The Caveman's Conscience: Evolution and Moral Realism

An increasingly popular moral argument has it that the story of human evolution shows that we can explain the human disposition to make moral judgments without relying on a realm of moral facts. Such facts can thus be dispensed with. But this argument is a threat to moral realism only if there is no realist position that can explain, in the context of human evolution, the relationship between our particular moral sense and a realm of moral facts. I sketch a plausible evolutionary story that illuminates this relationship. First, the sorts of adaptive pressures facing early humans would have produced more than just potent prosocial emotions, as evolutionary antirealists like to claim; it would have produced judgments—often situated within emotions—to the effect that others could reasonably disapprove of some bit of conduct, for an early human who cared deeply about how others might respond to her action enjoyed the benefits of more cooperative exchanges than those early humans who did not. Second, according to objectivist versions of moral constructivism, moral facts just are facts about how others, ideally situated, would respond to one's conduct. Thus if any objectivist moral constructivism story is true, then we can intelligibly assert that a) our capacity for moral judgment is the product of adaptive pressures acting on early humans and b) some moral judgments are objectively true.     

Psychotherapy as Moral Encounter: A Crisis of Modern Conscience

Psychotherapy can no longer be understood as a morally neutral or value-free practice. Many have argued that psychology is implicitly and inevitably laden with moral assumptions and has a significant impact on the moral and ethical fabric of its clients and surrounding society (Browning 1987; Doherty 1995; Dueck and Reimer 2003; Kelly and Strupp 1992; Rieff 1987, 2006). In this work, the authors highlight the profound identity crises within the field of psychology around the place of morality/ethics in its theories and practices. Chronicling some of the shifts between modern and postmodern theory will allow for a meaningful engagement with this issue. The postmodern shifts in the field have left clinicians ideologically hampered in their ability to attend to the moral dimensions of their clients’ lives. In conclusion, the authors posit a virtue ethics and consider avenues of holistically and meaningfully infusing clinical practice with moral sensibilities.     

Confidentiality in Professional Medical Ethics

Detection of deception and confirmation of truth telling with conventional polygraphy raised a host of technical and ethical issues. Recently, newer methods of recording electromagnetic signals from the brain show promise in permitting the detection of deception or truth telling. Some are even being promoted as more accurate than conventional polygraphy. While the new technologies raise issues of personal privacy, acceptable forensic application, and other social issues, the focus of this paper is the technical limitations of the developing technology. Those limitations include the measurement validity of the new technologies, which remains largely unknown. Another set of questions pertains to the psychological paradigms used to model or constrain the target behavior. Finally, there is little standardization in the field, and the vulnerability of the techniques to countermeasures is unknown. Premature application of these technologies outside of research settings should be resisted, and the social conversation about the appropriate parameters of its civil, forensic, and security use should begin.     

Breaching Confidentiality to Protect the Public: Evolving Standards of Medical Confidentiality for Military Detainees

Confidentiality is a core value in medicine and public health yet, like other core values, it is not absolute. Medical ethics has typically allowed for breaches of confidentiality when there is a credible threat of significant harm to an identifiable third party. Medical ethics has been less explicit in spelling out criteria for allowing breaches of confidentiality to protect populations, instead tending to defer these decisions to the law. But recently, issues in military detention settings have raised the profile of decisions to breach medical confidentiality in efforts to protect the broader population. National and international ethics documents say little about the confidentiality of detainee medical records. But initial decisions to use detainee medical records to help craft coercive interrogations led to widespread condemnation, and might have contributed to detainee health problems, such as a large number of suicide attempts several of which have been successful. More recent military guidance seems to reflect lessons learned from these problems and does more to protect detainee records. For the public health system, this experience is a reminder of the importance of confidentiality in creating trustworthy, and effective, means to protect the public's health.     

Social Constraints on Disclosure and Adjustment to Cancer

This article introduces the concept of social constraints on disclosure, puts it in a theoretical framework, and examines how it can affect adjustment to major life stressors using the exemplar of cancer. Cancer is a leading cause of death and disability worldwide. It is often life threatening, disfiguring, and unpredictable; hence, it can undermine people's basic and often positive beliefs and expectations about themselves, their future, and social relationships. For many people with cancer, it is important to come to terms psychologically with the illness – to make sense of or somehow accept the reality of it. People often do this by thinking about different aspects of the disease and its implications for their life, but also through socially processing, or talking about, their cancer-related thoughts, feelings, and concerns with others. When people experience social constraints on their disclosure of cancer-related thoughts and feelings, it can adversely affect how they think and talk about their illness, their coping behaviors, and psychological adjustment. In addition to discussing mechanisms and consequences of social constraints on disclosure, we discuss some of its determinants and future research directions.     

The Risks of Absolute Medical Confidentiality

Some ethicists argue that patient confidentiality is absolute and thus should never be broken. I examine these arguments that when critically scrutinised, become porous. I will explore the concept of patient confidentiality and argue that although, this is a very important medical and bioethical issue, this needs to be wisely delivered to reduce third party harm or even detriment to the patient. The argument for absolute confidentiality is particularly weak when it comes to genetic information and inherited disease.     

Well-Being and Moral Constraints: A Modified Subjectivist Account

Philosophia - In this paper, I argue that a modified version of well-being subjectivism can avoid the standard, yet unintuitive, conclusion that morally horrible acts may contribute to an...     

A Defense of Unqualified Medical Confidentiality

It is broadly held that confidentiality may be breached when doing so can avert grave harm to a third party. This essay challenges the conventional wisdom. Neither legal duties, personal morality nor personal values are sufficient to ground professional obligations. A methodology is developed drawing on core professional values, the nature of professions, and the justification for distinct professional obligations. Though doctors have a professional obligation to prevent public peril, they do not honor it by breaching confidentiality. It is shown how the protective purpose to be furthered by reporting is defeated by the practice of reporting. Hence there is no conflict between confidentiality and the professional responsibility to protect endangered third parties.     

Christianity in Singapore: The Voice of Moral Conscience to the State

Christianity has historically been influential in shaping morality, a project which still continues. While substantial literature has addressed the question how conservative Christians in America attempt to maintain moral control, there is little research on the way in which Christianity influences morality in other societies. This study examines the case of Singapore where conservative Christianity dominates the Christian landscape. The first part of this article discusses Christian groups which have become intricately involved in the production and policing of morality in Singapore and the state patronage which this attempt enjoys. This is based on evidence of state support for various Christian based initiatives which focus on the family and sexuality. Also, the recent sites of discord are considered which result from the state's increased tolerance of homosexuality and gambling. Interview data, public speeches, and writings of local church leaders are used to show that the Christian church wants to be the state's voice of conscience. However, while opposing moral degradation, the ‘well disciplined’ Singaporean Christian leaders have carefully negotiated their strategies and tried to avoid being labelled by the state as undesirable voices of conscience.     

当前医患纠纷解决模式的法律与道德评价

我国医患纠纷的最终解决是通过传统的民事诉讼途径,然而,这种模式并不符合医疗案件本身的特点。从法律和道德的角度而言,我们必须对医疗诉讼的制度设计重新进行反思,并在此基础上进行变革。     

当前医患纠纷解决模式的法律与道德评价

我国医患纠纷的最终解决是通过传统的民事诉讼途径,然而,这种模式并不符合医疗案件本身的特点.从法律和道德的角度而言,我们必须对医疗诉讼的制度设计重新进行反思,并在此基础上进行变革.     

Primordial Moral Awareness: Levinas,Conscience, and the Unavoidable Call to Responsibility

The phenomenon of conscience as articulated in Roman Catholic moral theology has at least three dimensions: a fundamental and universal call to moral goodness; the search for moral truth; and a commitment to act in a particular way. Recent moral theology has tended to focus on the latter two dimensions, but there has been a strong call from Thomas Ryan for attention to the first dimension of conscience, especially its constitution in ‘horizontal relationality’. In this article I respond to Ryan's call, and demonstrate that the philosophy of Emmanuel Levinas can show how the experience of conscience is constituted in horizontal relationality, as well as that it supports an understanding of conscience as a universal call to responsibility. Correlatively, and perhaps more significantly, the introduction of Levinas’ philosophy into the discussion of conscience sheds light on a significant aspect of this call to moral responsibility. This highlights that the Roman Catholic understanding of conscience has ethical consequences for theology more broadly considered (as well as the other academic disciplines) in terms of understanding why it is impossible to set aside considerations of responsibility in the search for truth.     

法律正义与道德正义

进入文明时代以来,社会正义一直是人们追求的基本价值目标.社会正义实质上是对人类社会关系(包括个人之间、群体及组织之间、个人与群体及组织之间的相互关系)的公平性、正当性的确认和捍卫,社会正义通常采取法律形式和道德形式来表达.法律正义是以国家意志的形式来表达的社会关系的规定性,它通过制度规范方式来确认和捍卫公民的合法权益和守法义务.道德正义是以德性和良心的形式来表现的社会关系的规定性,它通过伦理规范的方式来确认和维护公民的伦理权利和道德义务.法律正义是道德正义的基础和保障,因而也是社会正义的底线和起点;道德正义是法律正义的前提和灵魂,因而也是社会正义的理想和目标.构建法律正义与道德正义的良性互动关系.是实现社会正义的有效保证.     

医学专业精神及医疗保密：美国历史及现状中的冲突

讨论卫生部门宣传和加强强制汇报的法律的努力、强制性汇报的规定与医学专业精神及个人自主性之间的冲突、私人医生避免遵守这些规则的策略、病人和倡议者设法避免强制性登记和检测的策略,以及医生/病人和公共卫生官员达成的妥协。最后对公共卫生政策提出建议,认识到强制性汇报存在的问题和卫生政策透明度的重要性。