Physician empathy is considered essential for good clinical care. Empirical evidence shows that it correlates with better patient satisfaction, compliance, and clinical outcomes. These data have nevertheless been criticized because of a lack of consistency and reliability. In this paper, we claim that these issues partly stem from the widespread idealization of empathy: we mistakenly assume that physician empathy always contributes to good care. This has prevented us from agreeing on a definition of empathy, from understanding the effects of its (...) different components and from exploring its limits. This is problematic because physicians’ ignorance of the risks of empathy and of strategies to manage them can impact their work and wellbeing negatively. To address this problem, we explore the effects of the potential components of empathy and argue that it should be conceived as a purely descriptive and wide term. We end by discussing implications for medical education. (shrink)

BackgroundIn this article, we address questions regarding how people consider what they do or do not consent to and the reasons why. This article presents the findings of a citizen forum study conducted by the University of Geneva in partnership with the Geneva University Hospitals to explore the opinions and concerns of members of the public regarding predictive oncology, genetic sequencing, and cancer. MethodsThis paper presents the results of a citizen forum that included 73 participants. A research tool titled "the (...) mechanics of consent" was designed for this study. This tool is a table encouraging participants to reflect on social and research actors, types of data, and desired levels of control while sharing different types of data with different actors. Participants’ discussion that led to the completion of each table were audio-recorded, transcribed, and analyzed using thematic analysis.ResultsThe results are a compilation of responses from the mechanics of consent tool divided into two sections; the first presents quantitative results of collective responses regarding attitudes to consent to donate their data. The second section present qualitative findings emerged from the discussion amongst participants.DiscussionChoice and control of personal data is crucial for the public to be able to decide who and how to trust. Key information to be disclosed to potential research participants shall include information about potential risks and benefits; who will be accessing and using their data; as well as assurances that their choice will be respected. Furthermore, researchers ought to make sure they are trustworthy, by acting in a competent, reliable, and honest manner. Governance systems ought to be better equipped to address ethical issues raise by the growing presence of non-traditional research actors, consent of exchanges of data via digital devices and online activity such as social media and fairness of data trading. Finally, informed consent is one of the various elements that contribute to conducting ethical research. More needs to be done to strengthen governance and ensure adequate protection of research participants, particularly to address issues related to predictive health analytics. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics case consultation practices. The tool (...) was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices. (shrink)

Growing data on the socioeconomic determinants of health pose a challenge to analysis and application of fairness in health. In Just health: meeting health needs fairly, Norman Daniels argues for a change in the population end of our thinking about just health. What about clinical care? Given our knowledge of the importance of wealth, education or social status to health, is fairness in medicine served better by continuing to avoid considering our patients’ social status in setting clinical priorities, or by (...) attempting to equalise existing health inequalities by giving priority to the socioeconomically disadvantaged at the point of care? In this article, I argue that doctors should not attempt the latter. Granted, giving priority to low status would go some way towards compensating unjust health inequalities and the impression of being left aside in other social spaces. It would represent reverse discrimination, but could still be justified inasmuch as disadvantaged groups could be identifiable, and as long as the intent was compensation rather than retribution. However, under current circumstances such priority would risk being attributed arbitrarily, would represent a form of medical proselytising, risk leaving the worst-off with less by alienating the powerful, and require teaching doctors to act in strongly counter-cultural ways—possibly at great cost. Crucially, however, we protect both equal health and equal regard by treating all alike: priority to low status would promote the first somewhat, but at the expense of sacrificing the second. (shrink)

The Global Burden of Disease Study is one of the largest-scale research collaborations in global health, producing critical data for researchers, policy-makers, and health workers about more than 350 diseases, injuries, and risk factors. Such an undertaking is, of course, extremely complex from an empirical perspective. But it also raises complex ethical and philosophical questions. In this volume, a group of leading philosophers, economists, epidemiologists, and policy scholars identify and discuss these philosophical questions. Better appreciating the philosophical dimensions of a (...) study like the GBD can make possible a more sophisticated interpretation of its results, and it can improve epidemiological studies in the future, so that they are better suited to produce results that help us to improve global health. (shrink)

Theological engagement with quantum mechanics has been dominated by the Copenhagen interpretation, failing to reflect the fact that philosophers and physicists alike are increasingly moving away from the Copenhagen interpretation in favor of other approaches. One such approach, Hugh Everett's so-called Many Worlds Interpretation (MWI), is being taken increasingly seriously. As the MWI's credibility grows, it is imperative that metaphysicians, theologians, and philosophers of religion engage with its ideas and their implications. This article does just that, setting out some implications (...) of Everettian Quantum Mechanics that are particularly relevant to theism. It argues that taking seriously the radical consequences of the Everett interpretation means facing at least three major worries for theism pertaining to personal identity, the problem of evil, and salvation. The article concludes by calling on theologians and philosophers of religion to address these worries, in order that these matters of religious significance remain both coherent and credible if the MWI turns out to be correct. (shrink)

Non‐Interventionist Objective Divine Action (NIODA), introduced by Robert John Russell, is a model of divine action drawing upon insights from quantum mechanics. It presents an intriguing and significant challenge to classical conceptions of divine action with far‐reaching consequences. When applying NIODA to theistic evolution, however, significant questions emerge that require attention. We identify and assess two sets of concerns. The first relates to quantum physics, particularly whether and how quantum occurrences influence mutations and evolution. We argue that the current empirical (...) evidence is ambiguous in its support of the kinds of quantum action that Russell proposes, though emerging data from quantum biology look promising. The second set of concerns is metaphysical, especially concerning the problem of evil. NIODA gives Godextensive agency over evolution and genetics, which has adverse consequences for theodicy. We propose potential solutions to the problems highlighted in our article, both metaphysical and physical, to improve the viability of NIODA's application to theistic evolution. (shrink)

This article applies Paul Tillich's existentialist analysis of the human predicament, particularly what it means to exist and to be fallen, to social media. I argue that social media heightens feelings of alienation and estrangement, supporting this claim with evidence from empirical research in psychiatry and communication studies. Thus, I offer an application of a Tillichian approach to an area of culture previously unexamined in this way. I identify three primary ways in which social media exacerbates existentialist emotional states: social (...) media allows us to construct artificial versions of ourselves through the use of filters and photo editing software; it provides the means to quantify social approval in groups the size of which the human brain has not evolved for; it extends the size of our social networks but decreases the quality of interactions. Social media is yet to receive significant philosophical or theological engagement despite its prevalence, particularly within younger generations. I argue that this is a mistake – philosophy has a duty to engage with such a ubiquitous feature of modern life. (shrink)

This article brings time and theology together constructively in response to a pressing problem for the doctrine of personal salvation. The problem arises within the physics and metaphysics of time, as these support a so-called temporal B-theory in which time does not pass and reality is comprised of a block universe. Within this static temporal metaphysic, objective change is highly problematized. Yet salvation requires an objective change from fallenness to redemption. So, how can we understand a salvation-transformation in the block (...) universe? In other words, can sinners really change? I argue that on a B-theory of time, a salvation-transformation is best understood as a form of qualitative, phenomenological, and subjective change, rather than a robust ontological change. I conclude that the individual's transformation from fallen to saved is one of mind-dependent becoming. So, sinners can change. But, in this lifetime, that change can only be subjective. (shrink)

Background Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Method Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The findings (...) revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one’s interests unjustly considered. Results Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient’s needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. Conclusion Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient’s interests and the care provided, despite existing compensation systems. (shrink)

Quantum mechanics has recently indicated that temporal order is not always fixed, a finding that has far-reaching philosophical and theological implications. The phenomena, termed “indefinite causal order,” shows that events can be in a superposition with regard to their order. In the experimental setting with which this article is concerned, two events, A and B, were shown to be in the ordering relations “A before B” and “B before A” at the same time. This article introduces an ongoing project that (...) seeks to make sense of this result, with a particular focus on the methodology by which this research will be undertaken. Specific research questions, particularly regarding what indefinite causal order might mean for the metaphysics of time and the doctrine of salvation, are introduced. The collaborative approach detailed brings together the disciplinary skills of a working scientist and a working theologian. What is offered is a collaborative methodology for interaction between science and religion that is more than the sum of its parts. Alister McGrath’s idea of multiple rationalities is employed as an epistemological framework within which this research takes place. Within an epistemologically pluralistic model, collaborative efforts are not only encouraged but necessary. Complex reality requires an equally complex, usually interdisciplinary, explanation. I argue that such dialogue is both theologically justified and culturally valuable and indicates the direction in which this research will be taken. (shrink)

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes (...) be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. (shrink)

In Switzerland, people can be granted access to assisted suicide on condition that the person whose wish is to die performs the fatal act, that he has his decisional capacity and that the assisting person’s conduct is not selfishly motivated. No restrictions relating to the ground of suffering are mentioned in the act. Existential suffering as a reason for wanting to die, however, gives raise to controversial issues. Moreover, existential suffering lacks definition and no consensus exists on how to evaluate (...) and manage it. This study explores the perspectives of care professionals and volunteers from a “right-to-die organization” on existential suffering as a motive for assisted suicide requests. A qualitative study based on face-to-face interviews was conducted with twenty-six participants: palliative care and primary care providers as well as EXIT right-to-die organization volunteers. Elements from the grounded theory approach were used. The twenty-six participants described existential suffering in a multiplicity of individual ways. In total, sixty-three stories were recounted. Their representations were grouped into eight categories: physical decline and its consequences, loneliness, fear of the future, life is over, loss of social significance, loss of hope for a better future, being a financial burden and loss of pleasurable activities. According to all participants, suffering coming from the loss of self-identity was always linked to physical decline, as if one’s image completely defined someone’s identity. Society’s perception of old people and vulnerable people were also often questioned. Another interesting point was that only four stories referring to a “pure” existential suffering were found. This suffering was related to a feeling that life has come to an end, without identification of any other related restriction or suffering. Existential suffering is multifaceted. Legislators and right-to-die organisations have to address the question of what make a AS acceptable. The plurality of existential suffering implies the need of a very personalized care. A better understanding of what it is made of could provide a “toolbox” to people concerned by these requests, helping them to explore it in order to offer suffering people a wider range of alternatives. (shrink)

Chapter 15: "'What you do hurts all of us!' When women confront women through pro-life rhetoric." -/- In this chapter, I articulate a specific problem in the way the rhetoric and ideology of pro-life politics operates as a form of confrontation between women. This is a dilemma that emerges when women engage in the appearance of concern and solicitude while passively coercing other women as they may be ambivalent and vulnerable in forcing anti-abortion outcomes. This in a reinvestment in the (...) problem I raise in my prior work, The Pregnancy ≠ Childbearing Project: A Phenomenology of Miscarriage (2017), a dilemma that I think is essential to grapple with if not also to urgently reconcile: where is the solidarity among women as they are pregnant, independent of the outcomes or expectations of childbearing? Alongside of the testimony of my own personal experience, I analyze the substance of the confrontation narrated in Maisie Crow’s documentary Jackson (2016), juxtaposing it with the fictional hypothesis of Margaret Atwood’s The Handmaid’s Tale (1998) to outline the character of harm in the confrontations between women through pro-life discourse. (shrink)

Formal clinical trials of pig-to-human organ transplant—known as xenotransplantation—may begin this decade, with the first trials likely to consist of either adult renal transplants or pediatric cardiac transplant patients. Xenotransplantation as a systematic scientific study only reaches back to the latter half of the 20th century, with episodic xenotransplantation events occurring prior to that. As the science of xenotransplantation has progressed in the 20th and 21st centuries, the public's knowledge of the potential therapy has also increased. With this, there have (...) been shifting ethical stances toward xenotransplantation in key areas, such as religious and public viewpoints towards xenotransplantation, animal rights, and public health concerns. This review provides a historical–ethical account of xenotransplantation and details if or how viewpoints have shifted over time. (shrink)

Kolbe and de Melo-Martin’s (2023) arguments draw attention to what is most useful about moral distress—identifying its causes is at least as important as measuring its severity. Jameton’s original...

Moral distress, is, at its core, an organizational problem. It is experienced on a personal level, but its causes originate within the system itself. In this commentary, we argue that moral distress is not inherently good, that effective interventions must address the external sources of moral distress, and that while there is a place for resilience in the healthcare professions, it cannot be an effective antidote to moral distress.

In Thus Spoke Zarathustra (2006), Nietzsche presents Zarathustra as a sage and parodic prophet, who acquires and offers insight over the narrated journey of his spiritual development. Nietzsche’s conception of Zarathustra as a gift (to “all and none”) endorses learning as the kind of emulation condensed into Zarathustra’s complex formulation: rather than “corpses that I carry with me wherever I want... I need living companions who follow me because they want to follow themselves—wherever I want.” Thus I aim, firstly, to (...) follow the text closely to see what is given. However, noting that Zarathustra is deeply imbued with figures of laughter, I also impose an interpretation. “Repeating differently,” as demanded by Zarathustra, I outline a practicable, spiral‐shaped “learning curve” of traversal and return to various “shades of laughter,” advancing from the worst laughters to “golden laughter,” which embraces complexity. This represents what it means to laugh well. In so doing, I hope to demonstrate that the complex ethos of affirmative laughter in Zarathustra remains strikingly pertinent for a contemporary era urgently tasked with embracing complexity. (shrink)

Several contributions in this book tell of doctors' increasing emigration from developing countries where they are in critical shortage, especially from the underserved rural and public sectors of countries in sub-Saharan Africa (SSA) and South Asia. They point out the severe harm from that migration to some of the world's poorest and sickest populations who have no other doctors to turn to, and gain little from their emigration. Since significant harm to the badly off is bad, decline in that migration (...) is usually a good development. But how to strive to achieve it? (shrink)

Instead of paralysing readers with a technical account of its nature and genealogy, I aim to accumulate a sense of Derrida's quasi-transcendental thinking over a series of expositions. I begin with a critical account of the most prevalent misreading of Derrida's work, generated by attempts, such as Rorty's, to place it on one side of a clear duality that sets old-fashioned “philosophical” foundationalism against contemporary anti-foundationalist “textuality.” In contrast, through an analogy between what occurs in the giving of a gift (...) and the happening of différance, I shall try to articulate the more complex, quasi-transcendental “logic” of Derrida's thinking, which refuses a clear-cut “either/or” choice between the poles of this duality, precisely because these alternatives stand in a relation, not of analytical contradiction, but of aporia, or dilemma. If this exposition proves to be too abstruse and metaphysical for some, a second, more practical, example concerning the aporias of ethical decision- making should go some way to wards compensation. Through these expositions, I aim to show that a complex, quasi-transcendental way of thinking serves as a more sophisticated and accurate key to the interpretation of Derrida's texts than attempts to reduce it to the anti-foundationalist side of supposedly contradictory opposites. To support this claim, I return with a critical eye to Rorty's rejection of Jonathan Culler's argument that Derrida must and does maintain a philosophy/literature distinction, and of Christopher Norris's explanation for Derrida's claim that one cannot escape philosophy. I also try to answer Rorty's rejection of the very idea of quasi-transcendentality by reducing this mode of thinking to a mere restatement of the co-implication of binaries. I conclude with a brief outline of what deconstructive practice amounts to when understood in the light of quasi-transcendental thinking. S. Afr. J. Philos. Vol.23(3) 2004: 244-266. (shrink)

Fair resource allocation in humanitarian medicine is gaining in importance and complexity, but remains insufficiently explored. It raises specific issues regarding non-ideal fairness, global solidarity, legitimacy in non-governmental institutions and conflicts of interest. All would benefit from further exploration. We propose that some headway could be made by adapting existing frameworks of procedural fairness for use in humanitarian organizations. Despite the difficulties in applying it to humanitarian medicine, it is possible to partly adapt Daniels and Sabin's ‘Accountability for reasonableness’ to (...) this context. This would require: (1) inclusion of internally explicit decisions and rationales; (2) publicity to donors, local staff, community leaders and governments, as well as frank answers to any beneficiary—or potential beneficiary—who asked for clarification of decisions and their rationale; (3) a consistent reasoning strategy to weigh conflicting views of equity in specific situations; (4) advocacy within the organization as a mechanism for revision and appeals; and (5) internal regulation according to publicly accessible mechanisms. Organizations could generate a common corpus of allocation decisions from which to draw in future similar cases. Importantly, the complexity of these challenges should encourage, rather than hinder, broader discussion on ethical aspects of resource allocation in humanitarian medicine. CiteULike Connotea Del.icio.us What's this? (shrink)

In public health, the issue of pharmaceutical pricing is a perennial problem. Recent high-profile examples, such as the September 2015 debacle involving Martin Shkreli and Turing Pharmaceuticals, are indicative of larger, systemic difficulties that plague the pharmaceutical industry in regards to drug pricing and the impact it yields on their reputation in the eyes of the public. For public health ethics, the issue of pharmaceutical pricing is rather crucial. Simply, individuals within a population require pharmaceuticals for disease prevention and management. (...) In order to be effective, these pharmaceuticals must be accessibly priced. This analysis will explore the notion of corporate social responsibility in regards to pharmaceutical pricing with an aim of restoring a positive reputation upon the pharmaceutical industry in the public eye. The analysis will utilize the 2005 United Nations Educational, Scientific, and Cultural Organization’s Universal Declaration on Bioethics and Human Rights to establish implications regarding the societal responsibilities of pharmaceutical companies in a global context. To accomplish this, Article 14 of the UDBHR—social responsibility and health—will be articulated in order to advocate a viewpoint of socially responsible capitalism in which pharmaceutical companies continue as profit-making ventures, yet establish moral concern for the welfare of all their stakeholders, including the healthcare consumer. (shrink)

This analysis provides a fact-based examination of the doctrine of nationalism and its idol, the national interest, couched within the context of twentieth century wartime presidential speeches and writings. What is significant about this rhetoric is that it provides a clear delineation of the growth of nationalism as America’s underlying political ideology and has fueled reliance on the concept of the national interest in guiding foreign affairs. By building public policies around their own perceptions of what is in the public (...) good—perceptions at times motivated by genuine patriotism, but all too often motivated by private interests—America’s political leaders have routinely resorted to lies and subterfuge as the means to their nationalist ends. Presidents and their advisers have learned that by exerting their power over the people, by controlling the content and context of political discourse, they can manipulate public opinion, winning support for policies and actions that appear to serve public interests, but in actuality are opposed to what people want or need. (shrink)

Forty years after Dax Cowart fought to have his voice heard regarding his medical treatment, patient autonomy and rights are at the heart of patient care today. Yet, despite its centrality in patient care, the tension between a severely burned patient’s right to stop treatment and the physician’s role in saving a life has not abated. As this case study explores, barriers remain to hearing and respecting a patient’s treatment decisions. Dismantling these barriers involves dispelling the myths that burn patients (...) must grin and bear intense pain to recover and that a patient’s choice to discontinue treatment equals physician failure. Moreover, in these situations, sustained, direct engagement between physician and patient can reduce the moral distress of all involved and enable physicians to hear and better accept when a patient is calling for the end of the day. (shrink)

Background Decisions regarding Cardio-Pulmonary Resuscitation (CPR) and Do Not Attempt Resuscitation (DNAR) orders remain demanding, as does including patients in the process. Objectives To explore physicians’ justification for CPR/DNAR orders and decisions regarding patient inclusion, as well as their reports of how they initiated discussions with patients. Methods We administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. Results Justifications were provided for 59% of DNAR orders and included (...) severe comorbidity, patients and families’ resuscitation preferences, patients’ age, or poor prognosis or quality of life. Reasons to include patients in CPR/DNAR decisions were provided in 96% and 84% of cases, and were based on respect for autonomy, clinical assessment of the situation as not too severe, and the view that such inclusion was required. Reasons for not including patients were offered in 84% of cases for CPR and in 70% for DNAR. They included absent decision-making capacity, a clinical situation viewed as good (CPR) or offering little hope of recovery (DNAR), barriers to communication, or concern that discussions could be emotionally difficult or superfluous. Decisions made earlier in the patient's management were infrequently viewed as requiring revision. Residents reported a variety of introductions to discussions with patients. Conclusions These results provide better understanding of reasons for CPR/DNAR decisions, reasons for patient inclusion or lack thereof, and ways in which such inclusion is initiated. They also point to potential side-effects of implementing CPR/DNAR recommendations without in-depth and practical training. This should be part of a regular audit and follow-up process for such recommendations. (shrink)

This paper elaborates on Todd McGowan’s perspicacious, psychoanalytic explanation of capitalism’s resilience, due to its formidable ideological insinuation into the banal micro-desires of consumers...

Heaven falls into chaos during God's absence, and Hell becomes fairly democratic. With Lucifer caged up and out of the picture, demons build a relatively civil society through contracts. This is sovereignty by institution as opposed to acquisition. The leviathans are unlike the angels in that the angels lacked a unity of wills. Driven by their nature, people—and angels—cannot live in harmony without a central and absolute authority to keep them in order. Without the presence of God to command the (...) angels there can be no peace, only a natural state of war. The fact that even the heavenly host can fall into a Hobbesian state of nature does not bode well for humanity, but maybe that's why business has been so good for the King of the Crossroads. Each demon, after all, has willingly agreed to enter into the civil society of Hell. (shrink)

Reflecting on ‘human development’ theorists face conceptual confusion, borne out experientially by contemporary ecological, social, and economic crises. Since concepts create realities (i.e. justify and motivate practices), and philosophers create concepts, it is important to consider how philosophers might respond to conceptual difficulties caused by the modern era’s still influential ‘binary’ paradigm, exemplified by the law of the excluded middle, which entails a discursive split between modernism’s ultimately predictable cosmos and postmodernism’s insistence on fundamental chaos. Supposedly obliged to choose between (...) opposites, theorists are caught between the necessity and iniquity of both. This impasse sets up conditions for what Lyotard calls ‘differends,’ and constrains our power to create responsible concepts. To show that Morin’s ‘generalised complexity’ takes us beyond the modernist/postmodernist impasse, I take up his injunction to promote ‘an epistemological reversal,’ starting from the notion of ‘open system’ and moving through ‘emergence’ and ‘organization’ to ‘logical complexity.’ Our epistemological task accordingly is to establish strategies for interpreting multiple dimensions of phenomenal reality, given the irreducibly complex relation of co-implication between mutually negating opposites. I agree with Cilliers that deconstruction is exemplary in this respect, but aim to broaden the adventure by suggesting ideas for a ‘pragmatics of complexity’ involving vocabulary, concepts, strategies, metaphors, and heuristics derived also from other philosophers and psychoanalytic theorists. The difficulty of complex thought is that it must face messes ... interconnectedness among phenomena, fogginess, uncertainty, contradiction. However, we can elaborate some conceptual tools, some principles for this adventure, and we can begin to perceive the face of the new paradigm of complexity that should emerge. (Edgar Morin, On Complexity, 2008: 6). (shrink)

This article addresses a strange investment within ‘continental' philosophy, in asserting the impotence of a Derridean approach when it comes to addressing practical (juridical, political, ethical, economic) issues. Such assertions of impotence regularly stand as the foil for whatever is proposed as a more complex, and therefore powerful, means to make sense of concrete phenomena. Invariably, however, the criticism of a Derridean approach is based on reductive misconceptions of its complex logic, and the proposed correctives repeat the very pattern of (...) thinking that Derrida has consistently adopted throughout his writing. A case in point is Zizek's criticism of what he calls ‘Derrida's operation.' While Zizek's critique is more nuanced and contemporary than the hackneyed charge of ‘textualism,' his reductive conception of the logical structure of Derridean thinking remains open to challenge. Further, his Lacanian corrective, whose logic is represented by the figure of a ‘Borromean knot,' precisely matches the ‘plural logic of the aporia' that underpins a Derridean approach to concrete phenomena. Accordingly, what follows is an attempt to show how Lacanian and Derridean discourses can be brought into alliance as a consequence of their isomorphic logical structure. This attempt is motivated by the conviction that one can do well without the pseudo-antagonism generated by the unjust criticism directed at one another by like-minded thinkers, which, moreover, provides such thinkers with a far too facile excuse for dismissing one another, even before opening texts. I also have a hidden agenda of sorts, which is to outline and, indeed, promote the ‘complexity-thinking' characteristic of both Derridean and Lacanian discourses, as the most viable and appropriate approach to practical issues. South African Journal of Philosophy Vol. 27 (1) 2008 pp. 10-26. (shrink)

The present article is an analysis of Heidegger's notorious Rectoral Address in terms of its attempt to bring together philosophy and politics in a way that would revitalise both. Through the repossession and reconfiguration of common words and concepts, Heidegger hoped to provide the intellectual impetus for a radical, invigorating cultural revolution in Germany. Given this apparently laudable aim, one is faced with the pressing question concerning the tension between his philosophical insight, on the one hand, and his inexplicable political (...) blindness on the other. Hence the paper focuses, firstly, on the radical nature of Heidegger's transformation of traditional conceptions of philosophy (science), and secondly, on his failure to separate the originality and significance of this philosophy from a catastrophic ideological attachment to the idea of German spiritual unity and destiny. S. Afr. J. Philos. Vol.21(1) 2002: 18-34. (shrink)

Vice’s answer to the question of this white ‘I’ who must try to live well in South Africa, configures shame, political silence and humble self-reconfiguration. I accept her insightful analysis of ‘whiteness’ in terms of the oppressor’s shame, but find that her specification of identity does not accommodate the multiplicity of privilege/oppression relations in which individuals participate. Since this implies that many South Africans, albeit unevenly, share the oppressor’s shame, her advice concerning ‘whites only’ political withdrawal seems inappropriate and curiously (...) self-subversive. Focussing instead on her reflections concerning moral emotions in ethically-compromised selves, which should motivate self-reconfiguration, and drawing from Kristeva on ‘forgiveness’, I argue that compromised selves in privilege/oppression relations cannot reconfigure themselves independently, and should rather negotiate on-going forgiveness relationships. Further, since privileged and oppressed shoulder different but reciprocal ethical responsibilities, besides considering the privileged self who should appeal for forgiveness,1 one must address a gap in Vice’s argument concerning the reciprocal shame of the oppressed. (shrink)

There is a global consensus of ethicists, politicians, physicians, and international documents that reject any sort of market in human organs. Indeed, this issue has received much attention in the literature in the past few decades, with the majority of commentators placing a high correlation between the sale of organs and financial exploitation. While this argument may be tenable, this analysis seeks to draw out further implications of organ sale, including the idea of moralistic exploitation and the concept that providing (...) a market in a nonmarket good may crowd out certain morals that we should care about. This article will initially discuss the issue of moralistic exploitation, drawing implications from the 2005 UNESCO Declaration on Bioethics and Human Rights and will conclude with applying Michael Sandel’s concept that markets crowd out morals to the issue of organ markets. (shrink)

For addressing the problem of negotiating social orders in a way that protects one’s humanity, I have considered Deleuze and Guattari’s intriguing claim in Anti-Oedipus that “a schizophrenic out for a walk is a better model than a neurotic lying on the analyst’s couch‘. I outlined the associated principles of schizoid living developed in Anti-Oedipus via a critique that reverses the value of two Freudian concepts, namely, ”neurosis’ and ”psychosis’. I then cited some of the book’s eulogising ”praise poetry’, which (...) describes the ”schizo’ and connected it to a contemporaneous text, J.M. Coetzee’s Life and Times of Michael K, that addresses the same ethical problem of negotiating social orders. Through the activities and reflections of the novel’s protagonist, Michael K, who might be thought of as “a schizophrenic out for a walk‘, I showed that Coetzee explores various forms of resistance. He investigates the impotence of resistance as the active construction of an alternative story from the alienated position of the ”other’. I pointed out that this strategy fails because it remains within the neurotic desire to construct a coherent narrative. Similarly, I indicated that resistance fails as a gesture of pure refusal akin to schizophrenic antiproduction, because the neurotic response re-appropriates this extremity through self-serving gestures of externalisation. Finally, I pointed out how Coetzee alludes to a kind of resistance that might be called schizoid and that changes the rules of the game. In the novel, K experiments with the first and second options, but cannot make life possible, either as a servant to a social order, on his own terms, or on the absolute outside. Echoing the question posed by Deleuze and Guattari of whether the schizoid ”men of desire’ they praise exist yet, K only dreams of the third option in the novel’s final lines, which detail the thoughts of a man dying of starvation. (shrink)

This philosophical investigation is motivated by the common association between happiness and self-transcendence, and a question posed by Freud: “Why is it so hard for men to be happy?” I consider the answers given in three key texts from the psychoanalytic tradition, Daniel Kahneman’s Thinking, Fast and Slow, Sigmund Freud’s Civilization and its Discontents, and Abraham Maslow’s The Farther Reaches of Human Nature. Based on a distinction between opposing forms of self-transcendence, ego-actualisation and ego-dissolution, the authors articulate the relation between (...) self-transcendence and happiness in different, but equally unsatisfactory, ways. In all three texts, a dominant ideological framing is discernible, which prioritises the present/positive and ignores the work of the absent/negative, ironically leaving us with a sense of futility concerning the pursuit of happiness. I propose that an approach influenced by Lacanian ideas, which acknowledges the role played by unhappiness in producing happiness, plausibly challenges the traditional conception of happiness that places it out of human reach as the effect of a perfectly self-transcendent state. Instead, understood as the effect of resistance to the notion of self-transcendence as self-perfection, happiness, while still difficult to achieve because it requires another kind of self-transcendence, becomes attainable here and now by ordinary individuals. (shrink)

The clash between the public right to know and public safety is just one of the fundamental conflicts raised by Hurst and White in this, the first definitive study of ethics in the Australian news media. Hurst and White explore the concept of ethical conduct, apply it to journalism, then draw on a wealth of local examples where the news media's conduct was challenged. They examine the attempts to codify the principles - from the policies of press councils (...) to the journalists' own codes of ethics - and show where these are inadequate, muddled or honoured in the breach. They put forward some provocative ideas for reform. (shrink)