While agreeing with the main conclusion of Dominic Wilkinson and colleagues (Wilkinson, Butcherine, and Savulescu 2019), namely, that there is no moral difference between treatment withholding and withdrawal as such, we wish to criticize their approach on the basis that it treats the widespread acceptance of withdrawal aversion (WA) as a cognitive bias. Wilkinson and colleagues understand WA as “a nonrational preference for withholding (WH) treatment over withdrawal (WD) of treatment” (22). They treat WA as a manifestation of loss aversion (...) and refer to Kahneman and colleagues (1991), which defined this effect as follows: “the disutility of giving up an object is greater that the utility associated with acquiring it” (194). In a previous work, Wilkinson and Savulescu understood nonequivalence between treatment withholding and withdrawal as a reflection of slightly different, although related, phenomena: status quo bias or omission bias (Wilkinson and Savulescu 2012, 130–131). In neither of these two papers do they describe precisely the relation between these well-known psychological effects and WA, nor do they explain why they treat these effects as examples of nonrational preferences, despite the fact that these issues have been the subject of wide-ranging discussions on the intersection of psychology, economy, and philosophy. (shrink)

In this commentary, I suggest expanding the deliberative aspects of critical care policy development in two ways. First, critical-care policy development should expand the scope of deliberation by leaving fewer issues up to expertise or private choice. For instance. it should allow deliberation about the relevance of age, disability, social position, and psychological well-being to allocation decisions. Second, it should broaden both the set of costs considered and the set of stakeholders represented in the deliberative (...) process. In particular, it should consider efforts to reduce the cost of end-of-life care and to redirect resources away from the provision of costly interventions, and should expand the set of individuals included in deliberation to include stakeholders outside the health-care system. (shrink)

The authors developed this textbook in response to an increasing interest in ethics, and a growing number of courses on this topic that are now being offered in educational leadership programs. It is designed to fill a gap in instructional materials for teaching the ethics component of the knowledge base that has been established for the profession. The text has several purposes: First, it demonstrates the application of different ethical paradigms (the ethics of justice, care, critique, and the profession) (...) through discussion and analysis of real-life moral dilemmas that educational leaders face in their schools and communities. Second, it addresses some of the practical, pedagogical, and curricular issues related to the teaching of ethics for educational leaders. Third, it emphasizes the importance of ethics instruction from a variety of theoretical approaches. Finally, it provides a process that instructors might follow to develop their own ethics unit or course. * Part I provides an overview of why ethics is so important, especially for today's educational leaders, and describes a multiparadigm approach essential to practitioners as they grapple with ethical dilemmas. * Part II deals with the dilemmas themselves. Ethical dilemmas written by the authors' graduate students bring readers face-to-face with the kinds of dilemmas faced by practicing administrators in urban, suburban, and rural settings in an era full of complexities and contradictions. * Part III focuses on pedagogy and provides teaching notes for the instructor. The authors discuss the importance of self-reflection on the part of both instructors and students, and model how they thought through their own personal and professional ethical codes as well as reflected upon the critical incidents in their lives that shaped their teaching and frequently determined what they privileged in class. (shrink)

Moral (or ethical) sensitivity is widely viewed as a foundational learning goal in engineering ethics education. We have argued in this paper is that this view of moral sensitivity cannot be readily transported from the nursing context to the engineering context on the basis of a care-analogy. The particularized care characteristic of the nursing context is decisively different from the generalized and universalized forms of care characteristic of the engineering context. Through a focus on care and (...) maintenance, the engineering student’s moral sensitivity can be refined, opening up a perceptual awakening and affectivity towards the complex nature of the engineer’s Other. This awakening is in part promoted through an understanding of the ideology of neutrality as a moment in the history engineering. Becoming aware of this ideology as an ideology can then be seen as an activity of dividing loyalties that allows for a reflexive and critical view of the biases and presuppositions inherited within the world of engineering. This process of deepening the engineering student’s moral sensitivity is perhaps as much a process of the student becoming aware of her professional world, how it shapes her understanding of herself, and what it means to be a good engineer. (shrink)

In modern hospitals in developed countries, deaths are determined usually after a prearranged schedule of resuscitative efforts. By default, death is diagnosed and determined after “full code” or after the failure of intensive resuscitation. In end-of-life contexts, however, various degrees of less-than-full resuscitation and sometimes no resuscitation are allowed after the consent and shared decision-making of the patient and/or surrogates. The determination of brain death is a unique exception in these contexts because such an end-of-life care plan is usually (...) not offered until after brain death is declared. This essay analyzes and critiques three arguments for denying the family and/or surrogate a chance to consent to or forego the diagnostic protocol of brain death and choose an alternative end-of-life plan. First, opponents of consent for the determination of brain death argue that presenting it as a selectable end-of-life plan undermines the integrity of death determination. The second argument is that it is inconsistent to allow foregoing the determination of brain death when the determination of circulatory death is non-negotiable. The third argument is that allowing the patient/surrogate to forego the determination of brain death would jeopardize the fair and appropriate utilization of intensive care resources and potentially reduce organ donor pools. After closer conceptual examinations of these three arguments, this essay concludes that these arguments are conceptually and morally problematic. It defends an alternative patient-centered end-of-life care plan based on consent and shared decision-making. (shrink)

Objective: This main aim of the study is to explore COVID-19 pandemic problems from the perspective of public health-clinical care ethics through online mediareports in Turkey. Method: This research was designed as a descriptive and qualitative study that assesses COVID-19 through online media reports on critics between the periods of March 11, 2020 and April 2 2020 as a quantitative as number of reports and qualitative study, across Turkey. Reports were from Turkish Medical Association websites which included newspaper reports. (...) Study data were presented as statistically and qualitative data case and headlines. No ethical or ofTicial permission was sought as the study was conducted through open access internet news sites. Results: This online reports analysis retrieved about 6723 articles about the COVID-19. According to study data, information about COVID-19 were themed as follows: general deTiciencies in taking action and isolation, lack of isolation, passengers and transport vehicles not quarantined ; insufTicient diagnostic tests, decision to test after healthcare professionals become infected, lack of equipment, lack of evaluation outbreak countries [Table 2]. Conclusion and Suggestions: COVID-19 is a pandemic and is a global public health problem that concerns every individual and needs to be handled carefully. This requires a multi-faceted preparation and education. In this context, healthcare professionals should be well trained in this aspect and have all the necessary equipment throughout the process. Additionally, it should work systematically with the cooperation of all health organizations, the Ministry of Health, local governments and of course the media, in order to inform society, fairly distribute the resources and to implement the safety measures effectively. BrieTly, lack of transparency, insufTicient information, limited resources, lack of public health protection measures such as partial quarantine decision, partial implementation of the scientiTic board's re c ommenda ti on s fo r e c on omi c rea s on s, and contradiction of the explanations are revealed as serious ethical problems. (shrink)

Philosophers of science have insisted that evidence of underlying mechanisms is required to support claims about the effects of medical interventions. Yet evidence about mechanisms does not feature on dominant evidence-based medicine “hierarchies.” After arguing that only inferences from mechanisms (“mechanistic reasoning”)—not mechanisms themselves—count as evidence, I argue for a middle ground. Mechanistic reasoning is not required to establish causation when we have high-quality controlled studies; moreover, mechanistic reasoning is more problematic than has been assumed. Yet where the problems can (...) be overcome, mechanistic reasoning can and should be used as evidence. (shrink)

In the domain of medical science, factual evidence is usually considered as the criterion on which to base decisions and construct hypotheses. Evidence-based medicine is the translation of this approach into the field of patient care, and it means providing only the type of care that is based on evidence that proves its effectiveness and appropriateness. However, while the literature has focused on the types and force of evidence used to establish the recommendation and treatment guidelines, the (...) problem of how evidence is used in doctor–patient interactions to motivate, or refuse, treatment or habit change has been almost completely neglected. In this specific context, characterized by the epistemic unbalance between the interlocutors and a specific conversational goal, the scientific categories of evidence are often irrelevant. The goal of this paper is to address this challenge by analyzing the role evidence plays in doctor–patient interactions in diabetes care. After introducing an analytical distinction between the epistemic and the pragmatic aspect of evidence, we will propose a classification of the types and functions of evidence in chronic care communication, and illustrate its possible uses through its application to our corpus of diabetes-care consultations. From our qualitative analyses, it is possible to observe how in this communicative context a crucial role is played by the conflicts of evidence, in which providers correct patients’ uses of evidence leading them to using less defeasible levels of evidence. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity (...) care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds (...) in philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, (...) end-of-life care, bioethics, and health policy discuss if age should guide rationing decisions. (shrink)

At the height of the Covid-19 pandemic, frontline medical professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique lens through which to understand how the public reasons about real-world dilemmas involving trade-offs between human lives. In three studies (total N = 2298), we examined people’s moral attitudes toward the triage of acute coronavirus patients, and found elevated support for utilitarian triage policies. These utilitarian tendencies (...) did not stem from period change in moral attitudes relative to pre-pandemic levels–but rather, from the heightened realism of triage dilemmas. Participants favoured utilitarian resolutions of critical care dilemmas when compared to structurally analogous, non-medical dilemmas–and such support was rooted in prosocial dispositions, including empathy and impartial beneficence. Finally, despite abundant evidence of political polarisation surrounding Covid-19, moral views about critical care triage differed modestly, if at all, between liberals and conservatives. Taken together, our findings highlight people’s robust support for utilitarian measures in the face of a global public health threat, and illustrate how the dominant methods in moral psychology (e.g. trolley cases) may deliver insights that do not generalise to real-world moral dilemmas. (shrink)

At the height of the Covid-19 pandemic, frontline medical professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique lens through which to understand how the public reasons about real-world dilemmas involving trade-offs between human lives. In three studies (total N = 2298), we examined people’s moral attitudes toward triage of acute coronavirus patients, and found elevated support for utilitarian triage policies. These utilitarian tendencies did (...) not stem from period change in moral attitudes relative to pre-pandemic levels--but rather, from the heightened realism of triage dilemmas. Participants favored utilitarian resolutions of critical care dilemmas when compared to structurally analogous, non-medical dilemmas—and such support was rooted in prosocial dispositions, including empathy and impartial beneficence. Finally, despite abundant evidence of political polarization surrounding Covid-19, moral views about critical care triage differed modestly, if at all, between liberals and conservatives. Taken together, our findings highlight people’s robust support for utilitarian measures in the face of a global public health threat, and illustrate how hypothetical scenarios in moral psychology (e.g. trolley cases) should strive for more experiential and psychological realism, otherwise their results might not generalize to real-world moral dilemmas. (shrink)

Without doctors being able to explain medical decisions to patients, I argue their use of black box AIs would erode the effective and respectful care they provide patients. In addition, I argue that physicians should use AI black boxes only for patients in dire straits, or when physicians use AI as a “co-pilot” (analogous to a spellchecker) but can independently confirm its accuracy. I respond to A.J. London’s objection that physicians already prescribe some drugs without knowing why they (...) work. (shrink)

Kahneman's theory of two systems assumes that human decision making in Economy is based on two cognitive systems, one that is automatic, intuitive and mostly unconscious, and one that is reflexive, rational and fully conscious. The authors consider Kahneman’s approach incomplete and limited in accounting for the creativity of embodied agents grasping the opportunities afforded by physical and social environments. This limitation leads us to argue for the existence of a third system in decision making in Economy, the creative intuition (...) based on direct perception of affordances, addressing not only the dispositions and goals of agents but also the social and environmental responsibility of corporations and governments. The authors argue that the third decision-making system the authors propose implies a concept of intuition that is different from the type of association process discussed by Morewedge and Kahneman [2] and gives an example of the third system operation, the Bolsa Família in Brazil, and finding new options for the funding of similar programs. (shrink)

In this article, part of a special issue on meaning in life and medical ethics, I argue that several issues encountered in a bioethical context are not adequately addressed only with values such as morality and welfare. I maintain, more specifically, that the value of what makes a life meaningful is essential to being able to provide conclusive judgements about which decisions to make. After briefly indicating how meaningfulness differs from rightness and happiness, I point out how it is (...) plausibly central to making decisions in six ‘life and death’ matters. My aim is not to draw any firm conclusions about what to do when it comes to these topics, but rather to show that in order to arrive at any, one cannot plausibly ignore the category of life’s meaning that has, until recently, been nearly absent from Western bioethics since its inception. (shrink)

ABSTRACT When patients refuse to receive medical treatment, the consequences of honouring their decisions can be tragic. This is no less true of patients who autonomously decide to refuse treatment. I distinguish three possible implications of these autonomous decisions. According to the Permissibility Claim, such a decision implies that it is permissible for the patient who has made the autonomous decision to forego medical treatment. According to the Anti‐Paternalism Claim, it follows that health‐care professionals are not morally (...) permitted to treat that patient. According to the Binding Claim it follows that these decisions are binding on health‐care professionals. My focus is the last claim. After arguing that it is importantly different from each of the first two claims, I give two arguments to show that it is false. One argument against the Binding Claim draws a comparison with cases in which patients autonomously choose perilous positive treatments. The other argument appeals to considered judgments about cases in which disincentives are used to deter patients from refusing sound treatments. (shrink)

This author’s reply addresses critiques by Daniel Engster, Kelly Gawel, and Andrea Westlund about my 2020 book, Freedom to Care: Liberalism, Dependency Care, and Culture. I begin with a statement of my commitment to liberalism. In section two, I defend the value of a distinction between conceptions of persons in the real world and in contract theory to track inequalities in care when indexed to legitimate needs. I argue, as well, that my variety of contract theory supplies (...) the normative content needed to reject the subordination of women of color. Acknowledging the enduring danger of expressive subordination, I emphasize my theory’s compatibility with the full social inclusion of people with disabilities. Section three then defends liberal dependency care’s compatibility with radical critique and transformative change by emphasizing the abstract nature of its core theoretical module. Finally, in section four, I reaffirm conceptual distinctions between autonomy skills, care skills, and a sense of justice by explicating their theoretical roles. In that section, I also embrace Westlund’s insight that theorists of justice need to have skills enabling responsiveness to other perspectives. To this new requirement for actual theorists of justice, I further add that we must attain capacities to engage critically with our society’s norms. Thus, the final section of this article supplements the justificatory module of liberal dependency care, building from the necessary conditions specified as two-level contract theory toward an account of necessary and sufficient conditions for this liberalism’s justificatory module. (shrink)

The article analyses the necessary conditions an argument for popular punishment would need to meet, and argues that it faces the challenge of a dilemma of reasonableness: either popular views on punishment are unreasonable, in which case they should carry no weight, or they are reasonable, in which case the reasons that support them, not the views, should carry weight. It proceeds to present and critically discuss three potential solutions to the dilemma, arguing that only an argument for the beneficial (...) effects of coherence between popular views and penal policy is persuasive, but that it makes popular punishment less important than proponents claim, and offers a justification proponents will find it difficult to advance. (shrink)

Patient autonomy has a critical role in making decisions in medical practice and it is accepted by international conventions on health care and various national medical codes. However, pertaining to terminally ill patients, this right becomes very problematic in regards to end of life decisions. Utilitarian ethicists motivated by materialistic worldview and individualism have made patient autonomy based arguments for the permissibility of active euthanasia. An appraisal of pro-euthanasia arguments that include the best interest, golden rule, (...) and autonomy is made in this paper. The best interest and golden rule arguments are based on subjective moral judgment thus failing the universalization test. The argument from autonomy is unconvincing because of the confounded autonomy of the terminally ill patients. (shrink)

In a rigorous systematic review, Dukhanin and colleagues categorize metrics and evaluative tools of the engagement of patient, public, consumer, and community in decision-making in healthcare institutions and systems. The review itself is ably done and the categorizations lead to a useful understanding of the necessary elements of engagement, and a suite of measures relevant to implementing engagement in systems. Nevertheless, the question remains whether the engagement of patient representatives in institutional or systemic deliberations will lead to improved clinical outcomes (...) or increased engagement of individual patients themselves in care. Attention to the conceptual foundations of patient engagement would help make this systematic review relevant to the clinical care of patients. (shrink)

Prima facie, we make successful decisions as we act on and intervene in the world day-to-day. Epistemologists are often concerned with whether rationality is involved in such decision-making practices, and, if so, to what degree. Some, particularly in the post-structuralist tradition, argue that successful decision-making occurs via an existential leap into the unknown rather than via any determinant or criterion such as rationality. I call this view radical voluntarism (RV). Proponents of RV include those who subscribe to a view (...) they call Critical Complexity (CC). In this paper, I argue that CC presents a false dichotomy when it conceives of rationality in Cartesian – i.e. ideal and transcendental – terms, and then concludes that RV is the proper alternative. I then outline a pragmatist rationality informed by recent work in psychology on bounded rationality, ecological rationality, and specifically embodied rationality. Such a pragmatist rationality seems to be compatible with the tenets of post-structuralism, and can therefore replace RV in CC. (shrink)

When allocating scarce healthcare resources, the expected benefits of alternative allocations matter. But, there are different kinds of benefits. Some are direct benefits to the recipient of the resource such as the health improvements of receiving treatment. Others are indirect benefits to third parties such as the economic gains from having a healthier workforce. This article considers whether only the direct benefits of alternative healthcare resource allocations are relevant to allocation decisions, or whether indirect benefits are relevant too. First, (...) we distinguish different conceptions of direct and indirect benefits and argue that only a recipient conception could be morally relevant. We analyze four arguments for thinking that indirect benefits should not count and argue that none is successful in showing that the indirectness of a benefit is a good reason not to count it. We conclude that direct and indirect benefits should be evaluated in the same way. (shrink)

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers (...) correct verdicts about who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests on the (...) classic counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted. (shrink)

In this chapter, I critically examine two of the main approaches to colour categorization in cognitive science: the perceptual salience theory and linguistic relativism. I then turn to reviewing several decades of psychological research on colour categorical perception (CP). A careful assessment of relevant findings suggests that most of the experimental effects that have been understood in terms of CP actually fall on the cognition side of the perception-cognition divide: they are effects of colour language, for example, on memory or (...) decision-making. (shrink)

This is an OER, creative commons textbook for a course on critical thinking, logic, reasoning, and argumentation.

Albert Jonsen and Stephen Toulmin have argued that the best way to resolve complex “moral” issues in clinical settings is to focus on the details of specific cases. This approach to medical decision-making, labeled ‘casuistry’, has met with much criticism in recent years. In response to this criticism, Carson Strong has attempted to salvage much of Jonsen’s and Toulmin’s version of casuistry. He concludes that much of their analysis, including Jonsen’s further elaboration about the casuistic methodology, is on the mark. (...) In this essay, the details of Jonsen’s and Toulmin’s version of casuistry and the major criticisms against their approach to clinical decision-making are explicated. Furthermore, it is argued that Strong’s salvage efforts fail to deflect these criticisms. The upshot of this analysis, which includes a few additional criticisms, is that Jonsen’s and Toulmin’s version of casuistry is not an appropriate framework from which to resolve complex “moral” issues in clinical settings. (shrink)

This book introduces readers to the many arguments and controversies concerning abortion. While it argues for ethical and legal positions on the issues, it focuses on how to think about the issues, not just what to think about them. It is an ideal resource to improve your understanding of what people think, why they think that and whether their (and your) arguments are good or bad, and why. It's ideal for classroom use, discussion groups, organizational learning, and personal reading. -/- (...) From the Preface -/- To many people, abortion is an issue for which discussions and debates are frustrating and fruitless: it seems like no progress will ever be made towards any understanding, much less resolution or even compromise. -/- Judgments like these, however, are premature because some basic techniques from critical thinking, such as carefully defining words and testing definitions, stating the full structure of arguments so each step of the reasoning can be examined, and comparing the strengths and weaknesses of different explanations can help us make progress towards these goals. -/- When emotions run high, we sometimes need to step back and use a passion for calm, cool, critical thinking. This helps us better understand the positions and arguments of people who see things differently from us, as well as our own positions and arguments. And we can use critical thinking skills help to try to figure out which positions are best, in terms of being supported by good arguments: after all, we might have much to learn from other people, sometimes that our own views should change, for the better. -/- Here we use basic critical thinking skills to argue that abortion is typically not morally wrong. We begin with less morally-controversial claims: adults, children and babies are wrong to kill and wrong to kill, fundamentally, because they, we, are conscious, aware and have feelings. We argue that since early fetuses entirely lack these characteristics, they are not inherently wrong to kill and so most abortions are not morally wrong, since most abortions are done early in pregnancy, before consciousness and feeling develop in the fetus. -/- Furthermore, since the right to life is not the right to someone else’s body, fetuses might not have the right to the pregnant woman’s body—which she has the right to—and so she has the right to not allow the fetus use of her body. This further justifies abortion, at least, until technology allows for the removal of fetuses to other wombs. Since morally permissible actions should be legal, abortions should be legal: it is an injustice to criminalizing actions that are not wrong. -/- In the course of arguing for these claims, we: 1. discuss how to best define abortion; 2. dismiss many common “question-begging” arguments that merely assume their conclusions, instead of giving genuine reasons for them; 3. refute some often-heard “everyday arguments” about abortion, on all sides; explain why the most influential philosophical arguments against abortion are unsuccessful; 4. provide some positive arguments that at least early abortions are not wrong; 5. briefly discuss the ethics and legality of later abortions, and more. -/- This essay is not a “how to win an argument” piece or a tract or any kind of apologetics. It is not designed to help anyone “win” debates: everybody “wins” on this issue when we calmly and respectfully engage arguments with care, charity, honesty and humility. This book is merely a reasoned, systematic introduction to the issues that we hope models these skills and virtues. Its discussion should not be taken as absolute “proof” of anything: much more needs to be understood and carefully discussed—always. (shrink)

A number of health care professionals assert a right to be exempt from performing some actions currently designated as part of their standard professional responsibilities. Most advocates claim that they should be excused from these duties simply by averring that they are conscientiously opposed to performing them. They believe that they need not explain or justify their decisions to anyone; nor should they suffer any undesirable consequences of such refusal. Those who claim this right err by blurring or (...) conflating three issues about the nature and role of conscience, and its significance in determining what other people should permit them to do (or not do). Many who criticize those asserting an exemption conflate the same questions and blur the same distinctions, if not expressly, by failing to acknowledge that sometimes a morally serious agent should not do what she might otherwise be expected to do. Neither side seems to acknowledge that in some cases both claims are true: a conscientious professional should not do her professional duty AND others need not permit or excuse her refusal. I identify these conflations and specify conditions in which a professional might reasonably refuse to do what she is required to do. Then I identify conditions in which the public should exempt a professional from some of her responsibilities. I argue that professionals should refuse far less often than most advocates do . . . and that they should be even less frequently exempt for that failure. Finally, there are compelling reasons why we could not implement a consistent moral policy giving advocates what they want, likely not even in qualified form. (shrink)

Technological developments involving robotics and artificial intelligence devices are being employed evermore in elderly care and the healthcare sector more generally, raising ethical issues and practical questions warranting closer considerations of what we mean by “care” and, subsequently, how to design such software coherently with the chosen definition. This paper starts by critically examining the existing approaches to the ethical design of care robots provided by Aimee van Wynsberghe, who relies on the work on the ethics of (...) care by Joan Tronto. In doing so, it suggests an alternative to their non-principled approach, an alternative suited to tackling some of the issues raised by Tronto and van Wynsberghe, while allowing for the inclusion of two orientative principles. Our proposal centres on the principles of autonomy and vulnerability, whose joint adoption we deem able to constitute an original revision of a bottom-up approach in care ethics. Conclusively, the ethical framework introduced here integrates more traditional approaches in care ethics in view of enhancing the debate regarding the ethical design of care robots under a new lens. (shrink)

In the recent literature on episodic memory, there has been increasing recognition of the need to provide an account of its adaptive function. In this context, it is sometimes argued that episodic memory is critical for certain forms of decision making about the future. We criticize existing accounts that try to give episodic memory a role in decision making, before giving a novel such account of our own. This turns on the thought of a link between episodic memory and (...) the emotion of regret. We discuss how both experienced and anticipated regret can have a distinctive influence on decision making, and argue that the ability to recollect past events in episodic memory underpins the capacity to engage in the sophisticated types of mental time travel recruited in experiencing and anticipating regret. (shrink)

This paper critically engages Philip Mirowki's essay, "The scientific dimensions of social knowledge and their distant echoes in 20th-century American philosophy of science." It argues that although the cold war context of anti-democratic elitism best suited for making decisions about engaging in nuclear war may seem to be politically and ideologically motivated, in fact we need to carefully consider the arguments underlying the new rational choice based political philosophies of the post-WWII era typified by Arrow's impossibility theorem. A distrust (...) of democratic decision-making principles may be developed by social scientists whose leanings may be toward the left or right side of the spectrum of political practices. (shrink)

In this paper I analyze a view that is increasingly spreading among philosophers and even physicians. Many of them believe that it is right to apply the principle of responsibility for illness in the allocation of health care. I attempt to show that this idea is unacceptable.

This paper attempts to show how Adorno’s thought can illuminate our reflections on the future of work. It does so by situating Adorno’s conception of genuine activity in relation to his negativist critical epistemology and his subtle account of the distinction between true and false needs. What emerges is an understanding of work that can guide our aspirations for the future of work, and one we illustrate via discussions of creative work and care work. These are types of (...) work which cater to persistent human needs, albeit ones that are distorted under present social conditions. Adorno’s thought helps us to understand why this is the case. (shrink)

I develop the foundation for cosmopolitan care, an underexplored variety of moral cosmopolitanism. I begin by offering a characterization of contemporary cosmopolitanism from the justice tradition. Rather than discussing the political, economic or cultural aspects of cosmopolitanism, I instead address its moral dimensions. I then employ a feminist philosophical perspective to provide a critical evaluation of the moral foundations of cosmopolitan justice, with an eye toward demonstrating the need for an alternative account of moral cosmopolitanism as cosmopolitan (...) class='Hi'>care. After providing an explanation of how care ethics in connection with Kantian ethics generates a duty to care, I consider one main feature of cosmopolitan care, namely the theory of obligation it endorses. In developing this account, I place special emphasis on the practical ramifications of the theory by using it to analyze gender violence in conflict zones. (shrink)

This is a critical discussion of the accuracy-first approach to epistemic norms. If you think of accuracy (gradational or categorical) as the fundamental epistemic good and think of epistemic goods as things that call for promotion, you might think that we should use broadly consequentialist reasoning to determine which norms govern partial and full belief. After presenting consequentialist arguments for probabilism and the normative Lockean view, I shall argue that the consequentialist framework isn't nearly as promising as it might (...) first appear. (shrink)

I argue that partialist critics of deontological theories make a mistake similar to one made by critics of utilitarianism: they fail to distinguish between a theory’s decision procedure and its standard of rightness. That is, they take these deontological theories to be offering a method for moral deliberation when they are in fact offering justificatory arguments for moral principles. And while deontologists, like utilitarians do incorporate impartiality into their justifications for basic principles, many do not require that agents utilize impartial (...) methods of moral deliberation. It follows that insofar as partialists reject impartiality in deliberation, their criticisms may miss their mark. If however, partialists are opposed to justifications for basic principles that rely upon impartiality, they are committed, I argue, to drastic revisions in moral theory that have worrisome implications. (shrink)

Migrant women are often stereotyped. Some scholars associate the feminization of migration with domestic work and criticize the “care drain” as a new form of imperialism that the First World imposes on the Third World. However, migrant women employed as domestic workers in Northern America and Europe represent only 2% of migrant women worldwide and cannot be seen as characterizing the “feminization of migration”. Why are migrant domestic workers overestimated? This paper explores two possible sources of bias. The first (...) is sampling: conclusions about “care drain” are often generalized from small samples of domestic workers. The second stems from the affect heuristic: imagining children left behind by migrant mothers provokes strong feelings of injustice which trump other considerations. The paper argues that neither source of bias is unavoidable and finds evidence of gender stereotypes in the “care drain” construal. (shrink)

That a standard of medical care must outline services that benefit the patient is relatively uncontroversial. However, one must determine how the practices outlined in a medical standard of care should benefit the patient. I will argue that practices outlined in a standard of medical care must not detract from the patient’s well-functioning and that clinicians can refuse to provide services that do. This paper, therefore, will advance the following two claims: (1) a standard of medical (...) class='Hi'>care must not cause dysfunction, and (2) if a physician is medically rational to not provide some service which fails to meet the above condition (i.e. fails to be a standard of medical care), then she may refuse to do so. I then apply my thesis to the prescription of puberty blockers to children with gender dysphoria. (shrink)

Stochastic independence has a complex status in probability theory. It is not part of the definition of a probability measure, but it is nonetheless an essential property for the mathematical development of this theory. Bayesian decision theorists such as Savage can be criticized for being silent about stochastic independence. From their current preference axioms, they can derive no more than the definitional properties of a probability measure. In a new framework of twofold uncertainty, we introduce preference axioms that entail not (...) only these definitional properties, but also the stochastic independence of the two sources of uncertainty. This goes some way towards filling a curious lacuna in Bayesian decision theory. (shrink)

This paper is primarily about metaphysics; specifically, about a Cartesian view of the self, according to which it is a simple, enduring, non-material entity.I take a critical look at Nida-Rümelin’s novel conceptual arguments for this view and argue that they don’t give us decisive reasons to uphold the Cartesian view. But in Nida-Rümelin’s view, what is at stake in these arguments is not merely theoretical: the truth – and our beliefs about it – has practical consequences as well. In (...) her view, if the Cartesian simple view of the self were false, we would have no reason to love and care for family and friends, and our special interest in our own future would be pointless. In the last section of this paper, I will say something about the sense in which it is right and the sense in which it is wrong to think that the metaphysics of the self has broader relevance for our lives. (shrink)

In contemporary bioethics, two vocabularies can be distinguished:person-speak andnature-speak. The first is built around the claim that a person's moral decisions are to be respected, while the other stands on the claim that moral decisions should comply with standards for human behaviour conveyed by nature. While most bioethicists have obtained a thorough mastery ofperson-speak, they are considerably less well-versed innature-speak. Apparently, the latter has lost much of its former ability to capture important aspects of moral existence. In this (...) paper I attempt to rehabilitatenature-speak from a hermeneutical perspective. I believe that the task of ethics is to enlarge our range of moral description and to rediscover neglected ways of speaking about human experience. The ethicist should enable individuals in health care settings to become more articulate about their moral experience. He should not content himself with applying those moral vocabularies which happen to be readily available, but should rather proceed by recovering forgotten vocabularies from within the philosophical tradition. Finally, one particular effort at restoringnature-speak is critically reviewed. (shrink)

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the (...) other pillars of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

How can we make rational decisions that involve transformative experiences, that is, experiences that can radically change our core preferences? L. A. Paul (2014) has argued that many decisions involving transformative experiences cannot be rational. However, Paul acknowledges that some traumatic events can be transformative experiences, but are nevertheless not an obstacle to rational decision-making. For instance, being attacked by hungry sharks would be a transformative experience, and yet, deciding not to swim with hungry sharks is rational. Paul (...) has tried to explain why decisions involving ‘sharky’ outcomes are an exception to the rule. However, her putative explanation has been criticized by Campbell and Mosquera (2020). In this paper, I offer a different solution to this problem. Roughly, I argue that transformative experiences give rise a problem for rational decision-making only if the decision can lead to satisfying some of our (new) core preferences, but can also frustrate other (new) core preferences. I also argue that agents can partially project what traumatic transformative experiences are like. (shrink)

According to factive accounts of the norm of belief and decision-making, you should not believe or base decisions on a falsehood. Even when the evidence misleadingly suggests that a false proposition is true, you should not believe it or base decisions on it. Critics claim that factive accounts are counterintuitive and badly mischaracterize our ordinary practice of evaluating beliefs and decisions. This paper reports four experiments that rigorously test the critic’s accusations and the viability of factive accounts. (...) The results undermine the accusations and provide the best evidence yet of factive norms of belief and decision-making. The results also help discriminate between two leading candidates for a factive norm: truth and knowledge. Knowledge is the superior candidate. (shrink)

This paper argues that Kwasi Wiredu’s consensual democracy is an inadequate alternative to liberal democracy in contemporary Africa because it neglects the beliefs in supernatural realities underpinning governance and political decisions in traditional societies on the continent. The paper holds that as evident in their worldviews and activities, traditional Africans do not depersonalise entities or segregate physical realities from spiritual ones. Deploying historical and conceptual analyses, the paper contends that, essentially, the deficiency of Wiredu’s argument lies in his declining (...) to acknowledge the roles oaths and covenants play in the sustenance of Africa’s traditional governance systems. The paper thus holds that Wiredu’s discountenancing of the role of beliefs in supernatural realities in African societies generally may have resulted in this gap in his understanding of indigenous African political thought and practice. (shrink)

Existing discussions about automated decision-making focus primarily on its inputs and outputs, raising questions about data collection and privacy on one hand and accuracy and fairness on the other. Less attention has been devoted to critically examining the temporality of decision-making processes—the speed at which automated decisions are reached. In this paper, I identify four dimensions of algorithmic speed that merit closer analysis. Duration (how much time it takes to reach a judgment), timing (when automated systems intervene in the (...) activity being evaluated), frequency (how often evaluations are performed), and lived time (the human experience of algorithmic speed) are interrelated, but distinct, features of automated decision-making. Choices about the temporal structure of automated decision-making systems have normative implications, which I describe in terms of "disruption," "displacement," "re-calibration," and "temporal fairness," with values such as accuracy, fairness, accountability, and legitimacy hanging in the balance. As computational tools are increasingly tasked with making judgments about human activities and practices, the designers of decision-making systems will have to reckon, I argue, with when—and how fast—judgments ought to be rendered. Though computers are capable of reaching decisions at incredible speeds, failing to account for the temporality of automated decision-making risks misapprehending the costs and benefits automation promises. (shrink)

Chenyang Li argues, in an article originally published in Hypatia, that the ethics of care and Confucian ethics constitute similar approaches to ethics. The present paper takes issue with this claim. It is more accurate to view Confucian ethics as a kind of virtue ethics, rather than as a kind of care ethics. In the process of criticizing Li's claim, the distinctiveness of care ethics is defended, against attempts to assimilate it to virtue ethics.

Death can be bad for an individual who has died, according to the “deprivation approach,” by depriving that individual of goods. One worry for this account of death’s badness is the Lucretian symmetry argument: since we do not regret having been born later than we could have been born, and since posthumous nonexistence is the mirror image of prenatal nonexistence, we should not regret dying earlier than we could have died. Anthony Brueckner and John Martin Fischer have developed a response (...) to the Lucretian challenge by arguing that it is rational to have asymmetric attitudes toward posthumous and prenatal nonexistence. Recently, Jens Johansson has criticized the Brueckner/Fischer position, claiming that it is irrelevant whether it is actually rational to care about future pleasures but not past pleasures. What matters, according to Johansson, is whether it would be rational for us to care about past pleasures had we come into existence earlier. In this paper, I add to the conversation between Johansson and Brueckner/Fischer by suggesting a way to defend the latter side’s position in a way that has not yet been suggested. I do this by considering a suggestion of Johansson’s for interpreting the Brueckner/Fischer position and by arguing that Johansson’s worry for the position I consider is actually incoherent. (shrink)