This research ethics article focuses on an unexpected finding from my Master’s thesis examining bereaved participants’ experiences of taking part in sensitive qualitative research: some participants wanted their real names used in my written dissertation and any subsequent empirical publications. While conducting interviews for my thesis and explaining the consent process, early responses highlighted the problematic notion of anonymity for participants engaged in qualitative research. Several participants asserted the significance of immortalizing their deceased loved ones in the pages of my (...) thesis, retaining ownership over their words and maintaining a public attachment to their personal identity. The preliminary responses also resonate with concerns regarding the ethics of assigning pseudonyms and anonymity to participants in qualitative research. Themes in the extant literature tend to centre on issues of researchers’ accountability and transparency towards participants or respect. The present article contributes to the debates surrounding anonymity and confidentiality within qualitative research, and also expands on specific issues pertaining to bereavement research ethics. (shrink)

Background:The perceptions of core professional nursing values of men in baccalaureate nursing programs are poorly understood.Objective:The study purpose was to understand and interpret the meaning of core professional nursing values to male baccalaureate nursing students.Research design and context:One-to-one interviews were conducted with male nursing students from a public university in the Midwest, following interpretive phenomenology.Ethical considerations:Measures to protect participants included obtaining Institutional Review Board approval, obtaining signed informed consent, and maintaining confidentiality.Findings:The study revealed five themes and several subthemes under an (...) overarching finding of caring. Acquisition of professional nursing values began prior to the nursing program and continued to varying degrees throughout the program.Discussion:Several implications are offered for nursing education, nursing practice, research, and public policy. These include identification of common values, teaching-learning strategies, inclusive environments, teamwork, and conflict resolution.Conclusion:Caring was revealed using a metaphor of a puzzle. (shrink)

This article reports a content analysis of advertisements for household goods appearing in Ladies Home Journal between 1909-1910 and 1980, with the aim of understanding the ideological campaign that characterized the years in which households were mechanized and women's domestic labor transformed in the United States. More Journal ads featured directives about housework than descriptions of the product; they emphasized work performance far more frequently than liberation from housework, and they also promoted service to family. These findings supplement other evidence (...) that advertisers' efforts to create a market for household appliances and other means of domestic labor involved promotion of an ideology about housework that reinforced women's dedication to it. (shrink)

In his Lives, Giorgio Vasari mentions many artists who were talented at music when they were young, prominently Giorgione and Sebastiano del Piombo. Benvenuto Cellini resisted his father's pressure to choose music. Why? How rewarding was a musical profession in Renaissance Italy? It could be very lucrative, both for town musicians such as Cellini's father and for castratos. Moonlighting for banquets, dances, even spying, could bring in additional income. For gentlemen, music was a necessary social grace; they had private tutors, (...) such as Silvestro Ganassi dal Fontego, who was himself a painter as well as a printer. Amateurs could learn from cathedral choirmasters, who were often music theorists, the pinnacle of the profession. The theorist Pietro Aaron, choirmaster at Imola Cathedral, then tutor to the sons of Sebastian Michiel, Grand Prior of the Knights of St John of Jerusalem in Venice, had a wide acquaintance among humanists, noblemen and other musicians, and his letters open a window on the life of a musician. Among his many professions, the writer Antonfrancesco Doni counted music; a madrigal he wrote in 1560 is included in an appendix. The ability to improvise verses and music was much prized, ranging from star performers such as Serafino Aquilano to amateurs such as Niccolò Machiavelli. Portraits of musicians are discussed; they offer important evidence but are difficult to interpret. The theorist Lodovico Zacconi concluded in 1592 that being a musician was not only an honourable and lucrative profession but an enjoyable one. (shrink)

Resumen Los estudiantes universitarios pueden contribuir a la calidad de la democracia de su país en la medida en que aprendan a distinguir cómo la corrupción se instala en su práctica cotidiana, la combatan y se comprometan a estar atentos a la honestidad de sus acciones y la veracidad de su discurso. Describimos las implicaciones de comprender a la democracia como gobierno por discusión y pasamos a proponer a la razón pública como el sine qua non de una democracia que (...) busca hacer justicia social y que requiere ciudadanos dispuestos a debatir ideas con honestidad y rigor crítico, con debates públicos y pasión por la verdad. Estas ideas las contrastamos con los hallazgos de una encuesta sobre corrupción aplicada anualmente a estudiantes universitarios.University students maj contribute to the quality of democracy in their country to the extent that they learn to distinguish how corruption is part of their day-to-day practices, they combat it and commit themselves to be attentive regarding the honesty of their actions and the veracity of their discourse. We describe the implications of understanding democracy as government by discussion; we then propose public reason as the sine qua non of a democracy that seeks social justice and requires citizens willing to debate ideas honestly, rigorously, and critically, in public debates and with a passion for the truth. We contrast these ideas with the findings from a yearly survey of university students. (shrink)

This essay appraises the history of the International Academy of Practical Theology, arguing that competing aims have pulled it in different directions. The essay arose initially out of a roundtable on IAPT at an international congress in São Leopoldo, Brazil, in preparation for the next biennial conference there in 2019. Why is there a need for the IAPT? What are some of its developments? Why is it important for South America and Brazil? In response, the essay suggests that the IAPT (...) has struggled to sustain at least two prominent commitments - a desire to enhance practical theology's scholarly visibility and acumen and a real need to become a genuinely international organisation in terms of representation and inclusion. A secondary argument woven through the essay is that collegial friendships across complicated differences of location and perspective have the capacity to moderate and even heal conflicts. (shrink)

Social scientists using one or another concept of process have paid little attention to underlying issues of methodology and explanation. Commonly, the concept used is a loose one. When it is not, there often are other problems, such as errors of reification and of assuming that events sometimes connected in a sequence are invariably thus connected. While it may be useful to retain the term " process" for some sequences of intelligibly connected actions and events, causal explanation must be sought (...) with respect to the events constituting processes rather than with respect to processes regarded as unitary entities. (shrink)

Each year, millions of individuals in the United States are treated for a variety of serious medical conditions with prescription drugs whose therapeutic benefits are well known. The vast majority of these medications are used to treat medical and psychiatric illnesses. Generally, they are used as prescribed, and contribute to a better quality of life for persons suffering from debilitating or life-threatening disorders.The fact that a small portion of these medications is diverted by those who seek their psychoactive effects raises (...) the important policy issue: how to make drugs easily available for medical use while limiting access for purposes of abuse.Such a responsibility poses challenges very different from those of the so-called “war” on illicit drugs, because this control must be achieved without impeding patients’ access to medical care. A rational public policy would attempt to achieve a balance between the need to minimize abuse and the need to provide relief. (shrink)

Each year, millions of individuals in the United States are treated for a variety of serious medical conditions with prescription drugs whose therapeutic benefits are well known. The vast majority of these medications are used to treat medical and psychiatric illnesses. Generally, they are used as prescribed, and contribute to a better quality of life for persons suffering from debilitating or life-threatening disorders.The fact that a small portion of these medications is diverted by those who seek their psychoactive effects raises (...) the important policy issue: how to make drugs easily available for medical use while limiting access for purposes of abuse.Such a responsibility poses challenges very different from those of the so-called “war” on illicit drugs, because this control must be achieved without impeding patients’ access to medical care. A rational public policy would attempt to achieve a balance between the need to minimize abuse and the need to provide relief. (shrink)

Although death by neurologic criteria is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: the medical standards used to determine death by neurologic criteria, management of family objections before determination of death by neurologic criteria, and management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation (...) in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act and the rationale for these recommendations. (shrink)

The gap between the number of organs available for transplant and the number of individuals who need transplanted organs continues to increase. At the same time, thousands of transplantable organs are needlessly overlooked every year for the single reason that they come from individuals who were declared dead according to cardio pulmonary criteria. Expanding the donor population to individuals who die uncontrolled cardiac deaths will reduce this disparity, but only if organ preservation efforts are utilized. Concern about potential legal liability (...) for temporary preservation of organs pending a search for family members appears to be one of the impediments to wider use of donation in cases of uncontrolled cardiac death in states without statutes explicitly authorizing such action. However, we think that the risk of liability for organ preservation under these circumstances is de minimis, and that concerns about legal impediments to preservation should yield to the ethical imperative of undertaking it. (shrink)

In February 2022, the Court of Protection was faced with the question of whether a kidney transplant was in the best interests of William Verden. The case highlighted the legal, ethical and clinical complexities of treating potential kidney transplant patients with impaired decision-making. Above all, it exposed the potential risk of discrimination on the basis of disability when treatment decisions in relation to potential kidney recipients with impaired capacity are being made. In this paper, we draw on the Verden case (...) to (1) examine the role of the Court of Protection in cases relating to patients with impaired decision-making capacity who require a transplant, (2) to highlight the lack of empirical data on patients who have faced inequitable access to transplant and (3) highlight the shortcomings of the existing legal and regulatory framework in England and Wales guiding clinical decision making for patients in William’s position. We consequently argue that there is a clear need for action to ensure equitable access to transplant for those in William’s position. Furthermore, we suggest that there is a responsibility incumbent on policy makers and clinicians alike to develop a meaningful, and meaningfully operational, framework centred on preventing discrimination against potential organ recipients based on their decision-making capacity. (shrink)

In this paper, we assume that organ donation policy in the United States will continue to be based on an opt-in model, requiring express consent to donate, and that families will continue to have the prerogative to make donation decisions whenever the deceased person has not recorded his or her own preferences in advance. The limited question addressed here is what should be done when a potential donor dies unexpectedly, without any recorded expression of his or her wishes at hand, (...) while a family decision is being sought. (shrink)

Moral opposition by medical professionals to participation in the process of sentencing for capital crimes, including refusals to provide medical treatment, may compromise the integrity of the legal process.

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the society. (...) Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the society. (...) Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The determinative issue in applying the insanity defense is whether the defendant experienced a legally relevant functional impairment at the time of the offense. Categorical exclusion of personality disorders from the definition of mental disease is clinically and morally arbitrary because it may lead to unfair conviction of a defendant with a personality disorder who actually experienced severe, legally relevant impairments at the time of the crime. There is no need to consider such a drastic approach in most states and (...) in the federal courts, where the sole test of insanity is whether the defendant was “unable to appreciate the wrongfulness of his conduct at the time of the offense.” This is because the only symptoms that are legally relevant in such jurisdictions are those that impair reality-testing and thereby affect the person's capacity to understand the nature and consequences of her actions. However, if the test of insanity includes a “volitional prong” (inability to control one's behavior), some way must be found to limit the scope of the defense to the core cases (involving psychotic conditions) to which it has traditionally been applied, and to prevent a shift toward a deterministic account of criminal conduct — i.e., “people can't help being who they are and doing what they do.” The best way of accomplishing this is to limit the definition of mental disease to severe disorders characterized by gross disturbances of the person's capacity to understand reality. (shrink)

In his accompanying article, Dr. Kinscherff has convincingly demonstrated why a categorical exclusion of personality disorders from the definition of “mental disease” in insanity defense adjudication is arbitrary, both conceptually and clinically. He explains his position in the context of a vignette involving a hypothetical defendant, Wilhelmina Sykes, charged with ramming her car into another car obstructing her path, causing serious injury to its driver. Dr. Kinscherff correctly points out that the determinative issue in applying the insanity defense in any (...) case, including the hypothetical case involving Ms. Sykes, is whether the defendant experienced a legally relevant functional impairment at the time of the offense. In many states — and in the hypothetical jurisdiction in which Ms. Sykes is being prosecuted — the relevant functional impairments are those that could have affected her ability “to appreciate the wrongfulness of her conduct” or “to conform her conduct to the requirements of the law. (shrink)

Organ transplantation has become a proven, cost-effective lifesaving treatment, but its promise is contingent on the number of available organs. The growing gap between the demand and supply results in unnecessary loss and diminished quality of life as well as high costs for surviving patients and health insurers. Twenty years after the enactment of the National Organ Transplantation Act, it is time to rethink the moral basis and overall design of organ transplantation policy. We propose a national plan for organ (...) transplantation insurance under which the federal government would assume responsibility for increasing the organ supply and would cover all costs associated with transplantation for patients not otherwise covered. (shrink)

In 2011, Steven Pinker published The Better Angels of Our Nature: Why Violence Has Declined,1 arguing we are the beneficiaries of the "long peace." The problem with invoking long periods of peace is that they are often fleetingly ephemeral and can rapidly turn to hostility. The very year the book was published marked the beginning of the Arab Uprisings, unforeseen and unplanned for, apparently without historical precedent or analogy. The spiraling violence and polarization, as well as the accompanying refugee crisis (...) that has followed, have demonstrated this was a questionable, if not illusory designation. This sustained violence has profound effects on social consciousness across the political spectrum, ushering in... (shrink)

Organ transplantation remains one of modern medicine's remarkable achievements. It saves lives, improves quality of life, diminishes healthcare expenditures in end-stage renal patients, and enjoys high success rates. Yet the promise of transplantation is substantially compromised by the scarcity of organs. The gap between the number of patients on waiting lists and the number of available organs continues to grow. As of January 2006, the combined waiting list for all organs in the United States was 90,284. Unfortunately, thousands of potential (...) organs are lost each year, primarily due to lack of consent to donation from the deceased before death, or from the family thereafter. Only fifty percent of potential donors – the “conversion” rate – become actual donors. The costs attributed to organ shortage are substantial – Medicare paid over $15.5 billion in 2002 for treating patients with end-stage renal-disease, who predominate on organ waiting lists. (shrink)

This collection of papers by prominent feminist thinkers advances the positive feminist project of remapping the moral by developing theory that acknowledges the diversity of women.

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with (...) the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions. (shrink)

Obtaining informed consent has typically become a stylized ritual of presenting and signing a form, in which physicians are acting defensively and patients lack control over the content and flow of information. This leaves patients at risk both for being under-informed relative to their decisional needs and of receiving more information than they need or desire. By personalizing the process of seeking and receiving information and allowing patients to specify their desire for information in a prospective manner, we aim to (...) shift genuine control over the informational process to patients. A new paradigm of Information on Demand, such as we suggest, would also enhance legal certainty, achieve greater congruence between the information patients want and the information they receive, and promote more meaningful patient-physician interactions, a desirable outcome that has been difficult to achieve by other means. (shrink)

In an explicit attempt to reduce physician paternalism and encourage patient participation in making health care decisions, the informed consent doctrine has become a foundational precept in medical ethics and health law. The underlying ethical principle on which informed consent rests — autonomy — embodies the idea that as rational moral agents, patients should be in command of decisions that relate to their bodies and lives. The corollary obligation of physicians to respect and facilitate patient autonomy is reflected in the (...) rules that have been created to implement consent procedures, especially those requiring disclosure of relevant information.However, there are many practical impediments to patient self-determination in health care decisionmaking. Well-meaning physicians often lack the time to live up to the ideal of facilitating genuine, informed deliberation with and by their patients, and many lack the motivation or skill to do so successfully. (shrink)

A collection of personal narratives and essays, Living Professionalism is designed to help medical students and residents understand and internalize various aspects of professionalism. These essays are meant for personal reflection and above all, for thoughtful discussion with mentors, with peers, with others throughout the health care provider community who care about acting professionally.