In both popular and scholarly discussions, sexual consent is gaining traction as the central moral consideration in how people should treat one another in sexual encounters. However, while the concept of consent has been indispensable to oppose many forms of sexual violence, consent-based sexual ethics struggle to account for the phenomenological complexity of sexual intimacy and the social and structural pressures that often surround sexual communication and behavior. Feminist structural critique and social research on the prevalence of violation even within (...) consensual sex suggest that consent is insufficient to ground responsibility; a more fundamental orientation toward the value of sexual agency provides a better foundation for sexual ethics. Using feminist critical theory, phenomenology, and black feminist thought, this dissertation develops a socially situated and relational notion of sexual agency and diagnoses how such agency is neglected in prevailing discussions of consent in moral philosophy and legal theory. I argue that the ethical question of responsibility to another in a sexual encounter—apart from juridical considerations—should be reframed around the value of each person’s socially situated practices of agency. Preceding and extending beyond the obligation to gain valid consent for an action, responsibility demands adapting one’s intentions and behaviors in response to the wider range of another’s communicative expressions of agency. However, communicative expressions can be ambiguous or overdetermined by social context and cultural norms; they often offer only provisional traces of agency. To address this inherent uncertainty in intimacy, I propose drawing on insights from Emmanuel Levinas about the dynamic, open-ended nature of relationality, responsibility, and communication. Responsibility toward another does not depend on securing certainty about their “yes” or “no,” but requires responding continuously under conditions of uncertainty and ambiguity, adapting behaviors and intentions to make room for another’s agency despite its opacity. (shrink)

This thesis defends utilitarianism: the view that as far as morality goes, one ought to choose the option which will result in the most overall well-being. Utilitarianism is widely rejected by philosophers today, largely because of a number of influential objections. In this thesis I deal with three of them. Each is found in Bernard Williams’s ‘A Critique of Utilitarianism’ (1973). The first is the Integrity Objection, an intervention that has been influential whilst being subject to a wide variety of (...) interpretations. In Chapter Two I give my interpretation of Williams’s Integrity objection; in Chapter Three I discuss one common response to it, and in Chapters Four and Five I give my own defence of utilitarianism against it. In Chapter Six I discuss a second objection: the problem of pre-emption. This problem is also found in Williams, but has received greater attention through the work of other authors in recent years. It suggests that utilitarianism is unable to deal with some of the modern world’s most pressing moral problems, and raises an internal tension between the twin utilitarian aims of making a difference and achieving the best outcomes. In Chapter Seven I discuss a third objection: that utilitarianism is insufficiently egalitarian. I find this claim to be unwarranted, in light of recent social science and philosophy. My responses to Williams’s objections draw upon resources from the socialist tradition – in particular, that tradition’s emphasis on the importance of social connections between individuals. Socialists have often been hostile to utilitarianism, in part for socialist-inflected versions of Williams’s objections. Thus, in responding to these objections I aim to demonstrate that socialist thought contains the means to defuse not only mainstream philosophy’s rejection of utilitarianism but also its own, and thus to re-open the possibilities for a productive engagement between the two traditions. (shrink)

Shaming behavior on social media has been the cause of concern in recent public discourse. Supporters of online shaming argue that it is an important tool in helping to make social media and online communities safer and more welcoming to traditionally marginalized groups. Objections to shaming often sound like high-minded calls for civility, but I argue that shaming behavior poses serious risks. Here I identify moral and political risks of online shaming. In particular, shaming threatens to undermine our commitment to (...) the co-deliberative practices of morality. As a result, online shaming can undermine the very goals it is supposed to accomplish. (shrink)

This paper presents a case for a feminist care ethics approach to thinking about ethics and justice in the context of the COVID-19 pandemic. Much of the existing commentary has been focused on arri...

The ongoing trauma of COVID-19 will no doubt mark entire generations in ways inherent in an unmanaged global pandemic. The question that I ask is why this ongoing trauma seems so particularly profound and so uniquely shattering, and whether there is anything that we could do now, while still in the midst of disaster, to begin the process of social and moral repair? I will begin by considering the trauma of isolation with unknown time-horizons, and argue that it not only (...) damages our experiences as social selves, but its languages of overwhelming grief rob us of hope of self-restoration. Second, I will examine some reasons for the “why us”-type of trauma experienced by so many in the Global North, and suggest that such laments are predicated on the misalignment among our socio-historical awareness, disaster-imagination, and our sense of ourselves as uniquely unfortunate. Finally, relying in part on Viktor Frankl’s notion of “tragic optimism,” I conclude by considering how we may begin to reconsider our traumas as not just endings of what is, but beginnings of what still might be —as repair without a master plan. (shrink)

Spatial metaphors abound in feminist theory. The modest goal of this paper is to reassert the importance of temporal dimensions in thought for feminist thinking. In order to establish this general claim, several kinds of current thinking about time that are problematic for feminists are explored. First, the postmodern compression of time and space is considered from the standpoint of the changes it brings in the nature of care. Second, the privileging of the future over the past is considered in (...) light of the problems it creates for thinking about justice for historical wrongdoing. Forgiveness and remembrance require an attention to the past. (shrink)

In this article, I aim to contribute to the remedy of the current under-theorization of discourse on food ethics and politics from the perspective of the Islamic food tradition by proposing a formulation of an Islamic conception of food justice that extends the religious discourse on food beyond that of dietary laws. The conception of Islamic food justice that I propose makes explicit the connections between the religious, ethical, and political discourses on food. First, I argue that the similarity between (...) the central question of the secular approach to food ethics and that of the modern interpretation of the religious approach to food is best understood as a consequence of the shared assumption of the modern concept of subjectivity. Second, I argue that problematizing the concept of subjectivity that underlies both the secular and the religious approaches to food ethics is key to challenging the boundaries of the current disciplinary-bound discourses as it would allow for a reformulation of the central question beyond that of individual identity and extend the religious discourse on food to the realm on politics. (shrink)

Feminist socially constitutive conceptions of autonomy make the presence of idealized social conditions necessary for autonomy. I argue that such conceptions cannot, when applied under nonideal conditions, play two key feminist theoretical roles for autonomy: the roles of anti-oppressive character ideal and paternalism-limiting concept. Instead, they prescribe action that reinforces oppression. Treated as character ideals, socially constitutive conceptions of autonomy ask agents living under nonideal ones to engage in self-harm or self-subordination. Moreover, conceptions of autonomy that make idealized social conditions (...) a requirement of autonomy yield the conclusion that oppressed agents are appropriate objects of paternalism. (shrink)

This study develops conceptual means in philosophy of agency to better and more systematically address intentional omissions of agents, including those that are about resisting the action not done. I argue that even though philosophy of agency has largely concentrated on the actions of agents, when applying philosophy of action to the social sciences, a full-blown theoretical account of what agents do not do and a non-normative conceptual language of the phenomena in question is needed. Chapter 2 aims to find (...) out what kind of things intentional omissions are. I argue that although intentional omissions are part of our intentional behavior, they are not actions in the sense that the standard account of action assumes. Instead, because intentional omissions are homogenous, continuous, unbounded, indefinite and directly uncountable, they should be thought of as activities instead of performances. This view links the ontology of intentional omissions to the ontology of processes instead of to that of events, and I argue that this kind of ontology accounts for the fluid nature of the agency of alive agents not only instigating but controlling and sustaining their intentional omissions as well. Chapter 3 aims to find out on what conditions is an omission intentional. The aim is to find a naturalized explanation of them that would make it possible to combine psychological perspectives with philosophical ones so that intentional omissions could be treated as something that exist in the world, not just in our philosophical intuitions. I argue that intentional omissions necessarily require the agent’s procedural metacognition concerning the action not done. Based on this metacognition view, a non-normative conceptual typology of not doings is presented. Chapter 4 aims to find out on what conditions is an intentional omissions resistance toward something. The necessary elements of resistance are clarified and I argue that resistant intentional omissions in which the agent does not perform an action out of resistance toward something are a normal part of our everyday agency. The implications of the findings are considered for theories of action, especially when it comes to the belief-desire model that may not be able to fully account for resistant intentional omissions. Chapter 5 aims to find out what conceptual means do we have for talking about not doing something as a form of resistance. I argue that in the social sciences, bioethics and military ethics to not do something out of resistance is taken as something that exists, and as something that has causes and effects. However, concepts such as civil disobedience, conscientious refusing, exit and everyday resistance do not account for the ordinariness of this kind of not doings. Thus, I argue that such concepts are not able to fully cover resistant inaction and philosophy of intentional omissions can be of use not just in the social sciences. Finally, Chapter 6 considers the implications of these findings. The main implication of this study is that our view of social and ethical agency would need to better include intentional not doings, not just the sum of the intentional actions of agents. Another major implication is that agents themselves should be heard when analyzing their intentional omissions in society, because intentional omissions are phenomena that can easily be mixed with the passivities of agents from the perspective of an outside observer. (shrink)

Bioethics has increasingly become a standard part of medical school education and the training of healthcare professionals more generally. This is a promising development, as it has the potential to help future practitioners become more attentive to moral concerns and, perhaps, better moral reasoners. At the same time, there is growing recognition within bioethics that nonideal theory can play an important role in formulating normative recommendations. In this chapter we discuss what this shift toward nonideal theory means for ethical curricula (...) within healthcare education. In particular, we contend that more attention to the particularities of historical and social context needs to be incorporated into bioethics training. To make this argument, we focus on two examples: teaching units on race and medicine and those that focus on stigma and coercion in mental health. For both, we show how a pedagogical approach in which educators focus on social injustice could influence how practitioners engage in ethics in the clinic. This chapter, then, demonstrates what a commitment to nonideal theory can mean practically when it comes to bioethics education. (shrink)

I argue for the merits of studying historical moral revolutions to inform moral and political philosophy. Such a research program is not merely of empirical, historical interest but has normative implications. To explain why, I situate the proposal in the tradition of naturalized epistemology. As Alison M. Jaggar and other scholars have argued, a naturalistic approach is characteristic of much feminist philosophy. Accordingly, I argue that the study of moral revolutions would be especially fruitful for feminist moral and political philosophers.

O artigo tem como objetivo inicial apresentar, a partir de um panorama geral, alguns elementos centrais da concepção de moral no pensamento de Simone de Beauvoir, bem como suas articulações com outros conceitos pertinentes. A partir disso, pretende-se considerar determinadas apropriações e críticas de teóricas feministas recentes, buscando avaliar as possíveis contribuições do pensamento de Beauvoir à filosofia moral de viés feminista.

In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a (...) generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the “ethics platform.” We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a “principles plus medium-range narratives” approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels. (shrink)

This paper advances a framework to conceptualize societal care-giving arrangements abstractly. It is abstract in that it brackets the meaning of our particular relationships. This framework, which I call “the arrow of care map”, is a descriptive tracking model that is a necessary component of a theory of justice, but it is not a normative prescription in itself. The basic idea of the map is then multiply specifiable to track various ascriptive identity categories as well as different categories of care (...) labor. In this way, the idea of the arrow of care map serves as a conceptual frame within which to begin to understand every human society’s care-giving arrangement. I characterize it as a component of “ideal theory” insofar as it seeks to clarify our values, without the immediate aim of formulating principles to govern a just society. The resultant partial theory of justice is one that responds to non-ideal theory’s critiques of the ideological nature of liberal contractarianism’s idealizations and abstractions while moving towards new visions of a just society. (shrink)

In an age of professionalization and specialization, the practice of clinical ethics is facing an identity crisis. Are clinical ethicists moral experts, ethics experts, or merely quasi-lawyers giving legal advice? Are they extensions of the hospital, always working to advance the hospital’s interests? Or is there another option? Since 1998, when the American Society for Bioethics and Humanities first issued its Core Competencies for Healthcare Ethics Consultation, there has been debate about the role of standardization and proceduralism in clinical ethics (...) consultation. Now, as ASBH continues to move forward with its credentialing program, proceduralism in clinical ethics must be critically examined. In this paper, I argue that the proceduralist approach to clinical ethics consultation, as espoused by the ASBH’s call for credentialing, creates a demeaning experience for all parties involved and precludes goods internal to the practice of clinical ethics consultation from being actualized. As a practice embedded in medicine and in institutions such as the hospital, clinical ethics consultation must define and examine its own goods in order to bring about more than a sterile, law-like solution to difficult moral quandaries, as these sterile solutions leave patients, families, and providers unsatisfied, abandoned, and disappointed. Thus, in an effort to push back against this proceduralism in clinical ethics consultation, I will offer a preliminary exploration of what these goods might be. (shrink)

This paper focuses on the reasons for, and consequences of, expanding our notions of human embodiment to virtual worlds. Increasingly, it is within virtual environments that we seek to extend, and enhance, who we are. Yet, philosophical worries persist about what sorts of selves count as moral agents, and the extent to which self-enhancements affect personal identity and agency. This paper critiques and expands the discourse on embodiment and personal identity by locating it within the virtual environments of Second Life, (...) challenging the prevailing limitations of what counts as identity-constituting embodiment. I argue that more inclusive notions of embodiment make possible a deeper understanding of its moral and epistemic force that constitutes and locates our identities in a universe of shared moral understandings. Thus, by including enhanced virtual embodiments alongside the non-virtual, not only do we expand our ideas of what it might mean to be embodied, but we also deepen our moral vocabularies of the self. (shrink)

A decision was made at the UNFCCC, COP-18 meeting in Doha in 2012 to create a work programme on loss and damage. Part of this programme was to include the production of a technical paper to enhance the general understanding of non-economic losses from climate change. The following article looks carefully at that paper in order to discover whether it provides an adequate conceptual understanding of non-economic losses. Several shortcomings of the paper’s conceptualization of these losses are identified. An alternative (...) ethical framework with methods better suited for capturing a fuller range of non-economic losses is considered. This framework is likely to be most useful if used prospectively for the purpose of devising better adaptation policies to head off potential future losses rather than if used retrospectively for quantifying losses that have already occurred for the purposes of providing compensation. (shrink)

Moral madness is a symptom of the moral violence experienced by teachers who are expected to exercise responsibility for their students and their work, but whose moral voice is misrecognized as self-interest and whose moral agency is suppressed. I conduct a feminist ethical analysis of the figure of Cassandra to examine the ways in which teachers may be driven to moral madness.

Allies are extremely important to LGBT rights. Though we don’t often enumerate what tasks we expect allies to do, a fairly common conception is that allies “support the LGBT community.” In the first section I introduce three difficulties for this position that collectively suggest it is conceptually insufficient. I then develop a positive account by starting with whom allies are allied to instead of what allies are supposed to do. We might obviously say here that allies are allied to the (...) LGBT community, but I will argue that this community is better thought of as a loose coalition because there are often intersectional issues and conflicting interests that challenge any unified sense of community. I argue that people typically become allies because a friend or family member is experiencing some kind of specific harm; if that harm or discrimination is what causally explains why people become allies, then allies are required to do more than we commonly think. Although allies have a prima facie obligation to honor what members of a subcommunity identify as a harm, this obligation is defeasible if an ally believes fulfilling the obligation would be harmful. I conclude by looking at how we can understand what an ally is in terms of a larger discussion about moral obligations. If people already have these obligations, whatever they are, because morality requires it, then the status “ally” is redundant. I conclude by showing that certain social statuses can not only transform or reprioritize prior moral commitments, but can also introduce new kinds of responsibility that an agent did not have before. (shrink)

Autonomy in bioethics is coming under sustained criticism from a variety of perspectives. The criticisms, which target personal or individual autonomy, are largely justified. Moral conceptions of autonomy, such as Kant’s, on the other hand, cannot simply be applied in bioethical situations without moralizing care provision and recipience. The discussion concludes with a proposal for re-thinking autonomy by focusing on what different agents count as reasons for choosing one rather than another course of action, thus recognising their involvement in the (...) decision process. (shrink)

In this methodological reflection, I describe the multidisciplinary hermeneutic process of philosophizing about teacher dissatisfaction. I discuss how philosophy serves as a starting point for interpretive work based on interviews with former teachers and readings of qualitative and quantitative research on teacher attrition and dissatisfaction. The result has been a project that enabled me to offer new descriptions of phenomena and to develop concepts that can be used to interpret the moral dimensions of teacher dissatisfaction. The fact that I return (...) to language and concepts as my research outcomes is why, despite my multidisciplinary approach, I continue to describe my work as philosophical. I suggest that philosophical enquiry pursued through empirical research has the potential to inform larger empirical studies, serve as a “sensitizing instrument” for empirical analysis, and to open discursive spaces where common understandings limit interpretive possibilities. (shrink)

For the past several years patients have been expected to play a key role in their recovery. Self management and disease management have reached a hype status. Considering these recent trends what does this mean for the division of responsibilities between doctors and patients? What kind of role should healthcare providers play? With findings based on a qualitative research project of an innovative practice for people with Chronic Obstructive Pulmonary Disease (COPD) we reflect on these questions. In-depth interviews conducted with (...) people with COPD, physiotherapists and a pulmonologist show that shifting responsibilities require a supportive attitude from healthcare providers and a dialogical communication between patients and professionals. Our findings show more is needed in order to motivate people with COPD to take responsibility and become co-owners in a process of recovery. The case example illustrates that people with COPD need support from fellow patients to learn to accept their disabilities. Awareness that COPD is more than just a lack of air, that mind and body interact, is a first step to investigate other potential problems and to enhance one’s quality of life. (shrink)

Background Clinical moral case deliberation consists of the systematic reflection on a concrete moral case␣by health care professionals. This paper presents the study of a 4-year moral deliberation project.Objectives The objectives of this paper are to: (a) describe the practice and the theoretical background of moral deliberation, (b) describe the moral deliberation project, (c) present the outcomes of␣the evaluation of the moral case deliberation sessions, and (d) present the implementation process.Methods The implementation process is both monitored and supported by an (...) interactive responsive evaluation design with: (a) in-depth interviews, (b) Maastricht evaluation questionnaires, (c) evaluation survey, and (d) ethnographic participant observation. In accordance with the theory of responsive evaluation, researchers acted both as evaluators and moderators (i.e. ethicists).Results Both qualitative and quantitative results showed that the moral case deliberations, the role of the ethics facilitator, and the train-the-facilitator program were regarded as useful and were evaluated as (very) positive. Health care professionals reported that they improved their moral competencies (i.e. knowledge, attitude and skills). However, the new trained facilitators lacked a clear organisational structure and felt overburdened with the implementation process. The paper ends with both practical and research suggestions for future moral deliberation projects. (shrink)

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and methodologies have (...) emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry. (shrink)

In this paper I engage interdisciplinary conversation on inaction as the dominant response to climate change, and develop an analysis of the specific phenomenon of complacency through a critical-feminist lens. I suggest that Chris Cuomo's discussion of the “insufficiency” problem and Susan Sherwin's call for a “public ethics” jointly point toward particularly promising harm-reduction strategies. I draw upon and extend their work by arguing that extant philosophical accounts of complacency are inadequate to the task of sorting out what it means (...) to be complacent on climate change. I offer a sketch for an alternative account, which I take to be a start in the direction of mapping out a diverse array of “motivational vices” that need to be named, grappled with, and remedied. (shrink)

Moral theory is an important guide to bioethical decision-making, but it can confuse and mislead those who offer ethical advice to clinicians and researchers, delaying decisions that must be made in a timely fashion. In this paper I examine the ways moral theory can lead bioethicists astray. Absent a sensitivity to the empirical realities of ethical problems, moral theory 1) contributes to the disappearance of the persons caught in an ethical quandary, 2) focuses on the puzzle-solving rather than examining the (...) conditions that generate moral problems, and 3) universalizes ethical dilemmas, overlooking local processes for resolving moral questions. Taken together, empirically informed moral theory and theoretically informed empirical research can help bioethicists transcend the is/ought problem in ethical work. (shrink)

Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and (...) responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life. (shrink)

Before asking what U.S. bioethics might learn from a more comprehensive and more nuanced understanding of Islamic religion, history, and culture, a prior question is, how should bioethics think about religion? Two sets of commonly held assumptions impede further progress and insight. The first involves what “religion” means and how one should study it. The second is a prominent philosophical view of the role of religion in a diverse, democratic society. To move beyond these assumptions, it helps to view religion (...) as lived experience as well as a body of doctrine and to see that religious differences and controversies should be welcomed in the public square of a diverse democratic society rather than merely tolerated. (shrink)

This paper draws on Claudia Card’s discussions of moral luck to consider the complicated moral life of people—described as pessimists—who accept the heavy knowledge of the predictability of the bad moral luck of oppression. The potential threat to ethics posed by this knowledge can be overcome by the pessimist whose resistance to oppression, even in the absence of hope, expresses a sense of still having a ‘‘claim’’ on flourishing despite its unattainability under oppression.

Most people accept that if they can save someone from death at very little cost to themselves, they must do so; call this the ‘duty of easy rescue.’ At least for many such people, an instance of this duty is to allow their vital organs to be used for transplantation. Accordingly, ‘opt-out’ organ procurement policies, based on a powerfully motivated responsibility to render costless or very low-cost lifesaving aid, would seem presumptively permissible. Counterarguments abound. Here I consider, in particular, objections (...) that assign a moral distinctiveness to the physical boundaries of our bodies and that concern autonomy and trust. These objections are singled out as they seem particularly pertinent to the stress I place on a distinctive benefit of the particular policy I defend. An opt-out system, resting not on the authority of ‘presumed consent’ but on the recognition of a duty to one another, has the prospect of prompting people to understand more richly the ways in which they are both physically embodied and communally embedded. (shrink)

Neglect of the moral promise of disorientation is a persistent gap in even the most sophisticated philosophies of embodiment. In this article, I begin to correct this neglect by expanding our sense of the range and nature of disoriented experience and proposing new visions of disorientation as benefiting moral agency. Disorientations are experienced through complex interactions of corporeal, affective, and cognitive processes, and are characterized by feelings of shock, surprise, unease, and discomfort; felt disorientations almost always make us unsure of (...) how to go on. I argue that experiences of disorientation can strengthen the moral agency of individuals. I begin by clarifying experiences of felt ease and orientation. I then characterize disoriented embodiment by investigating select experiences that often involve or accompany disorientation, focusing throughout on how disorientation prompts changes in motivation and action. I conclude by charting how disoriented embodiments can help individuals become better moral agents overall, in part by challenging norms that restrict embodiment and undermining dualistic conceptions of the self. (shrink)

This article explores the notion of the dislocated self following deep brain stimulation (DBS) and concludes that when personal identity is understood in dynamic, narrative, and relational terms, the claim that DBS is a threat to personal identity is deeply problematic. While DBS may result in profound changes in behaviour, mood and cognition (characteristics closely linked to personality), it is not helpful to characterize DBS as threatening to personal identity insofar as this claim is either false, misdirected or trivially true. (...) The claim is false insofar as it misunderstands the dynamic nature of identity formation. The claim is misdirected at DBS insofar as the real threat to personal identity is the discriminatory attitudes of others towards persons with motor and other disabilities. The claim is trivially true insofar as any dramatic event or experience integrated into one’s identity-constituting narrative could then potentially be described as threatening. From the perspective of relational personal identity, when DBS dramatically disrupts the narrative flow, this disruption is best examined through the lens of agency. For illustrative purposes, the focus is on DBS for the treatment of Parkinson’s disease. (shrink)

Emotions play an important part in moral life. Within clinical ethics support (CES), one should take into account the crucial role of emotions in moral cases in clinical practice. In this paper, we present an Aristotelian approach to emotions. We argue that CES can help participants deal with emotions by fostering a joint process of investigation of the role of emotions in a case. This investigation goes beyond empathy with and moral judgment of the emotions of the case presenter. In (...) a moral case deliberation, the participants are invited to place themselves in the position of the case presenter and to investigate their own emotions in the situation. It is about critically assessing the facts in the case that cause the emotion and the related (moral) thoughts that accompany the emotion. It is also about finding the right emotion in a given situation and finding the right balance in dealing with that emotion. These steps in the moral inquiry give rise to group learning. It is a process of becoming open towards the perspectives of others, leading to new insights into what is an appropriate emotion in the specific situation. We show how this approach works in moral case deliberation. A physician presents a situation in which he is faced with a pregnant woman who is about to deliver multiple extremely premature infants at the threshold of viability. The moral deliberation of the case and the emotions therein leads to the participants’ conclusion that “compassion” is a more adequate emotion than “sadness”. The emotion “sadness” is pointed towards the tragedy that is happening to the woman. The emotion “compassion” is pointed towards the woman; it combines consideration and professional responsibility. Through the shift towards compassion, participants experienced more creativity and freedom to deal with the sad situation and to support the woman. The paper ends with an analysis and reflection on the deliberation process. In the conclusion we argue for more attention to emotions in clinical ethics support and offer some directions for doing this in the right way. (shrink)

In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of ‘theory’ and show how it is interwoven with ‘practice’ as we go along. First, we look at theory in its foundational role: in our case ‘narrative ethics’ and ‘philosophical hermeneutics’ provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of theoretical (...) notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like ‘story’, ‘responsibility’, or ‘vulnerability’ to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice-versa. (shrink)

Moral theory is an important guide to bioethical decision-making, but it can confuse and mislead those who offer ethical advice to clinicians and researchers, delaying decisions that must be made in a timely fashion. In this paper I examine the ways moral theory can lead bioethicists astray. Absent a sensitivity to the empirical realities of ethical problems, moral theory 1) contributes to the disappearance of the persons caught in an ethical quandary, 2) focuses on the puzzle-solving rather than examining the (...) conditions that generate moral problems, and 3) universalizes ethical dilemmas, overlooking local processes for resolving moral questions. Taken together, empirically informed moral theory and theoretically informed empirical research can help bioethicists transcend the is/ought problem in ethical work. (shrink)

In this paper the authors argue that the exploration of the nature of needs and rights should begin with the actually existing organization of care and of justice in society. The authors raise two key concerns with this organization: 1) the invisibility of care to some, and 2) the inaccessibility of rights to others. Recent work by care scholars has called attention to the ways the current organization of care work perpetuates the myth of self-sufficiency for some, while reducing others (...) to mere dependents. Law and Society scholars have demonstrated the problems of uneven access to legal remedies within the current organization of the legal system. Addressing these concerns simultaneously reveals both the problems of the current organization of needs and rights as well as illuminating alternative possibilities. The authors argue, first, that a justice perspective, based on rights is inadequate because its presumed universality is belied by the reality of the inaccessibility of rights to many. Second, the authors argue that a care perspective, currently formulated upon the assumption that only some people have needs, is also flawed because its presumed particularity distorts the human experience and subsequent policies. Instead, the authors need to conceive of care in a public way that permits both rights and needs to be understood as applicable to all. The authors propose some initial thoughts about how to create such a public concept of care. (shrink)

How do we know which institutions provide good care? Some scholars argue that the best way to think about care institutions is to model them upon the family or the market. This paper argues, on the contrary, that when we make explicit some background conditions of good family care, we can apply what we know to better institutionalized caring. After considering elements of bad and good care, from an institutional perspective, the paper argues that good care in an institutional context (...) has three central foci: the purpose of care, a recognition of power relations, and the need for pluralistic, particular tailoring of care to meet individuals? needs. These elements further require political space within institutions to address such concerns. (shrink)

It is time for the noon conference. Your job is to impart a career-changing experience in ethics to a group of students and interns gathered from four different schools with varying curriculums in ethics. They have just finished 1½ h of didactic sessions and lunch. One third of them were on call last night. Your first job is to keep them awake. The authors argue that this “tragic case” approach to ethics education is of limited value because it limits understanding (...) of moral problems to dilemmas; negates the moral agency of the student; encourages solutions that are merely intellectual; and suggests that ethical encounters are a matter for experts. The authors propose an alternative that focuses on three issues: the provider-patient relationship, the relationships between providers in the everyday world of health work and, the social position of healthcare providers in society. In this approach, teachers are not experts but more like guides on a journey who help students to learn that much of ethical practice comprises living through difficult situations of caring for vulnerable others and who help students to navigate some of these difficulties. (shrink)

Implicit in feminist and other critiques of ideal theorizing is a particular view of what normative theory should be like. Although I agree with the rejection of ideal theorizing that oppression theorists (and other theorists of justice) have advocated, the proposed alternative of nonideal theorizing is also problematic. Nonideal theorizing permits one to address oppression by first describing (nonideal) oppressive conditions, and then prescribing the best action that is possible or feasible given the conditions. Borrowing an insight from the "moral (...) dilemmas debate"— namely that moral wrongdoing or failure can be unavoidable—I suggest that offering (only) action-guidance under non-ideal conditions obscures the presence and significance of unavoidable moral failure. An adequate normative theory should be able to issue a further, non-action-guiding evaluative chim, namely that the best that is possible under oppressive conditions is not good enough, and may constitute a moral failure. I find exclusively action-guiding nonideal theory to be both insufficiently nonidealizing (because it idealizes the moral agent by falsely characterizing the agent as always able to avoid moral wrongdoing) and meanwhile too strongly adapted to the nonideal (because normative expectations are lowered and detrimentally adapted to options that, while the best possible, are still unacceptable). (shrink)

: International instruments now defend a "right to the truth " for victims of political repression and violence and include truth telling about human rights violations as a kind of reparation as well as a form of redress. While truth telling about violations is obviously a condition of redress or repair for violations, it may not be clear how truth telling itself is a kind of reparations. By showing that concerted truth telling can satisfy four features of suitable reparations vehicles, (...) I defend the idea that politically implemented modes of truth telling to, for, and by those who are victims of gross violation and injustice may with good reason be counted as a kind of reparations. Understanding the doubly symbolic character of reparations, however, makes clearer why truth telling is unlikely to be sufficient reparation for serious wrongs and is likely to be sensitive to the larger context of reparative activity and its social, political, and historical background. (shrink)

If business requires ethical solutions that are viable in the liminal landscape between concepts and corporate office, then business ethics and corporate social responsibility should offer tools that can survive the trek, that flourish in this well-traveled, but often unarticulated, environment. Indeed, feminist ethics produces, accesses, and engages such tools. However, work in BE and CSR consistently conflates feminist ethics and feminine ethics and care ethics. I offer clarification and invoke the analytic power of three feminist ethicists 'in action' whose (...) investigations into the "grey zones" of harms; identity and representational conventions; and "asymmetrical reciprocity" harmonize with business ethics' requirements. (shrink)

Disputes about theory in bioethics almost invariablyrevolve around different understandings of morality or practicalreasoning; I here suggest that the field would do well to becomemore explicitly contentious about knowledge, and start the taskof putting together a clinical epistemology. By way of providingsome motivation for such a discussion, I consider two cases ofresistance to shifts in clinical practice that are, by and large,not ethically controversial, highlighting how differentconceptions of epistemic authority may contribute to clinicians'unwillingness to adopt these changes, and sketching out (...) someinitial suggestions for epistemic analysis of clinical practice. (shrink)

: This project draws on scholarship of feminist and womanist scholars, and on results of interviews with scientists currently involved in molecular genetics. With reference to Margaret Urban Walker's "practices of moral responsibility," the social practices of molecular geneticists are explored, and strategies identified through which scientists negotiate their moral responsibilities. The implications of this work for scientists and for feminists are discussed.

: Care theorists have made significant gains over the past twenty-five years in establishing caring as a viable moral and political concept. Nonetheless, the concept of caring remains underdeveloped as a basis for a moral and political philosophy, and there is no fully developed account of our moral obligation to care. This article advances thinking about caring by developing a definition of caring and a theory of obligation to care sufficient to ground a general moral and political philosophy.

Contemporary critical approaches to bioethics increasingly present themselves as “relational,” though the meaning of relationality and its implications for bioethics seem to be many and varying. I argue that this confusion is due to a multiplicity of relational approaches originating from distinct theoretical lineages. In this article, I identify four key differences among commonly referenced relational approaches: the scope and nature of relationships considered, the extent of the determining influence on individual selfhood, and the integrity of individual selfhood. Importantly, these (...) four differences carry consequences for the usage of relational approaches within academic and clinical bioethics. I show that these differences attach to multiple objects of critique within mainstream bioethics and imply distinct metaethical commitments. Although I issue a cautionary note about combining relational approaches from distinct lineages, I close by suggesting that many such approaches may have their use, drawing on Susan Sherwin's sense of bioethical theories as lenses. (shrink)

This article uses two recent books on whistleblowing authored by political philosophers, to suggest that what political philosophy can contribute to the whistleblowing debate are notions of public interest that can help to enable and delineate responsibilities and protection of different actors. Whilst it is acknowledged that these recent works on whistleblowing offer a welcome articulation of the business ethics scholarship into that of political philosophy, it fails to deliver on its potential contribution. The argumentation proceeds along three objections, (1) (...) use of bad cases, (2) lack of new insights, and (3) conservative positioning. (shrink)

These last years, the development of AI robots for agriculture, livestock farming and food processing industries is rapidly increasing. These robots are expected to help produce and deliver food more efficiently for a growing human population, but they also raise societal and ethical questions. As the type of questions raised by these AI robots in society have been rarely empirically explored, we engaged in four case studies focussing on four types of AI robots for agri-food ‘in the making’: manure collectors, (...) weeding robots, harvesting robots and food processing robots which select and package fruits, vegetables and meats. Based on qualitative interviews with 33 experts engaged in the development or implementation of these four types of robots, this article provides a broad and varied exploration of the values that play a role in their evaluation and the ethical questions that they raise. Compared to the recently published literature reviews mapping the ethical questions related to AI robots in agri-food, we conclude that stakeholders in our case studies primarily adopt a relational perspective to the value of AI robots and to finding a solution to the ethical questions. Building on our findings we suggest it is best to seek a distribution of tasks between human beings and robots in agri-food, which helps to realize the most acceptable, good or just collaboration between them in food production or processing that contributes to realizing societal goals and help to respond to the 21 century challenges. (shrink)