It has become common in medical ethics to discuss difficult cases in terms of the principles of respect for autonomy, beneficence, nonmaleficence, and justice. These moral concepts or principles serve as maxims that are suggestive of appropriate clinical behavior. Because this language evolved primarily in the acute care setting, I consider whether it is in need of supplementation in order to be useful in the long-term care setting. Through analysis of two typical cases involving residents of long-term care facilities, I (...) argue for the additional principles of candor and responsibility for narrative integrity. (shrink)

Within the Western bioethical framework, we make adistinction between two dominant interpretations of the meaning of moral personhood: thenaturalist and the humanist one. While both interpretations of moral personhood claim topromote individual autonomy and rights, they end up with very different normativeviews on the practical and legal measures needed to realize these values in every daylife. Particularly when we talk about the end of life issues it appears that in general thearguments for euthanasia are drawn from the naturalist interpretation of (...) moral personhoodwhile the arguments against euthanasia, for their part, are derived from the idealistand/or humanist understanding of the same concept. This article focuses onexamining the metaphysical assumptions and internal contradiction found behind the opposingarguments presented by two prominent philosophers of these two traditions:Peter Singer and Ludger Honnefelder. The author claims that neither side of thedebate succeeds in defending its normative position without reconsidering how to takethe social aspects of moral personhood into account. The author holds that, despite ourneed to set individual's decision making into social context, the currentcommunitarian narrative concept of personhood fails to offer a convincing alternative.Instead of merely trying to replace psychological and atomistic view of personhood with acollective understanding of an individual's moral identity, we need to discuss thenormative relation between the concept of `moral personhood' and the demand for respect ofindividual autonomy in Western bioethics within a wider philosophical perspective. (shrink)

A standard framework for business ethics views the inquiry as an application of major ethical theories to specific issues in business. As these theories are largely presented as being principled, the exercise therefore becomes one of applying general principles to business situations. Many adopting this standard approach have thus resisted the implementation of the most prominent development in ethical theory in recent history: that of particularism. In this article, I argue that particularist thinking has much to offer to business ethics (...) and that standard resistance to particularist business ethics is based largely on misunderstandings. I do so by illustrating how the harbinger of particularism, W. D. Ross, countenances the practical wisdom of particularist ethics while being 1) invulnerable to standard objections to particularist business ethics and 2) compatible with the generalism of the standard approach. The Rossian business ethic is therefore one that the standard approach should be eager to include. (shrink)

In Bioethics and Secular Humanism: The Search for a Common Morality, Tristram Engelhardt examines various possibilities of finding common ground for moral discourse among people from different traditions and concludes their futility. In this paper I will argue that many of the assumptions on which Engelhardt bases his conclusion about the impossibility of a content-full secular bioethics are problematic. By starting with the notion of moral strangers, there is no possibility, by definition, for a content-full moral discourse among moral strangers. (...) It means that there is circularity in starting the inquiry with a definition of moral strangers, which implies that they do not share enough moral background or commitment to an authority to allow for reaching a moral agreement, and concluding that content-full morality is impossible among moral strangers. I argue that assuming traditions as solid and immutable structures that insulate people across their boundaries is problematic. Another questionable assumption in Engelhardt’s work is the idea that religious and philosophical traditions provide content-full moralities. As the cardinal assumption in Engelhardt’s review of the various alternatives for a content-full moral discourse among moral strangers, I analyze his foundationalist account of moral reasoning and knowledge and indicate the possibility of other ways of moral knowledge, besides the foundationalist one. Then, I examine Engelhardt’s view concerning the futility of attempts at justifying a content-full secular bioethics, and indicate how the assumptions have shaped Engelhardt’s critique of the alternatives for the possibility of content-full secular bioethics. (shrink)

Philosophically, the most interesting objection to the reliance on advance directives to guide treatment decisions for formerly competent patients is the argument from the loss of personal identity. Starting with a psychological continuity theory of personal identity, the argument concludes that the very conditions that bring an advance directive into play may destroy the conditions necessary for personal identity, and so undercut the authority of the directive. In this article, I concede that if the purpose of a theory of personal (...) identity is to provide an answer to the question What is it for a person to persist over time?, then reflection on personal identity poses a potentially serious threat to the moral authority of advance directives. However, as Marya Schechtman observes, questions about how a single person persists through change are not what most of us are interested in when we think about who a person is. Rather, we are interested in what it means to say that a particular set of actions, experiences, and characteristics is that of a given person rather than someone else. (shrink)

Since the publication of the first edition of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics there has been much debate about what a proper method in medical ethics should look like. The main rival for Beauchamp and Childress’s account, principlism, has consistently been casuistry, an account that recommends argument by analogy from paradigm cases. Admirably, Beauchamp and Childress have modified their own view in successive editions of Principles of Biomedical Ethics in order to address the concerns proponents of (...) casuistry and others have had about principlism. Given these adjustments to their view, some have claimed that principlism and casuistry no longer count as distinct methods. Even so, many still consider these two conceptions of bioethical methodologies as rivals. Both accounts of the relationship between casuistry and principlism are wrong. These two conceptions of methodology in biomedical ethics are significantly different, but the differences are not the ones pointed out by those who still claim that they are distinct positions. In this article, I explain where the real similarities and differences lie between these two views. (shrink)

Philosophically, the most interesting objection to the reliance on advance directives to guide treatment decisions for formerly competent patients is the argument from the loss of personal identity. Starting with a psychological continuity theory of personal identity, the argument concludes that the very conditions that bring an advance directive into play may destroy the conditions necessary for personal identity, and so undercut the authority of the directive. In this article, I concede that if the purpose of a theory of personal (...) identity is to provide an answer to the question What is it for a person to persist over time?, then reflection on personal identity poses a potentially serious threat to the moral authority of advance directives. However, as Marya Schechtman observes, questions about how a single person persists through change are not what most of us are interested in when we think about who a person is. Rather, we are interested in what it means to say that a particular set of actions, experiences, and characteristics is that of a given person rather than someone else. (shrink)

Resource allocation decisions are often made on the basis of clinical and cost effectiveness at the expense of ethical inquiry into what is acceptable. This paper proposes that a more compassionate model of resource allocation would be achieved through integrating ethical awareness with clinical, financial and legal input. Where a publicly-funded healthcare system is involved, it is suggested that having an agency that focuses solely on cost-effectiveness leaving medical, legal and ethical considerations to others would help depoliticise rationing decisions and (...) command greater public acceptance. (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)

I consider the problem liberalism poses for bioethics.Liberalism is a view that advocates that the state remain neutralto views of the good life. This view is sometimes supported by askeptical moral epistemology that tends to propel liberalismtoward libertarianism. I argue that the possibilities for sharedagreement on moral matters are more promising than is sometimesappreciated by such a view of liberalism. Using two examples ofpublic debates of moral issues, I show that commonly sharedintuitions may ground moral principles even if they may (...) be givendifferent weight by persons of different moral and religioustraditions. Nevertheless, the fact that the intuition andprinciple is widely shared may be sufficient to chart somedirections for public policy or cooperative action even if theydo not lead to complete agreement. As a result, I argue that aliberal communitarianism that presupposes a fairly minimalistepistemology is a legitimate approach to achieving sharedagreement in a pluralistic society. (shrink)

Contemporary bioethics has been somewhat skewed by its focus on high-tech medicine and the resulting development of ethical frameworks based on an acute-care model of healthcare. Research and scholarship in bioethics have payed only cursory attention to ethical issues related to disability. I argue that bioethics should concern itself with the full range of theoretical and practical issues related to disability. This encounter with the disability community will enrich bioethics and, potentially, society as well. I suggest a number of items (...) that the bioethics agenda should include, such as the development of a casuistry of the right to healthcare and to community integration and an advocacy role in fostering an understanding among the public and policy makers of the need to reform research and treatment related to disability. (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)

Thomas Hobbes is one of the most ardent and thoroughgoing opponents of participatory democracy among Western political philosophers. Though Hobbes 's alternative to participatory democracy - assent by subjects to rule by an absolute sovereign - no longer constitutes a viable political alternative for Westerners, his critique of participatory democracy is a potentially valuable source of insight about its liabilities. This essay elaborates five theses from Hobbes that stand as cogent warnings to those who embrace participatory democracy, especially those advocating (...) for deliberative democracy based on a rational consensus model. In light of these warnings, the author suggests an alternative, modus vivendi approach to deliberative democracy that would radically alter the current practice of bioethics. (shrink)

Assessment in ethics education faces a challenge. From the perspectives of teachers, students, and third-party evaluators like the Accreditation Board for Engineering and Technology and the National Institutes of Health, assessment of student performance is essential. Because of the complexity of ethical case analysis, however, it is difficult to formulate assessment criteria, and to recognize when students fulfill them. Improvement in students’ moral reasoning skills can serve as the focus of assessment. In previous work, Rosa Lynn Pinkus and Claire Gloeckner (...) developed a novel instrument for assessing moral reasoning skills in bioengineering ethics. In this paper, we compare that approach to existing assessment techniques, and evaluate its validity and reliability. We find that it is sensitive to knowledge gain and that independent coders agree on how to apply it. (shrink)

I explore the possible meanings that the notion of the common morality can have in a contemporary communitarian approach to ethics and public policy. The common morality can be defined as the conditions for shared pursuit of the good or as the values, deliberations, traditions, and common construction of the narrative of a people. The former sense sees the common morality as the universal and invariant structures of morality while the second sense is much more contingent in nature. Nevertheless, the (...) communitarian sees both aspects as integral in devising solutions to public policy problems. I outline how both meanings follow from communitarian philosophical anthropology and illustrate how they work together when addressing a question such as that of providing universal health insurance in the United States. The common morality forms the basis of building an implicit consensus that is available to and reaffirmed by the shared reflections of the citizenry. (shrink)

I analyze the insights present in Elisabeth Kübler-Ross’s seminal work, On Death and Dying that have laid the foundation for contemporary clinical bioethics as it is practiced by clinical ethics co...

The emergence of global bioethics is connected to a rise of interest in ethics in general (both in academia and in the public sphere), combined with an increasing awareness of the interrelatedness of peoples and their ethical dilemmas, and the recognition that global problems need global solutions. In short, global bioethics has two distinguishing features: first, its global scope, both geographically and conceptually; and second, its focus on justice (communal and individual).