Individual differences in ethical ideology are believed to play a key role in ethical decision making. Forsyths (1980) Ethics Position Questionnaire (EPQ) is designed to measure ethical ideology along two dimensions, relativism and idealism. This study extends the work of Forsyth by examining the construct validity of the EPQ. Confirmatory factor analyses conducted with independent samples indicated three factors – idealism, relativism, and veracity – account for the relationships among EPQ items. In order to provide further evidence of the instruments (...) nomological and convergent validity, correlations among the EPQ subscales, dogmatism, empathy, and individual differences in the use of moral rationales were examined. The relationship between EPQ measures of idealism and moral judgments demonstrated modest predictive validity, but the appreciably weaker influence of relativism and the emergence of a veracity factor raise questions about the utility of the EPQ typology. (shrink)

Both communitarianism and casuistry have sought to restore ethics as a practical science—the former by incorporating various traditions into a shared definition of the common good, the latter by considering the circumstances of each situation through critical reasoning. Mark G. Kuczewski analyzes the origins and methods of these two approaches and forges from them a new unified approach. This approach takes the communitarian notion of the person as its starting point but also relies upon the narrative and analogical tools (...) of case-based reasoning. He separates out the rhetoric that is incongruent with the Aristotelian aspirations of each method to show that the two are complementary, and that consensus can emerge from fragmentation. He then applies his resulting method to three major problems in bioethics: the difficulties that the issue of personal identity poses for advance directives, the role of the family in medical decision making, and the refusal of treatment because of religious beliefs. He analyzes the need to assume a communitarian notion of the person as a starting point for the application of casuistic insights. Combining theoretical, practical, and scholarly insights, this book will be of interest to philosophers, political and social scientists, and bioethicists. (shrink)

Epistemology -- Power I -- Power II -- Subjectivity -- Resistance -- Critique -- Ethics.

More is known about the pervasiveness of college cheating than reasons why students cheat. This article reports the results of a study that applied the theory of reasoned action and partial least squares methodology to analyze the responses of 144 students to a survey on cheating behavior. Approximately 60% of the business students and 64% of the non-business students admitted to such behavior. Among cheaters, a "desire to get ahead" was the most important motivating factor - a surprising result given (...) the comprehensive set of factors tested in the study. Among non-cheaters, the presence of a "moral anchor" such as an ethical professor was most important. The article also includes a set of important caveats that might limit this study and suggests some avenues for further study. (shrink)

Contemporary bioethics has been somewhat skewed by its focus on high-tech medicine and the resulting development of ethical frameworks based on an acute-care model of healthcare. Research and scholarship in bioethics have payed only cursory attention to ethical issues related to disability. I argue that bioethics should concern itself with the full range of theoretical and practical issues related to disability. This encounter with the disability community will enrich bioethics and, potentially, society as well. I suggest a number of items (...) that the bioethics agenda should include, such as the development of a casuistry of the right to healthcare and to community integration and an advocacy role in fostering an understanding among the public and policy makers of the need to reform research and treatment related to disability. (shrink)

This book outlines and evaluates the principal strands of critical legal studies, and achieves much more as well.

Bioethicists think about families in terms of conflicting interests. This mistake results from an impoverished notion of informed consent. Only by adequately characterizing the process of informed consent can we capture the phenomenon of shared decisionmaking.

I analyze the insights present in Elisabeth Kübler-Ross’s seminal work, On Death and Dying that have laid the foundation for contemporary clinical bioethics as it is practiced by clinical ethics co...

Spirituality or religion often presents as a foreign element to the clinical environment, and its language and reasoning can be a source of conflict there. As a result, the use of spirituality or religion by patients and families seems to be a solicitation that is destined to be unanswered and seems to open a distance between those who speak this language and those who do not. I argue that there are two promising approaches for engaging such language and helping patients (...) and their families to productively engage in the decision-making process. First, patient-centered interviewing techniques can be employed to explore the patient's religious or spiritual beliefs and successfully translate them into choices. Second, and more radically, I suggest that in some more recalcitrant conflicts regarding treatment plans, resolution may require that clinicians become more involved, personally engaging in discussion and disclosure of religious and spiritual worldviews. I believe that both these approaches are supported by rich models of informed consent such as the transparency model and identify considerations and circumstances that can justify such personal disclosures. I conclude by offering some considerations for curbing potential unprofessional excesses or abuses in discussing spirituality and religion with patients. (shrink)

Immigrants lacking health insurance access the health care system through the emergency departments of non-profit hospitals. Because these persons lack health insurance, continued care can pose challenges to those institutions. I analyze the values of our health care institutions, utilizing a Walzerian approach that describes its appropriate sphere of justice. This particular sphere is dominated by a caring response to need. I suggest that the logic of this sphere would be best preserved by providing increased access to health insurance to (...) this population. This access would marry the rights of these members of our community to access care to our responsibility to contribute to financing of the system. I close with some considerations on what it means to be a member of the community. (shrink)

ABSTRACTI consider objections to the use of living wills based upon the discontinuity of personal identity between the time of the execution of the directive anbd the time the person becomes incompetent. Recent authors, following Derek Parfit's “Complex View” of personal identity, have argued that there is often not sufficient identity interests between the competent person who executes the living will and the incompetent patient to warrant the use of the advance directive. I argue that such critics err by seeking (...) personal identity in a purely descriptive manner. By exploring Buchanan and Brock's concept of “surviving interests”, an argument is developed that certain future‐oriented acts have a normative force that contributes to the narrative unity which is constitutive of personal ideality. This narrative concept of the self is entailed by many of the our ordinary practices and challenges the philosophical consensus to view the self in a more dynamic and communitarian manner. (shrink)

I explore the possible meanings that the notion of the common morality can have in a contemporary communitarian approach to ethics and public policy. The common morality can be defined as the conditions for shared pursuit of the good or as the values, deliberations, traditions, and common construction of the narrative of a people. The former sense sees the common morality as the universal and invariant structures of morality while the second sense is much more contingent in nature. Nevertheless, the (...) communitarian sees both aspects as integral in devising solutions to public policy problems. I outline how both meanings follow from communitarian philosophical anthropology and illustrate how they work together when addressing a question such as that of providing universal health insurance in the United States. The common morality forms the basis of building an implicit consensus that is available to and reaffirmed by the shared reflections of the citizenry. (shrink)

Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals typically described as community hospitals; as a result, the cases do not focus on esoteric, high-tech dilemmas--viz., genetic engineering or experimental protocols--but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to send (...) a frail, elderly patient who refuses to go to a nursing home; what role the family should play in making a treatment decision; what a hospital should do when it is getting stuck with too many unpaid bills. This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically for those participants in the Neiswanger Institute for Bioethics' web-based instructional program. This edition has also been restructured for teachability, and will feature reformatted and revised commentaries. (shrink)

I consider the problem liberalism poses for bioethics.Liberalism is a view that advocates that the state remain neutralto views of the good life. This view is sometimes supported by askeptical moral epistemology that tends to propel liberalismtoward libertarianism. I argue that the possibilities for sharedagreement on moral matters are more promising than is sometimesappreciated by such a view of liberalism. Using two examples ofpublic debates of moral issues, I show that commonly sharedintuitions may ground moral principles even if they may (...) be givendifferent weight by persons of different moral and religioustraditions. Nevertheless, the fact that the intuition andprinciple is widely shared may be sufficient to chart somedirections for public policy or cooperative action even if theydo not lead to complete agreement. As a result, I argue that aliberal communitarianism that presupposes a fairly minimalistepistemology is a legitimate approach to achieving sharedagreement in a pluralistic society. (shrink)

Communitarian critics have derided case-based reasoning for ignoring the need to arrive at a shared hierarchy of goods prior to case.

It has become common in medical ethics to discuss difficult cases in terms of the principles of respect for autonomy, beneficence, nonmaleficence, and justice. These moral concepts or principles serve as maxims that are suggestive of appropriate clinical behavior. Because this language evolved primarily in the acute care setting, I consider whether it is in need of supplementation in order to be useful in the long-term care setting. Through analysis of two typical cases involving residents of long-term care facilities, I (...) argue for the additional principles of candor and responsibility for narrative integrity. (shrink)

Introduction: Foucault and political philosophy -- Marx: antinormative critique -- Lenin: the invention of party governmentality -- Althusser: the failure to denormativise Marxism -- Deleuze: denormativisation as norm -- Rorty: relativising normativity -- Honneth: the poverty of critical theory -- Geuss: the paradox of realism -- Foucault: the lure of neoliberalism -- Conclusion: What now?

In this chapter, the author analyzes Foucault's conception of subjectivity and his history of technologies of the self, the collections of practices by which subjectivity constitutes itself. The first section situates Foucault's conception of subjectivity in his overall body of work and intellectual context, particularly in relation to two figures in French philosophy. The second section explores the conception of the subject that Foucault develops in his late work. Having explained the importance of historical practices to his conception of subjectivity, (...) the third section considers his history of Western practices of the self, mapping the relative fortunes of what Foucault calls the “technologies” of ethics and spirituality. The fourth section explores Foucault's consideration of the contemporary implications of his position, his assessment of the scope for and importance of spiritual or ethical practices today. (shrink)

Contemporary bioethicists and scholars of ancient philosophy explore the import of classical ethics on pressing bioethical concerns.

The evaluation of new theories and pedagogical approaches to business ethics is an essential task for ethicists. This is true not only for empirical and applied evaluation but also for metatheoretical evaluation. However, while there is increasing interest in the practical utility and empirical testing of ethical theories, there has been little systematic evaluation of how new theories relate to existing ones or what novel conceptual characteristics they might contribute. This paper aims to address this lack by discussing the role (...) of metatheorising in assessing new approaches to ethics. The approach is illustrated through evaluating a new pedagogy and curriculum for ethics education called Giving Voice to Values (GVV). Our method involves identifying a number of metatheoretical lenses from existing reviews of ethical theories and applying these to examine GVV’s conceptual elements. Although GVV has been explicitly presented as a pedagogy and teaching curriculum, we argue that it has the potential to contribute significantly to the development of ethical theory. We discuss the general implications of this metatheoretical method of evaluation for new approaches to business ethics and for GVV and its future development. (shrink)

Ran is one of the most abundant and best conserved of the small GTP binding and hydrolyzing proteins of eukaryotes. It is located predominantly in cell nuclei. Ran is a member of the Ras family of GTPases, which includes the Ras and Ras‐like proteins that regulate cell growth and division, the Rho and Rac proteins that regulate cytoskeletal organization and the Rab proteins that regulate vesicular sorting. Ran differs most obviously from other members of the Ras family in both its (...) nuclear localization, and its lack of sites required for post‐translational lipid modification. Ran is, however, similar to other Ras family members in requiring a specific guanine nucleotide exchange factor (GEF) and a specific GTPase activating protein (GAP) as stimulators of overall GTPase activity. In this review, the multiple cellular functions of Ran are evaluated with respect to its known biochemistry and molecular interactions. (shrink)

In this essay, I take as a starting point Foucault’s rejection of two different ways of thinking about the future, prophecy and utopianism, and use this rejection as a basis for the elaboration of a more detailed rejection of them, invoking complexity-based epistemic limitations in relation to thinking about the future of political society. I follow Foucault in advocating immanent political struggle, which does not seek to build a determinate vision of the future but rather focuses on negating aspects of (...) the current conjuncture. I extend this argument into an ethical register, arguing that the same arguments apply mutatis mutandis to our personal lives. I conclude by engaging with Jacques Lacan’s account of subjectivity, and the interpretation of its political import furnished by Yannis Stavrakakis, drawing from these additional supports for my position, in particular the rejection of utopianism as an attempt to avoid limitation by the real. (shrink)

This is a clear and critical account of Foucault's political thought: what he said, how it's been used and its influence today. Michel Foucault, French philosopher, social theorist, historian of ideas and literary critic, is primarily known as a radical thinker who disturbs our understanding of society, yet little attention has been paid to his politics. Now, Mark Kelly details and criticises all of Foucault's major political ideas: the historical relativity of knowledge; exclusion and abnormality; his radical reconception of (...) power; his historical analysis of biopolitics in terms of discipline and biopower; his concept of governmentality; and his late work around ethics and subjectivity. Kelly shows how Foucault's positions changed over time, how his thought has been used in the political sphere and examines the importance of his work for politics today. It engages with Foucault's entire corpus, from his first works right up to his posthumously published College de France lectures and the unabridged version of the History of Madness. It looks at the theoretical reception of Foucault's thought and how it has been applied to real-world problems. (shrink)

In this essay, I take as a starting point Foucault’s rejection of two different ways of thinking about the future, prophecy and utopianism, and use this rejection as a basis for the elaboration of a more detailed rejection of them, invoking complexity-based epistemic limitations in relation to thinking about the future of political society. I follow Foucault in advocating immanent political struggle, which does not seek to build a determinate vision of the future but rather focuses on negating aspects of (...) the current conjuncture. I extend this argument into an ethical register, arguing that the same arguments apply mutatis mutandis to our personal lives. I conclude by engaging with Jacques Lacan’s account of subjectivity, and the interpretation of its political import furnished by Yannis Stavrakakis, drawing from these additional supports for my position, in particular the rejection of utopianism as an attempt to avoid limitation by the real. (shrink)

McCullough et al. propose adaptations that motivate forgiveness when the potential benefits of continuing the relationship outweigh the costs incurred by the transgression. The costs incurred are definite, whereas future benefits of forgiveness are only probabilistic. This situation exposes the forgiver to cheating in the form of repeat transgression. Adaptations motivating genuine forgiveness are therefore unlikely to evolve.

A step-by-step guide to Foucault's History of Sexuality Volume I, The Will to KnowledgeIn the first volume of his History of Sexuality, The Will to Knowledge, Foucault weaves together the most influential theoretical account of sexuality since Freud. Mark Kelly systematically unpacks the intricacies of Foucault's dense and sometimes confusing exposition, in a straightforward way, putting it in its historical and theoretical context.This is both a guide for the reader new to the text and one that offers new insights (...) to those already familiar with Foucault's work. (shrink)

This collection of thirty-one cases and commentaries addresses ethical problems commonly encountered by the average health care professional, not just those working on such high-tech specialties as organ transplants or genetic engineering. It deals with familiar issues that are rarely considered in ethics casebooks, including such fundamental matters as informed consent, patient decision-making capacity, the role of the family, and end-of-life decisions. It also provides resources for basic but neglected ethical issues involving placement decisions for elderly or technologically dependent patients, (...) rehabilitation care, confidentiality regarding AIDS, professional responsibility, and organizational and institutional ethics. The authors describe in detail the perspectives of each party to the case, the kind of language that ethicists use to discuss the issues, and the outcome of the case. A short bibliography suggests useful articles for further reading or curriculum development. Easily understood by readers with no prior training in ethics, this book offers guidance on everyday problems from across the broad continuum of care. It will be valuable for health-care professionals, hospital ethics committees, and for students preparing for careers in health-care professions. (shrink)

The economic theory of the consumer, which assumes individual satisfaction as its goal and individual freedom to pursue satisfaction as its sine qua non, has become an important ideological element in political economy. Some have argued that the political dimension of economics has evolved into a kind of “secular theology” that legitimates free market capitalism, which has become a kind of “religion” in the United States [Nelson: 1991, Reaching for Heaven on Earth: The Theological Meaning of Economics. (Rowman & Littlefield (...) Publishers, Inc, Savage, Maryland); 2001, Economics as Religion: From Samuelson to Chicago and Beyond (The Pennsylvania State University Press, University Park, Pennsylvania); Thurow: 1983, Dangerous Currents: The State of Economics (Random House, New York); Milbank: 1990, Theology and Social Theory, Beyond Secular Reason (Basil Blackwell, Cambridge, Massachusetts)]. Consumer theory in its ideological form provides an important base for this religion and is no longer merely a positive framework for understanding consumer choice or estimating market demand. The paper explores the view of the human being, the “anthropology,” that is implicit in the economic theory of the consumer and compares its “theological” implications with the corresponding theological anthropologies in the Judaeo-Christian tradition. The paper outlines the assumptions of consumer theory and then focuses on three aspects of the theory from a critical theological perspective: the individual in community, property ownership, and human destiny (or “eschatology” in theological terminology). The principal conclusion is that consumer theory, viewed from this perspective, leads to a reductionist and existentially harmful view of human beings. The maximization of individual satisfaction raises genuine ethical issues when viewed as a political and religious value. The paper argues that the issues could be ameliorated if economists would include more explicit treatment of a social dimension and ethical alternatives in consumer theory and if theologians would give greater attention to economic theory. (shrink)

The patient was born at 29 weeks gestation. There was a prenatal diagnosis that the child's small intestine had developed outside of the abdominal cavity. The length of gestation had made the initial prognosis good. But after birth, surgery to place the intestine back into the abdominal cavity found that the baby actually had very little small intestine and a diagnosis of was made. The amount of small intestine was not compatible with survival. The transplant service saw the baby twice (...) and each time said the baby's profile did not meet the transplant protocol. (shrink)

The debate regarding physician-assisted suicide continues in our society. Despite the recent opinions of the United States Supreme Court, this issue is unlikely to go away anytime soon. For a variety of reasons, this debate is now conducted in the legalistic terms of individual rights and liberties. As a result, perhaps we philosophers have been left behind. This is now a matter for the legal arena and philosophy is likely to be irrelevant. I would like to suggest otherwise for two (...) reasons. (shrink)

This special section deals with the new professionalism movement. The interest in the term “professionalism” has been growing steadily in medicine, and the word now seems to be everywhere. However, bioethicists have lagged behind our colleagues in medicine and nursing in explicitly contributing to this movement. This special section adds to the effort to catch up.

A 24-year-old Hispanic male came into the emergency room of a large public teaching hospital with acute cardiac failure and chest pain. He was admitted and diagnosed with rheumatic heart disease and regurgitation and stenosis of both mitral and aortic valves. Medical judgment concluded that the patient needed to be medically stabilized and then undergo cardiac surgery to repair heart valves. The patient spoke only Spanish. Investigation through an interpreter revealed that he was an illegal alien from a Central American (...) country who has lived in this country for five to seven years. He came to the United States so that he could receive treatment for his heart condition, evidently fearing that he would not receive treatment in his home country. The patient entered this country through the assistance of some distant relatives. He did not have a strong support system. (shrink)

The transplant coordinator scheduled a meeting that included numerous members of the multidisciplinary team, among them the transplant surgeon, a social worker, a psychologist, and an ethics consultant. The ethics consultant outlined the ethical issues and made a recommendation. The consultant argued that the question whether the patient should again be listed as a transplant candidate really came down to the kind of environment that could be provided during aftercare. That is, if a rather structured living environmentcould be found for (...) the patient, then retransplantation might be warranted. But without such an environment, the patient would again probably fail to adhere to the medical and psychological treatment regimen necessary for a successful life as a transplant recipient. The psychologist, who had been working closely with the ethics consultant, concurred in this opinion. (shrink)

This study reports on the use of like in Aboriginal English teen talk. The analysis of a sub-corpus of 40 adolescent texts from a corpus of 100 narratives by speakers of Aboriginal English in Western Australia revealed that like is often employed by these speakers, and that it achieves a multitude of functions. In general it is observed that like may mark off a) a discrepancy between the intended conceptualization and the expressed concept, b) an attitude, feeling, or certain (...) degree of commitment towards a lexical item, and c) a shift in some element of discourse. The results of this study support and extend the analysis carried out by Andersen on London teen talk. (shrink)

The World Health Organization has declared a world pandemic due to COVID-19. In response, most affected countries have enacted measures involving compulsory confinement and restrictions on free movement, which likely influence citizens' lifestyles. This study investigates changes in health risk behaviors with duration of confinement. An online cross-sectional survey served to collect data about the Spanish adult population regarding health behaviors during the first 3 weeks of confinement. A large sample of participants from all Spanish regions completed the survey. Binomial (...) logistic regressions adjusted for socioeconomic characteristics, body mass index, previous HRBs, and confinement context were conducted to investigate associations between the number of weeks confined and a set of six HRBs. When adjusted, we observed significantly lower odds of experiencing a higher number of HRBs than before confinement overall in a time-dependent fashion: OR 0.63; 95% CI: 0.49–0.81 for the second and OR 0.47; 95% CI: 0.36–0.61 for the third week of confinement. These results were equally consistent in all age and gender subgroup analyses. The present study indicates that changes toward a higher number of HRBs than before confinement, as well as the prevalence of each HRB except screen exposure, decreased during the first 3 weeks of COVID-19 confinement, and thus the Spanish adult population may have adapted to the new situational context by gradually improving their health behaviors. (shrink)

The economic theory of the consumer, which assumes individual satisfaction as its goal and individual freedom to pursue satisfaction as its sine qua non, has become an important ideological element in political economy. Some have argued that the political dimension of economics has evolved into a kind of "secular theology" that legitimates free market capitalism, which has become a kind of "religion" in the United States [Nelson: 1991, Reaching for Heaven on Earth: The Theological Meaning of Economics. ; 2001, Economics (...) as Religion: From Samuelson to Chicago and Beyond ; Thurow: 1983, Dangerous Currents: The State of Economics ; Milbank: 1990, Theology and Social Theory, Beyond Secular Reason ]. Consumer theory in its ideological form provides an important base for this religion and is no longer merely a positive framework for understanding consumer choice or estimating market demand. The paper explores the view of the human being, the "anthropology," that is implicit in the economic theory of the consumer and compares its "theological" implications with the corresponding theological anthropologies in the Judaeo-Christian tradition. The paper outlines the assumptions of consumer theory and then focuses on three aspects of the theory from a critical theological perspective: the individual in community, property ownership, and human destiny. The principal conclusion is that consumer theory, viewed from this perspective, leads to a reductionist and existentially harmful view of human beings. The maximization of individual satisfaction raises genuine ethical issues when viewed as a political and religious value. The paper argues that the issues could be ameliorated if economists would include more explicit treatment of a social dimension and ethical alternatives in consumer theory and if theologians would give greater attention to economic theory. (shrink)