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...

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)

To better understand the multiple individual factors that contribute to college cheating, we undertook a multivariate analysis of a national sample of 2,503 college students. Our findings indicated that demographic characteristics, character qualities, college experience, and student perceptions and attitudes are all significantly associated with academic cheating.

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)

‘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)

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

Physical activities are generally accepted as promoting important psychological benefits. However, studies examining martial arts as a form of physical activity and mental health have exhibited many methodological limitations in the past. Additionally, recent philosophical discussion has debated whether martial arts training promotes psychological wellbeing or illness. Self-efficacy has an important relationship with mental health and may be an important mechanism underpinning the potential of martial arts training to promote mental health. This study examined the effect of martial arts training (...) on the psychological construct of self-efficacy. A total of 283 secondary school students with a mean age of 12.76 (SD = 0.68) years were recruited to complete a time-limited (10-session) martial arts intervention, which was examined using a randomised controlled trial. Univariate ANOVAs found that the intervention improved the experimental group’s self-efficacy compared to the control group, which was sustained at follow-up. Regression analysis indicated that socio-educational status moderated this outcome. These findings support the martial arts-based intervention’s potential to improve self-efficacy and promote wellbeing through physical activity. Martial arts training may be an efficacious psychosocial treatment that can be used as a complementary approach to promote mental health. (shrink)

This comprehensive introductory text with readings offers a historical overview of all major subdivisions of Western Philosophy perspectives--including both the analytic and Continental traditions--as well as Eastern philosophy, postcolonial philosophy, and feminist philosophy. Written in an engaging and captivating style, it makes philosophy accessible without oversimplifying the material, and shows that philosophy's powerful ideas affect the lives of real people.

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

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

The first seven chapters of Doing without Concepts offer a perfectly reasonable view of current research on concepts. The last chapter, on which the central thesis of the book rests, provides little actual evidence that using the term impedes scientific progress. It thus fails to demonstrate that this term should be eliminated from the scientific vernacular.

More than any other textbook, Moore and Parker's Critical Thinking has defined the structure and content of the critical thinking course at colleges and universities across the country--and has done so with a witty writing style that students enjoy. Now in full-color, the eighth edition brings the concepts of critical thinking to life in vivid detail, with current examples relevant to today's students.

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)

The possibility of continuous backwards time travel—time travel for which the traveler follows a continuous path through space between departure and arrival—gives rise to the double-occupancy problem. The trouble is that the time traveler seems bound to have to travel through his or her younger self as the trip begins. Dowe and Le Poidevin agree that this problem is solved by putting the traveler in motion for a gradual trip to the past. Le Poidevin goes on to argue, however, that (...) the gradual trip gives rise to the Cheshire cat problem, a concern about whether the traveler survives the gradual trip. We address the Cheshire cat problem by proposing and considering new continuity constraints on identity over time. Along the way, we come upon an endurantist conception of temporal parts. (shrink)

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)

Abstract“Suffering” is a central concept within bioethics and often a crucial consideration in medical decision making. As used in practice, however, the concept risks being uninformative, ambiguous, or even misleading. In this paper, we consider a series of cases in which “suffering” is invoked and analyze them in light of prominent theories of suffering. We then outline ethical hazards that arise as a result of imprecise usage of the concept and offer practical recommendations for avoiding them. Appeals to suffering are (...) often getting at something ethically important. But this is where the work of ethics begins, not where it ends. (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)

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...

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)

Rationale: Deep brain stimulation (DBS) of the hippocampus is proposed for enhancement of memory impaired by injury or disease. Many pre-clinical DBS paradigms can be addressed in epilepsy patients undergoing intracranial monitoring for seizure localization, since they already have electrodes implanted in brain areas of interest. Even though epilepsy is usually not a memory disorder targeted by DBS, the studies can nevertheless model other memory-impacting disorders, such as Traumatic Brain Injury (TBI). Methods: Human patients undergoing Phase II invasive monitoring for (...) intractable epilepsy were implanted with depth electrodes capable of recording neurophysiological signals. Subjects performed a delayed-match-to-sample (DMS) memory task while hippocampal ensembles from CA1 and CA3 cell layers were recorded to estimate a multi-input, multi-output (MIMO) model of CA3-to-CA1 neural encoding and a memory decoding model (MDM) to decode memory information from CA3 and CA1 neuronal signals. After model estimation, subjects again performed the DMS task while either MIMO-based or MDM-based patterned stimulation was delivered to CA1 electrode sites during the encoding phase of the DMS trials. Each subject was sorted (post hoc) by prior experience of repeated and/or mild-to-moderate brain injury (RMBI), TBI, or no history (control) and scored for percentage successful delayed recognition (DR) recall on stimulated vs. non-stimulated DMS trials. The subject’s medical history was unknown to the experimenters until after individual subject memory retention results were scored. Results: When examined compared to control subjects, both TBI and RMBI subjects showed increased memory retention in response to both MIMO and MDM-based hippocampal stimulation. Furthermore, effects of stimulation were also greater in subjects who were evaluated as having pre-existing mild-to-moderate memory impairment. Conclusion: These results show that hippocampal stimulation for memory facilitation was more beneficial for subjects who had previously suffered a brain injury (other than epilepsy), compared to control (epilepsy) subjects who had not suffered a brain injury. This study demonstrates that the epilepsy/intracranial recording model can be extended to test the ability of DBS to restore memory function in subjects who previously suffered a brain injury other than epilepsy, and support further investigation into the beneficial effect of DBS in TBI patients. (shrink)

Introduction: What is the critical spirit?--Utopianism, ancient and modern, by M.I. Finley.--Primitive society in its many dimensions, by S. Diamond.--Manicheanism in the Enlightenment, by R.H. Popkin.--Schopenhauer today, by M. Horkheimer.--Beginning in Hegel and today, by K.H. Wolff.--The social history of ideas: Ernst Cassirer and after, by P. Gay.--Policies of violence, from Montesquieu to the Terrorist, by E.V. Walter.--Thirty-nine articles: toward a theory of social theory, by J.R. Seeley.--History as private enterprise, by H. Zinn.--From Socrates to Plato, by H. Meyerhoff.--Rational society (...) and irrational art, by H. Read.--The quest for the Grail; Wagner and Morris, by C.E. Schorske.--Valéry; Monsieur Teste, by L. Goldmann.--History and existentialism in Sartre, by L. Krieger.--German popular biographies; culture's bargain counter, by L. Lowenthal.--The Rechtsstaat as magic wall, by O. Kirchheimer. (shrink)

Bibliographical footnotes. Introduction: What is the critical spirit?--Utopianism, ancient and modern, by M.I. Finley.--Primitive society in its many dimensions, by S. Diamond.--Manicheanism in the Enlightenment, by R.H. Popkin.--Schopenhauer today, by M. Horkheimer.--Beginning in Hegel and today, by K.H. Wolff.--The social history of ideas: Ernst Cassirer and after, by P. Gay.--Policies of violence, from Montesquieu to the Terrorist, by E.V. Walter.--Thirty-nine articles: toward a theory of social theory, by J.R. Seeley.--History as private enterprise, by H. Zinn.--From Socrates to Plato, by H. (...) Meyerhoff.--Rational society and irrational art, by H. Read.--The quest for the Grail; Wagner and Morris, by C.E. Schorske.--ValeÌ ry; Monsieur Teste, by L. Goldmann.--History and existentialism in Sartre, by L. Krieger.--German popular biographies; culture's bargain counter, by L. Lowenthal.--The Rechtsstaat as magic wall, by O. Kirchheimer. Revolution from above: some notes on the decision to collectivize Soviet agriculture, by E.H. Carr.--Winston Churchill, power politician and counter revolutionary, by A.J. Mayer.--Brahmins and business, 1870-1914; a hypothesis on the social basis of success in American history, by G. Kolko.--On the limits of professional thought, by M.R. Stein.--The limits of integration, by P. Mattick.--The society nobody wants; a look beyond Marxism and liberalism.--Marcuse as teacher, by W. Leiss, J.D. Ober and E. Sherover.--Marcuse bibliography, by W. Leiss, J.D. Ober and E. Sherover (p. 427-433). (shrink)

"Moore's provocative conclusion is that monotheism - with its monopoly on virtue and failure to provide supernatural scapegoats - is responsible for some of the most virulent forms of intolerance and is a major cause of human nastiness and suffering.

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)

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)

The contemporary operating environment for deployed United States military operations largely focuses on deployments to predominantly Islamic countries. The differences in cultural values between d...

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)

Ms. P. is in the ICU with respiratory failure and sepsis. She has been on a ventilator for almost a week, and now has impending kidney failure. Her children, who have been taking turns at the bedsi...

The ELSI Program: Closing the Loop was an interpretive policy study undertaken to identify how the research and the researchers funded through the program to study the ethical, legal, and social implications of mapping the human genome contributed to the construction of a public policy agenda. The stated goals of this federal grant program, known as ELSI and administered through the National Center for Human Genome Research within the National Institutes of Health, was to maximize the benefits and minimize the (...) harms of the genetic information developed as a result of the government supported genomic research. The purpose of the research project was to generate meaning and understanding regarding the social constructions of this community of researchers. Specifically, identifying themes in the process and outcomes of the research activity was intended to inform future public policy actions, thereby, closing the loop on the reflexive activity generated by the ELSI Program. The activities of the sixty-four researchers granted awards between 1990 and 1993 comprised the core sample for the study. The research process was embedded in a constructivist philosophy and the design included participant observation and an analysis of textual materials generated by the grantees. Data included periodical articles, authored and edited books, videos, popular print and visual media materials, conference papers and presentations, forum reports, interviews, and materials generated by the researcher in the process of the research--notes and analytic memos. Data analysis was an interpretive synthesis of a content analysis, contextual analysis, grounded theory coding categories, and the reflexive process of the researcher. ;The phenomena under investigation were the interactional activities of the ELSI group of researchers through which meaning was shaped on the ethical, legal, and social implications of genomic mapping. A theoretical model of the constructions of the researchers as developed included two core categories: "Framing Academic Constructions" and "Institutionalizing the Myth". The ELSI researchers used a variety of strategies, including rhetorical questioning, professional blocking and impersonalizing, plying a trade, and academic time in generating constructions. The research and researchers contributed to institutionalizing a myth of a genome through strategies that included being the expert, narrowing the focus, and marveling. The consequence of these social interactions was a process of "Making Points Not Meaning", participation in symbolic activities that generated few issues for the public policy agenda. The constructions of the policy study were then situated in the context of the discipline of public administration and policy studies. Significant to the impact of the research findings was understanding how the cooptation of these researchers might effect an health care delivery system dominated by commercial interests such as biotechnology and managed care organizations. The study concluded with a discussion of how situated knowledge constructions, social epistemology, interdisciplinarity, and interpretive research methods might contribute to enhanced credibility in public policy actions. (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)