The twenty‐six‐year‐old patient requested a prophylactic bilateral mastectomy with reconstruction because of an extensive family history of cancer. She reported that she had developed melanoma at twenty‐five; that her mother, sister, aunts, and a cousin all had breast cancer; that a cousin had ovarian cancer at nineteen; and that a brother was treated for esophageal cancer at fifteen. The treating team was skeptical about this history, and they could find no documentation of the patient's reported melanoma. The surgeon wrote the (...) patient's primary care physician, explaining that he had seen the patient and planned to proceed with the bilateral mastectomy and reconstruction. The primary care physician responded that he was unable to substantiate several of the patient's claims; some of his colleagues believed the family history to be fabricated. Trying to make sense of the discrepancies, the genetic counselor called a counselor colleague who had met with this patient. The colleague suggested that the in‐house genetic counselor “google” the patient. The search revealed two Facebook pages linked to the patient. In one, apparently a personal profile, the patient stated that in addition to battling stage four melanoma, she had recently been diagnosed with breast cancer. She provided a link to a site where she solicited donations to attend a summit for young cancer patients. The other Facebook page featured numerous pictures of her with a bald head, as though she has been through chemotherapy. The genetic counselor showed the Facebook pages to the surgeon, who then decided not to operate. Should health care professionals “google” their patients? (shrink)

The adage “an ounce of prevention is worth a pound of cure” is widely used in healthcare settings and can be applied to the work of institutional clinical ethics committees. The model of clinical ethics consultation, however, is inherently reactive: a crisis or question emerges, and ethics experts are called to help. In an effort to employ a proactive component to the model of clinical ethics consultation (as well as to standardize our educational interventions), we developed ethics pocket cards. The (...) purpose of this article is to: (1) describe the rationale for using ethics pocket cards, (2) provide examples of our cards, and (3) begin a dialogue about the potential uses of ethics pocket cards. In doing so, we hope to explore how such portable, economical devices can advance the goals of ethics consultation as well as the educational aims of ethics committees. (shrink)

We applaud Brown, Elliott, and Paine (2013) for their overarching goal of providing ethical justification for decisions to withdraw nonfutile life-sustaining medical treatments in some cases after...

The American Journal of Bioethics, Volume 12, Issue 5, Page 8-9, May 2012.

The question 'Why should I obey the law?' introduces a contemporary puzzle that is as old as philosophy itself. The puzzle is especially troublesome if we think of cases in which breaking the law is not otherwise wrongful, and in which the chances of getting caught are negligible. Philosophers from Socrates to H.L.A. Hart have struggled to give reasoned support to the idea that we do have a general moral duty to obey the law but, more recently, the greater number (...) of learned voices has expressed doubt that there is any such duty, at least as traditionally conceived. (shrink)

This volume is a collection of essays by various contributors in honor of the late Laurence Berns, Richard Hammond Elliot Tutor Emeritus at St. John's College, Annapolis. The essays address the literary, political, theological, and philosophical themes of his life's work as a scholar, teacher, and constant companion of the "great books.".

In this response, George Ellis comments on the publications of Part I. He responds first to Sara Green and Robert Batterman, before outlining his thoughts on Otávio Bueno’s piece.

Mr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will (...) that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery. His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment? (shrink)

This paper poses the question, “what are providers’ obligations to patients who lie?” This question is explored through the lens of a specific case: a 26–year–old woman who requests prophylactic bilateral mastectomy with reconstruction reports a significant and dramatic family history, but does not want to undergo genetic testing. Using a conversational–style discussion, the case is explored by a breast surgeon, genetic counselor/medical geneticist, clinical psychologist, chair of a hospital ethics committee and director of a clinical ethics consultation service.

The genes involved in methionine biosynthesis are scattered throughout the Escherichia coli chromosome and are controlled in a similar but not coordinated manner. The product of the metJ gene and S‐adenosylmethionine are involved in the repression of this ‘regulon’.

There is an emerging consensus in the corporate social responsibility literature suggesting that the quest for the so-called business case for CSR should be abandoned. In the same vein, several researchers have suggested that future research should start examining not whether, but rather when CSR is likely to have strengthened, weakened or even nullified effects on organizational outcomes :69–74, 2012). Using perspectives from several theoretical frameworks, we contribute to the literature by empirically examining the tension between functional and sustainability attributes (...) in a novel context, namely that of green e-banking services. The findings indicate that the positive effect of CSR on users’ attitudes towards green e-banking services is moderated by two primarily utilitarian information systems factors—namely perceived ease of use and perceived usefulness—and an important utilitarian individual difference variable—namely perceived self-efficacy with technology. Our findings are also important if interpreted within the context of the ethical decision-making literature :375–413, 2005), as they indicate that the linkage between moral judgment and moral outcomes is unlikely to be that straightforward. (shrink)

Ch. 1. Divine plants and magical animals -- Ch. 2. Aesthetic effects of domestication -- Ch. 3. The rainforests of domestication -- Ch. 4. The rise of ornamental plants -- Ch. 5. Darwin's sublime -- Ch. 6. Playing God -- Ch. 7. Standards of excellence -- Ch. 8. Doubles -- Ch. 9. Kitsch plants -- Ch. 10. Bastard flowers -- Ch. 11. Biotechnology in the garden -- Ch. 12. Recent art involving DNA -- Ch. 13. Naming life -- Ch. 14. (...) Anthropocentrism and genetic art -- Ch.15. The angel of extinction -- Ch. 16. Seven breeding complexes -- Ch. 17. The slowest art -- Ch. 18. Breeding for wildness. (shrink)

Across the European Union, the receipt of agricultural subsidisation is increasingly being predicated on the delivery of public goods. In the English context, in particular, these changes can be seen in the redirection of money to the new Environmental Land Management scheme. Such shifts reflect the changed expectations that society is placing on agriculture—from something that provides one good (food) to something that supplies many (food, access to green spaces, healthy rural environment, flood resilience, reduced greenhouse gas emissions). Whilst the (...) reasons behind the changes are well documented, understanding how these shifts are being experienced by the managers expected to deliver on these new expectations is less well understood. Bourdieu’s social theory and the good farmer concept are used to attend to this blind spot, and to provide timely insight as the country progresses along its public goods subsidy transition. Evidence from 65 interviews with 40 different interviewees (25 of whom gave a repeat interview) show a general willingness towards the transition to a public goods model of subsidisation. The optimisation and efficiency that has historically characterised the productivist identity is colouring the way managers are approaching the delivery of public goods. Ideas of land sparing and land sharing (and the farming preference for the former over the latter) are used to help understand these new social and attitudinal realities. The policy implications of these findings are discussed, with reference to the new scheme’s ‘priority themes’. (shrink)

This volume brings together all the available letters between historian Catharine Macaulay and a number of eighteenth-century luminaries, including George Washington, David Hume, and Mary Wollstonecraft. It includes an extended introduction by the editor which offers unique insights into Macaulay's life and the thinking of her friends and correspondents.

While rooted in careful study of Mead’s original writings and transcribed lectures and the historical context in which that work was carried out, the papers in this volume have brought Mead’s work to bear on contemporary issues in metaphysics, epistemology, cognitive science, and social and political philosophy.