Several times each month, usually on a Thursday morning, I join one or more of my physician colleagues on teaching rounds. Most weeks these are traditional rounds, where an attending physician leads a group of medical students, residents, and clinical fellows from bed to bed reviewing charts, examining patients, and planning daily procedures. As a medical ethicist, my role is to discuss some of the ethical issues that are embedded in these decisions about medical care and help students to hone (...) the skills required to manage these issues successfully in the context of ongoing care.Although the clinical setting varies, questions of patient management are always at the center of teaching rounds. Since my training is in philosophy, and not in medicine or nursing, there have been occasions when this focus on patient care has prompted me to reflect upon my role as a medical ethicist in these contexts. Lacking even the most basic medical training, and having been remarkably fortunate in having had limited personal experiences as a patient, what can I possibly contribute to the training of physicians?I suspect that at some time or another most teachers, but perhaps especially those trained in the humanities, have moments when they question the usefulness of their teaching. In my case, by introducing perspectives from the humanities on teaching rounds, my hope is to add some balance to the often narrow focus on the ordering of diagnostic tests, scheduling of procedures, obtaining of patient consent, and other practical matters. I often stress, for example, how the patients with whom students and residents interact are not mere patients, but persons with lives outside the hospital that can be made profoundly better or worse as a result of the brief time they are seen in the hospital. I draw attention to the …. (shrink)

Among bioethicists and members of the public, genetics is often regarded as unique in its ethical challenges. As medical researchers and clinicians increasingly combine genetic information with a range of non-genetic information in the study and clinical management of patients with common diseases, the unique ethical challenges attributed to genetics must be re-examined. A process of genetic routinisation that will have implications for research and clinical ethics, as well as for public conceptions of genetic information, is constituted by the emergence (...) of new forms of genetic medicine, in which genetic information is interpreted in a multifactorial frame of reference. Although the integration of genetics in medical research and treatment may be a helpful corrective to the mistaken assumptions of genetic essentialism or determinism, the routinisation of genetics may have unintended consequences for the protection of genetic information, perceptions of non-genetic information and the loss of genetic research as a laboratory for exploring issues in research and clinical ethics. Consequently, new ethical challenges are presented by the increasing routinisation of genetic information in both biomedical and public spheres. (shrink)

Background: Despite the expansion of ethics consultation services, questions remain about the aims of clinical ethics consultation, its methods and the expertise of those who provide such services.Objective: To describe physicians’ expectations regarding the training and skills necessary for ethics consultants to contribute effectively to the care of patients in intensive care unit .Design: Mailed survey.Participants: Physicians responsible for the care of at least 10 patients in ICU over a 6-month period at a 921-bed private teaching hospital with an established (...) ethics consultation service. 69 of 92 eligible physicians responded.Measurements: Importance of specialised knowledge and skills for ethics consultants contributing to the care of patients in ICU; need for advanced disciplinary training; expectations regarding formal-training programmes for ethics consultants.Results: Expertise in ethics was described most often as important for ethics consultants taking part in the care of patients in ICU, compared with expertise in law , religious traditions , medicine and conflict-mediation techniques . When asked about the formal training consultants should possess, however, physicians involved in the care of patients in ICU most often identified advanced medical training as important.Conclusions: Although many physicians caring for patients in ICU believe ethics consultants must possess non-medical expertise in ethics and law if they are to contribute effectively to patient care, these physicians place a very high value on medical training as well, suggesting a “medicine plus one” view of the training of an ideal ethics consultant. As ethics consultation services expand, clear expectations regarding the training of ethics consultants should be established. (shrink)

Freud seems to have been torn between a literary and a scientific model for his enterprises. On the one hand he stresses the scientific nature of his researches to an extent which makes the suspicious reader wonder whether he protests too much. On the other hand it is well known that he regarded many writers, though predominantly Shakespeare, as anticipating his findings on the unconscious. In one famous passage in the Introductory Lectures on Psycho-analysis he places his discovery of the (...) unconscious on a par with the discoveries of Darwin and Copernicus in their effect upon man's picture of himself. He is justified, of course, and if we add Marx to this triumvirate we add a figure even closer to Freud in claiming a scientific status for his work, a scientific status which is, to the uncommitted, dubious. Theodore Mischel argues that Freud increasingly construes neurotic behaviour upon the model of ordinary intentional behaviour and, though he continued to show interest in the view that the unconscious impulses which are repressed are physiological in nature, this ideal of a reduction of the psychological to the physiological became a less active ingredient in his published work as his collaboration with Fliess receded into the past. So although he may have paid lip service to some form of psycho-physical identity, believing that mental phenomena are ultimately no more or less than physical happenings in the neurones of the brain, in mature Freud this seems to have been an idly spinning wheel. Roy Schafer has recently pointed out that many of Freud's followers use the concepts of natural science , whilst simultaneously retaining traces of anthropomorphism in their metapsychology. For instance Heinz Hartmann emphasizes the concept of a ‘higher organizing function’ which resists formulation in the mechanistic metapsychology he favours. Similar difficulties obtrude in the work of Waelder and Kohut. The significance of these conflicts leads Schafer to frame basic Freudian insights in terms of the theory of action, stressing the manner in which an action may be described in differing ways and thus allowing us to present the fact that a patient's behaviour may both tell and not tell us of his deepest anxieties. Yet curiously Schafer denies that freedom plays any part in his account whereas we would have expected a concept so central to agency to have an equally central role in any recasting of psycho-analysis in terms of the theory of action. (shrink)

In this note I have presented the essentials of a view of how laws are falsified, a view which has been held by some notable philosophers but which is radically opposed to that of Professor Popper. I have not scrupled to ?improve? upon it, so the view of no one philosopher is presented. I try to show that an interesting and convincing account of scientific simplicity is implicit in the theory and I conclude by suggesting how we can bring the (...) argument to bear on the problem of the logical status of laws of nature, showing that through their manner of falsifiability, laws share some characteristics with necessary statements as well as with empirical generalizations. (shrink)

'Most of us are still groping for answers about what makes life worth living, or what confers meaning on individual lives', writes Charles Taylor in Sources of the Self. 'This is an essentially modern predicament.' Charles Taylor's latest book sets out to define the modern identity by tracing its genesis, analysing the writings of such thinkers as Augustine, Descartes, Montaigne, Luther, and many others. This then serves as a starting point for a renewed understanding of modernity. Taylor argues that modern (...) subjectivity has its roots in ideas of human good, and is in fact the result of our long efforts to define and attain the good. The modern turn inwards is far from being a disastrous rejection of rationality, as its critics contend, but has at its heart what Taylor calls the affirmation of ordinary life. He concludes that the modern identity, and its attendant rejection of an objective order of reason, is far richer in moral sources that its detractors allow. Sources of the Self provides a decisive defence of the modern order and a sharp rebuff to its critics. (shrink)

Research on human genetic variation can present collective risks to all members of a socially identifiable group. Research that associates race or ethnicity with a genetic disposition to disease, for example, presents risks of group discrimination and stigmatization. To better protect against these risks, some have proposed supplemental community-based reviews of research on genetic differences between populations. The assumption behind these appeals is that involving members of study populations in the review process can help to identify and minimize collective risks (...) that otherwise could go unnoticed. In contrast to this position, critics have argued that supplemental community-based reviews are unnecessary, impractical, and morally problematic. This paper is our attempt to advance this debate by distinguishing the various goals of community review and the forms that it can take. (shrink)

Research on human genetic variation can present collective risks to all members of a socially identifiable group. Research that associates race or ethnicity with a genetic disposition to disease, for example, presents risks of group discrimination and stigmatization. To better protect against these risks, some have proposed supplemental community-based reviews of research on genetic differences between populations. The assumption behind these appeals is that involving members of study populations in the review process can help to identify and minimize collective risks (...) that otherwise could go unnoticed. In contrast to this position, critics have argued that supplemental community-based reviews are unnecessary, impractical, and morally problematic. This paper is our attempt to advance this debate by distinguishing the various goals of community review and the forms that it can take. (shrink)

This study investigates the differences in individuals'' ethical decision making between Canadian university business students and accounting professionals. We examine the differences in three measures known to be important in the ethical decision-making process: ethical awareness, ethical orientation, and intention to perform questionable acts. We tested for differences in these three measures in eight different questionable actions among three groups: students starting business studies, those in their final year of university, and professional accountants.The measures of awareness capture the extent to (...) which respondents felt that a particular action was unethical according to each of several ethical criteria. We found few differences between the two student groups on these measures, suggesting that their education had minimal effect on raising their awareness of the ethical issues in the vignettes. Indeed, overall, the graduating student''s scores were marginally lower than those of the entry-level students. However, the professionals viewed some actions as significantly less ethical than did the graduating students. (shrink)

Growing ties to private industry have prompted many to question the impartiality of academic bioethicists who receive financial support from for-profit corporations in exchange for ethics-related services and research. To the extent that corporate sponsors may view bioethics as little more than a way to strengthen public relations or avoid potential controversy, close ties to industry may pose serious threats to professional independence. New sources of support from private industry may also divert bioethicists from pursuing topics of greater social importance, (...) such as the needs of medically underserved communities. To inform ongoing debates about the financing of bioethics and its transparency to those concerned about potential sources of bias, we examined funding disclosures appearing in original research reports in major bioethics journals. Reviewing research published over a 15-year period, we found little evidence that for-profit corporations are influencing bioethics research directly. Instead, we found evidence that a great number of organizations, both public and private, support bioethics research. These findings suggest that worries about the cooption of bioethics research by a few interested stakeholders are greatly overstated and undersupported by available data. (shrink)

We describe the ethics consultation service (ECS) at the Cleveland Clinic and report on its activities over a 24-month period in which 478 consultations were performed. To our knowledge, this is the largest case series of ethics consultations reported to date. Established more than 25 years ago, the ECS at the Cleveland Clinic is staffed by multiple consultants with advanced training in bioethics. Several of these ethicists work closely with specialized clinical units and research departments, where they participate in multidisciplinary (...) meetings and provide specialized assistance. This combination of historical experience, large numbers of consultation requests, and specialized clinical ethicists suggests that the experience at the Cleveland Clinic may be helpful to ethicists and others who may be considering how to structure and sustain a vibrant ECS. Our results highlight the diversity of activities performed by a high-volume ECS at a tertiary care facility. Our hope in sharing the inner workings of the ECS at the Cleveland Clinic is to promote dialogue on common practices and approaches across medical institutions that support ethics consultation. (shrink)

Three arguments are proposed against the idea that ordinary talk about the mind constitutes a folk psychology, a sort of prescientific theory which explains human behaviour and which is ripe for replacement by a neurological or computational theory with better scientific credentials. First, not all talk of the mind is introduced to explain in the way assumed by those who think that mental talk hypothesizes inner processes to explain behaviour. Second, the individuation of the behaviour which is explained by the (...) inner processes itself requires reference to ?mental? states such as intentions or desires. Consequently the project is circular. Finally, scientific theory is a practice with a history which may be matched in the case of ordinary talk of the mind. Certainly ordinary talk of motives, intentions, and thoughts may be infected by the theorizing of economists and sociologists et al., but it is impossible that all talk of the mind should be theoretical in this way. (shrink)

While consensus exists among many practitioners of ethics consultation about the need for and identification of core competencies and standards, there has been virtually no attempt to determine how these competencies and standards are best taught and assessed. We believe that clinical ethics consultation has reached a state of sufficient maturity that expert practitioners can evaluate those who are new to the field. We will outline several steps that can facilitate the creation of a certification process for clinical ethics consultants, (...) assuring the competency and quality of consultation for the patients, families, and healthcare professionals who utilize ECSs. (shrink)

Bioethics and feminist scholarship has explored various justice implications of nonmedical sex selection and family balancing. However, prospective users’ viewpoints have been absent from the debate over the socially acceptable bounds of nonmedical sex selection. This qualitative study provides a set of empirically grounded perspectives on the moral values that underpin prospective users’ conceptualizations of justice in the context of a family balancing program in the United States. The results indicate that couples pursuing family balancing understand justice primarily in individualist (...) and familial terms rather than in terms of social justice for women and girls or for children resulting from sex selection. Study participants indicated that an individual’s desire for gender balance in their family is ethically complex and may not be inherently sexist, immoral, or socially consequential, particularly given the social context in which they live. Our findings suggest that the social conditions that contribute to prospective users’ desires for gender balance in their families may direct them away from recognizing or engaging broader social justice concerns relating to sexism and stratified reproduction. (shrink)

Like many trained in philosophy, we greatly value the work of those scholars with the courage to espouse contrarian views, particularly when the ideas in dispute lie at the very heart of entrenched...

It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients’ medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees (...) in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation. (shrink)

Strategies for protecting historically disadvantaged groups have been extensively debated in the context of genetic variation research, making this a useful starting point in examining the protection of social groups from harm resulting from biomedical research. We analyze research practices developed in response to concerns about the involvement of indigenous communities in studies of genetic variation and consider their potential application in other contexts. We highlight several conceptual ambiguities and practical challenges associated with the protection of group interests and argue (...) that protectionist strategies developed in the context of genetic research will not be easily adapted to other types of research in which social groups are placed at risk. We suggest that it is this set of conceptual and practical issues that philosophers, ethicists, and others should focus on in their efforts to protect identifiable social groups from harm resulting from biomedical research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Environmental Genome Project and BioethicsRichard R. Sharp (bio) and J. Carl Barrett (bio)Eight years ago, the Kennedy Institute of Ethics Journal published a brief selection by Eric Juengst (1991) entitled “The Human Genome Project and Bioethics.” That essay introduced and described the Ethical, Legal, and Social Implications (ELSI) Program at the National Center for Human Genome Research. 1 Since that time, the ELSI program has grown to (...) become one of the largest and most well regarded bioethics programs in the country, sponsoring the work of hundreds of researchers and coordinating bioethics activities both nationally and internationally (Marshall 1996; Meslin, Thomson, and Boyer 1997). In 1991, however, Juengst, the first director of the ELSI program, had no way of anticipating these developments. Juengst’s goal in his essay was simply to highlight some of the moral and social issues that were emerging as focal points for the ELSI program. Looking back, the issues he outlined may seem vague and overly broad. At the time, however, the essay served an important purpose, to identify areas requiring additional study and thereby to serve as a guide to others interested in joining in these discussions.In many ways, Juengst’s article serves as an inspiration to those of us working on a new bioethics project. The National Institute of Environmental Health Sciences (NIEHS) recently launched a multi-year project aimed at better understanding genetic influences on environmentally associated diseases (Albers 1997; Brown and Hartwell 1998; Cannon 1997; Kaiser 1997). This project, known as the Environmental Genome Project (EGP), plans to identify and study a number of common genetic variants that may play an important role in determining how individuals respond to environmental exposures. NIEHS hopes that the information learned through the EGP will be instrumental in developing more effective disease-prevention strategies and intervention programs. Following the precedent developed in connection with the Human Genome Project, NIEHS also plans to address the moral and social implications of the EGP. Efforts in this regard include sponsoring workshops and conferences to address such issues, as well as supporting research on the ethical, legal, and social implications of the EGP. Through this work, NIEHS hopes to anticipate potential problems before [End Page 175] they arise and to develop policies that maximize the benefits of the research while avoiding potential misuses of the information learned.In exploring the social implications of the EGP, we at NIEHS are very fortunate to be able to draw upon the work being done by the ELSI program at the National Human Genome Research Institute (NHGRI), as well as the ever-expanding bioethics literature that has been sparked by the ELSI program. Still, there is much to be done and this is an exciting time for those of us involved with the EGP. Many of the ethical, legal, and social implications of the project are only beginning to become clearer, and several of these issues appear quite different from the sorts of concerns that have previously been discussed in connection with other types of genetic research.This essay highlights some of the ethical, legal, and social implications that are emerging as important focal points for the Environmental Genome Project. Like Juengst’s 1991 paper, the goal of this article is to provide an overview of current areas of interest and to encourage others to join us in thinking about these difficult issues.The Environmental Genome ProjectIndividuals differ greatly in their responses to chemicals, drugs, radiation, smoking, alcohol, and other environmental exposures. These differential responses are the result of complex interactions between many factors, including an individual’s genetic make-up, age, sex, nutritional status, and overall health. The EGP aims to better understand the genetic basis of differential responses to environmental exposures. The vast majority of diseases, many forms of cancer, for example, are the consequence of both environmental and genetic contributions (Perera 1997). Hence, understanding the relationships between genetic variation and response to environmental exposure is important for understanding the causes of human disease and is crucial for the development of effective disease-prevention strategies.The EGP and projects like it represent a new stage of genomic research. It is expected that the Human Genome Project will complete... (shrink)

In the 11th chapter of the second book of Samuel, we read how King David saw Bathsheba in the evening: ‘v.2. And it came to pass in an eveningtide, that David arose from off his bed, and walked upon the roof of the king's house: and from the roof he saw a woman washing herself; and the woman was very beautiful to look upon.’.

R. A. Sharpe; VIII*—Art and Expertise, Proceedings of the Aristotelian Society, Volume 85, Issue 1, 1 June 1985, Pages 133–148, https://doi.org/10.1093/aristote.

R. A. Sharpe; VIII*—Art and Expertise, Proceedings of the Aristotelian Society, Volume 85, Issue 1, 1 June 1985, Pages 133–148, https://doi.org/10.1093/aristote.

For decades, the Belmont Report—and the associated regulatory framework it inspired—has been a cornerstone in the ethical conduct of research involving human subjects. Despite its canonic status, t...

Robert Sharpe examines the humanist conception of music as a language--as expressive and intelligible--which has been a dominant theory in Western culture. He argues against the view that music is expressive by causing certain states in us. Rather, he contends that our beliefs about music are integral to our appreciation of it. Differences in musical taste are then not just irresolvable differences in sensitivity, but the result of variations in circumstance and upbringing, of associations and ideology.