Mistakes and Mental Disturbances: Pleasants, Wittgenstein, and Basic Moral Certainty

In his article, “Wittgenstein and Basic Moral Certainty,” Nigel Pleasants argues that killing an innocent, non-threatening person is wrong. It is, he argues, “a basic moral certainty.” He believes our basic moral certainties play the “same kind of foundational role as [our] basic empirical certaint[ies] do.” I believe this is mistaken. There is not “simply one kind of foundational role” that certainty plays. While I think Pleasants is right to affiliate his proposition with a Wittgensteinian form of certainty, he exposes himself to a tension that exists in On Certainty regarding how we acquire it: is certainty natural, is it social? In this paper, I present two ways in which we come to possess certainty: a bottom-up approach, where certainty is part of our instinctual predisposition, and a top-down approach, where certainty is acquired through positive reinforcement by family and culture.     

Authenticity as a foundational principle of medical ethics

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous.     

Maya Moral and Ritual Discourse: Dialogical Groundings for Consuetudinary Law

Toward the end of the twentieth century, Highland Maya intellectuals and activists in Guatemala began to argue for the recognition of indigenous customary law, rooted in traditional Maya moral and ritual discourse. Such law is often in tension with the Western notion of rights (grounded in the idea of universal reason) that undergirds national and international treatises regarding indigenous peoples. This essay identifies three distinct but mutually engaged pairs of moral concepts—hot/cold, left/right (or positive/negative), and favorable/not favorable—articulated through K'iche' Maya quotidian and ceremonial practices and speech. It also identifies the extent to which they do not necessarily align with Western (Abrahamic and religious) notions of good and bad. These three pairs of moral terms, specifically as conserved through the high‐register of Maya discourse used by traditional ceremonial specialists, illustrate a normative means by which Highland Maya discern understandings of justice, and ground their advocacy for restorative (rather than retributive or punitive) justice.     

NEW NATURAL LAW THEORY AND FOUNDATIONAL SEXUAL ETHICAL PRINCIPLES: A CRITIQUE AND A PROPOSAL

The New Natural Law Theory (NNLT) argues against the morality (and legality) of same sex‐unions on the basis that homosexual (and non‐reproductive heterosexual) acts are unnatural, unreasonable, and therefore immoral. In this paper, we explore and critique the foundational principles – biological and personal complementarity, their subcategories, and the interrelationship between them – that the NNLT uses to justify its claim. We propose alternative principles – orientation, personal, and genital‐biological complementarity, with a distinct interrelationship – to argue that homosexual couples can engage in sexual acts that are natural, reasonable, and therefore moral. Our study clearly demonstrates that for the NNLT genital complementarity, a subcategory of biological complementarity, is the sine qua non for personal complementarity. In other words, personal complementarity within a sexual act is only possible if there is genital complementarity between male and female. We believe that the NNLT's foundational principles reflect too narrow an understanding of the human person and human sexuality. Instead, we propose “holistic complementarity” as the fully human integration of orientation, personal, and genital‐biological complementarity. What defines a natural, reasonable, and moral sexual act is not genital complementarity as the foundational principle, but a dialectic between these three principles of complementarity.     

What Does the Frame Problem Tell us About Moral Normativity?

Within cognitive science, mental processing is often construed as computation over mental representations—i.e., as the manipulation and transformation of mental representations in accordance with rules of the kind expressible in the form of a computer program. This foundational approach has encountered a long-standing, persistently recalcitrant, problem often called the frame problem; it is sometimes called the relevance problem. In this paper we describe the frame problem and certain of its apparent morals concerning human cognition, and we argue that these morals have significant import regarding both the nature of moral normativity and the human capacity for mastering moral normativity. The morals of the frame problem bode well, we argue, for the claim that moral normativity is not fully systematizable by exceptionless general principles, and for the correlative claim that such systematizability is not required in order for humans to master moral normativity.

Is there a genuine tension between cosmopolitan egalitarianism and special responsibilities?

Samuel Scheffler has recently argued that some relationships are non-instrumentally valuable; that such relationships give rise to “underived” special responsibilities; that there is a genuine tension between cosmopolitan egalitarianism and special responsibilities; and that we must consequently strike a balance between the two. We argue that there is no such tension and propose an alternative approach to the relation between cosmopolitan egalitarianism and special responsibilities. First, while some relationships are non-instrumentally valuable, no relationship is unconditionally valuable. Second, whether such relationships give rise to special responsibilities is conditional on those relationships not violating certain moral constraints. Third, these moral constraints arise from within cosmopolitan egalitarianism itself. Thus the value of relationships and the special responsibilities to which they give rise arise within the parameters of cosmopolitan egalitarianism itself. The real tension is not between cosmopolitan equality and special responsibilities, but between special responsibilities and the various general duties that arise from the recognition, demanded by cosmopolitan egalitarianism, of a multiplicity of other basic goods. Indeed, even the recognition of special relationships itself gives rise to general duties that may condition and/or weigh against putative special responsibilities.

Individual Moral Development and Moral Progress

At first glance, one of the most obvious places to look for moral progress is in individuals, in particular in moral development from childhood to adulthood. In fact, that moral progress is possible is a foundational assumption of moral education. Beyond the general agreement that moral progress is not only possible but even a common feature of human development things become blurry, however. For what do we mean by ‘progress’? And what constitutes moral progress? Does the idea of individual moral progress presuppose a predetermined end or goal of moral education and development, or not? In this article we analyze the concept of moral progress to shed light on the psychology of moral development and vice versa; these analyses are found to be mutually supportive. We suggest that: moral progress should be conceived of as development that is evaluated positively on the basis of relatively stable moral criteria that are the fruit and the subject of an ongoing conversation; moral progress does not imply the idea of an end-state; individual moral progress is best conceived of as the development of various components of moral functioning and their robust integration in a person’s identity; both children and adults can progress morally - even though we would probably not speak in terms of progress in the case of children - but adults’ moral progress is both more hard-won and to a greater extent a personal project rather than a collective effort.     

Ethical Dilemmas in the Use of Information Technology: An Aristotelian Perspective

As computer-based information systems start to have a great impact on people, organizations, and society as a whole, there is much debate about information technology in relation to social control and privacy, security and reliability, and ethics and professional responsibilities. However, more often than not, these debates reveal some fundamental disagreements, sometimes about first principles. In this article the authors suggest that a fruitful and interesting way to conceptualize some of these moral and ethical issues associated with the use of information technology is to apply the principles of Aristotle's ethics to this topic. They argue that framing the moral and ethical choices associated with information technology in Aristotelian terms draws attention to the fact that there are fundamental dilemmas to be addressed. These dilemmas are discussed in relation to the four areas suggested by Dejoie, Fowler, and Paradice (1991): (a) privacy, (b) information accuracy, (c) access to information, and (d) intellectual property rights. The dilemmas associated with all four areas are illustrated with references to recent legal developments in Australia and New Zealand.     

The Debate on the Moral Responsibilities of Online Service Providers

Online service providers (OSPs)—such as AOL, Facebook, Google, Microsoft, and Twitter—significantly shape the informational environment (infosphere) and influence users’ experiences and interactions within it. There is a general agreement on the centrality of OSPs in information societies, but little consensus about what principles should shape their moral responsibilities and practices. In this article, we analyse the main contributions to the debate on the moral responsibilities of OSPs. By endorsing the method of the levels of abstract (LoAs), we first analyse the moral responsibilities of OSPs in the web (LoA_IN). These concern the management of online information, which includes information filtering, Internet censorship, the circulation of harmful content, and the implementation and fostering of human rights (including privacy). We then consider the moral responsibilities ascribed to OSPs on the web (LoA_ON) and focus on the existing legal regulation of access to users’ data. The overall analysis provides an overview of the current state of the debate and highlights two main results. First, topics related to OSPs’ public role—especially their gatekeeping function, their corporate social responsibilities, and their role in implementing and fostering human rights—have acquired increasing relevance in the specialised literature. Second, there is a lack of an ethical framework that can (a) define OSPs’ responsibilities, and (b) provide the fundamental sharable principles necessary to guide OSPs’ conduct within the multicultural and international context in which they operate. This article contributes to the ethical framework necessary to deal with (a) and (b) by endorsing a LoA enabling the definition of the responsibilities of OSPs with respect to the well-being of the infosphere and of the entities inhabiting it (LoA_For).     

医疗事故纠纷的本质及法律责任

医疗事故纠纷及处理的道德本质和司法原则在于对病人权利的维护。强化医务人员对病人生命与健康的医德责任感和病人权利意识,并使之成为自律、自觉的行为是预防和减少医疗事故纠纷发生的第一要素;而提高医务人员的法律意识,完善法律的制约机制,对医疗事故的防范是同样重要的。     

Voices from the Front Lines: An Analysis of Physicians’ Reflective Narratives about Flaws with the ‘System’

Physicians often express frustration with the ‘system’ in which they work. Over time, this frustration may put them at risk of burnout and disengagement, which may impact patient care. In this study, we aimed to understand the nature of the system flaws that physicians identified in their published narratives and to explore their self-representation as agents of change. We reviewed all reflective narratives published in four medical journals (NEJM, JAMA, CMAJ, Annals IM) between January 2015 and December 2017 (n?=?282). By consensus, we identified those that addressed system flaws (n?=?87). Using content and narrative analysis, we analyzed the types of flaws and the physicians’ orientation to the flawed system. We identified seven recurring system flaws—five related to medical culture: failures of communication, erosive impact of the hidden curriculum, inadequate health advocacy, frenzied pace of work, and experience of stigma. Less frequently, physicians’ narratives also exposed limited and disparate healthcare resources and restrictive institutional practices as impeding patient-centered care. Physicians expressed agency to create change foremost when writing about flaws related to medical culture. While physicians are challenged by system flaws, they strive to practice in ways that do not succumb to them. We saw tension between the elements outside the physician’s control and those within it. This tension becomes a source of distress when the compromises that emerge from system flaws move physicians away from the values that define their professional identity.

     

彼彻姆和查瑞斯的原则主义进路及其改进

在全球化、多元化背景下,彼彻姆和查瑞斯通过寻找普世原则来容纳道德多元主义和避免道德相对主义,进而为医学伦理学提供一系列清晰、明确、有效的道德规范的努力无疑是可贵的,但其原则主义存在的突出问题是反思平衡方法在实践中不能有效解决根本性的道德冲突。针对这一不足,我们尝试提出解决道德冲突的更有希望的思路。     

Climate justice after Paris: a normative framework

This paper puts forward a normative framework to differentiate between the climate-related responsibilities of different countries in the aftermath of the Paris Agreement. It offers reasons for applying the chief moral principles of ‘historical responsibility’ and ‘capacity’ to climate finance instead of climate change mitigation targets. This will (i) provide a normative basis to realize the goal of climate change mitigation while allowing for developing and newly industrialized countries to develop economically and (ii) offer an account of the distributive principles that can regulate climate finance. This is a real-world interpretation of the 1992 UNFCCC principle of ‘common but differentiated responsibilities’ that takes into account the progress accomplished at the COP21 in Paris and offers a solution to the still unsolved problem of differentiated responsibilities. This paper offers an application of this proposal to the Green Climate Fund.     

Principle-Based Moral Judgement

It is widely acknowledged that moral principles are not sufficient to guide moral thought and action: they need to be supplemented by a capacity for judgement. However, why can we not rely on this capacity for moral judgement alone? Why do moral principles need to be supplemented, but are not supplanted, by judgement? So-called moral particularists argue that we can, and should, make moral decisions on a case-by-case basis without any principles. According to particularists, the person of moral judgement is a person of empathy, sensibility and virtue, rather than a person of principle. In this paper I argue that this is a false dichotomy. The person of good moral judgement is a person of principle. I propose that we think of moral principles as internalised long-term commitments that form our moral character and sensitivity, and, as such, are constitutive of moral judgement.     

In Defense of Penalizing (but not Punishing) Civil Disobedience

While many contemporary political philosophers agree that citizens of a legitimate state enjoy a moral right to civil disobedience, they differ over both the grounds of that right and its content. This essay defends the view that the moral right to civil disobedience derives from (or is a facet of) a general right to political participation, and the characterization of that right as precluding the state from punishing, but not from penalizing, those who exercise it. The argument proceeds by way of rebuttals to criticisms of both claims recently advanced by Kimberley Brownlee. While in some cases those criticisms fail on their merits, in other cases the responses offered here reveal that the dispute over the ground and content of a moral right to civil disobedience reflects deeper disagreements regarding two foundational issues: first, whether moral rights are best conceived of as defeasible evaluative principles or conclusive normative ones, and second, whether principles of justice should be theorized on the basis of full or partial compliance.     

How Outlandish Can Imaginary Cases Be?

It is common in moral philosophy to test the validity of moral principles by proposing counter‐examples in the form of cases where the application of the principle does not give the conclusion we intuitively find valid. These cases are often imaginary and sometimes rather ‘outlandish’, involving ray guns, non‐existent creatures, etc. I discuss whether we can test moral principles with the help of outlandish cases, or if only realistic cases are admissible. I consider two types of argument against outlandish cases: 1) Since moral principles are meant for guiding action in this world, cases drawn from other worlds are irrelevant. 2) We lack the capacity to apply our intuitive moral competence to outlandish cases. I argue that while the first approach is importantly flawed, the second approach is plausible, not because our moral competence per se is limited to cases from this world, but because we lack the capacity to imagine outlandish cases, and we cannot apply our moral competence to a case we fail to imagine properly.     

Social and moral norm differences among Portuguese 1st and 6th year medical students towards their intention to comply with hand hygiene

This study examines social and moral norms towards the intention to comply with hand hygiene among Portuguese medical students from 1st and 6th years (N = 175; 121 from the 1st year, 54 from the 6th year). The study extended the theory of planned behaviour theoretical principles and hypothesised that both subjective and moral norms will be the best predictors of 1st and 6th year medical students' intention to comply with hand hygiene; however, these predictors ability to explain intention variance will change according to medical students' school year. Results indicated that the subjective norm, whose referent focuses on professors, is a relevant predictor of 1st year medical students' intention, while the subjective norm that emphasises the relevance of colleagues predicts the intentions of medical students from the 6th year. In terms of the moral norm, 6th year students' intention is better predicted by a norm that interferes with compliance; whereas intentions from 1st year students are better predicted by a norm that favours compliance. Implications of the findings highlight the importance of role models and mentors as key factors in teaching hand hygiene in medical undergraduate curricula.     

Counselor-Client Sexual Contact: Implications for Ethics Training

Most programs spend little or no time addressing the prohibition against sexual contact with clients, yet it is the most commonly violated of the ethical principles. This article provides a brief overview of models of ethics training and addresses specific strategies for preventing counselor-client sexual contact. These strategies include knowledge, activities that promote self-awareness, and provision of a climate that enhances the development of moral values and behavior. The responsibilities of training programs are addressed, including the provision of clear statements of the rights and responsibilities of trainees and of a due process and grievance procedure for review of impaired or problematic trainees.