In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a model (...) to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

Background: Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. Research questions: How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Research design: Quantitative analysis of a (...) questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Participants and research context: Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Ethical considerations: Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Findings: Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. Conclusion: The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team’s cohesion as mutual understanding for one another’s views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents. (shrink)

Elliott Sober''s selection for/selection of distinction has been widely used to clarify the idea that some properties of organisms are side-effects of selection processes. It has also been used, however, to choose between different descriptions of an evolutionary product when assigning biological functions to that product. We suggest that there is a characteristic error in these uses of the distinction. Complementary descriptions of function are misrepresented as mutually excluding one another. This error arises from a failure to appreciate that selection (...) processes can be described at several different theoretical levels. (shrink)

The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor–patient relationship within which consent is given.

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and (...) should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. (shrink)

I am idebted to members of the Wellington Logic Seminar for useful discussions of work of which this essay forms part, in particular to M. J. Cresswell for comments in the earlier stages of the investigation and to R. I. Goldblatt who suggested the definition ofB infD supu and made numerous other suggestions.

This line has been thought corrupt by most editors, though there is no agreement on the remedy. The Herald is plainly asking why the people at home are despondent: picks up the Chorus's phrase . But as Wilamowitz says, ‘ de populo aut senatu Argivorum accipi non potest’: it can only mean the army at Troy, as in lines 538 and 545. The usual inference is that arparw is corrupt.

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

In this study, the drawbacks of using some religious concepts produced in the tradition of Western thought directly in their studies on Islamic belief will be discussed. The claim in question will be put forward within the framework of the concepts of deism, atheism and especially theism. Especially by reviewing the philosophy of religion studies made in Turkey, the fact that the three concepts mentioned are directly transferred to the philosophy of religion studies carried out in the Islamic world will (...) be revealed as a problem and this situation will be defined as the reduction of Islamic belief to some other concepts. The aim to be achieved by emphasizing such a problem is to ensure that the principles of Islamic belief are understood in their own meaning without reducing them to other meanings. Because every concept produced within the tradition of Western thought is directly related to its own intellectual and practical past. For this reason, when a solution or criticism that is formed in a different sense or dependent on a certain practical past is brought to Islamic thought, the philosophical and practical past of those concepts will also be carried. However, every belief should be evaluated by considering its own meaning and history. Evaluating this problem through concepts that Islam directly rejects, such as deism and atheism, is more understandable than the concept of theism. However, when it comes to the concept of theism, the subject becomes quite complex. Because in almost all sources, Islam is defined as a theistic religion and this is considered as a necessary pre-acceptance for the Islamic belief. However, theism is the understanding of God in modern Western thought, in which Descartes rationalism and Newtonian mechanics are accepted as the dominant element. Such an understanding of God, built within the epistemic boundaries of the thinking subject, is incompatible with the Islamic conception of God. (shrink)

Kai Nielson (Secession: The Case of Quebec), as did Allen Buchanan in Secession, discusses secession on an analogy with no-fault divorce. Both these writers fail to distinguish between what it is to be a person and what it is to be a people, where peoples are the items that secede. The issue of what constitutes a people is thus crucial to the theory of secession (for similar reasons to those that made it crucial to seventeenth century debate about the right (...) of resistance to the monarch). It is also the case that what makes a group of persons a people is often the fact that they are a particular racial group that has suffered unfair discrimination from the prevailing government or that they came to live where they do live by virtue of incidents that affect the justice of their relations with that government. Issues of justice thus enter the matter of the people's identity in a way that rules out the justifiability of unilateral no-fault secession. (shrink)

The overall aim of this article is to discuss the organization of limit setting in healthcare in terms of legitimacy. We argue there is a strong ethical demand that such processes should be arranged to provide adversely affected people well-justified reasons to confer legitimacy to the processes despite favouring a different decision-making outcome. Two increasingly popular approaches, Accountability for Reasonableness (A4R) and Multi-Criteria Decision Analysis (MCDA), can both be applied to support legitimate decision-making processes. However, the role played by ‘fair-minded (...) people’ in the A4R framework can be shown to undermine an adequate conceptualization of legitimacy according to the ethical demand. We discuss and specify conditions enabling A4R to meet this ethical demand when being implemented in a real-world setting without having to renounce the aim of striving for ‘reasonableness’ and impartiality. The methodological approach MCDA describes how to arrange for transparent resource allocation. This approach does not encompass any normative guidance on how to shape limit settings in terms of ‘reasonableness’; it basically promotes ‘rational’ decisions. We discuss how this practical methodology can be integrated with the theoretical A4R framework to meet the ethical demand while at the same time promoting politically required impartiality of healthcare limit setting. (shrink)

Corporations are moral persons to the extent that they have rights and duties, but their moral personality is severely limited. As artificial persons, they lack the emotional make-up that allows natural persons to show virtues and vices. That fact, taken with the representative function of management, places significant limitations on what constitutes ethical behavior by management. A common misunderstanding of those limitations can lead ethical managers to behave unethically and can lead the public to have improper expectations of corporations.

Volume 20, Issue 4, May 2020, Page 71-73.

Agathon, in his panegyric of Eros, had maintained that it is good, beautiful, and divine. Socrates begins his elenchus of this claim by pointing out that Eros is relational in character: love is always love of something, desire desire for something. Eros falls in that class of terms later described as ta pros ti, terms which have their meaning ‘toward’ something else. Furthermore, Eros lacks what it loves and desires to possess it: “everyone … who desires something desires what has (...) not been obtained and is not present; his love and desire are set on things he lacks, things he does not possess.” Desire implies privation. Agathon and Plato also agree that Eros is always in love with the beautiful ; as Agathon had earlier said, “the world was fashioned by the gods through love of beautiful things; for there is no love of the ugly.” It then follows that, since Eros is love of what it lacks, it cannot be beautiful or good, and since the gods possess both attributes, it cannot be divine. It is not, however, bad or ugly or mortal, but ‘intermediate’ between those attributes. (shrink)

Book reviewed in this article: Protecting The Vulnerable: A Reanalysis of Our Social Responsibilities. By Robert E. Goodin. Chicago: University of Chicago Press.

Denne artikkelen tar utgangspunkt i et skille mellom samfunnsstrukturer som avgrenser legers skjønnsmessige utfoldelse på den ene siden, og profesjonens tilrettelegging for kultiveringen av erkjennelsesmessige ferdigheter på den annen. Ved å videreføre H. Grimen og A. Molanders anvendelse av S.E. Toulmins modell for praktisk resonnering i en klinisk kontekst redegjør jeg for legeskjønnets multidimensjonale, epistemiske struktur. Gjennomgangen viser hvordan skjønnsanvendelse i legerollen kan analyseres i henhold til en fagteknisk, en distributiv og en relasjonell dimensjon. Mot denne bakgrunnen diskuterer jeg så (...) spenninger som oppstår i skjæringspunktet mellom strukturering og kultivering av skjønnets ulike dimensjoner. Diskusjonen tydeliggjør at den medisinske profesjonen ikke kan betraktes som en selvtilstrekkelig premissleverandør når det gjelder å sikre adekvat kultivering av medlemmenes skjønnsutøvelse i en klinisk kontekst. Ved å synliggjøre og vektlegge de relevante profesjonseksterne bidragene i profesjonens pågående selvregulering kan befolkningens berettigete tillit til profesjonen styrkes ytterligere.Nøkkelord: strukturelt skjønn, epistemisk skjønn, profesjon, selvregulering, tillitEnglish summary: In Between Structures of Society and Profession: On Delimitation, Cultivation and Premises for Adequately Exercising Judgment in the Role as PhysicianThe point of departure of this article is a distinction between societal structures that delimit the discretion of the physician on the one hand and the profession's arrangements for the cultivation of the physician's judgment on the other. By developing H. Grimen and A. Molander's application of S.E. Toulmin's model for practical reasoning in a clinical context, the multi-dimensional epistemic structure of the physician's judgment in terms of technical, distributive, and relational judgment is accounted for. Against this backdrop, tensions emerging in the intersection between delimitation and cultivation of professional judgment in its various dimensions are discussed. The discussion clarifies that the medical profession is not a self-sufficient provider when it comes to ensuring an adequate cultivation of its members' judgment in a clinical context. It is argued that by emphasising and implementing the relevant external contributions to the profession's ongoing self-regulation, the public's justified trust in the medical profession can be strengthened. (shrink)

Corporate social responsibility is a recognised and common part of business activity. Some of the regularly cited motives behind CSR are employee morale, recruitment and retention, with employees acknowledged as a key organisational stakeholder. Despite the significance of employees in relation to CSR, relatively few studies have examined their engagement with CSR and the impediments relevant to this engagement. This exploratory case study-based research addresses this paucity of attention, drawing on one to one interviews and observation in a large UK (...) energy company. A diversity of engagement was found, ranging from employees who exhibited detachment from the CSR activities within the company, to those who were fully engaged with the CSR activities, and to others who were content with their own personal, but not organisational, engagement with CSR. A number of organisational context impediments, including poor communication, a perceived weak and low visibility of CSR culture, and lack of strategic alignment of CSR to business and personal objectives, served to explain this diversity of employee engagement. Social exchange theory is applied to help explore the volition that individual employees have towards their engagement with CSR activities, and to consider the implications of an implicit social, rather than explicit economic, contract between an organisation and its employees in their engagement with CSR. (shrink)

‘There is a moral right to secede.’It is not, perhaps, always entirely clear what Buchanan means with his reference to a right to secede, and that is a matter we shall have to deal with in due course, but, anyway, the claim that there is a moral right to secede is a good deal more complex than is apparent from Buchanan's ground-breaking work and involves a number of assumptions that need to be gone into if Buchanan's work is to be (...) built on. Many other people, too, seem to assume such a right, especially in the context of discussions of an alleged right to self-determination. My main concern in this paper is with the self that might be self-determining and with what it must be like if it is to have a right. My conclusion is that, though there are many important questions to raise about secession, they are not, outside the case of federations, questions about a right to secede; a right to secede has bearing only in the least interesting cases. (shrink)

No one is excused from doing what he ought to do merely because he is unwilling to do it. But what if others are unwilling to play their necessary role in some joint venture that you all ought to undertake: might that excuse you from doing what you yourself ought to do as part of that? It would, if you were genuinely willing to play your necessary part if they were. But the unwillingness of everyone involved cannot reciprocally serve to (...) excuse one another from doing what they ought to do. (shrink)

Evidence based medicine has been a topic of considerable controversy in medical and health care circles over its short lifetime, because of the claims made by its exponents about the criteria used to assess the evidence for or against the effectiveness of medical interventions. The central epistemological debates underpinning the debates about evidence based medicine are reviewed by this paper, and some areas are suggested where further work remains to be done. In particular, further work is needed on the theory (...) of evidence and inference; causation and correlation; clinical judgment and collective knowledge; the structure of medical theory; and the nature of clinical effectiveness. (shrink)