Ethical Paradigm Research Articles

Ethical dilemmas in health

It is difficult to speak of ethic dilemmas in a society that has relativism as the oficial philosophical and political doctrine, i.e., stable values and behavior references, are denied, both in health care and in any other area of human knowledge. In the field of medical sciences it is even pretended to pass from the observational methodology to a field of manipulation and manipulability. It is the very Ethic that is presented as a dilemma. In these conditions one needs to know the lines of thought that are defended, to replace and make disappear the stable ethic references: ecletism, historicism, scientificism, pragmatism, and nihilism itself, that lead to the 'new ethic paradigm', that has created by itself a pseudo-spirituality. The truth is we are adrift in the 'Ethic of Convenience' which changes according to the majorities. In this setting the way to go is to rediscover the abandoned ethic values: only with an objective ethic, with sound references and foundations, it is possible to re-establish and perfect the patient-physician relationship, for a better social health. And this begins with the ethic problem of human life.

Virtue Ethics and the Problem of Moral Disagreement

According to many critics of virtue ethics the dominant virtue ethical paradigm of practical reasoning and right action both encourages a dismissive attitude to moral disagreement and offers a bad model for dealing with it. The charge of dismissiveness raises two issues. First, what is it to take moral disagreement seriously? Second, can virtue ethics respond to the charge?

Infinitely Demanding: Ethics of Commitment, Politics of Resistance (review)

Reviewed by: Infinitely Demanding: Ethics of Commitment, Politics of Resistance Sam B. Girgus Infinitely Demanding: Ethics of Commitment, Politics of Resistance. Simon Critchley. London and New York: Verso 2007. Pp. 168. $26.95 (cloth); $16.95 (paper). Simon Critchley begins his argument for a new paradigm for ethics and politics with a description of the “disappointment” (2) that he believes now grips our individual and collective lives. He says a “moral deficit” and a “motivational deficit” make meaningful political life and action impossible (7, 8). He calls this crisis of belief and action a bad case of Nietzschean nihilism. To begin changing this situation, Critchley insists that the ethical experience remains the best means for achieving selfhood and subjectivity. Even after decades of political failure, he argues that ethics and politics each constitute the condition of possibility for the other. Accordingly, Critchley writes a modern manifesto for ethics and politics. He does not simply offer another abstract argument to supersede theories in analytic philosophy that discuss ethics in terms of duty, character, and virtue or consequences. Instead, he argues that the ethical challenge proves inescapable in human experience and indispensable to meaningful political action. Critchley designs a theory of ethics, subjectivity, and politics to restore the motivation to act politically in a revised context of democratic thought and action. The trajectory of Critchley’s thought covers the great body of the modern philosophical tradition from Kant to contemporary continental writings. He writes with a clarity that makes his work accessible to the general reader while also challenging the ethical imagination and critical thinking of his peers in philosophy. In under 150 pages of text, Infinitely Demanding reverberates with the passion and conviction of earlier works of western thought that sought to change how people think and live in tumultuous times. From the outset, he wishes to replace the Kantian theory of autonomy with a paradigm of intersubjective human relationships that characterizes the work of contemporary thinkers such as Levinas and Lacan, among others. This would counter a “post-Kantian” philosophical tradition which “from left to right, from Marx to Heidegger, is dominated by what we might call the autonomy orthodoxy” (36). Seeking to find an “alternative inheritance” that breaks from this orthodoxy, Critchley focuses on the transcendental “moment” when ethical demand challenges autonomy with absolute responsibility for the other. This radical responsibility for the other takes Critchley from another tradition that for many equates knowledge with being in the work of the three H’s—Hegel, Husserl, and Heideggger. Instead of following in footsteps of this line of thinkers toward an ethical theory that centers on such basic concepts as autonomy, the ultimate power of knowledge, and the primacy of being, Critchley concentrates on “the ethical subject in terms of a split between itself and an exorbitant demand that it can never meet, the demand to be infinitely responsible” (40). In choosing this direction, Critchley links Levinas’s philosophy of radical ethical responsibility to Lacan’s controversial work on trauma. Still relatively unknown outside of philosophical and theoretical circles, Levinas has become crucial in contemporary philosophical discussion. From his first important work that was written during five years as a French soldier in a Nazi stalag for Jewish prisoners of war, Levinas extolled an extreme philosophy of absolute responsibility for others as even more important than individual freedom and being. To balance this Levinasian bent, [End Page 647] Critchley proposes a Lacanian “model of sublimation” that cultivates humor, difference, and distance as a vital mechanism for enabling “the subject” to satisfy Levinas’s “ethical demand” without being crushed by it (85). Critchley argues that Levinas and Lacan, who are so different, come together in maintaining that “there is something about the other person, a dimension of separateness” that remains beyond comprehension (66). For Levinas, this distance or otherness, which he terms “alterity,” requires a response of ultimate moral responsibility. Critchley also believes the human condition requires such responsibility even with its concomitant “trauma and lacerating guilt” (67) but that Lacanian theory helps to turn the trauma of separation into “reparation” (69). For “moderns” in “symbolically” and “ethically impoverished” cultures (70–71), Lacanian psychoanalysis manages trauma by putting “the subject in...

Food Aid and the Famine Relief Argument (Brief Return)

Recent publications by Pogge (Global ethics: seminal essays. St. Paul: Paragon House 2008) and by Singer (The life you can save: acting now to end world poverty. New York: Random House 2009) have resuscitated a debate over the justifiability of famine relief between Singer and ecologist Garrett Hardin in the 1970s. Yet that debate concluded with a general recognition that (a) general considerations of development ethics presented more compelling ethical problems than famine relief; and (b) some form of development would be essential to avoiding the problems of growth noted by Hardin. Better than renewing the debate, we should recognize two points. First, food needs do indeed evoke a moral response that is more direct and compelling than the philosophical positions often generated to rationalize a duty to bring aid. As such the argument for feeding hungry people cannot be generalized into a paradigm for development ethics without distortions that undercut the morally valid elements in Singer’s original argument. Second, contrary to prevailing assumptions in present day development ethics, food aid and famine relief continue to be important priorities for international agencies, notably the World Food Program. Emergency food assistance, the nominal topic of Singer’s original article, thus is an important issue for agricultural as well as development ethics, though one that should indeed be seen as distinct from more complex duties to address the conditions of chronic poverty and underdevelopment.

Palliative care in a multicultural society: a challenge for western ethics

Objective: This paper examines the notion of truth telling and its place in palliative care nursing with a particular focus on nursing people from minority cultures. Setting: The setting is palliative care nursing. Subjects: The subjects are patients receiving palliative nursing care particularly those from minority cultures. Primary argument: Australia is a multicultural society yet its dominant ethical paradigm is firmly placed in the western philosophical tradition. The fundamental concept that western ethics is based on is that of autonomy which implies that the individual is a free agent able to make their own decisions including accepting or rejecting medical treatments. These decisions are based on the individual’s right to be informed about all treatment options. From this position of the autonomous subject other ethical principles have their genesis. Nurses’ ethical behaviour is guided to some extent by ethical principals including beneficence, non‑maleficence and truth telling. The major contention, drawn from literature is that truth telling may be an inadequate ethical principle when working with people from minority cultures. Conclusion: This paper argues that the western ethical concepts of autonomy and truth-telling in the practice domain of palliative care nursing may not be appropriate for different cultural groups and that this may become a source of ethical dilemmas and a challenge for western ethics. The paper concludes with an option for nurses working in multicultural societies that accommodates differing cultural perspectives while not compromising the ethical principle of truth-telling.

Solar Ethics: A New Paradigm for Environmental Ethics and Education?

This article provides grounds for a new paradigm of environmental ethics and education based on the centrality of the sun and solar system – a shift from anthropocentrism to solar systemism. The article provides some grounds for this shift from the physical sciences that considers the planet Earth as part of a wider system that is dependent upon the star at its center. The article reviews the critcisms of anthropocentrism in the literature on environmental ethics and advances a set of cosmological arguments for considering the term ‘environment’ to include ‘beyond Earth’. Solar ethics is a frame that will help to re-position humans within nature and lead to a more sustainable world view.

Women novelists and the ethics of desire, 1684-1814: in the voice of our biblical mothers

In Women Novelists and the Ethics of Desire, 1684-1814, Elizabeth Kraft radically alters our conventional views of early women novelists by taking seriously their representations of female desire. To this end, she reads the fiction of Aphra Behn, Delarivier Manley, Eliza Haywood, Sarah Fielding, Charlotte Smith, Frances Burney, and Elizabeth Inchbald in light of ethical paradigms drawn from biblical texts about women and desire. Like their paradigmatic foremothers, these early women novelists create female characters who demonstrate subjectivity and responsibility for the other even as they grapple with the exigencies imposed on them by circumstance and convention. Kraft's study, informed by ethical theorists such as Emmanuel Levinas and Luce Irigaray, is remarkable in its juxtaposition of narratives from ancient and early modern times. These pairings enable Kraft to demonstrate not only the centrality of female desire in eighteenth-century culture and literature but its ethical importance as well.

Organ Transplantation: Ethical, Legal and Psychosocial Aspects. Towards a Common European Policy

Organ transplantation progresses so rapidly that it provides a paradigm for ethics and problems of justice in the whole field of modern medicine. ‘Organ transplantation: ethical, legal and psychosocial aspects’ illustrates this statement as it shows how the introduction of new techniques and the extension of medical applications beg for new app- roaches. This book presents the proceedings of a European commission-sponsored congress held in Rotterdam in April 2007. The organizers’ intent is not to formulate guidelines dealing with known problems but rather to identify new controversies and dilemmas faced by transplantation and to propose a platform for a further European consensus conference on their ethical, legal and psychosocial aspects. Three state-of-the-art lectures introduce the views of Europe, the United States and the developing countries. Free communications (6–15) are subsequently grouped in six workshops, each of which concludes on recommendations supported sometimes by interesting summaries: the way is thus paved for further discussions and possible guidelines. The first workshop on ‘commercialization and trafficking’ not only reiterates previously accepted recommendations on organ commerce but also digs deeper into the problem of compensation and its rationale in developing countries. The second workshop on ‘legal systems for organ donation and allocation’ raises challenging questions on who owns the body, on the differences between the spheres of living and deceased donation, on the rules of reciprocal donation or, eventually, on the impact of existing systems for renal allocation of deceased donors. The third workshop on ‘altruism, counselling and psychological aspects of living donation’ emphasizes the necessity to clarify, reformulate and unify the psychological approach of donation, to assist patients in the search for living donors and to gather information on the follow-up of living donors, perhaps through a registry of difficult cases. The fourth workshop on ‘minorities, religion and gender’ points to the implicated need for sociologists, religious stakeholders and theologians to assess the impact of ethnicity, social class, gender and religion on organ donation. The fifth workshop on ‘expanded criteria for deceased donors’ highlights the steps to be taken to prevent the use of non-heart beating donors lowering the number of heart beating donors. The distinction between the two types of donors should thus not be overemphasized. The last workshop on the ‘role of patients, media and industry’ concludes on the need to develop European ethical guidelines in new domains such as partial face transplantation, to promote Europe-backed public–private partnerships for the development of new drugs and, finally, to stimulate research on the impact of media on the public opinion on organ donation. Despite its mainly Dutch inspiration, illustrated by the number of experts and contributors, this congress retains an international flavour resting on the participation of 17 countries. Although the novelty of each workshop's approach is unequal, many challenging new ethical and legal issues are clearly identified and will, hopefully, provide a European platform for further progresses. These proceedings will therefore be of interest to all those who have chosen to study in more detail the ethical, legal and psychosocial aspects of (mainly renal) organ transplantation.

Pragmatic Sustainability: Translating Environmental Ethics into Competitive Advantage

In this article, I propose a business paradigm that allows and enables the integration of environmental ethics into business decisions while creating a competitive advantage through the use of an ethical framework based on classical American pragmatism. Environmental ethics could be useful as an alternative paradigm for business ethics by offering new perspectives and methodologies to grant consideration of the natural environment. An approach based on classical American pragmatism provides a superior framework for businesses by focusing on experimentation and innovation, driving a long-term focus, and providing actionable clarity. Under a pragmatic approach to ethics, the choice for sustainability becomes self-evident for business performance and moral reasons.

Ethics in American health 2: an ethical framework for health system reform.

I argue that an ethical vision resting on explicitly articulated values and norms is critical to ensuring comprehensive health reform. Reform requires a consensus on the public good transcending self-interest and narrow agendas and underpinning collective action for universal coverage. In what I call shared health governance, individuals, providers, and institutions all have essential roles in achieving health goals and work together to create a positive environment for health. This ethical paradigm provides (1) reasoned consensus through a joint scientific and deliberative approach to judge the value of a health care intervention; (2) a method for achieving consensus that differs from aggregate tools such as a strict majority vote; (3) combined technical and ethical rationality for collective choice; (4) a joint clinical and economic approach combining efficiency with equity, but with economic solutions following and complementing clinical progress; and (5) protection for disabled individuals from discrimination.

Paradigms in corporate ethics: the legality and values of corporate ethics

PurposeIt has always been claimed that business ethics are ambiguous and thus hard to define. As such, with recognizable unethical corporate behaviors as an epidemic, it is hard to hold perpetrators accountable. Even more detrimental are the miscommunication, the misunderstanding, the misinterpretation, and the misuse of the various paradigms in business ethics. Such flawed values and legality of business ethics paradigms cannot persist. There exist a gap and a bridging in the analysis of the paradigms in business ethics between the practitioners and the ethicists. This paper aims to provide an elaborate analysis of the values, trust, and legality of corporate behaviors in business ethics utilizing various paradigms.Design/methodology/approachThe analysis of this paper focused on the founding values and legality of business ethics and the underlying paradigms that practitioners and ethicists adopt.FindingsThe limitation of this study is that the probability of the diverse schools of thought intertwining is smaller than that their coexisting.Originality/valueIt is this coexistence of schools of thought that makes corporate USA humane, civilized, and balanced. Thus, to maintain this coexistence, if not improve it, this paper maintains that practitioners of higher education and corporate USA must take responsibility in training, educating, and producing future ethical business practitioners.

Clinical research: Protection of the “vulnerable”?

In this age of evidence-based medicine, clinical research is critical for developing new therapeutics and determining the best way to use these therapies. To perform appropriate clinical research, researchers must adhere to ethical standards. These standards have developed in large part as a response to egregious violations of ethically appropriate behavior. In this respect certain populations have been identified as at risk of being treated inappropriately in medical research. Current ethical guidelines prohibit or severely limit what types of research can be performed involving these "vulnerable" populations. Although this might protect these populations, the lack of research on them might actually do harm in limiting their access to life-saving therapies. We explore the historical underpinnings of protecting the vulnerable populations and whether a newer ethical paradigm that would allow for protected research on these populations should be adopted by society.

The Choice of Two Mothers: Disability, Gender, Sexuality, and Prenatal Testing

This article employs an autoethnographic method in describing and analyzing the moral dilemmas faced by two lesbian mothers when they contemplated prenatal, genetic testing options during two pregnancies. It focuses on the inconsistencies in their decision-making processes-that is, that these same parents opt to do amniocentesis for one pregnancy but choose not for another one fewer than 2 years later. The discussion highlights the influence that contextual factors have on the discrepancy in their reasoning and behavior. By critiquing both the mothers' rationales and clinicians' approaches to these procedures, the article seeks to show that the weakness of employing ethical and counseling paradigms and discussions in highly contextual, real-life situations.

Workshop Report

Virtue ethics challenges standard ethical paradigms about what constitutes social work as a morally right and good enterprise, locating the source of all morality in a person's character. It posits that a virtuous (caring, compassionate, just and generous), social worker is one whose authenticity derives from what it is to be a true human being exercising such virtues. What it is to be a true human being is for many connected essentially with spirituality, faith and religion. The idea of characteristic virtue as a human defining feature is to be found in most religions and faiths. Virtue ethics locates this authenticity through a primarily secular philosophical perspective. Both perspectives speak to what it is to be a good social worker but are they reconcilable? Does the secular challenge of virtue ethics to standard social work ethical paradigms also challenge the place of spirituality, faith and religion in social work education? This report presents a conversation between two social workers about these issues, one a committed secular virtue ethicist and one personally committed to the importance of spirituality, faith and religion in social work education. The audience were invited to participate in asking questions as the conversation explored the complexities.

MÉTODO DE INTERPRETACIÓN Y ANÁLISIS HOLÍSTICO EN CASOS BIOÉTICOS

The author of this report offers a phenomenological method together with an hermeneutic comprehension which stems from an anthropological and ethic paradigm...

Abstract of "New Ethical Paradigms for the Twenty-First Century"

Abstract of "New Ethical Paradigms for the Twenty-First Century"

For God's sake: why Sacrifice? Mediating Reflections on Peter Jonkers and John Milbank

Peter Jonkers' paper ‘Justifying Sacrifice’ presents a subtle and nuanced defence of the ethical paradigm of sacrifice as offering up ‘for the sake of’ another item or principle. He employs Hegel and Levinas for this purpose. While Jonkers presents his position as in basic agreement with the position of John Milbank in his paper ‘Midwinter Sacrifice’, I claim that the two positions are, in fact, diametrically opposed. Milbank is proposing a radical critique of the ethical paradigm of sacrifice as the product of, and in collusion with, secular nihilism. Thus there is no justification of sacrifice ‘for the sake of’ for Milbank: certainly not in the forms presented by either Hegel or Levinas. Milbank's motive for such a strident rejection of such theories lies in his overarching theory of the secular as itself an illegitimate alternative theology. I conclude, however, that Jonkers can withstand the challenge of Milbank. Nevertheless, any adequate justification of the model of sacrifice needs to be augmented by an account of both its metaphysical underpinning and its symbolism.

EUDAIMONIA AND AGAPE IN MACINTYRE AND KIERKEGAARD'SWORKS OF LOVE

ABSTRACTThis essay explores connections and divergences between Alasdair MacIntyre's eudaimonistic ethic and Søren Kierkegaard's agapeistic ethic—perhaps the greatest proponents of these ethical paradigms from the past two centuries. The purpose of the work is threefold. First, to demonstrate an impressive amount of convergence and complementarity in their approaches to the transcendent grounds of an ethic of flourishing, the rigors necessary for a proper self‐love, and the other‐directed nature of proper social relations. Second, given the inapplicability of common dichotomies, to pinpoint more precisely where Kierkegaard departs from eudaimonism, and where MacIntyre departs from agapeism. Finally, to show that both Kierkegaard's and MacIntyre's grounds for departure are inadequate, and thus that the most central insights of eudaimonist and agapeist ethics can be harmonized to a greater extent than either Kierkegaard's or MacIntyre's framework can allow.

Articulating a justice ethic for rheumatology: A critical analysis of disparities in rheumatic diseases

ad-dressed the problem of health disparities in the rheumaticdiseases (1). These studies investigated differences intreatment and disease progression, revealing significantdisparities between age, ethnicity, sex, and socioeconomicstatus. Collectively, these articles highlight broader con-cerns regarding access to treatment arising as a conse-quence of our health care system and augment the growingbody of literature pertaining to inequities in health caredelivery. Both the journal editors and the authors shouldbe congratulated on directing our attention to such animportant issue; however, the absence of commentary re-garding the ethical implications that arise from these stud-ies is noteworthy. More than simply a matter of healthpolicy, these reports demonstrate the lack of distributivejustice in our current health care system. Implied in thesearticles is the need for a deeper discussion within the fieldof rheumatology, one that seeks to understand the broaderimplications of these observations. It is not enough tosimply observe these disparities; rather, there is a need tomake explicit how their root cause is based in an ethicalframework of justice and equality.For individuals with chronic disease, the importance ofequitable access to health care becomes all the more ap-parent. Rheumatic diseases often impair mobility, andtherefore, at the most fundamental level, persons who areimmobile are limited more broadly in their ability to par-ticipate in society and specifically in seeking medical care(2). Furthermore, due to the chronic nature of rheumaticdiseases, effective treatment requires a consistent, longitu-dinal interaction with the medical system, a need not wellserved by our current construct of health care with itsfocus on acute conditions. There is the constant manage-ment of symptoms, the often complex medication regi-mens, and the need to balance daily activities with phys-ical limitations. The medical system lacks an efficientintegration and coordination of care to optimally deal withthe continuity required in treating conditions such as therheumatic diseases. To best care for this group of patients,we must understand how disparities interplay throughoutthe course of the disease. Therefore, in this commentarywe will make explicit how ethical issues arise at all pointsalong the rheumatic disease trajectory, first emphasizingvariables contributing to the development of disease, thenfocusing on the variability in receiving a proper diagnosisand accessing treatment, and finally looking at disparitiesin followup care.First, in examining how inequities place people at riskfor the development of rheumatic disease, it is clear thatvarious sociodemographic variables play an importantrole. As is shown by Busija et al (3) in the case of arthritis,lower education and income are strong predictors of ar-thritis in both men and women, controlling for other fac-tors. Subsequently, throughout the progression of rheu-matic disease, biologic constructs such as genetics and sexemerge as potential determinants of disease onset; never-theless, socioeconomic and environmental factors emergeas more important influences over the disease course (4).Thesestudiessuggestthatbroaderinequitiesinoursocietymay have a direct impact on etiology of rheumatic dis-eases.In addition to the impact disparities have on diseaseetiology, barriers to diagnosis also need to be understoodusing an ethical paradigm. Because early diagnosis inrheumatic diseases may be critical in lessening the perma-nent organ system damage and in some conditions disabil-ity and disfigurement, ensuring that all people receiveaccurate and timely diagnoses is of great concern (5). Peo-ple with early rheumatic disease with few disease-specificfeaturesmaynotseekexpertmedicalattentionparticularlywhen there are significant barriers to specialty care.As is seen often in patients arriving at our hospital,patients may spend months, sometimes years, experienc-ing symptoms that go undiagnosed before receiving aproper diagnosis. These patients often have not had accessto a rheumatologist in their neighborhood or community,

Who is a parent? Parenthood in Islamic ethics

Who is a parent? Parenthood in Islamic ethics