The American Journal of Bioethics, Volume 12, Issue 7, Page 1-2, July 2012.

Physicians may justifiably limit patients' refusals of medical interventions when the refusal is based on a negative right to noninterference coupled with a request for an unreasonable alternative.

The American Journal of Bioethics, Volume 11, Issue 12, Page 59-61, December 2011.

The ethics of managing obstetric patients in medical disasters poses ethical challenges that are unique in comparison to other disaster patients, because the medical needs of two patients—the pregnant patient and the fetal patient—must be considered. We provide an ethical framework for doing so. We base the framework on the justice-based prevention of exploitation of populations of patients, both obstetric and non-obstetric, in medical disasters. We use the concept of exploitation to identify a spectrum from ethically acceptable, to ethically challenging, (...) to ethically unacceptable, management of obstetric patients in medical disasters. We also address the ethics of the care of obstetric and neonatal patients when the resources of a hospital are completely overwhelmed in a large-scale medical disaster. (shrink)

Heuser, Eller and Byrne provide important descriptive ethics data about how physicians counsel women on the clinical management of pregnancies complicated by severe fetal anomalies. The authors present an account of what such counselling ought to be based on, the ethical concept of the fetus as a patient and the professional responsibility model of obstetric ethics. When there is certainty about the diagnosis and either a very high probability of either death as the outcome of the anomaly or survival with (...) severe and irreversible deficit of cognitive developmental capacity as a result of the anomaly diagnosed, the pregnant woman should be offered the alternatives of aggressive and non-aggressive obstetric management and induced abortion before viability. It is also ethically permissible to offer feticide followed by termination of pregnancy after viability in such cases. This ethically justified approach will reduce the variation in the actual practices of specialists in maternal–fetal medicine described by Heuser, Eller and Byrne. (shrink)

One of the challenging problems in large scale cyber-argumentation platforms is that users often engage and focus only on a few issues and leave other issues under-discussed and under-acknowledged. This kind of non-uniform participation obstructs the argumentation analysis models to retrieve collective intelligence from the underlying discussion. To resolve this problem, we developed an innovative opinion prediction model for a multi-issue cyber-argumentation environment. Our model predicts users’ opinions on the non-participated issues from similar users’ opinions on related issues using intelligent (...) argumentation techniques and a collaborative filtering method. Based on our detailed experimental results on an empirical dataset collected using our cyber-argumentation platform, our model is 21.7% more accurate, handles data sparsity better than other popular opinion prediction methods. Our model can also predict opinions on multiple issues simultaneously with reasonable accuracy. Contrary to existing opinion prediction models, which only predict whether a user agrees on an issue, our model predicts how much a user agrees on the issue. To our knowledge, this is the first research to attempt multi-issue opinion prediction with the partial agreement in the cyber-argumentation platform. With additional data on non-participated issues, our opinion prediction model can help the collective intelligence analysis models to analyze social phenomena more effectively and accurately in the cyber argumentation platform. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of 'unborn patient' has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of 'unborn child.' There is a long history of the descriptive use of 'unborn child.' Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of 'unborn child' should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of ‘unborn patient’ has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of ‘unborn child.’ There is a long history of the descriptive use of ‘unborn child.’ Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of ‘unborn child’ should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

Book reviewed in this article: Ethics in Obstetrics and Gynecology. By Laurence B. McCullough and Frank A. Chervenak.

Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method of (...) ethical reasoning, namely ethical analysis informed by pertinent prior work, followed by identifying the implications of clearly articulated ethical concepts, to meet these goals. The professional virtue of civility and the related concept of professional etiquette was first described by the English physician-ethicist Thomas Percival (1740–1804). Based on a historically informed philosophical account, we propose that the professional virtue of civility has cognitive, affective, behavioural and social components based on a commitment to excellence in scientific and clinical reasoning. Its practice prevents a dysfunctional organisational culture of incivility and sustains a civility-based organisational culture of professionalism. Medical educators and academic leaders are in a pivotal and powerful position to role model, promote and inculcate the professional virtue of civility as essential to an organisational culture of professionalism. Academic leaders should hold medical educators accountable for discharge of this indispensable professional responsibility. (shrink)

The clinical ethics literature is striking for the absence of an important genre of scholarship that is common to the literature of clinical medicine: systematic reviews. As a consequence, the field of clinical ethics lacks the internal, corrective effect of review articles that are designed to reduce potential bias. This article inaugurates a new section of the annual "Clinical Ethics" issue of the Journal of Medicine and Philosophy on systematic reviews. Using recently articulated standards for argument-based normative ethics, we provide (...) a systematic review of the literature on concealed medication for the management of psychiatric disorders. Four steps are completed: identify a focused question; conduct a literature search using key terms relevant to the focused question; assess the adequacy of the argument-based methods of the papers identified; and identify conclusions drawn in each paper and whether they apply to the focused question. We identified seven papers and provide an assessment of them. While none of the papers fully meet the standards of argument-based ethics, they did provide rationales for the use of concealed medications, with the important requirement such a practice be accountable in explicit organizational policy to prevent abuse of patients with mental illness or dementia. (shrink)

On February 3, 2010, a “Letter of Concern from Bioethicists,” organized by fetaldex.org, was sent to report suspected violations of the ethics of human subjects research in the off-label use of dexamethasone during pregnancy by Dr. Maria New. Copies of this letter were submitted to the FDA Office of Pediatric Therapeutics, the Department of Health and Human Services Office for Human Research Protections, and three universities where Dr. New has held or holds appointments. We provide a critical appraisal of the (...) Letter of Concern and show that it makes false claims, misrepresents scientific publications and websites, fails to meet standards of evidence-based reasoning, makes undocumented claims, treats as settled matters what are, instead, ongoing controversies, offers “mere opinion” as a substitute for argument, and makes contradictory claims. The Letter of Concern is a case study in unethical transgressive bioethics. We call on fetaldex.org to withdraw the letter and for co-signatories to withdraw their approval of it. (shrink)

On February 3, 2010, a “Letter of Concern from Bioethicists,” organized by fetaldex.org, was sent to report suspected violations of the ethics of human subjects research in the off-label use of dexamethasone during pregnancy by Dr. Maria New. Copies of this letter were submitted to the FDA Office of Pediatric Therapeutics, the Department of Health and Human Services (DHHS) Office for Human Research Protections, and three universities where Dr. New has held or holds appointments. We provide a critical appraisal of (...) the Letter of Concern and show that it makes false claims, misrepresents scientific publications and websites, fails to meet standards of evidence-based reasoning, makes undocumented claims, treats as settled matters what are, instead, ongoing controversies, offers “mere opinion” as a substitute for argument, and makes contradictory claims. The Letter of Concern is a case study in unethical transgressive bioethics. We call on fetaldex.org to withdraw the letter and for co-signatories to withdraw their approval of it. (shrink)

Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the previable and (...) periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness. (shrink)

In our ‘The Professional Virtue of Civility and the Responsibilities of Medical Educators and Academic Leaders’,1 we provided an historically based conceptual account of the professional virtue of civility and the role of leaders of academic health centres in creating and sustaining an organisational culture of professionalism that promotes civility among healthcare professionals and between medical educators and learners. We emphasised that any adequate understanding of the virtues, including professional virtues, has cognitive, affective, behavioural and social components. Some of the (...) commentators expand on these components in important ways. Xuhao et al emphasises the importance of role models, especially in the hierarchical context of medical education.2 The hierarchy of faculty in the senior position and junior doctors and other learners below them has characterised medical education for centuries. Xuhao et al rightly call for academic leaders to shape this hierarchy in a morally responsible way, by becoming ‘exemplary role models’.2 Berry, a clinician manager, in critiquing our account, calls for an increased appreciation for the psychological and environmental factors that might explain why uncivil behaviour occurs.3 …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:A Search for Unity in Diversity: The "Permanent Hegelian Deposit" in the Philosophy of John DeweyFrank X. RyanJames A. Good A Search for Unity in Diversity: The "Permanent Hegelian Deposit" in the Philosophy of John Dewey Lanham, MD: Lexington Books, 2006. xxx + 288 pp.Among the revelations of Dewey's rare moments of autobiographical reflection, none has generated more curiosity and investigative zeal than his 1930 claim to have (...) "drifted" from Hegel in the decade following his move from Michigan to Chicago in 1894. Beginning with Morton White's Origin of Dewey's Instrumentalism (1943), biographers have divided on the question of whether Dewey's later philosophy was more strongly influenced by William James's experimental psychology or F. J. E. Woodbridge's Aristotelian naturalism. Despite their differences, both approaches are essentially empirical and realistic, and thus the majority of sympathetic commentators have agreed that Dewey was a realist, albeit of a decidedly unorthodox stripe. For them the notion that Dewey retained any significant commitment to idealism, given its virtual eradication at the beginning of the twentieth century, would damage his influence and legacy.It has been something of a puzzle, accordingly, that in the same autobiographical essay Dewey alludes to a "permanent Hegelian deposit." For years Richard Rorty has claimed this differentiates a "good" Dewey committed to "social flourishing" from a "bad" Dewey prone to metaphysical dalliance. But the first systematic inquiry into Dewey's enduring Hegelianism is John R. Shook's Dewey's Empirical Theory of Knowledge and Reality (2000). Shook argues convincingly that Dewey never abandoned idealism, but rather transformed it into an experimental naturalism by doing away with both "mind-stuff" and equally noxious "things-in-themselves." In many ways James Good's A Search for Unity in Diversity is a bookend to Shook's project, though Good further differentiates Anglo-American Neo-Hegelianism from Hegel himself. According to Good, Dewey endorsed a Humanistic/Historicist interpretation of Hegel rooted in the reciprocal engagement of individuals and societies, rather than the supernatural and architectonic absolute championed by Neo-Hegelians such as T. H. Green, and F. H. Bradley. With [End Page 216] top-notch scholarship and scrupulous attention to detail, A Search for Unity in Diversity is both an excellent intellectual biography and a penetrating plea for a radical reinterpretation of Dewey's contribution to philosophy. I'll briefly sketch the historical account before addressing the more controversial claims about the "permanent Hegelian deposit."Even readers familiar with the half-dozen book-length treatments of Dewey's development will find this account refreshing and informative. Good's professional credentials as a historian shine as he recreates the rough and bustling Burlington of Dewey's youth. In the 1870s, German idealism was considered the epitome of political liberalism and progressive education, and Dewey's journey toward the "inclusive philosophical idea" of the social began in an environment swirling with the crosscurrents of Kant, Hegel, and Schelling. At the White Street Congregational Church, Lewis Barstow preached a liberal orthodoxy that was essentially "man-building" (102), and Good presents a convincing case for the likelihood that even in boyhood Dewey never viewed God as an aloof law-giver or cosmic architect, but as a process unifying the individual and the social within a natural world of unlimited potential. At the University of Vermont Dewey encountered a struggling rural college transformed into the first bastion of American transcendentalism by James Marsh, who inspired a "Burlington philosophy" that rejected atomistic empiricism for a holistic integrity of knowing and doing, facts and values, and pure and practical reasons (57–59).In noting the influence of the "St. Louis Hegelians" upon Dewey, most biographers have focused on W. T. Harris, the prominent founder of The Journal of Speculative Philosophy who published Dewey's earliest submissions and offered encouragement that led to his pursuit of graduate work at Johns Hopkins. Good augments this familiar tale with fascinating depictions of equally influential yet lesser-known Hegelians such as H. C. Brokmeyer, Denton Snider, and Thomas Davidson. At a time when European Hegelianism was polarized between, on the one hand, reactionary apologists for traditional Christianity and Prussian militarism and, on the other, radical... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:A Search for Unity in Diversity: The "Permanent Hegelian Deposit" in the Philosophy of John DeweyFrank X. RyanJames A. Good A Search for Unity in Diversity: The "Permanent Hegelian Deposit" in the Philosophy of John Dewey Lanham, MD: Lexington Books, 2006. xxx + 288 pp.Among the revelations of Dewey's rare moments of autobiographical reflection, none has generated more curiosity and investigative zeal than his 1930 claim to have (...) "drifted" from Hegel in the decade following his move from Michigan to Chicago in 1894. Beginning with Morton White's Origin of Dewey's Instrumentalism (1943), biographers have divided on the question of whether Dewey's later philosophy was more strongly influenced by William James's experimental psychology or F. J. E. Woodbridge's Aristotelian naturalism. Despite their differences, both approaches are essentially empirical and realistic, and thus the majority of sympathetic commentators have agreed that Dewey was a realist, albeit of a decidedly unorthodox stripe. For them the notion that Dewey retained any significant commitment to idealism, given its virtual eradication at the beginning of the twentieth century, would damage his influence and legacy.It has been something of a puzzle, accordingly, that in the same autobiographical essay Dewey alludes to a "permanent Hegelian deposit." For years Richard Rorty has claimed this differentiates a "good" Dewey committed to "social flourishing" from a "bad" Dewey prone to metaphysical dalliance. But the first systematic inquiry into Dewey's enduring Hegelianism is John R. Shook's Dewey's Empirical Theory of Knowledge and Reality (2000). Shook argues convincingly that Dewey never abandoned idealism, but rather transformed it into an experimental naturalism by doing away with both "mind-stuff" and equally noxious "things-in-themselves." In many ways James Good's A Search for Unity in Diversity is a bookend to Shook's project, though Good further differentiates Anglo-American Neo-Hegelianism from Hegel himself. According to Good, Dewey endorsed a Humanistic/Historicist interpretation of Hegel rooted in the reciprocal engagement of individuals and societies, rather than the supernatural and architectonic absolute championed by Neo-Hegelians such as T. H. Green, and F. H. Bradley. With [End Page 216] top-notch scholarship and scrupulous attention to detail, A Search for Unity in Diversity is both an excellent intellectual biography and a penetrating plea for a radical reinterpretation of Dewey's contribution to philosophy. I'll briefly sketch the historical account before addressing the more controversial claims about the "permanent Hegelian deposit."Even readers familiar with the half-dozen book-length treatments of Dewey's development will find this account refreshing and informative. Good's professional credentials as a historian shine as he recreates the rough and bustling Burlington of Dewey's youth. In the 1870s, German idealism was considered the epitome of political liberalism and progressive education, and Dewey's journey toward the "inclusive philosophical idea" of the social began in an environment swirling with the crosscurrents of Kant, Hegel, and Schelling. At the White Street Congregational Church, Lewis Barstow preached a liberal orthodoxy that was essentially "man-building" (102), and Good presents a convincing case for the likelihood that even in boyhood Dewey never viewed God as an aloof law-giver or cosmic architect, but as a process unifying the individual and the social within a natural world of unlimited potential. At the University of Vermont Dewey encountered a struggling rural college transformed into the first bastion of American transcendentalism by James Marsh, who inspired a "Burlington philosophy" that rejected atomistic empiricism for a holistic integrity of knowing and doing, facts and values, and pure and practical reasons (57–59).In noting the influence of the "St. Louis Hegelians" upon Dewey, most biographers have focused on W. T. Harris, the prominent founder of The Journal of Speculative Philosophy who published Dewey's earliest submissions and offered encouragement that led to his pursuit of graduate work at Johns Hopkins. Good augments this familiar tale with fascinating depictions of equally influential yet lesser-known Hegelians such as H. C. Brokmeyer, Denton Snider, and Thomas Davidson. At a time when European Hegelianism was polarized between, on the one hand, reactionary apologists for traditional Christianity and Prussian militarism and, on the other, radical... (shrink)

In a recent article in the American Journal of Obstetrics and Gynecology, Frank Chervenak et al. argue that home birth is less safe than hospital birth, and that physicians have a dual duty to avoid any collaboration with home birth midwives and to make hospital birth more psychologically and socially supportive to accommodate women who want more choices during labor. The assertion that home birth is significantly less safe than hospital birth has been responded to by Howard Minkoff (...) and Jeffrey Ecker and by a recent large observational study of home birth outcomes in America. Minkoff and Ecker argue that the evidence supports, at most, a minimal increased.. (shrink)

Since it can sometimes seem necessary to undertake research that might affect a developing fetus, it would be useful to have a satisfactory ethical framework governing such efforts. Frank Chervenak...

Laurence B. McCullough and Frank A. Chervenak (2008) provide a lucid and convincing account of the conceptual errors made by abortion opponents in using the term unborn child as a rhetorical device...

ABSTARCT When people go shopping, they enter a building. But the shop cannot be identified with the building, because it would remain the same shop if it moved to another building or if it became an e-store. Daniel Korman [2019] uses these two observations to argue that establishments are immaterial objects. However, all that follows is that establishments are not buildings. I argue that establishments are organisations or corporate agents that are constituted by people. This entails that they are material (...) objects. Korman’s observations can be accommodated in terms of the further observation that corporate agents can but need not own or rent buildings. (shrink)

Kochen has suggested an interpretation of quantum mechanics in which he denies that wavepackets ever collapse, while affirming that measurements have definite results. In this paper I attempt to show that his interpretation is untenable. I then suggest ways in which to construct similar, but more satisfactory, hidden variable interpretations.