Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem important, especially (...) where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record. (shrink)

Rereading Renée C. Fox's “A Sociological Perspective on Organ Transplantation and Hemodialysis,” published in 1970, one is likely to be struck more by continuity than by change. The most pressing of the social, policy, and ethical concerns that Fox raised remain problematic fifty years later. We still struggle with scientific and clinical uncertainty, with the boundary between experimentation and therapy, and with the cost of organ replacement therapies and disparities in how they are allocated. We still have an imperfect understanding (...) of transplant immune responses. We still debate when a potential donor “actually” dies, and we still seem to think better empirical criteria could harmonize the diverse religious, cultural, and socioeconomic values of patients, providers, third‐party payers, and policy‐makers. Organ transplantation was for Fox both a particular case unfolding in time and an entryway for discussing the difficult moral questions presented by many new medical technologies in a context of high demand and limited resources. (shrink)

Volume 19, Issue 7, July 2019, Page 69-71.

The experiences of individuals with intersex conditions include considerable abuse at the hands of medical personnel. Despite changes in expert opinion about full disclosure of the nature of each patient’s condition and recommendations to defer cosmetic surgical interventions, we do not know how much actual practice has changed over several decades. Moreover, discrepancies continue between the views of who have these conditions and medical practitioners, especially about preventing cancer and retaining gonads for the purpose of providing “natural” hormone production. We (...) have insufficient data to resolve these different perspectives. (shrink)

Off-label prescribing is an integral part of contemporary medicine. Many patients benefit when they receive drugs or devices under circumstances not specified on the label approved by the Food and Drug Administration. An off-label use may provide the best available intervention for a patient, as well as the standard of care for a particular health problem. In oncology, pediatrics, geriatrics, obstetrics, and other practice areas, patient care could not proceed without off-label prescribing. When scientific and medical evidence justify off-label uses, (...) physicians promote patients’ interests by prescribing products off label.Off-label prescribing can also harm patients, however. The potential for harm is greatest when an offlabel use lacks a solid evidentiary basis. A 2006 study examining prescribing practices for 169 commonly prescribed drugs found high rates of off-label use with little or no scientific support. Researchers examining off-label use in U.S. children’s hospitals concluded, “[W]e still have incomplete knowledge about the safety and efficacy of many medications commonly used to treat children across a range of drug classes and clinical diagnoses.”. (shrink)

The adoption of codes of ethics or values statements is intended to guide everyday decisions, as well as to influence the perceptions of external stakeholders. Questions have emerged in the literature about whether the effort to substantively direct decision-making in an organization is marginalized by the more obvious symbolic role of values statements. Here the perceived impact of values statements on decision-making in organizations is explored, and a number of positive effects observed. Respondents report that values statements create positive externalities (...) providing guidelines for decision-making, increasing accountability, and clarifying expectations. Yet, both cynicism and perceived management hypocrisy emerged in the survey, which together had strong negative effects on the perceived decision-making impact of values statements. Finally, positive external effects are almost never mentioned by respondents who give their firms high marks on the quality of values statement development, training, and implementation. Yet, such external effects get significantly greater representation in the comments of respondents who report less substance in their firms’ values statement development and implementation processes. In all, the results suggest that the substantive and symbolic roles of values statements are not independent and that external symbolism without internal legitimacy may in the long-run be problematic. (shrink)

Volume 20, Issue 4, May 2020, Page 76-78.

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Antiphon is often criticized for confusing two distinct species of responsibility, causal and moral. Insofar as this distinction is fundamental to any mature legal or ethical theory, Antiphon appears at best naïve, at worst dishonest. I argue that a careful analysis of his second tetralogy reveals that Antiphon was well aware of the distinction and the rationale for recognizing it. However, Antiphon questions whether the distinction can be so easily made in every case, and he suggests that the inadequacy of (...) the distinction might have radical implications for traditional ideas at the core of the Greek legal system. In short, Antiphon's second tetralogy gives us yet another reason to question whether the sophists were as philosophically unsophisticated as we are often led to believe. (shrink)

Although universal schooling has been adopted as a goal by international organizations, bilateral aid agencies, national governments, and non-profit organizations, little sustained international attention has been devoted to the purposes or goals of universal education. What is universal primary and secondary education intended to accomplish? This book, which grew out of a project of the American Academy of Arts & Sciences, offers views from Asia, Africa, Europe, North America and South America on the purposes of universal education while considering diverse (...) cultures, religions, and professions. It is the first book in which renowned authors from around the world have proposed, considered, and debated goals of basic and secondary education, engaging in a constructive dialogue on one of the most pressing issues facing education today. (shrink)

Empirical bioethics research has become an established field of study, with its own unique goals, vocabulary, and methods, and wi...

The ethics of long-term Extracorporeal Membrane Oxygenation (ECMO) use, especially when organ recovery appears highly unlikely and the patient does not qualify for organ transplantation, are compli...

While procurement of organs from donors who are not "brain dead" does not appear to pose insurmountable moral obstacles, the social practice may raise questions of conflict of interest. Non-heart-beating organ donation opens the door for pressure on patients or families to forgo possibly beneficial treatment to provide organs to save others. The combined effects of non-heart-beating donation and organ shortages at major transplant centers brought about by the 1991 United Network for Organ Sharing (UNOS) local-use organ allocation policy created (...) potential conflicts, including the fact that candidates for organs become potential donors far more frequently than previously. Hospitals with a major emphasis on transplantation have economic and academic interests that may have been hurt by the relative organ shortage. Some may view non-heart-beating organ donation as a way to restore weakened programs and thus unconsciously compromise recognition of problems associated with non-heart-beating donation. (shrink)

At the forefront of international concerns about global legislation and regulation, a host of noted environmentalists and business ethicists examine ethical issues in consumption from the points of view of environmental sustainability, economic development, and free enterprise.

Professionals in transplantation medicine have a particularly difficult task that most other healthcare professionals in the United States do not have to face explicitly. That is, the transplanters control the use of scarce solid organs. Because they invariably have more than one patient who might benefit from a new kidney (or liver, heart, etc.), they cannot focus single-mindedly on their duty to each and every patient as if no other patient mattered. In the case at hand, the patient has had (...) more than one of a life-sustaining organ. At some centers, one, perhaps two, previous organs would count as After that, the patient has had her chances and it is time to move on to others. Moreover, some believe the patient in this case has contributed to the current problem by inadequate care of the gifts she has been given. (shrink)

Volume 20, Issue 6, June 2020, Page 17-19.

In the twenty-first century, decisions to withhold or withdraw life-supporting measures commonly precede death in the neonatal intensive care unit without major ethical controversy. However, caregivers often feel much greater turmoil with regard to stopping medical hydration and nutrition than they do when considering discontinuation of mechanical ventilation or circulatory support. Nevertheless, forgoing medical fluids and food represents a morally acceptable option as part of a carefully developed palliative care plan considering the infant’s prognosis and the burdens of continued treatment. (...) Decisions to stop any form of life support should focus on the clinical circumstances, not the means used to sustain life. (shrink)

The American Journal of Bioethics, Volume 11, Issue 10, Page 15-16, October 2011.

In his response to our treatment of the medical excuse, Spital claims that we offer a flawed analysis of the practice of offering excuses to potential living organ donors. Spital's criticisms help sharpen our position and more clearly lay out the issues. In what follows, we address each of his concerns and replies and clarify our earlier analysis.

Sociologists who use in-depth interview methods have become sensitized to the ways that race-ethnicity and class can form barriers to rapport with respondents, but the question of gender has been largely unexamined. This article compares data from two independently conducted in-depth interview studies of male nurses: one by a female researcher and one by a male researcher. Observed differences in how the men in the samples framed their responses to questions in the two studies are discussed. It is argued that (...) in-depth interviewers can and should become sensitized to respondents' negotiation of the gendered context of the interaction, but the existing proscriptions against cross-gender research are challenged. (shrink)