Ethical lapses associated with the first facial transplant included breaches of confidentiality, bending of research rules, and film deals. However, discussions of the risk-benefit ratio for face transplantation are often deficient in that they ignore the needs, experience, and decision-making capability of potential recipients.

For over 30 years, Tias Little has explored yoga as a spiritual path. In this book he offers key teachings from his journey that will resonate with anyone who has dedicated themself to a mind/body discipline. In short, accessible chapters, Little shares his struggles and joys as a yogi and chronicles the transformation of his understanding and practice along the way.

Le devenir socioprofessionnel des ex-apprentis footballeurs est un phénomène social encore insuffisamment analysé à ce jour. Les différents travaux de Frédéric Rasera, explorant les conditions sociales individuelles de la recomposition vocationnelle chez un ex-apprenti footballeur, font office d’exception. Face à ce constat, cet article entend contribuer à la réflexion portant sur ces jeunes sportifs. À travers l’étude des trajectoires d’une vingtaine d’ex-apprentis footballeurs, nous verrons qu’il est possible de trouver des similarités biographiques caractérisant leur processus de recomposition vocationnelle. Plus précisément, (...) nous montrerons qu’une analyse en termes de temporalités vécues permet de dévoiler la résurgence de quatre séquences de vie au cours de leur recomposition vocationnelle, révélant ainsi, les dimensions collectives de ce processus. (shrink)

In recent years there has been an increasing awareness that a comprehensive understanding of language, cognitive and affective processes, and social and interpersonal phenomena cannot be achieved without understanding the ways these processes are grounded in bodily states. The term ‘embodiment’ captures the common denominator of these developments, which come from several disciplinary perspectives ranging from neuroscience, cognitive science, social psychology, and affective sciences. For the first time, this volume brings together these varied developments under one umbrella and furnishes a (...) comprehensive overview of this intellectual movement in the cognitive-behavioral sciences. (shrink)

New York City hospitals expanded resources to an unprecedented extent in response to the COVID pandemic. Thousands of beds, ICU beds, staff members, and ventilators were rapidly incorporated into h...

Older adults in the United States have been the age group hardest hit by the Covid pandemic. They have suffered a disproportionate number of deaths; Covid patients eighty years or older on ventilators had fatality rates higher than 90 percent. How could we have better protected older adults? Both the popular press and government entities blamed nursing homes, labeling them “snake pits” and imposing harsh fines and arduous new regulations. We argue that this approach is unlikely to improve protections for (...) older adults. Rather than focusing exclusively on acute and critical resources, including ventilators, a plan that respected the best interests of older adults would have also supported nursing homes, a critical part of the health care system. Better access to protective equipment for staff members, early testing of staff members and patients, and enhanced means of communication with families were what was needed. These preventive measures would have offered greater benefit to the oldest members of our population than the exclusive focus on acute care. (shrink)

The Institute of Medicine’s 2005 publication, Dietary Supplements: A Framework for Evaluating Safety, is authoritative and thorough, and thus representative of other reports by the Institute of Medicine. What makes this report particularly interesting, however, is the rich political subtext that exists in the interstices of the report, popping up here and there in brief comments and barely suppressed yelps of exasperation. To understand this context, it is useful to reflect for a moment on the special nature of the IOM (...) and its relationship to government.IOM is part of the National Academy of Sciences, and is a private, non-governmental organization that does not receive direct federal funding for its work. Rather, IOM studies are often funded by contract with governmental entities that request reports on particular topics. As a case in point, the dietary supplement study was requested and paid for by the FDA. (shrink)

The United States has recently made significant and positive civil rights gains for LGB people, including expanded recognition of marriages between people of the same sex. Among the central tropes that have emerged in the struggle for the rights of LGB people are that they are “born that way,” that sexual orientations cannot change, and that one's sexual orientation is not affected by choice. Writer Andrew Sullivan put it this way: “[H]omosexuality is an essentially involuntary condition that can neither be (...) denied nor permanently repressed.… [S]o long as homosexual adults as citizens insist on the involuntary nature of their condition, it becomes politically impossible to deny or ignore the fact of homosexuality.… [The strategy for obtaining LGB rights is to] seek full public equality for those who, through no fault of their own, happen to be homosexual.”This idea of linking LGB rights to empirical claims about sexual orientations has become so central that casting doubt on these claims is, in many circles, tantamount to opposing LGB rights. Nonetheless, claims about innateness, immutability, and lack of choice about sexual orientation should not be the primary basis for LGB rights. (shrink)

Biographical verse work illustrating Jaina ethics and morality; includes translation in Hindi.

Classical commentary on Tarkabhāṣā of Keśavamiśra, 13th cent., work on Nyaya and Vaiśeṣika school in Hindu philosophy; critical edition.

A proposta principal dese livro é fazer uma tessitura entre ética, arte e imaginário, elementos primordiais que se entrelaçam na relação com a sagrado e com as experiências religiosas. A obra é fruto de algumas pesquisas decorrentes do grupo Imagem, Arte, Ética e Sociedade, coordenado pela Profa. Dra. Kátia Mendonça e pelo Prof. Dr. Jones Gomes, em parceria entre as Universidade do Estado do Pará, Federal do Pará e Metodista de São Paulo por meio do Programa de Cooperação Acadêmica - (...) PROCAD. (shrink)

Mrs. K is a thirty-one-year-old Russian-speaking mother of two, who was brought in by ambulance after attempting suicide by jumping in front of train. Probable depression x months. Stressor: lost custody battle over older child. Current status: deep coma, ventilator-dependent, and prognosis grim. Next of kin is estranged husband; he demands participation in medical decision making. Legal proxy is patient's boyfriend; forcibly removed from the intensive care unit for agitated behavior and alcohol intoxication.I magine the difficulty for the ICU staff (...) as it tries to patch together the broken body of Mrs. K, described above. If, as appears likely, the physicians’ efforts begin to fail, who will speak for this patient, who can no longer speak for herself, and determine the appropriate goals and limits of intensive medical care? (shrink)

Mrs. K is a thirty-one-year-old Russian-speaking mother of two, who was brought in by ambulance after attempting suicide by jumping in front of train. Probable depression x months. Stressor: lost custody battle over older child. Current status: deep coma, ventilator-dependent, and prognosis grim. Next of kin is estranged husband; he demands participation in medical decision making. Legal proxy is patient's boyfriend; forcibly removed from the intensive care unit for agitated behavior and alcohol intoxication.I magine the difficulty for the ICU staff (...) as it tries to patch together the broken body of Mrs. K, described above. If, as appears likely, the physicians’ efforts begin to fail, who will speak for this patient, who can no longer speak for herself, and determine the appropriate goals and limits of intensive medical care? (shrink)

In writing these essays, we were asked to consider, “What makes a good life in late life?” I thought instantly, perhaps like many people, of photos and stories of older people taking up new careers and new hobbies—running marathons and soup kitchens, starting organic farms. This response is right and proper. Older people can leverage wisdom and creativity to make wonderful contributions to their communities and should be celebrated for doing so. But this happy picture is incomplete. We live longer (...) than ever before, and with that long life, many of us can expect disability. This is the product of medical success. We are less likely to die from cancer, a heart attack, or a stroke; we survive with chronic illnesses and their associated disabilities. A good life in late life, for many of us, will be a life with disability.For this essay, I focus on dementia, a common and ultimately fatal illness, and one that typically lasts many years from the start of symptoms to the end. More than five million Americans currently suffer from dementia; fifteen million paid and volunteer caregivers help support them. What would a good life with dementia look like? How would it change from the early phase, when cognitive impairment and other challenges are relatively modest, to the final phase marked by severe cognitive and physical decline? (shrink)

In Cognitive Gadgets, Heyes seeks to unite evolutionary psychology with cultural evolutionary theory. Although we applaud this unifying effort, we find it falls short of considering how culture itself evolves to produce indigenous psychologies fitted to particular environments. We focus on mentalizing and autobiographical memory as examples of how socialization practices embedded within culture build cognitive adaptations.

A good death is hard to find. Family members tell us that loved ones die in the wrong place—the hospital—and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates is a relatively (...) new and still vulnerable aspect of medical care. For thousands of years, patients and surrogates had no say in medical decision-making. Today, standards support shared decision-making, but these articles both carve out exceptions to those standards, limiting the rights of patients and families in decisions about specific end-of-life treatments. As bioethics consultants in an acute care setting, we frequently confront conflicts similar to those described by Jeffrey Berger and by Ellen Robinson and colleagues. In such cases, our service emphasizes redoubled efforts at communication and mediation. Focusing on goals and values, rather than interventions, produces the best possible collaboration in health care decision-making. Cases in which we would overturn a surrogate's recommendations regarding palliative sedation or do-not-resuscitate orders are rare and require careful processes and clear evidence that the surrogate's choice is contrary to patient values. (shrink)

Our goal in producing this special issue is to encourage our colleagues to incorporate topics related to LGBT populations into bioethics curricula and scholarship. Bioethics has only rarely examined the ways in which law and medicine have defined, regulated, and often oppressed sexual minorities. This is an error on the part of bioethics. Medicine and law have served in the past as society's enforcement arm toward sexual minorities, in ways that robbed many people of their dignity. We feel that bioethics (...) has an obligation to discuss that history and to help us as a society take responsibility for it.We can address only a small number of topics in this special issue of the Hastings Center Report, and we selected topics we believe will stimulate discourse. Andrew Solomon offers an elegant overview of the challenges that bioethics faces in articulating a solid basis for LGBT rights. Timothy F. Murphy asks whether bioethics still faces issues related to lesbian, gay, and bisexual people, given the deletion of homosexuality as a disease and the progress toward same‐sex marriage. Jamie Lindemann Nelson's essay addresses the search for identity for transgender persons and the role of science in that search. Two articles, those by Brendan S. Abel and by Jack Drescher and Jack Pula, take up the complex issue of medical treatment for children who reject their assigned birth gender. Celia B. Fisher and Brian Mustanski address the special challenges of engaging LGBT youth in research, balancing the need for better information about this vulnerable group against the existing restrictions on research involving children. Tia Powell and Edward Stein consider the merits of legal bans on psychotherapies intended to change sexual orientation, particularly in the light of current research on orientation. Mary Beth Foglia and Karen I. Fredricksen‐Goldsen highlight health disparities and resilience among LGBT older adults and then discuss the role of nonconscious bias in perpetuating disparities. Stephan Davis and Nancy Berlinger assess the challenges of access to care and health policy for transgender persons. Edward J. Callahan et al. tackle the ways in which diverse aspects of medicine should change to better incorporate the needs of LGBT patients, including through use of the electronic medical record, education of health professionals, and recruitment efforts for LGBT health professionals. Virginia Ashby Sharpe and Uchenna S. Uchendu describe multifaceted efforts within Veterans Administration facilities to create change for LGBT veterans across the largest integrated health care network in the United States. Lance Wahlert and Autumn Fiester find a mixed record in the use of case studies in teaching about LGBT issues. (shrink)

Responsibility is a moral quality of caring that is central to child health policies. In contemporary UK these policies are based on behavioural psychology and underpinned by individualism, an ideology central to neoliberal governance. Amid the complexities of “obesity” and inequalities, there is a multi-layered stigmatisation of parents as moral associates. Few studies consider the lived realities of food policy processes from the standpoint of class. This critical qualitative research draws on theorists who explain processes of power and class: Foucault, (...) Gramsci, Bourdieu and Marx. Its objectives are: (a) to understand the lived experience of parents as they interact with food policy; (b) to explore how parents resist stigmatisation; and (c) to reflect on implications for policy and practice. Methods: Using purposive sampling, 31 ethnographically-informed interviews were carried out in a London borough, with policy actors: policymakers, implementers and parents as policy recipients, including 12 working-class mothers. Results: A core theme of “responsibilities” emerged with four interconnecting sub-processes that provide insight into how stigmatisation and resistance evolve through policy. Discussion: As have others, this study reveals the idea of responsibility as fundamental to the processes of soft power. Child health is a priority for participants and a “ruling idea”. The diffusion of responsibility throughout policy leads to confusion about where it lies. New subjectivities are formed in line with ideas of governmentality. Parents engage with policy at multiple sites that elicit symbolic violence, and stigma sows social divisions. Against this background, working-class parents are left in a state of cognitive dissonance between being made responsible (responsibilisation), and feeling responsible (self-blaming) for their children’s weight while lacking the material resources to provide an optimal nutritious diet. Resistance is interwoven and is essentially found in parents’ policy alternatives that diverge from UK government policy. Conclusion: Critical qualitative research using multiple theorists is valuable in understanding how parents interact with policy in a complex social world. With UK policy failing, useful insights are provided into how involving parents in policymaking might determine a meaningful collective responsibility, with a political ethic of care and unity between parents that would advance health equity. (shrink)

In theory, a competent patient may refuse any and all treatments, even those that sustain life. The problem with this theory, confidently and frequently asserted, is that the circumstances of real patients may so confound us with their complexity as to shake our confident assumptions to their core.For instance, it is not the case that one may always and easily know which patients are competent. Indeed, evaluation of decision-making capacity is notoriously difficult. Not only may reasonable and experienced evaluators, say (...) a judge and a psychiatrist, disagree, but also a person's capacity may change from hour to hour and may extend to some decisions yet not to others. And yet it is on this subtle art of capacity evaluation that life and death decisions often turn, especially when patients decline life-sustaining treatment.An evaluation of capacity may consider the impact of serious medical or psychiatric illness, as well as the patient's life circumstances. (shrink)

In theory, a competent patient may refuse any and all treatments, even those that sustain life. The problem with this theory, confidently and frequently asserted, is that the circumstances of real patients may so confound us with their complexity as to shake our confident assumptions to their core.For instance, it is not the case that one may always and easily know which patients are competent. Indeed, evaluation of decision-making capacity is notoriously difficult. Not only may reasonable and experienced evaluators, say (...) a judge and a psychiatrist, disagree, but also a person's capacity may change from hour to hour and may extend to some decisions yet not to others. And yet it is on this subtle art of capacity evaluation that life and death decisions often turn, especially when patients decline life-sustaining treatment.An evaluation of capacity may consider the impact of serious medical or psychiatric illness, as well as the patient's life circumstances. (shrink)

1The opinions expressed are solely those of the author and not those of the New York State Task Force on Life & the Law, nor of New York State government.

This paper examines two topics in Japanese medical ethics: non-disclosure of medical information by Japanese physicians, and the history of human rights abuses by Japanese physicians during World War II. These contrasting issues show how culture shapes our view of ethically appropriate behavior in medicine. An understanding of cultural context reveals that certain practices, such as withholding diagnostic information from patients, may represent ethical behavior in that context. In contrast, nonconsensual human experimentation designed to harm the patient is inherently unethical (...) irrespective of cultural context. Attempts to define moral consensus in bioethics, and to distinguish between acceptable and unacceptable variation across different cultural contexts, remain central challenges in articulating international, culturally sensitive norms in medical ethics. (shrink)

The ethical implications of disaster planning garner increasing scrutiny. The role of families in disaster efforts is a topic that requires additional ethical examination. This article reviews the potential roles for families before and during disasters, with particular attention to the impact on children and vulnerable elderly patients. The potential positive and negative impact of family participation in different aspects of healthcare and disaster efforts is assessed.

Abstractabstract:This essay explores what it means to age happily, beginning with concepts of aging and happiness and proceeding to factors that promote or undermine happy aging. Relationships, contribution, and personal growth all add value to an aging life. Community also matters, as does the acceptance that a happy older age requires neither perfect health nor immense wealth.

How do we balance the rights of aging physicians against the right of the public to competent health care? This version of a classic public health ethics dilemma is here now and likely to increase as the population ages. Peer review has long been the standard mechanism for assessing physician competence, but it is subjective and too easily subverted. New options are needed, both in medicine and throughout the professions, but they are challenging to implement. Physicians have an ethical obligation (...) to protect the health of the public by acknowledging, assessing, and addressing the cognitive effects of aging on medical competence. (shrink)

ABSTRACT:Translational ethics is a practice that aims to apply bioethics insights and process to the real-world contexts of clinical medicine, but also government policy, systems issues, and public health. This work has been a career focus for a relatively small number of bioethicists over the years, but it has drawn greater attention due to the pandemic and a greater realization of the impact of health inequities and systemic injustice. This essay discusses the pathway, rewards, and challenges of translational bioethics as (...) experienced by one bioethicist working with state and national groups on a range of translational ethics issues, often related to public health disasters. There is much remaining work to be done, and the goal of the essay is to encourage rising bioethicists to engage in translational bioethics. (shrink)