Ethics consultation at the bedside has been hailed as a better way than courts and ethics committees to empower patients and make explicit the value components of treatment decisions. But close examination of the practice of ethics consultation reveals that it in fact risks subverting those ends by interpolating a third (expert) party into the doctor-patient encounter. In addition, the practice of bioethics through consultation does the broader cultural work of fashioning a shared moral order in the face of manifestly (...) plural individual commitments. In doing so, however, bioethics furthers medicine's position as a privileged domain of public moral discourse in contemporary American society. (shrink)

Anne Barnhill focuses her article in this issue on the American Medical Association's ethics policy governing clinical use of placebos, but the implications of her analysis are deeper, touching on how physicians should make judgments about which interventions to offer patients in the process of shared decision‐making. The bottom line is that, even if an undisclosed placebo might be marginally more effective for a particular patient in the short term, over the long haul the integrity of the patient‐physician relationship relies (...) on doctors being honest with their patients. Even when it comes to placebos, honesty remains the best policy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Conflicts—and Consensus—about Conflicts of Interest in MedicineMatthew K. Wynia and Bette–Jane Crigger*This fascinating collection of essays about individual experiences of conflict of interest leaves little doubt that physicians remain divided about the importance, impact and meaning of conflicts of interest in their work. These essays offer differing views about what conflicts of interest look and feel like “on the ground” and about whether specific conflicts of interest (...) are bad, just a fact of life, or maybe even good.Conflict, Conflict EverywhereThese essays situate conflict of interest in a variety of contexts: the treatment recommendations a physician makes for an individual patient; the relationship between teaching physician and medical student or practicing physician and health care organization; the interaction between academic researchers and industry collaborators or professional bodies and industry supporters. In this, the narratives taken together reflect the scope of concern about conflict of interest in medicine familiar in the literature. In his classic 1993 essay, Dennis Thompson noted that concerns about conflict of interest encompass issues of physician self–referral, risk sharing between physicians and health care institutions, gifts from industry, hospital purchasing practices, as well as sponsored research and research with patients (Thompson 1993). To that list have subsequently been added relationships with industry in medical education at all levels, physicians’ service as consultants to industry or members of industry speakers bureau, and development of clinical practice guidelines (Lo & Fields 2009).That almost none of these essays draw attention to some widely publicized situations of conflict of interest—for example, gifts to physicians or the provision of drug samples—should, we think, be seen more as an artifact of the authors’ varied individual experiences than as a failure by the authors to engage key concerns in the ongoing professional and public debate. It could also be that the authors, asked to submit personal stories, assumed that yet another essay about the ‘traditional’ issues in the conflicts of interest literature would be seen as redundant, routine or even boring. Or, there is the tantalizing possibility that the absence of some of the more familiar conflicts from these narratives is the early fruit of efforts to address these traditional issues through policies governing interactions between physicians and industry promulgated by academic medical centers and health systems, medical specialty societies, and industry.One significant area of concern that has emerged in recent years is conflict of interest in the development of clinical practice guidelines. E.g., Choudry et al. 2002; Sniderrman & Furberg 2009; Guyatt et al. 2010. Although none of the essays in this [End Page 101] collection address it head on, Perlmutter touches on several key issues. His depiction of how an FDA committee process limited the input he was able to provide as an expert, undermined his potential to contribute to the professional dialogue, and raised concerns about the objectivity of the drug approval process echoes concerns about objectivity, the role of expert opinion, and the presence on guideline development panels of individuals with financial interests in the recommendations to be developed that have been explored at some length in the literature, most recently by the Institute of Medicine in reports on evidentiary standards (Eden et al 2011) and principles for guideline development (Graham et al. 2011).Conflict of Interest or Dual Agency?Several essays set out physicians’ experience in navigating situations of diverging expectations. Bierut, for example, reflects on the disjunction between the goals and products of academic researchers and commercial sponsors. She saw herself advancing basic knowledge and was forced to grapple with the reality of sponsors’ goals to advance commercial ends as well. Nagldinne and Mikulec each recall struggles to reconcile their obligation to exercise professional judgment on behalf of patients with the demands of health care organizations focussed also on the bottom line. Cruz–Flores attests to the challenge of making recommendations for care when one is both a practicing clinician and a clinical investigator engaged in research that might offer benefit to a patient for whom there are limited options.Thompson defined conflicts of interest as “a set of conditions in which professional judgment concerning a primary interest (such as a patient’s welfare or the validity of... (shrink)

Although many physicians have been using the internet for both clinical and social purposes for years, recently concerns have been raised regarding blurred boundaries of the profession as a whole. In both the news media and medical literature, physicians have noted there are unanswered questions in these areas, and that professional self-regulation is needed. This report discusses the ethical implications of physicians’ nonclinical use of the internet, including the use of social networking sites, blogs, and other means to post content (...) online. It does not address the clinical use of the internet, such as telemedicine, e-prescribing, online clinical consultations, health-related websites, use of electronic media for clinical collaboration, and e-mailing patients (some of which are already covered in the AMA’s Code of Medical Ethics). (shrink)

Beginning Bioethics introduces students to the language of philosophical ethics before leading them in Part Two through six major issues in bioethics. The author gives clear explanations of all sides of a given issue and engages with several major contributions to the debate. This book can stand alone, but was written also to accompany the third edition of Bette-Jane Crigger's Cases in Bioethics, providing the philosophical counterpart to cases discussed there by US medical practitioners. Both books originate with St (...) Martin's Press in the United States. (shrink)

What was it like to be a practitioner of Pyrrhonist skepticism? This important volume brings together for the first time a selection of Richard Bett's essays on ancient Pyrrhonism, allowing readers a better understanding of the key aspects of this school of thought. The volume examines Pyrrhonism's manner of self-presentation, including its methods of writing, its desire to show how special it is, and its use of humor; it considers Pyrrhonism's argumentative procedures regarding specific topics, such as signs, space, or (...) the Modes; and it explores what it meant in practice to live as a Pyrrhonist, including the kind of ethical outlook which Pyrrhonism might allow and, in general, the character of a skeptical life - and how far these might strike us as feasible or desirable. It also shows how Pyrrhonism often raises questions that matter to us today, both in our everyday lives and in our philosophical reflection. (shrink)

Call the norms of inquiry zetetic norms. How are zetetic norms related to epistemic norms? At first glance, they seem quite closely connected. Aren't epistemic norms norms that bind inquirers qua inquirers? And isn't epistemology the place to look for a normative theory of inquiry? While much of this thought seems right, this paper argues that the relationship between the epistemic and the zetetic is not as harmonious as one might have thought and liked. In particular, this paper argues that (...) some familiar contemporary epistemic norms are in tension with, and even in conflict with, central zetetic norms. (shrink)

In this paper I look at belief and degrees of belief through the lens of inquiry. I argue that belief and degrees of belief play different roles in inquiry. In particular I argue that belief is a “settling” attitude in a way that degrees of belief are not. Along the way I say more about what inquiring amounts to, argue for a central norm of inquiry connecting inquiry and belief and say more about just what it means to have an (...) inquiry or question settled. (shrink)

The Aesthetics of Design offers the first full treatment of design in the field of philosophical aesthetics, challenging the discipline to broaden its scope to include the quotidian objects and experiences of our everyday lives and concerns ...

Nurses make mistakes in practice despite the culturally based expectation of perfection. Such a disparity between reality and expectation calls members of the profession to question the current attitudes toward mistakes in practice. Two explanatory models of the origin of mistakes are presented. The Perfectibility Model holds that any error or harm is caused by an individual practitioner's lack of knowledge or motivation. The Faulty Systems Model offers a broader explanation of human error. I conclude that a Faulty Systems Model (...) is more comprehensive and more effective for managing mistakes. Integrating the Faulty Systems Model into practice and education can result in more ethically fitting responses to errors and ultimately better outcomes for nurses, institutions and patients. (shrink)

In this paper I argue that there is a class of attitudes that have questions (rather than propositions or something else) as contents.

The study was prompted by (a) Frederick and Vogel's debate concerning future research in business and society, (b) such recently reported managerial excesses as golden parachutes, greenmail, and fraud, (c) the increasing emphasis on coursework in the area. It appears that there is a need to assess how students, our future business leaders, perceive social issues and if a business and society course can help them define and understand the importance of these issues.Three questions provided the focal point: (1) Which (...) issues do students perceive as most important before and after completing the course? (2) How much importance do students place on issues? (3) Does completing a business and society course make a significant difference in how students perceive the importance of the issues presented? (shrink)

The new science of genomics endeavors to chart the genomes of individuals around the world, with the dual goals of understanding the role genetic factors play in human health and solving problems of disease and disability. From the perspective of indigenous peoples and developing countries, the promises and perils of genomic science appear against a backdrop of global health disparity and political vulnerability. These conditions pose a dilemma for many communities when attempting to decide about participating in genomic research or (...) any other biomedical research. Genomic research offers the possibility of improved technologies for managing the acute and chronic diseases that plague their members. Yet, the history of particularly biomedical research among people in indigenous and developing nations offers salient examples of unethical practice, misuse of data, and failed promises. This dilemma creates risks for communities who decide either to participate or not to participate in genomic science research. Some argue that the history of poor scientific practice justifies refusal to join genomic research projects. Others argue that disease poses such great threats to the well-being of people in indigenous communities and developing nations that not participating in genomic research risks irrevocable harm. Thus, some communities particularly among indigenous peoples have declined to participate as subjects in genomic research. At the same time, some communities have begun developing new guidelines, procedures, and practices for engaging with the scientific community that offer opportunities to bridge the gap between genomic science and indigenous and/or developing communities. Four new approaches warrant special attention and further support: consulting with local communities; negotiating the complexities of consent; training members of local communities in science and health care; and training scientists to work with indigenous communities. Implicit is a new definition of “rigorous scientific research,” one that includes both community development and scientific progress as legitimate objectives of genomic research. Innovative translational research is needed to develop practical, mutually acceptable methods for crossing the divide between genomic researchers and indigenous communities. This may mean the difference between success and failure in genomic science, and in improving health for all peoples. (shrink)

The new science of genomics endeavors to chart the genomes of individuals around the world, with the dual goals of understanding the role genetic factors play in human health and solving problems of disease and disability. From the perspective of indigenous peoples and developing countries, the promises and perils of genomic science appear against a backdrop of global health disparity and political vulnerability. These conditions pose a dilemma for many communities when attempting to decide about participating in genomic research or (...) any other biomedical research. Genomic research offers the possibility of improved technologies for managing the acute and chronic diseases that plague their members. Yet, the history of biomedical research among people in indigenous and developing nations offers salient examples of unethical practice, misuse of data and failed promises. This dilemma creates risks for communities who decide either to participate or not to participate in genomic science research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Creating a Learning Space That Is Virtual and ExperientialBette E. Schneiderman (bio)The final product of the Rembrandt Project will be a Web site that is intended primarily for use by middle and high school teachers and their students. It is a celebration of Rembrandt’s work in the contexts of his time, place, and culture and all that may emanate from them. A special feature of the site is the (...) integration of art, aesthetic, and social studies education. Other articles in this issue address the rich content of the project’s work, that is, the artworks themselves, their contextual grounding, and the development of skills that maximize learning. This article looks at the creation of a learning space as a home for the development of the project. It explores issues related to learning spaces and features some of the technologies that can be used within them.The Rembrandt Project will not be a Web site that merely flattens images on a computer screen or conveys facts about Rembrandt and his oeuvre. Rather, it is a portal to a learning place with online features and opportunities for learners to have transformative experiences. Learning may occur online in electronic conversations, in opportunities to view and respond to reproductions in collections that cannot be visited in person, and in the creation and display of learners’ products. Learning is facilitated by access to a range of resources and people. Numerous announcements of activities, events, and products will be posted on the site. Some individuals will work in the space of the works themselves while others might undertake learning activities in museums, galleries, and private homes. In some cases special programs will highlight certain works and relate them to the project. Images of places in the Netherlands will also be presented with accompanying learning opportunities for those who may wish to see the paintings in person or simply ponder their influence from afar. All participants will be encouraged to share creations and reflections on the site. [End Page 38]To provide a sense of what this article is about, three cases are presented, each with two scenarios and a sample online discussion. The purpose of these cases is to draw readers into the experience of a virtual learning space before discussing contemporary learning communities, learning spaces, and technologies. The cases will show how to develop lively democratic conversation that makes communal learning possible. Participants can be of all kinds, from experts to those who simply want to learn. They can be located anywhere and participate at whatever time suits them best.Case A: Two ScenariosScenario 1: Viewing a Masterwork by RembrandtStanding before a work by Rembrandt you are drawn into its space. If you have viewed a Rembrandt in the past, recall your experience. If not, perhaps you might want to travel to a place that has one of his works or access some of his images online.1 Or you might think about a work of art that aroused your interest and prompted you to ponder its import and ask questions. Perhaps you returned to the work many times, experiencing it more deeply and differently upon each visit. What is it, specifically, about the encounter that resulted in a satisfying experience? And what changed the moment you viewed the work in a book reproduction, a slide, or a digitized image on a computer? In pursuing its purposes, the Rembrandt Project explores ways multiple skills can help maximize the experience of a wide range of works both online and off. Case A, Scenario 1, will set the stage for an experience with the work itself.Scenario 2: Viewing a Masterwork OnlineSelect a major work by Rembrandt online.2 What makes experiencing this image worthwhile, despite the fact that certain aspects cannot be captured in this flat digitized space? Upon reflecting on these scenarios, thoughts about experiencing the work may be recorded and discussed with others.3Case B: Two ScenariosScenario 1: An Experience of a LandscapeImagine wandering through an open field, tingled by a gentle breeze, warmed by the sun, refreshed by the aromas of moist grasses, mixed flowers, and the woody smells of trees. A village, visible... (shrink)

This article reviews the incredible growth of electronic commerce (e-commerce) and presents ethical issues that have emerged. Security concerns, spamming, Web sites that do not carry an "advertising" label, cybersquatters, online marketing to children, conflicts of interest, manufacturers competing with intermediaries online, and "dinosaurs" are discussed. The power of the Internet to spotlight issues is noted as a significant force in providing a kind of self-regulation that supports an ethical e-commerce environment.