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

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

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

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

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

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

Nurses make mistakes in practice despite the culturally based expectation of perfection. Such a disparity between reality and expectation calls members of the profession to question the current attitudes toward mistakes in practice. Two explanatory models of the origin of mistakes are presented. The Perfectibility Model holds that any error or harm is caused by an individual practitioner's lack of knowledge or motivation. The Faulty Systems Model offers a broader explanation of human error. I conclude that a Faulty Systems Model (...) is more comprehensive and more effective for managing mistakes. Integrating the Faulty Systems Model into practice and education can result in more ethically fitting responses to errors and ultimately better outcomes for nurses, institutions and patients. (shrink)

Access to communication is critical for individuals with late-stage amyotrophic lateral sclerosis and minimal volitional movement, but they sometimes present with concomitant visual or ocular motility impairments that affect their performance with eye tracking or visual brain-computer interface systems. In this study, we explored the use of modified eye tracking and steady state visual evoked potential BCI, in combination with the Shuffle Speller typing interface, for this population. Two participants with late-stage ALS, visual impairments, and minimal volitional movement completed a (...) single-case experimental research design comparing copy-spelling performance with three different typing systems: commercially available eye tracking communication software, Shuffle Speller with modified eye tracking, and Shuffle Speller with SSVEP BCI. Participant 1 was unable to type any correct characters with the commercial system, but achieved accuracies of up to 50% with Shuffle Speller eye tracking and 89% with Shuffle Speller BCI. Participant 2 also had higher maximum accuracies with Shuffle Speller, typing with up to 63% accuracy with eye tracking and 100% accuracy with BCI. However, participants’ typing accuracy for both Shuffle Speller conditions was highly variable, particularly in the BCI condition. Both the Shuffle Speller interface and SSVEP BCI input show promise for improving typing performance for people with late-stage ALS. Further development of innovative BCI systems for this population is needed. (shrink)

The study was prompted by (a) Frederick and Vogel's debate concerning future research in business and society, (b) such recently reported managerial excesses as golden parachutes, greenmail, and fraud, (c) the increasing emphasis on coursework in the area. It appears that there is a need to assess how students, our future business leaders, perceive social issues and if a business and society course can help them define and understand the importance of these issues.Three questions provided the focal point: (1) Which (...) issues do students perceive as most important before and after completing the course? (2) How much importance do students place on issues? (3) Does completing a business and society course make a significant difference in how students perceive the importance of the issues presented? (shrink)

The Emergence of Word-Meaning in Early China makes an innovative contribution to studies of language by historicizing the Chinese notion that words have "meaning" (content independent of instances of use). Rather than presuming that the concept of word-meaning had always existed, Jane Geaney explains how and why it arose in China. To account for why a normative term (yi, "duty, morality, appropriateness") came to be used for "meanings" found in dictionaries, Geaney examines interrelated patterns of word usage threading through and (...) across a wide range of genres. These patterns show that by the first millennium, as textual production exploded—and as radically different writing forms (in Buddhist sutras) were encountered—yi already functioned as an externally accessible "model" for semantic interpretation of texts and sayings. The book has far-reaching implications. Because the idea of word-meaning is fundamental to theorizing, the book illuminates not only semantic ideas and the normativity of language in Early China, but also aspects of early Chinese philosophy and intellectual history. As the internet supplants one form of media (print), thereby reducing knowledge to vast digital databases, so too, this book explains, two thousand years ago a culture that prized oral and visual balance became an "empire of the text.". (shrink)

Firms and industries increasingly subscribe to voluntary codes of conduct. These self-regulatory governance systems can be effective in establishing a more sustainable and inclusive global economy. However, these codes can also be largely symbolic, reactive measures to quell public criticism. Cross-sector alliances (between for-profit and nonprofit actors) present a learning platform for infusing participants with greater incentives to be socially responsible. They can provide multinationals new capabilities that allow them to more closely ally social responsibility with economic performance. This paper (...) examines learning facilitators in cross-sector alliances that enrich corporate understanding of stakeholder concerns. It suggests that these organizational learning experiments can translate into globally responsible practices and processes that improve the content and effectiveness of voluntary corporate codes. (shrink)

Augmentative and alternative communication brain-computer interface systems are intended to offer communication access to people with severe speech and physical impairment without requiring volitional movement. As the field moves toward clinical implementation of AAC-BCI systems, research involving participants with SSPI is essential. Research has demonstrated variability in AAC-BCI system performance across users, and mixed results for comparisons of performance for users with and without disabilities. The aims of this systematic review were to describe study, system, and participant characteristics reported in (...) BCI research, summarize the communication task performance of participants with disabilities using AAC-BCI systems, and explore any differences in performance for participants with and without disabilities. Electronic databases were searched in May, 2018, and March, 2021, identifying 6065 records, of which 73 met inclusion criteria. Non-experimental study designs were common and sample sizes were typically small, with approximately half of studies involving five or fewer participants with disabilities. There was considerable variability in participant characteristics, and in how those characteristics were reported. Over 60% of studies reported an average selection accuracy ≤70% for participants with disabilities in at least one tested condition. However, some studies excluded participants who did not reach a specific system performance criterion, and others did not state whether any participants were excluded based on performance. Twenty-nine studies included participants both with and without disabilities, but few reported statistical analyses comparing performance between the two groups. Results suggest that AAC-BCI systems show promise for supporting communication for people with SSPI, but they remain ineffective for some individuals. The lack of standards in reporting outcome measures makes it difficult to synthesize data across studies. Further research is needed to demonstrate efficacy of AAC-BCI systems for people who experience SSPI of varying etiologies and severity levels, and these individuals should be included in system design and testing. Consensus in terminology and consistent participant, protocol, and performance description will facilitate the exploration of user and system characteristics that positively or negatively affect AAC-BCI use, and support innovations that will make this technology more useful to a broader group of people.Clinical trial registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018095345, PROSPERO: CRD42018095345. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Creating a Learning Space That Is Virtual and ExperientialBette E. Schneiderman (bio)The final product of the Rembrandt Project will be a Web site that is intended primarily for use by middle and high school teachers and their students. It is a celebration of Rembrandt’s work in the contexts of his time, place, and culture and all that may emanate from them. A special feature of the site is the (...) integration of art, aesthetic, and social studies education. Other articles in this issue address the rich content of the project’s work, that is, the artworks themselves, their contextual grounding, and the development of skills that maximize learning. This article looks at the creation of a learning space as a home for the development of the project. It explores issues related to learning spaces and features some of the technologies that can be used within them.The Rembrandt Project will not be a Web site that merely flattens images on a computer screen or conveys facts about Rembrandt and his oeuvre. Rather, it is a portal to a learning place with online features and opportunities for learners to have transformative experiences. Learning may occur online in electronic conversations, in opportunities to view and respond to reproductions in collections that cannot be visited in person, and in the creation and display of learners’ products. Learning is facilitated by access to a range of resources and people. Numerous announcements of activities, events, and products will be posted on the site. Some individuals will work in the space of the works themselves while others might undertake learning activities in museums, galleries, and private homes. In some cases special programs will highlight certain works and relate them to the project. Images of places in the Netherlands will also be presented with accompanying learning opportunities for those who may wish to see the paintings in person or simply ponder their influence from afar. All participants will be encouraged to share creations and reflections on the site. [End Page 38]To provide a sense of what this article is about, three cases are presented, each with two scenarios and a sample online discussion. The purpose of these cases is to draw readers into the experience of a virtual learning space before discussing contemporary learning communities, learning spaces, and technologies. The cases will show how to develop lively democratic conversation that makes communal learning possible. Participants can be of all kinds, from experts to those who simply want to learn. They can be located anywhere and participate at whatever time suits them best.Case A: Two ScenariosScenario 1: Viewing a Masterwork by RembrandtStanding before a work by Rembrandt you are drawn into its space. If you have viewed a Rembrandt in the past, recall your experience. If not, perhaps you might want to travel to a place that has one of his works or access some of his images online.1 Or you might think about a work of art that aroused your interest and prompted you to ponder its import and ask questions. Perhaps you returned to the work many times, experiencing it more deeply and differently upon each visit. What is it, specifically, about the encounter that resulted in a satisfying experience? And what changed the moment you viewed the work in a book reproduction, a slide, or a digitized image on a computer? In pursuing its purposes, the Rembrandt Project explores ways multiple skills can help maximize the experience of a wide range of works both online and off. Case A, Scenario 1, will set the stage for an experience with the work itself.Scenario 2: Viewing a Masterwork OnlineSelect a major work by Rembrandt online.2 What makes experiencing this image worthwhile, despite the fact that certain aspects cannot be captured in this flat digitized space? Upon reflecting on these scenarios, thoughts about experiencing the work may be recorded and discussed with others.3Case B: Two ScenariosScenario 1: An Experience of a LandscapeImagine wandering through an open field, tingled by a gentle breeze, warmed by the sun, refreshed by the aromas of moist grasses, mixed flowers, and the woody smells of trees. A village, visible... (shrink)

The Aesthetics of Design offers the first full treatment of design in the field of philosophical aesthetics, challenging the discipline to broaden its scope to include the quotidian objects and experiences of our everyday lives and concerns ...

This article reviews the incredible growth of electronic commerce (e-commerce) and presents ethical issues that have emerged. Security concerns, spamming, Web sites that do not carry an "advertising" label, cybersquatters, online marketing to children, conflicts of interest, manufacturers competing with intermediaries online, and "dinosaurs" are discussed. The power of the Internet to spotlight issues is noted as a significant force in providing a kind of self-regulation that supports an ethical e-commerce environment.

This article reviews the incredible growth of electronic commerce (e-commerce) and presents ethical issues that have emerged. Security concerns, spamming, Web sites that do not carry an "advertising" label, cybersquatters, online marketing to children, conflicts of interest, manufacturers competing with intermediaries online, and "dinosaurs" are discussed. The power of the Internet to spotlight issues is noted as a significant force in providing a kind of self-regulation that supports an ethical e-commerce environment.