We describe a form of moral artificial intelligence that could be used to improve human moral decision-making. We call it the “artificial moral advisor”. The AMA would implement a quasi-relativistic version of the “ideal observer” famously described by Roderick Firth. We describe similarities and differences between the AMA and Firth’s ideal observer. Like Firth’s ideal observer, the AMA is disinterested, dispassionate, and consistent in its judgments. Unlike Firth’s observer, the AMA is non-absolutist, because it would take (...) into account the human agent’s own principles and values. We argue that the AMA would respect and indeed enhance individuals’ moral autonomy, help individuals achieve wide and a narrow reflective equilibrium, make up for the limitations of human moral psychology in a way that takes conservatives’ objections to human bioenhancement seriously, and implement the positive functions of intuitions and emotions in human morality without their downsides, such as biases and prejudices. (shrink)

This paper aims to clear up the epistemology of learning morality from Artificial Moral Advisors (AMAs). We start with a brief consideration of what counts as moral enhancement and consider the risk of deskilling raised by machines that offer moral advice. We then shift focus to the epistemology of moral advice and show when and under what conditions moral advice can lead to enhancement. We argue that people’s motivational dispositions are enhanced by inspiring people to (...) act morally, instead of merely telling them how to act. Drawing upon these insights, we claim that if AMAs are to genuinely enhance people morally, they should be designed as inspiration and not authority machines. In the final section, we evaluate existing AMA models to shed light on which holds the most promise for helping to make users better moral agents. (shrink)

Deep learning AI systems have proven a wide capacity to take over human-related activities such as car driving, medical diagnosing, or elderly care, often displaying behaviour with unpredictable consequences, including negative ones. This has raised the question whether highly autonomous AI may qualify as morally responsible agents. In this article, we develop a set of four conditions that an entity needs to meet in order to be ascribed moral responsibility, by drawing on Aristotelian ethics and contemporary philosophical research. We (...) encode these conditions and generate a flowchart that we call the Moral Responsibility Test. This test can be used as a tool both to evaluate whether an entity is a morally responsible agent and to inform human moral decision-making over the influencing variables of the context of action. We apply the test to the case of Artificial Moral Advisors and conclude that this form of AI cannot qualify as morally responsible agents. We further discuss the implications for the use of AMAs as moral enhancement and show that using AMAs to offload human responsibility is inadequate. We argue instead that AMAs could morally enhance users if they are interpreted as enablers for moral knowledge of the contextual variables surrounding human moral decision-making, with the implication that such a use might actually enlarge human moral responsibility. (shrink)

Artificial Intelligence (AI) has permeated every section of human life. Some even suggest that artificial moral advisors (AMAs)—that is, AI-driven artefacts designed to assist human moral growth by providing moral advice—can help humans to lead virtuous lives. With a focus on Thomas Aquinas's theological virtue ethics, this article will argue that AMA projects are cast into question because, theologically speaking, the cultivation of virtues and moral growth are inseparable from hope and patience given through God's grace, (...) which is immeasurable and cannot be reductively mathematised into AI models. Moreover, the tension between AI's efficiency and patient moral life offers further criticism of AMAs. That said, the theology of patience brings forth a conceptual apparatus through which to qualify the virtuous AMA as a tool to bring together human moral advisors as silent hearers and human moral advisees as patient inquirers. (shrink)

This paper is a critique of a paper by Robert Lipkin [1]. Arguments for the following claims are put forward: (1) that what is essential to the psychiatric relationship is what we want it to be for utilitarian reasons; (2) it would not be to our advantage to allow the medicalization of morality; (3) what we should expect from the psychiatrist is prudential advice, not moral advice, and that Lipkin has a confused view about the relationship between these two (...) areas; and (4) we should not allow the psychiatrist to restrict individuals on moral grounds, but only on public safety grounds. (shrink)

This essay accounts for Mengzi’s 孟子 failure in persuading King Xuan of Qi (Qi Xuan Wang 齊宣王) to act morally. We argue that the distinction between internal and external reasons in contemporary philosophy helps to highlight the nature of the failure. The problem of nontransmission of the compassionate impulse within a person despite moral persuasion, which Mencians need to address in order to enhance the success of moral conversion, is now explained as a result of misdirecting the advisee (...) to the lofty ideal of sagehood. We conclude by proposing a proleptic understanding of external reasons within a pragmatic model of giving moral advice. (shrink)

Professor Mitt Regan takes up Brad Wendel's suggestion that we have to distinguish the ethics of advocates from those which guide other forms of legal work, and proposes that the distinction be taken further. Legal advising can itself implicate different ethical positions. Regan concentrates on tax advisers, and argues that their work can, at times, legitimately require a partisan advocate's stance in the giving of tax advice or an impartial trustee's stance in ensuring that the spirit, as well as the (...) letter, of tax law is honoured. Especially in the US, there are strong systemic justifications for treating the tax adviser as an advocate: the wide latitude that tax law gives the citizen when calculating tax liability, the hazards of accurate interpretation of the tax code, and the need for predictability in client arrangements suggesting that it is preferable to concentrate strictly on the letter of the law. So too, the tax adviser as trustee is informed by the importance of tax collection for ordinary government services, and by 'tax morale' and the community's confidence in the tax system generally. The bifurcation of ethical stances in tax advising is, as a consequence, a function of the 'conflicted regulation' of citizen taxpayers. (shrink)

Traditional whistleblowing theories have purported that whistleblowers engage in a rational process in determining whether or not to blow the whistle on misconduct. However, stressors inherent to whistleblowing often impede rational thinking and act as a barrier to effective whistleblowing. The negative impact of these stressors on whistleblowing may be made worse depending on who engages in the misconduct: a peer or advisor. In the present study, participants are presented with an ethical scenario where either a peer or (...) class='Hi'>advisor engages in misconduct, and positive and the negative consequences of whistleblowing are either directed to the wrongdoer, department, or university. Participant responses to case questions were evaluated for whistleblowing intentions, moral intensity, metacognitive reasoning strategies, and positive and negative, active and passive emotions. Findings indicate that participants were less likely to report the observed misconduct of an advisor compared to a peer. Furthermore, the findings also suggest that when an advisor is the source of misconduct, greater negative affect results. Post-hoc analyses were also conducted examining the differences between those who did and did not intend to blow the whistle under the circumstances of either having to report an advisor or peer. The implications of these findings for understanding the complexities involved in whistleblowing are discussed. (shrink)

We conduct an experiment to investigate the joint effects of advisor reassurance and advice source in enhancing the impact of advice on auditors’ whistleblowing propensity. Participants from a Big 4 firm assess the likelihood that a questionable act involving a superior will be reported, both before and after receiving advice. We manipulate, between-participants, the advice source and advisor reassurance on the firm’s policy on whistleblower protection, holding constant the advice recommendation. Our study is underpinned by the premise that (...) moral agents may require an impetus to do the right thing in the form of advice whose effects may vary by its source and nature. Results are consistent with our hypothesis. Specifically, while auditors’ propensity to report a questionable act increases after receiving advice, the increase is significantly higher when the advice is received with reassurance on whistleblower protection than without reassurance, with the effect of reassurance being greater when the advice is from an authoritative source than from a non-authoritative source. These results underscore the importance of advice in promoting whistleblowing and demonstrate how the impact of advice is jointly determined by its source and reassurance on whistleblower protection. (shrink)

Can it ever be morally justifiable to tell others to do what we ourselves believe is morally wrong to do? The common sense answer is no. It seems that we should never tell others to do something if we think it is morally wrong to do that act. My first goal is to argue that in Analects 17.21, Confucius tells his disciple not to observe a ritual even though Confucius himself believes that it is morally wrong that one does not (...) observe the ritual. My second goal is to argue against the common sense answer and explain how Confucius can be justified in telling his disciple to do what Confucius thought was wrong. The first justification has to do with telling someone to do what is second best when the person cannot do what is morally best. The second justification has to do with the role of a moral advisor. (shrink)

In this paper, we suggest that personalized LLMs trained on information written by or otherwise pertaining to an individual could serve as artificial moral advisors (AMAs) that account for the dynamic nature of personal morality. These LLM-based AMAs would harness users’ past and present data to infer and make explicit their sometimes-shifting values and preferences, thereby fostering self-knowledge. Further, these systems may also assist in processes of self-creation, by helping users reflect on the kind of person they want to (...) be and the actions and goals necessary for so becoming. The feasibility of LLMs providing such personalized moral insights remains uncertain pending further technical development. Nevertheless, we argue that this approach addresses limitations in existing AMA proposals reliant on either predetermined values or introspective self-knowledge. (shrink)

There are many alleged problems with trusting another person’s moral testimony, perhaps the most prominent of which is that it fails to deliver moral understanding. Without moral understanding, one cannot do the right thing for the right reason, and so acting on trusted moral testimony lacks moral worth. This chapter, however, argues that moral advice differs from moral testimony, differs from it in a way that enables a defender of moral advice to (...) parry this worry about moral worth. The basic idea is that an advisor and an advisee can together constitute a joint agent, and that this joint agent’s action can indeed have moral worth. So while the advisee himself might not do the right thing for the right reason (this because all alone he lacks the right reason), and while the advisor herself might not do the right thing for the right reason (this because all alone she does not do the right thing), they together do the right for the right reason. (shrink)

:Preference-aggregation problems arise in various contexts. One such context, little explored by social choice theorists, is metaethical. ‘Ideal-advisor’ accounts, which have played a major role in metaethics, propose that moral facts are constituted by the idealized preferences of a community of advisors. Such accounts give rise to a preference-aggregation problem: namely, aggregating the advisors’ moral preferences. Do we have reason to believe that the advisors, albeit idealized, can still diverge in their rankings of a given set of (...) alternatives? If so, what are the moral facts when the advisors do diverge? These questions are investigated here using the tools of Arrovian social choice theory. (shrink)

Blackburn’s “quasi-realism” aims to show that expressivism can accommodate the sorts of claims about moral truth, facts, objectivity, and the like that are found in ordinary moral thought and discourse. Egan argues that expressivists cannot accommodate certain claims about the possibility that one’s own fundamental moral commitments are mistaken. He criticizes what I call the approved change strategy, which explains that judgment in terms of the belief that one might change one’s mind as a result of favored (...) processes such as getting more information. Egan targets a simple version of that strategy; I raise objections to a more sophisticated expressivist alternative. I argue against Horgan and Timmons’ claim that quasi-realists need not accommodate certain thoughts about moral fallibility on the grounds that they are metaethical rather than first-order moral claims, and that the implied orientation toward others that results is not objectionably smug. I also argue that the sophisticated strategy problematically commits the expressivist to an ideal observer or advisor theory in first-order ethics. (shrink)

Many philosophers think that we can identify, e.g., a weather expert by checking if she has a track record of making accurate weather predictions but that there isn’t an analogous way for laypeople to verify the judgement of a putative moral expert. The weather is an independent check for weather expertise but there is no independent check for moral expertise, and the only way for laypeople to identify moral experts is to engage in first-order moral reasoning (...) of one’s own. But if one can do that, one would not need to rely on a moral expert in the first place. This paper provides an account of Feedback as an independent check for moral expertise in the form of certain positive and negative changes in the lives of advisees after they started acting in accordance with an advisor’s advice whilst nothing else of significance changed in their lives in that period. Given our folk background theories, and some specific information about the advisee’s situation, Feedback suggests that the advisor’s advice was correct. Laypeople would identify moral experts by inferring that the best explanation of the correctness of the advisor’s advice in a high proportion of cases in which she dispensed advice is that the advisor had moral knowledge. Identifying moral experts in this way involves the use of some moral reasoning of one’s own but it is too elementary to make moral experts redundant. (shrink)

The “Phoenix Case” brought into public scrutiny a contemporary debate in Catholic moral theology over competing views on the relation of the object of the act to the physical structure of acts that arise from moral choices. A procedure that was described by hospital officials and their parent company as an indirect abortion was judged by the local ordinary, Bishop Thomas Olmsted, as a direct abortion. A debate ensued between Bishop Olmsted and Catholic Health Care West and their (...) advisors. Eventually, Bishop Olmsted excommunicated Sister Margaret Mary McBride for her role on the ethics committee approving the procedure and publicly announced his refusal to recognize the hospital as authentically Catholic. This author addresses the theological position of the hospital and addresses implications for other professionals in Catholic health care facing similar dilemmas. (shrink)

The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other person’s best interests and that the new legislation introduces only an advisor, (...) not a proxy with the moral authority to make treatment decisions on behalf of another. The criticism is threefold. First, there is good empirical evidence that people are poor proxy decision makers as regards accurately representing other people’s desires and wishes, and this is therefore a pragmatically inadequate method of gaining consent. Second, philosophical theory explaining how we represent other people’s thought processes indicates that we are unlikely ever to achieve accurate simulations of others’ wishes in making a proxy decision. Third, even if we could accurately simulate other people’s beliefs and wishes, the current construction of proxy consent in the Mental Capacity Act means that it has no significant ethical authority to match that of autonomous decision making. Instead, it is governed by a professional, paternalistic, best-interests judgement that undermines the intended role of a proxy decision maker. The author argues in favour of clearly adopting the paternalistic best-interests option and viewing the proxy as solely an advisor to the professional medical team in helping make best-interests judgements. (shrink)

How should a crisis sparked by migration of the poor be dealt with? How should tax evasion be addressed? What is the appropriate response to manipulation of elections? Daniel Schwartz's book illustrates that moralists, lawyers, political decision makers, and society at large already contended with these issues some four hundred years ago. The underlying problems and their normative implications were thoroughly analyzed by scholastic authors at the time, many of whom wrote with an eye on influencing the emerging interested public, (...) or doubled as advisors for political decision makers. Political morality, the moral analysis of political decisions, is a particular field of applied ethics (undoubtedly, an important... (shrink)

Meier et al. describe a pilot study that developed METHAD, an AI-based Medical Ethics Advisor tool that draws on the principlism approach and was tested using text-book cases and clinical et...

Leveraging perspectives from social cognitive theory, the attention-based view, and social networks literatures, we tested the relationship between unethical choice and network unethicality, which we define as respondents’ perceptions of their peer advisors’ unethical choices. Although social cognitive theory predicts that perceptions of peer advisor unethical choice are positively associated with unethical choice, we theorize that the nature of this relationship depends on the personality of the actor and the situation. Results from a lagged study suggest that individual and (...) situational variables may act as key buffers to the adverse impact of unethical social influence on ethical choice. Strengths, limitations, and directions for future research are discussed. (shrink)

This section is focused on some areas of concern which were identified in The Report of the Royal Commission into Commercial Activities of Government and Other Matters (1990–1992). In the Report a number of situations were examined in which some individuals acted without recourse to any ethical guidelines. Most of the people mentioned in the Report held responsible positions in either Government or the private sector, and all were very well known in the community. The Report of the Royal Commission (...) made a number of findings of serious impropriety on the part of several individuals, although there was comparatively little evidence of illegal or corrupt conduct. This section shows what happened to a governmental system in an Australian state when a number of Ministers and their advisors placed their personal or party advantage over their constitutional obligation to act in the community''s interests.Those who cannot remember the past are condemned to repeat it. (shrink)

To counter confusion about the term ‘mentor’, and address concerns about the scarcity of mentoring, I argue for an “honorific” definition, according to which a mentor is virtuous like a saint or hero. Given the unbounded commitment of mentors, mentoring relationships must be voluntary. In contrast, the role of advisor can be specified, mandated, and monitored. I argue that departments and research groups have a moral responsibility to devise a system of roles and structures to meet graduate students’ (...) and postdoctoral fellows’ needs for information and advice. (shrink)

Initial reflections on ethics, morality, and justice in an adversary system -- Undertaking a case -- Communication and confidentiality -- Loyalties and conflicts of interest -- Who controls the case? How should lawyers and clients share decisionmaking? -- What price truth? What price justice? What price advocacy? -- Tactics, free speech, and playing by the rules -- The special problems of the government lawyer -- The lawyer acting as advisor -- The lawyer as part of the law firm structure (...) -- Mental health, substance abuse, and the realities of modern practice -- The economics of lawyering -- Admissions, discipline, and some other rules of lawyering. (shrink)

Resumen Ésta es la primera traducción al español de las guías “Atención después de la investigación: un marco para los comités de ética de investigación del National Health Service (NHS) (borrador versión 8.0)”. El documento afirma que existe una fuerte obligación moral de garantizar que los participantes enfermos de un estudio clínico hagan una transición después del estudio hacia una atención de la salud apropiada. Con “atención de la salud apropiada” se hace referencia al acceso para los participantes a (...) la atención de la salud, proporcionada principalmente por el National Health Service (en adelante NHS), el sistema de salud del Reino Unido, y/o a la intervención en estudio, también llamada producto o tratamiento en investigación. Las guías “Atención después de la investigación” están dirigidas principalmente a los miembros de los 79 comités de ética de investigación del NHS y a quienes presentan sus estudios de investigación ante estos comités. Se trata de un documento borrador muy avanzado, trabajado en numerosas reuniones, durante más de 3 años, que ha sido discutido por participantes de estudios y miembros de la comunidad, miembros y presidentes de comités de ética de investigación del Reino Unido, especialistas internacionales en ética de la investigación, representantes de la industria y otras partes interesadas. La redacción de las guías es producto de la colaboración de Neema Sofaer y Penney Lewis, ambas investigadoras del King’s College London, en el Centre of Medical Law and Ethics del Dickson Poon School of Law, y Hugh Davies, Asesor en Ética de la Investigación de la Health Research Authority (HRA) del NHS. El traductor del presente documento, Ignacio Mastroleo, participó del workshop en la Fundación Brocher (Ginebra, Suiza, diciembre de 2011) donde se revisó el borrador versión 7.0 y contribuyó en la revisión del borrador de la versión 8.0 durante el 2012. -/- Abstract This is the first Spanish translation of the guidelines “Care after research: a framework for NHS RECs (8th draft)”. The document states that there is a strong moral obligation to ensure that participants in a clinical study who are ill transition after the study to appropriate healthcare. The terms "appropriate healthcare" refer to participants’ access to health care, mainly provided by the National Health Service (NHS), the health system in the UK, and/or to the intervention study also named investigational treatment or product. The guides "Care after research" are mainly directed to members of the 79 NHS committees of research ethics (RECs) and to those who submit their research to these committees. This is a very advanced draft document, worked in several meetings, for more than three years, that has been discussed with study participants and community members, members and chairs of RECs in the UK, international specialists in research ethics, industry representatives and other stakeholders. The drafting of the guidelines is the result of the collaboration of Neema Sofaer and Penney Lewis, both researchers at King's College London, at the Centre of Medical Law and Ethics of Dickson Poon School of Law, and Hugh Davies, Research Ethics Advisor of the Health Research Authority (HRA) of the NHS. The translator of this document, Ignacio Mastroleo, attended the workshop at the Brocher Foundation (Geneva, Switzerland, December 2011) where draft version 7.0 was revised and contributed in the revision of draft version 8.0 during 2012. (shrink)

Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the connections (...) between mechanistic processes and more fundamental reasons for medical interventions, particularly moral, ethical, religious, and political concerns about health, agency, and power. This paper uses debates over the controversial morning-after pill to gain insight into the deeper reasons for the production and use of mechanistic knowledge throughout biomedical research, clinical practice, and governmental regulation. To practice socially relevant philosophy of science, I argue that we need to account for mechanistic knowledge beyond immediate effectiveness, such as how it can also provide moral guidance, aid ethical categorization in the clinic, and function as a political instrument. Such insights have implications for medical epistemology, including the value-laden dimensions of mechanistic reasoning and the “epistemic friction” of values. Furthermore, there are broader impacts for teaching research ethics and understanding the role of science advisors as political advocates. (shrink)

Bioethicists working on national ethics commissions frequently think of themselves as advisors to the government, but distance themselves from any claims to actual authority. Governments however may find it beneficial to appear to defer to the authority of these commissions when designing laws and policies, and might appoint such commissions for exactly this reason. Where does the authority for setting laws and policies come from? This question is best answered from within a normative political philosophy. This paper explains the locus (...) of moral authority as understood within one family of normative political theories—liberal political theories—and argues that most major “liberal” commentators have understood both the source and scope of ethics commissions’ authority in a manner at odds with liberalism, rightly interpreted. The author argues that reexamining the implications of liberalism for bioethics commissions would mean changing what are considered valid criticisms of such commissions and also changing the content of national bioethics commission mandates. The author concludes that bioethicists who participate in such commissions ought to carefully examine their own views about the normative limits of governmental authority because such limits have important implications for the contribution that bioethicists can legitimately make to government commissions. (shrink)

Conflicts of interest can lead experts to give biased and corrupt advice. Although disclosure is often proposed as a potential solution to these problems, we show that it can have perverse effects. First, people generally do not discount advice from biased advisors as much as they should, even when advisors’ conflicts of interest are disclosed. Second, disclosure can increase the bias in advice because it leads advisors to feel morally licensed and strategically encouraged to exaggerate their advice even further. As (...) a result, disclosure may fail to solve the problems created by conflicts of interest and may sometimes even make matters worse. (shrink)

ABSTRACTExperts use their superior skills and understanding to mediate between evidence in some domain and non-experts. But how should we understand the proper relationship between experts and non-experts? In this paper, I present two ways of conceiving experts’ mediating role from the perspective of non-experts: the Authority View and the Advisor View. Jennifer Lackey has criticized the Authority View and defended the Advisor View. I defend an account of epistemic authority that avoids her criticisms while arguing the (...) class='Hi'>Advisor View lacks the advantages she claims. Ultimately, I present a hybrid approach according to which whether we should treat experts as authorities or advisors varies depending upon the presence of certain epistemic and moral concerns. (shrink)

One of the most detailed early modern discussions of the morality of esteem can be found in the work of the reformed jurist and historian Marquard Freher (1565–1614). Since the question of how much esteem others deserve is fraught with a high degree of uncertainty, Freher relied on the work of other legal humanists, who discussed questions of esteem from the perspective of arguments from the presumption of goodness. The humanist approach to the presumption of goodness integrated considerations about presumed (...) non-delinquency with considerations concerning natural needs, natural rights and natural duties grounded in natural rational capacities common to all (grown-up, healthy) human beings. It advised us to fulfill natural duties that derive from the natural need of being held in good esteem by others, and to develop socially valuable attitudes such as trust and positive emotions toward others. At the same time, this approach was responsive to considerations of prudence, both in grounding the presumption of goodness in considerations concerning causal powers and in balancing the presumption of goodness against a variety of presumptions of badness. Freher applied this understanding of the presumption of goodness to political practice in his role as an advisor to the Palatinate. (shrink)

Definition of the problemStaff and patients in institutions of organized health care experience and express a variety of adverse conditions of these organizations. Within a theoretical framework of institutional pathology we can explain some of these “miserable conditions” as effects of the activities of organizations belonging to the political system (health policy) and to the economic system (health economy). Clinical ethics committees (CECs) cannot effectively handle such adversities or even address them properly. Standard organizational ethics can address them but cannot (...) handle them effectively.ArgumentsI propose to strengthen organizational ethics by a theory of institutional pathology. Basic nosological distinctions such as disease, illness and sickness, whose primary reference is to biological organisms and persons, can be analogically extended to socially constituted entities (e.g. hospitals) in terms of functional deficiency, miserable conditions, and need for reform of such entities. A very promising focus for analysis are organizational disorders of responsibility allocation. This group of institutional pathological disorders engenders, amongst other kinds of miserable conditions, specifically morally relevant miserable conditions.ConclusionThe institutional pathology paradigm, oriented to concrete institutions and organizations, can help “clinical” organizational ethics to considerably expand, in theoretical ethics as well as in ethically guided practice e.g. for members of CECs and organizational ethics advisors, the capacities for observing, evaluating and, if necessary, amending disturbed relations of responsibility. (shrink)

It Is My Pleasure To Introduce this discussion of Naoko Saito's American Philosophy in Translation. We have contributions from three experts in American philosophy, all of whom have been in conversation with the author for many years: Jim Garrison, Vincent Colapietro, and Steven Fesmire. Prior to their contributions, I would like to set the scene with some brief remarks to introduce the book and to explain something of its background.Over the past two decades, I have worked closely with Saito on (...) a number of projects, and I have been familiar with her ideas for this book since its inception. In some respects, the book is the product of studies in American philosophy that go back to her time as an undergraduate in Tokyo in the 1980s, ideas that were advanced considerably when she did an MA at Harvard, taking classes with Stanley Cavell and Hilary Putnam, and subsequently when she completed her PhD at Teachers College, with René Arcilla as her advisor and Cavell as a member of her committee. It was against this background that, in 2006, Saito published her first singly authored book, The Gleam of Light: Moral Perfectionism and Education in Dewey and Emerson. As that title indicates, she was already exploring the relation between Dewey and pragmatism, on the one hand, and American transcendentalism, on the other. Her sense back then of some separation between these traditions of thought, and of the nature of the tensions between them, has been refined and, for the most part, strengthened in the years since that earlier publication. No doubt she has been influenced in this by Cavell, who, in one essay, for example, asks: “What's the use of calling Emerson a pragmatist?” In any case, her account of this relationship is extended and altered significantly in American Philosophy in Translation.Through the course of her research, Saito has been conscious of the fact that she is studying American philosophy from a distance—a distance that is geographical, cultural, and linguistic—and she retains a thoughtful humility in relation to this. But she also sees here a possible opening to the perception and release of untapped aspects of these traditions of thought, in ways that might fertilize and extend the ground in which the inheritance of American philosophy has flourished. This is very much the line that she pursues in this book. In the light of this, and as the book's title indicates, there is a particular focus on language and translation. It is important that the latter term is understood not merely as an attractive metaphor for change and transformation: crucial to her developing argument is the experience of translating between languages and the reality of the experience in the lives of so many today, within the academy and without. In the course of this experience, one is sometimes confronted, quite self-consciously, with a word or phrase that resists translation. But sometimes—more often in the life of the accomplished or habituated speaker of the foreign language in question—the experience persists as an undercurrent, subtly opening a world that is other in some respects from the one that comes to light in the mother tongue.By contrast, to the many (especially Anglophone) monolingually minded, the need for translation can appear as an unwanted barrier, something of a nuisance, a problem to be solved. This is by no means a response confined, however, to the uneducated (or the Anglophone or the monolingual). There is also a sophisticated variant of this narrowness of outlook where faith is placed in an artificial or technical language with the power, the fantasy runs, to overcome the vagaries of natural language. Hilary Putnam recalls how Rudolf Carnap, whose stature as a thinker and as a human being he does not doubt, felt strongly that “for all x, planned x is better than unplanned x” and was drawn to the idea of a common world language: Thus the idea of a socialist world in which everyone spoke Esperanto (except scientists, who, for their technical work, would employ notations from symbolic logic) was one which would have delighted him. And I recently had a conversation with a student who remarked quite casually that it would not be a bad idea if there were only one language and one literature: “We would get used to it, and it might help to prevent war.” (Putnam 185)Putnam does not deign to respond to the latter assertion. What is foregrounded in his discussion is that monolingualism is likely to hide the plurality of goods that is realized in different cultures. The importance of that plurality is surely something that the luminaries of American philosophy bring to light. Indeed, Putnam's key point of reference in making these remarks is William James.The undercurrent of translation in the experience of the more accomplished speaker of a foreign language can act then as a sensitization to cultural difference, to different possibilities of thought and being. But in fact, this shifting of thought can apply within any language itself, not just inter- but intra-lingually, opening an insight that is close to the heart of American philosophy. If one can hear the cry of the rooster, then one may be wakened also by Thoreau's turn of expression in the idea of the “father tongue”: through a maturing experience of the language we are brought up with, we come to “a reserved and select expression, too significant to be heard by the ear, which we must be born again in order to speak” (Thoreau 69). This renewed investment in language, this continual return to our words, is what opens them to new thought and gives them interest. It is first an inheritance from the culture we are brought up in, but it dies in our speech and thinking if we do not turn it to something new. To build, we must begin by borrowing an axe, but we can return it sharper than when we borrowed it.If translation is operative in our language as a whole, as Saito's argument shows, this points to the many little rebirths within ourselves and in our interactions with one another. In fact, the point becomes political in that democracy depends upon this renewal of our words. This renewal resists not only the allure of ideology but also the now familiar etiolated rhetoric of “political realism.” Moreover, it points beyond the reliance, within the politics of recognition, on the defining of groups and categories toward a politics of acknowledgment.In this vein, Saito's outsider perspective is in tune with what Richard Bernstein has called the “global resurgence of American pragmatism.” The borderline or outsider perspective can have a powerful effect on thought, in relation to which Saito invites the reader to recall that America's past was itself an outsider-past: it was outside Europe, a relation with which it was bound to struggle, but it was also ready, as Emerson and Thoreau demonstrate, to draw from greater cultural distances, where it found congenial aspects in East Asian thought.Saito stresses the anti-foundationalist character of American philosophy as of critical importance for both philosophy and politics, and again her discussion of language is crucial to this. Dewey's emphasis on communication, with his relatively flat style of prose, is contrasted with the stylistic experiment and invention that she finds in Emerson, Thoreau, and Cavell. She sees the style of these writers, in some contrast to that of Dewey, as having a salutary, destabilizing effect. She wants to destabilize Dewey. It is entirely consonant with her position, furthermore, that she raises doubts about the bland acceptance of a politics of inclusion. Not only can this become a surreptitious form of discipline and control: it can engender the conformism that Emerson worked so hard to prevent.The book finishes on a more aesthetic note, taking up lines of thought in Dewey's aesthetics but turning this toward the more extravagant elision, in Thoreau, of the functional and the beautiful. The thematization of the aesthetic in this way is, she tries to show, crucial to our (political) world. (shrink)

BackgroundSexual boundary violations in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations.MethodsWe carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other relevant experts to (...) explore their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data.ResultsWe found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: setting rules and regulations, engaging in dialogue about sexuality, and addressing systemic and organizational dimensions.ConclusionOur findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations. (shrink)

The rise of China could be the most important political development of the twenty-first century. What will China look like in the future? What should it look like? And what will China's rise mean for the rest of world? This book, written by China's most influential foreign policy thinker, sets out a vision for the coming decades from China's point of view. In the West, Yan Xuetong is often regarded as a hawkish policy advisor and enemy of liberal internationalists. (...) But a very different picture emerges from this book, as Yan examines the lessons of ancient Chinese political thought for the future of China and the development of a "Beijing consensus" in international relations. Yan, it becomes clear, is neither a communist who believes that economic might is the key to national power, nor a neoconservative who believes that China should rely on military might to get its way. Rather, Yan argues, political leadership is the key to national power, and morality is an essential part of political leadership. Economic and military might are important components of national power, but they are secondary to political leaders who act in accordance with moral norms, and the same holds true in determining the hierarchy of the global order. Providing new insights into the thinking of one of China's leading foreign policy figures, this book will be essential reading for anyone interested in China's rise or in international relations. (shrink)

To counter confusion about the term ‘mentor’, and address concerns about the scarcity of mentoring, I argue for an “honorific” definition, according to which a mentor is virtuous like a saint or hero. Given the unbounded commitment of mentors, mentoring relationships must be voluntary. In contrast, the role of advisor can be specified, mandated, and monitored. I argue that departments and research groups have a moral responsibility to devise a system of roles and structures to meet graduate students’ (...) and postdoctoral fellows’ needs for information and advice. (shrink)

Following the global financial crisis, banks have become more regulated to advance ethical sales cultures throughout the sector. Based on case studies of three retail banks, we find that they construct the ‘appropriate advisor’ in different ways. Inspired by Bakhtin’s work on ethics, we propose a vocabulary of relational ethics centered on the ‘answerable self.’ We argue that this vocabulary is apt for studying and discussing how organizations advance ethical sales cultures in ways that instead of encouraging value congruence (...) and alignment allow for ethical openness. In such cultures, employees—as moral agents—are morally questioning, critically self-reflexive, and answerable for their own actions toward others in their social relationships. Our paper makes three theoretical contributions, namely, problematizing the idea of cultural alignment and value congruence, demonstrating that identity regulation can both comprise and support the ‘answerable self,’ and advancing our understanding of the interdependence of ethical openness and ethical closure in fostering ethical sales cultures. (shrink)

Philosophers may play the role of insider, e.g., serving as advisor to government commissions, or of outsider, commenting on the work of such commissions. Each role may raise dilemmas. It is argued that as insider the philosopher's primary duties should be to clarify and inform, as well as philosophize with the commissioners, and help them stay on a course in which moral considerations are given their proper weight. Fulfilling these duties means that the philosopher will sometimes have to (...) help produce a weaker intellectual document than he would prefer, or lose a chance to directly promote the public good. The insider philosopher will also have to consider whether it is appropriate for a policy proposal from a commission to differ from much current government policy, and how morally appropriate compromise can be reached among commissioners. Given his understanding of how an insider philosopher should function and how commission reports are constructed, the outsider philosopher can comment both on how close a report comes to being perfect of its type, and how far short of an ideal philosophical analysis even a perfect government report is. It may be appropriate for him to give greater weight to the public good, if his comments are very likely to affect it, than the insider philosopher. Examples for discussion are drawn from government reports on organ transplantation, embryo research, terminating care, and compensation for research subjects. Keywords: embryo research, government commissions, moral conflict, moral compromise, organ transplants, philosophers and public policy CiteULike Connotea Del.icio.us What's this? (shrink)

Background: Ought nursing homes to establish clinical ethics committees (CECs)? An answer to this question must begin with an understanding of how a clinical ethics committee might be beneficial in a nursing home context – to patients, next of kin, professionals, managers, and the institution. With the present article, we aim to contribute to such an understanding. Aim: We ask, in which ways can clinical ethics committees be helpful to stakeholders in a nursing home context? We describe in depth a (...) clinical ethics committee case consultation deemed successful by stakeholders, then reflect on how it was helpful. Research design: Case study using the clinical ethics committee’s written case report and self-evaluation form, and two research interviews, as data. Participants and research context: The nursing home’s ward manager and the patient’s son participated in research interviews. Ethical considerations: Data were collected as part of an implementation study. Clinical ethics committee members and interviewed stakeholders consented to study participation, and also gave specific approval for the publication of the present article. Findings/results: Six different roles played by the clinical ethics committee in the case consultation are described: analyst, advisor, support, moderator, builder of consensus and trust, and disseminator. Discussion: The case study indicates that clinical ethics committees might sometimes be of help to stakeholders in moral challenges in nursing homes. Conclusions: Demanding moral challenges arise in the nursing home setting. More research is needed to examine whether clinical ethics committees might be suitable as ethics support structures in nursing homes and community care. (shrink)

For more than two thousand years, Confucius has been an inseparable part of China's history. Yet despite this fame,Confucius the man has been elusive. Now, in The Authentic Confucius , Annping Chin has worked through the most reliable Chinese texts in her quest to sort out what is really known about Confucius from the reconstructions and the guesswork that muddled his memory. Chin skillfully illuminates the political and social climate in which Confucius lived. She explains how Confucius made the transition (...) from court advisor to wanderer, and how he reluctantly became a professional teacher as he refined his judgment of human character and composed his vision of a moral political order. The result is an absorbing and original book that shows how Confucius lived and thought: his habits and inclinations, his relation to the people of the time, his work as a teacher and as a counselor, his worries about the world and the generations to come. In this book, Chin brings the historical Confucius within our reach, so that he can lead us into his idea of the moral and to his teachings on family and politics, culture and learning. The Authentic Confucius is a masterful account of the life and intellectual development of a thinker whose presence remains a powerful force today. (shrink)

This chapter examines the possibility of using AI technologies to improve human moral reasoning and decision-making, especially in the context of purchasing and consumer decisions. We characterize such AI technologies as artificial ethics assistants (AEAs). We focus on just one part of the AI-aided moral improvement question: the case of the individual who wants to improve their morality, where what constitutes an improvement is evaluated by the individual’s own values. We distinguish three broad areas in which an individual (...) might think their own moral reasoning and decision-making could be improved: one’s actions, character, or other evaluable attributes fall short of one’s values and moral beliefs; one sometimes misjudges or is uncertain about what the right thing to do is in particular situations, given one’s values; one is uncertain about some fundamental moral questions or recognizes a possibility that some of one’s core moral beliefs and values are mistaken. We sketch why one might think that AI tools could be used to support moral improvement in those areas, and describe two types of assistance: preparatory assistance, including advice and training supplied in advance of moral deliberation; and on-the-spot assistance, including on-the-spot advice and facilitation of moral functioning over the course of moral deliberation. Then, we turn to some of the ethical issues that AEAs might raise, looking in particular at three under-appreciated problems posed by the use of AI for moral self-improvement: namely, reliance on sensitive moral data; the inescapability of outside influences on AEAs; and AEA usage prompting the user to adopt beliefs and make decisions without adequate reasons. (shrink)

The present article discusses the Department of Kalam, its foundation, academic structuring, philosophy, and contribution to religious thought at the national and international level since the establishment of Ankara University Faculty of Divinity. The process regarding the field of Kalam since the establishment of Ankara University Faculty of Divinity in 1949 has been studied over two historical periods. The first is the period from its being taught as a course under the Chair of the History of Islam and Sects during (...) the establishment of the Faculty of Divinity to 1974 when it turned into an independent chair, and the second is the process from 1974 to the present. Higher religious education was continued in the Faculty of Theology, established under the Istanbul Dārulfunūn, which was constructed in the western style instead of the madrasahs that were closed in accordance with the Law of Unification of Education (Tawhid Tadrisāt) adopted on March 3, 1924.The faculty in question was closed in 1933 due to the shortage of students. Until Ankara University Faculty of Theology, which started its teaching activities in November 1949, was opened, there was no higher religious education for 16 years in Turkey. During this time, the need for experts trained in the field of religion emerged. In order to meet this need, Ankara University Faculty of Theology was opened. In the newly opened faculty, it is aimed to train theologians with versatile knowledge and perspective by teaching philosophy, psychology, sociology, foreign languages, as well as teaching disciplines related to the field of theology. One of the chairs in the faculty’s academic structure opened for this purpose was the chair of History of Islam and Sects. In Ankara University Faculty of Theology, where the academic structuring was organized according to the chair system, the science of Kalam was taught as a course within the Chair of the History of Islam and Sects until 1974. Within this chair, the teachings of Principles of Islam, the history of Islamic sects, and Kalam lessons were carried out. The first instructor of the chair was Prof. Yusuf ZiyaYörükân. Although there were changes in the academic staff during the process, one of the important names that contributed to the field of kalam until 1974 was Muhammad Tavît al-Tanji. These scholars not only made significant contributions to the field of Kalam in terms of method and content with their own studies but also taught scholars to work in this field after them.The doctoral advisor of HüseyinAtay, who is the founder of the Kalam Chair/Department, is M. Tavît al-Tancî. In 1974, when HüseyinAtay became a professor, the Kalam course was separated from the Chair of Islam and Sects and gained the status of an independent chair. HüseyinAtay is the architect of the transformation of Kalam from a lecture to a chair.As a result of Atay’s efforts, being a theologian in Turkey has turned into an identity rather than being a member of an academic discipline. In the studies carried out by Yörükân, Tancî, Atay and the academicians taught by them in Ankara University Faculty of Theology Department of Kalam, the emphasis on the Quran and reason, the importance of critical thinking in the field of theology, the human-centered theological thought, the effort to find solutions to current problems, the researches on Mu‘tazila and Maturidism, the study and translation activities that are carried out to bring the classical theology to the present day come to the fore. In the essence of academic studies conducted within this framework, the importance of correctly determining the distinction between the divine and human in the analysis of religious thought is emphasized. In addition, it is aimed to give a perspective on the meaning and value of human life. In the Department of Kalam, where the human-centered understanding of kalam is systematically dealt with on the basis of individual, responsibility, and morality, the science of kalam is structured not only as a system of thought consisting of abstract fictions but a discipline that has the function of developing and gaining a perspective on what is happening around us and in the World. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bernard Mandeville and the Therapy of “The Clever Politician”Harold J. CookAs the institutional authority of the learned physicians of Augustan London waned, new threats to the classical foundations of medical practice appeared. 1 Patients had more freedom to chose from a variety of practitioners and practices, giving both consumer demand and the advertising skills of suppliers an even more powerful hand in medical affairs. While the burgeoning medical marketplace (...) developed mostly because of the profound socio-economic and political changes of the late Stuart period, intellectual transformations were at play, too. The new science appeared to encourage empiricism and the development of new remedies based on experimentation, devaluing university education in medical classics, but conversely the new science could strengthen physicians’ claims to superiority over mere patients and practitioners. Medical materialists, for instance, could turn the classical advisor/client relationship into that of an expert contolling a passive recipient (patient) for his or her own good.One contemporary debate that shows the implications of materialism for medical relationships is the theory of the passions. The passions linked mind and body. According to most classical accounts, one could (or should) control the passions by applying reason, resulting in both a virtuous and a healthy life. But according to a strong version of materialism, the mind could not hope to control the passions. A doctor therefore could no longer appeal to patients’ reason; rather, he had to manipulate the patient’s passions for his or her own good. Hence for a materialist, the doctor was not an adviser to the patient but an expert therapist, not a teacher of health and virtue but a “clever politician” who ordered bodily passions. Some versions of the new science, then, favored [End Page 101] the expertise of physicians while undermining older views about learned authority. Such an outlook is clear in the work of Dr. Bernard Mandeville, whose famous Fable of the Bees shows how the “clever politician” played on passions to make the body politic run smoothly. Mandeville held coherent views on politics, economics, moral philosophy, and medicine. Like many doctors of his time, he fought to establish his expertise in the new science. His views are expressed most clearly in the theory of the passions. By examining his discussion of the passions in both his social commentary and his medical dialogues, we can note similarities among his various writings and glimpse one of his fundamental positions on medicine and humanity.The Fable and its CriticsTo many English minds of the early eighteenth century, no one exemplified materialism’s threat better than Dr. Bernard Mandeville. Mandeville’s famous slogan, the subtitle of his Fable of the Bees—“private vices, public benefits”—seemed to epitomize materialism’s inherent immorality. The book seemed to argue that what most people recognized as human vices were the main engines of the collective good. Mandeville’s famous book pictured human nature as animalistic, in which the passions held sway over reason. In Mandeville’s world, it appeared, reason became little more than the ability to rationalize, the instrument of hypocrisy, merely letting people cover their true motives (grounded as they were in the passions) with empty words pretending to more exalted ends.His Fable had begun as a little, anonymous, satirical poem in 1705, titled “The Grumbling Hive: or, Knaves Turn’d Honest.” It began by speaking of “A Spacious Hive well stockt with Bees, / That liv’d in Luxury and Ease.” Many of the bees were knaves, with no calling free of deceit, but while “every Part was full of Vice, / Yet [was] the whole Mass a Paradise; /... Such were the Blessings of that State; / Their Crimes conspir’d to make them Great.” Avarice, prodigality, luxury, pride, envy, vanity, folly, fickleness, and inconstancy employed millions, encouraging ingenuity and industry and creating pleasures and comforts “To such a Height, the very Poor / Liv’d better than the Rich before.” But many of the thriving bees complained, shouting for honesty and virtue. When Jove “rid / The bawling Hive of Fraud,” economic collapse followed, with the consequent end of arts and sciences as well; population declined; the hive’s territory decreased; and the remaining bees toiled long and... (shrink)

In this essay, I compare two pioneer thinkers of the “just war” tradition across cultures: Gratian in the Christian tradition, and Mengzi (Mencius) in the Confucian tradition. I examine their historical-cultural contexts and the need for both to discuss just war, introduce the nature of their treatises and the rudimentary theories of just war therein, and trace the influence both thinkers’ theories have had on subsequent just war ethics. Both deemed just cause, proper authority, and right intention to be necessary (...) conditions for initiating a just war. However, Gratian’s theory has a presumption against injustice whereas Mengzi’s theory has a presumption against war. As a jurist of the Church, Gratian sought to discriminate just from unjust wars, while Mengzi, a moral-political advisor to rulers, was more concerned with avoiding bloodshed and building lasting peace. In addition to examining these thinkers’ respective historical influences, I submit that Gratian’s Decretum and the Mengzi are pioneering in two more senses. First, they offer important clues to understanding how just war ideas were developed very differently in medieval Europe and in premodern China. Second, both embodied features that helped shape their subsequent intellectual tradition, which in turn molded the different legacies of these two works. (shrink)

abstract This article briefly examines Onora O'Neill's account of the relation between normative principles and practical ethical problems with an eye to suggesting that philosophers of practical ethics have reason to adopt fairly high moral ambitions to be edifying and instructive both as educators and as advisors on public policy debates.

Advice-giving is an important means of supporting others to act well. It inspires gratitude, indifference and resentment in equal measure. Although we can often predict a resentful reception for advice, its normative implications may be unclear. Should advice that is likely to be resented be withheld or modified because of its resentability, or delivered despite it? The norms that underwrite advice-giving, and which inform justified resentment, have thus far evaded systematic philosophical analysis. Using a case proposed by Edward Hinchman, the (...) first part of this paper develops three lines of reasoning that explain why advice might be resented. The second part explores three norms of advice suggested by the case. Together they cast light upon the role of advice in our moral and social lives, and offer a starting point for practical reasoning about when to give resentable advice, and how to be a good advisor. (shrink)

“Follow the science” was commonly repeated during debates on COVID-19-related policy. The phrase “follow the science” raises questions that are central to our theories of knowledge and the application of scientific knowledge to maximize the wellbeing of our society. The purpose of this study was to (1) perform a scoping review of literature discussing “follow the science” and COVID-19, and (2) consider “follow the science” in the context of pediatric health. A comprehensive search of 14 databases was performed on May (...) 23, 2023. Articles were included if they used terms such as “follow the science”, “follow the scientists”, “listen to science” or “listen to scientists”, and discussed COVID-19. There were 24 articles included in the final review. Existing literature on “follow the science” (1) differentiates between scientific knowledge and policy decisions; (2) emphasizes the importance of social sciences in policy making; (3) calls for more transparency in the knowledge synthesis and policy generating process; and (4) finds that scientific advisors see their role as advising on science rather than policy decision making. There was no definitional, epistemological, or philosophical intellectual defense of “follow the science” in the peer reviewed literature. Policy requires (1) reliable data and (2) agreement on what to do considering those empirical facts by appealing to values, ethics, morality, and law. A review of school shutdowns is used as an example of the inadequacy of “follow the science” as a guiding principle for public policy. (shrink)

Adam Smith is perceived, through his best-known book, An Inquiry into the Nature and Causes of the Wealth of Nations, as the founder of economics as a science. His thought has shaped modern ideas about the market economy and the role of the state in relation to it. Yet Smith needs to be recognized as more than this, as a man of letters, moralist, historian, and critic, as well as an economist, if we are to get full value for his (...) ideas and perspectives in contemporary applications. Ian Simpson Ross is the biographer of Lord Kames, Smith's patron, and of the Scottish poet William Dunbar, and has edited, with E C Mossner, Smith's correspondence for the Glasgow edition of his works. In this, the first full-scale biography of Adam Smith for a hundred years, Ross brings his subject in to historical light as a thinker and author by examining his family circumstance, education, career, and social and intellectual circle, including David Hume and Francois Quesnay, revealed through his correspondence, archival documents, the reports of contemporaries, and the record of his publications. Readers will meet Smith as a student at a lively Glasgow and sleepy Oxford; freelance lecturer in rhetoric; innovative university teacher; tutor travelling abroad with a Duke; acclaimed political economist; policy advisor to governments during and after the American crisis; and finally, if paradoxically in view of his tenets, a Commissioner of Customs coping with the free traders in the smuggling business. This is the life of a Scottish moral philosopher whose legacy of thought concerns and affects us all. Its lively and informed account will appeal to those interested in the social and intellectual milieu of the eighteenth century, and in scottish history. Economists and philosophers will find much to read about the history of their disciplines, supported by full documentation. (shrink)

President Bush and his Council of Economic Advisors have claimed that the U.S. shouldn’t adopt a national health program because doing so would slow innovation in health care. Some have attacked this argument by challenging its moral claim that innovativeness is a good ground for choosing between health care systems. This reply is misguided. If we want to refute the argument from innovation, we have to undercut the premise that seems least controversial -- the premise that our current system (...) produces more innovation than a national health program would. I argue that this premise is false. The argument requires clarifying the concept ‘national health program’ and examining various theories of human well-being. (shrink)

The allocation of critical care resources and triaging patients garnered a great deal of attention during the COVID-19 pandemic, but there is a paucity of guidance regarding the ethical aspects of resource allocation and patient prioritization in ‘normal’ circumstances for Canadian healthcare systems. One context where allocation and prioritization decisions are required are surgical waitlists, which have been globally exacerbated due to the COVID-19 pandemic. In this paper, we detail the process used to develop an ethics framework to support prioritization (...) for elective surgery at The Hospital for Sick Children, Toronto, a tertiary pediatric hospital. Our goal was to provide guidance for the more value-laden aspects of prioritization, particularly when clinical urgency alone is insufficient to dictate priority. With this goal in mind, we worked to capture familial, relational, and equity considerations. As part of our institution’s concerted efforts to ethically and effectively address our surgical backlog, an ethics working group was formed comprising clinicians from surgery, anesthesiology, intensive care, a hospital bioethicist, a parent advisor, and an academic bioethics researcher. A reflective equilibrium process was used to develop an ethics framework. To this end, the same methodology was used to create a support for patient prioritization that identifies clinically and morally relevant factors for prioritization among medically similar surgical cases, with a substantive goal being to identify and redress health inequities in surgical prioritization, inasmuch as this is possible. While further steps are needed to validate several aspects of the framework, our research suggests that an ethics framework grounded in the practical realities of hospital operations provides consistency, transparency, and needed support for decisions that are often left to individual clinicians, as well as an opportunity to reflect upon the presence of health inequities in all domains of healthcare delivery. (shrink)

Kant’s notion of autonomy is not only a central concept in pure moral philosophy; it is also a key organizing concept in applied moral philosophy. Across the whole spectrum of human endeavors, there are helping relationships wherein some helpers (e.g., doctors, teachers, social workers, advisors, managers, or organizers) try to help their counterparts (e.g., patients, students, clients, workers, and so forth) to help themselves. But there is a fundamental “helping self-help conundrum” in the very idea of helpers giving (...) external assistance to others to become more autonomous, i.e., to become independent of external assistance. This conundrum makes genuine autonomy-enhancing help very subtle, difficult, and scarce. There is, however, a golden thread in applied moral philosophy running from Socrates, Stoics, and Augustine down to modern philosophers such as John Dewey, Leonard Nelson, David Hawkins, and Gilbert Ryle. This tradition appreciates the limitations highlighted by the fundamental conundrum and which argues that genuine help must be indirect to create the preconditions and catalyze the processes of the others taking an active and constructive role in helping themselves. The analysis also highlights the “yin and yang” of unhelpful help as social engineering (yang) and “rapacious benevolence” (yin). Iven Illich in particular developed a general critique of the “helping profession,” with their professional cartels always finding more “needs” and “disabilities” that need to attended to, that thereby generate more learned disabilities and disabling help. (shrink)