The dual aim of this article is to reveal and explain a certain phenomenon of epistemic injustice as manifested in testimonial practice, and to arrive at a characterisation of the anti–prejudicial intellectual virtue that is such as to counteract it. This sort of injustice occurs when prejudice on the part of the hearer leads to the speaker receiving less credibility than he or she deserves. It is suggested that where this phenomenon is systematic it constitutes an important form of oppression. (...) [ABSTRACT FROM AUTHOR]. (shrink)

Recognition of conscientious objection seems reasonable in relation to controversial and contentious issues, such as physician assisted suicide and abortion. However, physicians also advance conscience‐based objections to actions and practices that are sanctioned by established norms of medical ethics, and an account of their moral force can be more elusive in such contexts. Several possible ethical justifications for recognizing appeals to conscience in medicine are examined, and it is argued that the most promising one is respect for moral integrity. It (...) is also argued that an appeal to conscience has significant moral weight only if the core ethical values on which it is based correspond to one or more core values in medicine. Finally, several guidelines pertaining to appeals to conscience and their ethical evaluation are presented. (shrink)

Three pictures of integrity have gained philosophical currency. On the integrated self picture, integrity involves the integration of "parts" of oneself into a whole. On the identity picture, integrity means fidelity to projects and principles constitutive of one's core identity. On the clean hands picture, integrity means maintaining the purity of one's agency, especially in dirty hands situations. I sketch each picture and suggest two general criticisms. First, integrity is reduced to something else with which it is not equivalent--to the (...) conditions of unified agency, to the conditions for continuing as the same self, and to the conditions for having reason to refuse cooperating with evil. Second, integrity is understood as a personal, but not also a social virtue; this limits the analysis of what integrity is and why it is a virtue. In the last section, I suggest a way of understanding integrity as the social virtue of standing before others for what, in one's best judgment, is worth persons' doing. (shrink)

Political interaction among citizens who hold opposing moral views commonly requires reaching beyond toleration, toward actual co‐operation with policies one opposes. On the more personal level, however, regarding (e.g.) interactions between healthcare providers and patients, several authors emphasise the importance of preserving integrity. But those who oppose any ‘complicity in evil’ often wrongly conflate instances in which the other's position is (and should be) totally rejected with instances of legitimate, although deep, disagreement. Starting with a striking example from the context (...) of a particular tradition, I argue generally that in the latter sort of disagreements, talk of ‘complicity’ should be largely replaced with a more co‐operative moral stance, grounded in a pluralistic framework. Co‐operation Despite Disagreement (CDD) should be sought either for institutional reasons – akin to the political – or for relational reasons. CDD involves sharing another's perspective and sometimes calls for adopting another's moral judgements in preference to one's own. I seek to identify some of the conditions and circumstances that would justify such a shift, particularly in scenarios involving assistance, such as physician‐assisted suicide (PAS) or the role of an anaesthesiologist in abortion. This discussion is meant to provide examples of the kind of second‐order reasons appropriate for determining the terms for CDD – in distinction from first‐order considerations (e.g., the much‐contested ‘active/passive’ distinction) which are likely to be the subject of the initial disagreement and hence cannot serve to resolve it. (shrink)

Imagine first the case of J (who might be anybody, jemand). J used to inhabit a social order, or rather an area within a social order, where socially approved roles were unusually well-defined. Responsibilities were allocated to each such role and each sphere of role-structured activity was clearly demarcated. These allocations and demarcations were embodied in and partly constituted by the expectations that others had learned to have of those who occupied each such role. For those who occupied those roles (...) to disappoint those expectations by failing to discharge their assigned responsibilities was to invite severe disapproval and other sanctions. To refuse to find one's place within the hierarchies of approved roles, or to have been refused a place, because judged unfit for any such role, was to be classified as socially deviant and irresponsible. The key moral concepts that education had inculcated into J were concepts of duty and responsibility. His fundamental moral beliefs were that each of us owes it to others to perform her or his assigned duties and to discharge her or his assigned responsibilities. A good human being performs those duties, discharges those responsibilities, and does not trespass into areas that are not her or his concern. A philosopher who comes across the likes of J will understand his attitudes as cultural parodies, in part of Plato (conceiving of justice as requiring ‘that each do her or his own work and not meddle with many things’ Republic 433a) and in part of Kant (doing one's duty just because it is one's duty and not for the sake of any further end), authors who had influenced J's school teachers. A sociologist will entertain the suspicion that in certain types of social order it may be only in the form of parodies that some types of concept can continue to find expression. But for the moment let us put this thought on one side and return to J. (shrink)

ABSTRACT Imagine Oskar Schindler before the bar of moral theory. Schindler, a minor industrialist, sheltered more than 1000 Jews during the Holocaust. This would seem to be a record of virtue. Or is it? The dominant consensus in moral theory stresses a rationality and universality of judgement and action that Oskar did not even consider. Efforts to interpret Schindler in universal terms by reference to human rights or to the tenet that ought implies can are entertained and denied. If Schindler's (...) deeds are moral reality, the consensus in contemporary moral theory is the poorer for being unable to recognise them. Schindler's virtue is noteworthy in its own right and also as a limiting case for the mainline of contemporary moral theory. (shrink)

Many types of `other-regarding' acts and beliefs cannotbe accounted for satisfactorilyas instances of sophisticated selfishness, altruism,team-reasoning, Kantian duty, kinselection etc. This paper argues in favour ofre-inventing the notion of solidarity as ananalytical category capable of shedding importantnew light on hitherto under-explainedaspects of human motivation. Unlike altruism andnatural sympathy (which turn theinterests of specific others into one's own), orteam-reasoning (which applies exclusivelyto members of some team), or Kantian duty (whichdemands universalisable principlesof action), the essence of solidarity lies in thehypothesis that people (...) are capable ofresponding sympathetically to (or empathising with)a condition afflicting ‘others’,irrespectively of who those others are or whetherone cares for them personally. Andwhen that condition is a social artefact, we argue,solidarity turns radical. (shrink)

: Two basic criticisms of managed care are that it erodes patient trust in physicians and subjects physicians to incentives and pressures that compromise the physician's fiduciary obligation to the patient. In this article, I first distinguish between status trust and merit trust, and then argue (1) that the value of status trust in physicians is probably over-rated and certainly underdocumented; (2) that erosion of status trust may not be detrimental if accompanied by an increase in well-founded merit trust; and (...) (3) that under conditions of managed care the physician's commitment to traditional medical ethics cannot serve as an adequate basis for merit trust. Next, drawing on an analogy between managed care organizations and polities, I argue that (4) the most appropriate basis for merit trust in managed care is a conception of organizational legitimacy that includes procedural justice, empowerment of constructive criticism within the organization, and organizational accommodation of the noninstrumental commitment to patient well-being that is distinctive of medical professionalism. I then explore the conditions necessary for robust competition for merit trust among managed care organizations and indicate the kinds of public policies needed to facilitate such competition. Finally, I show how the account of organization-based merit trust can accommodate the special fiduciary obligation of medical professionals, without indulging in the delusion that it is the physician's fiduciary obligation always to provide all care that is expected to be of any net benefit to the patient. (shrink)