Medical-legal partnerships (MLPs) — collaborative endeavors between health care clinicians and lawyers to more effectively address issues impacting health care — have proliferated over the past decade. The goal of this interdisciplinary approach is to improve the health outcomes and quality of life of patients and families, recognizing the many non-medical influences on health care and thus the value of an interdisciplinary team to enhance health. This article examines the unique, interrelated ethical issues that confront the clinical and legal partners (...) involved in MLPs. We contend that the ethical precepts of the clinical and legal professions should be seen as opportunities, not barriers, to further the interdisciplinary nature of MLPs. The commonalities in ethical approaches represent a potential bridge between legal and health care advocacy for patient/client well-being. Bioethics has a role to play in building and analyzing this bridge: bioethics may serve as a discourse and method to enhance collaboration by highlighting common ethical foundations and refocusing legal and clinical partners on their similar goals of service for patients/clients. This article explores this bridging role of bioethics, through a series of case studies. It concludes with recommendations to strengthen the collaborations. (shrink)

Recent years have witnessed a concern among theological bioethicists that secular debate has grown increasingly "thin," and that "thick" religious traditions and their spokespersons have been correspondingly excluded. This essay disputes that analysis. First, religious and theological voices compete for public attention and effectiveness with the equally "thick" cultural traditions of modern science and market capitalism. The distinctive contribution of religion should be to emphasize social justice in access to the benefits of health care, challenging the for-profit global marketing of (...) research and biotechnology to wealthy consumers. Second, religion and theology have been and are still socially effective in sponsoring activism for practical change, both locally and globally. This claim will be supported with specific examples; with familiar concepts like subsidiarity and "mid- dle axioms"; and with recent analyses of "participatory democracy" and of emerging, decentralized forms of global governance. (shrink)

Despite increased philosophical and psychological work on practical wisdom, contemporary interdisciplinary wisdom research provides few specifics about how to develop wisdom (Kristjánsson 2022). This lack of practically useful guidance is due in part to the difficulty of determining how to combine the tools of philosophy and psychology to develop a plausible account of wisdom as a prescriptive ideal. Modeling wisdom on more ordinary forms of expertise is promising, but skill models of wisdom (Annas 2011; De Caro et al. 2018; Swartwood (...) 2013b; Tsai 2023) have been challenged on the grounds that there are important differences between wisdom and expert skills (Hacker-Wright 2015, p. 986; Kristjánsson 2015, pp. 98, 101; Stichter 2015, 2016, 2018). I’ll argue that we can both vindicate the promise of skill models of wisdom and begin to specify practically useful strategies for wisdom development by attending to a reflective process that I call Case-Based Critical Reflection. I begin by demonstrating the process as it arose in a notable example from everyday life, illustrating how the process can be usefully applied to a case study of interest to wisdom scientists, and explaining its philosophical pedigree. After isolating the key features that make it relevant to wisdom development, I argue that attending to the importance of Critical Reflection can defuse prominent objections to skill models of wisdom. (shrink)

While making an important point for a strong role of philosophers and philosophical work in bioethics, Blumenthal-Barby and colleagues (2022) fail to mention one of the most pressing tasks in this...

BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any (...) given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well. (shrink)

Narrative ethics taps into an inherent human need to tell our own stories centred on our own moral values and to have those stories heard and acknowledged. However, not everyone’s words are afforded equal power. The use of narrative ethics in bioethical decision-making is problematized by a disparity in whose stories are told, whose stories are heard, and whose stories are believed. Here, I conduct an analysis of narrative ethics through a critical theory lens to show how entrenched patterns of (...) narrative neglect in medicine are harming not only our capacity to make use of narrative ethics but also our capacity to deliver effective healthcare. To illustrate this point, I use three examples where the patient’s gender affects how their stories unfold: autism, weight, and pain management. From these, I argue that the use of narrative ethics without the application of a critical theory lens risks the exacerbation of what Miranda Fricker refers to as “testimonial injustice,” the prima facie harm experienced by individuals whose credibility is undermined by others’ prejudices. Finally, I suggest that narrative ethics can be a powerful tool for mitigating oppressive practices in medicine if we couple it with critical analysis that enables us to understand the power dynamics at play in storytelling. (shrink)

Many contemporary ethicists use case-based reasoning to reach consistent beliefs about ethical matters. The idea is that particular cases elicit moral intuitions, which provide defeasible reasons to believe in their content. However, most proponents of case-based moral reasoning are not very explicit about how they resolve inconsistencies and how they abstract principles from judgments about particular cases. The aim of this article is to outline a methodology—called Consistency Reasoning Casuistry—for case-based reasoning in ethics. This methodology draws on Richmond Campbell and (...) Victor Kumar’s naturalistic model for the resolution of inconsistencies between the content of intuitions about particular cases. I argue that reasons similar to those that motivate their model also support a more abstract form of moral reasoning that goes beyond mere resolutions of inconsistencies between case judgments and demands the formulation of more abstract moral norms. Consistency Reasoning Casuistry, it is argued, is a good candidate for a methodology for case-based moral reasoning that is in harmony with paradigms of contemporary moral psychology and that can accommodate the methodology implicit in the work of many contemporary ethicists. (shrink)

The integration of ethical analysis in Health Technology Assessment (HTA) has proven difficult to implement even though it is explicitly recognized as an important component of such assessments in HTA literature. When compared to the standardized scientific method for systematic reviews in HTA, the diversity of ethical analysis has been characterized as a fundamental barrier to the integration of ethics. The present paper aims to identify the theoretical and practical differences between the approaches underpinning ethical analysis in HTA and clarify (...) the reasons for such diversity. Our systematic review of HTA literature pertaining to the barriers to the integration of ethics in HTA identified nine ethical approaches: Principlism, Casuistry, Coherence Analysis, Wide Reflective Equilibrium, Axiology, the Socratic approach, the Triangular model, Constructive Technology Assessment and Social Shaping of Technology. Citations pertaining to each approach were extracted and categorized according to three constitutive components of ethical argumentation established in a previous research evaluating nanotechnologies: i) the disciplinary foundation that grounds the validity of the ethical evaluation, ii) the characteristics of such evaluation, iii) the operational process involved in applying it to a particular case (i.e., its practical reasoning). This comparison shows that, 1) the difference between these approaches rests primarily on their disciplinary foundation (rooted in philosophy, philosophy/theology, or sociology), 2) their complexity can be observed in the distinct characteristics of ethical evaluation deriving from their differing disciplinary foundation, and 3) although four different types of operationalization procedure were identified, little information was available in regards to the practical reasoning associated with these approaches. (shrink)

[1st paragraph] A philosophical discussion on evidence-based medicine (EBM) can be probably perceived almost as an oxymoron. How can “the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions” (Jenicek 2012: 23) be compatible with the critical and systematic examination of fundamental problems such as the nature of being, reality, thinking, values and perception? How can a scientific field focused mainly on the search and evaluation of evidence and aimed at solid quantifications of (...) hypotheses (Jenicek 2003: 70) be approachable from a perspective that is characterized by probable or defeasible arguments? The challenge of this special issue is to show how a philosophical perspective on evidence is not opposed to, but rather at the grounds of evidence-based medicine. (shrink)

The concept of evidence has gone unanalysed in much of the current debate between proponents and critics of evidence-based medicine. In this paper I will suggest that part of the controversy rests on an understanding of the word “evidence” that is too broad, and therefore contains the contradictions that allow both camps to defend their position and charge their adversaries. I will argue that reconciling the different meanings of the word ‘evidence’ in “evidence-based medicine” should help put EBM in its (...) rightful place. (shrink)

In her short story “Stable Strategies for Middle Management,” Eileen Gunn imagines a future in which Margaret, an office worker, seeks radical genetic enhancements intended to help her secure the middle-management job she wants. One source of the story’s tension and dark humor is dramatic irony: readers can see that the enhancements Margaret buys stand little chance of making her life go better for her; enhancing is, for Margaret, probably a prudential mistake. This paper argues that our positions in the (...) real world are sufficiently similar to Margaret’s position in Gunn’s fictional world that we should take this story seriously as grounding an argument from analogy for the conclusion that radical genetic enhancements are, for us, probably a prudential mistake. The paper then defends this method. When the question at hand is one of speculative ethics, there is no method better fit to the purpose than argument from analogy to speculative fiction. (shrink)

This paper addresses the question: Who or what can have a moral status in the sense that we have direct moral duties to them? It argues for a biocentric answer which ascribes inherent moral status value to all individual living organisms. This position must be defended against an anthropocentric position. The argument from marginal cases propounded by Tom Regan and Peter Singer for this purpose is criticised as defective, and a different argument is proposed. The biocentric position developed here is (...) related to that of Albert Schweitzer and Paul F. Taylor, but rejects their assumption of equal inherent value for all living organisms. It argues instead for equal moral status value for moral persons and agents, and gradual moral status value for nonpersons, depending on their degree of similarity with moral persons. Mary Ann Warren's recent book on Moral Status is also discussed. The argument is constructed as a casuistic argument, proceeding by analogical extension from persons to non-persons. The meta-ethical question of its pragmatic validity is discussed. (shrink)

Casuistry, which involves analogical reasoning, is a popular methodological approach in bioethics. The method has its advantages and challenges, which are widely acknowledged. Meta-philosophical reflection on exactly how bioethical casuistry works and how the challenges can be addressed is limited. In this paper we propose a framework for structuring casuistry and analogical reasoning in bioethics. The framework is developed by incorporating theories and insights from the philosophy of science: Mary Hesse’s ideas on horizontal and vertical relations in analogical reasoning in (...) the sciences, Paul Bartha’s articulation model of analogical reasoning and Daniel Steel’s insights on mechanism-based extrapolation in biomedical research. Adopting our framework results in two practical benefits: it sets methodological standards for analogical reasoning and enables us to compare and evaluate diverging lines of analogical reasoning in a systematic way. Adopting the framework also has theoretical benefits: it helps to understand how analogical reasoning can have moral normativity; it pinpoints exactly where moral principles or theories enter analogical reasoning; and it helps to understand why casuistry is an attractive method in bioethics and in applied ethics more generally. (shrink)

A traditional association of judgment with "reason" has drawn upon and reinforced an opposition between reason and emotion. This, in turn, has led to a restricted view of the nature of moral judgment and of the subject as moral agent. The alternative, I suggest, is to abandon the traditional categories and to develop a new theory of judgment. I argue that the theory of judgment developed by Justus Buchler constitutes a robust alternative which does not prejudice the case against emotion. (...) Drawing on this theory I then develop how to conceptualize the ways in which feeling and emotion can be (or be components of) moral judgments. (shrink)

We present here a new method for bioethics: systemic modelling. In this method, the complex phenomenon being studied (e.g. personalized medicine, genetic testing, gene therapy, genetically modified organisms) is modelled as a whole, to shed light on its organization and functioning, and major (bio)ethical issues and solutions for their resolution are then identified. This systemic modelling method is ideal for use in the identification of solutions, rather than their validation, with other methods then used to test the solutions found. We (...) provide a description and reproducible instructions for the application of systemic modelling in bioethics, together with a brief example of the application of this method to the study of the impact of personalized medicine on French society. (shrink)

Comparing frameworks for AI development allows us to see trends and reflect on how we are conceptualizing, interacting with, and imagining futures for AI. Recent scholarship comparing a range of AI frameworks has often focused methodologically on consensus, which has led to problems in evaluating potentially ambiguous values. We contribute to this scholarship using a rhetorical perspective attuned to how frameworks shape people’s actions. This perspective allows us to develop the concept of an “AI mainstream” through an analysis of five (...) of the highest-profile frameworks, including Asimov’s Three Laws. We identify four features of this emerging AI mainstream shared by most/all of the frameworks: human-centered design focus, abstraction-oriented ethical reasoning, privileged authorship, and ahistorical regulatory justifications. Notably, each of these features permeates each framework, rather than being limited to a single principle. We then evaluate these shared features and offer scholarly alternatives to complement and improve them. (shrink)

In her thorough and thoughtful contribution to theCambridge Quarterly of Healthcare Ethicstitled “Medical Ethics: Common or Uncommon Morality” Rosamond Rhodes argues that contrary to American mainstream bioethics, medical ethics is not, and should not be, based on common morality, but rather, that the medical profession requires its own distinctive morality.1She goes on to list sixteen duties that, according to her, form the core of medical ethics proper.

Contemporary casuistry, informed by a centuries-old intellectual tradition within the Jesuit order of the Catholic Church, characteristically maintains that ethical judgment does not rely on abstract laws, general rules or universal principles. Ethical judgment is formed through a subtle activity of comparing prior, settled cases with the current problem one is experiencing. Judgment on moral matters is therefore thought to be highly context-dependent and requires a sensitivity to the unique facts and social circumstances of each case. This discussion reviews the (...) origins of casuistry within Jesuit thought and then examines the implications of casuistry for organizational ethics. Our central argument is that contemporary casuistry, while correct to emphasize the particularity of ethical judgment, is nonetheless compatible with an important role for general principles in ethical decision-making within organizations. (shrink)

Researchers in applied ethics, and some areas of bioethics particularly, aim to develop concrete and appropriate recommendations for action in morally relevant real-world situations. When proceeding from more abstract levels of ethical reasoning to such concrete recommendations, however, even with regard to the very same normative principle or norm, it seems possible to develop divergent or even contradictory recommendations for action regarding a certain situation. This may give the impression that such recommendations would be arbitrary and, hence, not well justified. (...) Against this background, we, first, aim at showing that ethical recommendations for action, although being contingent in some sense, are not arbitrary if developed appropriately. For this purpose, we examine two types of contingencies arising in applied ethics reasoning based on recent examples of recommendations for action in the context of the COVID-19 pandemic. In doing so, we refer to a three-step model of ethical reasoning towards recommendations for actions. This, however, leaves open the question of how applied ethics may cope with contingent recommendations for action. Therefore, in a second step, we analyze the role of bridge principles for developing ethically appropriate recommendations for action, i.e., principles which connect normative claims with relevant empirical information to justify certain recommendations for action in a given morally relevant situation. Finally, we discuss some implications for reasoning and reporting in empirically informed ethics. (shrink)

In this important and timely work, Gary Saul Morson and Morton Schapiro examine the current and growing prevalence of dogmatic, intellectually rigid forms of thought—so-called “Fundamentalisms”—whi...

This essay addresses the questions, “what good is religious ethics for?” and “what justification exists for the field?” in three steps. First, it canvases how religious ethicists have offered reasons for carrying out work in the field to identify anAnti‐Reductive Paradigmthat is guided by anEgalitarian Imperative. That imperative functions as a thin, minimal morality of inclusivity and equal respect that guides work in the field. Second, the essay considers the field's ends. Here the focus shifts from values that shape the (...) field'smethodsto values that can describe the field'spurposes. That shift requires us to think in terms of a thick rather than a thin morality, one with substantive rather than procedural virtues in mind. The essay offers a constructive, substantive proposal under the rubric ofCritical Humanism. Critical Humanism justifies the study of religious ethics as an enterprise that can expand the moral imagination through its encounter with difference. It is shaped by four values: post‐critical reasoning, social criticism, cross‐cultural fluency, and environmental responsibility. Third, the essay brings the two parts of the argument together by explaining how to connect such purposes to the thin morality of inclusivity and equal respect. One upshot of the essay is to have us think not only about values, but also about power as it pertains to scholarship in the guild; hence the attention to the ethics and politics of religious ethics. (shrink)

Definition of the problemFrom an ethical point of view we analyse the ruling of the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA) of September 2019 to revise the guidelines about the coverage of noninvasive prenatal tests (NIPT) by mandatory health insurance, in order to include them under specified conditions. The decision contains four essential elements: a definition of the aim of NIPT testing (to avoid invasive testing), a criterion of access (test must be “necessary” for the pregnant woman to tackle (...) her individual situation), statements about the process of decision-making (after counselling by a physician and case by case) and a normative contextualization (termination of pregnancy under § 218 a German penal law) which is to be found in its explanations. There are tensions in the proposed model that oscillate about two axes: (1) The suffering that results from a possible birth of a child with trisomy or from not knowing about the genetic condition of the fetus can ultimately only be evaluated subjectively, from the perspective of the pregnant woman. (2) The meaning of an individual decision in the case-by-case model remains unclear because when judging about individual cases general points of view also need to be considered. However, we argue that the model of the G‑BA could be a sociopolitically and ultimately also ethically defensible pragmatic solution, exactly because of its paradoxes and its inherent flexibility. (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

This paper considers the UN efforts to introduce a legally binding Treaty on corporate accountability for human rights impacts in the context of other proposed legislation at country level, on the one hand, and existing voluntary initiatives like the UN Guiding Principles (2011), on the other. What we are interested in is whether the proposed Treaty signals a transition from voluntary initiatives (based on moral commitments) to law (that is, a focus on compliance), and the extent to which it might (...) stimulate or hinder links between judicial and non-judicial initiatives. The scholars who have explicitly addressed these two divides are – Michael Sandel, on theory v. practice; and Amartya Sen, on law v. morality. We engage with their views, in sections II and III respectively, seeking to build an integrated approach to help us overcome these dualisms. We further consider John Ruggie’s “principled pragmatism”, a strategy that he uses to build the Protect, Respect and Remedy (henceforth, PRR) Framework; and we invoke arguments from casuistry as well as a practice-focused deontology (Thomas Donaldson’s) in favour of an ethics ‘beyond cognition’, which we consider better suited than either utilitarian or principle-based theories to guide the debate on human rights. This is because it allows us to take non-rational factors into account (such as emotions and personal affiliations), when judging the kind of common good we consider worth pursuing. In the last section of the paper, we investigate whether and how might the Treaty illustrate the two divides, trying to (a) distinguish between purely legal elements and those of a wider nature, to do with morality; and (b) understand what might help bridge the gap between theoretical commitments to the universality of human rights and various practical challenges. Our aim is not to evaluate the Treaty, from a legal viewpoint, or suggest improvements to it (lawyers are better placed to do that); rather, we seek to investigate the way in which the proposed Treaty – which is the first attempt to address the challenge of transnational business and human rights in international law – combines moral and legal aspects, and what this tells us about the world we live in. (shrink)

This article elaborates on the relation between ethical casuistry and common law reasoning. Despite the frequent talk of casuistry as common law morality, remarks on this issue largely remain at the purely metaphorical level. The article outlines and scrutinizes Albert Jonsen and Stephen Toulmin’s version of casuistry and its basic elements. Drawing lessons for casuistry from common law reasoning, it is argued that one generally has to be faithful to ethical paradigms. There are, however, limitations for the binding force of (...) paradigms. The most important limitations—the possibilities of overruling and distinguishing paradigm norms—are similar in common law and in casuistry, or so it is argued. These limitations explain why casuistry is not necessarily overly conservative and conventional, which is one line of criticism to which casuists can now better respond. Another line of criticism has it that the very reasoning from case to case is extremely unclear in casuistry. I suggest a certain model of analogical reasoning to address this critique. All my suggestions to understand and to enhance casuistry make use of common law reasoning whilst remaining faithful to Jonsen and Toulmin’s main ideas and commitments. Further developed along these lines, casuistry can appropriately be called “common law morality.”. (shrink)

This essay argues on behalf of a hybrid theory for an ethics of self-defense understood as the Forfeiture-Partiality Theory. The theory weds the idea that a malicious attacker forfeits the right to life to the idea that we are permitted to prefer one's life to another's in cases of involuntary harm or threat. The theory is meant to capture our intuitions both about instances in which we can draw a moral asymmetry between attacker and victim and cases in which we (...) cannot. I develop the theory by attending to instances of intentional, villainous harm and instances of involuntary danger—the latter of which are a matter of bad luck. I call some bad luck cases "Interpersonal Lottery Conflicts." These cases refer to potentially lethal conflicts into which parties are thrown as victims of circumstance. Although neither party has a moral advantage over another, that fact does not preclude permissible self-defense. (shrink)

Any fundamental examination of managerial practices must consider a philosophical conundrum at the heart of market exchange. Economically, the opportunity for profit seems to demand somebody else’s loss, and ethically, we must not take advantage of others’ misfortune. In a market system involving a multiplicity of stakeholders, profit opportunities may arise in which relationships between winners and losers are distant, indirect, or even nonexistent; their motives are multivalent; and their market participation may be intentional or accidental. Reflecting two decades later (...) upon several cases arising from the 9/11/2001 terrorist attacks, this paper describes several examples of profiting from loss that demonstrate the ubiquity and variety of the problem. It also invokes numerous bodies of literature that demonstrate the inherent complexity and interdisciplinarity of the problem and the absence of determinative principles to answer the question of when it is justifiable to profit from loss. The paper positions casuistry, the ancient philosophical art of case analysis that resembles modern business pedagogy, as a complement to ethical theory. The Loss Agency-Division of Benefits framework developed in the paper demonstrates the value of philosophy to managerial practices when economic theory is insufficient for ethically classifying and evaluating forms of profiting from loss. (shrink)

Die Frage nach den Faktoren, die eine wirksame Ethik-Lehre in der Medizin ausmachen, blieb bislang weitgehend unbeantwortet. Vor allem im deutschsprachigen Raum wird hier zu wenig Forschung betrieben. Aufgrund fehlender wissenschaftlich aussagekräftiger Evaluationsstudien lässt sich somit mitunter nur vermuten, wie wirksam bestimmte Lehrformate und -methoden in der Ethik-Lehre tatsächlich sind. Die Auswahl von Lehrformaten und -methoden, die Ethik-Dozierende für das Erreichen eines festgelegten Lernziels einsetzen, wird häufig nicht nach evidenzbasierten Kriterien, sondern auf der Grundlage von guten oder schlechten Lehrerfahrungen sowie (...) von unmittelbarem Feedback der Studierenden getroffen. Im vorliegenden Beitrag werden nach einem kurzen Überblick über Evaluationsverfahren ethischer Kompetenzen Erkenntnisse aus ausgewählten internationalen Wirksamkeitsstudien vorgestellt und auf ihre Relevanz für den Medizinethik-Unterricht diskutiert. Wenngleich die Erkenntnisse aus diesen Evaluations- und Meta-Studien aus anderen, angrenzenden Bereichen wie der Forschungsethik und anderen Lehrkontexten kommen, so können sie doch als Diskussionsanstoß dienen und dazu beitragen, Eckpunkte für die Gestaltung wirksamer Ethik-Lehre in der Medizin im deutschsprachigen Raum zu definieren. (shrink)

ProblemThe question of what factors drive the effectiveness of ethics teaching in medicine has remained largely unanswered in German-speaking countries. Due to the lack of scientifically sound evaluation studies, it is sometimes only possible to assume how effective certain teaching formats and methods actually are in ethics courses. The selection of teaching formats and methods that ethics lecturers use to achieve a specified learning objective is often not made according to evidence-based criteria, but on the basis of positive or negative (...) teaching experiences and direct feedback from students.Methods and argumentsIn this article, after a brief overview of evaluation procedures of ethical competences, findings from selected international effectiveness studies are presented and discussed in terms of their relevance for teaching medical ethics.Results and conclusionAlthough the findings from these evaluation and meta-studies come from other, related fields such as research ethics and other teaching contexts, they can serve as an impetus for discussion and contribute to defining cornerstones in order to design effective ways to teach ethics in medicine in the German-speaking countries. (shrink)

The article is dedicated to the application questions of a case study method known as casuistry. In its long tradition, it focuses on an influential variant of the early modern period and reconstructs its functionality. In the course of reading recent receptions, it is noted that some studies speak of a “casuistic revival” in moral case deliberation in health care. As a result of this revival, casuistry has been modified in such a way that it guides case discussions in practice (...) with the help of a tripartite methodology. However, as it turns out, casuistry, a case comparison method of ethical judgement based on reasoning logic, is less suitable for moral case deliberations in direct patient care. This stems from the fact that casuistry is a detailed procedure of ethical learning beneficial to institutionalized ethics committees or similar forms of ethics consultation in health care. (shrink)

In 1785, George Washington described a “knowing farmer” as “one who can convert every thing he touches into manure, as the first transmutation towards Gold.” With these words, Washington linked the “knowing farmer” to the alchemist who endeavored to transform base metals into gold with the aid of a philosopher's stone. In each instance, the challenge was to convert raw materials into something new and precious.Today, the “knowing bioethicist” is in a similar position. American bioethics harbors a variety of ethical (...) methods that emphasize different ethical factors, including principles, circumstances, character, interpersonal needs, and personal meaning. Each method reflects an important aspect of ethical experience, adds to the others, and enriches the ethical imagination. (shrink)

In 1785, George Washington described a “knowing farmer” as “one who can convert every thing he touches into manure, as the first transmutation towards Gold.” With these words, Washington linked the “knowing farmer” to the alchemist who endeavored to transform base metals into gold with the aid of a philosopher's stone. In each instance, the challenge was to convert raw materials into something new and precious.Today, the “knowing bioethicist” is in a similar position. American bioethics harbors a variety of ethical (...) methods that emphasize different ethical factors, including principles, circumstances, character, interpersonal needs, and personal meaning. Each method reflects an important aspect of ethical experience, adds to the others, and enriches the ethical imagination. (shrink)

So much philosophical theory is irrelevant for the practice of ethics! How many wasted volumes of tortuous arguments and counterarguments have been written in search of an elusive theory of ethics that could be applied deductively, without modification, to produce “correct” answers under all circumstances to any ethical problem? The practice of ethics is much closer to the common sense casuistry approach outlined by Jonsen and Toulmin, in which we work from. intuitively grasped, paradigm, cases by way of analogy to (...) provide presumptive answers to more complex problems. Alasdair Maclntyre argued however that we cannot trust such individualistic intuitive judgements. Thus we should start by looking at his critique of modern ethics. (shrink)

If there is one ethical concept considered to be central to human social life it is the idea of justice. Although there are several competing principles of justice, the core concept of justice embodies the obligation to treat like cases alike, in relevant respects. Women may differ from men in some respects, but the fact that women get sick, become injured, and die from preventable causes renders them similar to men in the need to carry out biomedical research, develop therapies, (...) and attend to health problems specific to women. An ethical perspective on women’s health begins and ends with principles of justice. Although particular circumstances and conditions differ in developed and less developed countries, the ethical conclusions regarding justice are the same for women in all societies. (shrink)

If there is one ethical concept considered to be central to human social life it is the idea of justice. Although there are several competing principles of justice, the core concept of justice embodies the obligation to treat like cases alike, in relevant respects. Women may differ from men in some respects, but the fact that women get sick, become injured, and die from preventable causes renders them similar to men in the need to carry out biomedical research, develop therapies, (...) and attend to health problems specific to women. An ethical perspective on women’s health begins and ends with principles of justice. Although particular circumstances and conditions differ in developed and less developed countries, the ethical conclusions regarding justice are the same for women in all societies. (shrink)

This paper consists of a story about unorthodox assessment procedures in theology, and a discussion of their implications. Among the issues raised are the possibility of testing values, the relationship of test validity to test reliability and ethical questions involved in assessment.

BackgroundCurrently a variety of novel scenarios have appeared within nursing practice such as confidentiality of a patient victim of abuse, justice in insolvent patients, poorly informed consent delivery, non-satisfactory medicine outputs, or the possibility to reject a recommended treatment. These scenarios presuppose skills that are not usually acquired during the degree. Thus, the implementation of teaching approaches that promote the acquisition of these skills in the nursing curriculum is increasingly relevant.ObjectiveThe article analyzes an academic model which integrates in the curriculum (...) a series of specific theoretical concepts together with practical skills to acquire the basic ethic assessment competency.Research designThe project includes designing two subjects, General Anthropology and Ethics-Bioethics, with an applied approach in the nursing curriculum. The sequential structure of the curriculum in both subjects is constituted by three learning domains (theoretical, practical, and communicative) with different educational strategies.Ethical considerationsNo significant ethical considerations as this is a discussion paper.FindingsThe model was structured from the anthropology’s concepts and decision-making process, applied to real situations. The structure of the three domains theoretical–practical–communicative is present in each session.DiscussionIt is observed that theoretical domain fosters the capacity for critical analysis and subsequent ability to judge diverse situations. The practical domain reflected two significant difficulties: students’ resistance to internalizing moral problems and the tendency to superficial criticism. The communicative domain has frequently shown that the conflicting points are in the principles to be applied.ConclusionWe conclude that this design achieves its objectives and may provide future nursing professionals with ethical competences especially useful in healthcare practice. The three domains of the presented scheme are associated with the same process used in decision making at individual levels, where the exercise of clinical prudence acquires particular relevance. (shrink)

The Spanish future subjunctive demonstrates how linguistics can inform modern language policy. The FS is described as an archaism to be eliminated from contemporary legal texts. We analyze a corpus of over 3000 tokens of the FS in Spanish legal texts dated between the 13th and 16th century. The FS has two functions in legal discourse. The casuistic function allows for indicating paradigmatic subordination; the forwarding function introduces new information. Our quantitative results suggest an increase in the usage frequency of (...) the FS in legal discourse, where an inverse trend appears in other genres. As shown by a linear regression analysis, the FS started appearing significantly closer to the beginning of the law article, indicating an increase in the forwarding function in time. In view of our results, reformers of legal Spanish should consider the functions of the FS in legal discourse when advising its suppression. (shrink)

The question of whether the normative testimony of ethics experts should be admissible under the rules of evidence has been the subject of much debate. Professor Imwinkelried's paper is an effort to get us, for a moment, to change that subject. He seeks to turn our attention, instead, to a means by which bioethics experts’ normative analyses might come before the court without regard to the rules of evidence - a means lying formally outside those rules’ jurisdiction. The court, he (...) argues, may freely consider evidence from expert bioethicists so long as it is performing a legislative rather than an adjudicative function. The rules of evidence apply to the court's efforts to find the facts of a particular case, Imwinkelried argues, but they do not constrain the court's investigations relative to its creative law-making efforts. (shrink)

The question of whether the normative testimony of ethics experts should be admissible under the rules of evidence has been the subject of much debate. Professor Imwinkelried's paper is an effort to get us, for a moment, to change that subject. He seeks to turn our attention, instead, to a means by which bioethics experts’ normative analyses might come before the court without regard to the rules of evidence - a means lying formally outside those rules’ jurisdiction. The court, he (...) argues, may freely consider evidence from expert bioethicists so long as it is performing a legislative rather than an adjudicative function. The rules of evidence apply to the court's efforts to find the facts of a particular case, Imwinkelried argues, but they do not constrain the court's investigations relative to its creative law-making efforts. (shrink)

Abstract: Particularism is usually understood as a position in moral philosophy. In fact, it is a view about all reasons, not only moral reasons. Here, I show that particularism is a familiar and controversial position in the philosophy of science and mathematics. I then argue for particularism with respect to scientific and mathematical reasoning. This has a bearing on moral particularism, because if particularism about moral reasons is true, then particularism must be true with respect to reasons of any sort, (...) including mathematical and scientific reasons. (shrink)

Socrates op de markt, Filosofie in bedrijf was first published in the Netherlands in 1997 and reprinted in 1999.1 It was translated into German and published in Germany in late 2000. The book covers the need today for Socratic dialogue, its methods, its uses and related concepts. These include elenchus (the refutation of what one thought one knew); maieutics (Socratic midwifery making latent knowledge conscious); the relationship of knowledge to feeling, virtue and the formation of personality; and the distinction between (...) three types of knowledge: scientific (episteme), professional (techne) and practical wisdom (phronesis). Our extracts — the first in English — set out Kessels’ arguments for using Socratic dialogue today, his account of its unique role in organisational learning, and a case history: a dialogue with a top management team in which elenchus plays a signal part as they seek to define a policy for handling redundancies. (shrink)

Software systems play an ever more important role in our lives and software engineers and their companies find themselves in a position where they are held responsible for ethical issues that may arise. In this paper, we try to disentangle ethical considerations that can be performed at the level of the software engineer from those that belong in the wider domain of business ethics. The handling of ethical problems that fall into the responsibility of the engineer has traditionally been addressed (...) by the publication of Codes of Ethics and Conduct. We argue that these Codes are barely able to provide normative orientation in software development. The main contribution of this paper is, thus, to analyze the normative features of Codes of Ethics in software engineering and to explicate how their value-based approach might prevent their usefulness from a normative perspective. Codes of Conduct cannot replace ethical deliberation because they do not and cannot offer guidance because of their underdetermined nature. This lack of orientation, we argue, triggers reactive behavior such as “cherry-picking,” “risk of indifference,” “ex-post orientation,” and the “desire to rely on gut feeling.” In the light of this, we propose to implement ethical deliberation within software development teams as a way out. (shrink)

In this paper, we present and defend the theoretical framework of an empirical model to describe people’s fundamental moral attitudes (FMAs) to animals, the stratification of FMAs in society and the role of FMAs in judgment on the culling of healthy animals in an animal disease epidemic. We used philosophical animal ethics theories to understand the moral basis of FMA convictions. Moreover, these theories provide us with a moral language for communication between animal ethics, FMAs, and public debates. We defend (...) that FMA is a two-layered concept. The first layer consists of deeply felt convictions about animals. The second layer consists of convictions derived from the first layer to serve as arguments in a debate on animal issues. In a debate, the latter convictions are variable, depending on the animal issue in a specific context, time, and place. This variability facilitates finding common ground in an animal issue between actors with opposing convictions. (shrink)

To paraphrase Lewis Carroll’s poem “The Walrus and the Carpenter” from his Through the Looking Glass, “The time has come to talk of many things.” Not as the Walrus did in the nursery rhyme, “of sho...

The aim of the paper is that of investigating the concept of “person” in the context of Italian law on informed consent and advance healthcare directives. The following paper will first consider the importance of the concept of “person” within bioethics; secondly it will exhibit how there are different levels of bioethics, and that on the discussion level of laws and regulations, concepts worthy of metaphysical and value references cannot be used, because they must be shared by everyone in a (...) pluralistic society. I’ll then move on to discuss the law on informed consent and advance healthcare directives; first I’ll discuss the references to the Italian Constitution, showing that the implied concept of “person” is closely linked to the concepts of “equality” and “autonomy”, and finally I’ll discuss the particular case of minors and the protection that the law provides them. (shrink)

Citizen science (CS) has been presented as a novel form of research relevant for social concerns and global challenges. CS transforms the roles of participants to being actively involved at various stages of research processes, CS projects are dynamic, and pluralism arises when many non-professional researchers take an active involvement in research. Some argue that these elements all make existing research ethical principles and regulations ill-suited for guiding responsible CS conduct. However, while many have sought to highlight such challenges from (...) CS, few have discussed principles per se providing the foundation for regulations. In this article we will investigate the possibilities of midlevel principlism in guiding responsible CS conduct. Principlism has the potential of accommodating many of the concerns taken to reduce the relevance of existing principles. (shrink)