The medical ethicist is a fairly recent addition to the clinical setting. The following four potential roles of the clinical ethicist are identified and discussed: consultant in difficult cases, educator of health care providers, counselor for health care providers and finally patient advocate to protect the interests of patients. While the various roles may sometimes overlap, the roles of educator and counselor are viewed as being more congruent with the education and training of medical ethicists than are the roles of (...) consultant and patient advocate. (shrink)

High moral standards and adherence to a moral code have long been strong tenets of the profession of medicine, even though there have been occasional lapses that have led to renewed calls for a revitalization of moral integrity in medicine. Certainly, a moral component has generally been held to be an important aspect of the concept of a physician.

The Norman Rockwell image of the American physician who fixed the broken arm of a child, treated the father for hypertension, and brought an unborn child into this world is now almost nonexistent. Since the time of the Rockwell portrait, a highly technical medical industry has evolved. Now two-thirds of physicians are board certified in subspecialties, and patients visit an average of 3–4 different physicians per year. Today's physicians see themselves less as “benevolent and wise counselors overseeing the patient's welfare (...) and more as objective scientists applying the latest technical methods to bring about the desired end.” The intimate patient-physician relationship that was once the norm in our society is rapidly disappearing. (shrink)

The past two decades have been a time of heightened interest in the moral aspects of the practice of medicine. This interest has been reflected in medical education by the establishment of medical humanities programs in both preclinical and clinical education in many medical schools. It has also been reflected in the literature with a dramatic increase in journal articles on medical ethics as well as the development of medical ethics in textbooks. A number of journals have developed that are (...) specifically devoted to medical ethics, including The Journal of Medical Ethics, The Journal of Medicine and Philosophy, The Journal of Medical Humanities, Theoretical Medicine, Cambridge Quarterly of Healthcare Ethics, just to name a few. The literature includes both theoretical foundations and conceptual analyses of particular issues as well as practical advice and general suggestions for how to implement programs in medical humanities. (shrink)

In the wake of a pilot study that indicated that the experience of medical education appears to Inhibit moral development In medical students, increased attention needs to be given to the structure of medical education and the Influence it has on medical students. Interest in ethics and moral reasoning has become widespread in many aspects of professional and public life. Society has exhibited great interest in the ethical issues confronting physicians today. Considerable effort has been undertaken to train medical students, (...) interns, and residents In how to reason through medical-ethical dilemmas. Media attention has focused on Issues such as abortion, euthanasia, care of severely handicapped infants, organ transplantation, and so forth, producing heated debates in both the professional and lay literature over the morality of the various positions. The curriculum of medical education has paralleled and reflected this general Interest in medical ethics. Most medical schools now offer, and frequently require, course work in ethics. However, further research Is needed to better characterize and understand the relationship of medical education to moral development. (shrink)

In recent years, the theoretical work of Gilligan in women's psychological development has led to the development of the concept of moral orientation or moral voice in contrast to the concept of moral reasoning or moral judgment developed by Kohlberg. These concepts have been of particular interest in gender studies, especially as applied to adolescence. These concepts of moral orientation and moral reasoning are being increasingly employed in healthcare ethics studies in a wide variety of settings. The recent work has (...) included studies of physicians, nurses, dentists, veterinarians, social workers, teachers of medical ethics, and hospital ethics committees. However, the study of moral development in healthcare providers has been hampered because collecting the necessary data from healthcare workers has been labor intensive and extremely time consuming. More efficient methods are needed. (shrink)

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while (...) nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way they function as clinical ethicists. (shrink)

Following a brief consideration of two contrasting purposes for teaching the medical humanities, a description is given of a film discussion elective course. In contrast to the usual teaching of medical ethics which is primarily a cognitive activity emphasizing the development of a code of principles such as justice, autonomy, and beneficence, the film discussion elective was primarily an affective activity emphasizing the development of an ethical ideal of caring, relatedness, and sensitivity to others. The pass/fail elective, offered for one (...) credit each quarter for two quarters, met once a week for one hour for twenty-four weeks. Each week a film was shown followed by a group discussion. A wide variety of social issues were covered. The objective of the course was to increase the ethical sensitivity of the medical students through promotion of introspection and reflection on social issues. A brief discussion is given of the importance and appropriateness of using film to promote the affective focus of medicine on the relief of suffering. Examples are given of how the course achieved its objective. A detailed description of the resource materials is provided. (shrink)

This study investigates the three major educational philosophies behind the medical humanities programs in the United States. It summarizes the characteristics of the Cultural Transmission Approach, the Affective Developmental Approach, and the Cognitive Developmental Approach. A questionnaire was sent to 415 teachers of medical humanities asking for their perceptions of the amount of time and effort devoted by their programs to these three philosophical approaches. The 234 responses constituted a 54.6% return. The approximately 80:20 gender ratio of males to females (...) and other demographic data on age and educational background were consistent with other studies of the field of medical humanities.Reflections on the results in Table II indicate that some changes need to take place in the teaching of the medical humanities if the perceived ideal is to be achieved. In order for the current teachers of the medical humanities to think that the appropriate philosophies behind the teaching of the medical humanities are being implemented as they should be, much less time and effort need to be devoted to the Cultural Transmission Approach. With no other published reports on the educational philosophies behind the medical humanities programs, this study created a new knowledge base about this relatively young and rapidly emerging field. (shrink)

On May 11th a round table discussion was held on the subject "The Interactions of Science and Art under the Conditions of the Revolution in Science and Technology ," organized by the editorial boards of the journals Voprosy filosofii and Voprosy literatury.

The most important distinction in value theory is the subjective-objective distinction which determines the epistemological status of value judgments about medical intervention. Ethical decisions in medical intervention presuppose one of three structures of justification — namely, an inductive approach, a deductive approach which can be either consequentialist or non-consequentialist, and a uniquely ethical approach. Inductivism and deductivism have been discussed extensively in the literature and are only briefly described here. The uniquely ethical approach which presupposes value objectivism is analyzed in (...) detail. This method involves a purely ethical inference which moves from facts to values directly with an emphasis on reason which involves a non-logical justification (as opposed to illogical). It involves the use of natural practical arguments which have an imperative conclusion but no imperative premise and exhibit a value-requiredness between two states of affairs. (shrink)

A study of physicians and medical students was conducted to determine the various philosophical positions they hold with respect to ethical decision-making in medicine and their epistemological presuppositions in relationship to the subjective-objective controversy in value theory. The study revealed that most physicians and medical students tend to be objectivists in value theory, i.e., believe that value judgements are knowledge claims capable of being true or false and are expressions of moral requirements and normative imperatives emanating from an external value (...) structure or moral order in the world, but that most physicians and medical students are inconsistent in the philosophical foundations of their medical ethical decision-making, i.e., in decision-making regarding values they tend to hold beliefs which are incompatible with other beliefs they hold about values. The study also revealed that most physicians and medical students think more emphasis should be placed upon medical ethics in medical education. (shrink)

A study of nurses and nursing students was conducted to determine the various philosophical positions they hold with respect to ethical decision-making in nursing and their relationship to the subjective-objective controversy in value theory. The study revealed that most nurses and nursing students tend to be subjectivists in value theory, i.e., believe that value judgments are purely personal, private expressions of one's own opinion or inner-feelings and not believe that value judgments are knowledge claims capable of being true or false (...) and therefore not expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most nurses and nursing students are inconsistent in the philosophical foundations of their ethical decision-making, i.e., in decision-making regarding values they tend to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value (...) judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

After noting why the issue of the use of animals in medical education and research needs to be addressed, this article briefly reviews the historical positions on the role of animals in society and describes in more detail the current positions in the wide spectrum of positions regarding the role of animals in society. The spectrum ranges from the extremes of the animal exploitation position to the animal liberation position with several more moderate positions in between these two extremes. Then (...) the philosophical issue of the moral agency of animals is discussed in terms of an explication of the concept of rights and the concept of personhood. Further research is suggested concerning institutional policies regarding medical students who refuse to do physiology dog labs or other assignments which involve the suffering and/or death of animals. (shrink)

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether (...) there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults. (shrink)

Whether ethics is too important to be left to the experts or so important that it must be is an age-old question. The emergence of clinical ethicists raises it again, as a question about professionalism. What role clinical ethicists should play in healthcare decision making – teacher, mediator, or consultant – is a question that has generated considerable debate but no consensus.

This study investigated gender related moral reasoning in student essays containing arguments on moral issues. Undergraduate students in a medical ethics course viewed two films on morally controversial issues. The students wrote brief essays about the films which were transcribed and numerically coded to conceal the author's gender from the evaluator. Using a coding scheme originated by Lyons, the evaluator classified each essay as a justice/right essay or a care/response essay or an equal response essay. Subsequently, calculations were made to (...) determine the percentage of male authored essays that were justice/rights essays or care/response essays and the percentage of female authored essays that were justice/rights or care/response essays. The males (87.7%) tended to exhibit the justice/rights moral orientation, and the females (69.4%) exhibited the care/response moral orientation. Several different calculations were made to determine various degrees of gender related orientations also. The difference in orientation was highly statistically significant (p≤0.001). These data contribute to understanding moral orientation and development. Interpretations are given to explain some differences between the genders and help explain the traditional roles in society that males and females have played historically. (shrink)

The enormous growth in medical humanities programs during the past decade has resulted in an extensive literature concerning the content of the discipline and the issues that have been addressed. Comparatively little attention, however, has been devoted to the structure of the discipline of medical humanities concerning the process or the theoretical aspects of the pedagogy of teaching the discipline. This report explicitly addresses the pedagogical aspects of the discipline by comparing and contrasting two different basic approaches to the discipline (...) referred to as the classical humanities approach and the humanistic psychology approach which roughly approximate the cognitive and affective approaches respectively. These two approaches are compared and contrasted in terms of their goals, objectives, methods of implementation, philosophical assumptions and evaluational techniques. (shrink)

This paper provides a philosophical critique of professional stereotypes in medicine. In the course of this critique, we also offer a detailed analysis of the concept of care in health care. The paper first considers possible explanations for the traditional stereotype that caring is a province of nurses and women, while curing is an arena suited for physicians and men. It then dispels this stereotype and fine tunes the concept of care. A distinction between ‘caring for’ and ‘caring about’ is (...) made, and concomitant notions of parentalism are elaborated. Finally, the paper illustrates, through the use of cases, diverse models of caring. Our discussion reveals the complexity of care and the alternative modes of caring in health care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Cognitive Error and Contemplative Practices:The Cultivation of Discernment in Mind and HeartWesley J. WildmanBrains are amazing organs in all creatures with central nervous systems and especially in human beings. But they are not perfect. Without forgetting the larger success story of cognitive evolution, I want to explore the way that cognitive biases sometimes produce errors in both religious and secular social settings and how such errors can be diagnosed (...) and corrected when they occur. This will involve noticing that error diagnosis and correction is a process that certain social groups have a vested interest in resisting or neglecting, in some respects, while the very same social groups may furnish resources that support the detection of cognitive errors, in other respects.This presents a moral quandary for both secular and religious groups. Should we educate children to be fully aware of their cognitive vulnerability to advertising, thereby learning how to resist and eventually become immune to one of the fundamental power sources of modern market economies? Should religious groups explain to young people their cognitive tendencies to posit the action of supernatural beings whether or not any such action exists, even though this may disrupt the power of religious groups to forge bracing social togetherness that supports psychologically useful coping skills? While I do not seek to answer such complex moral questions in this paper, I do argue that knowledge of cognitive biases and the resulting tendencies to cognitive error, self-defeating behaviors, and self-deception should be made available to those individuals and groups who are interested in promoting a high degree of critical self-awareness in the analysis of beliefs and behaviors in both secular and religious contexts.The term "error" is a potentially problematic one in that it misleadingly suggests that there might be a uniquely correct way in which cognition should work. I do not wish to suggest such a binary opposition. After all, biases exist in the human cognitive system either because they have been selected in the evolutionary process for their survival benefits or because they are side effects of other traits selected for their usefulness. My concern is with the wondrous human discovery that we can analyze [End Page 61] our behaviors and beliefs with such precision that we can sometimes detect when our cognitive biases produce mistaken beliefs and self-defeating behaviors. This forms the basis for my contention that cognition can often work better than it does—more accurately, less self-destructively—when tendencies to cognitive error are diagnosed, corrected, and perhaps even systematically resisted.The profound irony here is that the very same social groups (secular and religious) with an obvious vested interest in resisting such enlightenment in some respects can also promote processes of discernment and insight in other respects. Existing literature in the cognitive psychology of religion rarely bothers with such subtleties. It is common to assume that simply to notice the operation of cognitive biases in religion—say, in supporting belief in supernatural entities who providentially interact in human affairs, or in establishing and reinforcing people's willingness to defer to certain kinds of religious authority—is at the same time to establish the presence of rampant cognitive error, massive resistance to diagnosing and correcting it, and thus the infliction of pernicious cruelties on young children who have no way of escaping the resulting irrational indoctrination.This moral reflex to condemn religious groups because of their characteristic reluctance to acknowledge the role of cognitive biases in their beliefs and practices is understandable given the irrationality, ignorance, or denial that such reluctance suggests. I frankly acknowledge that I share this moral concern. But the actual complexities of religious practice demonstrate that the situation demands a subtler evaluation. Resistance to awareness of cognitive biases exists both inside and outside religious groups; economic and political practices in all eras and of all types have every bit as much to gain from neglecting to enlighten people about their cognitive operations as religious groups do—just consider the techniques employed in commercial advertising and political campaigns. Moreover, religious groups also promote methods of discernment and self-awareness that have historically been, and continue to be, the dominant method by which... (shrink)

Lovejoy (1873-1962) was America's foremost historian of ideas, a major participant in the philosophical debates of the twentieth century, and a prominent advocate of academic freedom. The product of an emotionally unsettled childhood and an evangelical father, Lovejoy reacted against his father by postulating the certainty of self-sufficient reason. He believed that only the principles of reason could order the world and so make our universe intelligible. Originally published in 1980. A UNC Press Enduring Edition -- UNC Press Enduring (...) Editions use the latest in digital technology to make available again books from our distinguished backlist that were previously out of print. These editions are published unaltered from the original, and are presented in affordable paperback formats, bringing readers both historical and cultural value. (shrink)

In this article I examine the metaphysical foundations of Guido de Ruggiero’s liberalism and ask what these can tell us about his changing view of Giovanni Gentile's actualism, which was such an influence on de Ruggiero before the First World War. I argue that de Ruggiero’s ‘actualism’ was never the same as Gentile’s, but was drawn from the same intellectual sources; that the actualist conception of free and self-conscious agency runs through both versions of the doctrine, though interpreted in (...) different ways; and finally that the contrasts between de Ruggiero’s and Gentile’s political allegiances result from something other than their differing interpretations of actualism, which serves, in the end, not so much as a theory as a set of basic principles, images and ideals that each philosopher tried to modify and match to the political circumstances in which he found himself. (shrink)

C. A. J. Littlewood approaches Seneca's tragedies as Neronian literature rather than as reworkings of Attic drama, and emphasizes their place in the Roman world and in the Latin literary corpus. The Greek tragic myths are for Seneca mediated by non-dramatic Augustan literature. In literary terms Phaedra's desire, Hippolytus' innocence, and Hercules' ambivalent heroism look back through allusion to Roman elegy, pastoral, and epic respectively. Ethically, the artificiality of Senecan tragedy, the consciousness that its own dramatic worlds, events, and people (...) are literary constructs, responds to the contemporary Stoical dismissal of the public world as mere theatre. (shrink)

Prologue: Toward a new Enlightenment -- From bounded to relational being -- Bounded being -- In the beginning is the relationship -- The relational self -- The body as relationship : emotion, pleasure and pain -- Relational being in everyday life -- Multi-being and the adventure of everyday life -- Bonds, barricades, and beyond -- Relational being in practice -- Knowledge as co-creation -- Education in a relational key -- Therapy as relational recovery -- Organizing : the precarious balance (...) -- From the moral to the sacred -- Beyond moral pluralism -- All our relations, approaching the sacred -- Epilogue: The coming of relational consciousness. (shrink)

Images of myself being Napoleon can scarcely merely be images of the physical figure of Napoleon.... They will rather be images of, for instance, the desolation at Austerlitz as viewed by me vaguely aware of my short stature and my cockaded hat, my hand in my tunic.

In their thought-provoking article, Sedlakova and Trachsel (2023) defend the view that the status—both epistemic and ethical—of Conversational Artificial Intelligence (CAI) used in psychotherapy is complicated. While therapeutic CAI seems to be more than a mere tool implementing particular therapeutic techniques, it falls short of being a “digital therapist.” One of the main arguments supporting the latter claim is that even though “the interaction with CAI happens in the course of conversation… the conversation is profoundly different from a conversation with (...) a human therapist” (Sedlakova and Trachsel 2023, 8). In particular, unlike a human therapist, CAI cannot help its users gain new insight and self-understanding (Sedlakova and Trachsel 2023). We agree that currently available therapeutic CAI cannot be considered a “digital therapist,” however, we think that the issue surrounding the acquisition of new self-understanding in the interaction with therapeutic CAI is more complicated than Sedlakova and Trachsel suggest. (shrink)