Utilitarianism and the Evolution of Ecological Ethics

R.M. Hare’s two-level utilitarianism provides a useful framework for understanding the evolution of codes of professional ethics. From a Harean perspective, the codes reflect both the fact that members of various professions face special kinds of ethically charged situations in the normal course of their work, and the need for people in special roles to acquire various habits of thought and action. This highlights the role of virtue in professional ethics and provides guidance to professional societies when considering modifications to their codes. From a Harean perspective, a professional society should ask both “Are there kinds of situations that members of this profession will normally encounter which members of other professions and/or the general public will not?” and “What habits of thought and action would it be good for individuals encountering such situations to have?”     

HAUERWAS AMONG THE VIRTUES

Despite the fact that Stanley Hauerwas has not taken up many of the topics normally associated with virtue ethics, has explicitly distanced himself from the enterprise known as “virtue ethics,” and throughout his career has preferred other categories of analysis, ranging from character and agency to practices and liturgy, it is nevertheless clear that his work has had a deep and transformative impact on the recovery of virtue within Christian ethics, and that this impact has largely to do with the ways in which his thought resists normalization. This essay traces the evolution of Hauerwas's reflections on virtue and the virtues over the course of his career, with special attention to how this has been bound up with an increasingly emphatic theological particularism that has remained ambivalent between what I term “comprehensive” versus “exclusive” particularism. I argue that it is important to distinguish between these, and suggest that grasping the destructive tendencies of “exclusive” particularism should cement our commitment to shouldering the responsibilities associated with comprehensive particularism.     

Can Lutheran Theology and Virtue Ethics Be Friends?

Lutheran theology is generally suspicious of virtue ethics. This suspicion arises from (1) the Lutheran commitment to justification by faith in God's unconditional promise; and (2) Luther's corollary understanding of sin as existential self‐absorption. Some Lutheran theologians have sought to incorporate virtue ethics by using it as an orientation for Christian life, while making sure to avoid any contamination of the doctrine of justification by virtue ethics. My project is to consider the possibility of a mutual illumination and interaction between the doctrine of justification and virtue ethics’ focus on formation by habituation. As an aid in exploring this possibility I use the distinction in Dietrich Bonhoeffer's Ethics between the “ultimate” and the “penultimate.”     

A Code of Ethics for Health Care Ethics Consultants: Journey to the Present and Implications for the Field

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here.     

Gouvernance et éthique cliniques : deux outils complémentaires pour une meilleure coordination des soins et des traitements

“Governance”, “ethics” and “clinical” three words for a same goal: protect the human health. “Corporate governance” must be associated with the new theory of the firm, for which the theory of asymmetric information provides the foundations. Indeed problems of information represent a fundamental change in the prevailing paradigm within economics; they are central to understanding political economy. “Clinical governance”, promoted by the UK government, constitutes an overarching mechanism designed to improve clinical quality in the National Health Service. To the medical establishment, it is a means to improve the quality of medical practice through clinical guidelines. To make a significant impact on the improvement of healthcare quality, the principles of clinical governance must produce synergy by involving professionals in the modernization of the organization. To obtain excellence in heath care, collective actions and shared decision making were essential. In this context, Clinical ethics consultations could provide a structured approach to decision making that could assist heath professional to resolve conflicts or ethical problems that arise in the care of particular patients.     

The Virtue of Care

There have been many attempts to define care in terms of the virtues, but meta‐analyses of these attempts are conspicuously absent from the literature. No taxonomies have been offered to situate them within the broader care ethical and virtue theoretical discourses, nor have any substantial discussions of each option's merits and shortcomings. I attempt to fill this lacuna by presenting an analysis of the claim that care is a virtue (what I call the “virtue thesis” about care). I begin by distinguishing weaker and stronger versions of the virtue thesis, arguing that the weaker version is an orthodox view among care ethicists. I then go on to develop a taxonomy of approaches available to care ethicists seeking to flesh out the virtue thesis. The three I identify are analogical approaches, according to which care is analogous to some existing virtue; supplementalist approaches, according to which care is a novel virtue; and cardinalist approaches, according to which care is a cardinal virtue. Following this, I defend the virtue thesis from some foreseeable objections and argue that its most promising version is analogical.     

Were the “Pioneer” Clinical Ethics Consultants “Outsiders”? For Them,Was “Critical Distance” That Critical?

“Clinical ethics consultants” have been practicing in the United States for about 50 years. Most of the earliest consultants—the “pioneers”—were “outsiders” when they first appeared at patients' bedsides and in the clinic. However, if they were outsiders initially, they acclimated to the clinical setting and became “insiders” very quickly. Moreover, there was some tension between traditional academics and those doing applied ethics about whether there was sufficient “critical distance” for appropriate reflection about the complex medical ethics dilemmas of the day if one were involved in the decision making. Again, the pioneers deflected concerns by identifying and instituting safeguards to assure professional objectivity in clinical ethics consultation services. One might suggest that in moving inside and establishing normative practices, the pioneer clinical ethics consultants anticipated adoption of their routines and professionalization of the field.     

THE MORAL SIGNIFICANCE OF GRATITUDE IN KANT'S ETHICS

In this essay, we examine the grounds, nature and content, status, acquisition and role, and justification of gratitude in Kant's ethical system, making use of student notes from Kant's lectures on ethics. We are especially interested in questions about the significance of gratitude in Kant's ethics. We examine Kant's claim that gratitude is a sacred duty, because it cannot be discharged, and explain how this claim is consistent with his insistence that “ought” implies “can.” We argue that for Kant a proper understanding of self‐esteem is importantly related to, if not necessary for, possession of the virtue of gratitude.     

Do Confucians Really Care? A Defense of the Distinctiveness of Care Ethics: A Reply to Chenyang Li

Chenyang Li argues, in an article originally published in Hypatia, that the ethics of care and Confucian ethics constitute similar approaches to ethics. The present paper takes issue with this claim. It is more accurate to view Confucian ethics as a kind of virtue ethics, rather than as a kind of care ethics. In the process of criticizing Li's claim, the distinctiveness of care ethics is defended, against attempts to assimilate it to virtue ethics.     

FORGETTING AND THE TASK OF SEEING: Ordinary Oblivion,Plato, and Ethics

The gaps, fissures, and lapses of attention in a life—what I call “ordinary oblivions”—are fertile fragilities that present a compelling source for ethics. Plato, not Aristotle, is the ancient philosopher specially poised to speak to this feature of human life. Drawing upon poet C. K. Williams's idea that forgetting is a “looking away” that makes possible “beginning again,” I present a Platonic approach to ethics as an alternative to Aristotelian or virtue ethics. Plato's Phaedrus is a key source text for this alternate picture; from it I suggest how we might construe Iris Murdoch's “task of seeing” in terms of the engagement with written form. Poetry is a central locale for such engagement, and thus suggests a kind of ethical praxis that arises from the theoretical emphases of my examination of forgetting, the unmoored self, remade other‐regard, and sacred sources.     

Les grands magasins de la médecine de Milton Friedman

The coronavirus pandemic has brought back the question in Western countries of the solidity of their health systems. This article discusses Friedman's 1962 piece of work, “Capitalism and Freedom”, and more specifically his presentation based on American occupational licensure. This research insists beyond the complexity of “de-licensing laws” passed for some U.S. health care facilities, on the consequences of a parasitic competition on health care ethics.     

Why Should a Knower Care?

This paper argues that the concept of care is significant not only for ethics, but for epistemology as well. After elucidating caring as a five‐step dyadic relation, I go on to show its epistemic significance within the general framework of virtue epistemology as developed by Ernest Sosa, Alvin Goldman, and Linda Zagzebski. The notions of “care‐knowing” and “care‐based epistemology” emerge from construing caring (respectively) as a reliabilist and responsibilist virtue.     

Saint Thomas Aquinas's Pagan Virtues?

Today's conversations in virtue ethics are enflamed with questions of “pagan virtues,” which often designate non‐Christian virtue from a Christian perspective. “Pagan virtues,” “pagan vices,” and their historied interpretations are the subject of Jennifer Herdt's book Putting On Virtue: The Legacy of the Splendid Vices (2008). I argue that the questions and language animating Herdt's book are problematic. I offer an alternative strategy to Herdt's for reading Thomas Aquinas's Summa Theologiae. My results are twofold: (1) a different set of conclusions and questions regarding the moral life that lend a fresh perspective to “pagan virtues” and (2) corresponding methodological suggestions for improving Herdt's project that would, to my mind, reaffirm her normative conclusions regarding the most viable ways forward for contemporary discussions of virtue.     

Engagement and suffering in responsible caregiving: On overcoming maleficience in health care

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as ‘clinical phronesis,’ i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of ‘virtue ethics,’ yet one that is informed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their “disengaged” form (reflecting the malaise of “modern medicine”). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the ‘silent world of doctor and patient’ — provides may deny or refuse any ‘given’ connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of ‘calculative reasoning’ only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can ‘save the life of medical ethics’ — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can ‘prevent the death of medical ethics.’     

Empirical Adequacy and Virtue Ethics

Situationists contend that virtue ethics is empirically inadequate. However, it is my contention that there is much confusion over what “empirical adequacy” or “empirical inadequacy” actually means in this context. My aim in this paper is to clarify the meanings of empirical adequacy in order to see to what extent virtue ethics might fail to meet this standard. I argue that the situationists frequently misconstrue the empirical commitments of virtue ethics. More importantly, depending on what we mean by empirical adequacy, either virtue ethics has no need to be empirically adequate or where it does have such a need, the psychological evidence fails to show that it is empirically inadequate. An additional contribution the paper intends to make is to provide a more detailed discussion of the explanatory nature of virtue ethics.     

Research in Emergency and Critical Care Settings: Debates,Obstacles and Solutions

Research is an integral part of evidence-based practice in the emergency department and critical care unit that improves patient management. It is important to understand the need and major obstacles for conducting research in emergency settings. Herein, we review the literature for the obligations, ethics and major implications of emergency research and the associated limiting factors influencing research activities in critical care and emergency settings. We reviewed research engines such as PubMed, MEDLINE, and EMBASE for the last two decades using the key words “emergency department”, “critical care”, “research”, “consent”, and “ethics” as the search terms. Research within emergency settings is slow or non-existent due to time and financial constraints as well as the lack of a research tradition. There are several barriers to conducting research studies in emergency situations such as who, what, when, and how to obtain patient consent. The emergency environment is highly pressurized, emotional, and overburdened. The time taken for research is a particular risk that could delay the desired immediate interventions. Ethical issues abound, particularly relating to informed consent. Research in emergency settings is still in its infancy. Thus, there is a strong need for extensive research in the emergency setting through community awareness, resource management, ethics, collaborations, capacity building, and the development of a research interest for the improvement of patient care and outcomes. We need to establish a well-structured plan to assess and track the decision-making capacity, consider a multistep enrolment and consent strategy, and develop an integrated approach for recruitment into studies.     

COMPARISON AND HISTORY IN THE STUDY OF RELIGIOUS ETHICS: An Essay on Michael Cook's Commanding Right and Forbidding Wrong in Islamic Thought1

Qur'an 3:104 speaks of “commanding right and forbidding wrong” as a constitutive feature of the Muslim community. Michael Cook's careful and comprehensive study provides a wealth of information about the ways Muslims in various contexts have understood this notion. Cook also makes a number of comparative observations, and suggests that “commanding” appears to be a uniquely Muslim practice. Scholars of religious ethics should read Cook's study with great appreciation. They will also have a number of questions about his comparative comments. In this article, I suggest that scholars of comparative ethics should think less about the “uniqueness” of the materials examined by Cook, and more about the ways groups of human beings discipline their members, thereby constituting and maintaining themselves as communities of virtue.     

智者必怀仁？智慧与美德的关系辨析

智慧与美德是独立但相互作用的心理结构。针对其关系,以往哲学家与心理学家基于个人经验和文化观念进行了大量规范性层面的理论思辨,但仍存在理论分歧（线性论、阈值论、从属论）,且缺少以定量方法为主的描述性层面的实证研究,尤其缺乏基于实验的关于“智”与“仁”双向因果关系的探索。未来研究可以借鉴实验伦理学的范式,着眼于研究特定领域、特定情境下智慧与美德之间的双向因果关系,加强中国文化背景下的智慧与美德关系的研究,并探索其潜在的认知神经机制。如何统一智慧与美德关系的“应然”与“实然”的研究,是接下来需要面临的挑战。     

"Broken covenant": healthcare aides' "experience of the ethical" in caring for dying seniors in a personal care home

Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.     

Toward an Horizon in Design Ethics

This paper suggests that design ethics can be enriched by considering ethics beyond the traditional approaches of deontology, teleology, and virtue ethics. Design practice and design ethics literature tend to frame ethics in design according to these approaches. The paper argues that a fundamental and concrete ethical understanding of design ethics can also be found in Sartrean Existentialism, a philosophy centered on the individual and his/her absolute freedom. Through the analysis of four core concepts of Sartrean Existentialism that define a specific ethics, the paper illustrates why such philosophical approach is relevant to design ethics. The paper also shows how Sartrean Existentialism and its ethics apply to critical issues of professional practice in design such as professional engagement and design decision-making. The paper finally argues that Sartre’s philosophy and ethics is a perspective that offers the designer in design practice a solid ground to engage his/her ethical dilemma.