Institutional design and moral conflict in health care priority-setting.

Priority-setting policy-makers often face moral and political pressure to balance the conflicting motivations of efficiency and rescue/non-abandonment. Using the conflict between these motivations as a case study can enrich the understanding of institutional design in developed democracies. This essay presents a cognitive-psychological account of the conflict between efficiency and rescue/non-abandonment in health care priority-setting. It then describes three sets of institutional arrangements-in Australia, England/Wales, and Germany, respectively-that contend with this conflict in interestingly different ways. The analysis yields at least three implications for institutional design in developed democracies: (1) indeterminacy at the level of moral psychology can increase the probability of indeterminacy at the level of institutional design; (2) situational constraints in effect require priority-setting policy-makers to adopt normative-moral pluralism; and (3) the U.S. health care system may be in an anti-priority-setting equilibrium.

Fairness and Risk: An Ethical Argument for a Group Fairness Definition Insurers Can Use.

Algorithmic predictions are promising for insurance companies to develop personalized risk models for determining premiums. In this context, issues of fairness, discrimination, and social injustice might arise: Algorithms for estimating the risk based on personal data may be biased towards specific social groups, leading to systematic disadvantages for those groups. Personalized premiums may thus lead to discrimination and social injustice. It is well known from many application fields that such biases occur frequently and naturally when prediction models are applied to people unless special efforts are made to avoid them. Insurance is no exception. In this paper, we provide a thorough analysis of algorithmic fairness in the case of insurance premiums. We ask what "fairness" might mean in this context and how the fairness of a premium system can be measured. For this, we apply the established fairness frameworks of the fair machine learning literature to the case of insurance premiums and show which of the existing fairness criteria can be applied to assess the fairness of insurance premiums. We argue that two of the often-discussed group fairness criteria, independence (also called statistical parity or demographic parity) and separation (also known as equalized odds), are not normatively appropriate for insurance premiums. Instead, we propose the sufficiency criterion (also known as well-calibration) as a morally defensible alternative that allows us to test for systematic biases in premiums towards certain groups based on the risk they bring to the pool. In addition, we clarify the connection between group fairness and different degrees of personalization. Our findings enable insurers to assess the fairness properties of their risk models, helping them avoid reputation damage resulting from potentially unfair and discriminatory premium systems.

Moral philosophy has much more to offer.

Moral philosophy is a rich tradition that contains many alternative approaches to determining what is right and wrong. A limited account that only considers (hedonistic) utilitarianism and deontology cannot do justice to moral philosophy. It is necessary to also consider the many other general-purpose moral theories that have been proposed, as well as the approaches developed in various branches of applied ethics, such as healthcare ethics, the ethics of technology, and the ethics of risk.

What We Do When We Define Morality (And Why We Need to Do It).

All psychological research on morality relies on definitions of morality. Yet the various definitions often go unstated. When unstated definitions diverge, theoretical disagreements become intractable, as theories that purport to explain "morality" actually talk about very different things. This article argues for the importance of defining morality and considers four common ways of doing so: The linguistic, the functionalist, the evaluating, and the normative. Each has encountered difficulties. To surmount those difficulties, I propose a technical, psychological, empirical, and distinctive definition of morality: obligatory concerns with others' welfare, rights, fairness, and justice, as well as the reasoning, judgment, emotions, and actions that spring from those concerns. By articulating workable definitions of morality, psychologists can communicate more clearly across paradigms, separate definitional from empirical disagreements, and jointly advance the field of moral psychology.

Evaluation as a moral practice: The case of virtue ethics.

Evaluation is a moral practice. With this in mind, we look to moral philosophy and the theory of virtue ethics as a case study to identify instances where virtue ethics undergirds professional evaluation. To aid in this we also contrast virtue ethics with the more commonly discussed philosophies of consequentialism and deontology and their corresponding evaluation practices. An important question we hope to address is: why does it matter for evaluators to understand connections between moral philosophy and practice? We argue that a greater awareness of moral philosophy will aid evaluators in seeing both the plurality of moral considerations that undergird an evaluation practice, as well as aid in their ability to make judgements among these considerations. In particular, identifying the moral perspectives that ground evaluation practices will aid in evaluation flexibility and use by helping evaluators to tailor evaluations to the situations and moral issue at hand and bringing evaluations explicitly closer to their implicit moral roots.

Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders.

PURPOSE OF REVIEW: Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT). RECENT FINDINGS: Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Luxemburg) have legalized MAiD-NT for patients with psychiatric disorders, while most have maintained the practices accessible only to people with somatic disease in a terminal phase. Also, how to make objective the criterion of irremediability of a mental disorder; how to balance suicide prevention with assisted suicide; how to avoid the risk of progressively including in requests for MAiD-NT vulnerable segments of the population, such as minors, elderly, or people with dementia, in a productive-oriented society, are some of the critical points to be discussed. The application of MAiD-NT in people with psychiatric disorders should be further explored to prevent end-of-life rights from contradicting the principles of recovery-oriented care.

Exploration of Students' Perception of Academic Misconduct: Do Individual Factors, Moral Philosophy, Behavioral Intention, and Judgment Matter?

Using Reidenbach and Robin's Multidimensional Ethics Scale, this study designs three scenarios related to academic dishonesty (AD) dilemmas to explore students' moral philosophies, behavioral intentions, and ethical judgments and further examines whether students with different individual factors (i.e., culture of place, gender, and educational level) have differences in the above variables. A total of 605 students from two areas, Taiwan and Mainland China, participated in this study. The results indicated that Taiwanese students had stricter moral equity, relativism, and contractualism philosophies in the duplicate submission scenario than Mainland China students. They also had stricter moral equity and relativism philosophies in the incomplete citation scenario. Similarly, relatively harsh relativism and contractualism philosophies accompanied by a low level of willingness to be a perpetrator in the failure to cite research published in other countries scenario were found. In addition, females applied relatively harsh moral equity and utilitarianism to all scenarios, reporting that they and their peers were less likely to engage in all AD activities. Graduates had a stricter egoism attitude toward duplicate submission and had stricter moral equity, relativism, and contractualism philosophies toward the behavior of incomplete citation. Graduate students also had strict moral equity, relativism, egoism, and contractualism beliefs in the failure to cite the foreign research scenario. Finally, regression analysis showed that moral equity, contractualism, and self-behavioral intention are significant predictors of students' ethical evaluations in the three scenarios.

What is the Foundation of Medical Ethics-Common Morality, Professional Norms, or Moral Philosophy?

This paper considers the relation between medical ethics (ME) and common morality (CM), professional norms, and moral philosophy. It proceeds by analyzing two recent book-length critical analyses of this relationship by Bob Baker in "The Structure of Moral Revolutions-Studies of Changes in the Morality of Abortion, Death, and the Bioethics Revolution" and Rosamond Rhodes in "The Trusted Doctor-Medical Ethics and Professionalism." It argues that despite the strengths of these critical arguments, there is nevertheless a relationship between ME, understood as the professional ethics of the healthcare professions, and both CM and moral philosophy. It also argues that ME cannot and should not be understood purely as the internally developed professional norms of the medical or healthcare professions.

Exploring the Dilemma of Ethical Issues Using the Lens of Seedhouse Can Help Oncology Nurses to Gain a Different Perspective on Caring for Older Adults with Cancer.

OBJECTIVE: To explore ethical issues associated with older adults with cancer and the people who matter to them. DATA SOURCES: A scoping review of the literature was conducted to inform the article using CINAHL, Medline, and Google Scholar databases using broad terms, older adults, geriatrics, cancer, and ethics. CONCLUSION: Older adults with cancer experience ageism, which stems from a range of uncertainties on best practice in care and treatment. By employing an ethical lens, decision-making by oncology nurses can be aided by creating and promoting autonomy through impeccable communication. Best interests for individual older adults with cancer can also be served by oncology nurses working in a way that serves needs first and acts in the best interests of the person and their family. IMPLICATIONS FOR NURSING PRACTICE: The article is of relevance to practicing oncology globally nurses because the framework can be easily used in clinical practice.

Does Ophthalmology Need Philosophy?

Although ophthalmology has made significant progress and awareness about eye care and the accessibility of health technology has increased, there are still aspects that might be improved. One of the ways to achieve improvement is philosophical investigation of some reasoning and behavior styles in ophthalmology. Philosophy means love of wisdom, and the philosophical approach can contribute to increasing the wisdom of ophthalmologists. Logical fallacies currently affecting the decisions of ophthalmologists can be reduced. "ontology" can contribute to a better understanding of "the nature of reality". A detailed inquiry about the basic concepts concerning ophthalmology may support better reasoning styles. Reflecting on epistemological questions such as "What is true knowledge?", justifying information, and having a skeptical attitude may help to make decisions with more accurate information. The philosophy of science is concerned with the detailed investigation, questioning, and understanding of ophthalmologists' scientific activities and may form the missing link between ophthalmology and philosophy. Moreover, the claim that philosophy's contribution to science is of no interest to scientists warrants consideration. The philosophers of science Karl Popper and Thomas Kuhn have made significant contributions to the perception of science that are still valid today. Karl Popper proposed that a demarcation between science and pseudo-science might be made through the concept of "falsification". According to this concept, a statement is scientific if it can be tested and falsified using valid methods. Thomas Kuhn stated that major scientific changes (i.e., revolutions) occur through paradigm shifts. Although the areas of moral philosophy/ethics/bioethics have generated useful ideas and practices for the improvement of the art of medicine, bioethics in particular deserves to be questioned philosophically by physicians living in real life. Ophthalmologists can develop more beneficial and realistic ophthalmology education, research, diagnosis, treatment, and rehabilitation practices by utilizing the basic methods of philosophy.

When Ethics is a Technical Matter: Engineers' Strategic Appeal to Ethical Considerations in Advocating for System Integrity.

Situated in critiques of the "moral muteness" of technical rationality, we examine concepts of ethics and the avoidance of ethical language among Australian gas pipeline engineers. We identify the domains in which they saw ethics as operating, including public safety, environmental protection, sustainability, commercial probity, and modern slavery. Particularly with respect to ethical matters that bear on public safety, in the course of design and operational activities, engineers principally advocated for action using technical language, avoiding reference to potential consequences such as death or destruction of property. Within their organizations, they saw themselves as occupying a technical "line of defense". We argue that this focus on technical language is action-oriented. Ethics tells practitioners of unacceptable outcomes, but it does not guide them in what they need to do to avoid that outcome in practice. We observed some cases where engineers had not made the connection between their role and ethics in the sense of public safety. We argue that muteness on ethical matters can obscure the nature of the risk where technical advice is being taken on by non-technical actors, and where technical actors themselves do not have a clear sense of their public safety obligations.

Hacia una teoría ética de animales humanos y no humanos / Towards an ethical theory for human and non-human animals

El objetivo de este artículo es exponer algunos de los principales trabajos desarrollados en la filosofía moral, arguyendo cómo estos se han hecho cargo (o no) del estatus moral de los animales no humanos. Para lograr este objetivo, el trabajo se divide en tres apartados. En primer lugar, delimito el objeto de estudio "animales" y me refiero a algunos mitos en relación con ellos. En segundo lugar, expongo someramente los trabajos filosóficos de las principales corrientes en filosofía moral. Finalmente, introduzco como una alternativa a la ética tradicional los postulados desarrollados desde la ética de la compasión (AU)

The aim of this article is to outline some of the main works developed in moral philosophy, arguing how they have (or haven't) dealt with the moral status of non-human animals. To achieve this objective, the paper is divided into three sections. First, I delimit the object of study "animals" and refer to some myths in relation to them. Secondly, I briefly outline the philosophical works of the main currents in moral philosophy. Finally, I introduce, as an alternative to traditional ethics, the postulates developed from the ethics of compassion (AU)

L'objectiu d'aquest article és exposar alguns dels principals treballs desenvolupats en la filosofia moral, argüint com aquests s'han fet càrrec (o no) de l'estatus moral dels animals no humans. Per a aconseguir aquest objectiu, el treball es divideix en tres apartats. En primer lloc, delimito l'objecte d'estudi "animals" i em refereixo a alguns mites en relació amb ells. En segon lloc, exposo succintament els treballs filosòfics dels principals corrents en filosofia moral. Finalment, introdueixo com una alternativa a l'ètica tradicional els postulats desenvolupats des de l'ètica de la compassió (AU)

A Man of Vision: Daniel Callahan on the Nasty Problem and the Noxious Brew.

This essay, published shortly before the 2020 U.S. presidential election (mired in controversy over a potential judicial appointment to the Supreme Court), celebrates Daniel Callahan's prescient book Abortion: Law, Choice and Morality. Nothing could be timelier. Callahan's central question was the "moral and social" struggle requisite for coherent policies and laws regulating abortion. He rejected "one-value" positions and strove to develop an expansive middle ground. He decried emotion untutored by reason, crude polemics, and bludgeoning: his recipe for a "noxious brew." Callahan's way of thinking preceded the development of a critical health humanities, the advent of moral foundations theory in psychology, and the philosophical concept of a moral imagination. Each of these inheres in his rigorous approach to the abortion problem. His honesty and humility led to a sea change in his position on abortion. Fifty years later, much can still be learned from Callahan's arguments-about abortion and other bioethics issues-most importantly, in how we address wider social issues in these polarized times.

Groups as moral boundaries: A developmental perspective.

In this chapter we present the perspective that social groups serve as moral boundaries. Social groups establish the bounds within which people hold moral obligations toward one another. The belief that people are morally obligated toward fellow social group members, but not toward members of other groups, is an early-emerging feature of human cognition, arising out of domain-general processes in conceptual development. We review evidence that supports this account from the adult and child moral cognition literature, and we describe the developmental processes by which people come to view social groups as shaping moral obligation. We conclude with suggestions about how this account can inform the study of social cognitive development more broadly, as well as how it can be used to promote positive moral socialization.

Successful societies: Decision-making and the quality of attentiveness.

Combining moral philosophy with sociological theory to build on themes introduced in Hall and Lamont's Successful Societies (2009), the paper outlines a distinctive perspective. It holds that a necessary condition of successful societies is that decision-makers base their decisions on a high level of attentiveness (concern and comprehension) towards subjectively valued and morally legitimate forms of life. Late modern societies consist of a plurality of forms of life, each providing grounds for what Alasdair MacIntyre has called internal goods-valued and morally valuable practices. The status of such goods is examined, and distinctions are drawn between their manifest and latent, and transposable and situationally specific, characteristics. We integrate this refined idea of internal goods into a developed conception of habitus that is both morally informed and situationally embedded. The sociological approach of strong structuration theory (SST) is employed to demonstrate how this conception of habitus can guide the critique of decision-making that damages internal goods. We identify the most pervasive and invidious forms of damaging decision-making in contemporary societies as those involving excessive forms of instrumental reasoning. We argue that our developed conception of habitus, anchored in the collectively valued practices of specific worlds, can be a powerful focus for resistance. Accounts of scholarship in higher education and of the white working class in America illustrate the specificities of singular, particular, social worlds and illuminate critical challenges raised by the perspective we advocate.

La experiencia moral y ética en tiempos de guerra: una aproximación a la antropología de las moralidades / Moral and Ethical Experience in Times of War: An Approach to the Anthropology of Moralities

Resumen La paz, como posibilidad y horizonte ontológico, requiere para ser realizable reconocer la dimensión simbólica de la violencia y las maneras en que esta es una guía para la formación ética y moral de los sujetos. El reconocimiento de estas secuelas nos permite diseñar estrategias pedagógicas orientadas a crear un ecosistema social que respalde la paz, a saber, una comunidad política capaz de comprender las realidades sociales fuera de los parámetros de la violencia.

Abstract In order to achieve a sustainable peace over time, it is necessary to recognize the symbolic dimension of violence and the ways in which it is a guideline for the ethical and moral formation of subjects. Recognition of these sequels allows us to design pedagogical strategies aimed at creating a social ecosystem, which supports peace, namely, a political community capable of understanding social realities outside the parameters of violence.

Is the four quadrant approach to military medical ethics a cargo cult? A call for more unity between philosophers and practitioners.

Moral theory should be practically useful, but without oversight from the philosophical community, the practical application of ethics by other institutions such as the military may drift into forms that are not theoretically robust. Ethical approaches that drift in this way run the risk of becoming 'cargo cults': simulations that will never properly fulfil their intended purpose. The four quadrant approach, a systematic method of ethical analysis that applies moral principles to clinical cases, has gained popularity in the last 10 years in a variety of medical contexts, especially the military. This paper considers whether the four quadrant approach is a cargo cult or whether it has theoretical value, with particular reference to the more popular four principles approach. This analysis concludes that the four quadrant approach has theoretical advantages over the four principles approach, if used in the right way (namely, with all four quadrants being used). The principal advantage is that the four quadrant approach leaves more room for clinical judgement, and thus avoids the charge of being too algorithmic, which has been levelled at the four principles approach. I suggest that it is the fourth quadrant, which invites the user to consider wider, contextual features of the case, which gives the approach this key advantage. Finally, I make a more general proposal that theoretical ethicists should work closely with those practitioners who apply ethics in the world, and I call for a symbiotic relationship between these two camps.

Filosofía y psicología / Philosophy and psychology

El trabajo trata de proporcionar información sobre psicología moral y filosofía moral, buscando lograr una teoría normativa estructurada sobre elementos de la realidad, teniendo en cuenta la existencia de una estructura profunda de la psicología moral. (AU)

The work tries to provide information on moral psychology and moral philosophy, seeking to achieve a normative theory structured on elements of reality, taking into account the existence of a deep structure of moral psychology. (AU)

Dialogic Consensus as the Moral Philosophical Basis for Shared Decision-making.

Shared decision-making is important and beneficial for patients. Practically, this requires that we explore the values of the patient and the clinician and then consider available treatment options. The aim is to maximize the good of the patient in the context of their illness. Hence, clinical consultations are situations in which we can, and should, draw upon moral philosophical precepts. One such precept, which can fortify the foundations of shared decision-making, is a process of inclusive, noncoercive, and reflective dialogue, which aims at reaching a consensual decision as to what is best for the patient in their situation. Summary: Shared decision making is important and helpful for patients. This is based upon having a conversation about values and what is important. We can base that conversation on principles of moral philosophy, via a process termed "dialogic consensus".

Refining moral agency: Insights from moral psychology and moral philosophy.

Research in moral psychology has recently raised questions about the impact of context and the environment on the way the human mind works. In a 2012 call to action, Paley wrote: "If some of the conclusions arrived at by moral psychologists are true, they are directly relevant to the way nurses think about moral problems, and present serious challenges to favoured concepts in nursing ethics, such as the ethics of care, virtue, and the unity of the person" (p. 80). He urges nurse ethicists and scholars to evaluate the impact these findings may have for moral theory. In this paper, I review some of Paley's (Nursing Philosophy, 13, 2012, 80) critique, focusing on the argument that theories of nursing ethics have failed to account for the role of context; both in terms of its impact on the way nurses make moral judgements and in terms of the environment's influence on the way the mind works. I then examine nursing literature on moral agency, and focus on the role of the environment and context play within existing theory. I argue that theories of moral agency have often accounted for the role of context on the way nurses make decisions; however, less attention has been paid to its impact on the mind. With this background, I use insights from the fields of moral philosophy and moral psychology to refine the conceptualization of nurse moral agency in a way that is reflective of current cognitive, philosophical and nursing practice-based science.