A chief objection to opt-out organ donor registration policies is that they do not secure people's actual consent to donation, and so fail to respect their autonomy rights to decide what happens to their organs after they die. However, scholars have recently offered two powerful responses to this objection. First, Michael B Gill argues that opt-out policies do not fail to respect people's autonomy simply because they do not secure people's actual consent to donation. Second, Ben Saunders argues that opt-out (...) policies do secure people's actual—if not explicit—consent, provided that certain conditions are satisfied. I argue that Gill and Saunders’ arguments are not successful. My conclusion does not imply that jurisdictions should not implement opt-out policies—their failure to secure people's actual consent may be outweighed by other considerations. But, my conclusion does imply that Gill and Saunders are mistaken to claim that opt-out policies are respectful of people's autonomy. (shrink)

Deceased organ donation is widely considered as a case of easy rescue―that is, a case in which A may bestow considerable benefits on B while incurring negligent costs herself. Yet, the policy implications of this observation remain unclear. Drawing on Christopher H. Wellman’s samaritan account of political obligations, the paper develops a case for a so-called opt-out system, i.e., a scheme in which people are defaulted into being donors. The proposal’s key idea is that we may arrange people’s options in (...) specific ways for the sake of others. (shrink)

As the HIV epidemic continues to grow worldwide, women are increasingly and disproportionally affected. With the introduction of anti-retroviral medications that have been found to effectively prevent perinatal transmission of HIV, the approach to HIV testing in pregnant women has grown increasingly more controversial. In recent years, the model of voluntary counseling and testing (VCT) has come into question with opt-out testing now advocated for by the Centers for Disease Control and occurring widely in pregnancy. The benefits of opt-out testing (...) are numerous and may justify its use in replacing the VCT that many have come to see as insufficient. An ethical analysis of opt-out testing suggests it may be at odds with true informed consent and involve a degree of coercion that would not be allowed outside the prenatal setting. If opt-out testing is going to remain the standard of care then the ethical issues it raises must be made transparent. Strategies need to be designed for ensuring that HIV counseling and testing in pregnancy is done in accordance with ethical and reproductive rights principles. (shrink)

This paper defends an ‘opt-out’ scheme for organ procurement, by distinguishing this system from ‘presumed consent’ (which the author regards as an erroneous justification of it). It, first, stresses the moral importance of increasing the supply of organs and argues that making donation easier need not conflict with altruism. It then goes on to explore one way that donation can be increased, namely by adopting an opt-out system, in which cadaveric organs are used unless the deceased (or their family) registered (...) an objection. Such policies are often labelled ‘presumed consent’, but it is argued that critics are right to be sceptical of this idea—consent is shown to be an action, rather than a mental attitude, and thus not something that can be presumed. Either someone has consented or they have not, whatever their attitude to the use of their organs. Thankfully, an opt-out scheme need not rest on the presumption of consent. Actual consent can be given implicitly, by one's actions, so it is argued that the failure to register an objection (given certain background conditions) should itself be taken as sign of consent. Therefore, it is permissible to use the organs of someone who did not opt out, because they have—by their silence—actually consented. (shrink)

This paper looks at the ethics of opt-in vs. opt-out of organ donation as Scotland has transitioned its systems to promote greater organ availability. We first analyse studies that compare the donation rates in other regions due to such a system switch and find that organ increase is inconclusive and modest at best. This is due to a lack of explicit opt-out choices resulting in greater resistance and family override unless there are infrastructures and greater awareness to support such change. (...) The paper then looks at the difference between informed consent of the opt-in vs. presumed consent in the opt-out approaches. Patient autonomy and dignity are better reflected with informed consent. Eighteen months have passed since the new organ donation policy has come into effect, this paper recommends more research into organ donors’ psychological motivations to help governments and the healthcare profession obtain more organs for transplantation. (shrink)

Much has been written about the global convergence on constitutional supremacy. Yet, a closer look suggests that while constitutional convergence trends are undoubtedly extensive and readily visible, expressions of constitutional resistance or defiance may in fact be regaining ground worldwide. This may point to a paradox embedded in global constitutionalism: the more expansive constitutional convergence trends are, the greater the likelihood of dissent and resistance are. In this article, I chart the contours of three aversive responses to constitutional convergence: neo-secessionism, (...) nullification, and deference to local authority, and draw on an array of comparative examples to illustrate the distinct logic and characteristics of each of these responses. Taken together, these increasingly common expressions of defiance provide ample evidence that global constitutionalism is not the only game in town. Neo-secessionism, nullification, and other forms of constitutional dissent and “opting out” may thus be viewed as a reaction against the centralization of authority and the decline of the local in an increasingly—constitutionally and otherwise—universalized reality. (shrink)

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the (...) psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An "opting in" paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An "opting in" program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of "organ takers" who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who "opt in" would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An "opting in" paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an "opting in" paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an "opting in" policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity. (shrink)

The book concerns what I take to be the least controversial normative principle concerning action: you ought to perform your best option—best, that is, in terms of whatever ultimately matters. The book sets aside the question of what ultimately matters so as to focus on more basic issues, such as: What are our options? Do I have the option of typing out the cure for cancer if that’s what I would in fact do if I had the right intentions at (...) the right times (e.g., the intention to type the letter T at t1, the intention to type the letter H at t2, the intention to type the letter E at t3, etc.)? If I can’t form intentions voluntarily, does that mean that I don’t have the option of forming the intention that I ought to form? Which options do we assess directly in terms of their own goodness and which do we assess in terms of their relations to the goodness of other options? What do we hold fixed when assessing how good an option is? Do we, for instance, hold fixed the agent’s future beliefs, desires, and intentions? And do we hold fixed the agent’s predictable future misbehavior? Lastly, how do the things that ultimately matter determine the goodness of an option? If one of the things that ultimately matters in determining the goodness of an option is that the option doesn’t involve violating anyone’s rights, do we evaluate the option itself in terms of whether it involves violating anyone’s rights or do we evaluate the option’s prospect in terms of this and then the option in terms of its prospect? And what if there is indeterminacy or uncertainty with regards to whether an option would involve violating someone’s rights? (shrink)

Co-opting the PLO analyzes the Oslo Accords, the interim self-government agreements signed between the government of Israel and the Palestine Liberation Organization, using a theoretical framework based on the work of Gilles Deleuze and Michael Hardt. Guided by these theoretical insights, Weinberger puts forth an innovative and provocative argument about Israel's simultaneous empowerment and disempowerment of its Palestinian partners-in-peace.

Understanding why individuals opt out of living donation is crucial to enhancing protections for all living donors and to identify modifiable barriers to donation. We developed an ethical approach to conducting research on individuals who opted out of living kidney donation and applied it in a small-scale qualitative study at one US transplant centre. The seven study participants had varied reasons for opting out, the most prominent of which was concern about the financial burden from lost wages during the postoperative (...) period. Several reported feeling alone during their decision-making process. Although no participants used an alibi, a centre-provided statement of non-eligibility to donate, all believed that centres should offer alibis to help preserve donor autonomy. Given the complexity of participants' decisions and the emotions they experienced before and after deciding not to donate, we suggest approaches for independent living donor advocates to support this population. This study demonstrates that research on individuals who opt out of donation is feasible and yields valuable insight into methods to improve the evaluation experience for potential living donors. (shrink)

The Organ Donation Act 2019 has introduced an opt-out organ donor register in England, meaning that consent to the donation of organs upon death is presumed unless an objection during life was actively expressed. By assessing the rights of the dead over their organs, the sick to those same organs, and the role of consent in their requisition, this paper interrogates whether such paradigms for deceased organ donation are ethically justifiable. Where legal considerations are applicable, I focus on the recent (...) changes in England as a case in point; however, this paper ultimately challenges the justifiability of opt-out systems in any form, concluding that ethical solutions to organ shortage do not lie in opt-out systems of deceased organ procurement. (shrink)

In African countries such as Ghana, microentrepreneurs make formal economy goods and services available to base of the pyramid (BOP) consumers. Multinational enterprises (MNEs) co-opt BOP business models when they enter the BOP market. We conducted a case study of six MNEs and 36 microentrepreneurs in three key sectors. In two sectors (fast-moving consumer goods and telecommunications), reverse bridging enables MNEs to capture value from BOP business models, which has a negative impact on both the financial and social capital of (...) microentrepreneurs. In the third sector (finance), microentrepreneurs are buffered from the negative effects of co-optation through a process of integrating, which enhances their social capital but reduces their financial capital. Our research contributes to the BOP literature, first by demonstrating that financial and social capital are intertwined at the BOP level, and second by analyzing how the negative effects of co-optation can be cushioned by enhancing microentrepreneurs’ social capital. (shrink)

In the context of organ donation and transplantation, societies are facing an increasing shortage. Several policies have been developed for the overcoming of such a deficit, mainly 'Opting-In', 'Opting-Out', and 'Required Request'. We believe that, as regards this opting between social policies for harvesting, moral theology has an opinion to share with other thinkers and with the decision-makers of our society. In order to present our Christian view, we start with considering the reasons that make us capable of using the (...) remains of a human person after death, the corpse. We see how every human being holds a right for respect of the remains of his/her former body, the corpse, but other human beings with equal dignity may be compelled to use those remains when their right at stake is of a higher rank, even in case that use goes against the due respect. In this line of thought two moral principles will be sorted out, showing the axis of our evaluation of the different policies, namely the 'benefit of the patients in need of transplantation' and a threefold 'consent', the consent of the deceased, the consent of his/her family, and the consent of his/her society. Analyzing the main strategies for harvesting transplantable organs currently applied through this set of criteria, we see how a sort of 'Routine Salvaging' and a type of 'Informed-Consent' in which we do not perform a wide campaign of education and conscientization, are to be rejected. The remaining types of policies were to be evaluated in each case. We position ourselves in favor of the 'Required Request', holding that it is preferable to ask the question directly than to presume any sort of behavior, whether it be for or against donation. Secondly, we consider that policies following the 'Opting-Out' style may obtain a higher degree of moral righteousness than the ones based on an 'Opting-In policy. In each of them, however, nuances are to be stressed and complementary systems developed, up to the point in which none of them can be enforced alone. (shrink)

In this reply to Wilkinson and De Wispelaere, I argue that an opt-out donation system can be regarded as tacit consent. I first separate the opt-in/opt-out issue from that of the role that the family ought to play. I then argue that what De Wispelaere calls minimal approval-tracking is not obviously necessary and that, even if it were, opt-out schemes can satisfy this requirement.

The time has come to implement the 2006 Centers for Disease Control and Prevention (CDC) recommendations for voluntary, routine opt-out screening for HIV infection in all areas of health care and t...

Objectives To increase postmortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the direct impact of consent policy defaults per se on deceased organ recovery rates when considering the role of the family in (...) the decision-making process. This study does not take into account any indirect effects of defaults, such as potential psychological and behavioural effects on individuals and their relatives. -/- Design Based on previous work regarding consent policies, we created a conceptual model of the decision-making process for deceased organ recovery that included any scenario that could be directly influenced by opt-in or opt-out policies. We then applied this model to internationally published data of the consent process to determine how frequently policy defaults could apply. -/- Main outcome measures We measure the direct impact that opt-in and opt-out policies have per se on deceased organ recovery. -/- Results Our analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. They only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The direct impact of consent policy defaults is typically circumscribed to a range of 0%–5% of all opportunities for organ recovery. Our study also shows that the intervention of the family improves organ retrieval under opt-in but hinders it under opt-out. -/- Conclusions This study may warn policy makers that, by emphasising the need to introduce presumed consent to increase organ recovery rates, they might be overestimating the influence of the default and underestimating the power granted to families. (shrink)

The neglected area of later Greek syntax is explored here with reference to the future optative. This form of the verb first appeared early in the classical age but virtually disappeared during the Hellenistic era. Under the influence of Atticism it reappeared in later literary texts, and this paper is concerned largely with its revival in late legal and epistolary texts on papyrus from Egypt. It is used mainly in set legal phrases of remote future conditions, but we also (...) see it in letters to express wishes (again, largely formulaic) for the future, both of which uses are foreign to Attic Greek. Finally, the future optative's appearance in conjugations on grammatical papyri from Egypt is used to demonstrate the form's presence in education even at the end of the classical world there, with the archive of Dioscorus of Aphrodito uniquely showing both this theoretical knowledge of it and examples of its application in legal documents. (shrink)

« La fin du SIDA » prévue en 2030 par le plan 90-90-90 de l’ONUSIDA est-elle possible au Québec? L’offre universelle proportionnée et systématique de dépistage avec consentement opt-out (consentement présumé) apparait comme la politique sanitaire la plus pertinente et équitable à mettre en place en vue d’identifier les personnes vivant avec le VIH ignorant leur statut sérologique. Cette démarche à première vue contraignante vis-à-vis des libertés individuelles peut être largement compensée par des bénéfices sanitaires, sociaux, économiques et structurels à (...) l’échelle individuelle et populationnelle. Dans la mesure où le VIH/SIDA reste un révélateur puissant des inégalités sociales, cette approche ne sera prolifique qu’en présence d’une ambition politique d’amélioration de l’accès aux soins et de couverture sanitaire universelle et inclusive à l’égard des individus échappant au dépistage. L’approche opt-out au sein des groupes à forte prévalence est une stratégie éthiquement pertinente pour augmenter les taux de dépistage. Bien que le consentement n’y soit pas explicite, la présomption tiendrait compte de « l’injustice structurelle » auxquels les groupes clés – présentant de forts taux de prévalence – sont soumis initialement. Cette dernière est responsable de leurs difficultés d’accès aux soins et aux dépistages. Cet article propose d’uniformiser l’offre de dépistage. Le Comité des Infections Transmissibles Sexuellement et par le Sang du Québec recommande actuellement l’approche opt-in pour les groupes-clés et le consentement opt-out en population générale. Nous pensons que cette différenciation constitue une barrière dans l’accès au dépistage et produit un effet d’éviction des groupes-clés craignant la stigmatisation. (shrink)

We live in a liberal, pluralistic, largely secular society where, in theory, there is fundamental protection for freedom of conscience generally and freedom of religion in particular. There is, however, both in statute and common law, increasing pressure on religious believers and conscientious objectors (outside wartime) to act in ways that violate their sincere, deeply held beliefs. This is particularly so in health care, where conscientious objection is coming under extreme pressure. I argue that freedom of religion and conscience need (...) to be put on a sounder footing both legislatively and by the courts, particularly in health care. I examine a number of important legal cases in the UK and US, where freedom of religion and conscience have come into conflict with government mandates or equality and anti-discrimination law. In these and other cases we find one of two results: either the conscientious objector loses out against competing rights, or the conscientious objector succeeds, but due to what I consider unsound judicial reasoning. In particular, cases involving cooperation in what the objector considers morally impermissible according to their beliefs have been wrongly understood by some American courts. I argue that a reasonable theory of cooperation incorporated into judicial thinking would enable more acceptable results that gave sufficient protection to conscientious objectors without risking a judicial backlash against objectors who wanted to take their freedoms too far. -/- I also venture into broader, more controversial waters concerning what I call freedom of dissociation – the fundamental right to withdraw from associating with people, groups, and activities. It is no more than the converse of freedom of association, which all free societies recognise as a basic right. How far should freedom of dissociation go? What might society be like if freedom of dissociation were given more protection in law than it currently has? It would certainly give freedom of religion and conscience a substantial foundation, but it could also lead to discriminatory behaviour to which many people would object. I explore some of these issues, before going back to the narrower area of freedom of conscience and religion in health care, making some proposals about how the law could strengthen these basic pillars of a liberal, free society. (shrink)

One way of increasing the supply of organs available for transplant would be to switch to an opt-out system of donor registration. This is typically assumed to operate on the basis of presumed consent, but this faces the objection that not all of those who fail to opt out would actually consent to the use of their cadaveric organs. This paper defuses this objection, arguing that people's actual, explicit or implicit, consent to use their organs is not needed. It borrows (...) David Estlund's notion of ‘normative consent’ from the justification of political authority and applies it to the case of organ donation. According to this idea, when it is wrong to withhold consent to something, the moral force of that lack of consent may be null and void. If it is wrong of a person to refuse to donate their cadaveric organs to others, then it may be that their actual consent is not needed. This supports an opt-out system, which provides protection for those who have genuine reasons to refuse donation, and spares the worries as to what the deceased would actually have wanted. (shrink)

We present a model of a fundamental property of consciousness as the capacity of a system to opt among presented alternatives. Any system possessing this capacity is "conscious" in some degree, whether or not it has the higher capacity of reflecting on its opting. We argue that quantum systems, composed of microphysical particles, as studied by quantum mechanics, possess this quality in a protomental form. That is, such particles display the capacity to opt among alternatives, even though they lack the (...) ability to experience or communicate their experiences. Human consciousness stands at the opposite end of the hierarchy of conscious life forms as the most sophisticated system of which we have direct acquaintance. We contend that it shares the common characteristic of a system capable of opting among alternatives. Because the fundamental property of consciousness is shared by human beings and the constituents of elementary matter in the universe, our model of consciousness can be considered as a modified form of panpsychism. (shrink)

Public health is concerned with how to improve the population’s health. At times, though, actions to improve the community’s health may collide with individual civil rights. For example, a public health response to a bioterrorism attack, such as smallpox, may require relaxing an individual’s due process protections to prevent the smallpox from spreading. This tension lies at the heart of public health policy. It also must be considered in discussing the concept of human rights in health.Proponents of incorporating the concept (...) of human rights in health emphasize the importance of both individual rights and collective rights. They argue that observing human rights is not only consistent with broad public health goals, but necessary to their attainment. To many human rights advocates, the concept is not limited to protecting against governmental intrusion. Accordingly, they emphasize the government’s obligation to promote attainment of human rights by, for instance, providing adequate health care. (shrink)

So far overlooked by the international business ethics literature, we introduce, characterize, and normatively analyze the use of affective ties and networks in South Korea from an ethical point of view. Whereas the ethics of using Guanxi in China has been comprehensively discussed, Korean informal networks remain difficult to manage for firms in South Korea due to the absence of existing academic debate and research in this field. In this study, we concentrate mainly on the question of whether foreign firms (...) will and can use affective ties in Korea. The informal social network forms are classified and contrasted with the conventional ethical approaches used in international business ethics to assess which categories can be regarded as ethical or unethical. Finally, foreign firms are advised how to cope with and use different affective network types. Although the nature of affective ties and networks in Korea differs from that found for instance in China, consistent with the conclusion of prior research, we recommend particularistic analysis and decision making regarding the circumstances in which to conclude affective ties and networks and when to opt out. We conclude that foreign firms in Korea should invest in establishing Inmaek, refrain from engaging in Yonjul, and support host country nationals’ Yongo ties. Moreover, it is suggested that foreign firms should find ways to monitor and manage informal ties effectively. (shrink)

This article focuses on the experiences of becoming and being mothers for lesbian co-parents who have children via donor insemination. Rather than the presence of children incorporating lesbians into the mainstream as “honorary heterosexuals,” the author argues that lesbian parenting represents a radical and radicalizing challenge to heterosexual norms that govern parenting roles and identities. It undermines traditional notions of the family and the heterosexual monopoly of reproduction. The same-sex context together with successful collaboration with donors supports the refashioning of (...) kinship relationships. An attentiveness to the gender dynamics of sexuality illuminates further contestations. The author argues that their structural similarities as women place them in contradiction with dominant gender practices enacted in heterosexual relationships. This facilitates the evaluation and negotiation of more egalitarian approaches to work and parenting, and through their operationalization, much of the logic supporting conventional divisions of labor is undermined. (shrink)

In almost all opt-in systems of postmortal organ procurement, if the deceased has not made a decision about donation, his relatives will be asked to make it. Can this decision power be justified? I consider three possible justifications. (1) We could presume the deceased to have delegated this power to his relatives. (2) It could be argued that, if the deceased has not made a decision, a proxy decision has to be made in his best interests. (3) The relatives could (...) have a standing of their own because they are singled out from the parties whose interests are being affected by the decision by the special relation they had to the deceased. None of these arguments turns out to be convincing. (shrink)

This paper clarifies the chronology surrounding the population geneticist Theodosius Dobzhansky's 1937 book, "Genetics and the Origin of Species." Most historians assume (a) Dobzhansky's book began as a series of 'Jesup lectures,' sponsored by the Department of Zoology at Columbia University in 1936, and (b) before these lectures were given, Dobzhansky knew he would produce a volume for the Columbia Biological Series (CBS). Archival evidence forces a rejection of both assumptions. Dobzhansky's 1936 Columbia lectures were not Jesup lectures. The book (...) he intended to write from his lectures began as a stand-alone text in evolutionary genetics; the CBS had been defunct since 1910. In May 1937 -- seven months after Dobzhansky's Columbia lectures -- Leslie Dunn lobbied Columbia University to revive the CBS and the Jesup lecture series. He then quietly back dated, naming Dobzhansky a Jesup lecturer and co-opting his book manuscript as the first volume in the revived CBS. A detailed chronology of this 1936-1937 period is provided. This relocates the CBS and Jesup revivals within the narrow context of zoology at Columbia University. These helped Dunn and colleagues define cutting edges and define themselves as managers and promoters of those edges. (shrink)

In an effort to solve the shortage of transplantable organs, there have been several proposals to introduce an opt-out approach to deceased organ donation in England (also termed ‘deemed’, or ‘presumed’ consent). In seeking to enact the so-called ‘opt-out proposal’ via an amendment to the Human Tissue Act 2004, The Organ Donation (Deemed Consent) Bill 2017–19 represents the most recent attempt at such legal reform. Despite popular calls to the contrary, I argue in this paper that it would be premature (...) for England, or, indeed, any country, to adopt an opt-out approach at this time. Not only is the available evidence inconclusive on whether introduction of the opt-out proposal would increase the supply of transplantable organs (a common misconception), but there is also a chance that doing so might bring about an otherwise avoidable moral harm through an unjustified interference with individual autonomy. I maintain that the resources required to change the law to such effect would be better expended on alternative, provenly efficacious and less contentious mechanisms for increasing the supply of transplantable organs, such as: improving communication with the family of the deceased, developing infrastructure, raising public awareness and enhancing staff training, attitudes and understanding towards organ donation. (shrink)

From all corners of the globe, the on-line revolution is proclaimed. The imperative is to connect; to shop, work, learn, be governed, even fall in love on-line. Government initiatives proliferate globally, stressing the urgency for citizens to become part of the so called Information Society. In the midst of all this euphoria the question must be raised 'Is this opportunity for all, or just a few?' Information and Communication Technologies are being introduced to the teaching and learning process at an (...) increasing pace. E-government ministers are particularly concerned about the 'have-nets' and 'have-nots' in this 'digital revolution'. Our research in schools and the HE sector, looking at women learning on-line, has indicated barriers. We discuss how gendered relations in the home, work and education go far beyond having access to IT. We illustrate how these relations contribute to the shaping of the gendered experiences of using technology in education. So whilst women are urged to get connected, we ask whether or not they will want to use technology as a tool to learn with. We suggest that the current gendered discourse surrounding technology and its use in all areas of society should inform government on-line learning policies globally, cutting through the euphoric hype. (shrink)

Volume 25, Issue 3, September 2019, Page 283-286.

We live in a liberal, pluralistic, largely secular society where, in theory, there is fundamental protection for freedom of conscience generally and freedom of religion in particular. There is, however, both in statute and common law, increasing pressure on religious believers and conscientious objectors (outside wartime) to act in ways that violate their sincere, deeply held beliefs. This is particularly so in health care, where conscientious objection is coming under extreme pressure. I argue that freedom of religion and conscience need (...) to be put on a sounder footing both legislatively and by the courts, particularly in health care. I examine a number of important legal cases in the UK and US, where freedom of religion and conscience have come into conflict with government mandates or equality and anti-discrimination law. In these and other cases we find one of two results: either the conscientious objector loses out against competing rights, or the conscientious objector succeeds, but due to what I consider unsound judicial reasoning. In particular, cases involving cooperation in what the objector considers morally impermissible according to their beliefs have been wrongly understood by some American courts. I argue that a reasonable theory of cooperation incorporated into judicial thinking would enable more acceptable results that gave sufficient protection to conscientious objectors without risking a judicial backlash against objectors who wanted to take their freedoms too far. I also venture into broader, more controversial waters concerning what I call freedom of dissociation – the fundamental right to withdraw from associating with people, groups, and activities. It is no more than the converse of freedom of association, which all free societies recognise as a basic right. How far should freedom of dissociation go? What might society be like if freedom of dissociation were given more protection in law than it currently has? It would certainly give freedom of religion and conscience a substantial foundation, but it could also lead to discriminatory behaviour to which many people would object. I explore some of these issues, before going back to the narrower area of freedom of conscience and religion in health care, making some proposals about how the law could strengthen these basic pillars of a liberal, free society. (shrink)

In contrast to several recent studies that align Vincent van Gogh's plans for a “Studio of the South” with entrepreneurial capitalism, this essay considers the scheme in the context of nineteenth-century cooperative socialism. It traces the artist's experiences among striking miners in Belgium and impoverished weavers in the Netherlands, and it examines the artworks that these encounters inspired. In the process, I identify basic principles that would inform Vincent's plan for a producers' cooperative in Arles in 1888. Working from Vincent's (...) letters, I identify two stages in the development of the artist's proposal. In the winter and spring, Vincent discussed a strategic “association” of Impressionist artists and dealers. By the fall, he had combined this concept with his long-standing desire for companionship; the resulting conception was a cooperative avant-garde atelier in which member artists and dealers would dedicate themselves to maintaining communal working and living spaces and providing materials for production. The essay then explores Vincent's plan in the context of mid-nineteenth-century discussions of cooperative organization. I conclude that Vincent's scheme should be understood as a revival of the reformist, even socialist, literature that was current at mid-century. (shrink)

This paper examines the influences on differential behaviors of multinational enterprises (MNEs) with respect to the adoption and implementation of voluntary codes of conduct in their host country operating environments. Both external institutional and internal leadership and organizational culture factors are offered as those conditions that are expected to predict the respective ability and willingness of firms to conduct their operations in socially responsible ways. A framework for furthering research in this area is developed.