Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention—a bridge to recovery or transplant—not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of (...) withdrawal, including distributive justice, quality of life, patients’ rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned. (shrink)

While experience often affords important knowledge and insight that is difficult to garner through observation or testimony alone, it also has the potential to generate conflicts of interest and unrepresentative perspectives. We call this tension the paradox of experience. In this paper, we first outline appeals to experience made in debates about access to unproven medical products and disability bioethics, as examples of how experience claims arise in bioethics and some of the challenges raised by these claims. We then motivate (...) the idea that experience can be an asset by appealing to themes in feminist and moral epistemology, distinguishing between epistemic and justice-based appeals. Next, we explain the concern that experience may be a liability by appealing to empirical work on cognitive biases and theoretical work about the problem of partial representation. We conclude with preliminary recommendations for addressing the paradox and offer several questions for future discussion. (shrink)

Patients who experience difficulty making medical decisions are often referred to as “ambivalent.” However, the current lack of attention to the nuances between a cluster of phenomena that resemble...

Volume 20, Issue 2, February 2020, Page 66-68.

Given the enduring debate over what constitutes quality, and therefore appropriate training, in clinical ethics consultation, it is unsurprising that there is variation in the structure and content of clinical ethics fellowship programs. However, this variation raises questions about the value of fellowship training when the ethicists that emerge from these programs might be quite different. The specifics of fellowship programs are largely internal. As such, the extent of variation and whether such variation is problematic remains unclear. In this article, (...) we summarize lessons learned from discussions between fellows, their mentors and program directors at the 2020 Clinical Ethics UnConference, and outline some possible ways to advance the conversation about variation in fellowship programs and training. We argue for the more open sharing of training specifics in order to help break down the siloed nature of fellowship programs. Greater transparency could, firstly, allow for more robust reflection on and refinement of training practices and, secondly, allow us to better balance professionally appropriate consistency with unavoidable or desirable variation based on local norms, culture and leadership. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 42-50, January/February 2022.

In their article, ‘The Two Front War on Reproductive Rights,’ Minkoff, Vullikanti, and Marshall (2024) highlight the challenges faced by pregnant persons following the overturn of Roe v. Wade (Dobb...

‘Why Not Common Morality?’ revisits an important and enduring question: is medical ethics distinct from ‘everyday’ ethics? In her paper, Rosamond Rhodes undertakes the ambitious project of answering this question, in addition to clarifying what constitutes a profession, how professions differ from ‘roles’ and how medical ethics relates to medical professionalism. Rhodes aims to challenge the status quo within medical ethics by departing from the views of certain giants within the field. The paper’s central contention is that the ethics of (...) everyday life and medical ethics are indeed distinct—the latter cannot be derived from the former and we consequently need a new theory of medical ethics. While I am sympathetic to the aims of the project and took no small delight in Rhodes’s gumption, the paper suffers from a number of issues. Putting aside the issue of whether Rhodes accurately represents the theories she critiques—and that is no small thing to set aside—first, many scholars have interrogated in great depth, and from many angles, the relationship between common morality and medical ethics.1–4 Scholarship from the philosophy of medicine, virtue ethics, role-differentiated ethics, narrative and care ethics has made a significant contribution to the projects of clarifying what is distinct about medical professionalism and understanding how we might subsequently treat ethical issues that arise in healthcare with due sensitivity to these myriad differences.5–10 Yet, Rhodes largely ignores this literature …. (shrink)

In this article, I sort through some of the confusion surrounding what constitutes the controversial notion of a “good death” for children. I distinguish, first, between metaphysical and practical disagreements about the notion of a good death, and, second, between accounts of a good death that minimally and maximally promote the dying child’s interests. I propose a narrowed account of the dying child’s interests, because they differ from the interests of non-dying children. Importantly, this account illustrates how disagreements at the (...) end of a child’s life are sometimes the result of a shift from a future to a present-oriented understanding of the child’s interests on the part of some stakeholders but not others, and sometimes the result of a values-based disagreement about how different interests should be weighted. This brings into sharper focus the questions of for whom, and in what way, a child’s death might be considered good. (shrink)

Bioethics, Volume 36, Issue 6, Page 613-620, July 2022.

Dominic Wilkinson suggests that one of Schubert’s songs has relevance for neonatologists today. In the song, Schubert suggests that death sometimes comes as a friend. Wilkinson ponders whether the song has a message for doctors and parents, who sometimes struggle to figure out whether death is an enemy or a friend to a dying baby. Wilkinson reflects on the case of baby ‘Hal’, who was born with serious cardiomyopathy. Hal’s parents and doctors disagree about whether to withdraw life-support. Through his (...) recreations of their discussions, Wilkinson shows how hard it is to confront—and maybe even welcome—death for a child. While adults often frame their own decision to forego life-sustaining treatment with thoughts that they have lived a good life, death in childhood can seem unfair because it robs the child of their opportunity to live a good or completed life. Much as we try, we cannot really imagine what a critically ill neonate experiences or desires. We have very little insight into Hal’s interests or subjective experience. Without direct access to the child’s experience, it is impossible to know whether, like an adult, a child would choose to allow death to occur. We cannot verify the claim that the child’s death was good in the sense that it was good for them. Wilkinson proposes that a prolonged dying process …. (shrink)

Clinical ethics services are increasingly receiving case referrals regarding requests for access to experimental therapies. Sometimes, patients or families seek access to an experimental therapy that has not been subsidised by any government scheme, and for which no local clinical trial is underway. All else being equal, a patient may benefit from receiving an experimental therapy without making any other patient worse off. However, within public healthcare systems, treating only one patient with an experimental therapy, when others might also benefit (...) from it, evokes a troubling sense of inequity. In this paper, I examine the relevance of Pareto principles and the ‘levelling down’ objection to ethical deliberation about patient or family-initiated requests for experimental therapies. While facilitating access to an experimental therapy may benefit a patient without making any other patients worse off, this does not dispel ethically relevant considerations concerning equity. When deliberating about cases i... (shrink)

In this paper, we examine healthcare organizations’ responses to high profile cases of doctor–parent disagreement. We argue that, once a conflict crosses a certain threshold of public interest, the stakes of the disagreement change in important ways. They are no longer only the stakes of the child’s interests or who has decision‐making authority, but also the stakes of public trust in healthcare practitioners and organizations and the wide scale spread of medical misinformation. These higher stakes call for robust organization‐level responses. (...) There are responsible and thoughtful ways for healthcare organizations to directly engage with these cases. Hospitals should seek an alliance with the parents around the goal of public discussion and utilize web‐based platforms to provide the public with information about medical conditions, experimental treatments, and how clinical ethics deliberation in hospitals works. We outline five important lessons for healthcare organizations to keep in mind when responding to such cases. Approached with care, these cases could become “teachable moments” for both healthcare organizations and society. (shrink)

While it is not explicitly included in capacity assessment tools, “consistency” has come to feature as a central concern when assessing patients’ capacity. In order to determine whether inconsistency indicates incapacity, clinicians must determine the source of the inconsistency with respect to the process or content of a patient’s decision-making. In this paper, we outline common types of inconsistency and analyze them against widely accepted elements of capacity. We explore the question of whether inconsistency necessarily entails a deficiency in a (...) patient’s capacity. While inconsistency may count as _prima_ _facie_ evidence of incapacity—enough evidence to justify a closer look—when making such determinations, it is important for clinicians to slow down, inquire about the reasons underlying the inconsistency and clearly show which of the elements of capacity the patient fails to satisfy. (shrink)

Tim Wardle’s 2018 documentary film Three Identical Strangers is an exploration of identity, family, and loss. It’s also about nature versus nurture and the boundaries of ethically permissible research, particularly research involving children. The film tells the story of identical triplets who were separated soon after birth in 1961. A different family adopted each boy, without being told that their son had two identical brothers. The adoption agency responsible for finding the families was collaborating with a group of researchers working (...) on a study about … something. Three Identical Strangers details the boys’ fight to obtain information about the study and for closure. But while the film may have received rave reviews, it left us feeling uneasy. We came away with two sets of questions, one having to do with the story that the film documents and the second with the ethics of filmmaking itself. (shrink)

While it is not explicitly included in capacity assessment tools, “consistency” has come to feature as a central concern when assessing patients’ capacity. In order to determine whether inconsistency indicates incapacity, clinicians must determine the source of the inconsistency with respect to the process or content of a patient’s decision-making. In this paper, we outline common types of inconsistency and analyze them against widely accepted elements of capacity. We explore the question of whether inconsistency necessarily entails a deficiency in a (...) patient’s capacity. While inconsistency may count as prima facie evidence of incapacity—enough evidence to justify a closer look—when making such determinations, it is important for clinicians to slow down, inquire about the reasons underlying the inconsistency and clearly show which of the elements of capacity the patient fails to satisfy. (shrink)

I had been on the phone with Madeleine's mother for fifteen minutes, and she had sobbed throughout. She pleaded with me, “You won't even let our family visit her together. If you really want to help my daughter, you will let us stay with her.” Madeleine, who was twenty‐four years old, was dying of end‐stage acute myeloid leukemia and was intubated in one of our intensive care units. Her intensivist had requested a clinical ethics consultation for potentially inappropriate medical treatment—in (...) my world of clinical ethics consultation, routine stuff. Except that, in March 2020, nothing was routine anymore. The Covid‐19 pandemic calls for creative thinking about ad hoc and post hoc bereavement efforts, and it may result in efforts to revise existing accounts of what constitutes a good death in order to accommodate patients’ and families’ experiences at the end of life during a pandemic. (shrink)

In pediatric health care, parents and clinicians sometimes have competing ideas of what should be done for a child. In this article, we explore the idea that notions of what should be done for a child partly depend on one's perception of one's role in the child's life and care. Although role‐based appeals are common in health care, role‐differentiated approaches to understanding parent‐clinician conflicts are underexplored in the pediatric bioethics literature. We argue that, while the parental role is recognized as (...) having social content or value, and sometimes legal force, it is not always recognized as having ethical content or value, as the clinician's role is. We draw together key insights from the normative and empirical literature on parental roles to show how a role‐based lens might inform clinicians’ and clinical ethicists’ approach to cases in which parents and clinicians disagree. (shrink)

Patients and families are increasingly turning to crowdfunding to help them cover the cost of medical care. The ethics of crowdfunding has garnered some attention in the bioethical literature. In this paper I examine an ethical aspect of medical crowdfunding (MCF) that has received limited attention: the role of donors. I defend a virtue ethical approach to analyzing the role of donors in MCF. Vicious donation, where donors do not exercise the relevant virtues, can compound some of the ethical risks (...) associated with MCF, as seen in the several recent, high‐profile cases. My primary contention in this paper is that encouraging donors to think about how donating to a particular campaign would measure against the virtues I outline could help to discourage acts of ethically problematic donation to MCF campaigns. (shrink)

The moral status of the emotion of grief has garnered little recognition in philosophical literature. Existing inquiry has consisted for the most part of deontological and virtue ethical approaches to evaluating grief. In my paper I build upon established understandings of the morality grief and move beyond them, towards an understanding of what I call “eros-transformative grief” as a gateway or intermediary emotion that enables a powerful reassessment and revaluation of the self’s relation to the world. This fundamental moral revaluation (...) is a result of the phenomenological absence of the relational self. The nature of grief reveals something vital about the way in which we relate to those around us—it is a fundamental reaffirmation of the inescapable separateness of the self, which can never truly be accepted without experiencing deep loss, but it is also a fundamental reaffirmation of the relationship that existed, and ultimately, of love. In eros-transformative grief, part of the grieving process involves accepting the permanency of our loss and moving past it through assimilating an intangible part of the lost loved one into the self. Thus, in addition to strengthening deontological and virtue ethical normative understandings of grief, I provide an account of eros-transformative grief that links it to the concept of love, allowing for a positive reading of an oft-neglected emotion. (shrink)

In “Acquiescence Is Not Agreement: The Problem of Marginalization in Pediatric Decision Making,” Caruso Brown argues that clinicians and ethicists should attend to voices marginalized by hie...

Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)

How should clinical ethicists be trained? Scholars have stated that clinical ethics fellowships create well-trained, competent ethicists. While this appears intuitive, few features of fellowship programs have been publicly discussed, let alone debated. In this paper, we examine how fellowships can foster effective mentoring relationships. These relationships provide the foundation for the fellow’s transition from novice to competent professional. In this essay, we begin by discussing our pedagogical commitments. Next, we describe the structures our program has created to assist our (...) fellows in becoming competent ethicists. We then outline the kinds of knowledge, skills, and professional attributes mentors should possess. Following this, we focus on the knowledge, skills, and professional attributes that fellows develop as they co-create effective mentoring relationships. We will not prescribe a single approach to fellowship training; instead, our perspective will, we hope, become a catalyst for further conversation on training and mentoring clinical ethics fellows. (shrink)

Résumé La localisation des implantations des grands éléments d’infrastructure collective pose des problèmes de légitimation juridique spécifique. Ils délimitent en effet plusieurs territoires distincts en fonction de la nature des impacts qu’ils provoquent, lesquels, chacun, sont soumis à leurs propres législations et rentrent dans les compétences d’autorités différentes, y compris celle dont dépend la décision sur l’infrastructure envisagée. De telles situations normatives complexes empêchent la sémantisation légitimante que le droit est censé assurer dans les décisions de l’appareil étatique: elle sera (...) toujours partielle, voire lacunaire. Les compensations ne peuvent être que procédurales, et celles-ci sont insuffisantes à atteindre l’idéal postulé par le principe de légalité des activités publiques. Mais il ne peut en aller autrement pour ces infrastructures. (shrink)

In print for the first time in over ten years, Act and Crime provides a unified account of the theory of action presupposed by both Anglo-American criminal law and the morality that underlies it. The book defends the view that human actions are always volitionally caused bodily movements and nothing else. The theory is used to illuminate three major problems in the drafting and the interpretation of criminal codes: 1) what the voluntary act requirement both does and should require; 2) (...) what complex descriptions of actions prohibited by criminal codes both do and should require ; and 3) when two actions are 'the same' for purposes of assessing whether multiple prosecutions and multiple punishments are warranted. The book both contributes to the development of a coherent theory of action in philosophy, and it provides both legislators and judges a grounding in three of the most basic elements of criminal liability. (shrink)

G.E. Moore, more than either Bertrand Russell or Ludwig Wittgenstein, was chiefly responsible for the rise of the analytic method in twentieth-century philosophy. This selection of his writings shows Moore at his very best. The classic essays are crucial to major philosophical debates that still resonate today. Amongst those included are: * A Defense of Common Sense * Certainty * Sense-Data * External and Internal Relations * Hume's Theory Explained * Is Existence a Predicate? * Proof of an (...) External World In addition, this collection also contains the key early papers in which Moore signals his break with idealism, and three important previously unpublished papers from his later work which illustrate his relationship with Wittgenstein. (shrink)

My reply to the comments of Parkinson (2010) and Kuppens (2010) is organized in three parts. The first part deals with Parkinson’s claim that the scope of our research is limited because no real emotions were elicited. I suggest that the outcomes in our studies are structurally similar to real emotions but that they lack intensity. In the second part, I try to correct three potential misunderstandings regarding the nature of the comparison process that I proposed. In the third part, (...) I respond to Kuppens’ suggestion that we also need to consider the transition of appraisal values into the other components of emotion (actions tendencies, responses, and subjective experience). (shrink)

Literary and philosophical reflections combine with true-life farm anecdotes to offer commentary on seeking the good life in the modern age.

This book focuses on six key practices for engaged learning: acknowledging and building on students' prior knowledge and experiences; facilitating relationships; offering feedback; framing connections to broader contexts; fostering reflection and metacognition; and promoting integration and transfer of knowledge and skills.

The Greek identification of certain Indian people as philosophoi at the end of the fourth century bce provides unique information about the meaning of the term philosophia, especially with respect to its reference to a certain kind of “way of life” (bios), at the time of its greatest maturity (at the start of the Hellenistic period). The Indica of Megasthenes, an ambassador to northern India after the death of Alexander, is our most important evidence; fragments from earlier works by Nearchus (...) and Onesicritus, intellectuals in Alexander’s cortege, provide corroboration. This essay argues that late classical Greeks did largely think of philosophia as a way of life. (shrink)

I argue that uniquely human forms of ‘Theory of Mind’ are a product of cultural evolution. Specifically, propositional attitude psychology is a linguistically constructed folk model of the human mind, invented by our ancestors for a range of tasks and refined over successive generations of users. The construction of these folk models gave humans new tools for thinking and reasoning about mental states—and so imbued us with abilities not shared by non-linguistic species. I also argue that uniquely human forms of (...) ToM are not required for language development, such that an account of the cultural origins of ToM does not jeopardise the explanation of language development. Finally, I sketch a historical model of the cultural evolution of mental state talk. (shrink)

Tout ce qui n’est pas reconnu par le droit comme norme juridique est traité par lui comme un fait—normes sociales, connaissances scientifiques, mœurs, événements, etc. Le droit, système autoréférentiel, institue les compétences et les procédures par lesquelles une assertion quelconque, portant sur des faits, devient une norme juridique. Le présent texte analyse les différents lieux de passage par lesquels des faits peuvent ainsi être reconnus par le droit comme normes juridiques. Il analyse d’abord la réception et la construction des faits (...) à considérer comme pertinents au regard de la norme applicable. Il introduit ensuite le concept de notions juridiques indéterminées, dont le sens ne peut être concrétisé que par référence à des faits de toute nature, ce qui requiert une argumentation propre à justifier cette référence. Les faits sont donc construits avant qu’une autorité instituée par le droit décide de leur donner la forme abstraite d’une norme juridique. Cette construction va être structurée comme un récit, dont la cohérence doit être assurée par référence à des schémas tirés de l’expérience sociale, de telle manière qu’elle puisse être acceptée comme raisonnable par la collectivité. Le juge comme le législateur apparaissent alors sous la double face d’une fonction juridique et d’un individu plongé dans la société, ce qui les met en mesure faire du droit avec des faits en les comprenant l’un et les autres. (shrink)

The argument from reason states that if naturalism is true, then our beliefs are caused by physical processes rather than being causally based in their reasons, so our beliefs are not knowledge—including the belief in naturalism itself. Recent critics of the argument from reason provide dual process replies to the argument from reason—our beliefs can have both a naturalistic cause/ explanation and be caused/explained by its reasons, thereby showing that naturalism can accommodate knowledge. In this paper I consider three dual (...) process replies and conclude that none of them are successful. (shrink)

This collection explores the subject of conflicts of interest. It investigates how to manage conflicts of interest, how they can affect well-meaning professionals, and how they can limit the effectiveness of corporate boards, undermine professional ethics, and corrupt expert opinion. Legal and policy responses are considered, some of which (e.g., disclosure) are shown to backfire and even fail. The results offer a sobering prognosis for professional ethics and for anyone who relies on professionals who have conflicts of interest. The contributors (...) are leading authorities on the subject in the fields of law, medicine, management, public policy, and psychology. The nuances of the problems posedby conflicts of interest will be highlighted for readers in an effort to demonstrate the manyways that structuring incentives can affect decision making and organizations' financial well-being. (shrink)

In this far-reaching essay, historian Michael Edward Moore examines modernity as an historical epoch following the end of the medieval period -- and as a "messianic concept of time." In the early twentieth century, a debate over the meaning and origins of modernity unfolded among the philosophers Ernst Cassirer, Hans-Georg Gadamer and Hans Blumenberg. These thinkers tried to resolve the puzzle of the fifteenth-century master Nicholas of Cusa. Was Cusanus the last great medieval thinker, his ideas a summa of (...) medieval tradition? Or was he a mysterious epochal figure, seated at one end of the bridge leading to modern thought? Nicholas of Cusa lived during a time of historical and existential crisis, or kairos, when medieval governments and cherished sources of unity were shaken. Likewise, the debate over his significance took place during a later phase of crisis for Europe, in the decades before and after the Second World War, when the collapse of European civilization was witnessed. Moore argues that modernity, so intently examined as an historical and spiritual problem, has significance for our contemporary sense of crisis. (shrink)

In the late Middle Ages the philosopher and mystic Meister Eckhart preached that to know the truth you must be the truth. But how to be the truth? Eckhart's answer comes in the form of an imperative: release yourself, let be. Only then will you be able to understand that the deepest meaning of being is releasement. Only then will you become who you truly are. This book interprets Eckhart's Latin and Middle High German writings under the banner of an (...) imperative of releasement, and then shows how the twentieth-century thinker Martin Heidegger creatively appropriates this idea at several stages of his career. Heidegger had a lifelong fascination with Eckhart, referring to him as "the old master of letters and life." Drawing on archival material and Heidegger's marginalia in his personal copies of Eckhart's writings, Moore argues that Eckhart was one of the most important figures in Heidegger's philosophy. This book also contains previously unpublished documents by Heidegger on Eckhart, as well as the first English translation of Nishitani Keiji's essay "Nietzsche's Zarathustra and Meister Eckhart," which he initially gave as a presentation in one of Heidegger's classes in 1938. (shrink)

Born in the fifth century BCE, Plato was one of the primary thinkers of Classical Greece. A mathematician, scientist, and philosopher, Plato is considered to be a foundational figure in Western thought.

We make decisions all day, don't we? Do I pick up the dog's poop when I take him for his walk? Should I tell Mom where I really went after school? When I see something wrong happening, what should I do? Making a good choice, doing the right thing, or even knowing right from wrong can be hard! In What Would You Do? ​you can practice making hard decisions and have some fun while we explore some everyday dilemmas!​.