Open-uterine surgery to repair spina bifida, or ‘fetal surgery of open neural tube defects,’ has generated questions throughout its history—and continues to do so in a variety of contexts. As clinical ethics consultants who worked (Mark J. Bliton) and trained (Virginia L. Bartlett) at Vanderbilt University—where the first successful cases of open-uterine repair of spina bifida were carried out—we lived with these questions for nearly two decades. We worked with clinicians as they were developing and offering the procedure, with (...) researchers in refining and studying the procedure, and with pregnant women and their partners as they considered whether to undergo the procedure. From this experience in the early studies at Vanderbilt, we learned that pregnant women and their partners approach the clinical uncertainty of such a risky procedure with a curious and unique combination of practicality, self-reflection, fear, and overwhelming hope. These early experiences were a major contributing factor to the inclusion of an ethics-focused interview in the informed consent process for the Management of Myelomeningocele Study (MOMS) trial study design. (shrink)

I explore some new directions—suggested by feminism—for medical ethics and for philosophical ethics generally. Moral philosophers need to confront two issues. The first is deciding which moral issues merit attention. Questions which incorporate the perspectives of women need to be posed—e. g., about the unequal treatment of women in health care, about the roles of physician and nurse, and about relationship issues other than power struggles. “Crisis issues” currently dominate medical ethics, to the neglect of what I call “housekeeping issues.” (...) The second issue is how philosophical moral debates are conducted, especially how ulterior motives influence our beliefs and arguments. Both what we select—and neglect—to study as well as the “games” we play may be sending a message as loud as the words we do speak on ethics. (shrink)

Background: An ongoing challenge for clinical ethics consultation is learning how colleagues in other healthcare professions understand, make use of, and evaluate clinical ethics consultation services. Aim: In pursuing such knowledge as part of clinical ethics consultation service quality assessment, clinical ethics consultation services can learn important information about the issues and concerns that prompt colleagues to request ethics consultation. Such knowledge allows for greater outreach, education, and responsiveness by clinical ethics consultation services to the concerns of clinician colleagues. Design: (...) This quality assessment project explores consultation requests and follow-up questionnaire responses voluntarily submitted from nurses who requested clinical ethics consultation. We present qualitative data analyzed using content analysis and constant comparison methods to identify key concerns that prompted requests as well as common themes among nurse requestors’ evaluations of what was most important in clinical ethics consultations. Participants and context: A total of 41 nurses requesting clinical ethics consultation and 15 who returned the follow-up questionnaire. Ethical considerations: Our Office of Research Compliance and Quality Improvement determined that our project was not considered human subjects research and so did not require institutional review board approval or exemption. However, efforts were made to avoid any sense of coercion and all data were de-identified prior to analysis. Findings: Our analysis revealed six main categories of issues that prompted nurses’ requests for ethics consultation, as well as unifying themes around nurses’ experiences, advocacy, and family support while caring for patients in the intersections of patients, families, and physicians. Discussion: The insights gained from analyzing nurses’ requests for and responses to clinical ethics consultation may serve as a resource for clinical ethics consultation services seeking to identify, respond to, and educate regarding issues of importance to nurse colleagues and may be a resource for nursing administrators and leadership seeking to identify and address common ethical issues nurses face. Conclusion: Ongoing work on clinical ethics consultation service quality improvement and engagement with our nursing colleagues about their concerns prompting—and their evaluations of—clinical ethics consultation are necessary. (shrink)

Bruno and Arora (2018) present a range of important ethical issues emerging from the development of procedures for uterine transplant (UT). They approach those issues by drawing on parallels to oth...

It has been observed that some groups in society tend to report their health to be better than would be expected through more objective measures. The available evidence suggests that while variations in self-assessed measures of health may act as good proxies of mortality and morbidity in homogeneous populations, in some groups, such as the Aboriginal and Torres Strait Islander communities of Australia, these subjective measures may provide a misleading picture. Useful insights into the formation of health perceptions can be (...) drawn from a range of disciplines, in particular, from social comparison theories, models of illness behaviour, survey literature and linguistics. These theories and models help to provide an understanding of the different ways in which illness may be perceived, evaluated and acted upon by different kinds of people. Such considerations can have very direct implications for those planning and evaluating public health programs as well as those responsible for funding such programs. (shrink)

Despite increased attention to the question of how best to evaluate clinical ethics consultations and emphasis on external evaluation, there has been little sustained focus on how we, as clinicians, make sense of and learn from our own experiences in the midst of any one consultation. Questions of how we evaluate the request for, unfolding of, and conclusion of any specific ethics consultation are often overlooked, along with the underlying question of whether it is possible to give an accurate account (...) of clinical ethics consultants’ experience as experienced by ethics consultants. Before the challenge of submitting one’s accounts or case reports for review and evaluation from others, there is an underlying challenge of understanding and evaluating our own accounts. To highlight this crucial and deeply challenging dimension of actual clinical ethics practice, we present an account of a complex consultation, explicitly constructed to engage the reader in the unfolding experience of the consultant by emphasizing the multiple perspectives unfolding within the consultant’s experience. Written in script format, the three perspectives presented—prototypical clinically descriptive account; didactically reflective and self-evidentiary account often seen in journal presentations; highly self-critical reflective account emphasizing uncertainties inherent to clinical ethics practice—reflect different manners for responding to the ways actual clinical involvement in ethics consultation practice accentuates and refocuses the question of how to understand and evaluate our own work, as well as that of our colleagues. (shrink)

There have been major developments in the understanding of children’s nonhuman concepts, particularly God concepts, within the past two decades, with a body of cross-cultural studies accumulating. Relatively less research has studied those of non-Christian faiths or children’s concepts of popular occult characters. This paper describes two studies, one in Spain and one in England, examining 5- to 10-year-olds’ human and nonhuman agent beliefs. Both settings were secular, but the latter comprised a Muslim majority. Children were given a false-belief task (...) in which they were asked to infer about three humans, three animals and three supernatural beings. Similar false beliefs about humans, with subtle differences in inferences about animals and supernatural beings, were found between the two locations. In London different patterns for God between participants with a family religion, in particular Muslims, and non-affiliates, were identified as well as an association between religious beliefs and practice and inferences about God. Findings are discussed in the light of theory and research on the role of sociocultural inputs in children’s theory of mind development and understanding of agency. (shrink)

While acknowledging the tremendous work that went into the Views in Bioethics Survey (VIBeS) project, my initial reaction to Pierson et al.’s work was … skeptical. Not because the research wasn’t w...

“If philosophy is essentially this activity of questioning and responding, that is, dialogue…” ∼ R.M. Zaner (The Way of Phenomenology)“Not to philosophize is to philosophize still.” E. Lévinas (“Go...

Since the concept of the living wills emerged nearly 50 years ago, there have been practical challenges in translating the concept of an advance directive into documents that are clinically useful across various healthcare settings and among different patient populations and cultures. Especially, challenging has been the reliance in most ADs on pre-selected “choices” about specific interventions which either revolve around broad themes or whether or not to utilize particular interventions, both of which about most laypersons know little and, more (...) importantly, lacking context, prove to be of limited meaningfulness. Moreover, whether by foundational frame, decade-long misunderstanding in medicine and bioethics, or different societal customs, these ADs present decision-making responsibility for initiating, continuing, or withdrawing medical interventions as a patient responsibility—creating a burden for which most patients are unprepared—and hence reducing healthcare providers’ responsibility to mere technical application or customer service. At our institution, significant efforts have focused on embracing the unique and complementary responsibilities of patients and physicians for enabling appropriate plans of care. This includes re-structuring our AD form to more accurately represent patient’s values as the frame within which physicians are responsible for determining appropriate care. Rather than specifying interventions, the AD makes patients responsible for specifying what matters to them as well as what they value in terms of function, interaction, and level of acceptable burden, thus providing clear goals for clinicians to pursue—or when goals are not reachable by available medical interventions, to acknowledge and allow for logical shifts to what may be achieved, including, in end of life contexts, care focused on respect and dignity. (shrink)

Against the background assumptions that knowing what clinical ethics consultation represents to those with whom ethics consultants work most closely is a necessary component for being responsible in the practice of ethics consultation, and the complexities of soliciting and understanding colleague evaluations require another inherent responsibility for the methods by which ethics consultations are evaluated, in this article we report our experience soliciting, analyzing, and trying to understand retrospective evaluations of our Clinical Ethics Consultation Service. These evaluations were collected through (...) a quality assessment effort at our institution. Drawing from the qualitative elements of our survey instrument, we describe unexpected variations among the requests for ethics consultation and the retrospective reports from those colleagues making the requests. Focusing on just one aspect – the reason for request – raised several core questions about how we should evaluate those retrospective reports, what could be learned from the differences that we were now encountering, and what we could learn about the process of evaluating our practices. Working through these questions, we suggest several issues to consider in ongoing efforts to describe and evaluate clinical ethics consultation: the role of time and memory in evaluating retrospective evaluations, the importance of attending to the language of moral shift or disruption with which our colleagues describe their experiences, and how to understand the role of ethics consultation in creating ‘moral space’ for colleagues to process their moral experiences. (shrink)

Volume 19, Issue 10, October 2019, Page 43-46.

Clinical ethics consultants (CECs) work in complex environments ripe with multiple types of expectations. Significantly, some are due to the perspectives of professional colleagues and the patients and families with whom CECs consult and concern how CECs can, do, or should function, thus adding to the moral complexity faced by CECs in those particular circumstances. We outline six such common expectations: Ethics Police, Ethics Equalizer, Ethics Superhero, Ethics Expediter, Ethics Healer or Ameliorator, and, finally, Ethics Expert. Framed by examples of (...) requests for ethics consultation that illustrate each kind, along with brief descriptions, we argue that while these expectations ought to be resisted for clear and practical reasons, they also create opportunities for CECs to articulate, educate, and ultimately be responsible to the professional demands of clinical ethics work. Recognizing, acknowledging, and at times resisting those expectations thus become key activities and responsibilities in the performance of ethics consultation. (shrink)

A more complete methodology for normative ethics is needed, and Kierkegaard's philosophy, which emphasizes the individual's role in moral decision-making, can help to meet this need. This essay discusses two ways in which Kierkegaard sought to expand a commonly accepted conception of morality. First, he stressed that the agent changes as part of the process of moral decision-making, with personal experience and insight integral parts of that process. Second, Kierkegaard included within the realm of morality decisions (e.g., about occupation) which (...) are normally viewed as simply matters of personal preference. (shrink)

Furthermore, adults with decision-making capacity, including pregnant women, can currently accept interventions with moderate net risks for themselves in other settings (e.g., open f...

Combining the liberalism of Locke and the "civic humanism" of Republicanism, Mary Wollstonecraft explored the need of women for coed and equal education with men, economic independence whether married or not, and representation as citizens in the halls of government. In doing so, she foreshadowed and surpassed her much better known successor, John Stuart Mill. Ten feminist scholars prominent in the fields of political philosophy, constitutional and international law, rhetoric, literature, and psychology argue here that Wollstonecraft, by reason of the (...) scope and complexity of her thought, belongs in the "canon" of political philosophers along with Rousseau and Burke, her contemporaries, both of whom she strenuously engaged in political debate. These essays explore the many aspects of her thought that resound so tellingly to the modern woman, including her groundbreaking attempt to be completely self-sufficient. The final bibliographical essay outlines the changing interpretations of Wollstonecraft's work over the past two hundred years and evaluates her standing among political theorists today. Contributors are Maria J. Falco, Penny A. Weiss, Virginia Sapiro, Virginia L. Muller, Wendy Gunther-Canada, Carol H. Poston, Miriam Brody, Moira Ferguson, Louise Byer Miller, and Dorothy McBride Stetson. (shrink)

Dieser Aufsatz ist eine kritische und erkundende Diskussion von Plantingas Behauptung, daß bestimmte Aussagen, aus denen evidentermaßen folgt, daß Gott existiert, berechtigterweise basal sein könnten. Im kritischen Abschnitt argumentiere ich dafür, daß es Plantinga nicht gelingt zu zeigen, daß das Kriterium des modernen Fundamentalisten für berechtigte Basalität, dem zufolge solche Aussagen nicht berechtigterweise basal sein können, selbstreferentiell inkohärent oder anderweitig mangelhaft ist. Im erkundenden Abschnitt versuche ich, ein Argument für die Auffassung zu entwickeln, daß solche Aussagen, selbst wenn sie berechtigterweise (...) basal sein könnten, wenn überhaupt, nur selten berechtigterweise basal für intellektuell differenzierte erwachsene Theisten unserer Kultur wären. (shrink)

The rapid evolution of drug resistance remains a major obstacle for HIV therapy. The capacity of the virus for recombination is widely believed to facilitate the evolution of drug resistance. Here, we challenge this intuitive view. We develop a population genetic model of HIV replication that incorporates the processes of mutation, cellular superinfection, and recombination. We show that cellular superinfection increases the abundance of low fitness viruses at the expense of the fittest strains due to the mixing of viral proteins (...) during virion assembly. Moreover, we argue that whether recombination facilitates the evolution of drug resistance depends critically on how resistance mutations interact to determine viral fitness. Contrary to the commonly held belief, we find that, under the most plausible biological assumptions, recombination is expected to slow down the rate of evolution of multi‐drug‐resistant virus during therapy. BioEssays 26:180–188, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

Dieser Aufsatz ist eine kritische und erkundende Diskussion von Plantingas Behauptung, daß bestimmte Aussagen, aus denen evidentermaßen folgt, daß Gott existiert, berechtigterweise basal sein könnten. Im kritischen Abschnitt argumentiere ich dafür, daß es Plantinga nicht gelingt zu zeigen, daß das Kriterium des modernen Fundamentalisten für berechtigte Basalität, dem zufolge solche Aussagen nicht berechtigterweise basal sein können, selbstreferentiell inkohärent oder anderweitig mangelhaft ist. Im erkundenden Abschnitt versuche ich, ein Argument für die Auffassung zu entwickeln, daß solche Aussagen, selbst wenn sie berechtigterweise (...) basal sein könnten, wenn überhaupt, nur selten berechtigterweise basal für intellektuell differenzierte erwachsene Theisten unserer Kultur wären. (shrink)

This paper addresses the Harmful Dysfunction Analysis of mental disorder. We argue that some mental conditions meet both of its criteria —the dysfunction criterion and the harm criterion— and yet should not count as mental disorders because of their value. We contend that the harm criterion, by taking harm as a proxy for disvalue, is an inadequate normative criterion in these cases. Therefore, further ethical considerations should be included as a normative criterion. To illustrate our view, we draw on the (...) experience and reflections of Jean Améry, a philosopher and Holocaust survivor who resisted the diagnosis of KZ-Syndrom. (shrink)

Als Goethe in seiner monumentalen Farbenlehre einen Angriff auf Newtons Theorie des Lichts und der Farben lancierte, setzte er eine Methode ein, die er als Vermannigfachung der Erfahrungen bezeichnete: Er variierte verschiedene Parameter der newtonischen Experimente, um neuen Spielraum für Alternativen zur Theorie Newtons zu gewinnen. Dabei erzielte er durchaus Erfolge. U.a. entdeckte er das Komplement zum newtonischen Spektrum (das aussieht wie dessen Farbnegativ und durch Vertauschung der Rollen von Licht und Finsternis entsteht). Kürzlich hat der Wiener Maler Ingo Nussbaumer (...) Goethes Methode kongenial fortgeführt. Dabei hat er sechs weitere Farbspektren entdeckt. Sie entstehen, wenn man anstelle des Hell/Dunkel-Kontrasts (in Newtons und Goethes Experimenten) mit Paaren bunter Komplementärfarben arbeitet. Die neuen Farbspektren sehen genauso differenziert aus wie Newtons und Goethes Spektrum; doch anders als diese enthalten sie die unbunten "Farben" Schwarz und Weiß. Die vielfältigen Ordnungsbeziehungen und Symmetrien, die Ingo Nussbaumer in der Farbenwelt der insgesamt acht Spektren ausgemacht hat, verhelfen uns vielleicht zu einem tieferen Verständnis der Prinzipien menschlicher Farbwahrnehmung. Und sie tauchen die überkommenen Prinzipien der additiven und der subtraktiven Farbmischung in neues Licht. (shrink)

Dies bietet einen knappen Überblick über Leben und Werk des britischen Philosophen P. T. Geach. Unter anderem wird vorgeführt, mithilfe welches Arguments Geach die Sein/Sollen-Schranke zu überwinden beanspruchte.

I wish to propose a new doctrine called epistemological pacifism. According to the doctrine, our objective knowledge concerning hard facts about a given war and its context is far too poor to justify entering that war. Our best and most informative accounts of any pre-war situation are value-laden; the same is true of counterfactual claims about any event during, or after, war. Here we have three new types of what has been discussed under the label of fact/value entanglement. Realizing this (...) helps us understand why pacifists and their opponents never agree about so-called facts. Both parties bring to bear different values in their descriptions. Although this is legitimate for both sides, the values of the pacifist are more attractive than those of the bellicist. The recent war in Mali is a case in point, as I’ll sketch at the end of the paper. (shrink)