Being a patient and living a life -- Clinical space and traits of healing -- False starts and frequent failures -- Three journeys : A.'Ibuprofen and love', B. 'Staying tuned up', C. 'We all want the same things' -- Being a patient : the moral field -- Rethinking healthcare ethics : the patient's moral authority.

Money plays a powerful role in modern medicine, both in terms of how health services are organized and delivered and increasingly in how physicians understand themselves and their work. The phrase “the hegemony of money” is intended to capture that power.

It is commonplace to point out that Alfred Kinsey's taxonomic work on gall wasps provided a methodology for his studies of human sexual behavior. It is equally commonplace to point out that, when researching and presenting his sexual studies, Kinsey's professedly neutral scientific data were constrained by a social agenda. What I have done in this paper is to join these two claims and demonstrate, with particular reference to Kinsey's Sexual Behavior in the Human Male, how his zoology helped guide (...) Kinsey to a naturalistic ethics that, despite contrasts to, shared certain parallel logical failures with the traditional ethics of his critics. (shrink)

Wittgenstein's insistence in his later philosophy that explanation comes to an end in the explication of what it is to follow a rule provides a locus for the awakening of wonder, analogous to the mystical awe referred to in the "Tractatus". While Wittgenstein did not explore this analogy, it provides a point of entry into the examination of the relevance of his work to religious concerns. Every regular practice is built on capacities of reaction, uptake, and response which are the (...) endpoints of explanation, whose sheer givenness in their relation to our physical and social environment can bring on amazement. This wonder at the end of explanation has been explored -- from quite a different perspective -- by Stephen Gould, whose conclusions complement Wittgenstein's own. (shrink)

The dynamic of religious expression employs symbolic language, actions, and art. These symbols are symbols of transcendence because it is transcendence which is the unique referent that sets apart symbols which give rise to religious understanding from symbols which do not. The main objective of this book is to demonstrate that in Louis Dupre's work all religious expression, insofar as it has a transcendent reference, is intrinsically symbolic. Religious language is never purely objective nor purely subjective, but a dialectical relation (...) with a transcendent dimension. True to the teachings of Dupre, this book uncovers that without a transcendent referent, religious symbols lose their religious significance. This is the plight of the (late-post)modern condition which resulted from the fracturing of nature into its cosmic, human and transcendent components. To regain a sense of transcendence the believer is forced to make an inward turn akin to the mystical practice of past ages. This does not recover a sense of transcendence for culture but can do so for the believer's personal spiritual life. (shrink)

"The fixed person for fixed duties, who in older societies was such a godsend, in the future ill be a public danger." Twenty years ago, a single legal metaphor accurately captured the role that American society accorded to physicians. The physician was "c- tain of the ship." Physicians were in charge of the clinic, the Operating room, and the health care team, responsible - and held accountabl- for all that happened within the scope of their supervision. This grant of responsibility (...) carried with it a corresponding grant of authority; like the ship's captain, the physician was answerable to no one regarding the practice of his art. However compelling the metaphor, few would disagree that the mandate accorded to the medical profession by society is changing. As a result of pressures from a number of diverse directions - including technological advances, the development of new health professionals, changes in health care financing and delivery, the recent emphasis on consumer choice and patients' rights - what our society expects phy- cians to do and to be is different now. The purpose of this volume is to examine and evaluate the conceptual foundations and the moral imp- cations of that difference. Each of the twelve essays of this volume assesses the current and future validity of the "captain of the ship" metaphor from a different perspective. The essays are grouped into four sections. In Section I, Russell Maulitz explores the physician's role historically. (shrink)

When health care providers make decisions to use resources, their devotion to the patient at hand must be mediated by a framework that puts individual autonomy and social equity into focus simultaneously. The concept of citizenship yields such a framework.

We will argue here that after more than 30 years of talk, theory, and clinical practice, we bioethicists still know far too little about what patients, subjects, and healthcare professionals are up to, morally. Bioethics is still near the beginning in grasping what it means to understand, much less to honor fully, the moral power and perspicacity of those bioethics is designed to serve. This is, of course, a serious charge, but one we will endeavor to show has merit. However, (...) we want to be clear from the start that we do not gainsay the important work that has been done in and through the influence of bioethics, both as a field of practical engagement and as a cultural movement, in improving how healthcare is delivered and how human subjects are treated. Thirty or 40 years—depending on how one marks the beginning point—is a very short time, and it is hard to imagine that wholesale changes, all of them in the right direction, could be the outcome for a field this young. Hence, we do not intend the title, “One Cheer for Bioethics,” as a wholesale indictment, but as an indication that there is a great deal of work yet to be done, and that following the currently dominant direction of the field is not likely to get us there. Our aim is to indicate just where future work should be focused, and to do so we will need to be critical of some of the preoccupations of the last three decades. a. (shrink)

Background Diversity in Institutional Review Board (IRB) membership is important for both intrinsic and instrumental reasons, including fairness, promoting trust, improving decision quality, and responding to systemic racism. Yet U.S. IRBs remain racially and ethnically homogeneous, even as gender diversity has improved. Little is known about IRB chairpersons’ perspectives on membership diversity and barriers to increasing it, as well as current institutional efforts to promote diversity, equity, and inclusion (DEI) within IRB membership.Methods We surveyed IRB chairpersons leading U.S. boards registered (...) with the Office for Human Research Protections. Here, we focus exclusively on responses from a subset of 388 chairpersons of IRBs at universities and academic medical centers (AMCs).Results Board chairs were predominantly white and evenly split between men and women. Only about half reported that their boards had at least one member who is Black or African American (51%), Asian (56%), or Hispanic (48%), with 85% of university/AMC boards comprised entirely (15%) or mostly (70%) of white members. Most IRB chairpersons (64%) reported satisfaction with the current diversity of their membership. Participants largely agreed that considering diversity in the selection of IRB members is important (91%), including to improve the quality of IRB deliberation (80%), with an emphasis on racial/ethnic (85%) and gender diversity (74%). Most participants (80%) reported some type of active DEI effort regarding board membership at their university/AMC and just over half (57%) expressed satisfaction with these efforts.Conclusions Our national survey found that although university/AMC IRB chairpersons report valuing diversity in board membership, it may be lacking in key areas. Going forward, it will be important to specify clear reasons for diversity in the IRB context, as well to establish targets for acceptable levels of board diversity and to match DEI efforts to those targets. (shrink)

Many philosophers judge that typical agent-causal accounts of freedom improperly sacrifice the possibility of rational explanation of the action for the sake of securing control, while others judge that the reverse shortcoming plagues typical event causal accounts. (Of course, many philosophers make both these judgments.) After briefly rehearsing the reasons for these verdicts on the two traditional strategies, we undertake an extended examination of Randolph Clarke's recent attempt to meet the challenge by proposing an original, "integrated agent-causal" account of human (...) free action. We argue that Clarke's account fails. In a final section, we sketch a more promising route to integration. (shrink)

The brief, practical texts in the Essentials of Qualitative Methods series introduce social science and psychology researchers to key approaches to capturing phenomena not easily measured quantitatively, offering exciting, nimble opportunities to gather in-depth qualitative data. In this book, Scott D. Churchill introduces readers to existential phenomenological research, an approach that seeks an in-depth, embodied understanding of subjective human existence that reflects a person's values, purposes, ideals, intentions, emotions, and relationships. This method helps researchers understand the lives and needs (...) of others by helping identify and set aside theoretical and ideological prejudgments. About the Essentials of Qualitative Methods book series: Even for experienced researchers, selecting and correctly applying the right method can be challenging. In this groundbreaking series, leading experts in qualitative methods provide clear, crisp, and comprehensive descriptions of their approach, including its methodological integrity, and its benefits and limitations. Each book includes numerous examples to enable readers to quickly and thoroughly grasp how to leverage these valuable methods. (shrink)

The Covid‐19 pandemic has concentrated bioethics attention on the “lifeboat ethics” of rationing and fair allocation of scarce medical resources, such as testing, intensive care unit beds, and ventilators. This focus drives ethics resources away from persistent and systemic problems—in particular, the structural injustices that give rise to health disparities affecting disadvantaged communities of color. Bioethics, long allied with academic medicine and highly attentive to individual decision‐making, has largely neglected its responsibility to address these difficult “upstream” issues. It is time (...) to broaden our teaching, research, and practice to match the breadth of the field in order to help address these significant societal inequities and unmet health needs. (shrink)

Throughout the 1990s, Jaegwon Kim developed a line of argument that what purport to be nonreductive forms of physicalism are ultimately untenable, since they cannot accommodate the causal efficacy of mental states. We argue that, while the argument needs some tweaking, its basic thrust is sound. In what follows, we lay out our preferred version of the argument and highlight its essential dependence on a causal-powers metaphysic, a dependence that Kim does not acknowledge in his official presentations of the argument. (...) We then discuss two recent physicalist strategies for preserving the causal efficacy of the mental in the face of this sort of challenge, strategies that (ostensibly) endorse a causal powers metaphysics of properties while offering distinctive accounts of the physical realization of mental properties. We argue that neither picture can be satisfactorily worked out, and that seeing why they fail strongly suggests that nonreductive physicalism and a causal powers metaphysic are not compatible, as our original argument contends. Since we also believe that robust realism concerning mental causation should not be abandoned, we take the argument of this paper to strongly motivate an account on which the mental is unrealized by and ontologically emergent from the physical. In a final section, we sketch what an ontologically emergentist account of the mental might look like. (shrink)

A key takeaway from the recent volume Theistic Evolution: A Scientific, Philosophical, and Theological Critique is that no version of theistic evolution that adheres largely to consensus views in biology is a plausible option for orthodox Christians. In this paper we argue that this is false: contrary to the arguments in the volume, evolutionary theory, properly understood, is perfectly compatible with traditional Christian commitments. In addition, we argue that the lines between Intelligent Design and theistic evolution are not as sharp (...) as most scholars have assumed, such that many who self-identify as Intelligent Design adherents would also qualify as theistic evolutionists. (shrink)

This essay strives to bring together the institutional history of phenomenological psychology within the American academy from the middle of the 20th century to the current moment. Although phenomenological psychology has always been a dynamically international and interdisciplinary movement, the scope of this essay is limited to the different ways in which this new field expressed itself in certain psychology departments and educational institutions across the United States. After presenting this institutional history, and some individual contributors, a brief commentary is (...) offered. (shrink)

Much has been written about the importance of narrative in teaching ethics and humanities to medical students and residents, as well as the value of narratives in clinical care. Relatively little has been said about the essential role of narrative in bioethics consultations. For most consults, the interpretation of narratives is the central moral feature, and the ethics consultant is inevitably one of the narrators. In a recent consult in which I participated, at least three narratives were in play. The (...) medical record itself was a narrative, or really, a variety of narratives. A second distinct narrative was the story of why this case had come to be categorized as an ethical concern for the medical team. A third narrative was the tentative sketch running through my mind as a consultant‐partly factual, partly anticipatory and conjectural, inevitably personal‐about what was going on here. (shrink)

"This book maps the moral terrain in the grounded reality of human experience without relying on theories or systems of ethics as the primary orienting strategy. Moral awareness needs first to be appreciated for what it is before it is made to conform to theories or systems. And moral consciousness is not a steady or stable set of perceptions; as we change so do the moral challenges that most concern us"--.

In a recent article in The Journal of Clinical Ethics, David Wendler argues that worries about the therapeutic misconception (TM) are not only misconceived, but detract from the larger agenda of a proper informed consent for subjects involved in clinical research. By contrast, we argue that Wendler mischaracterizes those who support TM research, and that his arguments are fragmentary, often illogical, and neglect a critical difference between clinical care and clinical research. A clear explanation about the chief aim of research (...) is, in fact, what gives the other elements in a consent process their meaning. We argue that informed consent must be both trial-specific and context-sensitive, and that concern about the TM is needed now more than ever. (shrink)

In March 1996, the General Accounting Office (GAO) issued the reportScientific Research: Continued Vigilance Critical to Protecting Human Subjects.It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always cleartoclinicians. Controversy (...) exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health (NIH) Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

In March 1996, the General Accounting Office (GAO) issued the reportScientific Research: Continued Vigilance Critical to Protecting Human Subjects.It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always cleartoclinicians. Controversy (...) exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health (NIH) Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

The ultimate challenge for psychology as a human science inheres in accessing the experience of the other. In general, the field of psychology has perpetuated the epistemological dualism of distinguishing between the realm accessible by external perception and the realm accessible by inner perception, and hence between the subjective and the objective , regarding the "first person" perspective as a legitimate means of access only to one's own private experience, while insisting that all others' experience must be observed from a (...) neutral "third person" perspective. By reflecting on his participant-observational encounters with the animal other of the Bonobo, the author attempts to demonstrate in this paper the possibility of a third approach between the antinomy of methodological subjectivism and methodological objectivism as a way out of the dilemmas posed by epistemological dualism. The alternative proposed is the "second person" framework of observation, which, by invoking empathic seeing as its means of accessing the private space of the other and creating the space of the "in between", allows for intersubjective engagement in an experiential gestalt consisting of "myself and the other", and offers the possibility of testing one's ‘own' experience of an intersubjective moment in dialogue with the other. In so far as it infers the focusing of consciousness on embodied experience and expression, and the synthesis of receptive and proprioceptive consciousness in "experiaction" , the "second person" perspective restores inner reality to the realm of the observable, and thus reclaims observation as the method of psychology, and behaviour as its subject matter. The notion of empathy and intuition as a reliable and valid mode of access to the psychological life of others is substantiated theoretically with reference to inter alia Husserl's concepts of "coupling" and "co-constitution", Merleau-Ponty's notions of "inter-corporeality" or "carnal intersubjectivity" and of "the intertwining and the chiasm" of the "Ineinander" as constitutive of the "flesh of the world", Laing's postulation of the possibility of "interexperience", and the sense of union with the object of perception implied by Scheler's term "Einsfühlung" as the essence of intersubjective encounter. (shrink)

In March 1996, the General Accounting Office issued the report Scientific Research: Continued Vigilance Critical to Protecting Human Subjects. It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always clear (...) to clinicians. Controversy exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

Theological determinism is, at first glance, difficult to square with the typical Christian commitment to the appropriateness of divine blame. How, we may wonder, can it be appropriate for God to blame someone for something that was determined to occur by God in the first place? In this paper, I try to clarify this challenge to Christian theological determinism, arguing that its most cogent version includes specific commitments about what is involved when God blames wrongdoers. I then argue that these (...) commitments are not essential to divine blame, and that there are plausible alternative accounts of such blame that would not court similar challenges. I end with a case for the intelligibility of divine blame within theological determinism, in light of its possible similarity in relevant respects to certain instances of intelligible human blame. (shrink)

Throughout the 1990s, Jaegwon Kim developed a line of argument that what purport to be nonreductive forms of physicalism are ultimately untenable, since they cannot accommodate the causal efficacy of mental states. His argument has received a great deal of discussion, much of it critical. We believe that, while the argument needs some tweaking, its basic thrust is sound. In what follows, we will lay out our preferred version of the argument and highlight its essential dependence on a causal-powers metaphysic, (...) a dependence that Kim does not acknowledge in his official presentations of the argument.i We then discuss two recent physicalist strategies for preserving the causal efficacy of the mental in the face of this sort of challenge, strategies that (ostensibly) endorse a causal powers metaphysics of properties while offering distinctive accounts of the physical realization of mental properties. We argue that neither picture can be satisfactorily worked out, and that seeing why they fail strongly suggests that nonreductive physicalism and a causal powers metaphysic are not compatible, as our original argument contends. Since we also believe that robust realism concerning mental causation should not be abandoned, we take the argument of this paper to strongly motivate an account on which the mental is unrealized by and ontologically emergent from the physical. In a final section, we sketch what an ontologically emergentist account of the mental might look like. (shrink)