Ethics consultation at the bedside has been hailed as a better way than courts and ethics committees to empower patients and make explicit the value components of treatment decisions. But close examination of the practice of ethics consultation reveals that it in fact risks subverting those ends by interpolating a third (expert) party into the doctor-patient encounter. In addition, the practice of bioethics through consultation does the broader cultural work of fashioning a shared moral order in the face of manifestly (...) plural individual commitments. In doing so, however, bioethics furthers medicine's position as a privileged domain of public moral discourse in contemporary American society. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Conflicts—and Consensus—about Conflicts of Interest in MedicineMatthew K. Wynia and Bette–Jane Crigger*This fascinating collection of essays about individual experiences of conflict of interest leaves little doubt that physicians remain divided about the importance, impact and meaning of conflicts of interest in their work. These essays offer differing views about what conflicts of interest look and feel like “on the ground” and about whether specific conflicts of (...) interest are bad, just a fact of life, or maybe even good.Conflict, Conflict EverywhereThese essays situate conflict of interest in a variety of contexts: the treatment recommendations a physician makes for an individual patient; the relationship between teaching physician and medical student or practicing physician and health care organization; the interaction between academic researchers and industry collaborators or professional bodies and industry supporters. In this, the narratives taken together reflect the scope of concern about conflict of interest in medicine familiar in the literature. In his classic 1993 essay, Dennis Thompson noted that concerns about conflict of interest encompass issues of physician self–referral, risk sharing between physicians and health care institutions, gifts from industry, hospital purchasing practices, as well as sponsored research and research with patients (Thompson 1993). To that list have subsequently been added relationships with industry in medical education at all levels, physicians’ service as consultants to industry or members of industry speakers bureau, and development of clinical practice guidelines (Lo & Fields 2009).That almost none of these essays draw attention to some widely publicized situations of conflict of interest—for example, gifts to physicians or the provision of drug samples—should, we think, be seen more as an artifact of the authors’ varied individual experiences than as a failure by the authors to engage key concerns in the ongoing professional and public debate. It could also be that the authors, asked to submit personal stories, assumed that yet another essay about the ‘traditional’ issues in the conflicts of interest literature would be seen as redundant, routine or even boring. Or, there is the tantalizing possibility that the absence of some of the more familiar conflicts from these narratives is the early fruit of efforts to address these traditional issues through policies governing interactions between physicians and industry promulgated by academic medical centers and health systems, medical specialty societies, and industry.One significant area of concern that has emerged in recent years is conflict of interest in the development of clinical practice guidelines. E.g., Choudry et al. 2002; Sniderrman & Furberg 2009; Guyatt et al. 2010. Although none of the essays in this [End Page 101] collection address it head on, Perlmutter touches on several key issues. His depiction of how an FDA committee process limited the input he was able to provide as an expert, undermined his potential to contribute to the professional dialogue, and raised concerns about the objectivity of the drug approval process echoes concerns about objectivity, the role of expert opinion, and the presence on guideline development panels of individuals with financial interests in the recommendations to be developed that have been explored at some length in the literature, most recently by the Institute of Medicine in reports on evidentiary standards (Eden et al 2011) and principles for guideline development (Graham et al. 2011).Conflict of Interest or Dual Agency?Several essays set out physicians’ experience in navigating situations of diverging expectations. Bierut, for example, reflects on the disjunction between the goals and products of academic researchers and commercial sponsors. She saw herself advancing basic knowledge and was forced to grapple with the reality of sponsors’ goals to advance commercial ends as well. Nagldinne and Mikulec each recall struggles to reconcile their obligation to exercise professional judgment on behalf of patients with the demands of health care organizations focussed also on the bottom line. Cruz–Flores attests to the challenge of making recommendations for care when one is both a practicing clinician and a clinical investigator engaged in research that might offer benefit to a patient for whom there are limited options.Thompson defined conflicts of interest as “a set of conditions in which professional judgment concerning a primary interest (such as a patient’s welfare or the validity of... (shrink)

Anne Barnhill focuses her article in this issue on the American Medical Association's ethics policy governing clinical use of placebos, but the implications of her analysis are deeper, touching on how physicians should make judgments about which interventions to offer patients in the process of shared decision‐making. The bottom line is that, even if an undisclosed placebo might be marginally more effective for a particular patient in the short term, over the long haul the integrity of the patient‐physician relationship relies (...) on doctors being honest with their patients. Even when it comes to placebos, honesty remains the best policy. (shrink)

Although many physicians have been using the internet for both clinical and social purposes for years, recently concerns have been raised regarding blurred boundaries of the profession as a whole. In both the news media and medical literature, physicians have noted there are unanswered questions in these areas, and that professional self-regulation is needed. This report discusses the ethical implications of physicians’ nonclinical use of the internet, including the use of social networking sites, blogs, and other means to post content (...) online. It does not address the clinical use of the internet, such as telemedicine, e-prescribing, online clinical consultations, health-related websites, use of electronic media for clinical collaboration, and e-mailing patients (some of which are already covered in the AMA’s Code of Medical Ethics). (shrink)

The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians’ professional ethical responsibility in the event that the security of patients’ electronic records is breached.

Beginning Bioethics introduces students to the language of philosophical ethics before leading them in Part Two through six major issues in bioethics. The author gives clear explanations of all sides of a given issue and engages with several major contributions to the debate. This book can stand alone, but was written also to accompany the third edition of Bette-Jane Crigger's Cases in Bioethics, providing the philosophical counterpart to cases discussed there by US medical practitioners. Both books originate (...) with St Martin's Press in the United States. (shrink)

Recent philosophy of mind has had a mistaken conception of the nature of psychological concepts. It has assumed too much similarity between psychological judgments and those of natural science and has thus overlooked the fact that other people are not just objects whose thoughts we may try to predict and control but fellow creatures with whom we talk and co-operate. In this collection of essays, Jane Heal argues that central to our ability to arrive at views about others' thoughts (...) is not knowledge of some theory of the mind but rather an ability to imagine alternative worlds and how things appear from another person's point of view. She then applies this view to questions of how we represent others' thoughts, the shape of psychological concepts, the nature of rationality and the possibility of first person authority. This book should appeal to students and professionals in philosophy of mind and language. (shrink)

Emerging infectious diseases remain a significant and dynamic threat to the health of individuals and the well-being of communities across the globe. Over the last decade, in response to these threats, increasing scientific consensus has mobilised in support of a One Health approach so that OH is now widely regarded as the most effective way of addressing EID outbreaks and risks. Given the scientific focus on OH, there is growing interest in the philosophical and ethical dimensions of this approach, and (...) a nascent OH literature is developing in the humanities. One of the key issues raised in this literature concerns ethical frameworks and whether OH merits the development of its very own ethical framework. In this paper, we argue that although the OH approach does not demand a new ethical framework, an OH approach does furnish the theoretical resources to support a novel ethical framework, and there are benefits to developing one that may be lost in its absence. We begin by briefly explaining what an OH approach to the threats posed by EIDs entails before outlining two different ways of construing ethical frameworks. We then show that although on one account of ethical frameworks there is no need for OH to generate its own, there may be advantages for its advocates in doing so. (shrink)

This paper investigates three morphosyntactic alternations in Estonian – those between the exterior locative cases allative, adessive and ablative and the corresponding postpositionspeale‘onto’,peal‘on’ andpealt‘off’. Based on the Complexity Principle (e.g., Rohdenburg, Günter. 2002. Processing complexity and the variable use of prepositions in English. In Hubert Cuyckens & Günter Radden (eds.),Perspectives on prepositions, 79–100. Tübingen: Niemeyer), we expect cognitively more complex constructions to use more explicit (i.e., morphologically more substantial) marking by means of a postposition. Further, we expect variation to be (...) conditioned similarly in all three semantic categories. For each of the three alternations, a random sample of the two outcomes (case vs. postposition) from the Estonian National Corpus is used, resulting in 3,000 data points. Using properties of the Landmark phrase as independent variables in Bayesian mixed-effects logistic regression models, we predict the choice of postpositions over case-marked realisations. Of the patterns found, only the frequency-related one supports our complexity-related hypothesis. We conclude that the Complexity Principle, in its general form, has little explanatory power for the Estonian constructions at hand and, in particular, that the derived principle of ‘analytic support’ is not generally applicable. We show, however, that the grammatical knowledge of Estonian exterior locative cases and the corresponding postpositions is regulated by our three factors in a relatively uniform way. (shrink)

This collection of essays by one of the foremost Kant scholars of our time is a welcome and timely addition to the literature. Henrich is a very prolific scholar, and the lack of English translations of most of his works may account in some measure for the fact that there has been surprisingly little sustained engagement with them by Anglo-American scholars, especially those working on Kant’s ethics. It is to be hoped that this volume will help provoke such an engagement.

Using an approach developed in the context of human bioethics, we argue that chimpanzees in research can be regarded as vulnerable subjects. This vulnerability is primarily due to communication barriers and situational factors—confinement and dependency—that make chimpanzees particularly susceptible to risks of harm and exploitation in experimental settings. In human research, individuals who are deemed vulnerable are accorded special protections. Using conceptual and moral resources developed in the context of research with vulnerable humans, we show how chimpanzees warrant additional safeguards (...) against harm and exploitation paralleling those for human subjects. These safeguards should include empowering third parties to act as surrogate decision makers for chimpanzees, ensuring participant “assent,” and avoiding recruitment of animal subjects based merely on convenience. (shrink)

This book introduces the experience and process of gestation into the philosophy of Merleau-Ponty, Levinas and Derrida as a feminist project of maternal emancipation.

“Gut issues” refers to any condition that affects our digestive systems and that causes pain or discomfort. The term points to the experience of our gut being an issue for us – interfering with our plans, undermining our bodily self-control, threatening our well-being. This paper aims to do three things: (1) to introduce and justify a disability theory approach to gut issues; (2) to use this lens to argue that the experience of gut issues has a social and relational dimension (...) that could be otherwise; and (3) to argue for a shared responsibility to ameliorate this dimension. (shrink)

Innovative surgery raises four kinds of ethical challenges: potential harms to patients; compromised informed consent; unfair allocation of healthcare resources; and conflicts of interest. Lack of adequate data on innovations and lack of regulatory oversight contribute to these ethical challenges. In this paper these issues and the extent to which problems may be resolved by better evidence-gathering and more comprehensive regulation are explored. It is suggested that some ethical issues will be more resistant to resolution than others, owing to special (...) features of both surgery and innovation. (shrink)