: Dr. Smith is an internist in private practice who works at an inner city clinic affiliated with a university hospital. He is also a member of the university faculty. Many of Dr. Smith’s patients have type 2 diabetes mellitus and struggle with health care and other costs. Thinking about opportunities to better serve his patients and advance his career, Dr. Smith considers conducting clinical research in his office. ACME is a respected pharmaceutical company that for decades has engaged in (...) research, development, and production of widely used drugs. Several of ACME’s oral agents for type 2 diabetes will soon go off patent. In an effort to retain its market share in this class of drugs, ACME wants to complete clinical trials expeditiously and obtain approval for its new oral hypoglycemic medicine. The company approaches Dr. Smith to be a coinvestigator in its multicenter clinical trial. (shrink)

The fifth edition of the Ethics Manual examines emerging issues in medical ethics faced by internists and their patients and revisits older issues that are ...

The AMA Council on Ethical and Judicial Affairs (CEJA) has initiated an important discussion on medical professionalism and the use of social media by issuing thoughtful and practical guidance for physicians and medical students. The implications of online activities for trust in the profession, as well as for trust between patient and doctor, however, will need further exploration as digital life expands and evolves.

Purpose: Physicians are often reluctant to discuss “Do Not Resuscitate” orders with patients. Although perceived self-efficacy is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions.Subjects and methods: A survey of 217 internal medicine attendings and 132 housestaff at two teaching hospitals about their attitudes and confidence regarding DNR discussions.Results: Participants were significantly less confident about their ability to discuss DNR orders than to discuss consent for medical procedures , and this was (...) true for both attendings and housestaff . In a multivariate logistic model of confidence regarding DNR discussions, women were less confident than men ; house officers were less confident than attendings , those who were less confident of their ability to discuss medical procedures were less confident discussing DNR , and those who found talking to patients about DNR orders very difficult reported less confidence than those who did not .Conclusion: We conclude that physicians’ confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics. (shrink)

The concept of minimal risk has been used to regulate and limit participation by adolescents in clinical trials. It can be understood as setting an absolute standard of what risks are considered minimal or it can be interpreted as relative to the actual risks faced by members of the host community for the trial. While commentators have almost universally opposed a relative interpretation of the environmental risks faced by potential adolescent trial participants, we argue that the ethical concerns against the (...) relative standard may not be as convincing as these commentators believe. Our aim is to present the case for a relative standard of environmental risk in order to open a debate on this subject. We conclude by discussing how a relative standard of environmental risk could be defended in the specific case of an HIV vaccine trial among adolescents in South Africa. (shrink)

The ethical treatment of cancer patientsparticipating in clinical trials requiresthat patients are well-informed about thepotential benefits and risks associated withparticipation. When patients enrolled in phaseI clinical trials report that their chance ofbenefit is very high, this is often taken as evidence of a failure of the informed consent process. We argue, however, that some simple themes from the philosophy of language may make such a conclusion less certain. First, the patient may receive conflicting statements from multiple speakers about the expected (...) outcome of the trial. Patients may be reporting the message they like best. Second, there is a potential problem of multivocality. Expressions of uncertainty of the frequency type can be confused with expressionsof uncertainty of the belief type. Patients may be informed using frequency-type statements and respond using belief-type statements. Third, each speech episode involving the investigator and the patient regarding outcomes may subservemultiple speech acts, some of which may beindirect. For example, a patient reporting ahigh expected benefit may be reporting a beliefabout the future, reassuring family members,and/or attempting to improve his or her outcome by apublic assertion of optimism. These sources oflinguistic confusion should be considered injudging whether the patient's reported expectation isgrounds for a bioethical concern that there hasbeen a failure in the informed consent process. (shrink)

This Element, written for researchers and students in philosophy and the behavioral sciences, reviews and critically assesses extant work on number concepts in developmental psychology and cognitive science. It has four main aims. First, it characterizes the core commitments of mainstream number cognition research, including the commitment to representationalism, the hypothesis that there exist certain number-specific cognitive systems, and the key milestones in the development of number cognition. Second, it provides a taxonomy of influential views within mainstream number cognition research, (...) along with the central challenges these views face. Third, it identifies and critically assesses a series of core philosophical assumptions often adopted by number cognition researchers. Finally, the Element articulates and defends a novel version of pluralism about number concepts. (shrink)

What is intellectual humility? In this essay, we aim to answer this question by assessing several contemporary accounts of intellectual humility, developing our own account, offering two reasons for our account, and meeting two objections and solving one puzzle.

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating (...) would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed. (shrink)

In Parkinson’s disease, the fronto-striatal network is involved in motor and cognitive symptoms. Working memory updating training engages this network in healthy populations, as observed by improved cognitive performance and increased striatal BOLD signal. This two-part study aimed to assess the feasibility of WM updating training in PD and measure change in cognition, movement and functional brain response in one individual with PD after WM updating training. A feasibility and single-subject study were performed in which patients with PD completed computerized (...) WM updating training. The outcome measures were the pre-post changes in criterion and transfer cognitive tests; cognitive complaints; psychological health; movement kinematics; and task-related BOLD signal. Participants in the feasibility study showed improvements on the criterion tests at post-test. FL displayed the largest improvements on the criterion tests and smaller improvements on transfer tests. Furthermore, FL reported improved cognitive performance in everyday life. A shorter onset latency and smoother upper-limb goal-directed movements were measured at post-test, as well as increased activation within the striatum and decreased activation throughout the fronto-parietal WM network. This two-part study demonstrated that WM updating training is feasible to complete for PD patients and that change occurred in FL at post-test in the domains of cognition, movement and functional brain response. (shrink)

The dead donor rule (DDR) originally stated that organ donors must not be killed by and for organ donation. Scholars later added the requirement that vital organs should not be procured before death. Some now argue that the DDR is breached in donation after circulatory determination of death (DCDD) programs. DCDD programs do not breach the original version of the DDR because vital organs are procured only after circulation has ceased permanently as a consequence of withdrawal of life-sustaining therapy. We (...) hold that the original rendition of the DDR banning killing by and for organ donation is the fundamental norm that should be maintained in transplantation ethics. We propose separating the DDR from two other fundamental normative rules: the duties to prevent harm and to obtain informed consent. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page W1-W3, June 2011.

EDITORS' INTRODUCTION B he Vedas tell of a conversation between a young man, Shvetaketu, and his father concerning what the son had learned in his education ...

During the mid 1980s, the renowned American documentary filmmaker Fred Wiseman produced a four-part series of films that sought to record the operations of institutions in Talladega, Alabama, devoted to the care and training of people with disabilities. These films—designated as the Multi-handicapped Series—have received much less attention than Wiseman's earlier work, as if films about disability mark a drastic departure from his previous award-winning productions, such as Titicut Follies (1965) and Hospital (1970). The Multi-handicapped Series takes up general categories (...) of disabled populations as discrete documentary topics, Deaf (1986), Blind (1986), Multi-handicapped (1986) and Adjustment & Work (1986) as opposed to a specific location as in his earlier films. As a result, the latter series of films identify social and interpersonal structures developed in the name of specific conditions. Like Foucault's research on disciplinary tactics, Wiseman's films seek out many of the segregated social spaces typically occupied by persons classified as deviant: prisons, hospitals, charity networks, sheltered workshops, resident facilities, and vocational training structures. The Multi-handicapped Series focuses on the activities of professions and practitioners in education, administration, and therapy, as well as the institutional roles designed for bodies marked as disabled. Unlike its 19th century predecessor classification, feebleminded, the latter twentieth century U.S. policy answer has been waged as a matter of dividing disabilities into a binary structure of orthopedic or cognitive categories. Such a development has left many crossover bodies in a diagnostic no-body's-land. To analyze the history of these developments, this essay recognizes the formation of today's disability category as an effect of new regimes of power; a form of domination based upon the application of particularized diagnostic pathologies that provide the basis for cordoning off bodies which fail to fit neatly within the cognitive/orthopedic binary. As documents of the social spaces that are occupied by disabled people, Wiseman's films offer a rare contemplation of institutional practices and their application to populations viewed as nonnormative. (shrink)

The idea that ethics can be derived from a common morality, while controversial, has become very influential in biomedical ethics. Although the concept is employed by several theories, it has most prominently been given a central role in principlism, an ethical theory endorsed by Tom Beauchamp and James Childress in Principles of Biomedical Ethics (2009).1 This text has become a cornerstone of medical ethics education, an achievement that has been commended by critics and supporters alike. It articulates a system of (...) ethical decision making that is firmly rooted in claims about the common morality. Beauchamp and Childress’s theory of common morality has been both defended and criticized in the bioethics .. (shrink)

Charles E. Snyder considers the New Academy's attacks on Stoic epistemology through a critical re-assessment of the 3rd century philosopher, Arcesilaus of Pitane. Arguing that the standard epistemological framework used to study the ancient Academy ignores the metaphysical dimensions at stake in Arcesilaus's critique, Snyder explores new territory for the historiography of Stoic-Academic debates in the early Hellenistic period. Focusing on the dispute between the Old and New Academy, reveals the metaphysical dimensions of Arcesilaus' arguments as essential to (...) grasping what is innovative about the so-called New Academy. Resisting the partiality for epistemology in the historical reconstructions of ancient philosophy, this book defends a new philosophical framework that re-positions Arcesilaus' attack on the early Stoa as key to his deviation from the metaphysical foundations of both Stoic and Academic virtue ethics. Drawing on a wide range of scholarship on Hellenistic philosophy in French, Italian, and German, Beyond Hellenistic Epistemology builds bridges between analytical and continental approaches to the historiography of ancient philosophy, and makes an important and disruptive contribution to the literature. (shrink)

Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the importance of treating suffering has generally (...) beenacknowledged, insufficient attention has been paid to the question ofwhether different types of terminal suffering require differnt responsesfrom health care professionals. In this paper we introduce a distinctionbetween two types of suffering likely to be present at the end of life,and we argue that physicians must distinguish between these types if theyare to respond appropriately to the suffering of their terminally illpatients. After introducing this distinction and explaining its basis,we further argue that the distinction informs a (novel) principle ofproportionality, one that should guide physicians in balancing theircompeting obligations in responding to terminal suffering. As weexplain, this principle is justified by reference to the intereststerminally ill patients have in restoration, as well as in therelief of suffering, at the end of life. (shrink)

The focus of this paper is the dispute between the Academic Arcesilaus of Pitane (ca. 316–240 BC) and the philosophy of Zeno of Citium. Scholars typically claim that Arcesilaus set out to attack Zeno’s epistemology or theory of knowledge. The framework of epistemology prevails in the modern reconstruction of Arcesilaus’s arguments. Proponents of this framework usually contend that the epistemic possibility of Stoic “cognition” or “apprehension” (κατάληψις) is the principal aim of Arcesilaus’s attack. The aim of this article is to (...) contest the limited scope of the framework of epistemology in the interpretation of Arcesilaus’s attack, and reposition his critical arguments, in view of the fragmentary evidence, within the framework of an ontology of knowledge. (shrink)

This article is an examination of Hannah Arendt's 1929 dissertation.

Less than a century after Plato’s death, the Academy’s scholarch Arcesilaus of Pitane inaugurates a peculiar oral phase of Academic philosophy, deciding not to write philosophical works or openly teach his own doctrines. Scholars often attribute a radical change of direction to the school under his headship, taking early Stoic epistemology to be the primary target of the New Academy’s attack on Stoic philosophy. This paper defends a rival view of Arcesilaus’ Academic revolution. Shifting the focus of that attack from (...) epistemology to ethics, the paper illuminates the continuity in development from Polemo to Arcesilaus and the evidence corroborating this continuity. (shrink)

Scholars of Greek and Roman antiquity advance a variety of reasons to explain why the study of Hellenistic philosophy remains dependent on fragments and testimonies. Mansfeld observes such dependence in his use of the premise that philosophers of late antiquity based philosophical instruction and school curricula on a core set of writings from the classical period. On this basis, Mansfeld infers that schools of late antiquity continually transcribed and preserved writings of instructional significance. The schools routinely excluded other classical and (...) Hellenistic writings from the curricula, thus ensuring that a sizable body of literature deemed less pedagogically significant would perish, along with the original material on which the inscriptions had been made. The main problem with this standard survey of reasons is that it fails to explain why we remain extraordinarily dependent on peripheral sources and later testimonies in studying the Hellenistic Academy. (shrink)

D‐amino acids are being recognized as functionally important molecules in mammals. We recently identified endogenous D‐cysteine in mammalian brain. D‐cysteine is present in neonatal brain in substantial amounts (mM) and decreases with postnatal development. D‐cysteine binds to MARCKS and a host of proteins implicated in cell division and neurodevelopmental disorders. D‐cysteine decreases phosphorylation of MARCKS in neural progenitor cells (NPCs) affecting its translocation. D‐cysteine controls NPC proliferation by inhibiting AKT signaling. Exogenous D‐cysteine inhibits AKT phosphorylation at Thr 308 and Ser (...) 473 in NPCs. D‐cysteine treatment of NPCs led to 50% reduction in phosphorylation of Foxo1 at Ser 256 and Foxo3a at Ser 253. We hypothesize that in the developing brain endogenous D‐cysteine is as a physiologic regulator of NPC proliferation by inhibiting AKT signaling mediated by Foxo1 and Foxo3a. Endogenous D‐cysteine may regulate mammalian neurodevelopment with roles in schizophrenia and Alzheimer's disease (AD). (shrink)

Reprinted in Philosophy of Religion: An Anthology, Wadsworth 2015, 6th edition, eds Michael Rea and Louis Pojman. What is propositional faith? At a first approximation, we might answer that it is the psychological attitude picked out by standard uses of the English locution “S has faith that p,” where p takes declarative sentences as instances, as in “He has faith that they’ll win”. Although correct, this answer is not nearly as informative as we might like. Many people say that there (...) is a more informative answer. They say that, at the very least, propositional faith requires propositional belief. More precisely, they say that faith that p requires belief that p or that it must be partly constituted by belief that p. This view is common enough; call it the Common View. I have two main aims in this paper: (i) to exhibit the falsity of the Common View and the paucity of reasons for it, and (ii) to sketch a more accurate and comprehensive account of what propositional faith is. (shrink)

For decades, physicians, philosophers, theologians, lawyers, and the public considered brain death a settled issue. However, a series of recent cases in which individuals were declared brain dead yet physiologically maintained for prolonged periods of time has challenged the status quo. This signals a need for deeper reflection and reexamination of the underlying philosophical, scientific, and clinical issues at stake in defining death. In this paper, I consider four levels of philosophical inquiry regarding death: the ontological basis, actual states of (...) affairs, epistemological standards, and clinical criteria for brain death. I outline several candidates for the states of affairs that may constitute death, arguing that we should strive for a single, unified ontological definition of death as a loss of integrated functioning as a unified organism, while acknowledging that two states of affairs may satisfy this concept. I argue that the clinical criteria for determining whole-brain death should be bolstered to meet the epistemic demand of sufficient certainty in defining death by adding indicators of cerebro-somatic dis-integration to the traditional triad of loss of consciousness, loss of brainstem function, and absence of confounding explanations. (shrink)

This book offers a systematic attempt to explore the point of convergance between feminist theory and the work of Michel Foucault.

Introduction -- Stoic ethics and rhetoric -- Eighteenth-century common sense and sensus communis -- Taste and sensus communis -- Propriety, sympathy, and style fusing individual and social -- Victorian language theories and the decline of sensus communis.

Important discussions about limiting care based on professional judgment often devolve into heated debates over the place of physicians in bedside rationing. Politics, loaded rhetoric, and ideological caricature from both sides of the rationing debate obscure precise points of disagreement and consensus, and hinder critical dialogue around the obligations and boundaries of professional practice. We propose a way forward by reframing the rationing conversation, distinguishing between the scale of the decision and its context avoiding the word “rationing.” We propose to (...) shift the terminology, using specific, descriptive words to defuse conflict and re-focus the debate towards substantive issues. These distinctions can clarify the real ethical differences at stake and facilitate a more constructive conversation about the clinical and social responsibilities of physicians to use resources ethically at the bedside and their role in allocating medical resources at a societal level. (shrink)

Important discussions about limiting care based on professional judgment often devolve into heated debates over the place of physicians in bedside rationing. Politics, loaded rhetoric, and ideological caricature from both sides of the rationing debate obscure precise points of disagreement and consensus, and hinder critical dialogue around the obligations and boundaries of professional practice. We propose a way forward by reframing the rationing conversation, distinguishing between the scale of the decision and its context avoiding the word “rationing.” We propose to (...) shift the terminology, using specific, descriptive words to defuse conflict and re-focus the debate towards substantive issues. These distinctions can clarify the real ethical differences at stake and facilitate a more constructive conversation about the clinical and social responsibilities of physicians to use resources ethically at the bedside and their role in allocating medical resources at a societal level. (shrink)

Increasingly, physicians are being asked to provide technical services that many believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, (...) I endeavor, firstly, to clarify the meaning of some of these terms: conscience, conscientious action, professional judgment, conscientious objection, conscience clauses, civil disobedience, and tolerance. I argue that use of the term conscientious objection to describe these refusals by health care professionals is mistaken and confusing. Secondly, relying on a proper understanding of the moral and technical character of medical judgment, the optimal deference that the state and markets ought to have toward professions, and general principles of Lockean tolerance for a diversity of practices and persons in a flourishing, pluralistic, democratic society, I offer a defense of tolerance with respect to the deeply held convictions of physicians and other health care professionals who hold minority views on contested but legal medical practices. (shrink)

The movement in bioethics toward disclosure of financial conflicts of interest is well and good, most of the time. But in some cases, disclosure is not only unnecessary but destructive. When bioethicists advance arguments whose premises and logical moves are open to scrutiny, disclosure—far from clearing the air of bias—introduces bias.

This book reassesses theories of agency and gender identity against the backdrop of changing relations between men and women in contemporary societies.

The word ‘dignity’ is used in a variety of ways in bioethics, and this ambiguity has led some to argue that the term must be expunged from the bioethical lexicon. Such a judgment is far too hasty, however. In this article, the various uses of the word are classified into three serviceable categories: intrinsic, attributed, and inflorescent dignity. It is then demonstrated that, logically and linguistically, the attributed and inflorescent meanings of the word presuppose the intrinsic meaning. Thus, one cannot (...) conclude that these meanings are arbitrary and unrelated. This categorization and logical and linguistic analysis helps to unravel what seem to be contradictions in discourse about dignity and bioethics, and provides a hierarchy of meaning that has potential normative implications. (shrink)

Schlusslogische Letztbegründung is a collection of essays in honor of Kurt Walter Zeidler. Mr. Zeidler is a distinguished Kant- and Neo-Kantian-scholar who has reconstructed Kant's concept of transcendental logic in connection with the logic of the concept of Hegel and the logic of symbolization of Peirce. (cf. Zeidler: Grundriss der transzendentalen Logik, 3rd ed., Wien 2017) He has most notably inquired intensively into the relation of transcendental logic to philosophy of science (cf. Zeidler: Prolegomena zur Wissenschaftstheorie, Wien 2000) and to (...) phenomenology (cf. Zeidler: Vermittlungen. Zum antiken und neueren Idealismus, Wien 2016). He has also published several studies on Neo-Kantianism (cf. Zeidler: Provokationen. Zu Problemen des Neukantianismus, Wien 2018). This is refelected in the collection of essays by distinguished scholars who discuss and critically examine Zeidler's work. It includes contributions by Steinar Mathisen (Oslo), Wolfdietrich Schmied-Kowarzik (Vienna), Werner Flach (Lichtenau), Thomas Knoppe (Straberg), Geert Edel (Wyk/Föhr), Martin Bunte (Münster), Reinhard Hiltscher (Dresden), Walter Tydecks (Bensheim), Christian Krijnen (Amsterdam), Hartwig Wiedebach (Zürich), Max Gottschlich (Linz), Thomas Sören Hoffmann (Hagen), Rudolf Meer (Kaliningrad), Hans-Jürgen Müller (Frankfurt am Main), Robert König (Vienna), Ulrich Blau (Marburg), Karen Gloy (Luzern/Munich), Reinhold Breil (Aachen), Erhard Oeser (Vienna), Hans-Dieter Klein (Vienna), Hans Martin Dober (Tübingen), Kurt Walter Zeidler (Vienna) and Lois Marie Rendl (Vienna). (shrink)