Johan Brännmark

Normative ethics usually presupposes background accounts of human agency, and although different ethical theorists might have different pictures of human agency in mind, there is still something like a standard account that most of mainstream normative ethics can be understood to rest on. Ethical theorists tend to have Rational Man, or at least some close relative to him, in mind when constructing normative theories. It will be argued here that empirical fndings raise doubts about the accuracy of this kind of account; human beings fall too far short of ideals of rationality for it to be meaningful to devise normative ideals within such a framework. Instead, it is suggested, normative ethics could be conducted more profiably if the idea of unifying all ethical concerns into one theoretical account is abandoned. Such a disunity of ethical theorizing would then match the disunited and heuristic-oriented nature of our agency. Some preliminary suggestions about what ethical theorizing might look like instead are provided here along with some remarks about how these relate to other approaches in the literature. © 2013 Elsevier B.V., All rights reserved.

Over the last decades the traditional emphasis on moral rules, or principles, has been attacked by particularists like Jonathan Dancy. I argue that particularists are correct in rejecting traditional attempts at moral codification, but that it is still possible to have a rule‐oriented approach to morality if we distinguish between different ways in which features can be morally relevant. I suggest that there are first a limited number of features that can serve as basic moral reasons for action, and then a class of relational features that can change the relevance of these features. I then argue that while particularists do well in drawing attention to the fact that sometimes our basic moral duties are put out of play by other relevant features, they fail to make sense of the exceptional nature of such situations. Only a rule‐oriented understanding of morality can do this.

This paper argues that we have a moral obligation to implement certain health technologies even if we have limited or incomplete evidence of their effectiveness. The focus is on technologies used in non-emergency settings, as opposed to “exceptional cases” such as compassionate use and emergency approvals during public health emergencies. A broadly plausible moral principle – the Ecumenical Principle – is introduced and applied to a test case: the use of Digital Breast Tomosynthesis in mammographic screening. The paper concludes by exploring the implications of the Ecumenical Principle for the adoption of other new health technologies.

In discussions about the possibly ideological character of ideal theory in liberal political philosophy, one worry concerns the underlying social ontology and how it can serve to make important structural injustices less visible. More recently, similar concerns have begun to appear within social ontology itself, with several authors arguing for a shift from more traditional models to different forms of nonideal or critical social ontology instead. This article develops a conception of ideal theory applicable to both social ontology and political theory, and it is then argued we should take seriously worries about ideal theory playing an ideological role. One consequence of how the ideal/nonideal distinction is understood here, however, is that the line between ideal and nonideal theory is not sharp. What we have is rather a continuum ranging from the strongly ideal to the strongly nonideal, and where the balance then needs to shift away from the former.

Liberal political theory is often understood as being underpinned by an individualistic social ontology, and it is sometimes objected that this type of ontology makes it difficult to address injustices that involve social groups and informal forms of privilege. It is argued here that, to the extent that liberals do fail to properly address such structural injustices, the main problem can instead be understood to lie with a rules-centric understanding of institutions – one which is actually out of line with a proper ontological individualism. If institutions are instead understood as distributions of right and duties, held by individuals, it becomes much more straightforward to identify institutional privilege in terms of inequalities in those distributions. The relevant rights and duties can be explicated in terms of informal Hohfeldian incidents and it is argued that patterned distributions of such incidents can come to exist, and be maintained, through how we develop a largely intuitive sense of where our interpersonal boundaries run and form social expectations about which kinds of behaviour will typically receive pushback in some form.

Although digital breast tomosynthesis has higher sensitivity than digital mammography and at least as high specificity, digital mammography remains the most common method for conducting mammographic screening. At the same time, mammography systems are now delivered “DBT-ready” and can be used for either digital mammography or digital breast tomosynthesis. In this paper, we ask whether it is ethically permissible to use such equipment for digital mammography, given its lower sensitivity. We argue it is not, and that clinics are ethically required to use their DBTready equipment to screen with digital breast tomosynthesis whenever this is practically possible. Our argument relies on a comparison between digital breast tomosynthesis and a hypothesized improvement in the image quality of digital mammography.

Social ontologists commonly think that our ideas about social entities, and about other people also inhabiting the social realm, play an important role in making those entities into what they are. At the same time, we know that our ideas are often indeterminate in character, which presumably would mean that this indeterminacy should carry over to the social realm. And yet social indeterminacy is a neglected topic in social ontology. It is argued that this neglect can be traced to how a particular approach that favors ahistorical reconstructions in making sense of social entities has come to dominate social ontology. If we think beyond the parameters set by this approach, however, we can see that recognizing indeterminacy as a pervasive phenomenon in the social realm might open up new interpretative possibilities in relation to different social categories. This argument is at least partly in line with recent calls for a move towards nonideal social ontology.

In her work on virtue ethics Rosalind Hursthouse has formulated an Aristotelian criterion of rightness that understands rightness in terms of what the virtuous person would do. It is argued here that this kind of criterion does not allow enough room for the category of the supererogatory and that right and wrong should rather be understood in terms of the characteristic behavior of decent persons. Furthermore, it is suggested that this kind of approach has the added advantage of allowing one to make sense of the centrality of negative precepts in commonsense morality.

Normative ethics usually presupposes background accounts of human agency, and although different ethical theorists might have different pictures of human agency in mind, there is still something like a standard account that most of mainstream normative ethics can be understood to rest on. Ethical theorists tend to have Rational Man, or at least some close relative to him, in mind when constructing normative theories. It will be argued here that empirical findings raise doubts about the accuracy of this kind of account; human beings fall too far short of ideals of rationality for it to be meaningful to devise normative ideals within such a framework. Instead, it is suggested, normative ethics could be conducted more profitably if the idea of unifying all ethical concerns into one theoretical account is abandoned. This disunity of ethical theorizing would then match the disunited and heuristic-oriented nature of our agency.

Jonathan Dancy works within almost all fields of philosophy but is best known as the leading proponent of moral particularism. Particularism challenges “traditional” moral theories, such as Contractualism, Kantianism and Utilitarianism, in that it denies that moral thought and judgement relies upon, or is made possible by, a set of more or less well-defined, hierarchical principles. During the summer of 2006, the Philosophy Departments of Lund University (Sweden) and the University of Reading (England) began a series of exchanges to take place every other year, alternating between the departments. Andreas Lind and Johan Brännmark arranged to meet Dancy during the first meeting in Lund to talk about questions regarding particularism, moral theory and the shape of the analytical tradition. The major part of the conversation is printed below.

This paper discusses the relation between medical ethics and general moral theory, the argument being that medical ethics is best seen as independent from general moral theory. According to this independence thesis, here explicated in terms of what is called a disunitarian stance, the very idea of applied ethics, which is often seen as underlying medical ethics (as well as many other more specific fields of ethics), is misguided. We should instead think of medical ethics as a domain-specific ethical inquiry among other domain-specific ethical inquiries. On this alternative kind of picture, such ethical inquiries should start with looking at the particularities of the domain under consideration and then proceed from there. Some possible consequences of this idea for medical ethics are then identified and discussed.

Some recent arguments for paternalist government interventions have been based in empirical results in psychology and behavioral economics that would seem to show that adult human beings are far removed from the ideals of rationality presupposed by much of philosophical and economic theory. In this paper it is argued that we need to move to a different conception of human decision-making competence than the one that lies behind that common line of philosophical and economic thinking, and which actually still lies in the background of some of these recent approaches to paternalist interventions. An alternative picture of human decision-making competence is outlined and four criteria for identifying areas where paternalist interventions have a basic moral and political legitimacy are then identified on the basis of this picture.

Human rights have increasingly been put forward as an important framework for bioethics. In this paper, it is argued that human rights offer a potentially fruitful approach to understanding the notion of Respect for Persons in bioethics. The idea that we are owed a certain kind of respect as persons is relatively common, but also quite often understood in terms of respecting people’s autonomous choices. Such accounts do however risk being too narrow, reducing some human beings to a second-class moral status. This paper puts forward a political approach to our standing as persons and a strongly pluralistic account of human rights that lays the ground for a more broadly applicable conception of Respect for Persons. It is further argued that this model also provides an example of a more general approach to philosophical ethics, an approach which is here called taxonomical pluralism. When it comes to Respect for Persons specifically, this principle is developed in terms of five distinct core concerns (autonomy, dignity, integrity, privacy, and vulnerability).

In recent years, several political theorists have argued that reasonable principles of justice are practice-dependent. In this paper it is suggested that we can distinguish between at least two main models for doing practice-dependent theorizing about justice, interpretivism and constructivism, and that they can be understood as based in two different conceptions of practices. It is then argued that the reliance on the notion of participants that characterizes interpretivism disables this approach from adequately addressing certain matters of justice and that a better way of developing the idea of practice-dependence can be found in a constructivism that starts from the Rawlsian idea of overlapping consensus, but which shifts the focus of that approach from societies to a more open-ended category of domains, and which understands the parties to a possible overlapping consensus as stakeholders in a certain set of interconnected practices.

Some contemporary paternalists argue in favor of government interventions based on how experimental psychologists and behavioral economists have found that our behavior often diverges from what would be predicted by rational-choice models. In this article it is argued that these findings can, more specifically, be used to identify decisional trouble spots where paternalist interventions may be legitimate. It is further argued that since the epistemic legitimacy of government paternalism ultimately rests on centralized decision-making having a comparative advantage, it also depends on the possibility of such interventions being governed by an ideal of evidence-based policy-making. The article asks how stringently this requirement should be understood, and to what extent government can legitimately engage in what might be called experimental policy-making of a paternalistic character.

In considering patriarchy as potentially institutional and as a characteristic also of contemporary Western societies, a fundamental issue concerns how to make sense of largely informal institutions to begin with. Traditional accounts of institutions have often focused on formalized ones. It is argued here, however, that the principal idea behind one commonly accepted conception of institutions can be developed in a way that better facilitates an explication of informal institutions. When applied to the phenomenon of patriarchy, such an approach can then also allow us to ontologically make sense of gray areas and hierarchies of authority, as well as the intersectionality of social positions.

Autonomy and consent have been central values in Western moral and political thought for centuries. One way of understanding the bioethical models that started to develop, especially in the 1970s, is that they were about the fusion of a long-standing professional ethics with the core values underpinning modern political institutions. That there was a need for this kind of fusion is difficult to dispute, especially since the provision of health care has in most developed countries become an ever more important concern of our political institutions, with governments playing a significant role in regulating and facilitating the provision of health care and in many countries even largely organizing it. There is, nevertheless, still room for dispute about how best to achieve this fusion and how to best think about autonomy and consent in a biomedical context. The simplest model we can have is probably about how being a person is largely about having the capacity of autonomous choice and that the main mode through which we exercise autonomy is by providing informed consent. Yet, liberal democracy's core idea that human beings have a high and equal value is also found in other accounts of the person. The human-rights framework provides an alternative model for thinking about personhood and about patient care. The human-rights approach is grounded, not in an account of autonomy, but in an account of the moral and political personhood that people possess merely by being human beings. In this approach, values like dignity and integrity, both highly relevant in a bioethical context, are identified as distinct values rather than being derived from and therefore reduced to respect for autonomous choice. The human-rights approach can supplement the problematic notion of autonomy that has been central to bioethics by placing this notion in a broader, strongly pluralistic framework.