Clinical ethics consultants should show bold moral courage in discharging their duties to patients, families, and healthcare providers. Given the corrosive impact on trust, and on the appropriate d...

The philosophical relation between Martin Heidegger and Jean-Paul Sartre is important, partly because of the considerable influence of Heidegger on Sartre, and partly because of their critiques of each other.

As currently practiced, the use of continuous sedation until death (CSD) is controlled by clinicians in a way that may deny patients a key choice in controlling their dying process. Ethical guidelines from the American Medical Association and the American Academy of Pain Medicine describe CSD as a “last resort,” and a position statement from the American Academy of Hospice and Palliative Medicine describe it as “an intervention reserved for extreme situations.” Accordingly, patients must progress to unremitting pain and suffering (...) and reach a last-resort stage before the option to pursue CSD is considered. Alternatively, we present and defend a new guideline in which decisionally capable, terminally ill patients who have a life expectancy of less than six months may request CSD before being subjected to the refractory suffering of a treatment of “last resort.”. (shrink)

Available for the first time in English, this is the definitive account of the practice of sexual slavery the Japanese military perpetrated during World War II by the researcher principally responsible for exposing the Japanese government's responsibility for these atrocities. The large scale imprisonment and rape of thousands of women, who were euphemistically called "comfort women" by the Japanese military, first seized public attention in 1991 when three Korean women filed suit in a Toyko District Court stating that they had (...) been forced into sexual servitude and demanding compensation. Since then the comfort stations and their significance have been the subject of ongoing debate and intense activism in Japan, much if it inspired by Yoshimi's investigations. How large a role did the military, and by extension the government, play in setting up and administering these camps? What type of compensation, if any, are the victimized women due? These issues figure prominently in the current Japanese focus on public memory and arguments about the teaching and writing of history and are central to efforts to transform Japanese ways of remembering the war. Yoshimi Yoshiaki provides a wealth of documentation and testimony to prove the existence of some 2,000 centers where as many as 200,000 Korean, Filipina, Taiwanese, Indonesian, Burmese, Dutch, Australian, and some Japanese women were restrained for months and forced to engage in sexual activity with Japanese military personnel. Many of the women were teenagers, some as young as fourteen. To date, the Japanese government has neither admitted responsibility for creating the comfort station system nor given compensation directly to former comfort women. This English edition updates the Japanese edition originally published in 1995 and includes introductions by both the author and the translator placing the story in context for American readers. (shrink)

Lukas J. Meier et al. offer the promise of a pathway for resolving clinical bioethical problems using an artificial intelligence interface. The ultimate goal, we assume, is...

People often choose intuitive rather than equally valid nonintuitive alternatives. The authors suggest that these intuitive biases arise because intuitions often spring to mind with subjective ease, and the subjective ease leads people to hold their intuitions with high confidence. An investigation of predictions against point spreads found that people predicted intuitive options more often than equally valid nonintuitive alternatives. Critically, though, this effect was largely determined by people's confidence in their intuitions. Across naturalistic, expert, and laboratory samples, against personally (...) determined point spreads, and even when intuitive confidence was manipulated by altering irrelevant aspects of the decision context, the authors found that decreasing intuitive confidence reduced or eliminated intuitive biases. These findings indicate that intuitive biases are not inevitable but rather predictably determined by contextual variables that affect intuitive confidence. (shrink)

In this paper, I argue that care ethics should be understood as a form of value pluralism. Writers on the ethics of care tend not explicitly to address issues in the theory of value, although much of what has been written about care ethics may be taken to suggest that it endorses some form of value monism. I argue against this conception of care ethics by showing that the practical reality of caregiving is more accurately represented by a pluralist account (...) of value. Practices of care are plausibly guided by a number of distinct and potentially conflicting values. These include quality of life, autonomy, dignity, personal development, and the value of nurturant relationships. Whilst caring takes each of these values to be important in its own right, they are not always jointly realisable, and carers are sometimes forced to promote one such value at the expense of another. The possibility of conflict between values is, of course, precisely what a pluralist conception of value tells us to expect. In this respect, then, value pluralism more faithfully reflects the reality of caregiving than does value monism, and care ethicists ought for this reason to endorse it. (shrink)

The goal of this study was to assess the relationships between computational approaches to analyzing constructed responses made during reading and individual differences in the foundational skills of reading in college readers. We also explored if these relationships were consistent across texts and samples collected at different institutions and texts. The study made use of archival data that involved college participants who produced typed constructed responses under thinking aloud instructions reading history and science texts. They also took assessments of vocabulary (...) knowledge and proficiency in comprehension. The protocols were analyzed to assess two different ways to determine their cohesion. One approach involved assessing how readers established connections with themselves. The other approach involved assessing connections between the constructed responses and the texts that were read. Additionally, the comparisons were made by assessing both lexical and semantic comparisons. The result showed that both approaches for analyzing cohesion and making the comparisons were correlated with vocabulary knowledge and comprehension proficiency. The implications of the results for theory and practice are discussed. (shrink)

Self-confidence is associated with many positive outcomes, and training programs routinely seek to build participants’ self-efficacy. In this article, however, we consider whether self-confidence increases unethical behavior. In a series of studies, we explore the relationship between negotiator self-efficacy—an individual’s confidence in his or her negotiation ability—and the use of deception. We find that individuals high in negotiator self-efficacy are more likely to use deception than individuals low in negotiator self-efficacy. We also find that perceptions of the risk of deception (...) mediate this relationship. By identifying negotiator self-efficacy as an antecedent to unethical behavior, our findings offer important theoretical and empirical insights into the use of deception, the role of individual differences in ethical decision making, and the broader consequences of self-confidence in business and society. (shrink)

Susan D. McCammon and Nicole M. Piemonte offer a thoughtful and thorough commentary on our manuscript entitled “Expanding the use of Continuous Sedation Until Death.” In this reply we attempt to clarify and further defend our position. We show how continuous sedation until death is not a “first resort” but rather a legitimate option among many that should available to terminally ill patients whose life expectancy is less than six months. We also attempt to show that we do not equivocate (...) the meaning of palliative care as the commentators suggested. We argue that the traditional notion of palliative care should move beyond relief of “experienced suffering” to relief of potential suffering for those whose life expectancy is less than six months. Lastly, we challenge the commentator’s position that the realm of ordinary medicine” should be the guide to care, by showing how the notion of ordinary medicine has been successfully challenged in both bioethical scholarship and the courts in a way that shows ordinary medicine to be an evolving concept rather than a static, universal guide. (shrink)

Truth and Meaning is a collection of essays on various aspects of contemporary logic. They are given to the public, the author states, in the hope that “they may be of some service to philosophers, scientists and social scientists interested in the logical and methodological foundations of their subject.” Professor Greenwood writes from the standpoint of a specialist in his field, and assumes in the reader a familiarity with the sources and the highly technical vocabulary of modern logic.

Moral distress has been the subject of extensive research and debate in the nursing ethics literature since the mid-1980s, but the concept has received comparatively little attention from those working outside of applied ethics. In this article, I defend a care ethical account of moral distress, according to which the phenomenon is the product of an agent’s inability to live up to one of her caring commitments. This account has a number of attractions. First, it places a greater emphasis on (...) the importance of the relationship between the caregiver and her cared-for than that found in previous accounts. Second, it does not make problematic assumptions about the correctness of a caregiver’s moral judgments, as has been claimed in relation to previous accounts of moral distress. Finally, my account allows for a clear conceptual distinction to be drawn between moral distress and other forms of negative moral emotion such as guilt and regret. Earlier accounts draw this distinction by appealing to the causal aetiology of moral distress, but as I show here, such appeals are ultimately unsuccessful unless they are made from an explicitly care ethical starting point. One of the implications of my account is that moral distress has the potential to occur in the context of any caregiving relationship. This claim is explored in the final section of the paper, in relation to student-teacher and parent-child caregiving. (shrink)

Utilitarians take an uncritical attitude toward the sort of individual claims they seek to aggregate. In this way they cannot account for an individual's valid claim against a policy which actually maximizes aggregate satisfaction. We thus claim that utilitarianism properly functions only after conflicting claims have been adjudicated; consequently, Utilitarianism properly maximizes the satisfaction of claims judged to be valid. In such a program, Utilitarianism ceases to be considered a part of ethics, But is seen as maintaining a principle of (...) feasibility and efficiency. Finally, We briefly suggest the methods we believe to be most effective in the resolution of ethical conflict. (shrink)

In Socrates among Strangers, Joseph P. Lawrence reclaims the enigmatic sage from those who have seen him either as a prophet of science, seeking the security of knowledge, or as a wily actor who shed light on the dangerous world of politics while maintaining a prudent distance from it. The Socrates Lawrence seeks is the imprudent one, the man who knew how to die. The institutionalization of philosophy in the modern world has come at the cost of its most (...) vital concern: the achievement of life wisdom. Those who have ceased to grow (those who think they know) close their ears to the wisdom of strangers—and Socrates, who stood face to face with death, is the archetypal stranger. His avowal of ignorance, Lawrence suggests, is more needed than ever in an age defined by technical mastery and expert knowledge. (shrink)

The controversy over the equivalence of continuous sedation until death (CSD) and physician-assisted suicide/euthanasia (PAS/E) provides an opportunity to focus on a significant extended use of CSD. This extension, suggested by the equivalence of PAS/E and CSD, is designed to promote additional patient autonomy at the end-of-life. Samuel LiPuma, in his article, “Continuous Sedation Until Death as Physician-Assisted Suicide/Euthanasia: A Conceptual Analysis” claims equivalence between CSD and death; his paper is seminal in the equivalency debate. Critics contend that sedation follows (...) proportionality protocols for which LiPuma’s thesis does not adequately account. Furthermore, sedation may not eliminate consciousness, and as such LiPuma’s contention that CSD is equivalent to neocortical death is suspect. We not only defend the equivalence thesis, but also expand it to include additional moral considerations. First, we explain the equivalence thesis. This is followed by a defense of the thesis against five criticisms. The third section critiques the current use of CSD. Finally, we offer two proposals that, if adopted, would broaden the use of PAS/E and CSD and thereby expand options at the end-of-life. (shrink)