Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

Despite broad agreement that the vulnerable have a claim to special protection, defining vulnerable persons or populations has proved more difficult than we would like. This is a theoretical as well as a practical problem, as it hinders both convincing justifications for this claim and the practical application of required protections. In this paper, I review consent-based, harm-based, and comprehensive definitions of vulnerability in healthcare and research with human subjects. Although current definitions are subject to critique, their underlying assumptions may (...) be complementary. I propose that we should define vulnerability in research and healthcare as an identifiably increased likelihood of incurring additional or greater wrong. In order to identify the vulnerable, as well as the type of protection that they need, this definition requires that we start from the sorts of wrongs likely to occur and from identifiable increments in the likelihood, or to the likely degree, that these wrongs will occur. It is limited but appropriately so, as it only applies to special protection, not to any protection to which we have a valid claim. Using this definition would clarify that the normative force of claims for special protection does not rest with vulnerability itself, but with pre-existing claims when these are more likely to be denied. Such a clarification could help those who carry responsibility for the protection of vulnerable populations, such as Institutional Review Boards, to define the sort of protection required in a more targeted and effective manner. (shrink)

Non‐Interventionist Objective Divine Action (NIODA), introduced by Robert John Russell, is a model of divine action drawing upon insights from quantum mechanics. It presents an intriguing and significant challenge to classical conceptions of divine action with far‐reaching consequences. When applying NIODA to theistic evolution, however, significant questions emerge that require attention. We identify and assess two sets of concerns. The first relates to quantum physics, particularly whether and how quantum occurrences influence mutations and evolution. We argue that the current empirical (...) evidence is ambiguous in its support of the kinds of quantum action that Russell proposes, though emerging data from quantum biology look promising. The second set of concerns is metaphysical, especially concerning the problem of evil. NIODA gives Godextensive agency over evolution and genetics, which has adverse consequences for theodicy. We propose potential solutions to the problems highlighted in our article, both metaphysical and physical, to improve the viability of NIODA's application to theistic evolution. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Park and Davies’ overview of arguments in favor and against vaccine sensitive allocation is a very useful summary (Park and Davies 2024). Discussions regarding whether it was ever justifiable to wi...

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

This article applies Paul Tillich's existentialist analysis of the human predicament, particularly what it means to exist and to be fallen, to social media. I argue that social media heightens feelings of alienation and estrangement, supporting this claim with evidence from empirical research in psychiatry and communication studies. Thus, I offer an application of a Tillichian approach to an area of culture previously unexamined in this way. I identify three primary ways in which social media exacerbates existentialist emotional states: social (...) media allows us to construct artificial versions of ourselves through the use of filters and photo editing software; it provides the means to quantify social approval in groups the size of which the human brain has not evolved for; it extends the size of our social networks but decreases the quality of interactions. Social media is yet to receive significant philosophical or theological engagement despite its prevalence, particularly within younger generations. I argue that this is a mistake – philosophy has a duty to engage with such a ubiquitous feature of modern life. (shrink)

Background Although methods proposed for the conduct of ethics consultation tend to be viewed as competing approaches, they may in fact function in a complementary manner. Methods We describe the experience of ethics consultation in two ethics committees at the University Hospitals of Geneva, Switzerland. Results Both committees provide case consultation by a multi-disciplinary team of committee members, but with different processes. These differences in process do not necessarily lead to differences in outcome. Discussion Different methods of ethics consultation are (...) not mutually exclusive, and can co-exist within the same institution. The practical application of one method of ethics consultation can lead to substantial variations in process between different groups of consultants. Conclusion Despite the importance of clarifying theoretical groundings, and consultation and deliberation processes, in ethics consultation, choosing between different processes may not be pressing. To assist these choices, exploration of the practical strengths and weaknesses of different methods will be necessary to assist clinical ethicists, and clinical ethics committees, in acquiring a flexible and evidence-based set of approaches to their work. (shrink)

Although rationing by clinical judgment is controversial, its acceptability partly depends on how it is practiced. In this paper, rationing by clinical judgment is defined in three different circumstances that represent increasingly wider circles of resource pools in which the rationing decision takes place: triage during acute shortage, comparison to other potential patients in a context of limited but not immediately strained resources, and determination of whether expected benefit of an intervention is deemed sufficient to warrant its cost by reference (...) to published population based thresholds. Notions of procedural justice are applied along with an analytical framework of six minimal requisites in order to facilitate fair bedside rationing: (1) a closed system that offers reciprocity, (2) attention to general concerns of justice, (3) respect for individual variations, (4) application of a consistent process, (5) explicitness, and (6) review of decisions. The process could be monitored for its applicability and appropriateness. (shrink)

Quantum mechanics has recently indicated that temporal order is not always fixed, a finding that has far-reaching philosophical and theological implications. The phenomena, termed “indefinite causal order,” shows that events can be in a superposition with regard to their order. In the experimental setting with which this article is concerned, two events, A and B, were shown to be in the ordering relations “A before B” and “B before A” at the same time. This article introduces an ongoing project that (...) seeks to make sense of this result, with a particular focus on the methodology by which this research will be undertaken. Specific research questions, particularly regarding what indefinite causal order might mean for the metaphysics of time and the doctrine of salvation, are introduced. The collaborative approach detailed brings together the disciplinary skills of a working scientist and a working theologian. What is offered is a collaborative methodology for interaction between science and religion that is more than the sum of its parts. Alister McGrath’s idea of multiple rationalities is employed as an epistemological framework within which this research takes place. Within an epistemologically pluralistic model, collaborative efforts are not only encouraged but necessary. Complex reality requires an equally complex, usually interdisciplinary, explanation. I argue that such dialogue is both theologically justified and culturally valuable and indicates the direction in which this research will be taken. (shrink)

Theological engagement with quantum mechanics has been dominated by the Copenhagen interpretation, failing to reflect the fact that philosophers and physicists alike are increasingly moving away from the Copenhagen interpretation in favor of other approaches. One such approach, Hugh Everett's so-called Many Worlds Interpretation (MWI), is being taken increasingly seriously. As the MWI's credibility grows, it is imperative that metaphysicians, theologians, and philosophers of religion engage with its ideas and their implications. This article does just that, setting out some implications (...) of Everettian Quantum Mechanics that are particularly relevant to theism. It argues that taking seriously the radical consequences of the Everett interpretation means facing at least three major worries for theism pertaining to personal identity, the problem of evil, and salvation. The article concludes by calling on theologians and philosophers of religion to address these worries, in order that these matters of religious significance remain both coherent and credible if the MWI turns out to be correct. (shrink)

B C Hurst; Means, Ends, Content and Objectives in Curriculum Planning: a critique of Sockett and Hirst, Journal of Philosophy of Education, Volume 18, Issue 1.

Quantum mechanics has recently indicated that, at the fundamental level, temporal order is not fixed. This phenomenon, termed Indefinite Causal Order, is yet to receive metaphysical or theological engagement. We examine Indefinite Causal Order, particularly as it emerges in a 2018 photonic experiment. In this experiment, two operations A and B were shown to be in a superposition with regard to their causal order. Essentially, time, intuitively understood as fixed, flowing, and fundamental, becomes fuzzy. We argue that if Indefinite Causal (...) Order is true, this is good evidence in favor of a B‐theory of time, though such a B‐theory requires modification. We then turn to theology, suggesting that a B‐theoretic temporal ontology invites serious reconsideration of the doctrine of salvation. This paper concludes that the best explanation for salvation given a B‐theory is mind‐dependent salvific becoming, a type of psychological soteriological change that occurs through downward causation. (shrink)

This article discusses Charles Taylor's analysis of the ‘politics of recognition’, which reveals that the major versions of the latter share an ideological conception of Eros as a binding, unifying force. Such striving for oneness is seen as key to forming harmonious, just communities and nations, and ultimately global cohesion. I refer to this as the ‘ideology of Eros’. However, Taylor highlights an ironically divisive opposition concerning how to realise such oneness, based on incompatible foundational principles: ‘sameness’ and ‘difference’. Instead (...) of a choice, Taylor opts for the demanding political task of ongoing negotiation between them. I augment Taylor's analysis by re-evaluating the figure of ‘non-recognition’ arising from Lacan's critique of the ‘ideology of Eros’, which is centred on Socrates’ encounter with Alcibiades in Plato's Symposium and to which he adds his notion of genuine love, which affirms an ethic of healthy ‘non-recognition’. I argue that this ethic supports the difficult political task that Taylor rightly calls for. (shrink)

The clash between the public right to know and public safety is just one of the fundamental conflicts raised by Hurst and White in this, the first definitive study of ethics in the Australian news media. Hurst and White explore the concept of ethical conduct, apply it to journalism, then draw on a wealth of local examples where the news media's conduct was challenged. They examine the attempts to codify the principles - from the policies of press councils (...) to the journalists' own codes of ethics - and show where these are inadequate, muddled or honoured in the breach. They put forward some provocative ideas for reform. (shrink)

Nietzsche's analysis of the self-poisoning of ‘the will to power' and his insistence upon overcoming its ideological outcome (the dogmatist's fake ‘Truth') by recognizing the ‘un-truth' of a ‘logic of contamination,' demonstrates that he understands ‘truth' as a paradox. What may one accordingly expect in response to the question ‘Supposing truth is a woman – what then?', posed in the preface to Beyond Good and Evil (1966)? Supported by Derrida's Spurs: Nietzsche's Styles, I argue that Nietzsche could have drawn two (...) radically different analogies between paradoxical ‘truth' and ‘woman.' However, due to the very kind of ideological conditioning (patriarchal), which his ‘free thinking' resists in principle, he explicitly draws only one, hazarding a self-betraying performative contradiction. The obvious move might be to retain the valuable critique of ideology made possible by his analysis of the ‘will to power,' while jettisoning the self-undermining rhetoric that constructs sexual difference according to values handed down by patriarchy. However, retaining and working through the terms of sexual difference, and highlighting Nietzsche's blindness concerning women, has the advantage of calling attention to its significance. The fact that one may say in retrospect that even Nietzsche (of all thinkers!) remained blindly subject to ideological conditioning, points to its unconscious nature and raises the question of what ‘overcoming' in relation to the will to power entails for the free thinkers he heralded. South African Journal of Philosophy Vol. 26 (1) 2007: pp. 44-55. (shrink)

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes (...) be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. (shrink)

Background Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Method Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The findings (...) revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one’s interests unjustly considered. Results Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient’s needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. Conclusion Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient’s interests and the care provided, despite existing compensation systems. (shrink)

This article brings time and theology together constructively in response to a pressing problem for the doctrine of personal salvation. The problem arises within the physics and metaphysics of time, as these support a so-called temporal B-theory in which time does not pass and reality is comprised of a block universe. Within this static temporal metaphysic, objective change is highly problematized. Yet salvation requires an objective change from fallenness to redemption. So, how can we understand a salvation-transformation in the block (...) universe? In other words, can sinners really change? I argue that on a B-theory of time, a salvation-transformation is best understood as a form of qualitative, phenomenological, and subjective change, rather than a robust ontological change. I conclude that the individual's transformation from fallen to saved is one of mind-dependent becoming. So, sinners can change. But, in this lifetime, that change can only be subjective. (shrink)

In Switzerland, people can be granted access to assisted suicide on condition that the person whose wish is to die performs the fatal act, that he has his decisional capacity and that the assisting person...

Many mammals use scent marks to advertise territory ownership, but only recently have we started to understand the complexity of these scent signals and the types of information that they convey. Whilst attention has generally focused on volatile odorants as the main information molecules in scents, studies of the house mouse have now defined a role for a family of proteins termed major urinary proteins (MUPs) which are, of course, involatile. MUPs bind male signalling volatiles and control their release from (...) scent marks. These proteins are also highly polymorphic and the pattern of polymorphic variants provides a stable ownership signal that communicates genome‐derived information on the individual identity of the scent owner. Here we review the interaction between the chemical basis of mouse scents and the dynamics of their competitive scent marking behaviour, demonstrating how it is possible to provide reliable signals of the competitive ability and identity of individual males. BioEssays 26:1288–1298, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

This article addresses a strange investment within ‘continental' philosophy, in asserting the impotence of a Derridean approach when it comes to addressing practical (juridical, political, ethical, economic) issues. Such assertions of impotence regularly stand as the foil for whatever is proposed as a more complex, and therefore powerful, means to make sense of concrete phenomena. Invariably, however, the criticism of a Derridean approach is based on reductive misconceptions of its complex logic, and the proposed correctives repeat the very pattern of (...) thinking that Derrida has consistently adopted throughout his writing. A case in point is Zizek's criticism of what he calls ‘Derrida's operation.' While Zizek's critique is more nuanced and contemporary than the hackneyed charge of ‘textualism,' his reductive conception of the logical structure of Derridean thinking remains open to challenge. Further, his Lacanian corrective, whose logic is represented by the figure of a ‘Borromean knot,' precisely matches the ‘plural logic of the aporia' that underpins a Derridean approach to concrete phenomena. Accordingly, what follows is an attempt to show how Lacanian and Derridean discourses can be brought into alliance as a consequence of their isomorphic logical structure. This attempt is motivated by the conviction that one can do well without the pseudo-antagonism generated by the unjust criticism directed at one another by like-minded thinkers, which, moreover, provides such thinkers with a far too facile excuse for dismissing one another, even before opening texts. I also have a hidden agenda of sorts, which is to outline and, indeed, promote the ‘complexity-thinking' characteristic of both Derridean and Lacanian discourses, as the most viable and appropriate approach to practical issues. South African Journal of Philosophy Vol. 27 (1) 2008 pp. 10-26. (shrink)

Applying equity to health care is difficult and it is especially challenging when applied to cases that involve urgent military medicine care under resource scarcity. Part of the difficulty centers on the concept of equity itself. It is not clear what the best concept of equity applicable to medical care would be, or that there should be only one, or the same ones, across all levels of military health care. Despite the fact that equity is a key concern in health (...) care, particularly in the age of the COVID-19 pandemic, it may be that there is no single theory of justice that would be most justified for military physicians to use. This paper examines whether a hybrid position of equity might be both theoretically robust and applicable in practice. After briefly introducing the discussion, we outline four major philosophical definitions of equity – (1) Egalitarianism, (2) Prioritarianism, (3) Desertism, and (4) Sufficientism. We then report empirical findings suggesting that a practice-based hybrid concept of equity is used by physicians within the practice of micro-allocation. Our findings will shed lights on ethical justifications and reasoning which should guide medical rules for military and humanitarian health care providers. (shrink)

Research is crucial to improve medicine's ability to care for the sick, and this includes research on conditions affecting cognition. This article focuses on whether persons suffering from diseases affecting cognition can be enrolled in research when the purpose is to investigate the condition leading to this impairment. It also discusses when they may be enrolled and on the precautions which are necessary if they are. Protections for vulnerable persons in research have two components: fair subject selection, and the specific (...) care required to minimize wrongs to vulnerable persons once they are enrolled in research. Finally, the article examines, and rejects, the idea that there could be circumstances in which persons suffering from diseases affecting cognition could have an obligation to participate in research addressing these disorders. (shrink)

Forty years after Dax Cowart fought to have his voice heard regarding his medical treatment, patient autonomy and rights are at the heart of patient care today. Yet, despite its centrality in patient care, the tension between a severely burned patient’s right to stop treatment and the physician’s role in saving a life has not abated. As this case study explores, barriers remain to hearing and respecting a patient’s treatment decisions. Dismantling these barriers involves dispelling the myths that burn patients (...) must grin and bear intense pain to recover and that a patient’s choice to discontinue treatment equals physician failure. Moreover, in these situations, sustained, direct engagement between physician and patient can reduce the moral distress of all involved and enable physicians to hear and better accept when a patient is calling for the end of the day. (shrink)

Both Heidegger's Being and Time and Helen Keller's The Story of my Life address the problem of what it means for humans to be optimally human. In reading these texts together, I hope to show that Helen's life-story confirms Heidegger's existential analyses to some extent, but also, importantly, poses a challenge to them with respect to the interrelated issues of disability, language and others. Heidegger's hermeneutic explication of what it means to be human is intended to uncover supposedly basic human (...) existential structures. As a fore-structure for this explication, Heidegger projects an already able-bodied, self-sufficient adult, resolutely engaged in daily activity. I shall argue, however, that it is due to this starting-point in adult-Dasein that Heidegger's existential analyses miss important insights concerning the meaning of being human to be gained from Helen's experience. Starting from the essentially disabled child-Dasein, Helen describes her struggle to achieve the very condition that Heidegger assumes from the start, first through rescue by the other as teacher, who offered the gift of language and community, and thereafter in her grasp of language as a “pharmakon.” I hope to show in the end that Helen's experience of a struggle for humanity offers the model for an alternative projection, that of an essentially disabled and needy Dasein, which, I believe, provides a more viable fore-structure than Heidegger's for a hermeneutics of humanity. S. Afr. J. Philos. Vol.22(1) 2003: 98-112. (shrink)

In the spirit of the work edited by Michel Foucault (1975) on Pierre Rivière, I propose to put philosophy to work by tackling a case study in which I shall analyse certain court transcripts that pertain to the defence of serial killer, Stewart Wilken, in Die Staat Teen Stewart Wilken. My analysis of these documents is intended to uncover the practices and struggles of the discourses that come together, and into conflict, at this event. The analysis is divided into two (...) parts. In Part One, I thematize subjectivity in relation to the idea of enlightenment autonomy. Here I aim to show that the discourses in law, psychiatry and psychology that dominated at Wilken's trial, appear to have undergone “normalization.” In other words, what Foucault uncovered as early internecine struggles among discourses for supremacy have given way to a unanimous stance concerning the nature of the autonomous subject and its legal ramifications; effectively silencing alternatives. In Part Two, I shall skirt around the frayed edges of these dominant discourses, with the aim of showing in more detail how internal theoretical tensions, such as those evident in the expert testimony given at Wilken's trial, may open up spaces for other accounts of subject- formation. S. Afr. J. Philos. Vol.22(4) 2003: 289-305. (shrink)

Issues of resource allocationResource allocation, triageTriage, and rationingRationing decisions are common in the context of disasters and public healthPublic health emergencies, such as pandemics. However, to date, the majorityMajority of the literature focuses on an adult population with very little attention given to a pediatric population or to a population that may be mixed: adults and children. Furthermore, decisions of rationingRationing scarce resources do not only occur during disasters and other wide-scale emergencies. Such decisions are commonplace in pediatric organ transplantation (...) and can creep into areas of experimental medicine, such as xenotransplantation. This chapter explicates differences between pediatric and adult triageTriage decisions by first looking at the trifold issues of resource allocationResource allocation, triageTriage, and rationingRationing decisions mainly in the context of a disaster situation or public healthPublic health emergency. However, the issues of pediatric organ transplantation, health disparitiesHealth disparities, and experimental medicine will also be covered. (shrink)