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PubMedDate not supplied

Using explicit decision rules to manage issues of justice, risk, and ethics in decision analysis: when is it not rational to maximize expected utility?

Concepts of justice, risk, and ethics can be merged with decision analysis by requiring the analyst to specify explicity a decision rule or sequence of rules. Decision rules are categorized by whether they consider: 1) aspects of outcome distributions beyond central tendencies; 2) probabilities as well as utilities of outcomes; and 3) means as well as ends. This formulation suggests that distribution-based decision rules could address both risk (for an individual) and justice (for the population). Rational choice under risk if choices are one-time only (vs. repeated events) or if one branch contains unlikely but disastrous outcomes might ignore probability information. Incorporating risk attitude into decision rules rather than utilities could facilitate use of multiattribute approaches to measuring outcomes. Certain ethical concerns could be addressed by prior specification of rules for allowing particular branches. Examples, including selection of polio vaccine strategies, are discussed, and theoretical and practical implications of a decision rule approach noted.

Beneficence↗
PubMed1988

Age as a basis for allocating lifesaving medical resources: an ethical analysis.

In light of the growing prominence of an age criterion in patient selection, it is essential to scrutinize the ethical legitimacy of arguments being offered both for and against using age as a criterion. Accordingly, the present study first explores the primary justifications for an age criterion, then examines the criterion's weaknesses. Weaknesses are grouped into two areas: deficiencies in the justifications of the criterion, and overarching critiques. Finally, a way forward in the midst of the present controversy is suggested. The study's conclusion is that an age criterion per se is unjustified, though age may play a carefully defined role in medical assessments relevant to patient selection.

Age Factors↗
PubMed1983

Invisible hand or fatherly hand? Problems of paternalism in the New Perspective on health.

This article examines the charge that the "New Perspective" on health (as exemplified by the Lalonde Report in Canada, by Prevention and Health in the United Kingdom) represents an abandonment of liberal principles in favor of a collectivist and paternalistic role for the state. It looks first at the problems confronting modern health policy, and at the reasoning behind the New Perspective's approach. It then explores whether and how the charge of paternalism applies to that approach, and just what such a charge implies. The article concludes with a discussion of the "liberal paternalist" viewpoint towards health policy, a viewpoint that combines respect for individual liberty with an interest in taking effective public action to improve the health status of modern populations.

Canada↗
PubMed1994

Casuistry and its communitarian critics.

Communitarian critics have derided case-based reasoning for ignoring the need to arrive at a shared hierarchy of goods prior to case resolution. They claim that such a failure means that casuistry depends on either a naive metaphysical realism or an ethical conventionalism. Casuistry does embrace a certain unobjectionable moral realism and can require appeals to narrative histories, but despite this dependence on the surrounding culture, casuists possess a way to remain critical of society through the concept of practical wisdom and the use of a moral taxonomy. Therefore, casuistry's viability depends upon the existence and employment of this Aristotelian virtue. Furthermore, the casuistry that emerges is a sophisticated type of communitarianism rather than a free-standing method.

Altruism↗
PubMed2000

Amenable to reason: Aristotle's rhetoric and the moral psychology of practical ethics.

An Aristotelian conception of practical ethics can be derived from the account of practical reasoning that Aristotle articulates in is Rhetoric and this has important implications for the way we understand the nature and limits of practical ethics. an important feature of this conception of practical ethics is its responsiveness to the complex ways in which agents form and maintain moral commitments, and this has important implications for the debate concerning methods of ethics in applied ethics. In particular, this feature enables us to understand casuistry, narrative, and principlism as mutually supportive modes of moral inquiry, rather than divergent and mutually exclusive methods of ethics. As a result, an Aristotelian conception of practical ethics clears the conceptual common ground upon which practical ethicists can forge a stable and realistic self-understanding.

Bioethics↗
PubMed2000

"Phronesis" on tour: cultural adaptability of Aristotelian ethical notions.

How might bioethics take account of cultural diversity? Can practical wisdom of an Aristotelian sort be applied across cultures? After showing that practical wisdom involves both intellectual cleverness and moral virtue, it is argued that both these components have universality. Hence practical wisdom must be universal as well. Hellenic ethical thought neither depended on outdated theoretical notions nor limited itself to the Greek world, but was in fact developed with constant awareness of cultural differences, so it arguably works as well in other times and places when formulated. Even the eudaemonistic setting for practical wisdom is unproblematic.

Bioethics↗
PubMed2005

Slaves, embryos, and nonhuman animals: moral status and the limitations of common morality theory.

Common morality theory must confront apparent counterexamples from the history of morality, such as the widespread acceptance of slavery in prior eras, that suggest core norms have changed over time. A recent defense of common morality theory addresses this problem by drawing a distinction between the content of the norms of the common morality and the range of individuals to whom these norms apply. This distinction is successful in reconciling common morality theory with practices such as slavery, but only at the cost of underscoring the limits of common morality theory, in particular its inability to resolve disputes about the moral status of entities. Given that many controversies in bioethics center on the disputed status of various entities, such as embryos and nonhuman animals, this is an important limitation. Nonetheless, common morality theory still can be a useful resource in diminishing moral conflict on issues that do not involve disputes over moral status.

Animal Rights↗