The impact of Roman Catholic moral theology on end-of-life care under the Texas Advance Directives Act.

This essay reviews the Roman Catholic moral tradition surrounding treatments at the end of life together with the challenges presented to that tradition by the Texas Advance Directives Act. The impact on Catholic health care facilities and physicians, and the way in which the moral tradition should be applied under this statute, particularly with reference to the provision dealing with conflicts over end-of-life treatments, will be critically assessed. I will argue, based on the traditional treatment of end-of-life issues, that Catholic physicians and institutions should appeal to the conflict resolution process of the Advance Directives Act only under a limited number of circumstances. The implications, under the Texas statute, of varied interpretations of Pope John Paul II's recent allocution on artificial feeding and hydration in the persistent vegetative state will also be considered.     

生前预嘱、预立医疗指示和预立医疗照护计划的概念关系辨析

通过回顾文献对生前预嘱、预立医疗指示、预立医疗照护计划三个概念产生的背景、定义、内容组成和法律实践等问题进行梳理与澄清,进一步指出概念之间的关系。生前预嘱与预立医疗指示属于归属关系。预立医疗照护计划是继预立医疗指示产生和应用后,为促进其签署而提出的概念,二者在内容、实施的侧重点及实施效果方面存在差异。通过概念辨析,旨在减少医务人员和公众对以上概念的混淆和误解,为后续研究和临床实践开展提供借鉴。     

根系生命:医疗卫生体制道德根基探微——《医疗卫生体制改革进程与前景的生命道德思考》一书评介

2009年初启动的深化医疗卫生体制改革也即“新医改”,既是改革开放前30年改革的继续,也是全新改革进程的开始。10年来医改成就惠及人民并得到广泛肯定,体现了改革在经济制度上科学性与伦理性的统一。站在生命道德哲学立场上反观改革的进程,可以为改革方向和道路的合理性提供道德哲学的辩护。医疗卫生体制及其改革是经济学、公共管理学、政策科学等社会科学的研究领域,也是涵括诸多哲学课题的认识和实践领域,生命道德哲学提供的是价值理性的思考。     

Moral Philosophers as Ethical Engineers: Limits of Moral Philosophy and a Pragmatist Alternative

Ever since Kant, moral philosophers have been more or less animated by the mission of discovering inescapable law‐like rules that would provide a binding justification for morality. Recently, however, many have started to question (a) whether this is possible and (b) what, after all, this project could achieve. An alternative vision of the task of moral philosophy starts from the pragmatist idea that philosophizing begins and ends in human experiencing. It leads to a view where morality is seen as a “social technology” that aims to make living together possible, and strengthens people's capability to live a good life within a society. The role of moral philosophy is, accordingly, to develop our moral tools further. Moral philosophers become ethical engineers who use their expertise in ethical topics to criticize existing “moral technology” and construct new concepts, tools, and theories that better answer the current challenges for living a good life.     

The Ethics of Organ Donor Registration Policies: Nudges and Respect for Autonomy

Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of nudges in this context is morally problematic. It is disrespectful of people's autonomy to take advantage of their cognitive biases since doing so involves bypassing, not engaging, their rational capacities. We conclude that while mandated active choice policies are not problem free—they are coercive, after all—voluntary active choice, opt-in, and opt-out policies are potentially less respectful of people's autonomy since their use of nudges could significantly affect people's decision making.     

论道德生活史研究的独特视阈及原则要求

道德生活史是一个国家和民族道德生活的历史叙述和再现,是以不同时期的道德生活为研究对象并力图揭示其发生发展线索的集描述性伦理学与规范性伦理学为一体的学科。道德生活史的研究因道德生活的本质特点决定了它有自己独特的研究视阈和原则要求。道德生活史的研究既是一种实证性的描述研究,同时又是一种规范性的价值研究,必须超越自然主义和超验主义的研究立场,而将自然主义与超验主义作一有机的整合,必须既联系伦理思想来进行研究但是又不能局限于伦理思想的研究,必须坚持事实与价值相统一、一元与多元相统一以及内容与形式相统一的研究原则。     

Tragic Dilemmas and the Priority of the Moral

My purpose in this paper is to argue that we are not vulnerableto inescapable wrongdoing occasioned by tragic dilemmas. I directmy argument to those who are most inclined to accept tragicdilemmas: those of broadly Nietzschean inclination who reject``modern moral philosophy' in favor of the ethical ideas of theclassical Greeks. Two important features of their project are todeny the usefulness of the ``moral/nonmoral distinction,' and todeny that what are usually classified as moral reasons always oreven characteristically ``trump' nonmoral reasons in anadmirable agent's deliberations.I show critics of modern moral philosophy such as BernardWilliams that their acceptance of tragic dilemmas underminestheir project of denying the moral/nonmoral distinction and thepriority of moral reasons. The possibility of tragic dilemmasrequires an account of practical deliberation in which moralreasons appear as already in-force obligations, with blame andguilt ready to be invoked, while nonmoral reasons appear as merereasons. This makes moral reasons importantly different fromnonmoral reasons in how they achieve their deliberative weight,and also makes them characteristically weightier. Thus,accommodating tragic dilemmas reinforces the moral/nonmoraldistinction and the priority of moral reasons, the very thingsthese critics want to deny. By accepting the possibility oftragic dilemmas, these critics are undermining their own project.The standard normative theories are dead set against tragicdilemmas, and the critics of modern moral philosophy shouldreject tragic dilemmas for the good of their project. Thus we allshould reject tragic dilemmas.     

Religious Ethics, History, and the Rise of Modern Moral Philosophy: Focus Introduction

In this introduction to a cluster of three articles on eighteenth-century ethics written by Mark Larrimore, John Bowlin, and Mark Cladis, the author maintains that although the broad narrative tracing the emergence of a religiously neutral or naturalistic moral language in the eighteenth century is a familiar one, many central questions concerning this development remain unanswered and require further historical study. Against those who contend that historical study is antecedent to, but not part of, the proper substance of religious ethics, the author argues that historical and normative studies are interdependent, each helping to define the questions central to the other. The introduction concludes with an overview of the three articles and suggests ways in which religious ethicists can, in the future, make a distinctive contribution to the history of ethics.     

论西方主流伦理理论的前提错误——兼论道德无力症与冷漠症对医疗的影响

从“畏死的恐惧”出发重塑扎根生命的道德基础,即道德行为和“生-生”式的道德关系是人的本真需要,道德权威性的根据是人类生命共同体这一“内在永恒大我”和人的本真存在方式的需要。这拯救了道德相对主义,也使个体作为潜在的人类生命共同体而能以“与永恒相关的生命意义”推开恐惧。进而,道德行为是出于内在自由而达于实在的自由的。道德主体应具备的道德实践能力包括独立能力、通达能力和勇气。生存性境况中的原子式个体不具备道德实践能力,生命境况中的“超个体的个体”才有此能力。由此,人类道德无力症和道德冷漠症的根源是西方主流伦理理论的前提错误,即以原子式个体充任道德主体。它是医疗纠纷和暴力频发的原因。     

Withdrawing Versus Withholding Freedoms: Nudging and the Case of Tobacco Control

Is it a stronger interference with people's freedom to withdraw options they currently have than to withhold similar options they do not have? Drawing on recent theorizing about sociopolitical freedom, this article identifies considerations that often make this the case for public policy. However, when applied to tobacco control, these considerations are shown to give us at best only very weak freedom-based reason to prioritize the status quo. This supports a popular argument for so-called “endgame” tobacco control measures: If we believe that cigarettes would and should be withheld from entering markets in hypothetical scenarios in which they do not yet exist, then we also have reason to seek their abolition in situations, such as ours, in which cigarettes do exist—if necessary by banning their sale. The same considerations are then used to disarm objections that have recently been raised to using nudges in public policy.     

Moral Compromises, Moral Integrity and the Indeterminacy of Value Rankings

Though the art of compromise, i.e. of settling differences by mutual concessions, is part of communal living on any level, we often think that there is something wrong in compromise, especially in cases where moral convictions are involved. A first reason for distrusting compromises on moral matters refers to the idea of integrity, understood in the basic sense of 'standing for something', especially standing for the values and causes that to some extent confer identity. The second reason points out the objective nature of moral values, which seems to make them immune from negotiation and barter. If one sincerely holds some moral conviction to be true, than compromising on that belief must be a sign of serious confusion.In order to reach a better understanding of these two reasons, I analyse what is involved in personal integrity and how this relates to moral integrity. I argue that the search for moral integrity naturally brings us to the question of how one could accept moral compromises and still uphold the idea that moral values and principles have an objective authority over us. To address this question I will present a version of moral pluralism which tries to capture the enormous complexity of what should matter to us as moral persons, and which explains why value-rankings are often deeply indeterminate. The general position I defend in this paper is that compromises involving moral values and norms may be morally required and, therefore, be laudable. To sustain this position I will arrive at a view of ethical objectivity that allows the possibility to negotiate about the truth of moral beliefs.     

Moral internalism,amoralist skepticism and the factivity effect

Philosophers are divided over moral internalism, the claim that moral judgement entails some motivation to comply with that judgement. Against moral internalism, externalists defend the conceptual coherence of scenarios in which an individual makes genuine moral judgements but is entirely unmoved by them. This is amoralist skepticism and these scenarios can be called amoralist scenarios. While the coherence of amoralist scenarios is disputed, philosophers seem to agree that the coherence of amoralist scenarios is not affected by whether the amoralist is described as having moral knowledge or mere belief. But recent experimental research challenges this assumption. When evaluating amoralist scenarios, people’s intuitions lean towards externalism when the amoralist is described as knowing that X is morally wrong, whereas people’s intuitions lean towards internalism when the amoralist is described as believing that X is morally wrong. Call this the factivity effect. In this paper, I argue that the factivity effect is unlikely to be explained as an experimental artifact and that as a consequence, the traditional dispute over moral internalism and amoralist skepticism may need a major overhaul. The results of three studies testing the factivity effect provide support for this thesis. Implications of these results for the traditional debate over moral internalism are discussed.     

Kant, Nonaccidentalness and the Availability of Moral Worth

Contemporary Kantians who defend Kant's view of the superiority of the sense of duty as a form of motivation appeal to various ideas. Some say, if only implicitly, that the sense of duty is always ``available' to an agent, when she has a moral obligation. Some, like Barbara Herman, say that the sense of duty provides a ``nonaccidental' connection between an agent's motivation and the act's rightness. In this paper I show that the ``availability' and ``nonaccidentalness' arguments are in tension with one another. And the ``availability' idea, although certainly supported by some passages in Kant himself, is also clearly denied in other passages. My conclusion is that Kantians will need to abandon either availability or nonaccidentalness if they wish to have a consistent set of views about the sense of duty.     

论天人合德与道德价值的定位

中国传统伦理道德的天人合德为伦理道德价值提供了本体上的根据,这是道德价值的根本定位。其把道德价值定位于整体利益,就是定位于超越的绝对本位。这与现代伦理道德价值定位于人类个体利益一样,都存在理论和实践上的失误。伦理道德的逻辑发展,必将从此引申出集体利益与个体利益和谐一致的集体主义原则。     

关于耳蜗传出神经系统功能研究的启示

对卫生管理中具有战略地位的卫生政策的理论与实践领域的背景和文献进行分析,认为卫生政策基本理论与方法论研究、卫生政策分析方法及技术研究、卫生决策科学化研究、卫生决策体制与过程的研究,社会公众参与卫生决策的研究等,是当前我国卫生政策的理论与实践中值得研究的主要问题。     

康德道德研究中道德规律与道德史的内在矛盾

康德从抽象的个人建立道德规律,与他所谓的人类的道德史相矛盾。解决的办法:是团体、社会性与集体思想作为个人先在的规定性与责任与道德的源泉。     

认知评价与心理控制感在中年人对社会政策变化感受与心理健康之间的作用

采用自编问卷以714名城镇中年人为被试,考察了认知评价与心理控制感在中年人对社会政策变化感受与心理健康之间的作用。结果发现:(1)总体上,社会政策变化对中年人造成的心理感受以及对心理健康的影响都是积极的。(2)认知评价、心理控制感在中年人对社会政策变化感受与心理健康之间起中介作用。