Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)

Many teachers of bioethics often express concern, in their writings and otherwise, about the theoretical basis (or lack of it) of bioethics and the allied issue of relativism. The companion articles by Tong and Momeyer are in this vein and rightly address such issues within the context of a liberal arts education. This article addresses such issues in a different venue, i.e., bioethics teaching in the clinical sphere of health care institutions. It presumes to suggest that many of these theoretical (...) concerns, as well as the threat of relativism, seldom arise in this sphere. Rather, a broad based, well accepted body of moral truth has been fashioned over the last quarter century and it is this that clinical bioethics regularly keys to and to which most moral dilemmas are referred for resolution. The various forms of this pedagogy, e.g., case consultations or institutional policy statements, are charted out in this regard, as well as the often tactical character of much of this teaching, i.e., not "what should we do?", but "how might we best do it?". The article then goes on to conclude with a reflection on the use and abuse of power in clinical bioethics teaching and consultation. (shrink)

Consumer culture and neoliberal political economy are often viewed by social psychologists as topics reserved for anthropologists, economists, political scientists and sociologists. This paper takes an alternative view arguing that social psychology needs to better understand these two intertwined institutions as they can both challenge and provide a number of important insights into social psychological theories of self-identity and their related concepts. These include personality traits, self-esteem, social comparisons, self-enhancement, impression management, self-regulation and social identity. To illustrate, we examine how (...) elements of consumer culture and neoliberal political economy intersect with social psychological concepts of self-identity through three main topics: ‘the commodification of self-identity’, ‘social categories, culture and power relations’ and the ‘governing of self-regulating consumers’. In conclusion, we recommend a decommodified approach to research with the aim of producing social psychological knowledge that avoids becoming enmeshed with consumer culture and neoliberalism. (shrink)

Although long touted as an ethical and legal requirement, some clinicians still seem to offer less than fully adequate informed consent processes; similarly the counseling of patients and families, particularly about post-intervention scenarios, is often perfunctory at best. Keyed to a narrative of a patient's experience with surgery for a deviated septum, this article reflects on why such less than adequate clinician behaviors tend to occur and what might be done about them. Certain legal misconceptions about informed consent are highlighted (...) in this reflection, as well as why certain clinicians seem to take such a narrow view of their responsibilities to patients. Further reference in this regard is also made to a recently constructed module on informed consent for medical residents. In it, though legal requirements for informed consent are reviewed, the basic perspective taken regards informed consent as a clinical intervention that pursues certain basic goods and values, only one of which lies in determining when legal closure for such processes has occurred. (shrink)

The programmatic thrust of Thomasma and Pellegrino [5] is clarified and underscored and is interpreted as an attempt to introduce a fixed point into the ethical dimension of medicine by specifying some regulative principles for the medical profession. Two important features of this type of enterprise are noted: on the one hand, it may lead the profession to distinguish between technically identical actions on the basis of the normative principles it produces, thus excluding some morally permissible actions as duties constitutive (...) of the art. It is argued that the formulation of the grounds for this ethic given by Thomasma and Pellegrino is insufficient. In order to speak to the clinical situation, medical ethics must not be based on merely the living human body alone, but on the patientqua person. (shrink)

Since the early 1970s humanistic psychology has struggled to remain a relevant force in the social and psychological sciences, we attribute this in part to a conceptualisation of the self rooted in theoretically outmoded thinking. In response to the issue of relevancy a sociocultural turn has been called for within humanistic psychology, which draws directly and indirectly on the conceptual insights of Michel Foucault. However, this growing body of research lacks a unifying conceptual base that is able to encompass its (...) new perspectives and the movement’s theoretical antecedents. This analysis suggests a way forward by offering a potential reconceptualisation of the self in humanistic psychology through the existential-phenomenology of Martin Heidegger. We argue that Heidegger’s conception of the self takes account of subjectivities produced in discourse and institutional practice, while acknowledging the human capacity for actualisation in his concept of the authentic-self. (shrink)

Considerable controversy has recently arisen regarding the patenting of medical and surgical processes in the United States. One such patent, viz. for a "chevron" incision used in ophthalmologic surgery, has especially occasioned heated response including a major, condemnatory ethics policy statement from the American Medical Association as well as federal legislation denying patent protection for most uses of a patented medical or surgical procedure. This article identifies and discusses the major legal, ethical and public policy considerations offered by proponents and (...) opponents of such patents. The existing literature divides up into those who favor such patents essentially without qualification, and those who condemn and wish to outlaw them. We advance a compromise position where administrative and legislative action is called for to provide more specific guidelines regarding the patentability of such processes by the Patent and Trademark Office. Our position, in sum, will be that too much is at stake in this complicated area for either the blanket prohibition, or wholesale, uncritical acceptance, of the patenting of medical and surgical processes or techniques. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 17-20, December 2011.

Current bioethics scholarship and pedagogy suffers from an insufficient correlation with the realities and variables of clinical medicine, particularly in its dominant paradigm of patient autonomy. Reference to various basic clinical factors will be made here toward proposing certain conceptual, tactical and pedagogical modifications to this paradigm. Keywords: clinical reality, informed consent, paternalism, patient autonomy, physician beneficence CiteULike Connotea Del.icio.us What's this?

This paper concerns itself with the concept of diminished competence with particular regard to the problems and options that mentally compromised patients raise for medical management. It proceeds through three general stages: (1) a restatement of the sense and grounds of the new patients' rights ethos which the existence of such patients calls into question; (2) a consideration of what expanded responsibilities and tactics physicians should embrace to protect and enhance such patients' autonomy; and (3) the standards, criteria, and mechanisms (...) by which paternalistic interventions might be justified in cases when the diminishment remains too substantial to merit acceptance of the patients' directives. (shrink)

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)

The idea of a market in human organs has traditionally met with widespread and emphatic rejection from both secular and religious fronts alike. However, as numerous human beings continue to suffer an uncertain fate on transplant waiting lists, voices are beginning to emerge that are willing at least to explore the option of human organ sales. Anyone who argues for such an option must contend, however, with what seem to be largely emotional rejections of the idea. Often it seems that (...) rebuffs offered on a secular ground are rooted in nothing more than vague discomforts. We suspect that these discomforts are often based in religious sentiments that have wound their way into the fabric of secular America. Therefore, in order to contribute further to those voices heard in favor of human organ sales, it is worthwhile to show that from a religious perspective, it is just as possible to affirm the appropriateness of human organ sales as it is from a secular basis. Since Protestantism has historically had a powerful influence in American society it is a proper starting point for such an investigation. (shrink)

Jack Freer, Stephen Wear; Culture Wars in New York State: Ongoing Political Resistance by Religious Groups to the Family Health Care Decisions Act, Christian bi.

Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the (...) meaning of “professionalism” itself, thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism. (shrink)

From the school yard to the workplace, there’s no charge more damning than “you’re being unfair!” Born out of democracy and raised in open markets, fairness has become our de facto modern creed. The very symbol of American ethics—Lady Justice—wears a blindfold as she weighs the law on her impartial scale. In our zealous pursuit of fairness, we have banished our urges to like one person more than another, one thing over another, hiding them away as dirty secrets of our (...) humanity. In Against Fairness, polymath philosopher Stephen T. Asma drags them triumphantly back into the light. Through playful, witty, but always serious arguments and examples, he vindicates our unspoken and undeniable instinct to favor, making the case that we would all be better off if we showed our unfair tendencies a little more kindness—indeed, if we favored favoritism. Conscious of the egalitarian feathers his argument is sure to ruffle, Asma makes his point by synthesizing a startling array of scientific findings, historical philosophies, cultural practices, analytic arguments, and a variety of personal and literary narratives to give a remarkably nuanced and thorough understanding of how fairness and favoritism fit within our moral architecture. Examining everything from the survival-enhancing biochemistry that makes our mothers love us to the motivating properties of our “affective community,” he not only shows how we favor but the reasons we should. Drawing on thinkers from Confucius to Tocqueville to Nietzsche, he reveals how we have confused fairness with more noble traits, like compassion and open-mindedness. He dismantles a number of seemingly egalitarian pursuits, from classwide Valentine’s Day cards to civil rights, to reveal the envy that lies at their hearts, going on to prove that we can still be kind to strangers, have no prejudice, and fight for equal opportunity at the same time we reserve the best of what we can offer for those dearest to us. Fed up with the blue-ribbons-for-all absurdity of "fairness" today, and wary of the psychological paralysis it creates, Asma resets our moral compass with favoritism as its lodestar, providing a strikingly new and remarkably positive way to think through all our actions, big and small. (shrink)

The Genre Legong is a secular (balih-balihan) Balinese dance genre (Anon. 1971).[1] Though originally associated with the palace,[2] legong has long been performed in villages, especially at temple ceremonies, as well as at Balinese festivals of the arts. Since the 1920s, abridged versions of legong dances have featured in concerts organized for tourists and in overseas tours by Balinese orchestras. Indeed, the dance has become culturally emblematic, and its image is used to advertise Bali to the world. Traditionally, the dancers (...) are three young girls; the servant (condong), who dances a prelude, and two legong. All wear elaborate costumes of gilded cloth with ornate accessories and frangipani-crowned headdresses.[3] The core repertoire consists of about fifteen dances (some of which are now lost), ranging in their longest versions from thirty to sixty minutes. Some of these are narrative, while others are abstract or general representations of nature, birds, insects, or plants. Those that involve narratives are, nevertheless, highly stylized, and the presentation of the drama is always secondary to the beauty of the dance. The genre is regarded as a treasury of the movements for Balinese women’s dance, and no dancer’s training is complete if she lacks a solid grounding in legong. The dance is accompanied by a gamelan of twenty-five or more players.[4] Though the legong dance remains popular in areas of traditional strength, and despite efforts to revive it, it is generally in decline (Davies 2006). (shrink)

Theists typically believe the following two propositions: God is omniscient, and Human beings are free. Are they consistent? In order to decide, we must first ask what they mean. Roughly, let us say that a being is omniscient if for any proposition he knows whether it is true or false. Since I have no wish to deny that there are true and false propositions about future states of affairs , omniscience includes foreknowledge, which we can say is knowledge of the (...) truth value of propositions about future states of affairs. For example, I believe the proposition ‘Davis will wear shoes tomorrow’ is true today, and if it is true today, i.e. if I will wear shoes tomorrow, an omniscient being knows today that it is true – and, if this being is eternally omniscient, he knew it millions of years ago. (shrink)

Body image research focuses almost exclusively on women or overweight and obesity or both. Yet, body image concerns among thin men are common and can result, at least in part, from mixed messages in society around how men qua men should dress and behave in order to look good and feel good. Stand-alone interventions to meet these different messages tend to provide men with little therapeutic relief. This conceptual paper draws on literature from the medical humanities; gender and body image (...) studies; the social psychology of clothing; and the author’s own lived experience to address this contemporary problem. The paper embraces visual culture as a resource that can frame discussion of how two sets of ‘performativity’ might reduce male anxiety about thinness. First, thin men could choose repeatedly to wear masculine-looking clothing, which could create their masculinity as a personal aesthetic that strengthens the confidence to harness masculine traits in healthy ways. Secondly, health and allied health service providers could promote and reinforce such dress behavior by offering advice that integrates aesthetic and functional aspects of clothing. Empirical studies are needed to test this dual model of performativity. (shrink)

The present study investigated variables potentially associated with a lack of concern about COVID-19 and belief in the conspiracy theory that China is responsible for the virus. In particular, the study looked at Authoritarianism, Conspiracy Beliefs, gender, and consistency of handedness as predictors of nine Likert-type items gauging attitudes, behavior, and beliefs regarding the virus. Initial analyses showed that Authoritarianism predicted less concern about the impact of the virus on health, less mask wearing, and a stronger belief in China’s responsibility (...) for the illness. Conspiracy Beliefs were associated with a stronger belief in China’s responsibility. Women expressed greater degrees of concern about their own and others’ health and about the financial wellbeing of others. In order to reduce the number of dimensions, and thus the number of tests that could yield a type one error, the nine items were then submitted to a principal components analysis which yielded a “Concern about COVID” factor and a “Blame for China” factor. Authoritarianism is generally associated with less concern about the virus. In addition, men showed less concern about the virus overall than women. Both Authoritarianism and Conspiracy Beliefs accounted for unique variance in blame on China for the virus. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ritual and Reverence in Ancient China and TodayStephen C. AngleReverence: Renewing a Forgotten Virtue. By Paul Woodruff. Oxford and New York: Oxford University Press, 2001. Pp. 248.It is a sad commonplace that works in moral philosophy rarely do much to make their readers more moral. Unusually gifted classroom teachers can sometimes make a difference in students' lives, though, and now and again there appears a piece of philosophical writing (...) that makes a similar impact. Paul Woodruff has written an extraordinary book that has a chance of joining this select company. Reverence: Renewing a Forgotten Virtue wears its scholarship and philosophy lightly; in addition to lucid exposition and argument, it employs anecdotes, readings of a range of poems, and in one chapter a question-and-answer format in order to engage readers in the very real, very contemporary concerns that motivate the book. Woodruff believes that we have largely forgotten how to talk about reverence, even though its practice has not disappeared, so his sources for the theory of reverence are largely ancient-both Greek (his specialty) and Chinese. He weaves together classical text and contemporary issue in masterful fashion, producing a book that is both philosophically challenging and potentially transformative. I will comment mainly on its philosophical themes, but I urge one and all to experience the book's power.Reverence, says Woodruff, is a virtue: indeed, one of the most important of virtues. It is the "well-developed capacity to have the feelings of awe, respect, and shame when these are the right feelings to have" (p. 8). He characterizes the "belief in human imperfection" as the "central belief of reverence" (p. 199), and this makes sense, even though reverence is not primarily about beliefs. The idea that we are limited or imperfect informs each of the three feelings through which reverence is expressed. It is easy to see how this works with awe, but respect and shame are more complicated, requiring further discussion below. Woodruff offers the following initial formulation of the interrelationship among the three:Reverence begins in a deep understanding of human limitations; from this grows the capacity to be in awe of whatever we believe to be outside our control—God, truth, justice, nature, even death. The capacity for awe, as it grows, brings with it the capacity for respecting human beings, flaws and all. This in turn fosters the ability to be ashamed when we show moral flaws exceeding the normal human allotment,(p. 3)He continues by saying that this syndrome was recognized by the Greeks before Plato, and that "the immediate followers of Confucius thought much the same." [End Page 471]Woodruff's tying of reverence to specific thinkers immediately makes one wonder what word or words he is translating as reverence, if it was known in Greece and China. Comparative philosophers will also ponder the words "much the same": is there really a single virtue called "reverence" that, without our previously realizing it, can be found in both the Greek and Chinese traditions? Or are there two, more loosely related, ideas?Woodruff's answer is that there is a single virtue, but that it is realized and theorized somewhat differently in different contexts. Indeed, he does not insist that the concept of reverence that he finds in ancient Confucianism is the only Confucian concept of reverence. He relies only on the Analects and Mencius as sources, and readily acknowledges that his picture is partial and simplified (p. 230). He makes similar qualifications with respect to his Greek sources. His "reverence," then, is in the first instance a rational reconstruction built upon the ideas/terms of different traditions as well as his own philosophical reasoning. In the Greek case, he says that the concept he is exploring is "named both by hosiotēs and its near synonym eusebia, which is frequently translated as 'piety'" (pp. 225-226). Once we know this, it is easy to see that his topic was discussed in Greek texts and to ask how these texts fit the awe-respect-shame schema he has identified.Rather than pursue this topic—on which see particularly Woodruff's chapter 5—I am going to spend some time... (shrink)

[Stephen Yablo] The usual charge against Carnap's internal/external distinction is one of 'guilt by association with analytic/synthetic'. But it can be freed of this association, to become the distinction between statements made within make-believe games and those made outside them-or, rather, a special case of it with some claim to be called the metaphorical/literal distinction. Not even Quine considers figurative speech committal, so this turns the tables somewhat. To determine our ontological commitments, we have to ferret out all traces (...) of nonliterality in our assertions; if there is no sensible project of doing that, there is no sensible project of Quinean ontology. /// [Andre Gallois] I discuss Steve Yablo's defence of Carnap's distinction between internal and external questions. In the first section I set out what I take that distinction, as Carnap draws it, to be, and spell out a central motivation Carnap has for invoking it. In the second section I endorse, and augment, Yablo's response to Quine's arguments against Carnap. In the third section I say why Carnap's application of the distinction between internal and external questions runs into trouble. In the fourth section I spell out what I take to be Yablo's version of Carnap. In the last I say why that version is especially vulnerable to the objection raised in the second. (shrink)

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)

Postmodernism has evoked great controversy and it continues to do so today, as it disseminates into general discourse. Some see its principles, such as its fundamental resistance to metanarratives, as frighteningly disruptive, while a growing number are reaping the benefits of its innovative perspective. In Political Theory and Postmodernism, Stephen K. White outlines a path through the postmodern problematic by distinguishing two distinct ways of thinking about the meaning of responsibility, one prevalent in modern and the other in postmodern (...) perspectives. Using this as a guide, White explores the work of Heidegger, Foucault, Derrida, Lyotard, and Habermas, as well as 'difference' feminists, with the goal of showing how postmodernism can inform contemporary ethical-political reflection. In his concluding chapter, White examines how this revisioned postmodern perspective might bear on our thinking about justice. (shrink)

This chapter defends the property dualism argument. The term “semantic premise” mentioned is used to refers to an assumption identified by Brian Loar that antiphysicalist arguments, such as the property dualism argument, tacitly assume that a statement of property identity that links conceptually independent concepts is true only if at least one concept picks out the property it refers to by connoting a contingent property of that property. It is argued that, the property that does the work in explaining the (...) possibility of a posteriori identities need not be a first-order property of the referent in question. On his view, the property dualism argument requires only a weaker semantic premise, which allows that the property in question be a higher order property. A refined version of the property dualism argument is formulated, which uses the weaker premise, and defends the argument against various objections. (shrink)

Mental causes are threatened from two directions: from below, since they would appear to be screened off by lower-order, e.g., neural states; and from within, since they would also appear to be screened off by intrinsic, e.g., syntactical states. A principle needed to parry the first threat -causes should be proportional to their effects- appears to leave us open to the second; for why should unneeded extrinsic detail be any less offensive to proportionality than excess microstructure? I say that the (...) second threat relies on a perversion of proportionality that would lay waste to all causal relations. (shrink)

Historical introduction -- Human being -- Identity and human incompletion in Sartre -- Identity and human incompletion in Aquinas -- Human understanding -- The subjective nature of objective understanding in Sartre -- The subjective nature of objective understanding in Aquinas -- Human freedom -- Freedom, choice, and the indetermination of reason in Sartre -- Freedom, choice, and the indetermination of reason in Aquinas -- Human fulfillment -- The possibility of human happiness in Sartre -- The possibility of human happiness in (...) Aquinas. (shrink)

'I think, therefore I am' - Descartes..'Such tricks hath strong imagination..That, if it would but apprehend some joy,..It comprehends some bringer of that joy;..Or in the night, imagining some fear,..How easy is a bush supposed a bear?' - Shakespeare..A unique compendium of key texts of psychology, from Aristotle to cutting-edge neuroscience.