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

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

Good listening is an essential element in the provision of quality healthcare (Attree 2001). Good listening also supports accurate diagnosis, patient adherence to medical recommendations, and stron...

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)

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)

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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)

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)

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.

It was the spring of 2020 when the email came to our inboxes—a memo from our Institutional Review Board informing us that we were approved to begin conducting our pragmatic clinical trial with a wa...

How does one committed to the claims of Christ and a biblical story of redemption live Christianly and navigate the competing worldviews encountered in everyday medical practice? Adopting the practical conceptual framework promoted by Reformed Christian philosopher and theologian Albert Wolters, we argue for an all-encompassing biblical understanding of God’s cosmic redemption plan for the entire creation order in contrast to a more typical sacred/secular duality. We then apply the concepts of structure and direction, drawn from a pretheological understanding of (...) human life drawn from the Scripture, to a semi-fictional case study in discerning Christian faithfulness in everyday mundane aspects of medicine. Our subsequent analysis seeks to render an interpretation of what it means to live life consistent with that worldview when confronted with challenges like those presented in the case. (shrink)

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)

Fluctuation phenomena are the ''tip of the iceberg'' revealing the existence, behind even the most quiescent appearing macroscopic states, of an underlying world of agitated, ever-changing microscopic processes. While the presence of these fluctuations can be ignored in some cases, e.g. if one is satisfied with purely thermostatic description of systems in equilibrium, they are central to the understanding of other phenomena, e.g. the nucleation of a new phase following the quenching of a system into the co-existence region. This volume, (...) originally published several years ago, has stood the test of time well, as interest in fluctuation phenomena continues to grow. It contains a collection of review articles, some of them updated, written by experts in the field, on the subject of fluctuation phenomena. Some of the articles are of a very general nature discussing the modern mathematical formulation of the problems involved, while other articles deal with specific topics such as kinetics of phase transitions and conductivity in solids. The juxtaposition of the variety of physical situations in which fluctuation phenomena play an important role is novel and should give the reader a comprehensive and deeper insight into this fascinating subject. (shrink)

Darwin himself suggested the idea of generalizing the core Darwinian principles to cover the evolution of social entities. Also in the nineteenth century, influential social scientists proposed their extension to political society and economic institutions. Nevertheless, misunderstanding and misrepresentation have hindered the realization of the powerful potential in this longstanding idea. Some critics confuse generalization with analogy. Others mistakenly presume that generalizing Darwinism necessarily involves biological reductionism. This essay outlines the types of phenomena to which a generalized Darwinism applies, and (...) upholds that there is no reason to exclude social or economic entities. (shrink)

This is the first book to offer the best essays, articles, and speeches on ethics and intelligence that demonstrate the complex moral dilemmas in intelligence collection, analysis, and operations. Some are recently declassified and never before published, and all are written by authors whose backgrounds are as varied as their insights, including Robert M. Gates, former Director of the Central Intelligence Agency; John P. Langan, the Joseph Cardinal Bernardin Professor of Catholic Social Thought at the Kennedy Institute of Ethics, Georgetown (...) University; and Loch K. Johnson, Regents Professor of Political Science at the University of Georgia and recipient of the Owens Award for contributions to the understanding of U.S. intelligence activities. Creating the foundation for the study of ethics and intelligence by filling in the gap between warfare and philosophy, this is a valuable collection of literature for building an ethical code that is not dependent on any specific agency, department, or country. (shrink)

Next SectionObjectives To evaluate the adequacy of paediatric informed consent and its augmentation by a supplemental computer-based module in paediatric endoscopy. Methods The Consent-20 instrument was developed and piloted on 47 subjects. Subsequently, parents of 101 children undergoing first-time, diagnostic upper endoscopy performed under moderate IV sedation were prospectively and consecutively, blinded, randomised and enrolled into two groups that received either standard form-based informed consent or standard form-based informed consent plus a commercial (Emmi Solutions, Inc, Chicago, Il), sixth grade level, (...) interactive learning module (electronic assisted consent). Anonymously and electronically, the subjects' anxiety (State Trait Anxiety Inventory), satisfaction (Modified Group Health Association of America), number of questions asked, and attainment of informed consent were assessed (Consent-20). Statistics were calculated using t test, paired t test, and Mann Whitney tests. Results The ability to achieve informed consent, as measured by the new instrument, was 10% in the control form-based consent group and 33% in the electronic assisted consent group (p<0.0001). Electronically assisting form-based informed consent did not alter secondary outcome measures of subject satisfaction, anxiety or number of questions asked in a paediatric endoscopy unit. Conclusions This study demonstrates the limitations of form-based informed consent methods for paediatric endoscopy. It also shows that even when necessary information was repeated electronically in a comprehensive and standardised video, informed consent as measured by our instrument was incompletely achieved. The supplemental information did, however, significantly improve understanding in a manner that did not negatively impact workflow, subject anxiety or subject satisfaction. Additional study of informed consent is required. Clinical trial registration number ClinicalTrials.gov Identifier NCT00899392. (shrink)

In "Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?," Wilkinson (2021) argues that the use of frailty scores in ICU triage does not necessarily involve discrimination on the basis of disability. In support of this argument, he claims, “it is not the disability per se that the score is measuring – rather it is the underlying physiological and physical vulnerability." While we appreciate the attention Wilkinson explicitly pays to disability in this piece, we find the (...) distinction between disability and underlying vulnerability untenable both theoretically and practically. In this peer commentary, we begin with a brief overview of research in philosophy of disability concerning the meaning of the concept itself. We argue that this research demonstrates that many forms of disability do not involve underlying vulnerabilities, and, furthermore, that Wilkinson equivocates between "disability" understood as a medical category vs. "disability" understood as a feature of lived experience. We reject Wilkinson’s distinction on these grounds and offer further considerations to avoid disability discrimination in emergency and crisis standards of care contexts. (shrink)

The managerial ethics literature is used as a base for the inclusion of Ethical Attribution, as an element in the consumer's decision process. A situational model of ethical consideration in consumer behavior is proposed and examined for Personal vs. Vicarious effects. Using a path analytic approach, unique structures are reported for Personal and Vicarious situations in the evaluation of a seller's unethical behavior. An attributional paradigm is suggested to explain the results.

While many commentators have remarked on Nietzsche’s admiration for the Greek historian Thucydides, most reduce the affinity between the two thinkers to their common commitments to “political realism” or “scientific naturalism.” At the same time, some of these same commentators have sought to minimize or dismiss Nietzsche’s enthusiasm for the Greek sophists. We do not deny the importance of realism or naturalism, but we suggest that, for Nietzsche, realism and naturalism are rooted in a rejection of moral absolutism and its (...) leading advocates, Socrates and Plato. Through careful exegesis of crucial sections from Daybreak, we show that, as early as 1880 (if not earlier), Nietzsche regarded the agonistic, anti-absolutist stance of the sophist Protagoras as an indispensable model both for Thucydides’s history and for his own philosophy. (shrink)