This thesis addresses the tension in pragmatic cluster-randomized trials between their social value and the requirement to respect the autonomy of research participants. Pragmatic trials are designed to evaluate the effectiveness of treatments in real-world settings to inform clinical decision-making and promote cost-efficient care. These trials are often embedded into clinical settings and ideally include all patients who would receive the treatments under investigation as a part of routine care. Trialists increasingly adopt cluster-randomized designs—in which intact groups, such as hospitals (...) or clinics, are allocated randomly to study interventions—to simplify the inclusion of all patients. But including all-comers conflicts with the requirement to obtain written informed consent from research participants. Since informed consent is central to respecting patient autonomy, the question arises: how can the ends of autonomy and pragmatism be served simultaneously? Some philosophers argue that patients have an obligation to participate in clinical research and that this may negate consent requirements. I argue that while there may be grounds for a prima facie obligation for patients to participate in clinical research, no compelling argument has demonstrated that the obligation is enforceable. Others assert that broad application of a waiver of consent will facilitate the conduct of pragmatic cluster-randomized trials. I demonstrate that this proposal sharply conflicts with the historical origins of the waiver. I articulate a novel moral foundation for the use of a waiver of consent and show that when trials evaluate treatments delivered directly to patients, the autonomy interests at stake for participants are too substantial to permit its use. My solution draws a distinction between consent requirements in existing policy and consent as an autonomous authorization. As many pragmatic cluster-randomized trials are conducted in primary care settings with no research staff, I argue that patient autonomy can be promoted and protected using clinical-style consent, in which health providers seek verbal informed consent from patients and document it in the electronic health record. This approach has been associated with high rates of recruitment and, thus, may satisfy both requirements for social value and respect for autonomy. (shrink)

This article assesses the quality of Integrative Social Contracts Theory (ISCT) as a social contract argument. For this purpose, it embarks on a comparative analysis of the use of the social contract model as a theory of political authority and as a theory of social justice. Building on this comparison, it then develops four criteria for any future contractarian theory of business ethics (CBE). To apply the social contract model properly to the domain of business ethics, it should be: (1) (...) self-disciplined, i.e., not aspire results beyond what the contract model can realistically establish; (2) argumentative, i.e., it should seek to provide principles that are demonstrative results of the contractarian method; (3) task-directed, i.e., it should be clear what the social contract thought-experiment is intended to model; and (4) domain-specific, i.e., the contractarian choice situation should be tailored to the defining problems of business ethics. (shrink)

Governments are subject to the requirements of justice, yet often seem to go above and beyond what justice requires in order to act in ways many people think are good. These kinds of acts – examples of which include putting on celebrations, providing grants to poets, and preserving historic architecture – appear to be acts of government supererogation. In this paper, I argue that a common view about the relationship between government, coercion, and justice implies that most such acts are (...) not supererogatory, but wrong. Many will find that conclusion unattractive, but rejecting the common view that implies it raises problems, too. (shrink)

The aim of this article is to review the recent popularity of casuistry as a model of moral inquiry. I argue that proponents of casuistry do not endorse the particularist epistemology that seems to be implied by their position, and that this is why casuistry does not seem to present something really new in comparison to 'top-down' generalist approaches. I contend that casuistry should develop itself as a (moderately) particularist position and that the challenge for the defender of casuistry is (...) to come up with ideas that strengthen the ('intuitionist') model of rationality that underlies most forms of particularism. (shrink)

The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral (...) anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research. (shrink)

With recent advancements in systems engineering and artificial intelligence, autonomous agents are increasingly being called upon to execute tasks that have normative relevance. These are tasks that directly—and potentially adversely—affect human well-being and demand of the agent a degree of normative-sensitivity and -compliance. Such norms and normative principles are typically of a social, legal, ethical, empathetic, or cultural nature. Whereas norms of this type are often framed in the abstract, or as high-level principles, addressing normative concerns in concrete applications of (...) autonomous agents requires the refinement of normative principles into explicitly formulated practical rules. This paper develops a process for deriving specification rules from a set of high-level norms, thereby bridging the gap between normative principles and operational practice. This enables autonomous agents to select and execute the most normatively favourable action in the intended context premised on a range of underlying relevant normative principles. In the translation and reduction of normative principles to SLEEC rules, we present an iterative process that uncovers normative principles, addresses SLEEC concerns, identifies and resolves SLEEC conflicts, and generates both preliminary and complex normatively-relevant rules, thereby guiding the development of autonomous agents and better positioning them as normatively SLEEC-sensitive or SLEEC-compliant. (shrink)

With recent advancements in systems engineering and artificial intelligence, autonomous agents are increasingly being called upon to execute tasks that have normative relevance. These are tasks that directly—and potentially adversely—affect human well-being and demand of the agent a degree of normative-sensitivity and -compliance. Such norms and normative principles are typically of a social, legal, ethical, empathetic, or cultural (‘SLEEC’) nature. Whereas norms of this type are often framed in the abstract, or as high-level principles, addressing normative concerns in concrete applications (...) of autonomous agents requires the refinement of normative principles into explicitly formulated practical rules. This paper develops a process for deriving specification rules from a set of high-level norms, thereby bridging the gap between normative principles and operational practice. This enables autonomous agents to select and execute the most normatively favourable action in the intended context premised on a range of underlying relevant normative principles. In the translation and reduction of normative principles to SLEEC rules, we present an iterative process that uncovers normative principles, addresses SLEEC concerns, identifies and resolves SLEEC conflicts, and generates both preliminary and complex normatively-relevant rules, thereby guiding the development of autonomous agents and better positioning them as normatively SLEEC-sensitive or SLEEC-compliant. (shrink)

The four principles approach to medical ethics plus specification is used in this paper. Specification is defined as a process of reducing the indeterminateness of general norms to give them increased action guiding capacity, while retaining the moral commitments in the original norm. Since questions of method are central to the symposium, the paper begins with four observations about method in moral reasoning and case analysis. Three of the four scenarios are dealt with. It is concluded in the “standard” Jehovah’s (...) Witness case that having autonomously chosen the authority of his religious institution, a Jehovah’s Witness has a reasonable basis on which to refuse a recommended blood transfusion. The author’s view of the child of a Jehovah’s Witness scenario is that it is morally required—not merely permitted—to overrule this parental refusal of treatment. It is argued in the selling kidneys for transplantation scenario that a fair system of regulating and monitoring would be better than the present system which the author believes to be a shameful failure. (shrink)

Practical wisdom is the intellectual virtue that enables a person to make reliably good decisions about how, all-things-considered, to live. As such, it is a lofty and important ideal to strive for. It is precisely this loftiness and importance that gives rise to important questions about wisdom: Can real people develop it? If so, how? What is the nature of wisdom as it manifests itself in real people? I argue that we can make headway answering these questions by modeling wisdom (...) on expert skill. Presenting the main argument for this expert skill model of wisdom is the focus of this paper. More specifically, I’ll argue that wisdom is primarily the same kind of epistemic achievement as expert decision-making skill in areas such as firefighting. Acknowledging this helps us see that, and how, real people can develop wisdom. It also helps to resolve philosophical debates about the nature of wisdom. For example, philosophers, including those who think virtue should be modeled on skills, disagree about the extent to which wise people make decisions using intuitions or principled deliberation and reflection. The expert skill model resolves this debate by showing that wisdom includes substantial intuitive and deliberative and reflective abilities. (shrink)

Wisdom, long a topic of interest to moral philosophers, is increasingly the focus of social science research. Philosophers have historically been concerned to develop a rationally defensible account of the nature of wisdom and its role in the moral life, often inspired in various ways by virtue theoretical accounts of practical wisdom (phronesis). Wisdom scientists seek to, among other things, define wisdom and its components so that we can measure them. Are the measures used by wisdom scientists actually measuring what (...) philosophers have in mind when they discuss practical wisdom? I argue that they are not. Contemporary measures of wisdom and its components may pick out some necessary prerequisites of practical wisdom, but they do not measure a philosophically plausible practical wisdom or its components. After explaining the argument and defending it against objections, I consider its implications. Should wisdom scientists ignore the philosophical conception of practical wisdom in favor of other conceptions, revise their methods to try to measure it, or continue the interdisciplinary study of practical wisdom without expecting to measure it? I make a preliminary argument for the third option. (shrink)

Shortly after the Presidential Commission for the Study of Bioethical Issues was constituted in 2010 and days before the commission members were to join a conference call to discuss possible topics for their deliberation, Craig Venter held a press conference announcing that his lab had created a synthetic chromosome for a species of mycoplasma and had inserted this genetic material into organisms of another species of mycoplasma (the genes of which had been deactivated), transforming the host species into the donor (...) species. While not overtly claiming to have “created life in the test tube,” Venter's publicity seemed cleverly designed to provoke the media into reporting his discovery in just that way. The resulting uproar caused President Obama to give his new bioethics commission the assignment of investigating the ethics of the emerging field of synthetic biology. The commission went right to work. It formed working groups to deliberate about parts of the report, feeding ideas and language to the staff members who would do the actual writing, and then present the working group suggestions to the commission as a whole for public deliberation at open meetings. One of those working groups was charged with coming up with ethical principles that would guide the analysis. Having served as a member of that working group, I report here on the process by which these principles emerged and reflect upon the suitability of that process for the work of public bioethics commissions. (shrink)

Various theories have been put forward in an attempt to explain what makes moral judgments justifiable. One of the main theories currently advocated in bioethics is a form of coherentism known as wide reflective equilibrium. In this paper, I argue that wide reflective equilibrium is not a satisfactory approach for justifying moral beliefs and propositions. A long-standing theoretical problem for reflective equilibrium has not been adequately resolved, and, as a result, the main arguments for wide reflective equilibrium are unsuccessful. Moreover, (...) practical problems that arise in using the method of wide reflective equilibrium undermine the idea that it is a viable approach for justifying moral judgments about cases and policies. Given that wide reflective equilibrium is the most prominent version of coherentism, these considerations call into question the coherentist approach to justification in bioethics. (shrink)

This paper explores the relevance of the debate about ethical expertise for the practice of clinical ethics. We present definitions, explain three theories of ethical expertise, and identify arguments that have been brought up to either support the concept of ethical expertise or call it into question. Finally, we discuss four theses: the debate is relevant for the practice of clinical ethics in that it (1) improves and specifies clinical ethicists' perception of their expertise; (2) contributes to improving the perception (...) of moral competence of non-ethicists; (3) gives insight into complementary styles of argumentation of ethicists and non-ethicists; and (4) contributes to the awareness of the problem of profession-building of (clinical) ethicists. (shrink)

This paper is about the methodology of doing practical ethics. There is a variety of methods employed in ethics. One of them is the principle-based approach, which has an established place in ethical reasoning. In everyday life, we often judge the rightness and wrongness of actions by their conformity to principles, and the appeal to principles plays a significant role in practical ethics, too. In this paper, I try to provide a better understanding of the nature of principle-based reasoning. To (...) accomplish this, I show in the first section that these principles can be applied to cases in a meaningful and sufficiently precise way. The second section discusses the question how relevant applying principles is to the resolution of ethical issues. This depends on their nature. I argue that the principles under consideration in this paper should be interpreted as presumptive principles and I conclude that although they cannot be expected to bear the weight of definitely resolving ethical problems, these principles can nevertheless play a considerable role in ethical research. (shrink)

ABSTRACT:Does effective moral judgment in business ethics rely upon the identification of a suitable set of moral principles? We address this question by examining a number of criticisms of the role that principles can play in moral judgment. Critics claim that reliance on principles requires moral agents to abstract themselves from actual circumstances, relationships and personal commitments in answering moral questions. This is said to enforce an artificial uniformity in moral judgment. We challenge these critics by developing an account of (...) principle-based moral judgment that has been widely discussed by contemporary Kantian scholars. In so doing we respond to some basic problems raised by so-called “moral particularists” who voice theoretical objections to the role of principles as well as to contemporary business ethicists who have criticized principle-based moral judgment along similar lines. We conclude with some future areas of research. (shrink)

In her target article “Shared health governance” (AJOB 11(7): 32-45, 2011) and in her book Health and Social Justice (2009), Jennifer Prah Ruger defends an original model of governance dubbed “Shared Health Governance” (SHG). This model borrows elements from many other models of governance, and one may wonder what is the secret sauce that holds together these diverse ingredients. In response, Ruger would perhaps ultimately turn to public moral norms. My comment raises some concerns about the function and content of (...) these norms in her model and their connection to her claims about shared sovereignty within SHG. (shrink)

Whereas most moral philosophers believe that the facts as to what we’re morally required to do are grounded by the facts about our moral reasons, which in turn are grounded by non-normative facts, I propose that moral requirements are directly grounded by non-normative facts. This isn’t, however, to say that there is no place in the picture for moral reasons. Moral reasons exist, and they’re grounded by moral requirements. Arguing for this picture of the moral sphere requires playing both offense (...) and defense; this article provides the defense. I defend this view against the objections that it must deny that one is generally blameworthy for having violated a moral requirement, that it implies the existence of genuine moral dilemmas, that it runs counter to an obviously true view of how moral deliberation should work, and that it cannot explain why it feels as though figuring about what one is morally required to do often takes the form of thinking about what one’s moral reasons are. (shrink)

Whereas most moral philosophers believe that the facts as to what we’re morally required to do are grounded by the facts about our moral reasons, which in turn are grounded by non-normative facts, I propose that moral requirements are directly grounded by non-normative facts. This isn’t, however, to say that there is no place in the picture for moral reasons. Moral reasons exist, and they’re grounded by moral requirements. Arguing for this picture of the moral sphere requires playing both offense (...) and defense; this article provides the defense. I defend this view against the objections that it must deny that one is generally blameworthy for having violated a moral requirement, that it implies the existence of genuine moral dilemmas, that it runs counter to an obviously true view of how moral deliberation should work, and that it cannot explain why it feels as though figuring about what one is morally required to do often takes the form of thinking about what one’s moral reasons are. (shrink)

Abstract:This paper develops a framework for examining decision making about ethical issues and tests the applicability of a social contract perspective. Using two separate samples of students and salespeople, we determine that community members (salespeople) tend to judge a potentially unethical act to constitute a violation of an implicit social contract and non-community members (students) do not. Also, consistent with the emphasis on context specificity of integrative social contracts theory, situational variables influence perceptions of ethicality for the community members, but (...) do not affect the perceptions of individuals outside the community. The study finds considerable support for the use of a social contractarian perspective in the study of decision-making processes about ethical issues. (shrink)

Specification is an integral part of Tom L Beauchamp and James F Childress' principlist approach to biomedical ethics. At the same time, the authors give much space conceding to critics that the method has significant limits. Although their pointing to limitations is not unreasonable as such, the emphasis Beauchamp and Childress put on them does not serve countering the critics' view that specification is insufficient for its intended purpose in applied ethics. This paper defends specification against Carson Strong's critique, showing (...) that his casuistic approach shares strong structural and functional similarities with specification. It concludes with the more general point that specification or some closely related method for determining morally relevant facts of concrete cases and issues is indispensable for any account of applied ethics. Beauchamp and Childress should endorse and defend specification more vigorously than they appear to do. (shrink)

The notion of common morality plays a prominent role in some of the most influential theories of biomedical ethics. Here, I focus on Beauchamp and Childress’s models in the fourth and fifth edition of Principles of Biomedical Ethics as well as on a revision that Beauchamp proposed in a recent article. Although there are significant differences in these works that require separate analysis, all include a role for common morality as starting point and normative framework for theory construction in combination (...) with a coherence theory of moral justification. I defend to some extent the existence and empirical significance of common morality, as delineated by Beauchamp and Childress in different versions, but criticize its normative role. It is neither convincing as a moral foundation nor well compatible with a standard coherentist justification. I suggest that the authors should give up the foundational account for a more modest account of common morality as resource of well-established moral insights and experiences, which have proved generally valid but neither sufficient nor infallible. Beauchamp’s latest proposal appears as a step in this direction; indeed, it may be the beginning of the end of his common-morality theory. (shrink)

Background There is a need for clearer guidance for pharmacists regarding their responsibilities when selling complementary medicines. A recently published ethical framework provides guidance regarding the specific responsibilities that pharmacists need to meet in order to fulfil their professional obligations and make a positive contribution to health outcomes when selling complementary medicines. Objective Evaluate the acceptability and feasibility of a new ethical framework for the sale of complementary medicines in community pharmacy. Methods Australian community pharmacists were invited to participate in (...) online focus groups and interviews. Participants were recruited via multiple methods, including social media and the professional networks of pharmacy groups. Participants were provided the ethical framework prior to the discussion. Discussions were transcribed verbatim and analysed using thematic analysis. Results Seventeen community pharmacists participated in the study. There was good representation among participants in terms of gender, years of practice, pharmacy location and script volume. Participants differed in how proactive they were in relation to selling and providing advice on complementary medicines, how they interpreted evidence in relation to complementary medicines, and how they navigated their practice within the retail environment of community pharmacy. The majority of participants found the framework was acceptable for practice and was feasible for implementation with targeted support. Participants identified two important areas for targeted support in implementing the framework: improved access to evidence-based information resources on complementary medicines and independent evidence-based education and training on complementary medicine for pharmacists and pharmacy support staff. Conclusion The ethical framework addresses an important gap in providing specific professional guidance to pharmacists when selling complementary medicines. The results of the study suggest that the framework may be acceptable to community pharmacists and be feasible to implement with targeted support. (shrink)

Moral contractualism holds that addressing our minds to the morality of right and wrong involves identifying principles for the mutual regulation of behavior that could be the object of reasonable agreement among persons if they were appropriately motivated and fully informed. A common criticism of the theory is that the test of reasonable agreement it endorses is indeterminate. To be more specific, it is claimed that the notion of reasonableness is too vague or ill-defined to be of use in guiding (...) our decisions in situations where it is necessary to balance the complaints of different people against each other, so that we may derive an all things considered conclusion regarding what we ought, morally, to do. In this article, I propose a novel interpretation of the contractualist method of reasoning that overcomes the indeterminacy objection, building on a broadly Aristotelian conception of practical deliberation about ends. I demonstrate that this criticism is based on a misunderstanding of the nature of contractualist moral reasoning. The key is to recognize that deliberation about what others could not reasonably reject is not a matter of applying a fixed criterion of reasonableness in order to arbitrate conflicts between the interests of different individuals, as it is commonly assumed. Rather, it is a process in which the ideal of justifiability to others and people’s moral claims are specified together through holistic deliberation. The goal of this process is to construct a coherent conception of both our particular moral claims and the general aim of reasonable agreement that is reasonably acceptable to each person. On this view, contrary to what critics assert, the contractualist method of reasoning, properly understood, will almost always have a determinate answer. (shrink)

In the initial phase of the COVID-19 pandemic, Sweden’s response stood out as an exception. For example, Sweden did not introduce any lockdowns, while many other countries did. In this paper I take the Swedish Corona Commission’s critique of the initial Swedish response as a point of departure for a general analysis of precaution in relation to pandemics. The Commission points out that in contrast to many other countries Sweden did not follow ‘the precautionary principle’. Based on this critique, the (...) Commission proposes that the precautionary principle should be included among Sweden’s guiding principles for crisis management. However, as the debate on this principle during the last 30 years indicates, the principle is loaded with problems. I discuss one of these problems, namely its lack of clarity. I argue, however, that this problem is not unsurmountable. A principle is lacking clarity precisely by being a principle and not a rule with a well-defined meaning. As a principle it indicates a direction but does not prescribe a specific action. However, to be action-guiding its content needs to be specified by rational deliberation. With this in mind, I propose a framework for specification of the precautionary principle as applied to pandemics. The framework focuses on the principle’s four key elements: threat, uncertainty, action and responsibility. I also suggest certain general ethical restrictions on specification. (shrink)

There is a story about the connection between the rise of consent theories of political obligation and the fall of natural law theories of political obligation that is popular among political philosophers but nevertheless false. The story is, to put it crudely, that the rise of consent theory in the modern period coincided with, and came as a result of, the fall of the natural law theory that dominated during the medieval period. Neat though it is, the story errs doubly, (...) for it supposes both that consent did not play a key role in natural law theories of political authority offered in the medieval period (a supposition falsified by close inspection of the view of Aquinas, perhaps the paradigmatic natural law theorist) and that natural law theory did not play a key role in the consent theories of political authority offered in the modern period (a supposition falsified by close inspection of the views of Hobbes and Locke, perhaps the paradigmatic consent theorists).Footnotes* I owe thanks to Pat Káin, Paul Weithman, Bob Roberts, and Henry Richardson for instructive criticisms. John Hare was particularly helpful both in criticism and in conversation. I was supported by a fellowship from the Erasmus Institute while this essay was drafted. (shrink)

The paper proposes a revised logic of rights in order to accommodate moral conflict. There are often said to be two rival philosophical accounts of rights with respect to moral conflict. Specificationists about rights insist that rights cannot conflict, since they reflect overall deontic conclusions. Generalists instead argue that rights reflect pro tanto constraints on behaviour. After offering an overview of the debate between generalists and specificationists with respect to rights, I outline the challenge of developing a logic of rights-reasoning (...) that is compatible with generalism. I then proceed to offer a new logical framework, which utilizes a simple non-monotonic logic of practical reasoning. Both generalist and specificationist interpretations of the logic are explored. The revised logic shows that traditional characterizations of the debate between specificationists and generalists obscure other relevant philosophical positions. (shrink)

This paper deals with the question of the conflict of constitutional rights with regard to basic rights. Two extreme accounts are outlined: the subsumptive approach and the particularistic approach, that embody two main conceptions of practical rationality. Between the two approaches there is room for a range of options, two of which are examined: the proportionalist approach, which conserves the scope of rights restricting their stringency, and the specificationist approach, which preserves the stringency of rights restricting their scope. I will (...) present arguments in defence of the latter. (shrink)

In this paper, I intend to articulate an answer to the powerful particularist objection against the notion of moral and legal reasoning based on universal principles. I defend a particular way of specifying and contextualising universal principles. I claim that this account preserves legal and moral justification conceived as subsumption to legal and moral principles. I also try to show how virtues can be reconciled with this account, i.e. what is the right place for virtues in legal adjudication. To carry (...) this out, I draw on a virtue epistemology. (shrink)

Many nonanthropocentric environmental ethicists subscribe to a ``principle-ist'''' approach to moral argument, whereby specific natural resource and environmental policy judgments are deduced from the prior articulation of a general moral principle. More often than not, this principle is one requiring the promotion of the intrinsic value of nonhuman nature. Yet there are several problems with this method of moral reasoning, including the short-circuiting of reflective inquiry and the disregard of the complex nature of specific environmental problems and policy arguments. In (...) the present paper, we advance an alternative, pragmatic contextualist approach to environmental ethics, one grounded in the moral theory of John Dewey. We present the results of an empirical study of public environmental ethics and natural resource management attitudes to support our position, and we conclude with a few recommendations for future inquiry in the field of environmental ethics. (shrink)

Choosing the right plan is often choosing the more coherent plan: but what is coherence? We argue that coherence-directed practical inference ought to be represented computationally. To that end, we advance a theory of deliberative coherence, and describe its implementation in a program modelled on Thagard's ECHO. We explain how the theory can be tested and extended, and consider its bearing on instrumentalist accounts of practical rationality.

Rosamond Rhodes makes a persuasive case for the view that medical ethics does not derive from common morality.1 Rhodes identifies the challenge that immediately arises and its corollary: Whence the origin of medical ethics? And, should we understand medical ethics as autonomous? From the perspective of professional ethics in medicine, the first question can now be restated: Whence the origin of the ethical concept of medicine as a profession, the basis of the ethical obligations of physicians in patient care, research, (...) medical education, and in advocacy and healthcare policy? The history of Western philosophy offers us two pathways to address this question. The first is the quest for certainty,2 a quest fulfilled by using methods designed to discover concepts that are independent of human thought and judgement and thus intellectually and morally authoritative for everyone. Such concepts are timeless and therefore transcultural, transreligious and transnational. Examples include Plato’s Forms,3 PF Stawson’s ‘our conceptual structure’,4 Edmund Pellegrino’s ‘fact of illness’ and the ‘act of profession’ in response to the vulnerability that illness creates,5 and common morality.6 Thought experiments, using what Rhodes characterises as ‘the hypethetico-deductive method’,1 aim to discover timeless concepts. Discovering timeless concepts must address their ontological and epistemological status. Plato’s ontology of Forms,2 for example, is not clear, as …. (shrink)

Volume 20, Issue 7, July 2020, Page 9-12.

Volume 20, Issue 3, March 2020, Page 65-68.

This paper develops and defends a conception of moral coherence that is suitable for use in contexts of principle pluralism. I argue that, as they are traditionally understood, coherence methods stack the deck against pluralist theories, by incorporating norms such as systematicity—that the principles of a theory should be as few and as simple as possible. I develop and defend an alternative, minimal, conception of coherence that focuses instead on consistency. It has been suggested that consistency in this context should (...) aim at the avoidance of conflict, but I argue against this: what matters is “case consistency,” or judging consistently from one case to another. This means judging in accordance with morally relevant similarities and differences. I defend my proposal of minimal coherence from objections having to do with complexity and arbitrariness. (shrink)

Although principles, as a framework to resolving moral dilemmas are still debated and seem to be in a philosophical quagmire, there are strong arguments that by specification one can resolve case-specific dilemmas in certain areas of bioethics. When it comes to genetic screening and testing however, the problem at the base is a moral disagreement on higher-order principles—such as the status of the embryo and parental issues. No amount of specification can resolve these issues without a dose of relativism. We (...) explore a possibility of agreement on debatable areas specifically in regard to genetics—such as conferring status to the embryo solely for purposes of preventing genetic selection; but it is difficult to see how this can be incorporated into law without extrapolation to other areas. We conclude therefore that the four-principles approach, albeit valuable for expounding opposing views and discussing issues, cannot either alone or by specification, help resolve issues of genetic screening and testing without agreeing on higher order principle. This does not seem to be a possibility in the near future. (shrink)

There have been many attempts during the history of applied ethics that have tried to develop a theory of moral reasoning. The goal of this paper is to explicate one aspect of the debate between various attempts of offering a specific method for resolving moral dilemmas. We contrast two kinds of deliberative methods: deliberative methods whose goal is decision-making and deliberative methods that are aimed at gaining edifying perspectives. The decision-making methods assessed include the traditional moral theories like utilitarianism and (...) Kantianism, as well as second order principles, such as principlism and specified principlism. In light of this assessment, we suggest taking a closer look at two perceptive models, casuistry and particularism. These models are used for dealing with moral dilemmas that provide for edifying perspectives rather than decision-making. These perceptive models, though less scientific and not as good at prescribing an action, are more human in the sense that they enrich our moral sensibilities and enhance our understanding of the meaning of the situation. (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.

Principlism, or principle based ethics, was one of the first approaches in an independent bioethics. After receiving some criticism towards the end of the 1980s, an adjusted version was put forward. This paper attempts to analyse the main theoretical problems associated with principlism and test them against the background of modern linguistic philosophy, the philosophy of Robert B. Brandom in particular.

Moral conflicts occur in theories that involve more than one principle. I examine basic ways of dealing with moral dilemmas in medical ethics and in ethics generally, and propose a different approach based on a principle I call the "mutuality principle". It is offered as an addition to Tom Beauchamp and James Childress' principlism. The principle calls for the mutual enhancement of basic moral values. After explaining the principle and its strengths, I test it by way of an examination of (...) three responses—in the recent Festschrift for Dr Raanon Gillon—to a case involving parental refusal of a blood transfusion. The strongest response is the one that comes closest to the requirements of the mutuality principle but yet falls short. I argue that the mutuality principle provides an explicit future orientation in principlism and gives it greater moral coherence. (shrink)

Reformed Christianity's qualified embrace of freedom of conscience is per- haps best represented by William Ames (1576-1633). This essay explores Ames's interpretation of conscience, his understanding of its relationship to natural law, Scripture, and civil authority, and his vacillation on the sub- ject of conscientious freedom. By rooting his interpretation of conscience in natural law, Ames provided a foundation for conscience as an authority whose convictions are binding and worthy of some civil respect and free- dom. At the same time, (...) his Puritan worldview ultimately required the deference of conscience to the superior manifestations of divine law in Scripture and civil institutions. As a result, Ames provided raw ingredients for a theological doctrine of freedom of conscience despite his unwillingness to commend the idea himself consistently. In this way, Ames symbolizes an ambiguity on freedom of conscience characteristic of the broader Reformed tradition. (shrink)

Currently, value sensitive design (VSD) does not commit to a particular ethical theory. Critiques contend that without such an explicit commitment, VSD lacks a methodology for distinguishing genuine moral values from mere stakeholders-preferences and runs the risk of attending to a set of values that is unprincipled or unbounded. We argue that VSD practitioners need to complement it with an ethical theory. We argue in favour of a mid-level ethical theory to fulfil this role.

Many ethical issues facing managers of multinational corporations are polycentric problems. That is, they involve a number of distinct centers -- each of which define rights and obligations of a multiplicity of affected parties -- and resolving matters around one center typically creates unpredictable repercussions around one or more of the other centers. Polycentricity is a normative phenomenon especially unsuited for adjudication, often requiring recourse to alternative processes of contract (or reciprocal adjustment) and managerial direction. This study explores how such (...) concerns about the limits of adjudication (and its various moral counterparts) apply to international decisionmaking connected to human rights obligations of multinational companies. The focus is on ethical problems such as controlling child labor in LDCs such as Bangladesh, India and Pakistan; setting wages in developing countries like Honduras; and conducting business transactions with rights-violating regimes, such as the governments of Nigeria and Myanmar. (shrink)

This article presents moral jurisprudence theory as a systematic approach to business ethics that analogizes core problems of the field to related problems in law. Adapting theoretical approaches from contemporary philosophy of law, the article develops a decision-making method for business ethics.

This article presents the framework Capability Sensitive Design (CSD), which consists of merging the design methodology Value Sensitive Design (VSD) with Martha Nussbaum's capability theory. CSD aims to normatively assess technology design in general, and technology design for health and wellbeing in particular. Unique to CSD is its ability to account for human diversity and to counter (structural) injustices that manifest in technology design. The basic framework of CSD is demonstrated by applying it to the hypothetical design case of a (...) therapy chatbot for mental health. By applying CSD to a design case, the merits of this new framework over the standard VSD approach become apparent. Also, the application demonstrates what a technology design would look like when attention is paid to capabilities right from the start of the design process. (shrink)