As in science, so in bioethics: if prohibiting conflicts of interest is not feasible, rigorous requirements for disclosure can at least manage them.

: The terms "appropriate" and "necessary" are crucial determinants in decisions regarding the use and reimbursement of medical treatments. This paper encourages greater awareness of the political, economic, and normative assumptions that give meaning to these concepts.

Carol Gilligan has identified two orientations to moral understanding; the dominant justice orientation and the under-valued care orientation. Based on her discernment of a voice of care, Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the (...) liberal ideal. My analysis of justice -oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others. (shrink)

Edmund Pellegrino has argued that the dramatic changes in American health care call for critical reflection on the traditional norms governing the therapeutic relationship. This paper offers such reflection on the obligation to do no harm. Drawing on work by Beauchamp and Childress and Pellegrino and Thomasma, I argue that the libertarian model of medical ethics offered by Engelhardt cannot adequately sustain an obligation to do no harm. Because the obligation to do no harm is not based simply on a (...) negative duty of nonmaleficence but also on a positive duty of beneficence, I argue that it is best understood to derive from the fiduciary nature of the healing relationship. (shrink)

In this paper, I examine the notion of accountability and its historical evolution in health care. Using medical mistakes and adverse patient outcomes as my focus, I examine the interests served by particular models of accountability and argue for a model of collective fiduciary responsibility in U.S. health care today.

Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...

Within health care systems, negative perceptions of lesbian, gay, bisexual, and transgender persons have often translated into denial of services, denial of visitation rights to same‐sex partners, reluctance on the part of LGBT patients to share personal information, and failure of workers to assess and recognize the unique health care needs of these patients. Other bureaucratic forms of exclusion have included documents, forms, and policies that fail to acknowledge a patient's valued relationships because of, for example, a narrow definition of (...) “spouse,” “parent,” or “family.” Bureaucratic exclusion has taken a particularly prominent form in the U.S. military. Until its repeal and termination in 2011, the “Don't Ask, Don't Tell” policy had for eighteen years barred openly gay men and lesbians from serving in the military. Among the effects of DADT is a dearth of information about the number and needs of LGBT service members who transition to the Veterans Health Administration for health care at the end of their military service. The long‐standing social stigma against LGBT persons, the silence mandated by DADT, and the often unrecognized bias built into the fabric of bureaucratic systems make the task of creating a welcoming culture in the VHA urgent and challenging.The VHA has accepted a commitment to that task. Its Strategic Plan for fiscal years 2013 through 2018 stipulates that “[v]eterans will receive timely, high quality, personalized, safe, effective and equitable health care irrespective of geography, gender, race, age, culture or sexual orientation.” To achieve this goal, the VHA undertook a number of coordinated initiatives to create an environment and culture that is informed, welcoming, positive, and empowering for the LGBT veterans and families whom the agency serves. (shrink)

This series of responses was commissioned to accompany the article by Singer et al, which can be found at http://www.biomedcentral.com/1472-6939/2/1. If you would like to comment on the article by Singer et al or any of the responses, please email us on [email protected].

This article reads the photo album, The ‘Life and Times’ of an American Called Pauli Murray as an archive of anti-lynching pasts and futures. While scholarly discourses have leveraged Murray’s archive for evidence of her ‘true’ gender and sexual orientation, this article uses the reading practice of ‘accompaniment’ to reframe investigations of Murray’s identity into thinking with and learning from the strategies she archived in the album for living in atmospheres of antiblackness. Working with Christina Sharpe’s (2016) concept of (...) ‘weathering’, I read several photographs in Murray’s album as burgeoning ecologies of repair in relation to visual technologies of racial capture, particularly that of lynching photography. Reading passages in which Murray talks about lynching and race as atmospheric from Proud Shoes (1999 [1956]) and Song in a Weary Throat (1987) alongside The ‘Life and Times’, I read Murray’s portraits as rupturing white property relations through turning lynching photography’s scripts inside out. (shrink)

The terms "appropriate" and "necessary" are crucial determinants in decisions regarding the use and reimbursement of medical treatments. This paper encourages greater awareness of the political, economic, and normative assumptions that give meaning to these concepts.

(2002). Review of Cynthia R. Daniels, At Women's Expense: State Power and the Politics of Fetal Rights. The American Journal of Bioethics: Vol. 2, No. 1, pp. 65-66.

A transdisciplinary exploration of the work of Kenneth Burke and posthumanist rhetorics. In considering questions of power and persuasion as well as of ethics, responsibility, the contributors to this volume imagine the contradictions among Burke's writings and posthumanism as opportunities for knowledge making"--Provided by publisher.

Although features of the dentition figure prominently in discussions of early hominid phylogeny, remarkably little is known of the developmental basis of the variations in occlusal morphology and dental proportions that are observed among taxa. Recent experiments on tooth development in mice have identified some of the genes involved in dental patterning and the control of tooth specification. These findings provide valuable new insight into dental evolution and underscore the strong developmental links that exist among the teeth and the jaws (...) and cranium. The latter has important implications for cladistic studies that traditionally consider features of the skull independently from the dentition. BioEssays 23:481–493, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 51-53, September‐October 2021.

Psychologists and neuroscientists often struggle to integrate findings in their respective domains, a problem due partly to implicitly and explicitly held philosophical positions on issues of reduction and autonomy across these domains. The present article reviews how reduction and autonomy have been used in philosophical arguments regarding how macro-scale findings relate to micro-scale findings across various scientific disciplines. The present article demonstrates how macro findings are indispensable to explanations of phenomena of interest by (a) providing information regarding higher levels of (...) organization in mechanisms, (b) including information not contained within certain micro explanations that (c) provides more general and stable causal explanations relative to micro explanations in certain situations. The purpose of presenting these analyses and recommendations is to disabuse psychologists and neuroscientists of pervasive assumptions that psychology is reducible to biology and that lower level phenomena (molecular) should be prioritized as somehow more explanatory than higher level phenomena (behavioral). The article concludes with 3 hypothetical scenarios from clinical psychology and psychiatry illustrating this critique and providing a pragmatic approach to clarify the relative roles, and importance, of biological and psychological data in service of general and stable explanations that are tailored to the kind of intervention desired. (shrink)

This article focuses on the analysis of gossip that is done in a playful key, including laughter as a salient feature, drawing on extracts taken from two naturally occurring conversations among Galician female undergraduate students. The analysis indicates that gossip emerges as a form of indirect mockery in the data, which are commonly based on dramatized reported speech of the ‘victim’, including parodic stylization devices that are orientated to elicit laughter by making fun or through ridicule. The evaluation component also (...) reveals important differences in relation to serious gossip, as it is not necessarily negative and is not always explicitly established or developed. For this reason, this component can be ambiguous in some cases. From a functional perspective, the article emphasizes that sociability and entertainment are not the only functions that playful and humorous gossip can play; at a fundamental level, this discourse practice has other benefits for the participants: as a way of constructing group identity and getting group comfort for a feeling of envy; of increasing self-esteem from the problems of another party; and of degrading other people’s success. The common element behind these underlying functions is a comparative competition of the gossipers with the person who is the subject of their talk. Thus, gossip as mockery is not free of maliciousness and competitiveness. (shrink)

"Making the Human Mind" is an attack on the widespread assumption that the mind has parts and that it is the interaction between these parts which accounts for some of the most characteristic human behaviour, the sorts of irrational behaviour displayed in self-deception and weakness of will. The implications of this attack are considerable: Professor Sharpe contests a realism about the mind, the belief that there is an inventory which an all-seeing deity could compile and which could contain answers (...) to all the questions we could ask about people. With this goes a hermeneutic approach to the understanding of human behaviour: these forms of understanding are markedly different from that suggested by the scientific model and favoured by those who partition the mind. Finally, the author undermines eliminative materialism and the idea that the way we talk about the mind constitutes a "folk psychology", arguing that what is distinctively human about the human mind has been created by self-consciousness and is self-created. (shrink)

A psychiatric advance directive (PAD) is a communication tool that promotes patients’ autonomy and gives capacitated adults who live with serious mental illnesses the ability to record their preferences for care and designate a proxy decision maker before a healthcare crisis. Despite a high degree of interest by patients and previous studies that recommend that clinicians facilitate the completion of PADs, the rate of implementation of PADs remains low. Research indicates that many clinicians lack the necessary experience to facilitate the (...) completion of PADs and to use them, and, as a consequence, do not effectively engage patients about PADs. This study developed practical recommendations for clinicians to improve their ability to communicate and facilitate PADs. We (1) thematically analyze definitions of PADs published in 118 articles across disciplines, and (2) present our recommendations for enhanced communication in clinical practice that emphasize patient-centeredness, usefulness, and clarity, aligned with evidence-based practices that put patients’ autonomy and understanding first. While there is no one-sizefits- all script to engage patients in complex conversations, our recommended strategies include an emphasis on patients’ autonomy, the adaptation of word choices, the use of metaphor not simile, and checking for patients’ understanding as effective methods of clinical communication. (shrink)