Contextual or Universal Ethics: A Non-Issue?

Universal Principles, Global Cooperation, and Moral Disagreement:A Natural Law Account Joseph Boyle (bio) I. Introduction Since ancient times a number of Western moral views have been described or self-described as "natural law" ethics. These views claim that there are universal moral principles and norms. Moral principles, according to natural law views, are somehow "natural," and, thus, are the common property of those who share human nature. That implies that the principles of the natural law are in principle accessible to all humans. Those who accept this ethical approach are not in full agreement about the precise sense and reference of the expression "natural law" or about the specific moral norms justified by the principles of the natural law. I do not here propose to address these differences among natural law theorists. Instead, I will sketch the approach to universal moral principles that I, as a philosopher working within the natural law tradition, think correct. My approach is within the broad tradition of natural law theorizing inspired by St. Thomas Aquinas; it is the version of Thomistic natural law called the "new natural law theory."1 Natural law theories include a conception of the nature and purpose of morality. Two closely related theses comprise the key elements of this conception. The first is that moral principles, and their implications in moral norms and judgments, are propositional realities having logical relationships and normative content that can be formulated, debated and judged either correct or incorrect. Thus, natural law theory is a form of ethical rationalism; moral judgments are a form of knowledge. The second thesis holds that moral principles are universal in two senses: they are applicable to all human actions, and they are accessible to all human beings capable of the reasoning needed for choice and action. Some immediate implications of these theses are obviously important for thinking about moral diversity, difference and consensus. First, the universal applicability of moral principles implies that there are no human actions, however complex their circumstances and obscure their significance, that are in principle immune from moral assessment. Second, the universal accessibility of the principles of the natural law implies that moral norms, customs, and practices are not finally a matter of local custom or particular circumstance. Criticism in the light of accessible moral principle is always possible. Third, the conjunction of the universal accessibility of natural law and its ethical rationalism makes the possibility of recognizing mistaken moral judgment and practice more than an abstract possibility, but, instead, an ordinary, intelligible aspect of moral life and thought. Any person capable of practical reasoning and choice can access enough of moral principle to criticize his or her own moral beliefs and those of his or her society. That capability is obviously ethically significant. Its availability in reflection to people generally implies that they are not simply stuck with the moral limitations and corruption of their culture, upbringing, and life experience; they have the resources for critical judgment and autonomous action based on that reflection. These claims about the nature of morality may now seem quaint given some defining features of post-modernity. The conjunction of two features of our post-modern world poses a special problem for natural law theory: (1) the rapidly emerging globalization of economic, social and political life; and (2) the pervasiveness of post-modern relativism, and "local-only" conceptions of morality. These conceptions reject the universalist theses I listed above. But they do so in a globalized context calling for moral guidance for the world-wide interactions that transcend the moralities of local communities and their members. Together these features challenge the core convictions of natural law theory. In this contribution, I will briefly articulate and defend these strong natural law claims about the nature of morality, and will bring natural law theory to bear on the challenge posed to them by the realities of our post-modern and globalized situation. I will develop this account as follows: In part II, I will summarize the account of the human good that underlies morality according to natural law theories that follow Aquinas's classic treatment. In Part III, I will sketch an account of how universal moral principles are justified...

Objectives: The INCNS (Infection, Nutrition, Consciousness, Neurological disorders, Systemic diseases) model provides a structured approach to improve patient care.This study evaluates INCNS training versus conventional training in enhancing Neurocritical Care Unit (NCU) resident performance.Methods: In a randomized controlled trial, 40 residents were assigned to INCNS (n=20) or conventional training (n=20).The INCNS group completed a two-week program with lectures, case discussions, and simulations.Outcomes included Patient Management Quality Score (PMQS), medical error rates, and patient outcomes (28-day mortality, ICU stay, complications).Results: The INCNS group showed higher PMQS (89.5 7.8 vs. 80.3 10.6, P=0.002), lower error rates (incorrect dosing: 2.4% vs. 6.7%,P=0.003; missed diagnoses: 3.6% vs. 7.1%, P=0.028), and fewer complications (ventilator-associated pneumonia: 22.6% vs. 41.3%,P=0.042; hypoproteinemia: 18.1% vs. 23.8%,P=0.015).No differences were found in 28-day mortality or ICU stay.Conclusions: INCNS training significantly enhances residents' patient management quality and reduces errors and complications in the NCU.Multicenter studies are needed to confirm these findings and evaluate long-term effects.

Clinical audit concerning the quality of management in patients with classic form of congenital adrenal hyperplasia

universal principle as the appropriate source of moral guidance, and both share the view that moral problems are to be solved by the application of such an abstract principle to particular cases. Both share an admiration for the rules of reason to be appealed to in moral contexts, and both denigrate emotional responses to moral issues. Many feminist philosophers have questioned whether the reliance on abstract rules, rather than the adoption of more context-respectfulrules, rather than the adoption of more context-respectful approaches, can possibly be adequate for dealing with moral problems, especially as women experience them.i6 Though Kantians may hold that complex rules can be elaborated for specific contexts, there is nevertheless an assumption in this approach that the more abstract the reasoning applied to a moral problem, the more satisfactory. And Utilitarians suppose that one highly abstract principle, The Principle of Utility, can be applied to every moral problem no matter what the context. A genuinely universal or gender-neutral moral theory would be one which would take account of the experience and concerns of women as fully as it would take account of the experience and concerns of men. When we focus on the experience of women, however, we seem to be able to see a set of moral concerns becoming salient that differs from those of traditional or standard moral theory. Women's experience of moral problems seems to lead us to be especially concerned with actual relationships between embodied persons, and with what these relationships seem to require. Women are often inclined to attend to rather than to dismiss the particularities of the context in which a moral problem arises. And we often pay attention to feelings of empathy and caring to suggest what we ought to do rather than relying as fully as possible on abstract rules of rea-

BackgroundOnly a few studies explore the role of nurses in genetic counselling and genetic health care, and none of them is related to orphan diseases. In addition, few studies address the issue of finding variables that might affect the economy of a service or perform a cost-effectiveness analysis of a having genetic nurse at a unit.MethodsA multidisciplinary panel of experts working in the hospital was set up to identify sensitive indicators and remove confounding variables. This panel evaluated efficiency and effectiveness indicators and drafted a questionnaire to estimate patient perception of the quality of the service. Data were captured from different sources, including the hospital patient database and a web-accessible platform for data collection. More than 600 clinical evaluations of 400 patients were considered, and economic parameters were studied by applying Porter’s Time-Driven Activity-Based Costing methodology to evaluate costs and outcomes. Additionally, an anonymous, semi-structured, paper-and-pencil interview questionnaire was given to patients at their periodic follow-ups.ResultsThe results showed an increase in the quality of patient management, more accurate data capturing, and higher quality ambulatory care. In fact, approximately 70% of the respondents reported positive changes. In addition, a parallel economic analysis explored indicators influencing economic impact, and outcomes showed positive results with the quality of outcomes improving more compared to the increase in costs.ConclusionsThe variety of evaluated issues highlighted that having a nurse in a genetic service and at day clinic activities resulted in better access, better scheduling, more satisfaction, and proved to be a cost-effective solution for patients affected by rare diseases.

The prevalence of difficult or prolonged weaning from the ventilator is increasing due to a growing number of multi-morbid, elderly and pulmonary deficient patients being mechanically ventilated. Intensive care units (ICU) tend to refer difficult to wean patients to specialised weaning facilities. A survey of 38 centres - performed in 2006 - included a total number of 2718 patients with difficult or prolonged weaning. Almost three quarters of the patients were transferred to a weaning centre from an external ICU. The weaning success rate was 66.3 %. After weaning in 31.9 % of the patients, home mechanical ventilation was started. The overall hospital mortality rate was 20.8 %. Recently the task force "WeanNet" - a network of weaning units - was founded under the auspices of the German Thoracic Society. The main aim of WeanNet is to improve cooperation among the weaning centres and the quality of patient management. Important tools of WeanNet are (i) the register of weaning patients and (ii) accreditation of the weaning centres. To develop the register an intensive cooperation between the task force and the Institute for Lung Research (ILF) was necessary. The finished register is now logistically run by ILF. In less than 1 year after the official start, already 70 weaning units with ca. 3000 patients are registered. In future "WeanNet", in particular in terms of the register and the accreditation, will stand for the quality of weaning centres in Germany.

Interest in business ethics has soared over the past ten to 15 years. Lacking in the literature are normative approaches that provide guidelines for managers to evaluate their behavior in order to determine whether that behavior is in fact ethical. This paper makes a contribution to normative research, by offering a graded task approach to applying certain principles based on the philosophy of ethics (referred to as universal moral principles). These principles include utilitarianism, the categorical imperative, rights, and justice. First, some arguments against the use of universal moral principles are discussed, and rebutted. Next, the principles themselves are explained. Finally, a worksheet is presented. This worksheet offers a step‐by‐step approach to applying each of the principles.

The central question of this study was the Analysis of deep brain stimulation (DBS) in the treatment of Parkinson's disease. The need to more deeply understand the benefits and limitations of DBS, especially given its increasing use as the standard treatment for advanced Parkinson's patients, justified this research. Detailed analysis of clinical outcomes and improvements in quality of life provided by DBS could offer valuable information for optimizing treatment protocols and clinical decision-making. This study aimed to address these issues through a comprehensive review of the existing literature, analysis of clinical data, and evaluation of best practices for DBS implementation in Parkinson's disease treatment. The methodology consisted of a qualitative literature review, utilizing sources such as Scielo, Google Scholar, scientific journals, and academic repositories. Relevant studies published in Portuguese, English, and Spanish over the last ten years were included. Inclusion and exclusion criteria ensured the selection of high-quality studies focused on the efficacy of DBS in treating Parkinson's disease. The results demonstrated significant benefits of DBS in improving both motor and non-motor symptoms, with DBS showing superior efficacy compared to other treatments. The study concluded that DBS is a highly effective therapeutic approach for Parkinson's disease, offering substantial improvements in patient quality of life and symptom management, highlighting the need for further research to optimize this treatment modality.

Codes of ethics typically provide rules and guidelines for best practices in marriage and family counseling. An emerging model for ethical decision making emphasizes the ethics of virtues and aspirations. Exploring fundamental models of helping, as well as contemporary issues in community systems, affords context for examining the professional development of marriage and family counseling. Dialectical reasoning, professional discourse, and case study present means by which 21st-century marriage and family counselors can resolve ethical dilemmas.

Justice goes some way to being served when statements from police interviews with suspects are admissible as evidence in court. Admissible evidence confirms that the police have worked within legal constraints and satisfied universal ethical principles that appear in the police code of conduct. Conversely, when police behave improperly and an accused person walks free, police authorities have needed to placate an outraged public by promising reforms. This paper explores sections of Arthurs’ case to illustrate differences between legal and illegal police conduct when interviewing a murder suspect. Parts of the interview were admissible as legal evidence; the majority was not. This paper then considers the practical relevance of ethical constraints formalised as universal moral principles in the police code of conduct. It suggests that Aristotle’s virtue ethics may be a more appropriate ethical response than referring to abstract moral principles in analysing police/suspect interviews. The paper concludes by calling for police to include virtue ethics as part of conversation management strategies when analysing police/suspect interviews.

This paper focuses primarily on the practical challenges and limitations of applying Immanuel Kant’s universal moral principle to the political unrest in Kenya. Kant’s universal moral principle embedded in the categorical imperative argues that we should act in a way that our actions can be at the same time be regarded as universal moral laws. From a critically unbiased lens, there are some challenges and limitations that are encountered during the application of Kants ethical principle to specific situations in Kenya. A more contextualized and nuanced ethical approach is required to navigate the intricate moral landscapes of political conflict effectively. In this regard, exploring compatibility with other ethical frameworks provides a more comprehensive understanding and approach for addressing political violence in diverse settings.

Online communication with participants, including online recruitment, electronic informed consent, and data communication, is one of the fields to which information and communication technology (ICT) has been applied in medical research. Online communication provides various benefits, especially for genome research and rare disease research. However, ethical challenges that are derived from or exacerbated by online communication need to be addressed. Here, we present an overview of such ethical issues and provide practical guidance for the ethical implementation of ICT. We specify the ethical issues in the context of using online communication for medical research by an analysis based on the eight ethical principles for clinical research. Informed by this ethical context, we then develop a novel framework for the governance of medical research involving ICT, which consists of eight categories: five research processes (ie, design of research, recruitment, informed consent, data communication, and dissemination and return of results) and three overarching perspectives related to multiple processes of research (ie, access to research and online dialog, community involvement, and independent review). Finally, we present a practical guidance chart for researchers, patient partners, independent reviewers, and funding agencies. We believe that our study will contribute to the ethical implementation of online communication in medical research.

This essay is devoted to a thorough analysis of the role and significance of the holy will in Kantian moral philosophy, highlighting its status as a crucial moral archetype and a pathway for reconciliation with human rational nature. By concentrating on the holy will, this paper illuminates its role as a normative model that not only sheds light on human capabilities and limitations within moral contexts but also advances a renewed understanding of freedom and duty. It is argued that the holy will, inherently aligned with moral laws and free from coercion, contrasts with the human will, which is characterized by conflict and restrictions. This contrast emphasizes the holy will as a fundamental ethical principle in Kant’s work, playing a key role in shaping his views on morality and human autonomy.

In the last decade, there has been generous support by Western nations to deal with the HIV/AIDS epidemic and accompanying plethora of infections, a significant portion of the aid is extended to resource-restricted countries (1). The wave of support has contributed to the development of a branch of biomedical activity, referred to as translational medicine. This new field covers two areas: (i) the ‘‘translational medicine proper’’ (T-1) to establish proofs of concepts mostly in animal models that lead to pilot studies in humans, and (ii) ‘‘the translational medicine-2’’ (T-2, also referred to as ‘‘implementation science’’) for optimizing already established medical concepts in rich and poor countries alike, for wider applications in communities (2). Fledgling journals which carry the ‘‘translational’’ title clearly favor T-1 publications; by contrast, on the pages of Clinical Cytometry mostly T-2 topics are featured as clinical implementations of diagnostically relevant developments. For two reasons, the T-2 field is subject to political scrutiny. First, In 2008, US $ 15.6 billion was spent on AIDS programs in low and middle income countries. Currently, a very high proportion (50%) of these are coming from external, including generous North American, sources and these may not be sustainable. Furthermore, the calculated trends reveal that this expenditure is to shoot up to 2–3 times higher levels, and that a major epidemic will still be with us in 2031 without a change in approach (3). Second, medical care in the West is, by tradition, expensive (4). The health care practiced in the US appears to be in the 37th position with respect to cost efficiency (5). Consequently, when suggesting that from now on the resource-restricted partners must contribute more to their HIV care/prevention (3), the possibilities of modifying diagnostics according to the local needs using local implementation science must be considered. This field in Africa has been revitalized since generic antiretroviral therapy (ART) became affordable. During the last decade requirements for simplifying diagnostics has frequently been advocated in the pages on Clinical Cytometry (6,7). When African health care workers are faced with acute crisis, they are often proven to be inventive. Evidence is gathering that the technologists in resource-poor regions are capable of developing and/or modifying methods in order that these are elegantly simplified for more affordable large scale testing formats. Some of these efforts represent improvements of precision, accuracy, quality assessment, and training (8–10). In his recent book, Nigel Crisp, the former Chief Executive of the National Health Service of the United Kingdom (11) explains that ‘‘poor countries do not need a diluted version of what rich countries have now, and may have an easier time building a better system from little.’’ Inspired by his approach, in this editorial, we would like to briefly review five recent papers (12–16). But first we need to consider two significant changes in the global outlook which influence the use of diagnostics. In 2006, the WHO recommended that all HIV positive patients start ART when their CD4 T-cell count fell to 200 cells/mm. In patients with CD4 counts between 200 and 350 cells/mm, the initiation of ART was optional on the basis of these patients showing some symptoms (Grade 2–4) or were still asymptomatic (Grade 1). However, in countries with poor resources this guideline was frequently interpreted as to start ART at 200/mm, reaching many patients too late (17,18) even at levels as low as 50–150 CD4 T-cells/mm. Recently, it has also been shown that earlier start of ART at higher CD4 T-cell counts reduces mortality and morbidity rates (17,18). Therefore WHO, in unison with other regulatory bodies, now recommends ART to be

Why some countries are so much richer than others is a question of central interest in economics. Low aggregate income per worker in poor countries is mostly accounted for by low labor productivity and high employment in agriculture. This thesis attempts to understand cross-country income difference through examining productivity differences at the sector level in agriculture and in non-agriculture. Between rich and poor countries, there is a 45-fold difference in agricultural output per worker and a 34-fold difference in mean farm size. In the first chapter, I argue farmer’s skill as a plausible explanation for these differences. The model features heterogeneity in innate agricultural skill, on-the-job skill accumulation, and span-ofcontrol in agricultural production. I show that low total factor productivity (TFP) in poor countries not only induces more individuals with low innate skill to choose farming, but also reduces the incentive to accumulate skill. Between rich and poor countries, the model generates substantial difference in farmer’s skill, which translates into differences in agricultural productivity and farm size distribution. Quantitatively, the calibrated model explains half of the cross-country differences in agricultural output per worker, and successfully replicates the size distribution of farms in both rich and poor countries. Cross-country productivity differences are asymmetric across sectors. The labor productivity gap between rich and poor countries in agriculture is twice as large as that in the aggregate, and ten times larger than that in non-agriculture. The 2 second chapter shows that these sectoral productivity differences can arise solely from difference in aggregate TFP. I extend the framework in the first chapter to allow for different skill in non-agricultural production as well. Low TFP distorts the allocation of skills across sectors and discourages skill accumulation on the job. To discipline the initial skill distribution and skill accumulation, the model is calibrated to match earnings distribution and age-earnings profiles in both agriculture and non-agriculture in the U.S. The model’s implications are then examined using a sample of 70 countries that covers a wide range of development. Between rich and poor countries, the model accounts for most of the productivity differences at the sector level productivity difference in agriculture in the model is 1.8 times larger than those in the aggregate and 6 times larger than those in non-agriculture. As in the data, the share of farmer in the labor force in the model declines from 85 percent in the poorest countries to less than 2 percent in the richest countries. These results suggest that policy aiming at improving overall efficiency should be prioritized. Abstract Approved: Thesis SupervisorApproved: Thesis Supervisor Title and Department