Introduction -- Part I: The good life -- Hedonism : its powerful appeal -- Is happiness all that matters? -- Getting what you want -- Problems for the desire theory -- Part II: Doing the right thing -- Morality and religion -- Natural law theory -- Psychological egoism -- Ethical egoism -- Consequentialism : its nature and attractions -- Consequentialism : its difficulties -- The kantian perspective : fairness and justice -- The kantian perspective : autonomy and respect -- The (...) social contract tradition : theory and attractions -- The social contract tradition : problems and prospects -- Ethical pluralism and absolute moral rules -- Ethical pluralism : prima facie duties and ethical particularism -- Virtue ethics -- Feminist ethics -- Part III: The status of morality -- Ethical relativism -- Moral nihilism -- Ten arguments against moral objectivity. (shrink)

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating (...) would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed. (shrink)

The publicity surrounding the recent McMath and Muñoz cases has rekindled public interest in brain death: the familiar term for human death determination by showing the irreversible cessation of clinical brain functions. The concept of brain death was developed decades ago to permit withdrawal of therapy in hopeless cases and to permit organ donation. It has become widely established medical practice, and laws permit it in all U.S. jurisdictions. Brain death has a biophilosophical justification as a standard for determining human (...) death but remains poorly understood by the public and by health professionals. The current controversies over brain death are largely restricted to the academy, but some practitioners express ambivalence over whether brain death is equivalent to human death. Brain death remains an accepted and sound concept, but more work is necessary to establish its biophilosophical justification and to educate health professionals and the public. (shrink)

We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” (...) demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike. (shrink)

Scholars have long asserted that public relations (PR) professionals should play the role of organizational conscience, but little research has focused on why and how they play this role effectively. We found that PR professionals who played the role of organizational conscience had broadened conceptions of their roles and responsibilities, including a fervent duty to the public interest. This often put them in the position of providing criticism to powerful organizational players. Rather than raising their ethical concerns as persuasive orators, (...) they used subtle, resourceful, and experiential approaches to persuasion. Playing the role of organizational conscience typically necessitated gaining access to informal coalitions since access to dominant power coalitions often was limited or late. Organizations with participative cultures supported the role of organizational conscience. (shrink)

Little is known and understood about ethics management or the development of formal, systematic, and goal-directed initiatives to improve ethics in the public relations workplace. This study found little ethics training and written guidelines in the public relations workplace. Organizational ethics initiatives are poorly communicated to practitioners and rely mostly on punitive restraints with little reward for ethical behavior. For many practitioners, ethics is not learned through workplace ethics initiatives but rather is mostly informed by external influences including personal values, (...) family upbringing, and professional work experiences. (shrink)

Terms such as ‘cultural competence’ and ‘transcultural nursing’ have comfortably taken their place in the lexicon of health care. Their high profile is a reflection of the diversity of western societies and health care’s commitment to provide care that is responsive to the values and beliefs of all who require treatment. However, the relationship between cultural competence and familiar ethical concepts such as patient autonomy has been an uneasy one. This article explores the moral foundations of cultural competence, ultimately locating (...) them in patient autonomy and patient good. The discussion of patient good raises questions about the moral relevance of a value’s rootedness in a particular culture. I argue that the moral justification for honoring cultural values has more to do with the fact that patients are strongly committed to them than it does with their cultural rootedness. Finally, I suggest an organizational approach to cultural competence that emphasizes overall organizational preparedness. (shrink)

Hideo Kimura, a 46-year-old Japanese male patient in a Boston hospital, needs to undergo surgery to remove part of his lower intestine but resists signing the consent form and has little understanding of English. Discussing this with an interpreter, Hideo is puzzled, because he has already authorized his wife Sachiko to decide on his behalf. The interpreter points out to him that he has a right, a moral right, to give his informed consent to the surgery and that Hideo is (...) quite competent to decide for himself. Nonetheless, Hideo cannot grasp the meanings of “informed consent” and “moral right.” Hideo agrees to sign the consent form only after he is told that this is official hospital policy. (shrink)