Most ethicists have paid little attention to the rhetorical features of case presentations. In order to examine the constructed nature of bioethics cases, this paper examines the literary characteristics of four presentations of Donald “Dax” Cowart's story. By comparing tellings of the same case, a pattern of redaction is revealed by which the tellers conceal the very features that would challenge the perspectives taken in their arguments. In conclusion, the issue of the applied nature of bioethics is examined.

For the most part, philosophers have regarded moral truth as propositional and as what follows from the application of moral theory to particular problematic cases. Here I maintain that this is not a useful way of conceiving moral truth in bioethics. Rather, we are better off conceiving of moral truth as what emerges from a process of inquiry conducted in a certain manner. There are four elements to this process: (1) careful exploration of the embedded norms (...) of medical practice, research, and delivery; (2) recognition of the irreducible plurality of ultimate moral values within and between these practices; (3) the cultivation and exercise of moral imagination; and (4) the attainment, however temporarily, of wide reflective equilibrium. This process, I argue, is reflected in the way bioethics is most fruitfully practiced, and it is further to be recommended by being true to the character of moral conscientiousness generally. This analysis suggests that moral truth is "unstable," but that this is not a bad thing. Further, the implication is drawn that moral theory would be better informed if formulated on the basis of paying more attention to lived moral practices. (shrink)

How do we know that particular answers in bioethical controversies are true, or are at least getting closer to the truth? We gain insight into this question by applying Alasdair MacIntyre’s work on the nature of rationality, rational justification, and tradition. Using MacIntyre’s work and the papers in this issue of The Journal of Medicine and Philosophy, I propose a framework for members of particular traditions to judge whether they themselves or other traditions are getting closer to or further (...) away from the truth in particular bioethical questions. Members of different traditions—be it Confucian, Aristotelian, politically liberal, utilitarian, or something else—should look at how they and their theoretical rivals look at empirical data to address bioethical questions, the moral judgments they make, and the laws and regulations they support. Some level of agreement on these issues need not require individual traditions to eschew their foundational premises or values; recognizing the reality of moral pluralism and disagreement should not prevent us from seeing this. Neither, as MacIntyre argues, should pluralism and disagreement obscure that a necessary condition for successful rational exchange and adjudication between competing traditions is granting authority to certain norms and virtues. (shrink)

Truth-telling is often regarded as a challenge in Chinese medical practices given the amount of clinical and ethical controversies it may raise. This study sets to collect and synthesize relevant ethical evidence of the current situation in mainland China, thereby providing corresponding guidance for medical practices. This study looks into the ethical issues on the basis of the philosophy of deontology and utilitarianism and the ethical principles of veracity, autonomy, beneficence, and nonmaleficence. Chinese philosophy, context and culture are also (...) discussed to provide some suggestions for decision-making about disclosure in a medical setting. This study holds that, in order to respect the basic rights to which critically ill patients are entitled, decisions regarding truth-telling and their implementation should be carried out with thorough consideration, which can be achieved by critical thinking, well-developed and effective communication skills, the consideration of cultural context, an understanding of individual differences, and compliance with relevant laws and regulations. (shrink)

This article describes how ethical issues in health are approached and resolved within the framework of Jewish bioethics. Its main purpose is to explore the range of sources and methodologies used to determine the appropriate hierarchy of values for various ethical scenarios. Its major thrust is to illustrate how a divinely based but humanly negotiated ethical code stands firm upon ‘red flag’ principles, while at the same time, allowing for ‘shades of gray’ flexibility informed by given contexts. It provides (...) significant insights and practical tools that can be instrumental in decision making for nurses and other health providers of all faiths. The following ethical domains are addressed: respect for patient autonomy, truth-telling and allocation of resources. (shrink)

A new political movement has arisen in bioethics, self‐consciously distingushed from the rest of the ield and characterized by a new way of writing and arguing. Unfortunately, that new method is mean‐spirited, mystical, and emotional. It claims insight into ultimate truth yet disavows reason.

Disclosure of health information is a sensitive matter, particularly in the context of serious illness. In conservative societies—those which predominate in the developing world—direct truth disclosure undoubtedly presents an ethical conundrum to the modern physician. The aim of this study is to explore the truth disclosure practices of physicians in Jordan, a developing country. In this descriptive, cross-sectional study, 240 physicians were initially selected by stratified random sampling. The sample was drawn from four major hospitals in Amman, Jordan. (...) A closed-ended questionnaire was distributed and completed by self-report. A total of 164 physicians completed the questionnaire. Thirty-seven physicians usually withheld the diagnosis of “serious illness” from patients, while 127 physicians usually divulged the information directly. Among the latter, 108 physicians made exceptions to their disclosure policy. Specialists were more likely to withhold health information. Non-disclosure was primarily motivated by request from the patient’s family. In twenty cases, non-disclosure was undertaken independently. In conclusion, most respondents opt to disclose the truth; however, the vast majority of these respondents make exceptions. Instances of non-disclosure are primarily motivated by sociocultural constructs. (shrink)

To what extent is truth required for reconciliation of peoples in conflict? What kind of truth? Objective truth, subjective truth? Maybe reconciliation require that the pursuit of truth be limited? The trial of the former “Khmer Rouge” leaders in Cambodia for crimes against humanity provides a case where these issues are examined.

In lieu of an abstract, here is a brief excerpt of the content:The Truth in WritingAmandaAn excerpt from my journal during a dark period in my life reads:I am a survivor of sexual mutilation, of coerced gender roles, and of perpetual lies all in the name of normalization. Sometimes I have a hard time even thinking about the true extent of what all happened. It’s like my mind doesn’t have that type of scope, like when I think about the (...) word “eternity.”I wrote this after combing through old medical records, reading comments like “her introitus has healed nicely and looks normal, but my exam suggests that her vagina is shortened,” and “reduction clitoroplasty... removal of testes.” The records go on to say that my “external genitalia is quite satisfactory,” and “on perineal exam, her neovaginal orifice is quite compliant and easily accepts my second and third digits.”My journal continues:I chose this fake hole when I was a teenager because I didn’t know there was another option. I was told from day one to be a female, to be heteronormative, to act like all the other girls, and the only way I could fully accomplish this is by looking the part. A fake hole would be necessary, I thought, to go along with the rest of the lies. Sometimes I think about how the doctors told me to lie about my surgeries and my scars. Sometimes I wonder what my parents would have told the world if I had died during one of surgeries. Maybe they would have said “we were just trying to make her fuckable.”My strength is growing from the stories and experiences I write and share. My journal started about four years ago, when I was in my early 20s, near the beginning of medical school. My initial purpose in writing the journal was to help sort through my feelings and experiences related to a newly discovered sexuality and a changing gender identity. Medical school was thousands of miles away from my previous life, my family, and my friends. Away from my old social network, I was free to self–discover on my own terms. In the first journal entry, I lay out reasons why I decided to get in contact with a therapist, something I had not done previously. Some of the reasons were fairly standard reasons one seeks out a therapist, such as moving away from home. But the fundamental reasons I sought out a therapist, and why I chose to journal, had to do with exploring feelings after my first sexual encounter with a woman, and then [End Page 98] accepting my intersexuality. My relationship with that therapist did not last, but the journaling did.In the beginning of the journal, I write:I am from a small, religious, white, non–diverse, family oriented suburb of Milwaukee. I was raised to be the picture–perfect daughter in a household that did not talk about feelings, sex, cultural or religious differences, etc. My brother and I also never talked about personal issues (and still don’t), which is quite remarkable since we are twins, and have grown up doing most everything together, from sharing birthday parties, to being locker buddies... [When my mother told me about having Androgen Insensitivity Syndrome (AIS)] knowing this little fact about my body kept me wanting to become as perfectly female in all ways possible.Growing up without being able to talk about having AIS was stifling to say the least. Closing communication implied great shame, and with the shame came even greater repression. My skate-boarding, baseball card collecting, and model car building interests disappeared after learning about my AIS, which I believe was when I was 12 years old, but I cannot remember exactly. Granted, it’s tough to say whether my interests just changed as I grew older, but I do remember having a fear of portraying any masculine tendencies that other girls in my town weren’t displaying (for example, playing soccer was okay, but I had to shave my legs). I also had crafted some pretty good covers for my AIS, including stories about when I first had my (fake) period, or how I acted fearful about a... (shrink)

The TRUTH is announced to creation by the Holy Spirit, the Spirit of Truth. Here, when the consciousness rises above “the double bound of space and time” and enters into eternity, here at this moment of annunciation, the One Who announces the Truth and the Truth Announced coincide completely. In the appearance of the Spirit of Truth, i.e., in the light of Tabor, the form and the content of the Truth are one (Florensky, 1997, (...) p. 106). (shrink)

Unveiling the Past—Preparing the Conditions for Human Beings to Live in the Midst of One Another Again? A Response From Living in Northern Ireland Content Type Journal Article Category Symposium Pages 333-335 DOI 10.1007/s11673-011-9334-y Authors Derick Wilson, University of Ulster, School of Education, Coleraine, Co. Londonderry, BT52 1SA UK Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 4.

This chapter examines truthfulness, or veracity, in the context of health care services within prisons, jails, and detention facilities in the United States. Mainstream discussions of bioethics often highlight the general importance of veracity within the patient-provider relationship, including providers’ obligations and constraints with respect to telling the truth to their patients, and, to a lesser extent, patients’ responsibilities and concerns regarding truthful reporting to their providers. However, a great deal of this literature largely overlooks how structural barriers (...) to health care impact the functions of veracity in the provision of health care—including racist and sexist biases in clinical judgment, inadequate staffing, infrastructure, and accessibility in medical facilities, and institutionally specific constraints. Through an analysis of Assata Shakur’s political autobiography, this chapter focuses on such structural barriers to health care in carceral facilities with a focus on the institutionally specific constraints that arise through the punitive aims of carceral facilities. By focusing on the intersection between punishment and health, this chapter argues that bioethicists and clinicians alike would be better equipped to analyze structural barriers to health care that exist both within and beyond prison walls through a nonideal approach. (shrink)

ABSTRACT The presence of truth and honesty is a permanent demand, and becomes vital the more committed and intimate a relationship is. Medical practice is relevant to this discussion when one questions whether or not a physician should always tell their patient the truth in the face of a progressive or potentially fatal disease, regarding the diagnosis, outcome, therapy and evolution of the specific disease. From this discussion we aim, with the present report, to look at the (...) class='Hi'>truth applicable to the patient‐physician relationship, and its ethical and moral implications; and also to look at where the Brazilian Code of Medical Ethics (BCME) and the medical literature stand regarding this issue. One concludes that there are only two moments not to tell a patient the truth: when the patient does not want to be informed, and when the truth could be iatrogenic. The question now is, when would the truth be iatrogenic? Physicians, in our opinion, would not be able to judge solitarily when the truth might be deleterious to their patient. Alternatively, we propose the appointment of a multidisciplinary commission to help the doctor with such a decision. (shrink)

Volume 19, Issue 7, July 2019, Page W1-W3.

The article summarizes and critically analyzes the encyclical letter of Pope Benedict XVI “Deus Caritas est.” This document discusses “diaconia” in the Roman Catholic Church in view of its biblical and theological foundations, its characteristics, and the position of works of mercy within the general self-understanding of the church. In going beyond the text, the author emphasizes the political dimension of church-based charity, the need to respond to the challenge of the principle of solidarity by contemporary neoliberal tendencies, and the (...) relationship of the church to those employed in the service of her diaconia. (shrink)

The multidisciplinary provenance of bioethics leads to a variety of discursive styles and ways of reasoning, making the discipline vulnerable to criticism and unwieldy to the setting of solid theoretical foundations. Applied ethics belongs to a group of disciplines that resort to deliberation rather than formal argumentation, therefore employing both factual and value propositions, as well as emotions, intuitions and other non logical elements. Deliberation is thus enriched to the point where ethical discourse becomes substantial rather than purely analytical. (...) Caution must be exercised to avoid this formal permissiveness from accepting empty and incorrigible statements that are but flatus voci since they can neither be supported nor falsified. It is therefore suggested that deliberation in bioethics should comply with three sets of conditions: (1) Be understandable, truthful, honest and pertinent, as suggested by communicative ethics; (2) Allow for second order, thick judgements as suggested by pragmatism; (3) Abide by additional criteria as here proposed: Doxastic propositions should be bolstered by a cognitive element; statements should be specific and proportional to the issue at hand, and they should be arguable and coherent. (shrink)

A Christian approach to the issues that constitute bioethics is inevitable for us who cherish the truth of historic, creedal, trinitarian Christianity. Scripture teaches and the Greek and Latin Church Fathers as well as the Reformers aver that man, created in the image of God, has an inherent, if vestigial, sense of right and wrong and a conscience however marred by the fall and by rebellion. We must believe that we share this most basic ecumenism with all humanity, (...) not because of rational observation and analysis of nature, but because Scripture reveals it. We who are convinced of the truth of historic, creedal, trinitarian Christianity have a high view of Scripture and hold it to be infallible and utterly trustworthy irrespective of the importance we assign to our specific post-biblical traditional distinctives. This is a narrower but much more vital ecumenism than the first. Faithful adherence to Scripture inevitably manifests itself in remarkably similar priorities and values, often, lamentably, not because of, but in spite of, ourselves. (shrink)

This article offers an exposition and critical discussion of the account of the truth of practical reason in the natural-law theory of Germain Grisez, Joseph Boyle, and John Finnis. The exposition rests mainly on an article published by these authors in 1987. There they argue that “true” is said of theoretical and practical knowledge in radically diverse senses. They also distinguish, within practical knowledge, between two kinds of truth, practical and moral. This distinction is tied to their understanding (...) of relations that obtain among the first principles of practical reason. The essay’s critical discussion raises problems for the account in all three areas and favors the view that “true” means the same for all knowledge. National Catholic Bioethics Quarterly 15.2 : 303–329. (shrink)

This commentary explains how the ecclesiological significance of charity is linked with the Christian option for the poor. It explores reasons for the obvious division of the church into two more or less isolated organizations (“pastoral church” and “caritas church”) and looks for ways of bringing these two parts closer together. Secondly, the text emphasizes why spiritual formation among people working for Christian charity organizations is so important, and it specifies under which conditions such a formation (formation of the heart) (...) probably can succeed. (shrink)

The article explored the fact that various bioethical principles underlie the evaluation of the patient’s status and role in therapeutic interactions in written medical documents. We have found that characterization of biomedical, social and behavioural aspects of the patient’s existence relies on such bioethical principles as obligation, truthfulness, respect for human rights and dignity, the patient’s good. A few facts of the violation of the principle of respect for human rights and dignity consisting in verbal stigmatization have been provided. Bioethical (...) perspective is also taken to evaluate the mode and extent of the patient’s involvement in a medical interaction, which are either negatively or positively assessed based on the patient’s compliance and good. (shrink)

This article summarizes some of the results of the BIOMED II project “Basic Ethical Principles in European Bioethics and Biolaw” connected to a research project of the Danish Research Councils “Bioethics and Law”. The BIOMED project was based on cooperation between 22 partners in most EU countries. The aim of the project was to identify the ethical principles of respect for autonomy, dignity, integrity and vulnerability as four important ideas or values for a European bioethics and biolaw. (...) The research concluded that the basic ethical principles cannot be understood as universal everlasting ideas or transcendental truths but they rather function reflective guidelines and important values in European culture. The method of the research was conceptual, philosophical analysis of the cultural background of the four values or normative ideas that people use and find important in their existence. Moreover, this was combined with analysis of empirical legal material and policy documents. Also, a number of qualitative interviews with relevant experts were carried out. Another important result of the BIOMED project was the partner's Policy Proposals to the European Commission, the Barcelona Declaration, unique as a philosophical and political agreement between experts in bioethics and biolaw from many different countries. The Policy Proposals are reprinted here at the end of the article. (shrink)

The development of the philosophy of medicine in the Federal Republic of Germany since 1945 is presented in a thematic form. The first two decades were characterized by the evolution of an anthropological school of thought that aimed at relating physician and patient in a more personal and existential form than had hitherto been the case. In the last years, this tendency to demand deeper psychic and broader social involvement with medical problems had increased. Somatic disorders were considered to be (...) fundamentally caused by socially induced mental stress. After a brief period during which the theme of organisms in general and phenomenologically grasped living-body of human beings in particular were discussed, there followed since the mid-seventies an essential preoccupation with the methodology and epistemology of medicine. According to this trend, medicine is to be analyzed in terms of the theory of action, with its conceptual and strategic orientation towards practice and not, as generally believed, towards the standards of scientific truth. The concepts of disease, diagnosis and therapy are therefore relative and their validity is dependent on time, persons and circumstances involved. Thus, the highest criteria of utility for medical actions cannot but be the affected patient and society. (shrink)

Health care providers are expected both to relieve pain and to provide anticipatory guidance regarding how much a procedure is going to hurt. Fulfilling those expectations is complicated by the cognitive modulation of pain perception. Warning people to expect pain or setting expectations for pain relief not only influences their subjective experience, but it also alters how nociceptive stimuli are processed throughout the sensory and discriminative pathways in the brain. In light of this, I reconsider the characterization of placebo analgesia (...) as pharmacologically inert and the use of it as deceptive. I show that placebo analgesia exploits the same physical mechanisms as proven analgesics and argue that it should be utilized to relieve pain. Additionally, I describe factors to help identify situations in which clinicians have the obligation to disclose the potential for pain coupled with ways of mitigating the risk of high-intensity pain by setting positive expectations. (shrink)

The aim of the article is to analyze the modern mass media, in which the line between truth and lies has been blurred, leading to a lack of responsibility for words and their cognitive value. In the first part of the article, the value of truth in journalism is explored and the professional ethos associated with it, known as being ‘pro-truth’. In the second part, the negative effects of media lies and their various forms are described.

Good People, by Singaporean playwright Haresh Sharma, unmasks racial and religious tensions between Singapore’s increasingly diverse racial groups and the attendant ramifications on the healthcare ecosystem and the doctor-patient relationship. Drawing upon Michel Foucault’s notion of heterotopia, this paper argues that, in Good People, Sharma employs theater as a site of resistance by calling into question state and medical authority. First, state authority is challenged through the play’s scrutiny of the ideological principle of multiculturalism and its usefulness in fostering meaningful (...) cross-cultural exchanges and acceptance of different cultural and religious beliefs in the clinic. Second, the play destabilizes medical authority by surfacing the complex relationship between the doctor’s unconscious biases, racial and religious prejudice, and clinical judgment, thereby casting doubt on medicine’s claims of objectivity. In doing so, this paper argues, the play resists simplistic binary categorizations of the behaviors and motivations of the characters into good/bad or right/wrong, instead raising questions about power, knowledge, and contesting truths within the confines of the cultural space of a hospice. (shrink)

Telling the truth is one of the most respected virtues in medical history and one of the most emphasized in the code of medical ethics. Health care providers are frequently confronted with the dilemma as to whether or not to tell the truth. This dilemma deepens when both choices are critically vicious: The choice is no longer between “right and right” or “right and wrong,” it is between “wrong and wrong.” In the case presented and discussed in this (...) paper, a research team in Saudi Arabia unintentionally uncovered information regarding misattributed paternity. In such a situation and in the context of a tribal cultural system, what should the team do with this information? This case analysis demonstrates the joint application of ethical resources originating from within and outside the Saudi Arabian context. The article analyses the case based on the moral problems involved, relevant medical application, and the impact of such information in the Saudi tribal and Islamic domains. The most pertinent relevant values and secular debates on similar matters are discussed. Finally, the article aims to provide an Islamic dimension of family, fatherhood, and adultery. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:THE MEANING OF VIRTUE IN THE CHRISTIAN MORAL LIFE: ITS SIGNIFICANCE FOR HUMAN LIFE ISSUES RoMANUS CESSARIO, O.P. Dominican House of Stuaies Washington, D.a. RCENTLY, AN International Congress of moral theology convened in Rome brought together some three hundred academicians. They participated in an open forum devoted to current questions in moral theology and bioethics. Held at the Lateran University, the Congress, "Humanae vita,e: 20 Anni Dopo," was (...) divided into two parts. Although a majority of the presentations concerned the relevance of the Church's teaching on artificial contraception, the membership did devote the second part of the Congress to a sustained discussion of some new issues raised by Donum vitae (1987), the recent instruction of the Congregation for the Doctrine of the Faith on " Respect for Human Life in its Origin and on the Dignity of Procreation." To be sure, both documents emphasize the Church's constant teaching concerning the providence of God in human life and the dignity of the human person. Nevertheless, procedures such as GIFT (gamete intra.-fallopian transfer), LTOT (low tubal ovum transfer ), TOT (tubal ovum transfer) provide the moral theologian with new challenges to interpret the Church's position which insists on identifying the procrea.tive and unitive aspects of Christian marriage. The following article discusses the papal documents from the perspective of a realist moral theology. First of all, I would like to recall a principle which Paul VI, however obliquely, enunciated in the course of Humanae Vitae, for I consider the principle an axiomatic one in the present discussion. At the beginning of section 8 entitled "Pastoral 178 174 ROMANUS CESSARIO, O.P. Directives," we find a statement of theological purpose which should guide all Catholic moral practice. Hence, I would like to quote this text as a way of introducing the meaning of virtue in the Christian moral life. The Church, in fact, cannot have a different conduct toward men [and women] than that of the Redeemer: she knows their weaknesses, has compassion on the crowd, receives sinners; but she cannot renounce the teaching of the law which is, in reality, that law proper to a human Zife restored to its original truth and conducted by the Spirit of God.1 I am especially struck by the phrase " that law proper to a human life restored to its original truth," for I believe it actually describes the kind of life which develops in those who practice the virtues. Yet, before speaking about the implications of a virtue-centered morality for the difficult issues of bioethics, I would like to remark briefly on the way certain contemporary theologians misinterpret what Paul VI calls the " law proper to a human life restored to its original truth." In order to do so I have divided this paper into three parts. Thus, the first section of the paper examines several themes in contemporary moral methodology. The second section provides a general statement about the relationship between moral theology and the sa,cra domrina. Finally, the third section briefly considers why the life of virtue remains the only legitimate means for fulfilling the " law proper to a human life restored to its original truth." First, then, to contemporary themes. I Proportionate Reason and the Ethics of Personal Responsibility In an earlier draft of this paper, I titled this section "St. Ignatius, St. Alphonsus, and St. Elsewhere." I had considered actually outlining the moral methodologies of two Roman theo1 Paul VI, Humanae vitae, n. 20. VIRTUE THEORY AND HUMAN LIFE ISSUES 175 logians, the German Jesuit Josef Fuchs 2 and the Redemptorist Bernard Haring.3 These authors have influenced most leading revisionist moral theologians in America, especially Charles Curran.4 One could argue, therefore, that they figure among the principals in the current debate over bioethical norms. Upon reflection, however, it seemed rpreferable simply to signal two or three basic themes which appear in most revisionist moral theology, especially as it has been developed in the United States. In brief, these themes focus principally on (1) the freedom of the individual, and (2) the consequences or end results of an action. Revisionist moral theologians receive their name from the fact that their announced purpose... (shrink)

Following a series of undercover sting operations organized by Live Action at several Planned Parenthood clinics in 2008, there has been renewed interest in truthfulness and lying from the perspective of St. Thomas Aquinas. Some scholars have used these stings as an opportunity to criticize Aquinas’s position on lying, while others have defended the position of the Angelic Doctor. What implications does this renewed discussion of truthfulness and lying have on medical practice? Although deception in medicine has long been the (...) subject of scholarship, an authentic Thomistic analysis may shed new light on the issue and renew support for truthfulness in medicine while still permitting the prudent masking of the truth for the patient’s benefit. National Catholic Bioethics Quarterly 12.4 (Winter 2012): 633–651. (shrink)

Empirical studies have now established that many patients make clinical decisions based on models other than Anglo American model of truth-telling and patient autonomy. Some scholars also add that current medical ethics frameworks and recent proposals for enhancing communication in health professional-patient relationship have not adequately accommodated these models. In certain clinical contexts where health professional and patients are motivated by significant cultural and religious values, these current frameworks cannot prevent communication breakdown, which can, in turn, jeopardize patient care, (...) cause undue distress to a patient in certain clinical contexts or negatively impact his/her relationship with the community. These empirical studies have now recommended that additional frameworks developed around other models of truth-telling; and which take very seriously significant value-differences which sometimes exist between health professional and patients, as well as patient's cultural/religious values or relational capacities, must be developed. This paper contributes towards the development of one. Specifically, this study proposes a framework for truth-telling developed around African model of truth-telling by drawing insights from the communitarian concept of ootọ́ amongst the Yoruba people of south west Nigeria. I am optimistic that if this model is incorporated into current medical ethics codes and curricula, it will significantly enhance health professional-patient communication. (shrink)

Feminist explorations of fitness and health are concerned with the ways in which fitness serves as a component of women’s health and well-being. Feminists considering the rhetoric of fitness and health interrogate assumptions about what constitutes “fitness” and “health” and examine the ramifications of these assumptions in socialization, privilege, and power. Although there are limited academic explorations of them, many feminist accounts of these issues find a home with Health at Every Size, a campaign that promotes the idea that an (...) appropriate, healthy weight cannot be determined for an individual by a number on a scale or in a chart. Instead, HAES proponents maintain that labels such as... (shrink)

An acute hospital environment is a confusing place for many patients requiring admission, especially when they are presenting as acutely unwell. This can be particularly difficult for people living with dementia. As cognition changes it is not uncommon for people living with dementia to have difficulties with their ability to orientate to time, place and person. These disorientating moments can lead to personal distress, and at times behavioural changes. As well as being distressing for the person living with dementia, it (...) can also be emotionally and ethically challenging for acute hospital staff, including nurses. One area found to be particularly challenging is the concept of whether actively engaging with a person living with dementia's living truth is deceitful. This raises further questions of what forms of nurse responses to temporal disorientation might be constituted as lying, colluding, or alternatively validating. This article uses autoethnography as a research methodology with which to explore a mental health nurse's lived experience of the challenges of responding truthfully to disorientation and distress in an acute hospital. This article is not attempting to offer conclusive answers to these challenging ethical questions. It is instead re‐opening and re‐visiting the discourse of what is truth in dementia from a personal and professional nurse perspective through a lived narrative. The conclusion to the concept of truth in dementia is complex, nuanced and individualized. However, it is essential that a nurse's response to disorientation and distress is always person and living present focused, and not lie focused. (shrink)

This article argues that criminal justice and health institutions under settler colonialism collude to create and sustain “truths” about First Nations lives that often render them as “bare life,” to use the term of Giorgio Agamben. First Nations peoples’ existence is stripped to its sheer biological fact of life and their humanity denied rights and dignity. First Nations people remain in a “state of exception” to the legal order and its standards of care. Zones of exception place First Nations people (...) in a separate and diminished legal order. Medical and health agencies have been instrumental in shaping colonial “biopower,” both in and beyond carceral settings to ensure that First Nations lives are managed in accordance with the colonial settler state project. This project is able both to threaten First Nations rights to live and to maintain settler self-perceptions of decency and care. We illustrate this discussion with reference to the tragic and unnecessary deaths in custody of twenty-two-year-old Yamatji woman Ms Dhu in 2014 in South Hedland Police Station, Western Australia, and twenty-six-year-old Dunghutti man David Dungay Jnr in Long Bay jail in Sydney, NSW, in 2015. Health professionals and police demonstrated callous disregard to Ms Dhu and Mr Dungay—treating them as “bare life.”. (shrink)

In order to prepare bioethics and clinical ethics courses for clinicians in Turkey, we needed to know the attitudes of physicians when placed in ethically difficult care situations. We presented four cases to 207 physicians who are members of the Physicians’ Association in Kocaeli, Turkey. Depending on the decisions they made in each case, we determined whether they were aware of the ethical aspects of the cases and the principles they chose as a basis for their decisions. We aimed (...) to gain information about their ethical tendencies and moral sensitivity. A small number of physicians stated that they would ‘show respect for a patient’s living will’ in the first case, but more stated that they would ‘let the patient refuse the treatment’ in the second. In the third case, where medical confidentiality was the significant ethical issue, most of the physicians said that they would act in order to maintain confidentiality. For the last case, more than half the physicians chose to ‘tell the truth’ to the patient. The paternalism shown in the doctors’ decisions on the first two cases was no longer observed in those made for the last two cases. We concluded that the physicians who participated in our study have low sensitivity to living wills (or advance directives) and patients refusing treatment. However, when issues of medical confidentiality and truth-telling are concerned, they take care to protect the autonomy of the individual and are relatively more aware of the ethical aspects of these cases. (shrink)

The impact of machine learning in healthcare on patient informed consent is now the subject of significant inquiry in bioethics. However, the topic has predominantly been considered in the context of black box diagnostic or treatment recommendation algorithms. The impact of machine learning involved in healthcare resource allocation on patient consent remains undertheorized. This paper will establish where patient consent is relevant in healthcare resource allocation, before exploring the impact on informed consent from the introduction of black box machine (...) learning into resource allocation. It will then consider the arguments for informing patients about the use of machine learning in resource allocation, before exploring the challenge of whether individual patients could principally contest algorithmic prioritization decisions involving black box machine learning. Finally, this paper will examine how different forms of opacity in machine learning involved in resource allocation could be a barrier to patient consent to clinical decision-making in different healthcare contexts. (shrink)

In Truthfulness and Tragedy Stanley Hauerwas provides an account of moral existence and ethical rationality that shows how Christian convictions operate, or should operate, to form and direct lives. In attempting to conceptualize the basis of Christian ethics in a manner that will render Christian convictions morally intelligible, the author casts fresh light on traditional theoretical issues and articulates the distinctive Christian response to contemporary concerns such as suicide, medical ethics, and child care. The first section of the book deals (...) with methodological issues: the meaning and nature of practical reason, obligation claims, natural law, and self deception, and the affinity of story and ethics. It focuses on the relation of truthfulness and tragedy and the need for a story--a set of religious convictions or "grammar of theology"--that does justice to the tragic character of human existence. The second section addresses substantive issues: suicide, euthanasia, and the value of survival; the moral limits of population growth; the definition of "person" for medical reasons; and social involvement and Christian ethics. The overall theme is the need for a community in which truthfulness is a way of life. In the final section, devoted to the problem of how to care for retarded children, the implications of the author's ethical position are given concrete expression. He discusses the assumptions underlying the willingness to have children, criteria for humanness, medical ethics, and how truthful communities deal with suffering. In Truthfulness and Tragedy Stanley Hauerwas extends and clarifies the ethical position set forth in his earlier books Character and the Christian Life and Vision and Virtue. He is associate professor of theology at the University of Notre Dame. He was a senior fellow in Christian medical ethics at the Joseph and Rose Kennedy Institute for the Study of Reproduction and Bioethics, and taught medical ethics at the University of Texas medical branch in Galveston. (shrink)

In their address of structural racism in healthcare, Sabatello and colleagues provide both a remarkable review of the empirical literature regarding the disproportionate impacts of the COVID...

The aim of this chapter is to engage with the inherent humanism of bioethics and consider the possibility of thinking bioethics otherwise - beyond the belief in the intrinsic dignity and superior value of the human, and beyond the rules and procedures rooted in this belief. It is also to challenge what we may call the ‘cognitivist pretence’ of humanism, i.e. the conviction that the human can be distinguished from other forms of life by the inherent ‘truth’ (...) and teleology of his being which is to be revealed to him, and which he can uniquely grasp. The human as both a discrete subject and an object of bioethics becomes thus a critical point of interrogation in this study. What I want to outline in response is a non-systemic bioethics of relations which does not abdicate its ethical responsibility or its political commitment, although it questions many of the premises of established moral and political theories. Indeed, I want to ‘put to the test the pretentious belief that only a liberal and humanistic view of the subject can guarantee basic elements of human decency: moral and political agency and ethical probity’. But my project is more genealogical than futurologist. By revisiting the story of bioethics’ emergence as a separate discipline, I want to consider the following question: what if the cyborg rather than the human had been adopted as its foundation? Or, to put it another way, what would a bioethics for humans, animals and machines look like? (shrink)

This article reports the results of a survey, by mailed questionnaire, of the attitudes, values and practices of doctors in Singapore with respect to the doctor-patient relationship. Questionnaires were sent to a random sample of 475 doctors (261 general practitioners and 214 medical specialists), out of which 249 (52.4%) valid responses were completed and returned. The survey is the first of its kind in Singapore. Questions were framed around issues of medical paternalism, consent and patient autonomy. As the doctors were (...) exposed to Western ethical concepts in their training, we were not surprised to find that they would mostly allow patients some say in decision-making and keep patients reasonably informed. In respecting patient autonomy, they would usually seek to influence patient choice by persuasion. However, the residual "Asian-ness" of doctors in Singapore gives rise to some inconsistencies between values and practices. Many doctors still believe that a number of their patients are incapable of rational choice. There is some lack of openness in telling patients the whole truth. When patients choose to refuse treatment, many doctors are prepared to involve family members in making a consensus decision. Doctors were also asked how they made ethical judgements in the face of dilemmas, and how they would like disputes with patients to be resolved. By and large, the doctors prefer to make their own judgements rather than to rely on rules. They also wish to keep the law courts out of disputes with patients, preferring less public ways of settling disputes. (shrink)

I outline a dilemma for Derek Parfit’s project to vindicate moral realism. In On What Matters, Parfit argues that the best versions of three of the main moral traditions agree on a set of moral principles, which should make us more confident about the prospects of truth in ethics. I show that the result of this Convergence Argument can be interpreted in two ways. Either there remain three separate and deontically equivalent theories or there remains just one theory, the (...) Triple Theory. Both interpretations fail to deliver what Parfit is looking for. The first interpretation leads to a situation of underdetermination of theory choice that gives rise to a skeptical challenge. The second interpretation jettisons Parfit’s Conciliatory Project, that is, the reconciliation of the three moral traditions. The dilemma, I contend, is the result of Parfit failing to resolve two antithetical lines of thought. His search for the Trinity of moral theorizing must thus fail. (shrink)

In “Deception and the Clinical Ethicist,” Christopher Meyers defends that view that deception practiced by clinical ethicists is legitimate if it satisfies a series of justifying conditions (Meyers...

This book offers the most complete and up-to-date overview of the philosophical work of Evandro Agazzi, presently the most important Italian philosopher of science, and one of the most influential in the world. Scholars from seven countries explore his contributions in areas ranging from philosophy of physics and general philosophy of science to bioethics, philosophy of mathematics and logic, epistemology of the social sciences and history of science, philosophy of language and artificial intelligence, education and anthropology, metaphysics, and philosophy (...) of religion. Agazzi developed a complete and coherent philosophical system, anticipating some of the turns in the philosophy of science after the crisis of logical empiricism and exerting an equal influence on continental hermeneutic philosophy. His work is characterized by an original synthesis of contemporary analytic philosophy, phenomenology, and classical philosophy, including the scholastic tradition, and these threads are reflected in the different backgrounds of the contributors to this book. While upholding the epistemological value of science against scepticism and relativism, Agazzi eschews scientism by stressing the equal importance of non-scientific forms of thought, such as metaphysics and religion. While defending the freedom of research as a cognitive enterprise, he argues that as a human and social practice it must nonetheless respect ethical constraints. (shrink)

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by (...) claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. (shrink)