We write in response to the original article by Rennie and Rudland published in the April 2003 edition of this journal.1 Current and former Dundee Medical School students are concerned at the media misinterpretation of the study and the consequences that this branding of “dishonesty” will have on Dundee Medical School’s reputation and also on individuals embarking on their ….

This article discusses what level of consent is needed from a child or parent before a primary-school medical can take place . It also considers whether there are occasions when a doctor can see a child if the parents have failed to give consent or have explicitly refused consent.Primary-school children are considered incompetent to make decisions about their own medical treatment and so their consent does not need to be gained before a medical takes place, although it (...) is highly desirable to obtain it. However, a doctor cannot justify a decision to see a child purely in terms of the benefit conferred on the child. Parents can be wronged if their wishes are ignored and usually those wishes should be considered overriding. Normally, general consent, which need not be fully informed, is needed before a school medical. However, if a child is considered to be in danger of being harmed significantly or suspected to have a major medical condition, a medical should go ahead regardless of the level of consent obtained from the parent, so that a reasonable standard of health is maintained for the child. (shrink)

In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students’ levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics (...) education: counteracting the bad effects of the “hidden curriculum,” teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors’ right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course. (shrink)

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. -/- Methods: We searched the curriculum websites of all accredited medical schools (...) in Canada, the UK and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. -/- Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. -/- Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. (shrink)

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools’ websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on (...) required and elective humanities content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools. 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean and 30 median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students. (shrink)

Professions typically formulate codes of ethics. Medical students are exposed to various codes and often are expected to recite some.

The goal of the present study was to elucidate what influences medical students’ attitudes and interests in medical ethics. At the end of their first, fifth and last terms, 409 medical students from all six medical schools in Sweden participated in an attitude survey. The questions focused on the students’ experience of good and poor role models, attitudes towards medical ethics in general and perceived effects of the teaching of medical ethics. Despite a low (...) response rate at some schools, this study indicates that increased interest in medical ethics was related to encountering good physician role models, and decreased interest, to encountering poor role models. Physicians involved in the education of medical students seem to teach medical ethics as role models even when ethics is not on the schedule. The low response rate prevents us from drawing definite conclusions, but the results could be used as hypotheses to be further scrutinised. (shrink)

Learning burnout is an important indicator that reflects an individual’s learning state. Understanding the influencing factors and mechanism of learning burnout of medical students has practical significance for improving their mental health. This study aimed to explore the mediating roles of school identity and collective self-esteem between school psychological environment and learning burnout in medical students. A total of 2,031 medical students were surveyed using the School Psychological Environment Questionnaire, School Identity Questionnaire, Collective Self-esteem Scale, and Learning (...) Burnout Scale. The results showed the following: school psychological environment had a negative effect on learning burnout among medical students, and school identity and collective self-esteem played significant mediating roles between school psychological environment and learning burnout [95% CI = ]. Specifically, there were three paths that school psychological environment and learning burnout: first, through the independent mediating role of school identity; second, through the independent mediating role of collective self-esteem; and third, through the chain mediating roles of school identity and collective self-esteem. The findings reveal that school psychological environment not only directly influences the learning burnout of medical students but also indirectly influences it through school identity and collective self-esteem. Thus, this study has some important implications for prevention and intervention of learning burnout among medical students. (shrink)

In October 2012, the Loyola University Chicago Stritch School of Medicine amended its eligibility requirements for admission. In addition to U.S. citizens and permanent residents, persons who qualify for the Deferred Action for Childhood Arrivals program of the United States Citizenship and Immigration Service are now eligible for admission. Simply put, we extended the educational opportunity of medical school to people who are in a particular category of undocumented immigrants. We became the first medical school in the United (...) States to have an intentional, transparent policy of eligibility for persons eligible for the DACA program. This expanded admissions policy has gained some attention in the popular press and brought us many expressions of support. It has also dismayed a few members of our school's circle of faculty and alumni.We wish to walk you through the history of our policy's development. We believe that viewing it as it developed will make clear three pertinent ideas: this policy flows directly from the mission of medical schools, it suits a positive notion of social justice and is also compelled by a duty not to discriminate on arbitrary grounds, and educators who steward educational institutions must have the moral courage to place considerations of institutional mission and social justice above the political views and negative responses of some alumni and donors. (shrink)

The objective of this study was to review the design and delivery of medical ethics education within medical programs across Australia and New Zealand, how current teaching has been informed by the proposed core curriculum published in 2001 by the ATEAM and how it could look moving forward. We conducted a mixed methods study using an online questionnaire consisting of 51 items. This included both binary and open-ended questions to categorise and explore similarities and differences in medical (...) ethics curricula in medical programs accredited by the Australian Medical Council across ANZ. Participants were asked about curriculum design format, duration, goals, assessments, content areas of their own ME curriculum. Convenors from 18 universities responded. The main commonality was that ME curricula were integrated both longitudinally and laterally with other content. There was also commonality in content areas addressed. The goals, format, educators, and assessments of the ME curricula were highly variable. Most respondents described a curriculum which prioritised knowledge and skill development related to ME. Although the core goals of including knowledge, skills, and attitudinal development in ME curricula are still present, there is no uniformity in terms of format, delivery, or assessment across medical programs in ANZ. This is an area for collaborative development. (shrink)

Efforts to reform medical education have emphasized the need to formalize instruction in medical ethics. However, the discipline of medical ethics education is still searching for an acceptable identity among North American medical schools; in these schools, no real consensus exists on its definition. Medical educators are grappling with not only what to teach (content) in this regard, but also with how to teach (process) ethics to the physicians of tomorrow. A literature review focused on (...) medical ethics education among North American medical schools reveals that instruction in ethics is considered to be vitally important for medical students. Agreement by medical educators on a possible core curriculum in ethics should be explored. To develop such a curriculum, deliberative curriculum inquiry by means of a targeted Delphi technique may be a useful methodology. However, the literature reveals that medical curricular change is notoriously slow. General implications for medical ethics education as a discipline are discussed. (shrink)

Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching in all (...) three subjects combined comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)

Evidence‐based medicine has become both the mantra of clinical practice and the dominant contemporary approach to patient care. Gordon Guyatt et al. first proposed applying the concept to medical education in the early 1990s, arguing for training that “de‐emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale” in favor of “examination of evidence from clinical research”; over the following twenty‐five years, nearly every medical school and residency program in the United States incorporated these methods into its training. During this (...) same period, admissions requirements and protocols have continued to rely on subjective, non‐evidence‐based ideals largely developed a century earlier. In light of the continued underrepresentation of certain demographic groups among matriculants, as well as the national controversy surrounding admissions standards at undergraduate institutions—most notably embodied in the lawsuit by Students for Fair Admissions against Harvard University—the moment may be ripe for a radical reexamination of those requirements. (shrink)

A significant body of evidence shows that law schools and many elite colleges use large admissions preferences based on race, and other evidence strongly suggests that large preferences can undermine student achievement in law school and undergraduate science majors, thus producing highly counterproductive effects. This article draws on available evidence to examine the use of racial preferences in medical school admissions, and finds strong reasons for concern about the effects and effectiveness of current affirmative action efforts. The author calls (...) for better data and careful investigation of several identified patterns. (shrink)

Rationale, aims and objectives: Bioethics and professionalism are standard subjects in medical training programmes, and these curricula reflect particular representations of meaning and practice. It is important that these curricula cohere with the actual concerns of practicing clinicians so that students are prepared for real-world practice. We aimed to identify ethical and professional concerns that do not appear to be adequately addressed in standard curricula by comparing ethics curricula with themes that emerged from a qualitative study of medical (...) practitioners. Method: Curriculum analysis: Thirty-two prominent ethics and professionalism curricula were identified through a database search and were analysed thematically. Qualitative study: In-depth, semi-structured interviews were conducted with 20 medical practitioners. Participants were invited to reflect upon their perceptions of the ways in which values matter in their practices and their educational experiences. The themes emerging from the two studies were compared and contrasted. Results: While representations of meaning and value in ethics and professionalism curricula overlap with the preoccupations of practicing clinicians, there are significant aspects of ‘real-world’ clinical practice that are largely ignored. These fell into two broad domains: ‘sociological’ concerns about enculturation, bureaucracy, intra-professional relationships, and public perceptions of medicine; and epistemic concerns about making good decisions, balancing different kinds of knowledge, and practising within the bounds of professional protocols. Conclusions: Our findings support the view that philosophy and sociology should be included in medical school and specialty training curricula. Curricula should be reframed to introduce students to habits of thought that recognize the need for critical reflection on the social processes in which they are embedded, and on the philosophical assumptions that underpin their practice. (shrink)

Objectives To investigate high school cheating experiences and attitudes towards academic misconduct of freshmen at all four medical schools in Croatia, as a post-communist country in transition, with intention of raising awareness of academic (dis)honesty. Design and method Students were given an anonymous questionnaire containing 22 questions on the atmosphere of integrity at their high school, self-reported educational dishonesty, their evaluation of cheating behaviour, and on their expectations about the atmosphere of integrity at their university. Setting All schools of (...) medicine of Croatian universities (Zagreb, Rijeka, Split and Osijek). Main measures Descriptive statistics and differences in students' self-reported educational dishonesty, perception of cheating behaviour, and perception of the high school integrity atmosphere. Results Of the 761 freshmen attending the four medical schools, 508 (67%) completed the questionnaire: 481 Croatian and 27 international students. Of the Croatian respondents, almost all (>99%) self-reported engaging in at least one behaviour of educational dishonesty, and 78% of respondents admitted to having frequently cheated in at least one form of assessed academic misconduct. Only three students admitted to having reported another student for cheating. For most of the questions, there was no significant difference in the responses among Croatian students. However, significant differences were found in most responses between Croatian students and their international counterparts, who were significantly less likely to engage in dishonest behaviours. No individual factor was found to correlate with the incidence of self-admitted dishonest behaviour. Frequent cheaters evaluated academic dishonesty significantly more leniently than those who did not cheat. Conclusion Academic dishonesty of university students does not begin in higher education; students come to medical schools ready to cheat. (shrink)

The Medical School for International Health was created in 1996 by the Faculty of Health Sciences at Ben-Gurion University of the Negev in affiliation with Columbia University’s Health Sciences division. It is accredited by the New York State Board of Education. Students complete the first three years of the program on the Ben-Gurion University campus in Be’er-Sheva, Israel, while fourth-year electives are completed mainly in the United States along with a two-month global health elective at one of numerous sites (...) located around the world . The unique four-year, American-style curriculum is designed not only to prepare physicians who will be able to work at both an individual and community level but also at both of these levels anywhere in the world. In this way, it combines elements of medical and public health curricula not limited to an American perspective. (shrink)

In this paper, I argue that medical school admissions should be limited to statistically relevant factors. My argument rests primarily on three assumptions. A state professional school should maximize production. If a state professional school should maximize production, then it should maximize production per student. If a state professional school should maximize production per student, then, within the optimum budget, a state medical school should maximize quality-adjusted medical services per graduate. I put forth a tentative equation for (...) ranking applicants as a way of maximizing quality-adjusted medical services per graduate. This way of ranking is cheaper than the way admissions is currently done. Hence, the proposal is practically as well as theoretically appealing. (shrink)

Objectives To investigate high school cheating experiences and attitudes towards academic misconduct of freshmen at all four medical schools in Croatia, as a post-communist country in transition, with intention of raising awareness of academic honesty. Design and method Students were given an anonymous questionnaire containing 22 questions on the atmosphere of integrity at their high school, self-reported educational dishonesty, their evaluation of cheating behaviour, and on their expectations about the atmosphere of integrity at their university. Setting All schools of (...) medicine of Croatian universities . Main measures Descriptive statistics and differences in students' self-reported educational dishonesty, perception of cheating behaviour, and perception of the high school integrity atmosphere. Results Of the 761 freshmen attending the four medical schools, 508 completed the questionnaire: 481 Croatian and 27 international students. Of the Croatian respondents, almost all self-reported engaging in at least one behaviour of educational dishonesty, and 78% of respondents admitted to having frequently cheated in at least one form of assessed academic misconduct. Only three students admitted to having reported another student for cheating. For most of the questions, there was no significant difference in the responses among Croatian students. However, significant differences were found in most responses between Croatian students and their international counterparts, who were significantly less likely to engage in dishonest behaviours. No individual factor was found to correlate with the incidence of self-admitted dishonest behaviour. Frequent cheaters evaluated academic dishonesty significantly more leniently than those who did not cheat. Conclusion Academic dishonesty of university students does not begin in higher education; students come to medical schools ready to cheat. (shrink)

For centuries medical schools in Britain and elsewhere had a fairly static curriculum based on what might be called the 'three Rs' of medicine, and consequently had to make room for new subjects as the need arose in a fashion which was sometimes makeshift. However, Southampton University has only had a medical school for six years, and therefore their course on medical ethics and legal medicine was carefully integrated into the curriculum after some preliminary experiments carried out (...) by a subcommittee which is continually reviewing the situation. Medical ethics has now a definite place in the fourth year, preceded by an introduction to ethical problems encountered in medicine in the first year. Not only do members of the medical faculty participate in this teaching but also members of the faculties of law and the arts. (shrink)

Concern is growing as research continues to find evidence of academic misconduct among medical students. There is, however, paucity of information on this issue among medical students and medical graduates in Africa. We determined the perceptions and attitude of house officers on academic misconduct within Nigerian medical schools. We conducted 7 focus group discussions among pre-registration house-officers working in a Nigerian Teaching hospital between October and November 2013. A FGD guide containing 7 broad questions related to (...) their perception and attitude on academic misconduct was employed. Ethnographic content analysis and manual coding were adopted in identifying themes, issues and representative quotations. A total of 58 participants out of an eligible pool of 76 PRHOs were recruited. All the groups associated academic misconduct chiefly with cheating in examinations, and perceived it as a commonplace problem. “It is a part of school life”, admitted one PRHO. Copying during exam appeared to be the commonest form of cheating. Another respondent opined that “The lecturers should be more concerned with helping students understand better. They should not make passing an exam a do-or-die affair.” The perception and attitudes towards academic misconduct may be a reflection of the prevailing moral decline in the contemporary Nigerian society. Underlying the reasons adduced by the participants for getting involved in academic misconduct is the fear of failure in examinations. Apart from consolidating formal and informal medical ethics education, the medical schools should ensure that the opportunities and pressures to indulge in academic misconduct are minimized. (shrink)

In this article, the author explores a model of alternative medical education being pioneered at Loyola University Chicago Stritch School of Medicine. The five-year Global Health Fieldwork Fellowship track allows two students per year to complete an extra year of medical education while living and working in a free rural clinic in the jungle lowlands of Bolivia. This alternative curricular track is unique among other existing models in that it is longitudinally immersive for at least one full additional (...) year of medical education, grounded in clinical and service learning, and heavily focused upon global health and the social components of medicine. Studies have shown that both longitudinal alternative medical curricular tracks and short-term global health electives have long-term benefits upon the professional development of participants, suggesting that the GHFF is likely to do the same. The author also argues that the GHFF is an advantageous model of global health education compared to standard offerings and provides a unique curricular model by which to foster the development of social values—such as professionalism, advocacy, and social justice—that are widely considered lacking in today’s medical education. (shrink)

Teaching and learning of medical ethics and law are at the heart of medical education because they are integral to all clinical encounters and public health interventions, and a foundation in medical ethics and law is essential for students to become virtuous doctors. The first model curriculum for medical ethics and law within medical education in the UK, published in 1998, has recently been reviewed and updated. Now called a core content of learning, it emphasizes (...) that teaching and learning of medical ethics and law should be attuned to the students' needs appropriate both to their particular stage of training and to relevant specialty-specific ethical issues; is a shared obligation of all teachers throughout the course; and should be integrated vertically and horizontally throughout the whole medical curriculum. The General Medical Council and the British Medical Association have confirmed that the revised core content of learning is consistent with their guidance on undergraduate education. (shrink)

Law is now routinely included in the medical school curriculum, often incorporated into bioethics and/or practice of medicine coursework. There seems to lack, however, a systematic understanding of what works in terms of getting across an effective depth and breadth of legal knowledge for medical students — or what such would even look like. Moreover, and more critically, while some literature addresses these what, when, how, and who questions, a more fundamental question is left unanswered: why teach law (...) in medical school? This article suggests a process to reveal a more consensual understanding of this latter question. The author highlights findings and recommendations of some of the leading literature to date related to teaching law in medical schools, and also recent U.K. projects addressing legal teaching in medical schools. Reflecting on these materials and activities, the author suggests that we take a “pause” before we argue for more or different legal topics within the medical curriculum. Before we alter the curricula for more and/or different “law,” first, it is critical to have a meaningful, stakeholder-driven, consensus-seeking discussion of the goals of legal education: why do we think it matters that medical students learn about “the law”? (shrink)

[T]each the law to empower physicians individually and collectively to use the law and law colleagues to serve patients and promote public welfare; in short to better foster the goals of the medical profession.And yet:[A]ntipathy appears to be deeper and more pervasive than ever before, making it hard to imagine that relations between attorneys and physicians can get much worse.It has long been recognized that an understanding of at least some core legal rules and concepts is an important piece (...) of medical training. To address this, law is now typically part of the core medical school curriculum, often incorporated into bioethics and/or practice of medicine coursework — whether as part of a distinct course or series of courses or threaded through the curriculum. While often this education focuses on rules, some have recommended that it also include fundamentals of legal reasoning, and go beyond knowledge to include skills, attitudes, and behaviors vis-à-vis the law. (shrink)

Introduction: We live in a society that encourages self-medication and one reason is the availability of drugs that do not require a prescription and are easily accessible, the abuse of these have important implications for the health of the general population; being the most commonly used drugs: analgesics, antibiotics, antihistamines and others. Objective: Determine the causes that induce self-medication in freshmen and fifth year of the Faculty of Medicine of the Universidad Mayor, Real y Pontificia de San Francisco Xavier de (...) Chuquisaca - Bolivia, 2012. Methodology: Quantitative and descriptive cross-sectional approach. A sample of 284 students which they apply structural survey was obtained. Results.A high percentage of students who are self-medicating themselves without.medical.supervision. Conclusions: We can say that self-medication on freshmen and fifth year of medical school at the University Of San Francisco Xavier De Chuquisaca is induced by influence of social circle (friends and parents), advertising of certain medications, access to internet and lack of time. (shrink)

There are at present 28 Jesuit colleges and universities in the United States, which together offer more than 50 health sciences degree programs. But as the Society's membership is shrinking and the financial risks involved in sponsoring health sciences education are rising, the question arises whether the Society should continue to sponsor health sciences degree programs. In fact, at least eight Jesuit health sciences schools have already closed their doors. This paper attempts to contribute to the resolution of this urgent (...) question by reexamining Ignatius' own views on health sciences education and, more specifically, his prohibition of the Society's sponsoring medical education. It concludes on the basis of an historical analysis of Ignatius' views that there is insufficient support for today's ,Jesuits to maintain their engagement in medical and health care education. (shrink)

Changes in medical and medical ethics education are being considered with little attention to the experience of the medical students involved. This study attempts to characterize and highlight certain aspects of that experience from a literary perspective. After a brief review of the history of traditional academic studies in the field, eight novels, written by physician-writers and featuring medical student protagonists, are analyzed. Several common themes of the student experience are identified in the novels, and are (...) contrasted with themes found in the medical literature. A plea is made to acknowledge literary as well as scientific interpretations of the medical student experience when considering changes in medical education. (shrink)

IntroductionExperimental research on animals has been guided by principles of the three Rs: reduction, refinement and replacement.1 Recently the fourth R—rehabilitation—has also been incorporated to enhance the welfare of animals that are used in research. With growing scientific curiosity and increasing research, animal use has anything but reduced despite the fact that modern technology has brought to fore many alternatives to animal use.2 ,3 There are many arguments for and against animal use. In India, there has been a proposal to (...) ban the use of animals for training and academic purposes, as reported in two major daily newspapers. This has evoked mixed reactions from the scientific community. We conducted this study to assess the awareness, attitudes and practices regarding the use of animals and their alternatives, in medical training and research amongst medical teachers and students.Study designA …. (shrink)

This paper begins with a vignette of Juan Carlos, an immigrant to America who works to support his family, attends classes at a community college, and cares for his ill daughter. It argues that an Aristotelian virtue ethicist could condone a safe, legal, and virtuous use of cognitive enhancements in Juan Carlos’s case. The argument is that if an enhancement can lead him closer to eudaimonia (i.e., flourishing, or a good life), then it is morally permissible to use it. The (...) paper closes by demonstrating how common objections to cognitive enhancement fail to undermine Juan Carlos’s justifiable use of the technology. The particularities of his case make it morally acceptable for him to use enhancements in certain situations. The paper, thus, constructs a limited, positive case for the virtuous use of pharmaceutical cognitive enhancements. (shrink)

This paper begins with a vignette of Juan Carlos, an immigrant to America who works to support his family, attends classes at a community college, and cares for his ill daughter. It argues that an Aristotelian virtue ethicist could condone a safe, legal, and virtuous use of cognitive enhancements in Juan Carlos’s case. The argument is that if an enhancement can lead him closer to eudaimonia, then it is morally permissible to use it. The paper closes by demonstrating how common (...) objections to cognitive enhancement fail to undermine Juan Carlos’s justifiable use of the technology. The particularities of his case make it morally acceptable for him to use enhancements in certain situations. The paper, thus, constructs a limited, positive case for the virtuous use of pharmaceutical cognitive enhancements. (shrink)