Ethical Issues in Cancer Genetics: 1) Whose Information Is It?

This article presents and discusses four clinical cases that exemplify the complexity of ethical dilemmas concerning the provider's obligation to disclose or withhold genetic information from patients. Case 1: What is the responsibility of the cancer genetics provider to ensure that a positive test results is shared with distant relatives? Case 2: To ensure that results go to at-risk relatives, do we have the right to ignore the wishes of the designated next-of-kin? Case 3: Do we have the right to reveal a familial BRCA1 mutation to a patient's relative, who is at 50% risk? Case 4: Do we have an obligation to reveal that a patient is not a blood relative and therefore, not at risk to have inherited a familial mutation? These cases form the basis for discussing the provider's dual obligations to keeping patient confidentiality and informing patients and families about risk (i.e. duty to warn). We also provide a summary of consensus points and additional discussion questions for each case.     

Care and Justice in Real-Life Moral Reasoning

Moral reasoning of 57 (Time 1) and 59 (Time 2) nursing, social-work and law-enforcement students was investigated in terms of care and justice reasoning about hypothetical and real-life dilemmas. The analysis methods were the Ethic of Care Interview, the Moral Judgment Interview, Lyons' Moral Orientation Scheme and Wark and Krebs' classification of real-life dilemmas. The type of dilemma predicted moral orientation usage. Prosocial dilemmas pulled for care and antisocial dilemmas for justice orientation. Level of justice reasoning varied according to the type of dilemma. Real-life care reasoning was consistent with participants' competence, with the exception of transgression-type dilemmas at Time 2. Levels of care and justice reasoning were highly correlated with each other. These results underscore the importance of the dilemma type and suggest that care reasoning is a significant part of real life morality. The study recommends the ECI as a new model to account for real-life care reasoning.     

Emotional engagement in professional ethics

Recent results from two different studies show evidence of strong emotional engagement in moral dilemmas that require personal involvement or ethical problems that involve significant inter-personal issues. This empirical evidence for a connection between emotional engagement and moral or ethical choices is interesting because it is related to a fundamental survival mechanism rooted in human evolution. The results lead one to question when and how emotional engagement might occur in a professional ethical situation. However, the studies employed static dilemmas or problems that offered only two choices whose outcome was certain or nearly so, whereas actual problems in professional ethics are dynamic and typically involve considerable uncertainty. The circumstances of three example cases suggest that increasing personal involvement and uncertainty could have been perceived as changes, threats, or opportunities and could therefore have elicited an emotional response as a way to ensure the reputation, integrity or success of oneself or a group to which one belongs. Such emotional engagement is only suggested and more studies and experiments are required to better characterize the role of emotional engagement in professional ethics.     

Moral Dilemmas and Offence

In 1963 Roderick Chisholm proposed a category of acts called “offences” to capture what he called acts of “permissive ill-doing.” Chisholm’s proposal has proven to be controversial. Here I propose that some progress can be made in validating acts of offence by focusing upon moral dilemmas. Given the problems which have been alleged to beset moral dilemmas, this may initially seem like a puzzling strategy. However, I will call attention to a type of moral dilemma unlike what is standardly discussed in the literature and attempt to show that those who acknowledge that such dilemmas are possible are likewise obliged to acknowledge that acts of offence are possible. My suggestion, then, is that, since the former are plausible to acknowledge, so are the latter.     

Culture and collective argumentation

What are the mechanisms underlying the reproduction and change of collective beliefs? The paper suggests that a productive and promising approach for dealing with this question can be found in ontogenetic and cross-cultural studies on ‘collective argumentations and belief systems’; this is illustrated with regard to moral beliefs: After a short discussion of the rationality/relativity issue in cultural anthropology some basic elements of a conceptual framework for the empirical study of collective argumentations are outlined. A few empirical case studies are summarized; the results deliver some empirical evidence to the assumption that as the ‘logic of collective argumentations’ develops in children and adolescent there will be different and increasingly more complex constraints on the kinds of basic moral beliefs that can be collectively accepted. Most importantly, as children approach adolescence they may have acquired a ‘logic of argumentation’ which makes possible a collectively valid distinction between the ‘is’ and the ‘ought’ of some disputed particular moral issue. A comparison with a land litigation among Trobriands (Papua New Guinea) shows that the ‘logic of argumentation’ and the corresponding basic moral beliefs of Trobriands very much resemble the ‘logic of argumentation’ and moral rationality standards of (German) adolescents.     

Paradigms and Personhood: A Deepening of the Dilemmas in Ethics and Medical Ethics

There are many calls for a definitions personhood, but also many logical and Wittgensteinian reasons to think fulfilling this is unimportant or impossible. I argue that we can consider many contexts as language-games and consider the person as the key player in each. We can then examine the attributes, presuppositions and implications of personhood in those contexts. I use law and therapeutic psychology as two examples of such contexts or language-games. Each correlates with one of the classic “theories” of ethics-deontology and consequentialism. But each is a large enough cluster to consider them as paradigms in a sense related to Thomas Kuhn's notion in The Structure of Scientific Revolutions. Showing the presuppositions about and “takes” on personhood together with the connections involved in the paradigms deepens the dilemmas we already know to be present. This revised version was published online in August 2006 with corrections to the Cover Date.     

A Study of the Ethical Dilemmas Experienced by School Psychologists in Portugal

This study examines the ethical dilemmas and difficulties encountered by Portuguese school psychologists. As part of a larger survey, participants were asked about ethical issues faced in daily practice and asked to describe ethical incidents. Of the 477 respondents, 274 reported 441 ethically troubling or challenging situations. Responses were coded into a six-category system based on the code of ethics of Portuguese psychologists. Most of the reported dilemmas concerned privacy and confidentiality principles (53%). Results are discussed in light of relevant literature and international findings. Implications for the development of the profession and future research are provided.     

孟子“万物皆备于我”章臆解

孟子“万物皆备于我”章从已有的和可能的解释看 ,大致包含三重意蕴 :在知识论层面 ,孟子的命题并未建构一种主—客之间对象性关系框架和主体性姿态 ,而是超越了认识论意义上的主—客体关系 ,超越了唯物论和唯心论及其对立意义上的心物关系 ;在道德哲学层面 ,它从性善论和道德的自足性角度给出了道德的内在理由 ,并从境界和功夫两个方面说明了“万物皆备于我”的伦理学意义 ;在形而上学层面 ,它彰显了人的存在论基础 ,“万物之理皆备于我”和“万物皆备于吾心”从不同侧面阐释并发挥了孟子的命题 ,从而凸显了“万物皆备于我”的形而上学意蕴。     

Two Egocentric Sources of the Decision to Vote: The Voter's Illusion and the Belief in Personal Relevance

The decision to vote in a national election requires a choice between serving a social good and satisfying one's self-interest. Viewed as a cooperative response in a social dilemma, casting a vote seems irrational because it cannot have a discernible effect on the electoral outcome. The findings of two studies with undergraduate samples suggest that some people vote not because they set aside self-interest, but because they expect their own behaviors to matter. Two psychological processes contribute to this belief: the voter's illusion (the projection of one's own choice between voting and abstention to supporters of the same party or candidate), and the belief in personal relevance (the belief that one's own vote matters regardless of its predictive value for the behavior of others). The rationality of these two egocentric mechanisms depends on the normative framework invoked. Their relevance for actual voting behavior is indicated by their ability to account for four types of variation in turnout rates.