Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of confusion as to what really (...) is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)

Deprescribing is the term used to describe the process of withdrawal of an inappropriate medication supervised by a clinician. This article presents a discussion of how the Four Principles of biomedical ethics that may guide medical practitioners’ prescribing practices apply to deprescribing medications in older adults. The view of deprescribing as an act creates stronger moral duties than if viewed as an omission. This may explain the fear of negative outcomes which has been reported by prescribers as a barrier to (...) deprescribing. Respecting the autonomy of older adults is complex as they may not wish to be active in the decision-making process; they may also have reduced cognitive function and family members may therefore have to step in as surrogate decision-makers. Informed consent is intended as a process of information giving and reflection, where consent can be withdrawn at any time. However, people are rarely updated on the altered risks and benefits of their long-term medications as they age. Cessation of inappropriate medication use has a large financial benefit to the individual and the community. However, the principle of justice also dictates equal rights to treatment regardless of age. (shrink)

As media reports have made widely known, in November 2009, the ethics committee of St. Joseph’s Hospital in Phoenix, Arizona, permitted the abortion of an eleven-week-old fetus in order to save the life of its mother. This woman was suffering from acute pulmonary hypertension, which her doctors judged would prove fatal for both her and her previable child. The ethics committee believed abortion to be permitted in this case under the so-called principle of double effect, but Thomas J. Olmsted, the (...) bishop of Phoenix, disagreed with the committee and pronounced its chair, Sister Margaret McBride, excommunicated latae sententiae, “by the very commission of the act.” In this article, I take the much discussed Phoenix case as an occasion to subject the principle of double effect to another round of philosophical scrutiny. In particular, I examine the third condition of the principle in its textbook formulation, namely, that the evil effect in question may not be the means to the good effect. My argument, in brief, is that the textbook formulation of the principle does not withstand philosophical scrutiny. Nevertheless, in the end, I do not claim that we should then “do away” with the principle altogether. Instead, we do well to understand it within the context of casuistry, the tradition of moral reasoning from which it issued. (shrink)

Discussing the workings of technology in care as aesthetic rather than as ethical or epistemological interventions focusses on how technologies engage in and change relations between those involved. Such an aesthetic study opens up a repertoire to address values that are abundant in care, but are as yet hardly theorized. Kamphof studies the problem that sensor technology reveals things about the elderly patients without the patients being aware of this. I suggest improvement of these relations may be considered in aesthetic (...) terms, for instance by developing the affective quality of people’s technological relationships. (shrink)

The use of case-based reasoning in teaching professional ethics has come of age. The fields of medicine, engineering, and business all have incorporated ethics case studies into leading textbooks and journal articles, as well as undergraduate and graduate professional ethics courses. The most recent guidelines from the National Institutes of Health recognize case studies and face-to-face discussion as best practices to be included in training programs for the Responsible Conduct of Research. While there is a general consensus that case studies (...) play a central role in the teaching of professional ethics, there is still much to be learned regarding how professionals learn ethics using case-based reasoning. Cases take many forms, and there are a variety of ways to write them and use them in teaching. This paper reports the results of a study designed to investigate one of the issues in teaching case-based ethics: the role of one’s professional knowledge in learning methods of moral reasoning. Using a novel assessment instrument, we compared case studies written and analyzed by three groups of students whom we classified as: Experts in a research domain in bioengineering. Novices in a research domain in bioengineering. The non-research group—students using an engineering domain in which they were interested but had no in-depth knowledge. This study demonstrates that a student’s level of understanding of a professional knowledge domain plays a significant role in learning moral reasoning skills. (shrink)

Stuart Russell defines the value alignment problem as follows: How can we build autonomous systems with values that “are aligned with those of the human race”? In this article I outline some distinctions that are useful for understanding the value alignment problem and then propose a solution: I argue that the methods currently applied by computer scientists for embedding moral values in autonomous systems can be improved by representing moral principles as conceptual spaces, i.e. as Voronoi tessellations of morally similar (...) choice situations located in a multidimensional geometric space. The advantage of my preferred geometric approach is that it can be implemented without specifying any utility function ex ante. (shrink)

The Ethics of Technology: A Geometric Analysis of Five Moral Principles proposes five moral principles for analyzing ethical issues related to engineering and technology. The objections raised by several authors to the multidimensional scaling technique used in the book reveal a lack of familiarity with this widely used technique.

The misunderstanding of philosopher Immanuel Kant's principle of morality - the categorical imperative - by journalism professionals, professors, and students comes in many forms. To better understand Kant's ethical theory, however, one must go beyond Kant's Groundwork for the Metaphysics of Morals and study his Doctrine of Virtue: Part 2 of The Metaphysics of Morals; to apply the categorical imperative, one must also understand the importance Kant placed on moral education.

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)

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)

Professional work is currently based on explicit knowledge and evidence to a greater degree than in the past. Standardising professional services in this way requires repetitive scenarios and might be seen as a challenge to professional autonomy. In the context of policing, officers perform a range of familiar tasks, but they may also encounter novel challenges at any moment. Moreover, police tasks are not well-defined. Therefore, many missions require police officers to rely on common sense, tacit knowledge or gut feeling. (...) In this article, I argue that a values-based methodology may serve as a tool to help evaluate decisions in unfamiliar situations, to learn from experience, as well as be a quality control for established routines. _Keywords:_ ethics, policing, decision-making, values, experiential learning routines. (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)

It seems intuitive to the believer that God intended through instruction in the Law to define morality, intended to lead humankind to “the right and the good.” Further, God's love for humankind, exemplified by the incarnation, atonement and teachings of Jesus, and empowered by the Holy Spirit, should lead to a better world. Indeed, the Christian worldview is a coherent and valid way to look at bioethical issues in public policy and at the bedside. Yet, as this paper explores, in (...) a pluralistic society such as the United States, it is neither possible nor desirable for Christians to try to force their views on others. Still, it is obligatory for Christians to stand up and articulate their views in the public square. We should try to persuade others using either prudential or moral arguments. While we must be willing to live with “the will of the people,” at the same time, we must not be intimidated into accepting the position that our voice is not valid because it has a religious basis. (shrink)

The objective of this article is to analyse and compare four methods of ethical case deliberation. These include Clinical Pragmatism, The Nijmegen Method of ethical case deliberation, Hermeneutic dialogue, and Socratic dialogue. The origin of each method will be briefly sketched. Furthermore, the methods as well as the related protocols will be presented. Each method will then be evaluated against the background of those situations in which it is being used. The article aims to show that there is not one (...) ideal method of ethical case deliberation, which fits to all possible kinds of moral problems. Rather, as each of the methods highlights a limited number of morally relevant aspects, each method has its strengths and weaknesses as well. These strengths and weaknesses should be evaluated in relation to different types of situations, for instance moral problems in treatment decisions, moral uneasiness and residue, and the like. The suggestion arrived at on the basis of the findings of this paper is a reasonable methodological plurality. This means that a method can be chosen depending on the type of moral problem to be deliberated upon. At the same time it means, that by means of a method, deliberation should be facilitated. (shrink)

Cognitive semantics has made important empirical findings about human conceptualization. In this paper some findings concerning moral concepts are analyzed and their implications for medical ethics discussed. The key idea is that morality has to do with metaphors and imagination rather than with well-defined concepts and deduction. It is argued that normative medical ethics to be psychologically realistic should take these findings seriously. This means that an imaginative casuistry is to be preferred compared to principlism and to other forms of (...) casuistry. Furthermore, the metaphorical character of central principles in medical ethics such as autonomy, utility, justice, and integrity is indicated. Such principles are interpreted as rules of thumb summarizing the collective wisdom concerning prototype cases. (shrink)

The last forty years have produced a dramatic reversal in leading accounts of science. Once thought necessary to (explain) scientific progress, a rigid method of science is now widely considered impossible. Study of products yields to study of processes and practices, .unity gives way to diversity, generality to particularity, logic to luck, and final justification to heuristic scaffolding. I sketch the story, from Bacon and Descartes to the present, of the decline and fall of traditional scientific method, conceived as The (...) Central Planning Bureau for Science or as Rationality Czar. I defend a deflationary account of method and of rational judgment,. with emphasis on heuristic appraisal and cognitive economy. (shrink)

Vom biblischen Gleichnis des barmherzigen Samariters über die Stilisierung von Figuren wie Mahatma Gandhi bis hin zur medialen Inszenierung von Spendengalas oder heldenhaften Rettungsaktionen – unsere Kultur- und Zeitgeschichte kennt viele Erzählungen von Personen, die anscheinend mehr tun, als moralisch geboten ist und denen dafür hohe Anerkennung zukommt. Aber auch im Alltag werden wir mit Handlungsweisen konfrontiert, die wir in besonderem Maße lobenswert finden, deren Unterlassung hingegen nicht tadelnswert; man denke etwa an besondere Freundlichkeit, Akte des Verzeihens oder auch ehrenamtliche (...) Leistungen. Diese Phänomene scheinen – wenigstens in westlichen Kulturkreisen – einen wichtigen Teil der moralischen Erfahrungen auszumachen. Um unserer moralischen Praxis an dieser Stelle Rechnung zu tragen, wird oftmals so argumentiert, dass diese Phänomene eine eigenständige Handlungskategorie konstituierten, nämlich die der Supererogation. Unter supererogatorischen Handlungen werden dabei solche verstanden, die zwar moralisch gut, nicht jedoch moralisch geboten sind. Dabei ist auffällig, dass die Supererogationsdebatte wie kaum eine andere in der Moralphilosophie durch die Erzählung von konkreten Fällen geprägt zu sein scheint, doch was sollen und was können diese in methodischer Hinsicht leisten und was nicht? Es wird zunächst gezeigt, dass diesen mindestens drei Funktionen zukommen: erstens dienen sie der Veranschaulichung und Etablierung des Forschungsgegenstandes; zweitens dienen sie als Bezugspunktes für bestimmte moralische Intuitionen und Praxen und somit gleichsam der intuitiven Unterstützung von Existenzargumenten einer Kategorie der Supererogation; drittens dienen sie als Reflexionsmediums zur Untersuchung des Konzepts der Supererogation. Der Verweis auf konkrete Fälle unserer moralischen Praxis mag nun zweifelsohne Anlass dazu geben, sich mit den Phänomenen im Rahmen moralphilosophischer Überlegungen auseinanderzusetzen, jedoch ist er für sich betrachtet nicht hinreichend dafür, Supererogation als Handlungskategorie zu etablieren. Die eigentliche Leistungsfähigkeit, so die hier vertretene These, entwickeln die Erzählungen konkreter Fälle mit Blick auf ihren Beitrag zur Konzeptanalyse. Solche narrativen Theorieelemente lassen sich an dieser Stelle nicht ohne weiteres aussparen, da supererogatorische Handlungen am besten als Grenzsituationen des moralischen Handelns zu verstehen sind. Vermittelt über Erzählungen lässt sich daher erst ein umfassender Zugang zu den Phänomenen und insbesondere der Perspektive der Handelnden selbst erlangen. (shrink)

Nanoparticles have multifaceted advantages in drug administration as vaccine delivery and hence hold promises for improving protection of farmed fish against diseases caused by pathogens. However, there are concerns that the benefits associated with distribution of nanoparticles may also be accompanied with risks to the environment and health. The complexity of the natural and social systems involved implies that the information acquired in quantified risk assessments may be inadequate for evidence-based decisions. One controversial strategy for dealing with this kind of (...) uncertainty is the precautionary principle. A few years ago, an UNESCO expert group suggested a new approach for implementation of the principle. Here we compare the UNESCO principle with earlier versions and explore the advantages and disadvantages by employing the UNESCO version to the use of PLGA nanoparticles for delivery of vaccines in aquaculture. Finally, we discuss whether a combined scientific and ethical analysis that involves the concept of responsibility will enable approaches that can provide a supplement to the precautionary principle as basis for decision-making in areas of scientific uncertainty, such as the application of nanoparticles in the vaccination of farmed fish. (shrink)

Autumn Fiester (2015) argues that when an ethics consult simply issues a recommendation it may leave a vacuum then filled by moral distress or moral emotion. “Assisted conversation”—a dialogue-focu...

Consensus is commonly identified as the goal of ethics committee deliberation, but it is not clear what is morally authoritative about consensus. Various problems with the concept of an ethics committee in a health care institution are identified. The problem of consensus is placed in the context of the debate about realism in moral epistemology, and this is shown to be of interest for ethics committees. But further difficulties, such as the fact that consensus at one level of discourse need (...) not imply consensus at another, oblige us to look more closely at the deliberative process itself. That yields two complementary methods of deliberation that have proven their worth. Finally, placing ethics committees in the context of Dewey's philosophy of social intelligence suggests that consensus should be regarded primarily as a condition rather than as the goal of inquiry. Keywords: ethics committee, consensus, moral authority CiteULike Connotea Del.icio.us What's this? (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)

The use of platelet rich plasma as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013–16 seasons. Analysis of the data produced several overarching themes: conservatism versus experimentalism in medical attitudes; therapy perspectives divergence; conflicting versions of appropriate evidence; subcultures; community beliefs/practices; and negotiation of medical decision-making. The contested evidence base for the efficacy of PRP is presented (...) in the context of a broader professional shift towards evidence based medicine within sports medicine. Many of the participants while accepting this shift are still committed to casuistic practices where clinical judgment is flexible and does not recognize a context-free hierarchy of evidentiary standards to ethically justifiable practice. We also discuss a tendency in the data collected to consider the use of deceptive, placebo-like, practices among the clinician participants that challenge dominant understandings of informed consent in medical ethics. We conclude that the complex relation between evidence and ethics requires greater critical scrutiny for this emerging specialism within the medical community. (shrink)

The six papers in the 2014 clinical ethics number of the Journal get us back to the basics in the work of clinical ethics and clinical ethicists: getting clear about concepts that should be used in achieving deliberative clinical ethics. The papers explore the concepts of the best interests of the patient, health and disease understood in their proper relationship to autonomy in our species, the therapeutic obligation, and the therapeutic imperative. The final paper appraises the systematic review, a scholarly (...) tool for tracking the basic concepts of clinical ethics in the literature. (shrink)

The empirical basis for this article is threeyears of experience with ethical rounds atUppsala University Hospital. Three standardapproaches of ethical reasoning are examined aspotential explanations of what actually occursduring the ethical rounds. For reasons given,these are not found to be satisfyingexplanations. An approach called ``imaginativeethics'', is suggested as a more satisfactoryaccount of this kind of ethical reasoning. Theparticipants in the ethical rounds seem to drawon a kind of moral competence based on personallife experience and professional competence andexperience. By listening to (...) other perspectivesand other experiences related to one particularpatient story, the participants imaginealternative horizons of moral experience andexplore a multitude of values related toclinical practice that might be at stake. Inhis systematic treatment of aesthetics in theCritique of Judgement, Kant made use ofan operation of thought that, if applied toethics, will enable us to be more sensitive tothe particulars of each moral situation. Basedon this reading of Kant, an account ofimaginative ethics is developed in order tobring the ethical praxis of doctors and nursesinto sharper relief. The Hebraic and theHellenic traditions of imagination are used inorder to illuminate some of the experiences ofethical rounds. In conclusion, it is arguedthat imaginative ethics and principle-basedethics should be seen as complementary in orderto endow a moral discourse with ethicalauthority. Kantian ethics will do the job if itis remembered that Kant suggested only amodest, negative role of principle-baseddeliberation. (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)

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)

This article addresses the problem of expertise in a democratic political system: the tension between the authority of expertise and the democratic values that guide political life. We argue that for certain problems, expertise needs to be understood as a dialogical process, and we conceptualize an understanding of expertise through and as argument that positions expertise as constituted by and a function of democratic values and practices, rather than in the possession of, acquisition of, or relationship to epistemic materials. Conceptualizing (...) expertise through argument leads us to see expertise as a kind of phronetic practice, oriented toward judgments and problems, characterized by its ability to provide inventional capacities for selecting the best possible resolution of a particular problem vis-à-vis particular expectations regarding the resolution of a problem. At its core, expertise thus comes to exist in reference not to epistemic but to dialogical, deliberative, democratic practice. (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)

In the field of health technology assessment, there are several approaches that can be used for ethical analysis. However, there is a scarcity of literature that critically evaluates and compares the strength and weaknesses of these approaches when they are applied in practice. In this paper, we analyse the applicability of some selected approaches for addressing ethical issues in HTA in the field of complex health interventions. Complex health interventions have been the focus of methodological attention in HTA. However, the (...) potential methodological challenges for ethical analysis are as yet unknown.Six of the most frequently described and applied ethical approaches in HTA were critically assessed against a set of five characteristics of complex health interventions: multiple and changing perspectives, indeterminate phenomena, uncertain causality, unpredictable outcomes, and ethical complexity. The assessments are based on literature and the authors’ experiences of developing, applying and assessing the approaches.The Interactive, participatory HTA approach is by its nature and flexibility, applicable across most complexity characteristics. Wide Reflective Equilibrium is also flexible and its openness to different perspectives makes it better suited for complex health interventions than more rigid conventional approaches, such as Principlism and Casuistry. Approaches developed for HTA purposes are fairly applicable for complex health interventions, which one could expect because they include various ethical perspectives, such as the HTA Core Model® and the Socratic approach.This study shows how the applicability for addressing ethical issues in HTA of complex health interventions differs between the selected ethical approaches. Knowledge about these differences may be helpful when choosing and applying an approach for ethical analyses in HTA. We believe that the study contributes to increasing awareness and interest of the ethical aspects of complex health interventions in general. (shrink)

Geography is experiencing a ‘moral turn’ in its research interests and practices. There is also a flourishing interest in animal geographies that intersects this turn, and is concurrent with wider scholarly efforts to reincorporate animals and nature into our ethical and social theories. This article intervenes in a dispute between Michael Dear and Richard Symanski. The dispute is over the culling of wild horses in Australia, and I intervene to explore how geography deepens our moral understanding of the animal/human dialectic. (...) I begin by situating the inquiry into ethics and animals in geography. Next, I provide a synopsis of Dear and Symanski's comments on ‘animal rights’, followed in turn by discussions of moral value and value paradigms. I then introduce a value paradigm termed geocentrism as a geographical account of our moral relations to animals. Finally, I discuss the wider significance of this debate for geographical ethics, moral philosophy and social theory. (shrink)

Different judgments by Christian communities on issues in sexual ethics involve different weightings of various sources of moral authority, different understandings of the normativity of the natural, and different assessments of the scope of freedom to be exercised in relation to the goods of marriage. These fundamental differences of interpretation can be exemplified by the ongoing Roman Catholic discussion of the legitimacy of voluntary sterilization in certain “hard cases.” The contributors to this issue of Christian Bioethics, in their spirited exchange (...) on that issue, exemplify the need for careful attention to the ways that differences of theological emphasis and moral method lead to different judgments in particular cases, both within and between particular Christian communities. (shrink)

After criticizing three common conceptions of therelationship between practical ethics and ethical theory, analternative modeled on Aristotle's conception of the relationshipbetween rhetoric and philosophical ethics is explored. Thisaccount is unique in that it neither denigrates the project ofsearching for an adequate comprehensive ethical theory norsubordinates practical ethics to that project. Because the purpose of practical ethics, on this view, is tosecure the cooperation of other persons in a way that respectstheir status as free and equal, it seeks to influence thejudgments (...) of others by providing them with reasons that areaccessible to their own understanding. On this account, theindependence of practical ethics is rooted in an appreciation ofthe constraints that non-ideal circumstances place on the rolethat the philosophically refined premises of moral theory canplay in such public deliberations. Practical and philosophicalethics are united, not by shared theoretical frameworks orprinciples, but by the need to exercise intelligently the sameintellectual and affective capacities. They are separated, notby the particularity or generality of their starting points, butby their responsiveness to the practical problem of facilitatingsound normative deliberations among persons as we find them,under non-ideal circumstances. (shrink)

Erhics committees and ethics consultants are becoming more involved in helping individuals make decisions and in advising institutions and legislatures about drafting policy. The role of these committees and consultants has been acknowledged in law, and their function is generally considered salutory and helpful. Ethics consultants and committees, furthermore, play a critical role in educating students and members of the hospital community and the public at large. More over, many ethicists engage in scholarky activities to expand the boundaries of our (...) understanding and, in turn, facilitate our capacity for helping. The role of the ethicist and of the ethics committee is thus manifold. Ethics committees and ethics consultants somehow “in competition” is a mistaken notion: when ethics committees, ethics consultants, and the community work smoothly together, much good can be accomplished. (shrink)

ABSTRACT The core teaching of Buddhism revolves around understanding and alleviating suffering. Since the purpose of international humanitarian law (IHL) is to minimise suffering during armed conflict, by protecting the innocent and restricting the means and methods of warfare, Buddhists should support IHL. In this paper, I try not to utilise the Buddha’s well-known teachings such as karma, impermanence, non-self, emptiness, compassion and so on, to explain why Buddhists should support IHL. Instead, I present how and why Buddhism underlines the (...) importance of secular ethics, indicating that humanity comes first for Buddhism, which would be the main reason for Buddhists to support IHL. Buddhist monks such as Yinshun and the 14th Dalai Lama view common humanity, conventional morality and inner values as the grounds for Buddhism. An enhancement of humanity and the promotion of morality are also part of the way of Buddhist practice. Viewed from a humanistic perspective, Buddhism may endorse all laws, rules, and regulations that are in the best interest of the public and align with values such as peace, freedom, equality, justice, benevolence, and more, regardless of whether they are applied internationally or domestically. Buddhism upholds IHL for similar reasons. (shrink)

According to intentionalism, a demonstrative d refers to an object o only if the speaker intends d to refer to o. Intentionalism is a popular view in metasemantics, but Gauker has recently argued that it is circular. We defend intentionalism against this objection, by showing that Gauker’s argument rests on a misconstrual of the aim of metasemantics. We then introduce two related, but distinct circularity objections: the worry that intentionalism is uninformative, and the problem of intentional bootstrapping, according to which (...) it is impossible to have referential intentions. We also show how intentionalists could respond to these new objections. (shrink)

Contemporary liberal democracies contain multiple cultural, religious, and philosophical traditions. Within these societies, different interpretive communities provide divergent models for understanding health, illness, and moral obligations. Bioethicists commonly draw upon models of moral reasoning that presume the existence of shared moral intuitions. Principlist bioethics, case-based models of moral deliberation, intuitionist frameworks, and cost-benefit analyses all emphasise the uniformity of moral reasoning. However, religious and cultural differences challenge assumptions about common modes of moral deliberation. Too often, bioethicists minimize or ignore the (...) existence of multiple traditions of moral inquiry. Careful consideration of the presence of multiple horizons for moral deliberation generates challenging questions about the capacity of bioethicists to effectively resolve complex cases and social policy disputes. (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)

To be able to understand the history of bioethics, it is necessary to provide an overview of the mainstreams in philosophy which influenced them. That way one can clarify the theoretical origins of several ways of thought in bioethics as well as pinpoint certain problems within the field of bioethics. This paper will give a brief overview of moral theories in the history of philosophy and the way the have influenced ethical thought on biotechnology.

Casuistry and principlism are two of the leading contenders to be considered the methodology of bioethics. These methods may be incommensurable since the former emphasizes the examination of cases while the latter focuses on moral principles. Conversely, since both analyze cases in terms of mid-level principles, there is hope that these methods may be reconcilable or complementary. I analyze the role of principles in each and thereby show that these theories are virtually identical when interpreted in a certain light. That (...) is, if the gaps in each method are filled by a concept of judgment or Aristotelian practical wisdom, these methods converge. (shrink)

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. (...) In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems. (shrink)

Traditional philosophy of science regards theoretical reasoning, based on the example of Euclidian geometry, as the hallmark of a mature science. There is, however, a parallel tradition of practical reasoning based on specific cases that goes back to Aristotle. In this paper I argue that practical reasoning is an essential part of the practice of chemistry and should be understood and appreciated on its own merits rather than regarded as a symbol of the immaturity and inferiority of chemistry as a (...) science. (shrink)

A dispute exists about whether bioethics should become a new discipline with its own methods, competency standards, duties, honored texts, and core curriculum. Unique expertise is a necessary condition for disciplines. Using the current literature, different views about the sort of expertise that might be unique to bioethicists are critically examined to determine if there is an expertise that might meet this requirement. Candidates include analyses of expertise based in "philosophical ethics," "casuistry," "atheoretical or situation ethics," "conventionalist relativism," "institutional guidance," (...) "regulatory guidance and compliance," "political advocacy," "functionalism," and "principlism." None succeed in identifying a unique area of expertise for successful bioethicists that could serve as a basis for making it a new discipline. Rather expertise in bioethics is rooted in many professions, disciplines and fields and best understood as a second-order discipline. (shrink)

There is a growing consensus that the offer of a reasonable compensation for oocyte donation for reproductive treatment is acceptable if it does not compromise voluntary and altruistically motivated donation. However, how to translate this ‘reasonable compensation’ in practice remains unclear as compensation rates offered to oocyte donors between different European Union countries vary significantly. Clinics involved in oocyte donation, as well as those in other medical contexts, might be encouraged in calculating a more consistent and transparent compensation for donors (...) if the elements that constitute a reasonable compensation are explicated. In doing so, lessons can be learnt from living organ donation and medical research participation. Practices in which the elements of a reasonable compensation for the individuals involved have already been more defined in the literature. By means of analogical reasoning, we will outline the different components of a reasonable compensation and subsequently apply these to the context of oocyte donation. We will argue that oocyte donors should first of all be reasonably reimbursed direct expenses related to the donation, without standard remuneration of lost wages. Second, donating oocytes requests a serious time investment, therefore donors are entitled to suitable compensation for their time spent and efforts made. Finally, we will explain that a reasonable compensation consisting of these two components allows for altruism to remain the key value of oocyte donation for reproductive treatment. However, if we acknowledge that donors’ motives are more complex and often include reasons from self-interest, the reasonable compensation may be complemented with modest (non)monetary benefits. (shrink)