Pluralism in Multicultural Liberal Democracy and the Justification of Female Circumcision

This article discusses the problems that a liberal, multicultural democracy has in dealing with cultural practices, such as female circumcision, which themselves suppress the liberal values of autonomy and pluralism. In this context I have chosen the justification of female circumcision as my issue for three reasons. First, with increasing immigration, in Western multicultural and pluralistic societies this practice has recently been given a good deal of public attention; second, I believe that it is time to put this cruel and discriminatory tradition finally in the past; and third, the paradox that the victims of this practice are also often its strongest proponents well demonstrates the problems that liberal democracies have in dealing with the question of autonomy and tolerance in real-life situations. My main argument is that, without giving up tolerance, we can show that there can be no moral justification for such a tradition as female circumcision, even within a multicultural and pluralist society.
I shall first show why neither female circumcision nor any other tradition that oppresses and harms individuals and is maintained by coercion can be satisfactorily defended by liberal arguments. Then I shall discuss why 'communitarian'counter-arguments which appeal to the significance of communal values and traditions or to cultural rights also fail to give any plausible support to the maintenance of this tradition. Finally, I shall consider in more detail how the value of autonomy should be normatively understood in a modern pluralist society [1].     

Reweighing the Ethical Tradeoffs in the Involuntary Hospitalization of Suicidal Patients

Suicide is the 10th leading cause of death in the United States and the second cause of death among those ages 15–24 years. The current standard of care for suicidality management often involves an involuntary hospitalization deemed necessary by the attending psychiatrist. The purpose of this article is to reexamine the ethical tradeoffs inherent in the current practice of involuntary psychiatric hospitalization for suicidal patients, calling attention to the often-neglected harms inherent in this practice and proposing a path for future research. With accumulating evidence of the harms inherent in civil commitment, we propose that the relative value of this intervention needs to be reevaluated and more efficacious alternatives researched. Three arguments are presented: (1) that inadequate attention has been given to the harms resulting from the use of coercion and the loss of autonomy, (2) that inadequate evidence exists that involuntary hospitalization is an effective method to reduce deaths by suicide, and (3) that some suicidal patients may benefit more from therapeutic interventions that maximize and support autonomy and personal responsibility. Considering this evidence, we argue for a policy that limits the coercive hospitalization of suicidal individuals to those who lack decision-making capacity.     

Autonomy,constraining options,and organ sales

Although there continues to be a chronic shortage of transplant organs the suggestion that we should try to alleviate it through allowing a current market in them continues to be morally condemned, usually on the grounds that such a market would undermine the autonomy of those who would participate in it as vendors. Against this objection Gerald Dworkin has argued that such markets would enhance the autonomy of the vendors through providing them with more options, thus enabling them to exercise a greater degree of control over their bodies. Paul Hughes and T. L. Zutlevics have recently criticized Dworkin's argument, arguing that the option to sell an organ is unusual in that it is an autonomy–undermining "constraining option" whose presence in a person's choice set is likely to undermine her autonomy rather than enhance it. I argue that although Hughes' and Zutlevics' arguments are both innovative and persuasive they are seriously flawed — and that allowing a market in human organs is more likely to enhance vendor autonomy than diminish it. Thus, given that autonomy is the preeminent value in contemporary medical ethics this provides a strong prima facie case for recognizing the moral legitimacy of such markets.     

新加坡中小学的公民道德教育及借鉴

借鉴新加坡中小学公民道德教育的成功经验,加强我国学校中的道德教育工作,必须提高认识,加强领导;改进德育课的教学方法,灌输和启发相结合;在各科教学中进行德育渗透;构建学校教育、社会教育、家庭教育一体化的德育网络;注重东西方德育经验的综合利用;强化道德实践,完善学校德育教育质量评价标准。     

Coercive Interference and Moral Judgment

Coercion is by its very nature hostile to the individual subjected to it. At the same time, it often is a necessary evil: political life cannot function without at least some instances of coercion. Hence, it is not surprising that coercion has been the topic of heated philosophical debate for many decades. Though numerous accounts have been put forth in the literature, relatively little attention has been paid to the question what exactly being subjected to coercion does to an individual that makes it so hostile to his person. This paper develops an analysis of the subjective aspect of coercion whereby this hostility is explained. It is argued that coercion is not just a matter of interference with one’s agency, but also affects one’s morality. Because coercion is a form of subjugation it does more than merely limit one’s freedom, it constitutes an affront to one’s dignity as well. A new account of coercion is developed that pays particular attention to the subjectivity inherent in coercion. This account takes a middle ground in the ongoing debate between advocates of moralised and non-moralised conceptualisations of coercion. The paper closes by applying this account to two prominent issues in the literature on coercion: the use of coercion claims in attempts to avoid being held responsible for one’s actions, and the coerciveness of the law.     

Placement of responsibility and moral reasoning in couple therapy

Within the past two decades there has been a growing awareness of the importance of moral and ethical judgements in family and couple therapy. In this article we provide a detailed analysis of placements of responsibility related to blame in one couple therapy session. We suggest that it is important to study therapeutic interaction in situ , when searching for an understanding of moral reasoning in couple therapy and an ethical evaluation of the practice. A detailed analysis of discursive tools used by clients and therapists makes it possible to look at moral reasoning in action as it unfolds within the flow of therapeutic conversation. The findings are discussed in relation to two discourses of moral justification: autonomy and relationality. The principle guiding the therapists' actions in the studied conversation could be called 'relational autonomy'.     

网络主体的道德意识培养

为了保证网络社会的健康运行 ,网络道德建设已成为无法回避重要的课题。在网络道德建设中 ,我们必须注重培养网络主体的道德意识 ;在培养网络道德意识的过程中 ,我们既要坚持对网络主体的道德灌输、提高其道德认识能力 ,又要锻炼其道德意志并加强道德修养。     

The many faces of autonomy

What does autonomy mean from a moral point of view? Throughout Western history, autonomy has had no less than four different meanings. The first is political: the capacity of old cities and modern states to give themselves their own laws. The second is metaphysical, and was introduced by Kant in the second half of the 18th century. In this meaning, autonomy is understood as an intrinsic characteristic of all rational beings. Opposed to this is the legal meaning, in which actions are called autonomous when performed with due information and competency and without coercion. This last meaning, the most frequently used in bioethics, is primarily legal instead of moral. Is there a proper moral meaning of the word autonomy? If so, this would be a fourth meaning. Acts can only be called moral when they are postconventional (using the terminology coined by Lawrence Kohlberg), inner-directed (as expressed by David Riesman), and responsible (according to Hannah Arendt). Such acts are autonomous in this new, fourth, and to my mind, the only one proper, moral meaning. The goal of ethics cannot be other than forming human beings capable of making autonomous and responsible decisions, and doing so because they think this is their duty and not because of any other nonmoral motivation, like comfort, convenience, or satisfaction. The goal of ethics is to promote postconventional and mature human beings. This was what Socrates tried to do with the young people of Athens. And it is also the objective of every course of ethics and of any process of training.     

Ethics Consultation and Autonomy

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist.     

SELF‐KNOWLEDGE AND MORAL STUPIDITY

Most commonplace moral failure is not conditioned by evil intentions or the conscious desire to harm or humiliate others. It is more banal and ubiquitous – a form of moral stupidity that gives rise to rationalization, self‐deception, failures of due moral consideration, and the evasion of responsibility. A kind of crude, perception‐distorting self‐absorption, moral stupidity is the cause of many moral missteps; moral development demands the development of self‐knowledge as a way out of moral stupidity. Only once aware of the presence or absence of particular desires and beliefs can an agent have authority over them or exercise responsibility for their absence. But what is the connection between self‐knowledge and moral development? I argue that accounts (such as Kant's and Richard Moran's) which construe instances of self‐knowledge as like the verdicts of a judge cannot explain its potential role in moral development, and claim that it must be conceived of in a way that makes possible a process of self‐refinement and self‐regulation. Making use of Buddhist moral psychology, I argue that when self‐knowledge plays a role in moral development, it includes a quality of attention to one's experience best modeled as the work of the craftsperson, not as judge.     

The promises and perils of pragmatism: commentary on Fins, Bacchetta, and Miller

Fins, Bacchetta, and Miller's clinical pragmatism has several appealing features: an emphasis on dialogue, a commitment to consensus, a focus on particular individuals rather than persons in general, and a strong interest in the process as well as the product of moral decision making. Nevertheless, for all its protests to the contrary, clinical pragmatism has a tendency to privilege medical facts over nonmedical values, to conflate appropriate medical decisions with right moral decisions, and to conceive problems at the bedside in terms of "getting" patients and families to "go along" with the treatment plans of clinicians. In sum, there is within clinical pragmatism the potential for physicians to take back some of the power they ceded to patients during the height of the patients' rights and autonomy movement. Provided that clinicians guard against the temptation to use clinical pragmatism manipulatively, however, the method promises, more than most other methods of moral problem solving, to help increasingly diverse individuals make good moral decisions about patients' care under conditions of enormous uncertainty.     

Sterilization, Catholic health care, and the legitimate autonomy of culture.

Disagreement over the legitimacy of direct sterilization continues within Catholic moral debate, with painful and at times confusing ramifications for Catholic healthcare systems. This paper argues that the medical profession should be construed as a key moral authority in this debate, on two grounds. First, the recent revival of neo-Aristotelianism in moral philosophy as applied to medical ethics has brought out the inherently moral dimensions of the history and current practice of medicine. Second, this recognition can be linked to Catholic morality through Vatican II's affirmation of the legitimate autonomy of culture, including the sciences. A partial precedent for understanding the moral authority of medicine can be found in the recent history of Catholic medical morality, and we further argue that a full contemporary recognition of that authority would weigh against an absolute prohibition of direct sterilizations. Institutionally, we propose the allowance of direct sterilizations in cases where the clinically perceived biomedical good of the patient is at stake.     

The use of health technology and information: e-learning technological approach.

The Internet is becoming the preferred place for finding information. Millions of people go online in search of health and medical information. Likewise, health care professionals must be able to retrieve and manage information in an efficient, effective manner. The development of health technology and informatics (HTI) has been rapid, yet little is known about the knowledge and attitudes of nursing students with regard to using HTI. Therefore, the objective of the present study was to explore nursing students' knowledge of and attitudes toward using HTI and to use an e-learning workshop to enhance the effective use of HTI. In Phase I, 115 first-year full-time nursing students were invited to complete a 13-item questionnaire regarding knowledge of and attitudes toward computer and Internet use, knowledge of HTI, and attitudes toward the future development of HTI. Participants perceived themselves to be knowledgeable in computer and Internet use, while knowledge of HTI was perceived to be low and attitudes toward the future development of HTI were generally positive. Phase II was an e-learning HTI workshop; topics included an introduction to HTI, examples of HTI in use, and the application and implementation of various HTI projects. There were 30 participants in the E-learning workshop, and their feedback was positive. Nurses and all health care professionals must be prepared to participate in the development of health technology and informatics. Teaching and learning activities should be geared toward mastery of HTI in the nursing education curriculum in order to enhance health care quality and safety.     

III—Moral Obligation: Form and Substance

Beginning from an analysis of moral obligation's form that I defend in The Second-Person Standpoint as what we are answerable for as beings with the necessary capacities to enter into relations of mutual accountability, I argue that this analysis has implications for moral obligation's substance . Given what it is to take responsibility for oneself and hold oneself answerable, I argue, it follows that if there are any moral obligations at all, then there must exist a basic pro tanto obligation not to undermine one another's moral autonomy.     

Life is Good

Abstract

The author inquires into the relation between the production of genetic knowledge on the one hand, and human autonomy and self-determination on the other. He does so by specifying the notions of “genetic test” and “human autonomy”; by discussing the epistemic status of genetic knowledge, given its importance for the clarification of its anthropological and ethical implications; and by inquiring into some ethical implications by investigating the conditions under which genetic knowledge of the individual may justifiably be established. This discussion shows that the autonomy-based right to self-determination as far as gene information is concerned, is fundamental. This has major implications, which the author identifies with regard to the difficult problem of the moral legitimacy of the use of genetic knowledge in the context of insurance policies.     

Why we need a theory of suffering, and lots of other theories as well: commentary

In the first section of his article, "The Role of Suffering and Community in Clinical Ethics," Erich Loewy sketches a theory of suffering. His conviction is that clinical medical ethics is not clearly rooted in theory and is inadequately grounded because of this. While acknowledging the merits of virtue ethics and casuistry, Loewy quickly dispenses with them, as contenders for this theoretical basis. Kantianism and utilitarianism are likewise rejected as "a universally acceptable grounding for ethics." In their place, Loewy proposes that "a deeper and more universal grounding can be found in the capacity of sentient beings to suffer." It is on this capacity to suffer that he builds his hierarchies of moral value, including primary, secondary, and symbolic worth. This theory of suffering should be welcomed. It promises to expand our awareness of clinical experience, and moral life generally, away from autonomy, utility, or virtue orientations toward attention to suffering and our response to it. Such a theory can give us a revitalized language to probe the issues of medical ethics. This should lead us to a careful reading of Loewy's larger work on which this article is based. Yet my enthusiasm is tempered by Loewy's noncritical acceptance of a peculiar, yet pervasive, understanding of the role and use of theory in ethics....     

Fathers and fetuses

Harris postulates that in certain instances it would be morally impermissible for a woman to have an abortion because it would be a wrongful harm to the father and a violation of his autonomy. He constructs and analyzes five cases chosen to elucidate the moral issues involved and concludes that, for a man to lay claim to the fetus being his in a sense that the mother is obligated to respect, the fetus must be the result of his having pursued a legitimate interest in procreation in a morally legitimate way. When a man has satisfied the requirements of autonomy both for himself and for his sexual partner in regard to the interest in procreation, the woman has a prima facie obligation to him not to harm the fetus. Therefore, unless there is some contravening moral consideration that overrides this obligation, the abortion of the fetus is morally impermissible.     

Claiming Responsibility for Action Under Duress

This paper argues that to understand the varieties of wrongs done in coercion, we should examine the dynamic normative relation that the coercer establishes with the coerced. The case rests on a critical examination of coercion by threat, which is proved irreducible to psychological inducement by overwhelming motives, obstruction of agency by impaired consent or deprivation of genuine choice. In contrast to physical coercion, coercion by threat requires the coercee’s participation in deliberation to succeed. For this kind of coercion to be successful, there must be a normative relation established by the coercer and the coercee, in which they recognize each other as rational agents. In such cases, the coercee is wronged in the exercise of her deliberative powers. As a consequence, this form of coercion does not cancel the coercee’s moral responsibility for coerced action. Reclaiming the coercee’s responsibility for action under threat does not diminish the visibility and gravity of the coercer’s wrongdoing. On the contrary, it allows us to capture some features of the coercive relation that otherwise remain unfocused and thus identify the distinctive ways in which the coercee is wronged.