Expertise, Democracy, and Applied Ethics

Is expertise in applied ethics compatible with individual autonomy and democratic self-governance? This depends on whether a ‘tracking condition’ is satisfied for expert claims about issues in applied ethics. This condition requires that, when expert deliberations are properly conducted they ‘track’ the courses of reasoning that the experts’ clients would themselves have undertaken if they had (perhaps subject to certain conditions) considered the matters for themselves. Pluralism of the kind thematised by Isaiah Berlin and Stuart Hampshire suggests that the tracking condition typically will not be satisfied and, hence, that whatever experts are praticising in applied ethics they are doing it contrary to democratic principles of autonomy and self-government. The implications of this result are sketched and some standard objections briefly considered.     

Conflicts Between Ethics and Law in Counseling and Psychotherapy

Codes of ethics are designed to guide and govern the behavior of the professional for whom they are written. In such fields as counseling, psychology, and social work, ethical standards are necessary to protect clients, guide professionals, safeguard the autonomy of professional workers, and enhance the status of the profession. Sometimes, however, the professional worker finds that the ethical standards of the profession seem to be in conflict with the law. These conflicts may arise in such areas as advertising, confidentiality, and clients' rights of access to their own files. The authors discuss the nature, ramifications, and implications of ethical-legal conflicts in the helping professions.     

Certifying clinical ethics consultants: who pays?

The movement advocating the formal certification of clinical ethics consultants may result in major changes to the field of clinical ethics consultation by creating a new standard of care. The actual certification process is still in the development phase, but unanswered questions include: What will certification cost, and, Who will pay? Currently there is little salary support for ethics consultants and no regulation requiring healthcare institutions to offer clinical ethics consultation. Without the support of healthcare administrators and accreditation bodies, this may remain unchanged. Healthcare administrators may be unwilling to pay for certification or professional services if accreditation bodies do not require healthcare institutions to provide certified ethics consultants' services. If consultants will not be reimbursed or paid, they may not seek certification. If certified consultants are required, healthcare administrators may look for ways to cover the costs for providing this service, including insurance or third-party reimbursement and direct billing of patients for consultations, which may affect who performs and who participates in ethics consultation. However, this is less than ideal, as bioethicists believe ethics consultation should be available to all as part of providing safe, quality ethical care and support and guidance for patients, families, and healthcare staff. Going forward, bioethicists should study quality improvement, patient safety, and cost-savings resulting from certification-eligible clinical ethics consultants' activities. Administrators and financial personnel can be surveyed regarding their support for the certification process. Bioethicists should enlist the help of patient rights and safety advocacy groups, professional medical associations, and healthcare administrators. Bioethicists should invite accreditation bodies, healthcare administrators, and financial personnel to collaborate in the development of the certification process. Without their support, certification may be of value only to the bioethics community, and may have little standing in actual clinical healthcare institution settings.     

Assisted Suicide: Do We Own Our Bodies?

Abstract:  The ethics of physician‐assisted suicide is explored here in light of classic philosophical discussions of the ownership of one's body plus biblical discussions of the relationship of body and soul. Motives for individual and group suicide are brought to bear on bioethical principles such as that of autonomy. Ethical analysis is here challenged by the case of a 91 year‐old woman, Ragnhild, who lived after professional judgments that her life should be ended.     

Were the “Pioneer” Clinical Ethics Consultants “Outsiders”? For Them,Was “Critical Distance” That Critical?

“Clinical ethics consultants” have been practicing in the United States for about 50 years. Most of the earliest consultants—the “pioneers”—were “outsiders” when they first appeared at patients' bedsides and in the clinic. However, if they were outsiders initially, they acclimated to the clinical setting and became “insiders” very quickly. Moreover, there was some tension between traditional academics and those doing applied ethics about whether there was sufficient “critical distance” for appropriate reflection about the complex medical ethics dilemmas of the day if one were involved in the decision making. Again, the pioneers deflected concerns by identifying and instituting safeguards to assure professional objectivity in clinical ethics consultation services. One might suggest that in moving inside and establishing normative practices, the pioneer clinical ethics consultants anticipated adoption of their routines and professionalization of the field.     

Introduction to the Special Issue “Phenomenological Studies in Multidimensional Views”

How should Scheler’s critique of Kant’s ethics be interpreted? This paper focuses on two aspects of Scheler’s critique of Kant’s ethics: 1) the problem of “formalism” in Kant’s ethics, and 2) the problem of the “ethics of autonomy” and “ethics of heteronomy.” Generally speaking, Scheler’s project has a “modern” starting point; that is to say, his work starts with the rejection or critique of Kant and Aristotle. Most essentially, Scheler’s “material ethics of values” (ethics of person) must stay autonomous. Following Kant, Scheler takes Aristotle’s theory as an “ethics of heteronomy,” and then competes with Kant within the “ethics of autonomy” and further develops his own “ethics of personal autonomy.”     

Towards a research programme for ethics and technology

In this editorial contribution, two issues relevant to the question, what should be at the top of the research agenda for ethics and technology, are identified and discussed. Firstly: can, and do, engineers make a difference to the degree to which technology leads to morally desirable outcomes? What role does professional autonomy play here, and what are its limits? And secondly, what should be the scope of engineers' responsibility; that is to say, on which issues are they, as engineers, morally obliged to reflect? The research agendas proposed by the authors contributing to this special section, implicitly, give different answers to these questions. We suggest that an explicit discussion of these issues would greatly help in constructing a common research agenda.     

A Debate on the Ethics of Aging: Does the Concept of Autonomy Provide a Sufficient Framework for Aging Policy?

This article presents a debate on the issue of autonomy in aging policy held at the 1994 annual meeting of the American Society on Aging held in San Francisco, California. Harry R. Moody, director of the Institute for Human Values in Aging at Hunter College, supports a reconceptualized notion of personal autonomy which focuses on issues of power, theory, and practice, and finds conflicts between autonomy and justice in the lived world of the elderly and disabled. In aging policy, he promotes an emphasis on social movements such as Hospice rather than on autonomy of individuals. He suggests alternatives to extreme paternalism or complete autonomy, such as a communicative ethics approach. Larry Polivka, director of the Florida Policy Exchange Center on Aging at the University of South Florida, affirms that policy for the aging and disabled should be based ona commitment to autonomy. He describes an integrated model for long-term care that places autonomy first and includes features of communicative ethics and the negotiated consent and virtues models of ethics.     

Self-Serving Evaluations of Conflict Behavior and Escalation of the Dispute1

There is good evidence that people generally tend to evaluate behaviors, contributions, and outcomes in terms favorable to the self. The present series of studies expands this finding by showing that professional negotiators (Study 1), governmental decision makers (Study 2), and organizational consultants (Study 3) make self-serving evaluations of conflict behavior: They view their own conflict behaviors as more constructive and as less destructive than those of their opponents. In addition, results revealed that self-serving evaluation of conflict behavior is associated with increased frustration, with reduced problem solving, and with enhanced likelihood of future conflict. It is argued that these findings expand the conflict literature in that they provide better insight into the motivational-cognitive antecedents and consequences of conflict escalation.     

History and theory in "applied ethics"

Robert Baker and Laurence McCullough argue that the "applied ethics model" is deficient and in need of a replacement model. However, they supply no clear meaning to "applied ethics" and miss most of what is important in the literature on methodology that treats this question. The Baker-McCullough account of medical and applied ethics is a straw man that has had no influence in these fields or in philosophical ethics. The authors are also on shaky historical grounds in dealing with two problems: (1) the historical source of the notion of "practical ethics" and (2) the historical source of and the assimilation of the term "autonomy" into applied philosophy and professional ethics. They mistakenly hold (1) that the expression "practical ethics" was first used in a publication by Thomas Percival and (2) that Kant is the primary historical source of the notion of autonomy as that notion is used in contemporary applied ethics.     

患者的自主权及困境

在生命伦理学中,尊重自主性原则是指尊重病人或受试者的自主性,可理解为病人自主原则。自主性的实现涉及到自主性的人与自主性的选择,面对复杂的医疗情境,患者自主权的实施面临着重重困境。从自主、病人自主原则、病人自主的实践三个层面讨论了该原则,并尝试用境遇伦理学原理来解决病人自主原则的实践困境。     

Addressing the dual relationship problem in forensic and correctional practice

The dual relationship problem in forensic and correctional practice emerges from conflict between two sets of ethical norms: those associated with community protection and justice versus norms related to offender/defendant well-being and autonomy. The problem occurs because forensic practitioners typically have their professional roots in mental health or allied disciplines such as psychiatry, clinical psychology, social work, or law, and as such, often struggle to ethically justify aspects of forensic and/or correctional work. First, the problem of dual relationships will be described and its nuances explored. As will become apparent, the problem extends beyond the straightforward conflict of roles and resides at the very heart of professional practice. It is a core normative conflict created by practitioners varying ethical allegiances. Second, contemporary ways of resolving the dual relationship problem will be briefly outlined, that is, approaches that assert the primary of one set of codes over the other or involve the construction of hybrid ethical codes. Third, after briefly reviewing the shortcomings of these approaches I present a possible way forward drawing from relational ethics and the concept of moral acquaintances.     

Autonomy in the medical profession in the United Kingdom – an historical perspective

This paper reviews the concept of professional autonomy from anhistorical perspective. It became formalised in the United Kingdom onlyafter a long struggle throughout most of the nineteenth century. In itspure form professional autonomy implies unlimited powers to undertakemedical investigations and to prescribe treatment, irrespective of cost.Doctors alone should determine the quality of care and the levels ofremuneration to which they should be entitled. In the second half of thetwentieth century a steady erosion of professional autonomy occurred inthe United Kingdom. The level of remuneration has been restricted formost doctors for nearly fifty years, whilst the costs of health carehave steadily reduced the doctor's ability to provide unrestricted carewithin the health care system. Reorganisation of the National HealthService in 1983 and 1991 has substantially eroded professional autonomy,to the point where research developments, clinical judgement and ethicalstandards are all now being placed at risk.     

Prescriptions: Autonomy,Humanism and the Purpose of Health Technology

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems.     

Rethinking paradigms in geriatric ethics

This paper calls for a shift away from autonomy as the central value in geriatric ethics. In treatment and experimental settings, differences between older and younger adults are easily attributed to deficiencies on the part of the elderly when autonomy is the central value. Overemphasis on the concept of autonomy skews our understanding of human relationships toward excessively rational models, distracts attention from important physical and social characteristics of aged persons, and results in ethics by default. This paper describes several principles that would be more useful starting points than autonomy in developing a geriatric ethic.     

Information Privacy for Technology Users With Intellectual and Developmental Disabilities: Why Does It Matter?

This article aims to explore the attitudes and behaviors of persons with intellectual and developmental disabilities (IDD) related to their information privacy when using information technology (IT). Six persons with IDD were recruited to participate to a series of 3 semistructured focus groups. Data were analyzed following a hybrid thematic analysis approach. Only 2 participants reported using IT every day. However, they all perceived IT use benefits, such as an increased autonomy. Participants demonstrated awareness of privacy concerns, but not in situations involving the use of technology; their awareness is not transferred to the abstract context of IT use. Privacy breaches were revealed to be a major risk for persons with IDD, who did not seem to understand how their personal information was used. Most protection mechanisms and tools reported were those suggested and implemented by caregivers and close relatives who had a great influence on the participants’ attitudes and behaviors toward IT and privacy. Our findings suggest that when using IT, persons with IDD often experience the consequences of a trade-off between autonomy and privacy. Further research and action is needed to support persons with IDD to understand and balance the benefits of IT use and the inherent threats to information privacy.     

Precedent Autonomy and Subsequent Consent

Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her “precedent autonomy” by giving her what she used to want? There is a similar problem with “subsequent consent”: How can we justify interfering with someone's autonomy on the grounds that she will later consent to the interference, if she refuses now? Both problems arise on the assumption that, to respect someone's autonomy, any preferences we respect must be among that person's current preferences. I argue that this is not always true. Just as we can celebrate an event long after it happens, so can we respect someone's wishes long before or after she has that wish. In the contexts of precedent autonomy and subsequent consent, the wishes are often preferences about which of two other, conflicting preferences to satisfy. When someone has two conflicting preferences, and a third preference on how to resolve that conflict, to respect his autonomy we must respect that third preference. People with declining competence may have a resolution preference earlier, favoring the earlier conflicting preference (precedent autonomy), whereas those with rising competence may have it later, favoring the later conflicting preference (subsequent consent). To respect autonomy in such cases we must respect not a current, but a former or later preference.     

教师教学自主权与教师领导力的关系：心理授权和教学自主性的中介作用

教师领导力是指教师在课堂内外带领同事提升专业技能,与其他教师和校长合作处理学校事务的一种专业特质。为探究教师教学自主权与教师领导力的关系,以及教师心理授权和教学自主性的中介作用,从而寻求提升教师领导力的路径,研究选取403名中小学教师进行问卷调查。结果发现：（1）教学自主权与教师领导力呈显著正相关,且前者对后者有显著直接效应;（2）教师心理授权和教学自主性分别在教学自主权与教师领导力间发挥部分中介作用;（3）教师心理授权和教学自主性在教学自主权对教师领导力间发挥部分链式中介作用,即教学自主权的提高会促进教师心理授权和教学自主性的提升,进而促进教师领导力的发展。     

A Polyvocal Body

This essay aims to elucidate how multiple voices and traditions should interact with one another in the practice of ethics. First, it explores some of the major ways in which questions of bodily autonomy function in secular feminist and Jewish bioethical discourses. It then uses case studies to illuminate ways each discourse's concepts of bodily autonomy can be deeply problematic, and argues that the strengths in each discourse can serve as important correctives for the weaknesses in the other. It suggests that some formal features of rabbinic texts can serve as a model for a discourse of constant and animated mutual correction. Finally, it examines two case studies in light of this model.