Ethics

"Having convinced herself that Mr Casaubon was altogether right, she recovered her equanimity, and was an agreeable image of serene dignity when she came into the drawing-room in her silver-grey dress—the simple lines of her dark-brown hair parted over her brow and coiled massively behind, in keeping with the entire absence from her manner and expression of all search after mere effect. Sometimes when Dorothea was in company, there seemed to be as complete an air of repose about her as if she had been a picture of Santa Barbara looking out from her tower into the clear air; but these intervals of quietude made the energy of her speech and emotion the more remarked when some outward appeal had touched her."

"Soon after the time of Açoka, the great Buddhist emperor of the third century before Christ, India became the theater of protracted invasions and wars. Vigorous tribes from the North conquered the region of the upper Pan jab and founded several states, among which the Kingdom of Gandhâra became most powerful. Despoliations, epidemics, and famines visited the valley of the Ganges, but all these tribulations passed over the religious institutions without doing them any harm. Kings lost their crowns and the wealthy their riches, but the monks chanted their hymns in the selfsame way. Thus the storm breaks down mighty trees, but only bends the yielding reed. By the virtues, especially the equanimity and thoughtfulness, of the Buddhist priests, the conquerors in their turn were spiritually conquered by the conquered, and they embraced the religion of enlightenment."

"What I find terrifying is the detachment and equanimity with which we view and discuss an unbearable tragedy. We all know that if Russia or China were guilty of what we have done in Vietnam, we would be exploding with moral indignation at these monstrous crimes."

"The most extraordinary man... is John Dalton... He is generally styled... the Father of Modern Chemistry... Yet this man... is earning... a penurious existence by teaching boys the elements of mathematics, with which he is so totally occupied, that he can hardly snatch a moment for the prosecution of discoveries which have already put his name on a level with the courtly and courted Davy. But the remarkable thing is that this simple and firm-minded man preserves all the original simplicity and equanimity of his mind, and calmly leaves his fame, like Bacon, to other nations and future ages."

"Nor can the violation of the Great Church be listened to with equanimity. For the sacred altar, formed of all kinds of precious materials and admired by the whole world, was broken into bits and distributed among the soldiers, as was all the other sacred wealth of so great and infinite splendor. [...] Nay more, a certain harlot, a sharer in their guilt, a minister of the furies, a servant of the demons, a worker of incantations and poisonings, insulting Christ, sat in the patriarch's seat, singing an obscene song and dancing frequently."

"Diane di Prima, revolutionary activist of the 1960s Beat literary renaissance, heroic in life and poetics: a learned humorous bohemian, classically educated and twentieth-century radical, her writing, informed by Buddhist equanimity, is exemplary in imagist, political and mystical modes. ...She broke barriers of race-class identity, delivered a major body of verse brilliant in its particularity."

"Vermont sort of demands humility and equanimity. No one really cares if you’re fancy or high achieving, and if you lead with that energy you will learn quickly that it’s unwelcome. There’s a coldness here that shocked me for years—but I’ve learned to appreciate the authenticity. No one’s faking much of anything; there’s no lipstick on the pigs here."

"By letting go of happiness and unhappiness, as a result of the earlier disappearance of pleasure and pain, I lived having attained the pure equanimity and mindfulness of the fourth absorption, which is free of happiness and unhappiness."

"Unless plutocracy can persuade the majority of the people to close up the public schools and make illiterates of the next generation, and unless it can also persuade them to give up the electoral franchise, plutocracy is doomed. So much is clear. And that is the reason why we Socialists can look with such equanimity and complacence into the future. The future belongs to some form of Socialism."

"I perform, sir, the rite of equanimity. I abandon all bad activity for the course of my life, threefold by threefold, in mind, body and speech. I will not perform nor cause anybody to perform nor approve anybody performing any bad action. I repent of it, sir, I censure, reject and abandon myself."

"[M]an cuts out for himself a manageable world: he throws himself into action uncritically, unthinkingly. He accepts the cultural programming that turns his nose where he is supposed to look; he doesn't bite the world off in one piece as a giant would, but in small manageable pieces, as a beaver does. He uses... "character defenses": he learns not to expose himself, not to stand out... to embed himself in other-power, both of concrete persons and of things and cultural commands; the result is that he comes to exist in the imagined of the world around him. He doesn't have to have fears when his feet are solidly mired and his life mapped out in a ready-made maze. All he has to do is to plunge ahead in a compulsive style of drivenness in the "ways of the world" that the child learns and in which he lives later as a... grim equanimity."

"Remember that the term Rational was intended to signify a discriminating attention to every several thing and freedom from negligence; and that Equanimity is the voluntary acceptance of things which are assigned to thee by the common nature; and the is the elevation of the intelligent part above the pleasurable or painful sensations of the flesh, and above that poor thing called fame, and death, and all such things. If then, thou maintainest thyself in the possession of these names, without desiring to be called by these names by others, thou wilt be another person and wilt enter into another life."

"When a monk abides [in equanimity], if his mind inclines to talking, he resolves: ‘Such talk as is low, vulgar, coarse, ignoble, unbeneficial, and which does not lead to disenchantment, dispassion, cessation, peace, direct knowledge, enlightenment, and Nibbāna, that is, talk of kings, robbers, ministers, armies, dangers, battles, food, drink, clothing, beds, garlands, perfumes, relatives, vehicles, villages, towns, cities, countries, women, heroes, streets, wells, the dead, trivialities, the origin of the world, the origin of the sea, whether things are so or are not so: such talk I shall not utter.’"

"[W]hen a Westerner discusses, say, Hindu-ism or Buddhism, he is always conscious of the fundamental differences between these ideologies and his own. He may admire this or that of their ideas, but would naturally never consider the possibility of substituting them for his own. Because he a priori admits this impossibility, he is able to contemplate such really alien cultures with equanimity and often “with sympathetic appreciation. But when it comes to Islam - which is by no means as alien to Western values as Hindu or Buddhist philosophy this Western equanimity is almost invariably disturbed by an emotional bias. Is it perhaps, I sometimes wonder, because the values of Islam are close enough to those of the West to constitute a potential challenge to many Western concepts of spiritual and social life?"

"Be not uneasy, discouraged, or out of humour, because practice falls short of precept in... particulars. If you happen to be beaten, come on again, and be glad if most of your acts are worthy of human nature. Love that to which you return, and do not go like a schoolboy to his master with... ill will. ...[Y]ou must apply to philosophy... as those who have sore eyes make use of a good receipt. And when you are thus disposed, you will easily acquiesce in reason, and make your abode with her. ...[P]hilosophy will put you upon nothing but what your nature wishes and calls for. But you are crossing the inclinations of your nature. Is not this the most agreeable? And does not pleasure often deceive us under this pretence? ...[W]hat is ...more delightful than greatness of mind, and generosity, simplicity, equanimity, and piety? And once more, what can be more delightful than prudence? than to be furnished with that faculty of knowledge and understanding which keeps a man from making a false step, and helps him to good fortune in all his business?"

"Sapphire produces peace of mind and equanimity. It chases out evil thoughts by establishing healthy circulation. It opens barred doors to the spirit. It produces a desire for prayer. It brings peace, but he who would wear it must lead a pure and holy life."

"Adversity, if a man is set down to it by degrees, is more supportable with equanimity by most people than any great prosperity arrived at in a single lifetime. Nevertheless a certain kind of good fortune generally attends self-made men to the last. ...[I]t often happens that the grandson of a successful man will be more successful than the son—the spirit ...having lain fallow ...ready for fresh exertion in the grandson. A very successful man, moreover, has something of the hybrid in him; he is a new animal, arising from the coming together of... unfamiliar elements and... the reproduction of abnormal growths, whether animal or vegetable, is irregular and not to be depended upon..."

"Fisher the Breezebuilder: Trouble with the trolley, eh?"

"Michael: Well, obviously the dilemma is clear. How do you kill all six people? So I would dangle a sharp blade out the window to slice the neck of the guy on the other track as we smush our five main guys."

"Rursus prosperum ac felix scelus virtus vocatur; sontibus parent boni, ius est in armis, opprimit leges timor."

"Es stände besser um die Welt, wenn die Mühe, die man sich gibt, die subtilsten Moralgesetze auszuklügeln, zur Ausübung der einfachsten angewendet würde."

"The Whites, by law of conquest, by justice of civilization, are masters of the American continent, and the best safety of the frontier settlements will be secured by the total annihilation of the few remaining Indians. Why not annihilation? Their glory has fled, their spirit broken, their manhood effaced; better that they die than live the miserable wretches that they are."

"When the dictators of today appeal to reason, they mean that they possess the most tanks. They were rational enough to build them; others should be rational enough to yield to them."

"Although only few have admitted it, not even the standard and seemingly uncontroversial demands for universality, consistency and coherence can be upheld in non-cognitivist philosophy. Thus we are deprived of a platform on which to take a critical stance, and simply have to accept the given as it is. Legal non-cognitivism slides easily into the decisionism of the leading legal theorist of the Third Reich, Carl Schmitt."

"The market is neutral and relativistic; it does not inquire as to the origin or validity of the desires it responds to. ... We do not think we require discussions about our use of resources but are willing simply to sum up dollar-backed private desires. There is a rather good correspondence between these characteristics of the market and the relativistic, subjectivistic ways of thinking about ethical issues."

"With his attractive picture of human flourishing, Aristotle offers lasting refuge against the seas of moral relativism. Taking us on a tour of the museum of the virtues — from courage and moderation, through liberality, magnificence, greatness of soul, ambition, and gentleness, to the social virtues of friendliness, truthfulness, and wit — and displaying each of their portraits as a mean between two corresponding vices, ­Aristotle gives us direct and immediate experience in seeing the humanly beautiful. Anyone who cannot see that courage is more beautiful than cowardice or rashness, or that liberality is more beautiful than miserliness or prodigality, suffers, one might say, from the moral equivalent of color-blindness."

"It is as if a man were acquiring the knowledge of the humors and desires of a great strong beast which he had in his keeping, how it is to be approached and touched, and when and by what things it is made most savage or gentle, yes, and the several sounds it is wont to utter on the occasion of each, and again what sounds uttered by another make it tame or fierce, and after mastering this knowledge by living with the creature and by lapse of time should call it wisdom, and should construct thereof a system and art and turn to the teaching of it, knowing nothing in reality about which of these opinions and desires is honorable or base, good or evil, just or unjust, but should apply all these terms to the judgments of the great beast, calling the things that pleased it good, and the things that vexed it bad. ... Do you suppose that there is any difference between such a one and the man who thinks that it is wisdom to have learned to know the moods and the pleasures of the motley multitude in their assembly?"

"If mind/subjectivity weren't a natural feature of the cosmos, then the mind-dependence of value might indeed impugn its status. Yet mind is as much a part of the natural world as are atoms and molecules. The "subjectivity" of value no more threatens its reality than the "subjectivity" of pain makes surgical anaesthetics redundant. For sure, it's all in the mind. But minds are all in the world."

"Overall, the German system for compensating for medical injury illustrates the imagination and freedom of the courts in developing the rules patient. As noted, the effect is over-compensation (on a corrective justice approach), but this has been seen as an aspect of permissible loss redistribution. At least in the past, in the context of the affluent conditions of German society, with costs shared between the social security system and liability insurers, this was a stable solution with broad support, which kept reform initiatives in this area largely off the political agenda. This position is now under threat in light of the ever higher sums of damages awarded in a minority of cases, as well as the increasing tendency for patients' social and private insurers to invoke their rights of subrogation. As noted above, this is beginning to produce a crisis in the medical liability insurance sector. Although some commentators have expressed the hope that patient safety initiatives, once they bear fruit, may lead to a fall in such cases, this seems unlikely: as noted, one of the findings underlying the patient safety movement is how rarely cases of medical injury lead to a compensation claim. It will at any rate be interesting to see how matters develop in the future."

"Under state law, a patient may pursue a civil claim against physicians or other health care providers, called medical liability or medical malpractice, if the health care provider causes injury or death to the patient through a negligent act or omission. To recover damages, the patient must establish: 1. The physician owed a duty to the patient. 2. The standard of care and that the physician violated that standard. 3. A compensable injury. 4. The violation of the standard of care caused the harm suffered by the patient."

"Medical malpractice and compensation for medical injuries are highly visible, controversial, and publicly debated topics that regularly create tension and innovation in legal systems around the world, but the analysis and debate in each country is often limited to national audiences with an assumption that the issues are unique to that location. These chapters address this subject matter in a uniquely global context that demonstrates the universal nature of the issues and the diversity of approaches currently taken around the world and reveal key areas of tension and the likely direction of future developments. Wherever possible, the analysis is supported by reference to the available empirical data, though in many countries this is unfortunately very limited."

"“Health courts” would “entail some huge potential increases in total system costs. …If we take health care proponents at their word, their goal is to bring…currently non-claiming people into the process.” This, however “would multiply the number of claims involving negligence by a factor between 33 and 50.”"

"In Canada, as in the United States, there is a perception that the country is in the throes of a malpractice "crisis" involving both liability and insurance issues-health care providers perceive an increased exposure to or risk of legal availability for ever larger amounts of money. However, claims data from the two countries vary widely, in part because of procedural and doctrinal difference between the two legal systems."

"In order to prevail in a medical malpractice action, the patient must prove that an injury resulted from the substandard medical care. If the patient has other medical conditions, the patient may have to prove that a claimed injury was caused by the alleged medical negligence and not by a different medical condition. Not all incidents of medical malpractice will support a medical malpractice claim, as even a clear medical error may not result in damages to the patient. Damages are a necessary element of a medical malpractice claim. If the patient's treatment or prognosis is not affected by the negligent act or omission, the patient may not be entitled to compensation."

"Mr Darnley’s lawyer, Deborah Blythe of law firm Russell Cooke, told the HSJ: “The defendants were arguing that the giving of information about the availability of medical assistance is purely a matter of courtesy. Even if they get it horribly wrong the trust shouldn’t be responsible for any consequences. That has now changed.” Today’s ruling overturned judgements made in the High Court and Court of Appeal. After its success in the Court of Appeal last year, NHS Resolution said this claim was “a novel one which we considered important to resist in the interests of the NHS” because “opening up receptionists to negligence claims of this kind would have had very serious consequences for the NHS.”"

"A claim based upon lack of informed consent alleges that had the risks been properly disclosed to the patient, the patient would have declined treatment or sought a different course of treatment. If a healthcare professional fails to obtain informed consent, even if the care provided satisfied the governing standard of care, it may be possible for the patient to bring a medical malpractice case if the patient experiences an unexpected side-effect or complication."

"The Swedish system begins, like U.S. “health court” proposals, with an insurance component. This is where the great majority of Swedish claims are settled. The insurance adjuster confers with doctors and medical advisors who are specialists in their fields and decides within a year whether to pay the victim this extra amount above what the government is already paying. Compensation is based on each victim’s specific injury. Non-economic (i.e., pain and suffering) damages, based on age and injury, are capped."

"In response to increasing costs of medical malpractice insurance and insurers withdrawing from the market in the late 1980s, Virginia and Florida both created funds to compensate families for the lifetime medical expenses they incur when their child is born severely impaired because of neurological injuries suffered during the birthing process. Infants were singled out because lawsuits associated with these cases have a relatively high success rate and successful cases tend to result in large monetary awards. The fund and claims process is an alternative to malpractice litigation. If a family that volunteered for the program is eligible for coverage, it cannot pursue a malpractice claim; if it is found ineligible for coverage, it can then litigate."

"In 1978 the Pearson Commission in the United Kingdom rejected a no-fault system in dealing with clinical negligence. While declaring the existing tort system as costly, cumbersome, prone to delay, and too capricious in its operation to be defensible, the commission rejected no-fault compensation on grounds of the difficulty in overhauling the tort liability system and the perceived difficulties in causation judgments. A general conservatism in the legal profession and opposition from the insurance industry were other factors. Much has changed in the NHS since then."

"As is the problem in other countries, there has been an increasing recognition in Germany of the prevalence of avoidable patient injury in the course of medical treatment. In 2007 an expert committee charged with monitoring developments presented statistics (compiled on the basis of 184 studies) suggesting an annual rate of preventable adverse events (vermeidbare unerwiinschte Ereignisse) of 2-4% in hospital care, and a PAE-related mortality rate of 0.1%.6 Given that some 17 million in-patient treatments take place each year, this corresponds to half-a-million injuries and 17,000 preventable deaths."

"Overall, 32 reports examining the association between doctors’ sex and medico-legal action were included in the systematic review (n=4,054,551), of which 27 found that male doctors were more likely to have experienced medico-legal action. 19 reports were included in the meta-analysis (n=3,794,486, including 20,666 cases). Results showed male doctors had nearly two and a half times the odds of being subject to medico-legal action than female doctors. Heterogeneity was present in all meta-analyses. Male doctors are more likely to have had experienced medico-legal actions compared to female doctors. This finding is robust internationally, across outcomes of varying severity, and over time."

"For years, proponents of wiping out the right to jury trials in U.S. medical malpractice cases have pointed to two countries with “no-fault” systems – Sweden and New Zealand – maintaining that if such systems work in those countries, they can also work here. This contention has become part of the case for so-called “health courts,” a U.S. proposal that would force all medical malpractice cases into a system based on workers’ compensation “no-fault” models."

"Using these sources of guidance and others, seven main principles have been described as guiding the conduct of ethical research: Social and clinical value, Scientific validity, Fair subject selection, Favorable risk-benefit ratio, Independent review, Informed consent, Respect for potential and enrolled subjects."

"Medical necessity has traditionally meant targeting disease processes to achieve physiological health. Transgender treatments such as hormones instead disrupt physiological health to achieve a body that aligns with a patient’s mental state. This new direction mandates that doctors adjust their risk assessment to accept iatrogenic side effects as a necessary cost of treating patients. This is in stark contrast to the traditional “do no harm” approach that doctors are bound to by oath, cracking medicine’s foundational integrity. …It remains to be seen if medicine will continue to operate within the boundaries of healing disease under an oath to “first, do not harm,” or be pushed into unchartered territory that dismisses the potential of causing disease [and infertility] in an effort to heal the psyche of gender-distressed children."

"I believe in individual freedom; that's my primary and complete commitment—individual liberty. That’s what it's all about. And that's what socialism was supposed to be about, or anarchism was supposed to be about, and tragically has been betrayed. … I feel much safer in your company."

"Solidarity involves commitment."

"The closer a man approaches tragedy the more intense is his concentration of emotion upon the fixed point of his commitment, which is to say the closer he approaches what in life we call fanaticism."

"It takes two things to change the world, and you'd be surprised how many people have good ideas, but—commitment? true commitment?—that's the hard one. It requires sacrifice."

"That is, I suggest that we need not only an evolutionary epistemology but also an evolutionary account of moral traditions, and one of a character rather different than hitherto available. Of course the traditional rules of human intercourse, after language, law, markets and money, were the fields in which evolutionary thinking originated. Ethics is the last fortress in which human pride must now bow in recognition of its origins. Such an evolutionary theory of morality is indeed emerging, and its essential insight is that our morals are neither instinctual nor a creation of reason, but constitute a separate tradition – 'between instinct and reason', as the title of the first chapter indicates – a tradition of staggering importance in enabling us to adapt to problems and circumstances far exceeding our rational capacities. Our moral traditions, like many other aspects of our culture, developed concurrently with our reason, not as its product. Surprising and paradoxical as it may seem to some to say this, these moral traditions outstrip the capacities of reason."

"If evolutionary ethics were sound, we ought to be entirely indifferent as to what the course of evolution may be, since whatever it is is thereby proved to be the best."