach to stakeholder theory suggests a political interpretation of Boatright’s Moral Market approach, one that emphasizes the rights/place of citizens. And this approach to (...) stakeholder theory – in terms of citizens – raises a further question, what rights and obligations do economic agents have, beyond those attached to their roles as citizens? Rawls would reject additional rights and obligations of this sort for two reasons, one tied to freedom and one tied to pluralism. Rawls’ work therefore presses us to re-conceptualize the place of ethical claims in the economic context. (shrink)

The Food and Drug Administration authorizes the marketing of a drug only for uses that the manufacturer has demonstrated to be safe and effective, based on evidence from at least two clinical trials. However, the FDA does not regulate the practice of medicine, so physicians may prescribe drugs in any manner they choose. Prescribing drugs in ways that deviate from the uses specified in the FDA-approved drug label, package insert, and marketing authorization is referred to as off-label prescribing. This occurs (...) when physicians prescribe a drug for a therapeutic purpose other than the one approved by the FDA; treat patients in a different age cohort or gender than the population on which it was tested; or prescribe a different dose, for a different duration of use, or a different mode of administration than indicated on the label. (shrink)

The Problem of Doxastic Shift may be stated as a dilemma: on the one hand, the distribution of nominal complements of the form `the ψ that p’ strongly suggests that `that’-clauses cannot be univocally assigned propositionaldenotations; on the other hand, facts about quantification strongly suggest that `that’-clauses must be assigned univocal denotations. I argue that the Problem may be solved by defining the extension of a proposition to be a set of facts or, more generally, conditions. Given this, the logical (...) operation of descriptive predication can be introduced in a way that resolves the dilemma withoutsacrificing the singular term analysis of `that’-clauses. (shrink)

Joseph Heath defends competitive markets and conceptualizes business ethics with reference to Pareto efficiency, which he takes to be the “implicit morality of the market.” His justification for markets is that they generate Pareto efficient outcomes, meaning that markets optimally satisfy consumer preferences. And, for Heath, business ethics is the set of normative constraints—regulation and beyond-compliance norms—needed to preserve that outcome. The present paper accepts Heath’s claim that the economic justification for markets is ethical, in that satisfying consumer preferences is (...) a good. But, contra Heath, the ethical consideration at work is a consequentialist one; and acknowledging this consequentialism exposes limitations of Heath’s “market failures” approach to business ethics. We suggest two limitations, and we expect many will accept our argument that Heath’s conception of business ethics is too narrow. The present paper outlines two broader implications. First, acknowledging that the justification for markets is ethical eliminates the apparent—and false—conflict between purportedly amoral economic activity on one hand and ethical considerations on the other; instead, business ethics is a matter of weighing the consequentialist ethical benefit of economic activity and markets against other moral arguments/other ethical considerations. Second, Heath restricts business ethics to the constraints needed to protect the market’s ability to efficiently satisfy consumer preferences, constraints he calls “efficiency imperatives”; this restriction supports the widespread tendency to think that all social problems are economic; and, a business ethics so-conceived diminishes the perceived importance of noneconomic values—this attitude is dangerous. (shrink)

The heart of the matter -- The evolution of the French medicine -- Coping with physicians' conflicts of interest in France -- The rise of a protected medical market : the United States before 1950 -- The commercial transformation : the United States, 1950-1980 -- The logic of medical markets : the United States, 1980 to the present -- Coping with physicians' conflicts of interest in the United States -- The evolution of Japanese medicine -- Coping with physicians' conflicts of (...) interest in Japan -- Reforms -- Professionalism reconsidered. (shrink)

Bernard Williams briefly discusses agent regret in his broader account of moral luck. The present paper first outlines one way to develop Williams’s notion with reference to the unintended harm; it then suggests that agent regret can be counteracted by externalizing the action that caused unintended harm, in Harry Frankfurt’s sense of externalization; and then the present paper argues that apology is a mechanism by which a person can externalize an offending action/effect—in that way counteracting agent regret. This function for (...) apology—self-repair—is different from others described in the literature, which address the role of apology in repairing relationships. The present paper describes a nonfictional example, that of a veteran of the U.S. war in Iraq who contacts a family gravely injured by him and his combat unit; the veteran is motivated to contact the family to apologize. The example serves as a prototypical case of agent regret. The example is taken from a recent literature on the clinical psychology of self-inflicted “moral injury”; categorizing this example of moral injury as agent regret also helps broaden our understanding of moral injury as a philosophical category and as a psychological phenomenon. (shrink)

Public policy tries to promote appropriate drug use by allowing firms to market drugs in interstate commerce only for uses that the Food and Drug Administration has found to be safe and effective. Because of their medical knowledge, physicians are authorized to prescribe drugs even for uses unapproved by the FDA. Nevertheless, physicians have relied on drug firms for information on appropriate prescribing despite the inherent tension between drug firm dissemination of information to promote sales and rational prescribing. In the (...) past, physicians often relied particularly on drug firm advertising for information on drug use. Today, physicians rely on drug firms to finance continuing medical education. A historical review reveals connections between these two different ways commercial interests have influenced the information that physicians receive and points the way to needed reforms. (shrink)

Why is female violence a taboo? We suggest that both men and women actively contribute to the creation of this stigma. Men may benefit because nonaggressive women may make better mothers and be more faithful and fertile. Females may benefit by downplaying their aggressive nature because they will be perceived as more valuable mates and because they will be more accepted within female social groups.

Across the management, social science, and business ethics literatures, and in much of the philosophy literature, trust is characterized as a disposition to act given epistemic states—beliefs and/or expectations about others and about the risks involved. This characterization of trust is best thought of as epistemological because epistemic states distinguish trust from other dispositions. The epistemological characterization of trust is the amoral one referred to in the title of this paper, and we argue that this characterization is conceptually inadequate. We (...) outline and defend an alternative conception of trust as a moral phenomenon: when A trusts B to do something, A invites B to acknowledge and accept an obligation; when B accepts the invitation, B takes on an obligation; in that way trust creates an obligation. We conclude with an application, drawing out the difference between the epistemological conception of trust and our own in the context of Ghoshal et al.'s (Sloan Management Review 40:9—20, 1995, Academy of Management Learning & Education 4:75—91, 2005) critique of transaction cost theories of the firm. (shrink)

This book explores convergences and divergences between process thought and Roman Catholicism. It examines why process philosophy and process theology have had a minimal impact in Roman Catholic circles compared to Protestantism, and investigates avenues of promising engagement between process thought and Roman Catholicism.

Dissent and Philosophy in the Middle Ages offers scholars of Dante's Divine Comedy an integral understanding of the political, philosophical, and religious context of the medieval masterwork. First penned in French by Ernest L. Fortin, one of America's foremost thinkers in the fields of philosophy and theology, Dissidence et philosophie au moyen-%ge brings to light the complexity of Dante's thought and art, and its relation to the central themes of Western civilization. Available in English for the first time through this (...) superb translation by Marc A. LePain, Dissent and Philosophy will make a supremely important contribution to the discussion of Dante as poet, theologian, and philosopher. (shrink)

This chapter argues that trust is an intrinsic good (that is, a good to be pursued apart from material or instrumental beneft), and so we have moral reason to trust.

Jared D. Harris, Brian T. Moriarty, and Andrew C. Wicks’ recent book collects eleven chapters by well-known scholars on the question of public trust in business, published along with an introduction and conclusion by the editors. But the collection doesn’t make progress on what this reviewer takes to be the two essential questions. This review outlines those questions and then addresses a further, more technical difficulty with the conceptualizations of trust at work across the chapters. The central theme here is (...) that business as an institution has obligations to society; we—the public—trust business to act on those obligations; and when business violates those obligations our trust is betrayed. The essays collected in this volume do not directly address the question of what those obligations are, but this should be the starting point for an investigation of public trust in business. (shrink)

I draw attention to a group of thinkers in Ireland in the first half of the eighteenth century that made significant contributions to the philosophy of political economy. Loosely organized around the Dublin Philosophical Society founded in 1731, these individuals employed a similar set of assumptions and shared a common interest in the well-being of the Irish people. I focus on Samuel Madden (1686-1765), Arthur Dobbs (1689-1765), and Thomas Prior (1680–1751) and argue for two main theses. First, these Irish thinkers (...) shared a number of commonalities with the English mercantilist thinkers of the eighteenth century, and to the degree that they did, their proposals to aid Ireland and reduce poverty were largely doomed to failure. Second, these Irish thinkers also importantlydivergedfrom typical eighteenth-century mercantilist thinking in several ways. These modifications to mercantilism resulted in large part from the unusual political situation of Ireland (as a nation politically dependent on England) and helped orient their economic thinking along more institutional lines. In particular, the emphasis of the Irish on full employment and on the modification of social as well as political institutions is an early step forward in making political economy more sophisticated. (shrink)

Of all of Berkeley’s claims about perception, perhaps the most unusual is his assertion that we do not see the numerically same objects we feel. Ideas are radically heterogeneous. The question I seek to answer is why Berkeley thought this thesis true. Traditional accounts hold that Berkeley was forced into accepting heterogeneity by his views concerning either distance or abstraction, but careful analysis reveals these to be mistaken. I conclude that how Berkeley thought of the ontic status of ideas finishes (...) the incomplete picture provided by traditional accounts, and supplies us with a better under‐standing of his views on perceptual heterogeneity. (shrink)

I argue that Berkeley has reasonable grounds for believing both that (a) the supposition of the existence of material substance leads to atheism and (b) endorsing immaterialism provides a better support for the Christian faith than any rival that posits the existence of matter. Together, those claims lead to the conclusion that if one wants to be a Christian, there is good reason to think that one ought to be an immaterialist. Je montre que Berkeley a raison de croire que (...) l'existence de la matière conduit à l'athéisme et que la reconnaissance de l'immatérialisme donne un meilleur support à la croyance chrétienne que n'importe quelle autre assertion qui défend l'existence de la matière. Ensemble ces thèses mènent à la conclusion que pour qui veut être chrétien, il y a une bonne raison de croire qu'il faut être immatérialiste. (shrink)

"A wide-ranging study of the 'way of ideas' and its metaphysics, culminating in a bold reinterpretation of Berkeley.".

Due to their financial incentive, clinicians who earn income from a firm that markets medical devices, pharmaceuticals, tests, etc. might inappropriately prescribe their products or services. The Cleveland Clinic’s conflict of interest (CI) policy creates rules governing clinicians who accept compensation from outside firms that market products they prescribe or use in their practice (hereafter, covered financial relationships). The CI policy is implemented by the Innovation Management and Conflict of Interest Program (IM&COI) (hereafter the Committee).

The case "Caprica Energy and Its Choices" concerns a fictionalized energy corporation choosing between three potential drilling sites. According to the published Teaching Note, the case is an exercise in the stakeholder approach to business: it requires balancing profit considerations with potential harm to those who live near those drilling sites. Though unintended, the case raises a further question not addressed in the case or in the Teaching Note: what gives Caprica Energy the right to impose risk on members of (...) the communities surrounding its drilling sites? The first section of the present article argues that, in such cases, manage- ment can only justify imposing risk on the local community by securing those stakeholders' consent. The second section outlines the implications for stakeholder theory and stake- holder management. The third section outlines one con- nection between this material and recent literature on the imposition of risk and moral theory; that section offers an account of what make this particular instance of imposing risk morally problematic, with reference to the directedness of the imposition. (shrink)

El presente ensayo sostiene que los principios de justicia de Rawls proporcionan una fundamentación normativa para la teoría de los stakeholders. Los principios articulan (en un nivel abstracto) los derechos de los ciudadanos; estos derechos crean intereses en todos los aspectos de la sociedad, incluyendo el ámbito de la actividad económica; y, por lo tanto, los stakeholders –en calidad de ciudadanos–tienen intereses legítimos en dicho ámbito. Así, la obra de Rawls nos obliga a fundamentar cuestiones de la ética de la (...) empresa en la filosofía política: los derechos e intereses de los stakeholders (que son los derechos e intereses de los ciudadanos en la esfera económica) están protegidos en el nivel institucional, por lo que no pueden venir determinados por los directivos ni las corporaciones. (shrink)

Many writers suggest that managed care had a brief life and that we are now in a post-managed care era. Yet managed care has had a long history and continues to thrive. Writers also often assume that managed care is a fixed entity, or focus on its tools, rather than the context in which it operates and the functions it performs. They overlook that managed care has evolved and neglect to examine the role that it plays in the health system.This (...) article argues that private actors and the state have used managed care tools to promote diverse goals. These include the following: increasing access to medical care; restricting physician entrepreneurialism; challenging professional control over the medical economy; curbing medical spending; managing medical practice and markets; furthering the growth of medical markets and private insurance; promoting for-profit medical facilities and insurers; earning bounties for reducing medical expenditures; and reducing governmental responsibility for, and oversight of, medical care. Struggles over these competing goals spurred the metamorphosis of managed care internationally. (shrink)

Joseph A. Bracken, S.J,. is one of the more significant North American theologians of the past 40 years. With 12 monographs, two edited or co-edited volumes, over 150 articles, numerous professional and popular conference presentations and media appearances, he is one of the foremost interlocutors in contemporary theological discourse. Having developed and consistently defended a comprehensive and intellectually rigorous worldview that combines the modern and classical Christian worldviews, Bracken has accomplished an invaluable service to the academy, the church, and the (...) world. He has not favored a particular theological or philosophical system, past or present. Instead, he culls what he judges to be true and good in a myriad of seemingly prima facie noncompossible thinkers and systems with divergent programs. Synthesizing the Catholic intellectual tradition and process-relational metaphysics, Bracken also incorporates aspects of German and Anglo-American Idealism, Pragmatism, recent philosophy of science, and a litany of past and present theologians and philosophers. The present volume is a Festschrift to honor Bracken’s career and accomplishments. It differs from the standard Festschrift genre in that the contributors, while certainly explicating and reflecting upon various aspects of his comprehensive worldview, offer their original contributions n a variety of topics. They do in dialogue with Bracken’s positions, simply as starting points, not as end points. The common theme of the Festschrift, then, is serious reflection on and in some cases critique of Bracken’s comprehensive process-relational, Catholic, and Trinitarian worldview and its pertinence for work in contemporary theology from a given perspective. Yet there is a certain richness coming from the diverse perspectives of the contributors whose work intersects with Bracken’s, and not always in terms of process thought per se. The contributors come from diverse backgrounds, not only in process and Roman Catholic theology but also including even other academic disciplines. They represent a balance of senior and junior scholars, and of genders. (shrink)