As medical technology has advanced, the question of medical futility has become a topic of intense debate both within the medical community and within society as a whole. However, a unanimous definition thereof is yet to be decided—some commentators are sceptical as to whether an agreement will ever be reached—and this continues to lead to difficulties, tension, and even legal action when a treating physician disagrees with a patient and/or a patient’s family regarding care and treatment options. Although living in (...) a pluralistic society presents one of the major reasons as to why, despite 30 years of intense discussion, no consensus has been made; the issue of medical futility will always be complex as it is, by nature, multifaceted, and numerous elements—including possible risks, evidence of the probability of benefit, the wishes of the patient (and family), professional standards, and cost—interact. Nevertheless, the global medical community has seen the development of two distinctly different approaches to medical futility: one in which the autonomy of patients is of paramount importance in the decision whether or not to pursue a treatment; and one in which beneficence and primum non nocere—first do no harm—are almost entirely the clinician’s prerogative, and whereby he/she has a duty to refuse any treatment for which the potential risks outweigh the potential benefits for the patient. Recently, however, there has been a rejection of this dichotomous view of medical futility and the apparent “power struggle” between physician and patient, and a positive movement towards a more collaborative decision-making process that highlights the necessity of communication, aiming to result in the obtainment of the best possible outcome for each patient as an individual. (shrink)

Hypocrisy is a multi-faceted concept that has been studied empirically by psychologists and discussed logically by philosophers. In this study, we pose various behavioral scenarios to research participants and ask them to indicate whether the actor in the scenario behaved hypocritically. We assess many of the components that have been considered to be necessary for hypocrisy (e.g., the intent to deceive, self-deception), factors that may or may not be distinguished from hypocrisy (e.g., weakness of will), and factors that may moderate (...) hypocrisy (e.g., the degree of discrepancy between the attitude and behavior, whether the attitude is stated publicly, and the nature and severity of the behavioral consequences). Our findings indicate that lay conceptions of hypocrisy are often at odds with philosophical speculation. We argue that a complete understanding of the criteria for hypocrisy requires consideration of how ordinary people construe the concept. In contrast to some concepts (e.g., physical causation), for which lay conceptions, while interesting, are largely irrelevant, hypocrisy is an essential component of social judgment. One could argue, therefore, that folk wisdom is the ultimate arbiter of what hypocrisy entails. We note limitations of our methodology and suggest avenues for future research. (shrink)

This book takes a new approach to ethics by focusing on the kinds of dilemmas that confront people almost daily on the job.

Following extensive examination of published and unpublished materials, we provide a history of the use of dexamethasone in pregnant women at risk of carrying a female fetus affected by congenital adrenal hyperplasia (CAH). This intervention has been aimed at preventing development of ambiguous genitalia, the urogenital sinus, tomboyism, and lesbianism. We map out ethical problems in this history, including: misleading promotion to physicians and CAH-affected families; de facto experimentation without the necessary protections of approved research; troubling parallels to the history (...) of prenatal use of diethylstilbestrol (DES); and the use of medicine and public monies to attempt prevention of benign behavioral sex variations. Critical attention is directed at recent investigations by the U.S. Food and Drug Administration (FDA) and Office of Human Research Protections (OHRP); we argue that the weak and unsupported conclusions of these investigations indicate major gaps in the systems meant to protect subjects of high-risk medical research. (shrink)

We are living at the dawn of the first truly scientific picture of the universe-as-a-whole, yet people are still dragging along prescientific ideas about God that cannot be true and are even meaningless in the universe we now know we live in. This makes it impossible to have a coherent big picture of the modern world that includes God. But we don't have to accept an impossible God or else no God. We can have a real God if we redefine (...) God in light of knowledge no one ever had before. The key question is, “Could anything actually exist in the scientific universe that is worthy of the name, God?” My answer is yes: God is an “emergent phenomenon,” as real as the global economy or the government or the worldwide web, which are all emergent phenomena. But God arose from something deeper: the complex interactions of all humanity's aspirations. An emerging God has enormous implications. (shrink)

Confidentiality is a cornerstone of the physician-patient relationship. Breaches of confidentiality in the context of genetic testing are of particular concern for a number of reasons. First, genetic testing reveals information not only about a particular patient, but also about his or her family members. Second,genetic testing can label healthy people as “at risk,” subjecting them to possible stigmatization or discrimination by third parties. Third, as genetic testing becomes more widespread and is incorporated into primary care, breaches of confidentiality might (...) inadvertently occur more frequently because primary care providers may not be trained to understand the uniqueness of genetic information. Until now, genetic services have been provided primarily by medical geneticists and genetic counselors. However, with the proliferation of new genetic presymptomatic and carrier tests, primary care physicians are going to become increasingly involved in genetic testing. Currently, little is known about physicians’ attitudes toward disclosure of confidential genetic information to third parties. (shrink)

The question of a genealogy of race and gender is first and foremost a question of methodology. By bringing to bear the critical tools provided by Foucauldian methodology on the construction of race and gender in the specific historical case of Levittown, this chapter explores the manner in which the stories that inform our sense of “the way things are,” are shaped historically. Moreover, the chapter argues that the significance of the institutions and discourses becomes apparent only once they are (...) placed within the context of the play of relations of power and the deployment of bodies of knowledge. A genealogical analysis of Levittown reveals that the concepts of race and gender are not only essential to any conception of modern subjectivity, but also for the products of a network of relations of power. (shrink)

This is the first book-length study of the conception of emotions in premodern, or more specifically, pre-Han Chinese philosophical traditions, ranging from the early-5th to the late-3rd centuries BCE. This era is known as the "Warring States period" in China and marked by the flourishing of a number of different schools of philosophers who advocated their visions of how society should be run. The author looks at wide-ranging views about the nature of emotions and their proper role in moral life (...) espoused by representative thinkers of the time. The approach taken by the author is based on a premise that what constitutes emotions as phenomena in the world is of primary importance to questions concerning the... (shrink)

Cancer rates in men and women of reproductive age have continued to increase in recent years; however, therapy has dramatically decreased the mortality rates. Since 1990, the prevalence of cancer survivors in young adults increased from 1 in 1,000 to 1 in 250 patients due to more aggressive therapies. Current therapies may have profound toxic effects on gamete function with infertility as an expected consequence of cancer therapy. Depending on the site and stage of cancer, age of the patient, and (...) the type of treatment, approximately 90% of men and women diagnosed with cancer may be at risk of permanent infertility.Fertility preservation has emerged as a discipline dedicated to improving the future reproductive potential of cancer survivors. Significant progress in the advancement of fertility preservation therapies and a heightened awareness of the availability of therapies has occurred in the past 10 years. The American Society of Clinical Oncology and the American Society of Reproductive Medicine have advanced these efforts by formally recognizing the importance of fertility awareness. (shrink)

BackgroundThis paper represents a portion of the findings from one of the first research studies eliciting the lived experience of adults with an early diagnosis of Phenylketonuria living in Ireland. Ireland has one of the highest prevalence rates of PKU in Europe, however, little is known about the experience of Irish adults with PKU. Furthermore, Ireland is one of the first countries in the world to introduce neonatal screening followed by the introduction of long-term dietary therapy over 50 years ago. (...) This study presents the first comprehensive assessment of the lived experience of Irish adults with PKU on long term dietary therapy.MethodsNarrative data was collected from eleven self-selected participants, using semi-structured interviews. The interviews were divided into five sections focused on eliciting a holistic understanding of the lived experience of adults with PKU living in Ireland. Thematic analysis was guided by Colaizzi's Framework in conjunction with NVivo qualitative data analysis software.FindingsFindings from the original research encompassed a broad understanding of the lived experience of adults with PKU living in Ireland, including factors influencing dietary therapy and managing PHE blood levels. The themes being discussed within this article are those which appear to be least represented within current literature: living with PKU, including reproductive health, the importance of self-management and establishing routine, support networks in adulthood and concerns regarding aging with PKU.ConclusionIt was evident from the findings that a diagnosis of PKU can influence how adults with PKU may experience aging and their own mortality. These findings offer new insight into the vulnerability attached to the experience of aging with PKU and may be beneficial to advocacy groups and for future development of policy and practice. (shrink)

Ellen Meiksins Wood is a leading contemporary political theorist who has elaborated an innovative approach to the history of political thought, the social history of political theory .

The formation of the modern state, the rise of capitalism, the Renaissance and Reformation, the scientific revolution and the Age of Enlightenment have all been attributed to the “early modern” period. Nearly everything about its history remains controversial, but one thing is certain: it left a rich and provocative legacy of political ideas unmatched in Western history. The concepts of liberty, equality, property, human rights and revolution born in those turbulent centuries continue to shape, and to limit, political discourse today. (...) Assessing the work and background of figures such as Machiavelli, Luther, Calvin, Spinoza, the Levellers, Hobbes, Locke and Rousseau, Ellen Wood vividly explores the ideas of the canonical thinkers, not as philosophical abstractions but as passionately engaged responses to the social conflicts of their day. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Putting the ethical tools of philosophy to work, Ellen K. Feder seeks to clarify how we should understand "the problem" of intersex. Adults often report that medical interventions they underwent as children to "correct" atypical sex anatomies caused them physical and psychological harm. Proposing a philosophical framework for the treatment of children with intersex conditions—one that acknowledges the intertwined identities of parents, children, and their doctors—Feder presents a persuasive moral argument for collective responsibility to these children and their families.

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)