The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the American (...) Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

This paper is the first of two in a series. In this paper, we identify mental health needs and challenges in the age of COVID-19 among Nepali-speaking, Bhutanese resettled refugees in the USA. We argue for a public health justice framework that looks critically at social determinants impacting mental health (SDIMH) barriers, which negatively impact our Bhutanese population, and serves as a theoretical foundation toward public policy and law that will inform healthcare decisions and fair treatment of resettled refugees at (...) the clinical bedside and in the community. We first describe our Bhutanese refugee population and the critical mental health issues that, for many, originated during political persecution and violent ethnic cleansing initiatives, or while living in refugee camps prior to resettlement to the USA. We present a social justice framework emerging from an extensive literature review and incorporating core social determinants specific to mental health in the age of COVID-19, which are guided by the social determinants of economic stability; neighborhoods and physical environment; education; nutrition and exercise; community and social context; healthcare system; and legal system. We illustrate specific SDIMH of our resettled Bhutanese refugees during the pandemic, followed by a second paper that details recommendations for applying the SDIMH in a collective effort to address specific barriers to mental healthcare and support. (shrink)

This paper explores the vulnerability of Latin American human subjects, and how their vulnerability is ignored due to the complexities and inconsistencies of oversight committees and institutional policies. Secondly, the concept of apology is examined and its meaning to victims of past research abuses.

As much as we can be squeamish and angry over what was being done in these studies, they force us to consider how we tell these stories and the policy we make now, as so much of our research is global and the risks and benefits of experimentation always in need of recalibration.Susan M. ReverbyA growing distrust exists among Latin American populations as past abuses in medical research have rightly been publicized, and as researchers continue to intentionally and unintentionally circumvent (...) the systems of regulation and oversight. Beyond the cultural gaps between researcher and subject, the Latin American people have their own perspectives about responsible conduct of research formed by sociopolitical thought and familial and community identity, which may be overlooked or ignored by the U.S. and other foreign nations. Just as the Havasupai Tribe in Arizona have challenged us to think about the role of culture and the need for improved regulations and practices in conducting research within the United States, through past abuses in human experimentation and the emergence of discourse between our Latin American neighbors, similar challenges confront us. (shrink)

This paper is the second of two in a series. In our first paper, we presented a social justice framework emerging from an extensive literature review and incorporating core social determinants specific to mental health in the age of COVID-19 and illustrated specific social determinants impacting mental health (SDIMH) of our resettled Bhutanese refugee population during the pandemic. This second paper details specific barriers to the SDIMH detrimental to the basic human rights and social justice of this population during this (...) pandemic. The SDIMH, as described, further informs the need for social justice measures and cultural humility in mental healthcare, public health, law, and community engagement. This work concludes with a proposed call to action toward mental health improvement and fair treatment for refugee populations in three core areas: communication and education, social stigma and discrimination, and accessibility and availability of resources. (shrink)

Volume 20, Issue 3, March 2020, Page 46-50.

In this mixed methods study we identify and assess ethical and pragmatic issues and dilemmas surrounding e-health technologies in the context of primary care, including what is already in the literature. We describe how primary healthcare professionals can access reliable and accurate data, improve the quality of care for patients, and lower costs while following institutional guidelines to protect patients. Using qualitative and quantitative methodologies we identify several underlying ethical and pragmatic burdens and benefits of e-health technologies. The 41 study (...) participants reported more burdens than benefits, and were generally ambivalent about their level of satisfaction with their institutions’ ehealth technologies, their general knowledge about the technologies, and whether e-health can improve team-based communication and collaboration. Participants provided recommendations to improve e-health technologies in primary care settings. (shrink)

In this case, Brian, a 42-year-old patient with decision-making capacity and a history of non-adherence to treatment, refuses to leave the hospital due to concerns about a bothersome rash on his ar...

The American Journal of Bioethics, Volume 11, Issue 12, Page 44-46, December 2011.

Although bedbug infestation is not a new public health problem, it is one that is becoming more alarming among healthcare professionals, public health officials, and ethicists given the magnitude of patients who may be denied treatment, or who are unable to access treatment, especially those underserved populations living in low income housing. Efforts to quarantine and eradicate Cimicidae have been and should be made, but such efforts require costly interventions. The alternative, however, can further exacerbate the already growing problems of (...) injustice, i.e., unfair treatment of patients, inaccessibility of needed resources. In the following paper, I examine the ramifications of denying access to medical care, among other healthcare justice dilemmas surrounding bedbug infestations. I also explore the value of health, and how healthcare professionals and public officials often feel as though bedbugs are not a priority because they, themselves, are not diseases, regardless of the fact they cause physical and mental problems that affect a person’s health. I propose recommendations for improving the health and well-being of those vulnerable populations who are facing a difficult and growing public health problem that is currently being ignored in medical and public health ethics literature, regardless of increased media attention and unusual habitats of localized infestations, e.g., Statue of Liberty, New York City. (shrink)

With a shift from genetics to genomics, the study of organisms in terms of their full DNA sequences, the resurgence of eugenics has taken on a new form. Following from this new form of eugenics, which I have termed "eugenomics", is a host of ethical and social dilemmas containing elements patterned from controversies over the eugenics movement throughout the 20th century. This paper identifies these ethical and social dilemmas, drawing upon an examination of why eugenics of the 20th century was (...) morally wrong. Though many eugenic programs of the early 20th century remain in the dark corners of our history and law books and scientific journals, not all of these programs have been, nor should be, forgotten. My aim is not to remind us of the social and ethical abuses from past eugenics programs, but to draw similarities and dissimilarities from what we commonly know of the past and identify areas where genomics may be eugenically beneficial and harmful to our global community. I show that our ethical and social concerns are not taken as seriously as they should be by the scientific community, political and legal communities, and by the international public; as eugenomics is quickly gaining control over our genetic futures, ethics, I argue, is lagging behind and going considerably unnoticed. In showing why ethics is lagging behind I propose a framework that can provide us with a better understanding of genomics with respect to our pluralistic, global values. (shrink)

We expand on the article “Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force” to consider the ways in which rural...

Our objective was to better understand the values and ethical dilemmas surrounding advance care planning through stories told by registered nurses and licensed social workers, who were employed as care managers within Area Agencies on Aging. We conducted eight focus groups in which care managers were invited to tell their stories and answer open-ended questions focusing on their interactions with consumers receiving home-based long-term care. Using narrative analysis to understand how our participants thought through particular experiences and what they valued, (...) we identified seven themes representative of their work with consumers and families: humility, respect, responsibilities, boundaries, empowerment, courage, and veracity. (shrink)

This is a qualitative examination of ethics consultation requests, outcomes, and ethics committee recommendations at a tertiary/quaternary pediatric hospital in the U.S. The purpose of this review of consults over an 18-year period is to identify specific trends in the types of ethical dilemmas presented in our pediatric setting, the impact of consultation and committee development on the number and type of consults provided, and any clinical features and/or challenges that emerged and contributed to the nature of ethical situations and (...) dilemmas. Furthermore, in reviewing clinical ethics consultation trends for nearly two decades, we can identify topic areas for further ethics education and training for ethics consultants, ethics committee members, and pediatric healthcare teams and professionals based on our experiences. Our study with nearly two decades of data prior to the COVID-19 pandemic can serve as groundwork for future comparisons of consultation requests and ethics support for pediatric hospitals prior to, during, and following a pandemic. (shrink)

Without a better understanding of mental disease, patients diagnosed with a mental disease may be mistreated clinically and/or socially, and caregivers and families may be wrongfully blamed for causing the disease and/or for not effectively helping and developing meaningful relationships with the patient as person. In trying to understand mental disease and why its various dimensions raise difficulties for our systems of classification and our medical models of diagnosis and treatment, a framework is required. This framework will connect metaphysical, epistemological, (...) and ethical considerations in ways that are mutually supportive and illuminating. This, in turn, will benefit those who are diseased and those persons who study, classify, diagnose, and treat disease. (shrink)

There is a critical need to establish a space to engage in careful deliberation amid exciting, important, necessary, and groundbreaking technological and clinical advances in pediatric medicine. Extracorporeal membrane oxygenation (ECMO) is one such technology that began in pediatric settings nearly 50 years ago. And while not void of medical and ethical examination, both the symbolic progression of medicine that ECMO embodies and its multidimensional challenges to patient care require more than an intellectual exercise. What we illustrate, then, is a (...) person-centered framework that incorporates the philosophy and practice of palliative care and care-based ethical approaches. This person-centered framework is valuable for identifying and understanding challenges central to ECMO, guides collaborative decision-making, and recognizes the value of relationships within and between patients, families, healthcare teams, and others who impact and are impacted by ECMO. Specifically, this person-centered approach enables caregivers to provide compassionate and effective support in critical, and often urgent, situations where conflicts may emerge among healthcare team members, families, and other decision makers. By reflecting on three cases based on actual situations, we apply our person-centered framework and identify those aspects that were utilized in and informed this project. We aim to fill a current gap in the pediatric ECMO literature by presenting a person-centered framework that promotes caregiving relationships among hospitalized critically ill children, families, and the healthcare team and is supported through the philosophy and practice of palliative care and clinical ethics. (shrink)

Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors Jessica Richmond Moeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Kimberly Garchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA Steven Radwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

An important volume connecting classical studies with feminism, Feminism and Ancient Philosophy provides an even-handed assessment of the ancient philosophers' discussions of women and explains which ancient views can be fruitful for feminist theorizing today. The papers in this anthology range from classical Greek philosophy through the Hellenistic period, with the predominance of essays focusing on topics such as the relation of reason and the emotions, the nature of emotions and desire, and related issues in moral psychology. The volume contains (...) some new, ground-breaking essays on Plato, Aristotle, and the Stoics, as well as previously published pieces by established scholars like Martha Nussbaum and Julia Annas. It promises to be of interest to an interdisciplinary audience including those working in classics, ancient philosophy, and feminist theory. (shrink)

This is an overview of Davidson's theory of anomalous monism. Objections and replies are also detailed.

In this paper, I examine a heretofore ignored critic of Descartes on the heterogeneity problem: Anton Wilhelm Amo. Looking at Amo’s critique of Descartes reveals a very clear case of a thinker who attempts to offer a causal system that is not a solution to the mind-body problem, but rather that transcends it. The focus of my discussion is Amo’s 1734 dissertation: The Apathy [ἀπάθεια] of the Human Mind or The Absence of Sensation and the Faculty of Sense in the (...) Human Mind and their Presence in our Organic and Living Body. Amo’s discussion of the interaction, or lack thereof, of the mind and body hinges on the essential feature he identifies for the human mind—apathy, that is, impassivity. In this work, Amo engages explicitly with Descartes’s writing, which allows us to more precisely see the nature of his agreement and disagreement with the Cartesian metaphysics of mind. I proceed by treating Amo’s five stated criteria for spirit-hood which, in turn, reveal the kinds of causal connections that are possible for embodied spirits on his view. My aim is threefold: To lay out what I take to be Amo’s view of and arguments for the five criteria he takes to be required for a substance to be spirit. To locate Amo’s agreement and disagreement with Descartes. To suggest that Amo’s view on mind-body interaction involves a kind of occasional causation. (shrink)

This article discusses what is involved in having full moral status, as opposed to a lesser degree of moral status and surveys different views of the grounds of moral status as well as the arguments for attributing a particular degree of moral status on the basis of those grounds.

We propose the Selfish Goal model, which holds that a person's behavior is driven by psychological processes called goals that guide his or her behavior, at times in contradictory directions. Goals can operate both consciously and unconsciously, and when activated they can trigger downstream effects on a person's information processing and behavioral possibilities that promote only the attainment of goal end-states (and not necessarily the overall interests of the individual). Hence, goals influence a person as if the goals themselves were (...) selfish and interested only in their own completion. We argue that there is an evolutionary basis to believe that conscious goals evolved from unconscious and selfish forms of pursuit. This theoretical framework predicts the existence of unconscious goal processes capable of guiding behavior in the absence of conscious awareness and control (theautomaticity principle), the ability of the most motivating or active goal to constrain a person's information processing and behavior toward successful completion of that goal (thereconfiguration principle), structural similarities between conscious and unconscious goal pursuit (thesimilarity principle), and goal influences that produce apparent inconsistencies or counterintuitive behaviors in a person's behavior extended over time (theinconsistency principle). Thus, we argue that a person's behaviors are indirectly selected at the goal level but expressed (and comprehended) at the individual level. (shrink)

In a recent article in this journal, Brian Alters argued that, given the many ways in which the nature of science is described and poor student responses to NOS instruments such as Nature of Scientific Knowledge Scale, Nature of Science Scale, Test on Understanding Science, and others, it is time for science educators to reconsider the standard lists of tenets for the NOS. Alters suggested that philosophers of science are authorities on the NOS and that consequently, it would be wise (...) to investigate their views of current NOS tenets. To that end, he conducted a survey of members of the Philosophy of Science Association, and, via various statistical techniques, made claims about the nature and extent of variation among philosophers of science regarding basic beliefs about the NOS. As three philosophers of science, we laud Alters’ attempt to understand philosophers of science’ view on the NOS. We believe, however, that his techniques for investigating this question are inappropriate and that consequently, several of his conclusions are unwarranted. In this comment, we will substantiate these criticisms. In addition, we will address some of the important questions that motivate Alters’ research and attempt to unravel the “byzantine complexity” of philosophical views about the NOS. We begin with our concerns regarding Alters’ research. We then provide a taxonomy of philosophic issues; and finally, we suggest some roles for philosophy of science in science teaching and the education of science teachers. (shrink)

The National Institutes of Health and other federal health agencies are considering establishing a national biobank to study the roles of genes and environment in human health. A preliminary public engagement study was conducted to assess public attitudes and concerns about the proposed biobank, including the expectations for return of individual research results. A total of 141 adults of different ages, incomes, genders, ethnicities, and races participated in 16 focus groups in six locations across the country. Focus group participants voiced (...) a strong desire to be able to access individual research results. Recognizing the wide range of possible research results from a large cohort study, they repeatedly and spontaneously suggested that cohort study participants be given ongoing choices as to which results they received. (shrink)

When we consider early modern philosophers who engage with sceptical arguments, Nicolas Malebranche is not usually among the first names to come to mind. But, while Malebranche does not spend much time with this topic, the way in which he responds to it when he does is nevertheless valuable. This is because his response underlines the central role of a particular principle in his system: the utter dependence of all created things on God. In this paper, I argue that the (...) end of Malebranche’s engagement with scepticism in general is to show that it is a position, like atheism, that is only possible if one has a disordered imagination. And, importantly, one feature of a disordered imagination is the questioning or denial of what Malebranche takes to be a foundational principle of human knowledge: that we, and all other finite things, utterly depend on God for everything. (shrink)

This collection of papers investigates the most recent debates about individualism and holism in the philosophy of social science. The debates revolve mainly around two issues: firstly, whether social phenomena exist sui generis and how they relate to individuals. This is the focus of discussions between ontological individualists and ontological holists. Secondly, to what extent social scientific explanations may and should, focus on individuals and social phenomena respectively. This issue is debated amongst methodological holists and methodological individualists. -/- In social (...) science and philosophy, both issues have been intensively discussed and new versions of the dispute have appeared just as new arguments have been advanced. At present, the individualism/holism debate is extremely lively and this book reflects the major positions and perspectives within the debate. This volume is also relevant to debates about two closely related issues in social science: the micro-macro debate and the agency-structure debate. -/- This book presents contributions from key figures in both social science and philosophy, in the first such collection on this topic to be published since the 1970s. -/- . (shrink)

Recent debates about inequality have focused almost exclusively on the distribution of wealth and disparities in income, but little notice has been paid to the distribution of free time. Free time is commonly assumed to be a matter of personal preference, a good that one chooses to have more or less of. Even if there is unequal access to free time, the cause and solution are presumed to lie with the resources of income and wealth. In Free Time, Julie (...) Rose argues that these views are fundamentally mistaken. First, Rose contends that free time is a resource, like money, that one needs in order to pursue chosen ends. Further, realizing a just distribution of income and wealth is not sufficient to ensure a fair distribution of free time. Because of this, anyone concerned with distributive justice must attend to the distribution of free time. On the basis of widely held liberal principles, Rose explains why citizens are entitled to free time—time not committed to meeting life's necessities and instead available for chosen pursuits. The novel argument that the just society must guarantee all citizens their fair share of free time provides principled grounds to address critical policy choices, including work hours regulations, Sunday closing laws, public support for caregiving, and the pursuit of economic growth. Delving into an original topic that touches everyone, Free Time demonstrates why all citizens have, in the words of early labor reformers, a right to "hours for what we will.". (shrink)

Acknowledgments THROUGHOUT this book I cite the many people who have provided information on individual programs and activities. ...

Julie K. Ward examines Aristotle's thought regarding how language informs our views of what is real. First she places Aristotle's theory in its historical and philosophical contexts in relation to Plato and Speusippus. Ward then explores Aristotle's theory of language as it is deployed in several works, including Ethics, Topics, Physics, and Metaphysics, so as to consider its relation to dialectical practice and scientific explanation as Aristotle conceived it.

Some interesting exceptions notwithstanding, the traditional logic of economic efficiency has long favored hierarchical forms of organization and disfavored democracy in business. What does the balance of arguments look like, however, when values besides efficient revenue production are brought into the picture? The question is not hypothetical: In recent years, an ever increasing number of corporations have developed and adopted socially responsible behaviors, thereby hybridizing aspects of corporate businesses and social organizations. We argue that the joint pursuit of financial and (...) social objectives warrants significant rethinking of organizational democracy’s merits compared both to hierarchy and to non-democratic alternatives to hierarchy. In making this argument, we draw on an extensive literature review to document the relative lack of substantive discussion of organizational democracy since 1960. And we draw lessons from political theory, suggesting that the success of political democracy in integrating diverse values offers some grounds for asserting parallel virtues in the business case. (shrink)

Encouraged by the financial incentives in the Health Information Technology for Economic and Clinical Health Act of 2009, electronic health record adoption is on the rise. According to a study by the Centers for Disease Control and Prevention published in 2014, 78% of office-based physicians had adopted some type of EHR system, up from 18% in 2001. Implementation of EHRs able to support the Department of Health and Human Services “meaningful use” requirements has also significantly increased since 2010. Such a (...) growth in EHR adoption with the capacity to achieve “meaningful use” standards suggests that the goal of nationwide, interoperable health records is moving closer to a reality.While movement toward a system-wide, interoperable EHR promises benefits of such an electronic information management tool, the risks related to patients’ privacy of their health information remains a concern. (shrink)