BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Entrepreneurship is increasingly studied as a fundamental and foundational economic phenomenon. It has, however, received less attention as an ethical phenomenon. Much contemporary business ethics assumes its core application purposes to be (1) to stop predatory business practices and (2) to encourage philanthropy and charity by business. Certainly predation is immoral and charity has a place in ethics, neither should be the first concerns of ethics. Instead, business ethics should make fundamental the values and virtues of entrepreneurs - i.e., those (...) self-responsible and productive individuals who create value and trade with others to win-win advantage. (shrink)

This is the Dawes Hicks Lecture on Philosophy for 1967. Interestingly enough the previous year's Lecture, by G. J. Warnock, was also on Kant's moral theory. Körner is a bit more reverential toward his subject than Warnock, but not too much more. In particular, he criticizes Kant's exclusion of freedom from the realm of phenomena. This is a familiar criticism but Körner does not merely state it. He firms it up by offering a different account of the relation between (...) categoreal and phenomenal intelligibility. Kant regarded the latter as simply an expression, albeit confused, of the former: science, with an assist from transcendental logic, could be expected to recapitulate exhaustively the intelligibility of phenomenal experience in categoreal and, most importantly, deterministic terms. Körner's account of the relation between these two forms of intelligibility stresses, on the contrary, the logical discontinuity between the two. In the language of contemporary philosophy of science, the relation between experience and theory is instrumental. Körner has developed his basic argument more clearly and sophisticatedly in the last two chapters of his Experience and Theory, and his application in this lecture of its essentials to Kant, although certainly appropriate, is not very smooth. It is cluttered up with a lot of miscellaneous observations which could be harmonized in a longer study of Kant but only tend to distract here.--E. A. R. (shrink)

This volume is designed as an anthology of shorter texts centered around some of the standard problems in natural theology. The first section contains readings pertaining to the theistic proofs; the section on the Ontological argument is particularly well-organized here. The inclusion of Braithwaite's paper, "Religious Statements as Ethically but not Factually Significant" and Hick's own paper on "Eschatological Verification" makes these papers available in an inexpensive form for the first time. Hick's own conviction that religion can at best assume (...) an attitude of indifference or armed neutrality towards philosophy is reflected in his introduction.—E. A. R. (shrink)

This Dawes Hicks Lecture on Philosophy for 1966 is concerned to exhibit the basis of Kant's deontological moral theory and primacy-warranting of practical over theoretical reason. One would have thought this had been done often enough, but Warnock has apparently not benefited from past attempts. For his effort to undermine both of Kant's contentions and push in a utilitarian direction is based on an unsympathetic and unprobing manipulating of the key terms in the theory: freedom, reason, virtue. For example, (...) Warnock cites the historical influence of Rousseau on Kant in the matter of stressing the primacy of practical reason but fails to note the deeper connection between Kant's deontologism and Rousseau's sentimentalism: the link emerges when we realize that aesthetic beauty, which is the norm that Rousseau presses toward in his sentimentalism, is, like Kantian virtue, an embodiment of the good which has no purpose beyond itself. Warnock also fails to see that Kant was more than dimly aware of the fact that Reason is realized Freedom; and consequently his disparaging reference to Kant's rationalism is ill-conceived.--E. A. R. (shrink)

The thesis of this article is that there has never been any ground for the controversy between the doctrine of free will and determinism, that it is based upon a misapprehension, that the two assertions are entirely consistent, that one of them strictly implies the other, that they have been opposed only because of our natural want of the analytical imagination. In so saying I do not tamper with the meaning of either phrase. That would be unpardonable. I mean free (...) will in the natural and usual sense, in the fullest, the most absolute sense in which for the purposes of the personal and moral life the term is ever employed. I mean it as implying responsibility, merit and demerit, guilt and desert. I mean it as implying, after an act has been performed, that one " could have done otherwise " than one did. I mean it as conveying these things also, not in any subtly modified sense but in exactly the sense in which we conceive them in life and in law and in ethics. These two doctrines have been opposed because we have not realised that free will can be analysed without being destroyed, and that determinism is merely a feature of the analysis of it. And if we are tempted to take refuge in the thought of an "ultimate ", an "innermost" liberty that eludes the analysis, then we have implied a deterministic basis and constitution for this liberty as well. For such a basis and constitution lie in the idea of liberty. -/- The thesis is not, like that of Green or Bradley, that the contending opinions are reconciled if we adopt a certain metaphysic of the ego, as that it is timeless, and identifies itself with a desire by a " timeless act". This is to say that the two are irreconcilable, as they are popularly supposed to be, except by a theory that delivers us from the conflict by taking us out of time. Our view on the contrary is that from the natural and temporal point of view itself there never was any need of a reconciliation but only of a comprehension of the meaning of terms. (The metaphysical nature of the self and its identity through time is a problem for all who confront memory, anticipation, etc.; it has no peculiar difficulties arising from the present problem.) -/- I am not maintaining that determinism is true; only that it is true insofar as we have free will. That we are free in willing is, broadly speaking, a fact of experience. That broad fact is more assured than any philosophical analysis. It is therefore surer than the deterministic analysis of it, entirely adequate as that in the end appears to be. But it is not here affirmed that there are no small exceptions, no slight undetermined swervings, no ingredient of absolute chance. All that is here said is that such absence of determination, if and so far as it exists, is no gain to freedom, but sheer loss of it; no advantage to the moral life, but blank subtraction from it. -- When I speak below of "the indeterminist" I mean the libertarian indeterminist, that is, him who believes in free will and holds that it involves indetermination. (shrink)

This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and (...) should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. (shrink)

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the (...) field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

2. The Meno offers a dramatic demonstration of the validity of the first argument put forward for Anamnesis and the immortality of the soul in the Phaedo.

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a model (...) to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

Volume 20, Issue 4, May 2020, Page 71-73.

No one is excused from doing what he ought to do merely because he is unwilling to do it. But what if others are unwilling to play their necessary role in some joint venture that you all ought to undertake: might that excuse you from doing what you yourself ought to do as part of that? It would, if you were genuinely willing to play your necessary part if they were. But the unwillingness of everyone involved cannot reciprocally serve to (...) excuse one another from doing what they ought to do. (shrink)

This distinction has sometimes been read as purely epistemic, resting not on things, but on our knowledge of them: there is one world, not two, though it may be apprehended in two ways. But this view is patently at odds with the text. Knowledge and opinion are δυνάμεις, "faculties," to be distinguished and defined by their objects, no less than by the state of mind they produce, and Plato clearly states that the fallibility and unclearness of opinion is rooted in (...) the relative unreality of opinables. (shrink)

: George Rupp's Beyond Existentialism and Zen, in its typological-structural analysis and model of religious pluralism, proffers an alternative to the dominant Kantian models (e.g., by John Hicks and Sarvepalli Radhakrish nan). The question for Rupp is not which religion is true and how to decide that issue—answered in the Kantian approach in terms of an unknowable Ding an sich that all religions, albeit imperfectly, try to approximate or conceptualize (i.e., God or the Transcendent)—but rather how do religions represent, (...) at least in principle, a structural possibility for salvation or human flourishing, however different and incompatible their distinct prima facie truth claims might be. Although the potential for a radically relativistic model is implicit in Rupp's approach, it is argued here that his Hegelian assumptions lead him to accept relativism only in a provisional ("critical") way; for Rupp, under ideal epistemic conditions (e.g., the Peircian "end of inquiry"), one final conceptualization of ultimate reality will emerge as absolute truth. In the final part of this essay a version of the relativistic model implicit in Rupp's approach is defended against both the Kantian model of Hicks et al. and Rupp's Hegelian-Peircian model, which, it is argued, is incompatible certainly with the spirit of his own typological-structural analysis, if not with the letter. In challenging what Rupp calls the truth of Zen, it is further argued that not only is more than one salvific structural possibility available to us through the different world religions but also that realizing these possibilities is principally a human responsibility, and that the cosmos is quite indifferent to and compatible with several possibilities, from the most destructive to the most conducive to human well being and flourishing. (shrink)

George Rupp's Beyond Existentialism and Zen, in its typological-structural analysis and model of religious pluralism, proffers an alternative to the dominant Kantian models (e.g., by John Hicks and Sarvepalli Radhakrish nan). The question for Rupp is not which religion is true and how to decide that issue-answered in the Kantian approach in terms of an unknowable Ding an sich that all religions, albeit imperfectly, try to approximate or conceptualize (i.e., God or the Transcendent)-but rather how do religions represent, at (...) least in principle, a structural possibility for salvation or human flourishing, however different and incompatible their distinct prima facie truth claims might be. Although the potential for a radically relativistic model is implicit in Rupp's approach, it is argued here that his Hegelian assumptions lead him to accept relativism only in a provisional ("critical") way; for Rupp, under ideal epistemic conditions (e.g., the Peircian "end of inquiry"), one final conceptualization of ultimate reality will emerge as absolute truth. In the final part of this essay a version of the relativistic model implicit in Rupp's approach is defended against both the Kantian model of Hicks et al. and Rupp's Hegelian-Peircian model, which, it is argued, is incompatible certainly with the spirit of his own typological-structural analysis, if not with the letter. In challenging what Rupp calls the truth of Zen, it is further argued that not only is more than one salvific structural possibility available to us through the different world religions but also that realizing these possibilities is principally a human responsibility, and that the cosmos is quite indifferent to and compatible with several possibilities, from the most destructive to the most conducive to human well being and flourishing. (shrink)

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

Book reviewed in this article: Protecting The Vulnerable: A Reanalysis of Our Social Responsibilities. By Robert E. Goodin. Chicago: University of Chicago Press.

Corporate social responsibility is a recognised and common part of business activity. Some of the regularly cited motives behind CSR are employee morale, recruitment and retention, with employees acknowledged as a key organisational stakeholder. Despite the significance of employees in relation to CSR, relatively few studies have examined their engagement with CSR and the impediments relevant to this engagement. This exploratory case study-based research addresses this paucity of attention, drawing on one to one interviews and observation in a large UK (...) energy company. A diversity of engagement was found, ranging from employees who exhibited detachment from the CSR activities within the company, to those who were fully engaged with the CSR activities, and to others who were content with their own personal, but not organisational, engagement with CSR. A number of organisational context impediments, including poor communication, a perceived weak and low visibility of CSR culture, and lack of strategic alignment of CSR to business and personal objectives, served to explain this diversity of employee engagement. Social exchange theory is applied to help explore the volition that individual employees have towards their engagement with CSR activities, and to consider the implications of an implicit social, rather than explicit economic, contract between an organisation and its employees in their engagement with CSR. (shrink)

George Rupp's Beyond Existentialism and Zen, in its typological-structural analysis and model of religious pluralism, proffers an alternative to the dominant Kantian models (e.g., by John Hicks and Sarvepalli Radhakrish- nan). The question for Rupp is not which religion is true and how to decide that issue-answered in the Kantian approach in terms of an unknowable Ding an sich that all religions, albeit imperfectly, try to approximate or conceptualize (i.e., God or the Transcendent)-but rather how do religions represent, at (...) least in principle, a structural possibility for salvation or human flourishing, however different and incompatible their distinct prima facie truth claims might be. Although the potential for a radically relativistic model is implicit in Rupp's approach, it is argued here that his Hegelian assumptions lead him to accept relativism only in a provisional ("critical") way; for Rupp, under ideal epistemic conditions (e.g., the Peircian "end of inquiry"), one final conceptualization of ultimate reality will emerge as absolute truth. In the final part of this essay a version of the relativistic model implicit in Rupp's approach is defended against both the Kantian model of Hicks et al. and Rupp's Hegelian-Peircian model, which, it is argued, is incompatible certainly with the spirit of his own typological-structural analysis, if not with the letter. In challenging what Rupp calls the truth of Zen, it is further argued that not only is more than one salvific structural possibility available to us through the different world religions but also that realizing these possibilities is principally a human responsibility, and that the cosmos is quite indifferent to and compatible with several possibilities, from the most destructive to the most conducive to human well-being and flourishing. (shrink)

Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined. Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. (...) Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions. Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8). Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature. (shrink)

This essay explores the role of informal logicand its application in the context of currentdebates regarding evidence-based medicine. This aim is achieved through a discussion ofthe goals and objectives of evidence-basedmedicine and a review of the criticisms raisedagainst evidence-based medicine. Thecontributions to informal logic by StephenToulmin and Douglas Walton are explicated andtheir relevance for evidence-based medicine isdiscussed in relation to a common clinicalscenario: hypertension management. This essayconcludes with a discussion on the relationshipbetween clinical reasoning, rationality, andevidence. It is argued that (...) informal logic hasthe virtue of bringing explicitness to the roleof evidence in clinical reasoning, and bringssensitivity to understanding the role ofdialogical context in the need for evidence inclinical decision making. (shrink)

There are a variety of puzzling features about this argument. One of them—questions of validity apart—is its apparent redundancy. Parmenides’ initial division provided him with an infinite plurality of parts. He might therefore have given an existence proof of infinitely many numbers, conceived as pluralities of units, by means of this division. Instead, he introduces a new principle of division for the purpose. Again, he derives the conclusion that Unity has infinitely many parts from the infinity of number; but he (...) has already shown that Unity is infinitely divisible into parts consisting of being and unity. In short, the new principle of division introduced for number seems unnecessary, and Parmenides has twice shown that Unity has infinitely many parts. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

As a counter-argument to Moore's "Refutation of Idealism," this article explains how the application of non-dualistic idealism reveals the underlying problem in both narrowly defined "esse is principi" brands of idealism and Moore's realism. The issue at hand, this article suggests, is the presupposition that experience naturally forks off into subjective consciousness and particular objects of consciousness. Rather than agree with either Moore or dualistic forms of idealism, the Vedanta-inspired view set forth in this article provides a third option to (...) reject the ontological commitments of the former two philosophical stances. This third stance suggests that reality amounts to consciousness, and, thus, motivates the conclusion that modes of consciousness are what differentiate experience, not the bifurcation of experience into subject and object. (shrink)

When loyalty is discussed, a very rare thing in recent years, it is sometimes listed as one of the virtues and just as often derided. Its relationship to the virtues, or to the other virtues, is difficult to discern, and that is at least partly because the role that judgement plays in loyalty seems odd. The argument of this paper is that there is a core value to loyalty, and that understanding this core value is of critical importance in understanding (...) the virtues despite the fact that loyalty is not itself one of them. I shall suggest at the end of the paper that it is the raw material of the virtues and of at least some vices. (shrink)