The Ethics Working Group of Clinton's Health Care Task Force developed a list of principles and values that should govern health care reform. These principles and values are compatible with central moral and political traditions, as well as with more rigorous theoretical accounts of justice and health care, but they are "freestanding" points of agreement, not presupposing any particular theoretical background. Though imprecise and not ranked by priorities, the principles guide thinking about the fairness of alternative reform proposals. Their use (...) is illustrated by comparing alternatives on universality of access, phase-in period, the creation of unequal tiers, and the provision for wise allocation and rationing. Keywords: principles, health care reform, rationing, universal access CiteULike Connotea Del.icio.us What's this? (shrink)

CHAPTER ONE Is the Sex of the Knower Epistemologically Significant? The Question A question that focuses on the knower, as the title of this chapter does, ...

In this lively and accessible book Lorraine Code addresses one of the most controversial questions in contemporary theory of knowledge, a question of fundamental concern for feminist theory as well: Is the sex of the knower epistemologically significant? Responding in the affirmative, Code offers a radical alterantive to mainstream philosophy's terms for what counts as knowledge and how it is to be evaluated. Code first reviews the literature of established epistemologies and unmasks the prevailing assumption in Anglo-American philosophy that "the (...) knower" is a value-free and ideologically neutral abstraction. Approaching knowledge as a social construct produced and validated through critical dialogue, she defines the knower in light of a conception of subjectivity based on a personal relational model. Code maps out the relevance of the particular people involved in knowing: their historical specificity, the kinds of relationships they have, the effects of social position and power on those relationships, and the ways in which knowledge can change both knower and known. In an exploration of the politics of knowledge that mainstream epistemologies sustain, she examines such issues as the function of knowledge in shaping institutions and the unequal distribution of cognitive resources. What Can She Know? will raise the level of debate concerning epistemological issues among philosophers, political and social scientists, and anyone interested in feminist theory. (shrink)

In this lively and accessible book Lorraine Code addresses one of the most controversial questions in contemporary theory of knowledge, a question of fundamental concern for feminist theory as well: Is the sex of the knower epistemologically significant? Responding in the affirmative, Code offers a radical alterantive to mainstream philosophy's terms for what counts as knowledge and how it is to be evaluated. Code first reviews the literature of established epistemologies and unmasks the prevailing assumption in Anglo-American philosophy that "the (...) knower" is a value-free and ideologically neutral abstraction. Approaching knowledge as a social construct produced and validated through critical dialogue, she defines the knower in light of a conception of subjectivity based on a personal relational model. Code maps out the relevance of the particular people involved in knowing: their historical specificity, the kinds of relationships they have, the effects of social position and power on those relationships, and the ways in which knowledge can change both knower and known. In an exploration of the politics of knowledge that mainstream epistemologies sustain, she examines such issues as the function of knowledge in shaping institutions and the unequal distribution of cognitive resources. What Can She Know? will raise the level of debate concerning epistemological issues among philosophers, political and social scientists, and anyone interested in feminist theory. (shrink)

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

This article tries to present a broad view on the values and ethicalissues that are at stake in efforts to rationalize health policy on thebasis of economic evaluations (like cost-effectiveness analysis) andrandomly controlled clinical trials. Though such a rationalization isgenerally seen as an objective and `value free' process, moral valuesoften play a hidden role, not only in the production of `evidence', butalso in the way this evidence is used in policy making. For example, thedefinition of effectiveness of medical treatment or (...) health care serviceis heavily dependent on dominant individual or social views about thegoals of the particular treatment or service. There is also a concernthat a reliance on EBM in health policy will occur at the expense ofwidely shared social values like equity and solidarity. Moreover, thereis a concern that when economic considerations and rational proceduresbecome more influential, various `outside' groups third parties likeinsurance companies and policy makers will get a stronger influence onmedical practice which may lead to a change in the patient-providerrelationship. The authors conclude that social values and patientpreference should be explicitly addressed when health policy making isbased on economic and other scientific evidence. (shrink)

This article examines the emergence of casuistical case analysis as a methodological alternative to more theory-driven approaches in bioethics research and education. Focusing on The Abuse of Casuistry by A. Jonsen and S. Toulmin, the article articulates the most characteristic features of this modernday casuistry (e.g., the priority allotted to case interpretation and analogical reasoning over abstract theory, the resemblance of casuistry to common law traditions, the ‘open texture’ of its principles, etc.) and discusses some problems with casuistry as an (...) ‘anti-theoretical’ method. It is argued that casuistry so defined is ‘theory modest’ rather than ‘theory free’ and that ethical theory can still play a significant role in casuistical analysis; that casuistical analyses will encounter conflicting ‘deep’ interpretations of our social practices and institutions, and are therefore unlikely sources of increased social consensus on controversial bioethical questions; that its conventionalism raises questions about casuistry's ability to criticize norms embedded in the societal consensus; and that casuistry's emphasis upon analogical reasoning may tend to reinforce the individualistic nature of much bioethical writing. It is concluded that, notwithstanding these problems, casuistry represents a promising alternative to the regnant model of ‘applied ethics’ (i.e., to the ritualistic invocation of the so-called ‘principles of bioethics’). The pedagogical implications of casuistry are addressed throughout the paper and include the following recommendations: (1) use real cases, (2) make them long, richly detailed and comprehensive, (3) present complex sequences of cases, (4) stress the problem of ‘moral diagnosis’, and (5) be ever mindful of the limits of casuistical analysis. Keywords: casuistry, interpretation, methodology, pedagogy CiteULike Connotea Del.icio.us What's this? (shrink)

Offers a compelling vision of how to achieve and conduct a liberal but democratic society through the ideal of Neutrality--between people and ideas of the good--and using the tool of Neutral dialogue.

In this classic work of feminist political thought, Iris Marion Young challenges the prevailing reduction of social justice to distributive justice.

In this paper we want to briefly illustrate the ways in which technical, ethical and political judgements of various kinds are interwoven in the processes of healthcare decision-making in the UK. Drawing upon the research for the “Choices in Health Care” project we will borrow the notion of the hidden curriculum from education to illuminate the nature of resource allocation decision processes. In particular we will indicate some of the fundamental but largely hidden political factors in play in these processes (...) and the importance of the inchoate and implicit notion of “NHS values” in shaping UK resource allocation policies. We suggest that these more diffuse, holistic and system level value judgements are both central to understanding priority setting and at the same time difficult to reduce or abstract out into lists of single values/principles. (shrink)

How are we to understand the role of bioethics in the health care system, government, and academe? This collection of original essays raises these and other questions about the nature of bioethics as a discipline.

During the last decade a “technical” approach has become increasingly influential in health care priority setting. The various country reports illustrate, however, that non-technical considerations cannot be avoided. As they often remain implicit in health care package decisions, this paper aims to make these normative judgements an explicit part of the procedure. More specifically, it aims to integrate different models of distributive justice as well as the principle of solidarity in four different phases of a decision-making procedure, and to identify (...) important moral choices which present themselves. First four important justice models are discussed, then a justification is given for their inclusion in a four-step decision making procedure. This is followed by a discussion of different justice and solidarity problems—with their inherent conceptual difficulties in each of these stages. The paper concludes with a summary of the major moral choices that are to be made in health care package decisions. (shrink)

Since it appeared in 1971, John Rawls's A Theory of Justice has become a classic. The author has now revised the original edition to clear up a number of difficulties he and others have found in the original book. Rawls aims to express an essential part of the common core of the democratic tradition--justice as fairness--and to provide an alternative to utilitarianism, which had dominated the Anglo-Saxon tradition of political thought since the nineteenth century. Rawls substitutes the ideal of the (...) social contract as a more satisfactory account of the basic rights and liberties of citizens as free and equal persons. "Each person," writes Rawls, "possesses an inviolability founded on justice that even the welfare of society as a whole cannot override." Advancing the ideas of Rousseau, Kant, Emerson, and Lincoln, Rawls's theory is as powerful today as it was when first published. (shrink)

Assessment of evidence is becoming a centralpart of health policy decisions – not least inlimit setting decisions. Limit-settingdecisions can be defined as the withholding ofpotentially beneficial health care. Thisarticle seeks to explore the value choicesrelated to the use of evidence in limit-settingdecisions at the political level. To betterspecify the important but restricted role ofevidence in such decisions, the value choicesof relevance are discussed explicitly. Fourcriteria are often considered when settinglimits:1. The severity of disease if untreated or treatedby standard care2. The (...) effectiveness of the new technology3. The cost-effectiveness of the new technology4. The quality of evidence on (1)–(3)The production and assessment of evidence isimportant for each criterion, but severalpoints are identified where the practice ofevidence-based medicine could be furtherdeveloped to capture a broader spectrum ofethical and political concerns that suchdecisions naturally evoke among citizens. (shrink)

In this engaging study, the authors put casuistry into its historical context, tracing the origin of moral reasoning in antiquity, its peak during the sixteenth and early seventeenth century, and its subsequent fall into disrepute from the mid-seventeenth century.

First published in 1903, this volume revolutionized philosophy and forever altered the direction of ethical studies. A philosopher’s philosopher, G. E. Moore was the idol of the Bloomsbury group, and Lytton Strachey declared that Principia Ethica marked the rebirth of the Age of Reason. This work clarifies some of moral philosophy’s most common confusions and redefines the science’s terminology. Six chapters explore: the subject matter of ethics, naturalistic ethics, hedonism, metaphysical ethics, ethics in relation to conduct, and the ideal. Moore's (...) simplicity of style and precise use of everyday language exercised an enormous influence on the development of analytic philosophy, and they contribute to the continuing resonance of his compelling arguments. (shrink)

Three standard tasks undertaken by applied ethicists engaged in the public policy process are identifying value issues, clarifying concepts and meanings, and analyzing arguments. I urge that these should be expanded to include making specific moral judgments and advocating positions and policies. Three objections to philosophers/ethicists' engagement in the formation of public policy are advanced and evaluated: philosophers necessarily do public policy badly, doing it at all compormises one's integrity as a seeker after truth, and frequently participation is in the (...) service of a repressive status quo that is structured simultaneously to preclude radical change and to co-opt ethicists. finally, however, I argue that those who would be ‘applied ethicists’ cannot avoid all participation in some form of a public policy process; that engagement holds the hope as well for improved ethical theory; that the preferred form of participation is frequently from outside of establishment bodies; and that wherever philosophers do involve themselves in policy formulation, this is best done in the expanded sense urged at the outset. Keywords: applied ethics, moral reasoning, public policy CiteULike Connotea Del.icio.us What's this? (shrink)

Though the revised edition of A Theory of Justice, published in 1999, is the definitive statement of Rawls's view, so much of the extensive literature on Rawls's theory refers to the first edition. This reissue makes the first edition once again available for scholars and serious students of Rawls's work.

Where we once spoke in military terms, we now often wield the language of the market: health care is a “product” and we are its “providers” and “consumers.” The market metaphor constrains in various ways our vision of the goals we pursue in making health policy, of the options available to us in pursuing them, indeed—because policy implies a certain view of moral agency—of the way we relate to each other.

This classic and controversial book examines the roots of the idea of virtue, diagnoses the reasons for its absence in modern life, and proposes a path for its recovery.

Bioethics and its offspring Health-care Ethics have a variety ofuses and obligations among which and perhaps most importantly istheir social obligation. This paper raises questions as toBioethics fulfilling the necessary criteria for a profession,suggests that it can serve as a link between individual andcommunal problems, discusses the task of health-care ethics as well as ways of teaching it, lists some of the obligationsof health-care ethics professionals and discusses the dangers to and failings of these health-care professionals today. Itconcludes that we (...) are at a crossroads in which we must choosebetween our own personal security and comfort and fulfilling our social role. (shrink)

What is at the basis of moral action? An altruism acquired by the application of rule and principle? Or, as Noddings asserts, caring and the memory of being cared for? With numerous examples to supplement her rich theoretical discussion, Noddings builds a compelling philosophical argument for an ethics based on natural caring, as in the care of a mother for her child. The ethical behavior that grows out of natural caring, and has as its core care-filled receptivity to those involved (...) in any moral situation, leaves behind the rigidity of rule and principle to focus on what is particular and unique in human relations. Noddings's discussion is wide-ranging, as she considers whether organizations, which operate at a remove from the caring relationship, can truly be called ethical. She discusses the extent to which we may truly care for plants, animals, or ideas. Finally, she proposes a realignment of education to encourage and reward not just rationality and trained intelligence, but also enhanced sensitivity in moral matters. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

In this engaging study, the authors put casuistry into its historical context, tracing the origin of moral reasoning in antiquity, its peak during the sixteenth and early seventeenth century, and its subsequent fall into disrepute from the mid-seventeenth century.

What has moral theory to do with practical judgment? The practical ethicist can move by analogy from case to case, saying of most new cases, “Oh, I think I've been here before.” Theory, ascending to a broader view, can provide directions when the ethicist finds herself in unfamiliar territory.

Part I: WHAT IS ETHICS? Plato: Socratic Morality: Crito. Suggestions for Further Reading. Part II: ETHICAL RELATIVISM VERSUS ETHICAL OBJECTIVISM. Herodotus: Custom is King. Thomas Aquinas: Objectivism: Natural Law. Ruth Benedict: A Defense of Ethical Relativism. Louis Pojman: A Critique of Ethical Relativism. Gilbert Harman: Moral Relativism Defended. Alan Gewirth: The Objective Status of Human Rights. Suggestions for Further Reading. Part III: MORALITY, SELF-INTEREST AND FUTURE SELVES. Plato: Why Be Moral? Richard Taylor: On the Socratic Dilemma. David Gauthier: Morality and (...) Advantage. Gregory Kavka: A Reconciliation Project. Derek Parfit: Later Selves and Moral Principles. Bernard Williams: Persons, Character, and Morality. Suggestions for Further Reading. Part IV: VALUE. Jeremy Bentham: Classical Hedonism. Robert Nozick: The Experience Machine. Richard Taylor: Value and the Origin of Right and Wrong. Friedrich Nietzsche: The Transvaluation of Values. Derek Parfit: What Makes Someone’s Life Go Best? Thomas Nagel: Value: The View from Nowhere. Suggestions for Further Reading. Part V: UTILITARIANISM AND CONSEQUENTIALISM. John Stuart Mill: Utilitarianism. J.J.C. Smart: Extreme and Restricted Utilitarianism. Kai Nielsen: Against Moral Conservatism. Bernard Williams: Against Utilitarianism. John Hospers: Rule-Utilitarianism. Robert Nozick: Side Constraints. Peter Singer: Famine, Affluence and Morality. Suggestions for Further Reading. Part VI: KANTIAN AND DEONTOLOGICAL SYSTEMS. Immanuel Kant: Foundation for the Metaphysic of Morals. W. D. Ross: What Makes Right Acts Right? Onora O’Neill: Kantian Formula of the End in Itself and World Hunger. Thomas Nagel: Moral Luck. Philippa Foot: Morality as a System of Hypothetical Imperatives. Judith Jarvis Thomson: Killing, Letting Die, and the Trolley Problem. Suggestions for Further Reading. Part VII: CONTRACTARIAN ETHICAL SYSTEMS. Thomas Hobbes: The Leviathan. David Gauthier: Why Contractarianism? John Rawls: Contractualism: Justice as Fairness. T.M. Scanlon: Contractualism and Utilitarianism. Suggestions for Further Reading. Part VIII: VIRTUE-BASED ETHICAL SYSTEMS. Aristotle: The Ethics of Virtue. Bernard Mayo: Virtue and the Moral Life. William Frankena: A Critique of Virtue-Based Ethics. Walter Schaller: Are Virtues No More than Dispositions to Obey Moral Rules? Alasdair MacIntyre: The Nature of the Virtues. Susan Wolf: Moral Saints. Louis P. Pojman: In Defense of Moral Saints. Suggestions for Further Reading. Part IX: THE FACT/VALUE PROBLEM: METAETHICS IN THE TWENTIETH CENTURY. David Hume: On Reason and the Emotions: The Fact/Value Distinction. G. E. Moore: Non-Naturalism. A. J. Ayer: Emotivism. R. M. Hare: Prescriptivism: The Structure of Ethics and Morals. Geoffrey Warnock: The Object of Morality. Suggestions for Further Reading. Part X: MORAL REALISM AND THE CHALLENGE OF SKEPTICISM. J.L. Mackie: The Subjectivity of Values. Jonathan Harrison: A Critique of Mackie’s Error Theory. Gilbert Harman: Moral Nihilism. Nicholas Sturgeon: Moral Explanations. Bernard Williams: Ethics and the Limits of Philosophy. Bruce Russell: Two Forms of Ethical Skepticism. Michael Smith: A Defense of Moral Realism. Suggestions for Further Reading. Part XI: RELIGION AND ETHICS. Plato: Morality and Religion. Immanuel Kant: God and Immortality as Necessary Postulates of Morality. George Mavrodes: Religious and the Queerness of Morality. Kai Nielson: Ethics Without God. Suggestions for Further Reading. Part XII: CONTEMPORARY CHALLENGES TO CLASSICAL ETHICAL THEORY. Part A. Sociobiology and the Question of Moral Responsibility. Charles Darwin: Ethics and the Descent of Man. E.O.Wilson: Sociobiology and Ethics. Michael Ruse: Evolution and Ethics: The Sociobiological Approach. Elliot Sober: Prospects for an Evolutionary Ethics. J.L. Mackie: The Law of the Jungle, Evolution and Morality. Suggestions for Further Readingon Sociobiology. Part B. The Challenge of Determinism to Moral Responsibility and Desert. Galen Strawson: The Impossibility of Moral Responsibility. Louis Pojman: Free Will, Determinism, and Moral Responsibility:A Response to Galen Strawson. Richard Taylor: A Libertarian Defense of Free Will and Responsibility. Suggestions for Further Reading on Moral Responsibility. Glossary of Ethical Terms. (shrink)

No other cluster of medical issues affects the genders as differently as those related to procreationcontraception, sterilization, abortion, artificial insemination, in-vitro fertilization, surrogate motherhood, and genetic screening. Rosemarie Tong s approach to feminist bioethics serves as a catalyst to bring together different feminist voices in hope of actually doing something to make gender equity a present reality rather than a mere future possibility.".

Theories of justice, argues Virginia Held, are usually designed for a perfect, hypothetical world. They do not give us guidelines for living in an imperfect world in which the choices and decisions that we must make are seldom clear-cut. Seeking a morality based on actual experience, Held offers a method of inquiry with which to deal with the specific moral problems encountered in daily life. She argues that the division between public and private morality is misleading and shows convincingly that (...) moral judgment should be contextual. She maps out different approaches and positions for various types of issues, including membership in a state, legal decisions, political activities, economic transactions, interpersonal relations, diplomacy, journalism, and determining our obligation to future generations. Issues such as these provide the true test of moral theory, since its success is seen in the willingness of conscientious persons to commit themselves to it by acting on it in their daily lives. (shrink)

ACKNOWLEDGMENTS. Among Those Who helped greatly in the initial stages of this project by making constructive suggestions on my first "caring" papers are Nick Burbules, William Doll, Bruce Fuller, Brian Hill, William Pinar, Mary Anne ...

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

A physician says, "I have an ethical obligation never to cause the death of a patient," another responds, "My ethical obligation is to relieve pain even if the patient dies." The current argument over the role of physicians in assisting patients to die constantly refers to the ethical duties of the profession. References to the Hippocratic Oath are often heard. Many modern problems, from assisted suicide to accessible health care, raise questions about the traditional ethics of medicine and the medical (...) profession. However, few know what the traditional ethics are and how they came into being. This book provides a brief tour of the complex story of medical ethics evolved over centuries in both Western and Eastern culture. It sets this story in the social and cultural contexts in which the work of healing was practiced and suggests that, behind the many different perceptions about the ethical duties of physicians, certain themes appear constantly, and may be relevant to modern debates. The book begins with the Hippocratic medicine of ancient Greece, moves through the Middle Ages, Renaissance and Enlightenment in Europe, and the long history of Indian and Chinese medicine, ending as the problems raised modern medical science and technology challenge the settled ethics of the long tradition. (shrink)

Her careful building of positions, her unique approaches to analyzing problems, and her excellent insights make this an important work for feminists, those ...

First Published in 1993. Routledge is an imprint of Taylor & Francis, an informa company.

In a Different Voice is the little book that started a revolution, making women's voices heard, in their own right and with their own integrity, for virtually the first time in social scientific theorizing about women. Its impact was immediate and continues to this day, in the academic world and beyond.

In Common Values, now with a new preface, Bok writes eloquently and clearly while combining moral theory with practical ethics, demonstrating how moral values apply to all facets of life—personal, professional, domestic, and international. Drawing on a great deal of historical material, Bok also includes in her examination consideration of the 1993 United Nations World Conference on Human Rights; the World Parliament of Religions; the publication of Veritatis Splendor, Pope John Paul II's proclamation on morality; and the International Commission of (...) Global Governance. Bok's defense of shared morality addresses a crucial topic for our time. (shrink)

In Common Values, Sissela Bok asks what moral values, if any, might be capable of being shared across national, ethnic, religious, and other boundaries, under what circumstances, and with what qualifications.

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.