As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)

The purpose of the work was to produce a framework to guide the development of meritorious clinical trial proposals. The framework consists of essential features of rigourous methodology, ethical acceptability, and a component referred to as "community context". These three domains were woven together in a checklist format under the headings of general, scientific and ethical considerations. Since texts concerning clinical trial methodology do not integrate ethics criteria and ethics guidelines do not provide detailed scientific criteria in obvious and practical (...) ways, we outline a more contemporary and comprehensive set of guidelines. (shrink)

Biobanks are increasingly being created specifically for research purposes. Concomitantly, we are seeing significant and evolving shifts in research ethics in relation to biobanking. Three discrete shifts are identified in this article. The first extends the ethical focus beyond the protection of human subjects to the promotion of broader community benefits of research utilizing biobanked resources, and an expectation that these benefits will be shared. The second involves the evolution of the traditional consent paradigm for future research uses of biobanks (...) resources that are not in contemplation at the time of donation. The third involves a move away from single project management to more dynamic governance accountability to research participants and the public. These shifts may take different local and institutional forms but share common recognizable elements. (shrink)

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue that (...) these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that (1) principles should be understood as heuristics that can be “specified” as described by DeGrazia (1992), and (2) that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ethical, Legal, and Social Implications Research Program at the National Human Genome Research InstituteEric M. Meslin (bio), Elizabeth J. Thomson (bio), and Joy T. Boyer (bio)Organizers of the Human Genome Project (HGP) understood from the beginning that the scientific activities of mapping and sequencing the human genome would raise ethical, legal, and social issues that would require careful attention by scientists, health care professionals, government officials, and (...) the public. The establishment of the ELSI (ethical, legal, and social implications) programs at the National Human Genome Research Institute (NHGRI) and the Department of Energy (DOE) was thought to be vital to the success of the HGP in the United States. It also provided a novel approach to the simultaneous study of ethical, legal, and social issues and basic scientific issues. Eric Juengst, the first director of the ELSI program, described its origins in a previous issue of the Kennedy Institute of Ethics Journal (Juengst 1991). Now in its seventh year, the ELSI program has accomplished much. This article summarizes the evolution and goals of the ELSI program at NHGRI, outlines the program’s current research priorities with examples of activities within each priority area, and provides a look to the future, including the initiation of a strategic planning process.Evolution and Goals of the ELSI Research ProgramThe HGP’s “genomic” goals are unique: to map and sequence the entire human genome—some 3 billion base pairs that make up approximately 80–100,000 genes—and the genomes of related model organisms by the year 2005. This goal was particularly ambitious since, when it was proposed, the technologies for mapping and sequencing had yet to be developed. When the HGP was first established, its organizers also elaborated a set of ELSI goals, which they saw as vital to the success of the genome project. The original ELSI goals were: (1) to anticipate and address the implications of the HGP for individuals and society and (2) to examine the ELSI consequences of mapping and sequencing the human genome in order to stimulate public discussion. To meet these goals, the NHGRI created its ELSI research program in 1990. Along with mapping, sequencing, [End Page 291] and mammalian genetics, ELSI was one of four original branches in the NHGRI Division of Extramural Research that funded research in those areas. Although the individual “branches” no longer exist, the mechanisms for funding research remain much the same. While the overall goals of the program have not changed, the specific ways of achieving the goals have continued to evolve. The importance of the ELSI program lies not in the collection of a full set of data that will be valuable in and of itself, but in the value of using and interpreting this new set of information.Early on, the NHGRI described a set of somewhat more specific goals: (1) to develop a program to help understand the ethical, legal, and social implications of the human genome project and (2) to identify and define the major issues of concern and develop policy options to address them. These more specific goals have been largely met. As the most recent biennial NHGRI Progress Report notes, “a robust ELSI research and education program has been established, many of the most urgent ELSI issues have been identified, and many policy options to address these issues have been proposed” (NCHGR 1995, p. 21). Between 1990 and 1996, ELSI provided more than $32.5 million in funding through 128 research and education grants in more than 30 states and in Canada (Table 1). The ELSI research budget is unique in that when originally created, it was specifically tied to the amount of money provided for the overall NHGRI budget. The NHGRI originally devoted 3 percent of its extramural budget to fund ELSI projects, but in FY 1991, it increased the ELSI budget to 5 percent, a figure that remains today. Table 2 lists the expenditures for each fiscal year since 1990 and the cumulative expenditures to date. The ELSI research budget at NHGRI this year will be about $7 million. When other sources of funding—e.g., co-funding arrangements with other institutes and agencies and the funding of ELSI... (shrink)

The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses’ power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant (...) discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions. (shrink)

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue that (...) these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that principles should be understood as heuristics that can be “specified” as described by DeGrazia , and that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials. (shrink)

Is God's foreknowledge compatible with human freedom? One of the most attractive attempts to reconcile the two is the Ockhamistic view, which subscribes not only to human freedom and divine omniscience, but retains our most fundamental intuitions concerning God and time: that the past is immutable, that God exists and acts in time, and that there is no backward causation. In order to achieve all that, Ockhamists distinguish ‘hard facts’ about the past which cannot possibly be altered from ‘soft facts’ (...) about the past which are alterable, and argue that God's prior beliefs about human actions are soft facts about the past. (shrink)

Stephen Davies offers a compelling account of adornment as a form of aesthetic enhancement that aims either to intensify or to contribute to beauty and sublimit.

Two experiments examine the effects of unreportable hints on anagram solving performance and on solvers' subjective experience of insight. In Experiment 1, after seeing a hint presented too briefly to identify, participants solved anagrams preceded by the solution fastest and solved anagrams preceded by unrelated hints slowest. Participants' “warmth” ratings for solution hints were more insight-like than those for unrelated hints. In Experiment 2 a hint, or no hint, was presented at one of three different exposure durations . Participants benefited (...) from solution-relevant hints that were either unreportable or reportable, but showed a cost only for unrelated hints that were reportable. Participants' ratings of their insight experiences showed that unreportable solution and semantically related hints produced more insight-like experiences than did unrelated hints. The results suggest that unreportable processing of solution-related information is important for the insight experience. (shrink)

Recombinant DNA technology will soon allow physicians an opportunity to carry out both somatic cell- and Germ-Line gene therapy. While somatic cell gene therapy raises no new ethical problems, gene therapy of gametes, fertilized eggs or early embryos does raise several novel concerns. The first issue discussed here relates to making a distinction between negative and positive eugenics; the second issue deals with the evolutionary consequences of lost genetic diversity. In distinguishing between positive and negative eugenics, the concept of malady (...) is applied as a definitional criterion for identifying genetic disorders that could qualify for Germ-Line therapy. Because gene replacement techniques are currently unavailable for humans, and because even if they were possible the number of people involved would be quite small, the loss of diversity concern seems moot. Finally, we dissuss the issue of iatrogenic disorders associated with gene therapy and discuss several ‘real world considerations.’. (shrink)

In this article, I examine the moral dimensions of gender affirmation. I argue that the moral value of gender affirmation is rooted in what Iris Murdoch called loving attention. Loving attention is central to the moral value of gender affirmation because such affirmation is otherwise too fragile or insincere to have such value. Moral reasons to engage in acts that gender affirm derive from the commitment to give and express loving attention to trans people as a way of challenging their (...) marginalization. In the latter part of the paper, I will discuss how my arguments bear on recent arguments by Robin Dembroff and Daniel Wodak (2018) on the use of gender-neutral language. They argue that we have a duty not to use gender-specific pronouns for anyone. Their conclusion turns, in part, on a rejection of gender affirmation as a moral duty. The value of gender affirmation, rooted in our moral perception of trans people, should make us skeptical of this conclusion, in favor of a more nuanced and pluralistic approach to the ethics of gendering. (shrink)

Feldman has recently argued that leibniz never stated leibniz' law. This article seeks to rebut his arguments and makes a number of incidental points about the interpretation of the law.

Comparatively speaking, philosophy has not been especially long-winded in attempting to answer questions about what is funny and why we should think so. There is the standard debate of many centuries’ standing between superiority and incongruity accounts of humor, which for the most part attempt to identify the intentional objects of our amusement.1 There is the more recent debate about humor and morality, about whether jokes themselves may be regarded as immoral or about whether it can in certain circumstances be (...) wrong to laugh.2 There is even apparently some disagreement about whether amusement is an emotion proper or a different kind of psychological attitude altogether. While I have almost despite myself taken .. (shrink)

The starting point of this paper is a recent exchange in the Journal of Aesthetics and Art Criticism1 that pits moderate moralism against robust immoralism and has Humean antecedents. I will proceed by agreeing in part with both, but fully with neither, thereby annoying as many people as possible in one go. I believe, with Anne Eaton, the proponent of robust immoralism, that fictions which valorize what she calls "rough heroes" can arouse both aesthetically compelling and morally troubling reactions. On (...) the other hand, I argue that the troubling moral reaction targeted need not be a sufficient ground for attributing a moral flaw to the... (shrink)

This essay offers an overview of the reasons why tattoos are philosophically interesting. Considered here will be a partial survey of potential areas of philosophical interest with respect to tattoos, fortified by a little historical context. Claims about the ethical significance of tattoos and about the significance of tattoos for self-expression and as expressions of identity will be canvassed in the first two sections, as will questions about what they express or signify, how they might do so, and whose expression (...) we might take it to be. The final sections will address the contention that at least some tattoos are art and will raise various considerations about their closest analogs as well as their authorship. Although it will be argued that analogs can be found between tattoos and works recognized as art, it will also be maintained that tattoos raise unique aesthetic issues for consideration. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 30, Number 2, November 2004, pp. 213-236 Pleased and Afflicted: Hume on the Paradox of Tragic Pleasure E. M. DADLEZ How fast can you run? As fast as a leopard. How fast are you going to run? A whistle sounds the order that sends Archie Hamilton and his comrades over the top of the trench to certain death. Racing to circumvent that order and arriving seconds (...) too late, Archie's friend Frank screams in rage and despair. Archie is cut down before he has run twenty yards. Peter Weir's film Gallipoli is a chronicle of the disastrous Dardanelles campaign of the first World War, but it is also a film about racing. Archie is trained by his uncle Jack to run "as fast as a leopard." The film begins as it ends, with Archie sprinting in response to a whistle. Frank is first shown racing after a train, along with friends who are on their way to enlist. Archie and Frank meet while competing in a race, they race in Cairo once they have enlisted, and they finally race death. From the beginning, Archie has been faster; even at the end he is the first to die. And from the beginning he has swept Frank along in his wake, encouraging him, pushing him, inspiring him, and helping him to positions for which he is inadequately qualified. In the end, Archie's compassion and kindness prompt a decision which has grim consequences both for himself and for hundreds of others. Knowing that his friend fears death in the trenches, Archie recommends Frank as a substitute for himself, a designated message runner. But Frank is not fast enough, and falls short by mere seconds which Archie would not have lost. This is what leads to the failure of the one real effort to countermand the fatal charge. E. M. Dadlez is Professor of Humanities and Philosophy, University of Central Oklahoma, Edmond, OK 73034, USA. e-mail: [email protected] 214 E. M. Dadlez I am an emotional wreck by the time the movie is over, though I should admit that most of my tears are the result of sheer rage. Both my dogs exited the room in some haste once I began to shout at the television and the unpardonably dimwitted British officers who sat sipping tea at a comfortable distance as they gave the order for soldiers to commit suicide. But it isn't just the scope of the real human disaster, or the enormity of the blunder, or the pointlessness of the entire enterprise, or even my renewed conviction that stupidity is, in fact, evil, that is so unsettling. The film unnerves with respect to personal as well as global concerns, focusing attention on the chance of vanity's leading one to undertake responsibilities beyond one's competence, the possibility of advancement or security being achievable only at the expense of another, and the realization of how easy it might be to let those things happen. Gallipoli is a sad, disturbing film, and the spectator is grieved and disturbed in the course of watching it. Yet, having said that, I must own to having a copy in my possession, and to having watched it more than once. I recommend it to friends, offering to lend them my videotape. In fact, I press it on them. I say that it is a terrific, rewarding work which they should take the time to see. How is it that I can describe my experience of the film in such glowing terms and at the same time acknowledge the extreme distress I felt in the course of watching it? How can I reconcile the discordant aspects of my experience? David Hume explores some possible answers in his essay "Of Tragedy."1 He begins by calling attention to the paradox of tragic pleasure: It seems an unaccountable pleasure, which the spectators of a well written tragedy receive from sorrow, terror... and other passions, which are in themselves disagreeable and uneasy. The more they are touched and affected, the more are they delighted with the spectacle.... The whole art of the poet is employed in rousing and supporting the compassion and... (shrink)