Accountable Care Organizations are a key mechanism of the Patient Protection and Affordable Care Act. ACOs will influence incentives for providers, who must understand these changes to make well-considered treatment decisions. Our paper defines an ethical framework for physician decisions and action within ACOs. Emerging ethical pressures providers will face as members of an ACO were classified under major headings representing three of the four principles of bioethics: autonomy, beneficence, and justice. Conflicts include a bias against transient populations, a motive (...) to undertreat conditions lacking performance measures, and the mandate to improve population health incentivizing life intrusions. After introducing and explaining each conflict, recommendations are offered for how providers ought to precede in the face of novel ethical choices. Our description of novel ethical choices will help providers know what to expect and our recommendations can guide providers in choosing well. (shrink)

While cochlear implantation is now considered routine in many parts of the world, the debate over how to ethically implement this technology continues. One’s stance on implantation often hinges on one’s understanding of deafness. On one end of the spectrum are those who see cochlear implants as a much needed cure for an otherwise intractable disability. On the other end of the spectrum are those who view the Deaf as members of a thriving culture and see the cochlear implant as (...) an attempt to eliminate this culture. Rather than take a stance in this debate, we will argue that the informed consent process for cochlear implantation must include access to Deaf perspectives. Deaf individuals know best what it is like to be a member of the Deaf community; the reasonable person would put significant weight on the testimony of Deaf individuals when considering whether to undergo cochlear implantation. The reasonable person standard determines what information careproviders must present as part of the informed consent process; thus, informed consent for cochlear implantation requires access to the testimony of Deaf individuals. (shrink)

Personal identity is critical to provider–patient interactions. Patients and doctors tend to self-select, ideally forming therapeutic units that maximise the patients' benefit. Recently, however, ‘reality’ has changed. The internet and virtual worlds such as Second Life allow models of identity and provider–patient interactions that go beyond the limits of mainstream personal identity. In this paper some of the ethical implications of virtual patient–provider interactions, especially those that have to do with personal identity, are explored.

Frantic warnings about the threat the Internet poses to our privacy are now a dime-a-dozen. Though gallons of ink have been spilled on the topic, it has largely gone unanalyzed from the perspective...

In a methodological milieu characterized by efforts to bring the methods of philosophy closer to the methods of the sciences, one can find, with increasing regularity, meta-ethical arguments relying on scientific theory or data. The received view appears to be that, not only is it implausible to think that a scientific vindication of a non-mentalist moral semantics will be forthcoming but that evidence from a variety of sciences threatens to undermine non-mentalist views. My aim is to push back against this (...) apparent consensus. The well-established phenomenon whereby moral judgments influence our attributions of putatively purely descriptive properties has come to be known as the Knobe Effect. Joshua Knobe has attempted to explain this surprising phenomenon by arguing that our folk psychological judgments are partially constituted by moral judgments. Drawing on an argument originally offered by Moore, I argue that if some instantiation of Knobe’s explanatory strategy is accurate, we have good reason to believe that mentalist moral semantics are untenable. (shrink)