Cultivating ethics consultation: commentary on "The development of a clinical ethics consultation service in a community hospital

Conclusion: Simpson's article [in this issue, p. 124-130] provides us with needed data about the development and utilization of an ethics consultation service in a community hospital. It makes clear, however, how much further we have to go in developing guiding standards for practitioners and institutions. We need to learn much more about the effectiveness of ethics consultation in meeting well-defined goals and producing desired processes and outcomes before standards for credentials and accountability have a sound empirical basis.     

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.     

Cultural diversity in nanotechnology ethics

Along with the rapid worldwide advance of nanotechnology, debates on associated ethical issues have spread from local to international levels. However unlike science and engineering issues, international perceptions of ethical issues are very diverse. This paper provides an analysis of how sociocultural factors such as language, cultural heritage, economics and politics can affect how people perceive ethical issues of nanotechnology. By attempting to clarify the significance of sociocultural issues in ethical considerations my aim is to support the ongoing international dialogue on nanotechnology. At the same time I pose the general question of ethical relativism in engineering ethics, that is to say whether or not different ethical views are irreconcilable on a fundamental level.     

How Christian ethics became medical ethics: the case of Paul Ramsey.

Over the last century Christian ethics has moved from an attempt to Christianize the social order to a quandary over whether being Christian unduly biases how medical ethics is done. This movement can be viewed as the internal development of protestant liberalism to its logical conclusion, and Paul Ramsey can be taken as one of the last great representatives of that tradition. By reducing the Christian message to the 'ethical upshot' of neighbour love, Ramsey did not have the resources to show how Christian practice might make a difference for understanding or forming the practice of medicine. Instead, medicine became the practice that exemplified the moral commitments of Christian civilization, and the goal of the ethicist was to identify the values that were constitutive of medicine. Ramsey thus prepared the way for the Christian ethicist to become a medical ethicist with a difference, and the difference simply involved vague theological presumptions that do no serious intellectual work other than explaining, perhaps, the motivations of the ethicist.     

A comment on Fry's "The role of caring in a theory of nursing ethics

Our response to Sara Fry's paper focuses on the difficulty of understanding her insistence on the fundamental character of caring in a theory of nursing ethics. We discuss a number of problems her text throws in the way of making sense of this idea, and outline our own proposal for how caring's role may be reasonably understood: not as an alternative object of value, competing with autonomy or patient good, but rather as an alternative way of responding toward that which is of value.     

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.     

Service-learning and engineering ethics

This paper explores ways in which service-learning programs can enhance ethics education in engineering. Service-learning programs combine volunteer work and academic study. The National Society for Professional Engineers (NSPE) and American Society for Civil Engineers (ASCE) codes of ethics explicitly encourage engineers to seek opportunities, beyond their work-related responsibilities, to serve their communities. Examples of how this can be encouraged as a part of the educational experiences of engineering students are explored.     

Phronesis in clinical ethics

This essay argues that while we have examined clinical ethics quite extensively in the literature, too little attention has been paid to the complex question of how clinical ethics is learned. Competing approaches to ethics pedagogy have relied on outmoded understandings of the way moral learning takes place in ethics. It is argued that the better approach, framed in the work of Aristotle, is the idea of phronesis, which depends on a long-term mentorship in clinical medicine for either medical students or clinical ethics students. Such an approach is articulated and defended.     

Doctoral essays in computer ethics

Computer technologies are having a profoundly transforming effect on how the United States federal government operates. As technologies become more sophisticated, Federal agencies are becoming more innovative, devising creative ways to use these technologies for program delivery. One hopes that the near-term effect of these technology applications will be more efficient operation of government, the goal that generally leads to their implementation.     

The beginning of ethics: confucius and socrates

The paper is an effort to better understand, through a comparison, how Confucius and Socrates initate their ethical inquiries that have laid down, respectively, the foundations of Chinese and Western ethics. Since both Confucius and Socrates claim to have a divine mission to undertake their investigations, the paper focuses on the issue about how religion and rational philosophy are related when ethics begins. It shows that both have serious religious belief, yet each has secular rational grounds for doing what he is doing. Finally, each philosopher has a different view about how human beings are related to the divine being, and the difference determines their different approaches to ethics.     

"Facilitated consensus," "ethics facilitation," and unsettled cases

In "Consensus, Clinical Decision Making, and Unsettled Cases:' David M. Adams and William J.Winslade' make multiple references to both editions of the American Society of Bioethics and Humanities (ASBH) Core Competencies for Healthcare Ethics Consultation in their discussion of two assumptions that are supposed to be at the heart of the facilitated consensus model's inability to handle unsettled cases; that is, that: 1. Consultants "should maintain a kind of moral impartiality or neutrality throughout the process," "explicitly condemn[ing] anything resembling a substantive 'ethics' recommendation, and 2. "What counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible' Herein, I argue that neither of these assumptions is required by ASBH's ethics facilitation approach. I then conclude by suggesting that, despite their fundamentally mistaken interpretation of the ASBH approach-perhaps even because of it-Adams and Winslade have made two important contributions to the ethics consultation literature.     

Evolutionary ethics and moral theory

Conclusion This example, like the others, demands further discussion. My conclusion must therefore remain modest: an agent-neutral theory of our moral competence is not biologically implausible. Agent-centered rules like tit-for-tat, prerogatives, special obligations, and duties not to harm others might be best regarded as belonging to the theory of moral performance rather than the theory of moral competence. For biologists who may think otherwise, the general argument of this essay is that any claims to the contrary must be based on more empirically well-developed theories of our moral competence and moral performance.More adequate theories of both kinds are worth developing, even if by themselves they determine nothing about how we ought to live our lives. Biology may help us understand the broad taxonomical categories of moral performance. It may also explain why, at the deepest levels of our moral thinking, we so easily slide into agent-neutral ways of reasoning. But how we ought to live our lives is something that must be determined by social experiment and moral argumentation. Discoveries regarding the empirical nature of morality cannot be made independently of the actual workings of our moral competence, which is itself only one factor in broader social and psychological processes that are capable of leading human beings down any number of more or less morally laudable paths.

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The politics, economics, and ethics of "appropriateness"

The terms "appropriate" and "necessary" are crucial determinants in decisions regarding the use and reimbursement of medical treatments. This paper encourages greater awareness of the political, economic, and normative assumptions that give meaning to these concepts.     

A plea for pragmatism in clinical research ethics

Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research.     

Expanding motivations for global justice: A dialogue between public Christian social ethics and Ubuntu ethics as Afro-communitarianism

Faced with the ongoing tragedy of poverty, ethicists call for effective measures of global justice to set up just institutional structures. Their arguments for a transnational obligation to help however remain contested, one of the main reasons for that being the lack of motivational support for trans-national visions of global justice. This articles suggests that the debate will gain new and helpful insights if it studies the motivational mechanisms at work in the dominant religious and cultural traditions, asking: How do these particular traditions conceive of social justice; how do they motivate their adherents to extend solidarity? And how can the similarities surfacing in their motivational strategies be informative for the quest to devise a motivationally saturated account of global justice? The article demonstrates the potential of such an concrete-universal discourse in an exemplary manner by staging a dialogue between public Christian Social Ethics and African Ubuntu Ethics.     

Defining web ethics

The design of Web browsers has resulted in a transfer of power to Web users and developers who often lack an ethical framework in which to act. For example, the technology makes it simple to copy and use other people’s Web page formatting without their permission. The author argues that we need to educate more people about ethical Web practices, and the author asks for “rules of the road” which amateurs and professionals can understand and follow. This article discusses four areas of concern about Web development: the browser wars, information storage and retrieval, access for the handicapped, and cookies. For teachers, there are suggestions on how to use browsers to help students learn about Web ethics. “We are all idiots and we are going to make mistakes.” Scott Adams An earlier version of this paper was presented by the author at a mini-conference, Practicing and Teaching Ethics in Engineering and Computing, held during the Sixth Annual Meeting of the Association for Practical and Professional Ethics, Washington, D.C., March 8–9, 1997. This paper is one of a series edited by Michael C. Loui. See Volume 3, No. 4, 1997 for other papers in this series.