Case method and casuistry: The problem of bias

Case methods of reasoning are persuasive, but we need to address problems of bias in order to use them to reach morally justifiable conclusions. A bias is an unwarranted inclination or a special perspective that disposes us to mistaken or one-sided judgments. The potential for bias arises at each stage of a case method of reasoning including in describing, framing, selecting and comparing of cases and paradigms. A problem of bias occurs because to identify the relevant features for such purposes, we must use general views about what is relevant; but some of our general views are biased, both in the sense of being unwarranted inclinations and in the sense that they are one of many viable perspectives. This reliance upon general views to determine relevancy creates additional difficulties for defenders who maintain that case methods of moral reasoning are not only useful, but more basic, reliable or prior to other forms of moral reasoning. If we cannot identify the case's relevant features and issues independently of our general views or biases, we need further explanation about why a case method or casuistry should be viewed as prior to or more basic or reliable than other forms of moral reasoning. Problems of bias also arise for other methods of reasoning. In medical science, case reviews are regarded as an unreliable way to form generalizations, and methods such as clinical trials are used to address bias.     

Feminist directions in medical ethics

I explore some new directions—suggested by feminism—for medical ethics and for philosophical ethics generally. Moral philosophers need to confront two issues. The first is deciding which moral issues merit attention. Questions which incorporate the perspectives of women need to be posed—e. g., about the unequal treatment of women in health care, about the roles of physician and nurse, and about relationship issues other than power struggles. “Crisis issues” currently dominate medical ethics, to the neglect of what I call “housekeeping issues.” The second issue is how philosophical moral debates are conducted, especially how ulterior motives influence our beliefs and arguments. Both what we select—and neglect—to study as well as the “games” we play may be sending a message as loud as the words we do speak on ethics.     

Does change in ethical education influence core moral values? Towards history- and culture-aware morality model with application in automatic moral reasoning

In this study, we focus on ethical education as a means to improve artificial companion’s conceptualization of moral decision-making process in human users. In particular, we focus on automatically determining whether changes in ethical education influenced core moral values in humans throughout the century. We analyze ethics as taught in Japan before WWII and today to verify how much the pre-WWII moral attitudes have in common with those of contemporary Japanese, to what degree what is taught as ethics in school overlaps with the general population’s understanding of ethics, as well as to verify whether a major reform of the guidelines for teaching the school subject of “ethics” at school after 1946 has changed the way common people approach core moral questions (such as those concerning the sacredness of human life). We selected textbooks used in teaching ethics at school from between 1935 and 1937, and those used in junior high schools today (2019) and analyzed what emotional and moral associations such contents generated. The analysis was performed with an automatic moral and emotional reasoning agent and based on the largest available text corpus in Japanese as well as on the resources of a Japanese digital library. As a result, we found out that, despite changes in stereotypical view on Japan’s moral sentiments, especially due to historical events, past and contemporary Japanese share a similar moral evaluation of certain basic moral concepts, although there is a large discrepancy between how they perceive some actions to be beneficial to the society as a whole while at the same time being inconclusive when it comes to assessing the same action’s outcome on the individual performing them and in terms of emotional consequences. Some ethical categories, assessed positively before the war, while being associated with a nationalistic trend in education have also disappeared from the scope of interest of post- war society. The findings of this study support suggestions proposed by others that the development of personal AI systems requires supplementation with moral reasoning. Moreover, the paper builds upon this idea and further suggests that AI systems need to be aware of ethics not as a constant, but as a function with a correction on historical and cultural changes in moral reasoning.     

Richard Zaner’s “Troubled” Voice In <Emphasis Type="Italic">Troubled Voices</Emphasis>: Poseur,Posing, <Emphasis Type="Italic">Possibilizing</Emphasis>?

This essay considers Richard Zaner’s storytelling in Troubled Voices as a form of possibilizing which uses the stories to exemplify important moral themes such as contingency and freedom. Distinguishing between activities of moral discovery through the telling of a story and “posing” in the sense of writing to tell the “moral” of the story, I suggest that something crucial goes on for Zaner in his own tellings. Several of the more insistent implications Zaner reveals about the moral relationships encountered in the activity of clinical ethics consultation are examined in that light, especially regarding this question: is it more beneficial, or harmful, to articulate elements of core meanings and values that are entailed in individual viewpoints, which, prior to an ethics consultant’s participation, may have remained unspoken and possibly unacknowledged?     

MORAL AND EPISTEMIC LUCK

Abstract: It is maintained that the arguments put forward by Bernard Williams and Thomas Nagel in their widely influential exchange on the problem of moral luck are marred by a failure to (i) present a coherent understanding of what is involved in the notion of luck, and (ii) adequately distinguish between the problem of moral luck and the analogue problem of epistemic luck, especially that version of the problem that is traditionally presented by the epistemological sceptic. It is further claimed that once one offers a more developed notion of luck and disambiguates the problem of moral luck from the problem of epistemic luck (especially in its sceptical guise), neither of these papers is able to offer unambiguous grounds for thinking that there is a problem of moral luck. Indeed, it is shown that in so far as these papers succeed in making a prima facie case for the existence of epistemic luck, it is only the familiar sceptical variant of this problem that they identify.     

Medical Ethics Research Between Theory and Practice

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.     

Relieved after GP's consultation? Change in the complaint-related worry of young adult patients

Patients tend to get relieved during a general practitioner's (GP's) consultation, but some patients remain worried. This study aimed to explore the change in worry and to identify factors associated with non-worry, relief and persistent worry by interviewing GPs' patients before and after a consultation. Patients aged 18-39 years consulting their doctor because of a somatic complaint were interviewed about their complaint-related worry, complaint characteristics and their expectations and experiences concerning the consultation. They completed questionnaires about general illness worry (IWS) and psychiatric symptoms (SCL-90). The GPs assessed the medical severity of each complaint and reported whether the complaint was medically explained. Persistently worried patients reported more anxiety and thoughts that something was seriously wrong in their body. They expected more often medical examinations, were less certain about what was wrong with them and considered their complaint more severe than the other patients, even though its medical severity did not differ from that of the other patients.     

制度伦理与社会转型期的医德建设

市场经济的发展,多元价值观的形成,各种伦理价值观念之间发生了冲突,医疗道德失范现象成为我国社会转型期的一个重要社会问题。制度伦理对道德建设起着基础性和根本性的作用,以制度伦理建设为契机,并辅以正确的激励手段等,可以让医务人员树立正确的道德理念,引导和强化医务人员的价值选择和行为规范,重塑良好医德医风。     

New Directions in Ethics: Naturalisms, Reasons and Virtue

This paper discusses three topics in contemporary British ethical philosophy: naturalisms, moral reasons, and virtue. Most contemporary philosophers agree that 'ethics is natural' - in Section 1 I examine the different senses that can be given to this idea, from reductive naturalism to supernaturalism, seeking to show the problems some face and the problems others solve. Drawing on the work of John McDowell in particular, I conclude that an anti-supernatural non-reductive naturalism plausibly sets the limits on what we can do in ethics. Moral reasons are widely discussed - in Section 2 I describe some of the criteria that used to distinguish moral practical reasons, and note possibilities and problems. Drawing on the work of Elizabeth Anscombe in particular, I suggest that an inclusive, minimalist account of moral reasons may be most fruitful. There has been a revival of philosophical interest in virtue ethics, which I take to be linked to the emergence of non-reductive naturalisms - in Section 3 I describe three points where virtue ethics has an especially significant contribution to make: learning, motivational self-sufficiency, and the question of whether virtues can be reasons. The naturalism of Section 1 constrains the accounts of moral reasons considered in Section 2, and depends upon an account of virtue as learned second nature, discussed in Section 3.     

Four Roles of Ethical Theory in Clinical Ethics Consultation

When clinical ethics committee members discuss a complex ethical dilemma, what use do they have for normative ethical theories? Members without training in ethical theory may still contribute to a pointed and nuanced analysis. Nonetheless, the knowledge and use of ethical theories can play four important roles: aiding in the initial awareness and identification of the moral challenges, assisting in the analysis and argumentation, contributing to a sound process and dialogue, and inspiring an attitude of reflexivity. These four roles of ethical theory in clinical ethics consultation are described and their significance highlighted, while an example case is used as an illustration throughout.     

The relationship of selected consultant/teacher characteristics to consultation outcomes

This study examined the relationship of teacher life position, teacher dogmatism, perceived consultant facilitativeness, years of teacher teaching experience and number of consultations per year to the consultation outcomes of teacher satisfaction, teacher strength, and problem resolution. A number of significant findings resulted, with the consultant's perceived facilitativeness being the main predictor of the desirable consultation outcomes. These results are consistent with some earlier findings. Some results that are inconsistent with other studies also are discussed.     

Exemplarist Environmental Ethics

This article argues that environmental ethics can deemphasize environmental problem‐solving in preference for a more exemplarist mode. This mode will renarrate what we admire in those we have long admired, in order to make them resonate with contemporary ethical needs. First, I outline a method problem that arose for me in ethnographic fieldwork, a problem that I call, far too reductively, “solution thinking.” Second, I relate that method problem to movements against “quandary ethics” in ethical theory more broadly. Third, I discuss some interpretive work I am engaged in about Henry David Thoreau and how it bears on the methodological issues my fieldwork raised. I argue that some of the most important icons of right relation to environment, especially Francis of Assisi and Thoreau, should be envisioned as far more politically invested than they usually are. They demonstrate to scholars of religious ethics that an exemplarist ethic focused on character need not neglect politics.     

关于医学伦理学教育的几点思考

医学伦理学教育中长期存在的一些问题尚未很好解决.由于较多强调课程的道德教育功能,对其作为独立学科存在的性质和意义仍重视不够,医学伦理学是进行道德分析、准则与价值评判的理论体系,通过医学伦理学的学习和训练,应使学生能够对有关问题在广阔的背景中进行深层次思考并做出独立判断.我们应在进一步更新观念的基础上,改进哲学、伦理学基础教育,以促进医学伦理学教育的发展,而其意义已远超出医学伦理学之外.     

Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure

Clinical ethics consultations (CECs) are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient “closure” for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as “bioethics mediation.”     

The design and use of the Bioethics Consultation Form

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the Bioethics Consultation Form as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case.The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.     

Withholding and Withdrawing Life-Sustaining Treatment: Ethically Equivalent?

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment.     

Toward a methodology for moral decision making in medicine

The failure of medical codes to provide adequate guidance for physicians' moral dilemmas points to the fact that some rules of analysis, informed by moral theory, are needed to assist in resolving perplexing ethical problems occurring with increasing frequency as medical technology advances. Initially, deontological and teleological theories appear more helpful, but critcisms can be lodged against both, and neither proves to be sufficient in itself. This paper suggests that to elude the limitations of previous approaches, a method of moral decision making must be developed incorporating both coherence methodology and some independently supported theoretical foundations. Wide Reflective Equilibrium is offered, and its process described along with a theory of the person which is used to animate the process. Steps are outlined to be used in the process, leading to the application of the method to an actual case.     

“洗”出来的效应:清洁启动对道德判断作用方向不同的影响因素探析

"身体清洁与道德洁净"的隐喻联系被广泛应用于现实生活中。基于清洁启动与道德判断的关联性研究,身体清洁与道德判断存在两个不同的作用方向,即清洁启动之后是更为严苛还是更为宽松。文章从清洁启动对道德判断作用方向不同的影响因素出发,探讨和分析了以下5个潜在的因素:清洁启动前的初始情绪状态、不同清洁操纵方式、道德事件行为主体、道德事件类型及中介(道德自我意象、政治立场等)或调节变量(强迫倾向、完美人格、思维类型等),认为未来研究不仅要考虑这些影响因素,也应该重视清洁启动操纵上的规范化,同时关注清洁启动对特殊群体的作用(如罪犯、法官等)及注重文化上的适用性。。     

GERT ON UNRESOLVABLE MORAL DEBATES

Abstract: Bernard Gert argues that, while the moral system contains a procedure for resolving most moral disagreements, it does not allow for such resolution in all cases. For example, it does not allow for the resolution of disputes about whether animals and human fetuses should be included within the scope of those to whom the moral rules apply. I agree with Gert that not all moral debates can be resolved, but I believe that Gert does not use all the argumentative resources available to philosophers to resolve them. I argue that considerations outside the moral system proper can be used to provide argumentative support favoring some positions over their rivals in moral controversies that Gert regards as intractable. I illustrate this with reference to the abortion debate. I also argue that reaching such conclusions about the superiority of one position over rivals need not result in moral arrogance.