The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering (...) conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

A clinical ethics consultant may, at times, be called upon to make independent substantive moral judgments and then offer justifications for those judgments. A CEC does not act unprofessionally by utilizing background beliefs that are religious in nature to justify those judgments. It is important, however, for a CEC to make such judgments authentically and, when asked, to offer up one’s reasons for why one believes the judgment is true in a transparent fashion.

In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God’s-eye perspective. In this paper, I focus on the implications of Engelhardt’s views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt’s views for this question. Finally, (...) I discuss some of Engelhardt’s foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation. (shrink)

Head transplantation fits within the broader conceptual space occupied by transhumanists and others who seek to extend the lives of human beings indefinitely. It is reasonable to reflect on whether, under what circumstances, and in what ways human immortality would be good. In this paper, I disambiguate the ways in which immortality might be considered a human good and then argue that immortality is neither necessary nor sufficient condition for objective meaning in life. I also argue that mortality is not (...) a necessary condition for objective meaning in life. (shrink)

Religions often operate as comprehensive worldviews, attempting to answer the deepest existential questions that human beings can ask: Who am I? Where do I come from? Where am I going after I die? How should I live? Often ethical systems are embedded and justified within these broader narratives. Inevitably, the clinical ethics consultant will encounter and engage with religiously based ethical systems. In this issue, the authors reflect seriously and deeply on the implications of such engagement.

This issue of The Journal of Medicine and Philosophy is dedicated to topics in clinical ethics with essays addressing clinician participation in state sponsored execution, duties to decrease ecological footprints in medicine, the concept of caring and its relationship to conscientious refusal, the dilemmas involved in dual use research, a philosophical and practical critique of principlism, conundrums that arise when applying surrogate decision-making models to patients with moderate intellectual disabilities, the phenomenology of chronic disease, and ethical concerns surrounding the use (...) of artificial intelligence in medicine. Throughout the issue, the themes of conceptual and moral boundaries in bioethics, critiques of current clinical ethics paradigms, and the importance of transparency are prominent. (shrink)

Often lurking below the surface of many clinical ethical issues are questions regarding background metaphysical, epistemological, meta-ethical, and political beliefs. In this issue, authors critically examine the effects of background beliefs on conscientious objection, explore ethical issues through the lenses of particular theoretical approaches like pragmatism and intersectional theory, rigorously explore the basic concepts at play within the patient safety movement, offer new theoretical approaches to old problems involving decision making for patients with dementia, explicate and explore the problems and (...) promises of machine learning in medicine, and offer us a non-rights-based argument for the just distribution of healthcare resources. (shrink)

Conceptual clarity is essential when engaging in dialogue to avoid unnecessary disagreement and to promote mutual understanding. In this issue devoted to clinical bioethics, the authors exemplify the virtue of careful conceptual analysis as they explore complex clinical questions regarding the essential nature of medicine, the boundaries of killing and letting die, the meaning of irreversibility in definitions of death, the argument for a right to try experimental medications, the ethical borders in complex medical billing, and the definition and modeling (...) of complex disease states. (shrink)

Clear and careful thinking is an indispensable aid in the pursuit of answers to the difficult ethical question faced by clinicians, patients, and families. In this issue of The Journal of Medicine and Philosophy devoted to issues in clinical ethics, the authors engage in this enterprise by reflecting on morally good medical decision making, conscientious objection, presumed consent in organ donation, the permissibility of surrogate decision making, and the failure of legislative limits on the scope of euthanasia in Belgium.

An important role of the philosopher is to critically reflect on what is often taken for granted, using the tools of argument and analysis. This article engages with six different papers that offer critical reflections on conventional concepts and beliefs in bioethics regarding informed consent, continuous deep sedation, traditional moral theories underlying bioethical thinking, the definition of mental disease, and codes of ethics for particular medical specialties.

The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering (...) conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

Society and social structures play an important role in the formation and evaluation of concepts and practices in clinical ethics. This is evident in the ways the authors in this issue explore a wide range of arguments and concepts in clinical ethics including moral distress and conscience based practice, phenomenological interview techniques and gender dysphoria, continuous deep sedation (CDS) at the end of life, the notion of patient expertise, ethically permissible medical billing practices, the notion of selfhood and patient centered (...) care in dementia patients, and the definition of minimal risk as used in research regulations. (shrink)

Decision-making capacity (DMC) is, in many ways, a central organizing concept of modern health care ethics. Patients with DMC have the moral—if not always the legal—authority to make all manner of...

Much philosophical attention has been devoted to “The Land Ethic,” especially by Anglo-American philosophers, but little has been paid to A Sand County Almanac as a whole. Read through the lens of continental philosophy, A Sand County Almanac promulgates an evolutionary-ecological world view and effects a personal self- and a species-specific Self-transformation in its audience. It’s author, Aldo Leopold, realizes these aims through descriptive reflection that has something in common with phenomenology-although Leopold was by no stretch of the imagination a (...) phenomenologist. Consideration of human-animal intersubjectivity, thematized in A Sand County Almanac, brings to light the moral problem of hunting and killing animal subjects. Leopold does not confront that problem, but it is confronted and resolved by Jose Ortega y Gassett, Henry Beston, and Paul Shepard in terms of an appropriate human relationship with wild-animal Others. Comparison with the genuinely Other-based Leopold-Ortega-Beston-Shepard wild-animal ethic shows the purportedly Other-based humanand possibly animal ethic of Emmanuel Levinas actually to be Same-based after all. (shrink)

A diagnosis of dementia often comes with difficulties in understanding a conversational context and expressing how one feels. So far, research on how to facilitate advance care planning for people with dementia focused on defining relevant themes and topics for conversations, or on how to formalize decisions made by surrogate decision makers, e.g., family members. The aim of this review is to provide a better scope of the existing research on practical communication aspects related to dementia in ACP conversations. In (...) November 2020, seven databases were searched to select papers for inclusion. This search was updated in December 2021. The search strategy consisted of three tiers, intersected by using the Boolean term “AND,” and resulted in 787 studies. Two researchers followed explicit criteria for two sequential levels of screening, based on titles and abstracts and full papers. A total of 22 studies were included for data analysis. Seven topics emerged clustered around two themes. This scoping review provides practical suggestions for healthcare professionals to improve ACP communication and uncovered gaps in research on communication aspects related to dementia in ACP conversations, such as non-verbal behavior, timing and implementation, and personal preferences. (shrink)

BackgroundCommunity engagement is increasingly promoted as a marker of good, ethical practice in the context of international collaborative research in low-income countries. There is, however, no widely agreed definition of community engagement or of approaches adopted. Justifications given for its use also vary. Community engagement is, for example, variously seen to be of value in: the development of more effective and appropriate consent processes; improved understanding of the aims and forms of research; higher recruitment rates; the identification of important ethical (...) issues; the building of better relationships between the community and researchers; the obtaining of community permission to approach potential research participants; and, the provision of better health care. Despite these diverse and potentially competing claims made for the importance of community engagement, there is very little published evidence on effective models of engagement or their evaluation.MethodsIn this paper, drawing upon interviews with the members of a Community Advisory Board on the Thai-Myanmar border, we describe and critically reflect upon an approach to community engagement which was developed in the context of international collaborative research in the border region.Results and conclusionsDrawing on our analysis, we identify a number of considerations relevant to the development of an approach to evaluating community engagement in this complex research setting. The paper also identifies a range of important ways in which the Community Advisory Board is in practice understood by its members to have morally significant roles and responsibilities beyond those usually associated with the successful and appropriate conduct of research. (shrink)

A full separation theorem for the derivable rules of intuitionistic linear logic without bounds, 0 and exponentials is proved. Several structural consequences of this theorem for subreducts of (commutative) residuated lattices are obtained. The theorem is then extended to the logic LR+ and its proof is extended to obtain the finite embeddability property for the class of square increasing residuated lattices.

A call to advance integrative teaching and learning in higher education. From Parker Palmer, best-selling author of The Courage to Teach, and Arthur Zajonc, professor of physics at Amherst College and director of the academic program of the Center for Contemplative Mind in Society, comes this call to revisit the roots and reclaim the vision of higher education. The Heart of Higher Education proposes an approach to teaching and learning that honors the whole human being--mind, heart, and spirit--an essential (...) integration if we hope to address the complex issues of our time. The book offers a rich interplay of analysis, theory, and proposals for action from two educators and writers who have contributed to developing the field of integrative education over the past few decades. Presents Parker Palmer's powerful response to critics of holistic learning and Arthur Zajonc's elucidation of the relationship between science, the humanities, and the contemplative traditions. Explores ways to take steps toward making colleges and universities places that awaken the deepest potential in students, faculty, and staff. Offers a practical approach to fostering renewal in higher education through collegiality and conversation. The Heart of Higher Education is for all who are new to the field of holistic education, all who want to deepen their understanding of its challenges, and all who want to practice and promote this vital approach to teaching and learning on their campuses. (shrink)

As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...) a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

Couples need to make their wishes explicit if we are to allow postmortem gamete donation.

Misattributed paternity or ‘false’ paternity is when a man is wrongly thought, by himself and possibly by others, to be the biological father of a child. Nowadays, because of the progression of genetics and genomics the possibility of finding misattributed paternity during familial genetic testing has increased. In contrast to other medical information, which pertains primarily to individuals, information obtained by genetic testing and/or pedigree analysis necessarily has implications for other biologically related members in the family. Disclosing or not a (...) misattributed paternity has a number of different biological and social consequences for the people involved. Such an issue presents important ethical and deontological challenges. The debate centres on whether or not to inform the family and, particularly, whom in the family, about the possibility that misattributed paternity might be discovered incidentally, and whether or not it is the duty of the healthcare professional to disclose the results and to whom. In this paper, we consider the different perspectives and reported problems, and analyse their cultural, ethical and legal dimensions. We compare the position of HCPs from an Italian and British point of view, particularly their role in genetic counselling. We discuss whether the Oviedo Convention of the Council of Europe can be seen as a basis for enriching the debate. (shrink)

We apply the theory of partial algebras, following the approach developed by Van Alten, to the study of the computational complexity of universal theories of monotonic and normal modal algebras. We show how the theory of partial algebras can be deployed to obtain co-NP and EXPTIME upper bounds for the universal theories of, respectively, monotonic and normal modal algebras. We also obtain the corresponding lower bounds, which means that the universal theory of monotonic modal algebras is co-NP-complete and the universal (...) theory of normal modal algebras is EXPTIME-complete. It also follows that the quasi-equational theory of monotonic modal algebras is co-NP-complete. While the EXPTIME upper bound for the universal theory of normal modal algebras can be obtained in a more straightforward way, as discussed in the paper, due to its close connection to the equational theory of normal modal algebras with the universal modality operator, the technique based on the theory of partial algebras is applicable to the study of universal theories of algebras corresponding to a wide range of logics with intensional operators, where no such connection is available. (shrink)

Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.

This primer on authentic education explores how mind and heart can work together in the learning process. Moving beyond the bankruptcy of our current model of education, Parker Palmer finds the soul of education through a lifelong cultivation of the wisdom each of us possesses and can share to benefit others.

In this paper we discuss ethical implications of the use of mobile phone apps in the control of the COVID-19 pandemic. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks and epidemics. However, the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this problem, many countries around the world have deployed or are developing mobile phone apps (...) capable of supporting instantaneous contact tracing. Informed by the on-going mapping of ‘proximity events’ these apps are intended both to inform public health policy and to provide alerts to individuals who have been in contact with a person with the infection. The proposed use of mobile phone data for ‘intelligent physical distancing’ in such contexts raises a number of important ethical questions. In our paper, we outline some ethical considerations that need to be addressed in any deployment of this kind of approach as part of a multidimensional public health response. We also, briefly, explore the implications for its use in future infectious disease outbreaks. (shrink)

This special issue arose from a joint conference of the History of Education Society, UK and the Australian and New Zealand History of Education Society, held in Malvern in Worcestershire, England in 2016 on the theme ‘sight, sound and text in the history of education’. The conference drew together media and educational historians, as well as archivists and museum professionals, to examine both methodological issues and a range of examples of sensory and textual histories. The three-day event, as well as (...) being enriching for its international character, proved that although much work has already been done in this area, there is so much more to consider and exploit when it comes to the study of the ‘new’ sonic and visual sources and their intertextual relationship with the documentary, as well as traditional understandings of ‘text’. (shrink)

In the original publication of the article, the authors name were abbreviated as “D. Shkatov” and “C. J. Van Alten”. However it should be “Dmitry Shkatov” and “Clint J. Van Alten”. The original article has been corrected.

A call to advance integrative teaching and learning in higher education. From Parker Palmer, best-selling author of The Courage to Teach, and Arthur Zajonc, professor of physics at Amherst College and director of the academic program of the Center for Contemplative Mind in Society, comes this call to revisit the roots and reclaim the vision of higher education. The Heart of Higher Education proposes an approach to teaching and learning that honors the whole human being--mind, heart, and spirit--an essential (...) integration if we hope to address the complex issues of our time. The book offers a rich interplay of analysis, theory, and proposals for action from two educators and writers who have contributed to developing the field of integrative education over the past few decades. Presents Parker Palmer's powerful response to critics of holistic learning and Arthur Zajonc's elucidation of the relationship between science, the humanities, and the contemplative traditions. Explores ways to take steps toward making colleges and universities places that awaken the deepest potential in students, faculty, and staff. Offers a practical approach to fostering renewal in higher education through collegiality and conversation. The Heart of Higher Education is for all who are new to the field of holistic education, all who want to deepen their understanding of its challenges, and all who want to practice and promote this vital approach to teaching and learning on their campuses. (shrink)

In this dissertation I re-assert the significance of the ancient Greek aphorism - ‘know thyself’: I identify the individual human self as the starting point and ubiquitous preamble of all epistemology and ontology. I argue that the primary feature of the way we find ourselves living is as an individual conscious bodily subject and this is the locus or starting point of all our possible knowledge. Although we find ourselves as individual subjects of experience and action we are not isolated; (...) rather we are always already with others as part of a wider world. I therefore propose a proto-ontology of ‘me, others, and world’ with corresponding interlocking modes of ‘individuality, intersubjectivity, and interdependence’. I argue that our direct knowing-by-being of our selves reveals some further primary facts about ourselves in terms of unity, compositionality, temporality, judgment, agency, and teleology. I acknowledge the phenomenological concept of pre-reflective self-awareness as an expression of the universal individuality of experience. However while some phenomenologists want to confine this mineness to the way that experience occurs, I argue that this mineness points to a more substantial knowing of ourselves as bodily subjects or selves. I claim that this human centered starting point becomes relevant or critical when we try to construct - or claim to have knowledge of - universal metaphysical theories such as scientism, which purports to be able to give a complete physicalist scientific picture of the world that sees nothing special in our individual first person perspectives. I argue that purely third personal objective scientific metaphysical theories have a blind spot in accounting for consciousness, which is what makes possible any theory whatsoever. Also since the twentieth century the results of physical science itself, notably quantum physics, seem, on some interpretations, to point to a reality that is not independent of individual observers. To alleviate these problems, I argue for a re-ordering of the priority of self and science. I reject strong forms of scientific realism and scientism in favour of a view that understands science as just one form of our human exploration of our world. Our knowing-by-being of ourselves is existentially and epistemically prior to any third-person knowledge and reflects our human cosmic significance as sources of explanatory knowledge and judgment. However, because our experience of ourselves is from within a wider world we should not expect to have a complete ontological picture of everything. Our limited ontological knowledge leaves us in a situation of subject and object duality but this is not a matter of dividing the world; rather it is a matter of recognizing our own situation. This can be seen as limiting, in that we are not in a position to know everything: but a proper understanding of ourselves liberates us from universalist doctrines and allows us to know ourselves as a source of nature’s self understanding from within. (shrink)

On a basic level, "cyberpsychology" refers to the comparison of the mind with different kinds of machines. This multidisciplinary collection brings together essays by leading psychologists and cultural theorists working in the spheres of technology and psychology to explore links between popular culture, technoscience, feminism and politics. Tracing historical and contemporary lines of argument around the fascination between different forms of psychological and machine culture, contributors articulate "cyberpsychological" reflections on contemporary crises in psychology with emerging technologies of the self. The (...) volume offers challenging perspectives and insights to anyone interested in the connections between psychology and technological developments in the information age. (shrink)

BackgroundObtaining consent has become a standard way of respecting the patient’s rights and autonomy in clinical research. Ethical guidelines recommend that the child’s parent/s or authorised legal guardian provides informed consent for their child’s participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child’s illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy will (...) assist in developing appropriate consent guidelines.MethodsWe conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants’ views about informed consent processes. Data analysis was facilitated by NVIVO 11 software.ResultsAll participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting.ConclusionThe health care context, culture and research process influenced participants’ understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent.Trial registration Not applicable. (shrink)

During the WHO-GloPID COVID-19 Global Research and Innovation Forum meeting held in Geneva on the 11th and 12th of February 2020 a number of different ethical concepts were used. This paper briefly states what a number of these concepts mean and how they might be applied to discussions about research during the COVID-19 pandemic and related outbreaks. This paper does not seek to be exhaustive and other ethical concepts are, of course, relevant and important.