Abstract Medical futility is commonly understood as treatment that would not provide for any meaningful benefit for the patient. While the medical facts will help to determine what is medically appropriate, it is often difficult for patients, families, surrogate decision-makers and healthcare providers to navigate these difficult situations. Often communication breaks down between those involved or reaches an impasse. This paper presents a set of practical strategies for dealing with cases of perceived medical futility at a major cancer center. Content (...) Type Journal Article Pages 1-8 DOI 10.1007/s10730-011-9168-3 Authors Colleen M. Gallagher, Section for Integrated Ethics in Cancer Care, Unit 1430, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402, USA Ryan F. Holmes, St. Louis University, St. Louis, MO, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

During a clinical ethics fellow’s first week of independent supervised service, two unhoused patients on the same floor were resisting the medical team’s recommendations to discharge. In the team’s view, both were medically stable and no longer required hospitalization in an acute setting. The medical team suspected malingering for both. The social worker and case manager had employed their usual means of gentle persuasion and eliminating psychosocial barriers to no avail. Rather than call the police, the attending physician, social worker, (...) and case manager decided to call ethics. These cases lead the fledgling fellow to consider the appropriate role for ethicists in difficult discharge cases. The article analyzes each case, evaluates their similarities and differences in the context of suspected malingering, and comments on ethical issues surrounding cases of suspected malingering. Finally, I reflect on the value and importance of developing and maintaining epistemic and professional independence. (shrink)

This case study details a request from a patient family member who calls our service without an articulated ethical dilemma. The issue that arose involved the conflict between continuing further medical interventions versus transitioning to supportive or palliative care and transferring the patient home. Beyond the resolution of the ethical dilemma, this narrative illustrates an approach to ethics consultation that seeks practical resolution of ethical dilemmas in alignment with patient goals and values. Importantly, the family’s suffering is addressed through a (...) relationship driven, humanistic approach that incorporates elements of compassion, empathy and dialog. (shrink)

The American Journal of Bioethics, Volume 12, Issue 10, Page 47-49, October 2012.

The biopsychosocial model is characterized by the systematic consideration of biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. This model opposes the biomedical model, which is the foundation of most current clinical practice. In the biomedical model, quest for evidence based medicine, the patient is reduced to molecules, genes, organelles, systems, diseases, etc. This reduction has brought great advances in medicine, but it lacks a holistic view of the person. To solve (...) the problem, we propose an early team based approach where the primary care physician leads a group of people that can help her/him address the psychosocial issues while she/he attends to the biomedical issues. This article addresses one case where the clinical ethicist facilitating a team based biopsychosocial model for the care of a patient worked as a bridge between the primary team, the critical care team, and the psychosocial team to advance the argument that good communication among the groups can lead to a true biopsychosocial model where the collaboration of the social worker, psychologist, chaplain, ethicist and the different medical teams can improve the overall patient experience. (shrink)

At the 2022 Clinical Ethics Unconference, the authors perceived a significant lack of racial and ethnic diversity, which was consistent with their experiences in other clinical ethics settings. As a result, they convened a working group to address the pervasive lack of diversity present in the field of clinical ethics and to propose strategies to increase the representation of people from racial and ethnic minority populations. This article identifies the harms associated with the lack of diversity in the healthcare setting (...) and translates these to the field of clinical ethics. The article then proposes a framework that may be used to help diversify the field of clinical ethics. Specifically, the authors identify existing barriers to appropriate diversity, actionable steps to increase diversity, and tools the field can utilize to systematically assess its progress with respect to achieving diversity. (shrink)

La nueva enfermedad del coronavirus de 2019 (Covid-19), producida por el coronavirus del Síndrome Respiratorio Agudo Severo 2 (SARS-CoV-2), es una pandemia que está creando una creciente crisis sanitaria mundial, dada su novedad, su alcance y sus inicialmente limitadas opciones de tratamiento eficaz. En efecto, se sabe poco acerca de las intervenciones no farmacéuticas óptimas para evitar la morbilidad y mortalidad causadas por él, y también se conoce poco sobre la rentabilidad y aspectos éticos de dichas intervenciones. Por lo tanto, (...) éste es el primer análisis ético y de rentabilidad de las medidas de contención del Covid-19 que se conoce (así como de las medidas de cuarentena de la población para cualquier pandemia en particular), con el fin de ayudar a los sistemas de salud y a los gobiernos a garantizar la atención clínica más rentable que pueda proporcionarse equitativamente al mayor número posible de pacientes, durante esta pandemia y en las futuras crisis mundiales que sean similares. Este análisis utilizó la metodología adoptada por los Centros para el Control y la Prevención de Enfermedades (CDC), cifras comúnmente aceptadas como entradas, y los supuestos mínimos tanto extremos como del mundo real para proporcionar los resultados más sólidos y confiables posibles. El análisis de costos indicó que en los escenarios extremos, o en el mejor de los casos para las medidas de contención del Covid-19 durante la cuarentena de la población, hay una relación de costo-efectividad de $154.86 millones de dólares gastados por cada muerte evitada, y un costo neto de $1.92 billones a nivel mundial. En el mundo real, esta intervención tiene una proporción de 2,520 millones de dólares gastados por cada muerte evitada y un costo neto de 1,99 billones de dólares. La ética del contrato social personalista, tal y como se articula en el popular sistema ético de derechos y deberes de las Naciones Unidas, pone de manifiesto la especial preocupación por el hecho de que estos confinamientos pueden derivar en injusticias poco éticas perpetuadas por los Estados, de manera que socavan las vidas y las libertades individuales, al tiempo que afectan de manera des- proporcionada a las comunidades de menores ingresos, especialmente a las minorías raciales. Este estudio sugiere, por tanto, que la práctica prevalente de la cuarentena entre la población, en comparación con las precauciones de tipo estándar y las intervenciones más específicas, puede proporcionar un beneficio neto inadecuado por su costo financiero y ético. En un momento de escasez mundial, que pone a prueba la capacidad de los sistemas sanitarios para detectar y atender adecuadamente a los pacientes con Covid-19, especialmente en los países en desarrollo y en las comunidades desatendidas, este estudio respalda que se dediquen menos recursos a intervenciones con una relación costo- beneficio poco clara, y más recursos a intervenciones más asequibles, éticas y equitativas, con mayores pruebas de sus beneficios netos para salvar vidas. (shrink)

Context: Challenges by embodied, enactive, extended and ecological approaches to cognition have provided good reasons to shift away from neurocentric theories. Problem: Classic cognitivist accounts tend towards internalism, representationalism and methodological individualism. Such accounts not only picture the brain as the central and almost exclusive mechanism of cognition, they also conceive of brain function in terms that ignore the dynamical relations among brain, body and environment. Method: I review four areas of research where enactivist accounts have shown alternative ways of (...) thinking about the brain. Results: Taken together, such analyses form a comprehensive alternative to the classic conceptions of cognitivist, computational neuroscience. Implications: Such considerations motivate the need to re-think our understanding of how the brain itself works. They suggest that the best explanation of brain function may be found in the mixed vocabularies of embodied and situated cognition, developmental psychology, ecological psychology, dynamic systems theory, applied linguistics, the theory of affordances and material engagement, rather than the narrow vocabulary of computational neuroscience. Constructivist content: This account is consistent with an enactivist-constructivist approach to cognition. (shrink)

This paper, in opposition to the standard theories of social cognition found in psychology and cognitive science, defends the idea that direct perception plays an important role in social cognition. The two dominant theories, theory theory and simulation theory , both posit something more than a perceptual element as necessary for our ability to understand others, i.e., to “mindread” or “mentalize.” In contrast, certain phenomenological approaches depend heavily on the concept of perception and the idea that we have a direct (...) perceptual grasp of the other person’s intentions, feelings, etc. This paper explains precisely what the notion of direct perception means, offers evidence from developmental studies, and proposes a non-simulationist interpretation of the neuroscience of mirror systems. (shrink)

This new introduction by Shaun Gallagher gives students and philosophers not only an excellent concise overview of the state of the field and contemporary debates, but a novel way of addressing the subject by looking at the ways in which phenomenology is useful to the disciplines it applies to. Gallagher retrieves the central insights made by the classic phenomenological philosophers (Husserl, Heidegger, Merleau-Ponty, Sartre, and others), updates some of these insights in innovative ways, and shows how they directly (...) relate to ongoing debates in philosophy and psychology. Accounts of phenomenological methods, and the concepts of intentionality, temporality, embodiment, action, self, and our ability to understand other people are integrated into a coherent contemporary statement that shows why phenomenology is still an active and vital philosophical approach. Each chapter begins with a discussion of the classic analyses and then goes on to show their relevance to contemporary debates in philosophy about embodied, enactive and extended approaches to our understanding of human experience. Along the way Gallagher introduces some novel interpretations that suggest how phenomenology can both inform and be informed by the terms of these debates. (shrink)

Hegemonic masculinity, a framework where stereotypically masculine traits are over-emphasized, plays a central role in sport, partly due to an excessive focus on winning. This type of masculinity marginalizes those that do not possess specific traits, including many women and men. I argue sport reform focused on mitigating hypercompetitive attitudes can reduce this harmful and marginalizing hegemonic masculinity in sport. I make this argument first by challenging the dichotomous nature of sport, especially in recognizing that all outcomes are a blend (...) of winning and losing, that ties are relevant and informative outcomes to contests, and that winning and losing do not always tell accurate stories of the outcome. Secondly, I contend that expanding the potential outcomes in sport can help broaden the emphasis of competitive sport to take into account playing well and improving, in terms of both the test and the contest. I conclude that these reforms decrease hegemonic masculinity, making sport better for all. (shrink)

Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and (...) distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change. (shrink)

The purpose of this study was to assess student perceptions of self-plagiarism. Students at three university campuses offering graduate and undergraduate classes in a residential and online format were queried; 284 students responded. Overwhelmingly, students perceived they owned their own previous published works and over half reported they believed self-plagiarism should not be considered an academic honesty offense. Most faculty members did not provide information about self-plagiarism to their students. Only about one-fourth of the students reported recycling parts of an (...) assignment in the past. Students who took online courses were more likely to have been educated about self-plagiarism than those who took residential courses. Understanding students’ perceptions about academic honesty offenses such as plagiarism can help institutions develop effective policies and interventions. (shrink)

This content analysis examines online accounts of choices of marital and child surnames to understand the predominance of exclusively patrilineal surnames. I demonstrate how surnaming processes present the classic tension between commitment to self and others as moral dilemmas of self versus family, children, and spouse. Social and cultural mechanisms create an either/or exclusive framing and a false dichotomy where women’s selves and others’ needs are incompatible. I also show how some parents reconceptualize family, children, and expectations for men and (...) women, which helps reconfigure dilemmas into a both/and inclusive framework and permits outcomes integrating self, family, children, and partnership. This study illustrates how maintaining a system that promotes giving fathers’ surnames to children as the only proper choice feeds the inertia of micro- and macro-structures that reflect and reinforce gendered differences in moral responsibility regarding self-sacrifice for family, children, and spouses. (shrink)

I clarify recently developed phenomenological approaches to social cognition. These are approaches that, drawing on developmental science, social neuroscience, and dynamic systems theory, emphasize the involvement of embodied and enactive processes together with communicative and narrative practices in contexts of intersubjective understanding. I review some of the evidence that supports these approaches. I consider a variety of criticisms leveled against them, and defend the role of phenomenology in the explanation of social cognition. Finally, I show how these phenomenological approaches can (...) solve the “starting problem” of social cognition. (shrink)

In their article “Racial Justice Requires Ending the War on Drugs,” Earp, Lewis, and Hart argue for the end of our War on Drugs in order to alleviate our reliance on mass incarceration, harm...

Many countries have attempted to transition to democracy following conflict or repression, but the basic meaning of transitional justice remains hotly contested. In this book, Colleen Murphy analyses transitional justice - showing how it is distinguished from retributive, corrective, and distributive justice - and outlines the ethical standards which societies attempting to democratize should follow. She argues that transitional justice involves the just pursuit of societal transformation. Such transformation requires political reconciliation, which in turn has a complex set of (...) institutional and interpersonal requirements including the rule of law. She shows how societal transformation is also influenced by the moral claims of victims and the demands of perpetrators, and how justice processes can fail to be just by failing to foster this transformation or by not treating victims and perpetrators fairly. Her book will be accessible and enlightening for philosophers, political and social scientists, policy analysts, and legal and human rights scholars and activists. (shrink)

This edited collection recalls the events that led up to the Fitzgerald Inquiry and examines the extraordinary influence the ‘watershed' inquiry has had on police and public sector reform at the state, national and international levels.

This article addresses questions about the sense of agency and its distinction from the sense of ownership in the context of understanding schizophrenic thought insertion. In contrast to “standard” approaches that identify problems with the sense of agency as central to thought insertion, two recent proposals argue that it is more correct to think that the problem concerns the subject’s sense of ownership. This view involves a “more demanding” concept of the sense of ownership that, I will argue, ultimately depends (...) on the sense of agency. In this regard, the sense of agency still appears to be the originating problem. (shrink)

It is difficult to give a nice succinct précis of The Phenomenological Mind since it is composed of a set of chapters each of which addresses a different topic. The topics are linked in numerous ways. There is one way, however, in which all of the chapters are bound together to constitute a unified whole, and this might be considered something like a framework proposition. Phenomenology, understood as the philosophical approach taken up by Husserl and a number of people who (...) loosely follow his lead, has something important to contribute to philosophy of mind and the cognitive sciences. The proof of this claim is to be found in the details of the various chapters. In some cases it consists of showing that a phenomenological approach provides a genuine alternative to the standard or current approaches to be found in these areas. In other cases, phenomenological methods may provide insights about certain key concepts; or insights that are suggestive for experimental work. To do any of this requires that we take an interdisciplinary approach and recognize that these various investigations do not move on a one-way track. (shrink)

During his long and continuing scholarly career, Patrick Suppes contributed significantly both to the sciences and to their philosophies. The volume consists of papers by an international group of Suppes colleagues, collaborators, and students in many of the areas of his expertise, building on or adding to his insights. Michael Friedman offers an overview of Suppes accomplishments and of his unique perspective on the relation between science and philosophy. Paul Humphreys, Stephen Hartmann, and Tom Ryckman present essays in the philosophy (...) of physics. Jens-Erik Fenstad, Harvey Friedman, and Jaako Hintikka consider problems in the foundations of mathematics, while the late Duncan Luce, Jean-Claude Falmagne, Brian Skyrms, and Hannes Leitgeb have contributed essays in theory of measurement, decision theory and probability. Foundations of economics and political theory are addressed by Adolfo Garcia de la Sienra, Russell Hardin, and Kenneth Arrow. Psychology, language, and philosophy of language are addressed by Elizabeth Loftus, Anne Fagot-Largeault, Willem Levelt, Dagfinn Follesdal, and Marcos Perreau-Guimares and some of Suppes most recent research in neurobiology is addressed in essays by Colleen Crangle, Acadio de Barros and Claudio Carvalhes. Finally Nancy Cartwright and Alexandre Marcelles consider the alignment (or misalignment) of method and policy. Each of the essays is accompanied by a response from Suppes.". (shrink)

"Center for the Study of Language and Information, Leland Stanford Junior University.".

Following extended periods of conflict or repression, political reconciliation is indispensable to the establishment or restoration of democratic relationships and critical to the pursuit of peacemaking globally. In this book, Colleen Murphy offers an innovative analysis of the moral problems plaguing political relationships under the strain of civil conflict and repression. Focusing on the unique moral damage that attends the deterioration of political relationships, Murphy identifies the precise kinds of repair and transformation that processes of political reconciliation ought to (...) promote. Building on this analysis, she proposes a normative model of political relationships. A Moral Theory of Political Reconciliation delivers an original account of the failure and restoration of political relationships, which will be of interest to philosophers, social scientists, legal scholars, policy analysts, and all those who are interested in transitional justice, global politics, and democracy. (shrink)

Processes of transitional justice deal with large-scale wrongdoing committed during extended periods of conflict or repression. This paper discusses three common moral objections to processes of transitional justice, which I label shaking hands with the devil, selling victims short, and entrenching the status quo. Given the scale of wrongdoing and the context in which transitional justice processes are adopted, compromise is necessary. To respond to these objections, I argue, it is necessary to articulate the conditions that make a compromise principled. (...) I defend three criteria that distinguish principled from unprincipled compromises. (shrink)

In the past dozen years a number of theoretical models of schizophrenic symptoms have been proposed, often inspired by advances in the cognitive sciences, and especially cognitive neuroscience. Perhaps the most widely cited and influential of these is the neurocognitive model proposed by Christopher Frith (1992). Frith's influence reaches into psychiatry, neuroscience, and even philosophy. The philosopher John Campbell (1999a), for example, has called Frith's model the most parsimonious explanation of how self-ascriptions of thoughts are subject to errors of identification. (...) "On reflection, it also seems that this is not just one possible theory; it is the simplest theory which has any prospect of explaining the sense of agency, and we ought to work from it, introducing complications only as necessary" (1999a, p. 612). Not everyone agrees. In their recent analysis of alien voices and inserted thoughts in schizophrenia, Stephens and Graham (2000) offer a critique of Frith. Their criticism, however, although serious, is neither deep nor extensive. They outline three points. First, Frith fails to provide an adequate account of why a subject who experiences thought insertion would misattribute that thought to some other agent. Second, Frith does not clarify the distinction between thought insertion and thought influence. And third, Frith fails to explain how a subject can claim both that he is thinking the thought and that the thought is someone else's thought (Stephens and Graham.. (shrink)

Colleen Glenney Boggs puts animal representation at the center of the making of the liberal American subject. Concentrating on the formative and disruptive presence of animals in the writings of Frederick Douglass, Edgar Allan Poe, and Emily Dickinson, Boggs argues that animals are critical to the ways in which Americans enact their humanity and regulate subjects in the biopolitical state. Biopower, or a politics that extends its reach to life, thrives on the strategic ambivalence between who is considered human (...) and what is judged as animal. It generates a space of indeterminacy in which animal representations intervene to define and challenge the parameters of subjectivity. The renegotiation of the species line produces a tension that is never fully regulated. Therefore, as both figures of radical alterity and the embodiment of biopolitics, animals are simultaneously exceptional and exemplary to the biopolitical state. An original contribution to animal studies, American studies, critical race theory, and posthumanist inquiry, Boggs thrillingly reinterprets a long and highly contentious human-animal history. (shrink)