Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since patients guide care in patient-centered care, and respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use of a principle of respect (...) for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

Some feminists have been critical about the dominant conception of autonomy, questioning, for example, its conception of persons and ideal of personhood. Tom Beauchamp and James Childress (BC), the major proponents of the dominant conception of autonomy, believe that these feminists have misunderstood their theory and, moreover, that their theory is immune to feminist attack. Their response to feminist critics, however, has been dismissive and does nothing to assuage these critics concerns. In this paper I briefly review the state of (...) play in this debate about autonomy, showing that BC are not without positive rejoinders to objections raised by feminist critics. These rejoinders rest on the notion that feminist concerns are a matter of what is logically entailed by BCs theory of autonomy and attempt to show that feminist commitments are logically consistent with that theory. However, these rejoinders are less than convincing for reasons illuminated by Cheshire Calhoun. Calhoun reminds us that feminists are sensitive to ways in which the shape of discourse is influenced by non-epistemic considerations. In particular, Calhoun draws our attention to the cumulative effect of a whole tradition of moral reasoning that focuses on too narrow a range of moral problems and too narrow an understanding of people and the human condition. BCs conception of autonomy relies on and reinforces ideologies of the moral life created in just this way. Following Calhoun, I show that criticism of their theory as ideology is not criticism of its logical implications, but something far more damaging, something without available rejoinders. (shrink)

The purpose of this paper is to show that the standard notion of informed choice is unacceptable and must be replaced. To do so, I examine Foucault's analysis of people in contemporary society, drawing attention to the ways power relations act upon us, and to the possibility of resistance. I show how feminist moral theory can be enriched by Foucault's analysis. Applying this new understanding of people and moral theory to an analysis of informed choice, I claim that the standard (...) notion of informed choice is unacceptable, in part because it relies on a false conception of people. Its “necessary” features—intention, understanding, and absence of controlling influences—are much more difficult, if not impossible, to obtain than proponents of the standard notion believe. I end by offering direction for creating a new, Foucault-inspired, feminist theory of informed choice. (shrink)

Lisa A. Eckenwiler and Felicia G. Cohn, The ethics of bioethics: Mapping the moral landscape, Baltimore: The Johns Hopkins University Press, 2009, reviewed by Carolyn Ells.

(2010). Levels of Intervention: Communicating with More Precision About Planned Use of Critical Interventions. The American Journal of Bioethics: Vol. 10, No. 1, pp. 78-79.

The Ethics of Bioethics: Mapping the Moral Landscape is a compelling, thoughtful, sobering examination of the moral practice of bioethics. Jonathan D. Moreno sets the tone in the foreword by unsettling the reader with questions from critics about the intellectual legitimacy of bioethics (e.g., the frequent tensions of political ideology with normative expertise in the public debate) and the practices of some in bioethics (e.g., the controversial roles in for-profit industry or health care). Twenty-five essays follow, addressing issues and activities (...) that mark the relatively brief history and much of the scope of bioethics practice. Each essay turns bioethics practice inward to lay bare, explore, and possibly .. (shrink)

The Declaration of Helsinki is recognised worldwide as a cornerstone of research ethics. Working in the wake of the Nazi doctors’ trials at Nuremberg, drafters of the Declaration set out to codify the obligations of physician-researchers to research participants. Its significance cannot be overstated. Indeed, it is cited in most major guidelines on research involving humans and in the regulations of over a dozen countries.Although it has undergone five revisions,1 and most recently incorporated language aimed at addressing concerns over research (...) carried out in resource-poor countries,2–5 the Declaration could go much farther in addressing the profoundly altered landscape of research with humans. Research involving humans is now a global enterprise and often involves participants from resource-poor countries. Rather than being carried out at single institutions by veteran researchers, many studies are now conducted at many locations—including sites that are not academic medical centres—by new and relatively inexperienced investigators. A growing number of projects involve novel agents, based on innovative work in genomics and proteomics. Increasingly, research is sponsored by the for-profit sector. National governments and professional organisations around the globe provide laws, regulations and standards for the conduct of research involving humans. Considerable scholarship also critiques and guides this endeavour.In light of the current effort of the World Medical Association to revise the Declaration, we offer ideas on how to re-conceive the concept of “vulnerability” and its links with the principle of justice and, in turn, redirect the attention of researchers towards those who might be so designated.In the research context, “vulnerability” is associated with an inability partly or totally to protect one’s own interests. Typically, conceptions of vulnerability centre upon characteristics associated with particular groups that …. (shrink)

Ethical review and analysis of health policy may help to ensure policies address the needs of society and align with relevant values and principles. Indeed, researchers and bioethicists have recognized the need for ethical frameworks specifically for public health applications. The objective of this research was to compile structured tools for ethical review of health policy and to analyze these tools for their scope and philosophical underpinnings. A systematic search and review of academic and grey literature was conducted to compile (...) existing tools designed for health policy ethics review. The search yielded 13 health policy ethical review tools. Qualitative content analysis revealed that all of the tools were influenced by multiple ethical values and that a majority were influenced by more than one ethical theory. The most common values were non-maleficence and beneficence. The most common influencing ethical theory was the Principles Approach. The structure of the tools demonstrates a heterogeneity of methodology designs to approach policy ethics review. This research offers a unique contribution to the bioethics field that provides a useful resource and understanding of the current ethical review tools for health policy. (shrink)

Numerous issues confront women's healthcare today, among them the medicalization of women's bodies, cosmetic genital surgery, violence against women, HIV, perinatal mental health disorders. This volume uniquely explores such difficult topics and others at the intersection of clinical practice, policy, and bioethics in women's health care through a feminist ethics lens. With in-depth discussions of issues in women's reproductive health, it also broadens scholarship by responding to a wider array of ethical challenges that many women experience in accessing health care. (...) Contributions touch on many themes previously tackled by feminist ethics, but in new, contemporary ways. Some chapters expand into new fields in the bioethics literature, such as the ethical issues related to the care of Indigenous women, uninsured refugees and immigrants, women engaged in sex work, and those with HIV at different life stages and perinatal mental health disorders. Authors seek to connect theory and practice with users of the health system by including women's voices in their research. Bringing to bear their experience in active clinical practice in medicine, nursing, and ethics, the authors contemplate new conceptual approaches to important issues in women's healthcare, and make ethical practice recommendations for those grappling with these issues. Topical and up-to-date, this book provides a valuable resource for physicians, nurses, clinical ethicists, and researchers working in some of the most critical areas of women's health and applied ethics today. (shrink)

Immigration medicine and the work carried out by Panel Physicians within the Canadian immigration system give rise to ethically troublesome practices and consequences. In this analysis in three parts, we explore the context of the immigration medical examination, characterize the observed and potential burdens and harms for immigrant and refugee applicants with HIV, and critically assess the possibilities for transforming immigration medical practices and policy to reduce inequities. We use the Code of Ethics of the Canadian Medical Association and the (...) Medical Ethics Manual of the World Medical Association to analyse six practices that fail to meet ethical expectations. This analysis opens up new lines of inquiry into the medico-administrative practices regulating immigration to Canada. It also extends knowledge about the functioning of immigration medical policy and the collection and uses of HIV-related health information. We argue that to reduce burdens and harms to prospective immigrants and refugees to Canada with HIV, changes must occur in how Citizenship and Immigration Canada asks Panel Physicians to work with these applicants. This argument is empirically informed by institutional ethnographic research results of the Canadian immigration system and its treatment of applicants with HIV. (shrink)

This commentary was submitted to the World Medical Association on behalf of the International Network on Feminist Approaches to Bioethics. Our submission included a description of feminist research ethics, suggestions for specific revisions to the Declaration, and elements found in other international research ethics codes that are important from a feminist perspective. Our goals were to encourage the WMA to craft a declaration that: conceptualizes issues of vulnerability in richer and more nuanced ways, resists the influence of profit motives, and (...) extends the scope of responsibility for ethical research more broadly. (shrink)

Comme son titre l’indique, l’ouvrage, publié en 2012 et édité par Margaret Jolly, Christine Stewart et Carolyn Brewer, vise à réinvestir la question de la violence en Papouasie Nouvelle Guinée (PNG) à partir d’une lecture par le genre : il s’agit de « genrer » (engender) la violence, dans un pays où elle apparaît omniprésente. Les huit chapitres du livre, écrits en majorité par des anthropologues sur un terrain classique de l’anthropologie, s’inscrivent ainsi dans l’abondante littérature prod...

The Declaration of Helsinki is recognised worldwide as a cornerstone of research ethics. Working in the wake of the Nazi doctors’ trials at Nuremberg, drafters of the Declaration set out to codify the obligations of physician-researchers to research participants. Its significance cannot be overstated. Indeed, it is cited in most major guidelines on research involving humans and in the regulations of over a dozen countries.Although it has undergone five revisions,1 and most recently incorporated language aimed at addressing concerns over research (...) carried out in resource-poor countries,2–5 the Declaration could go much farther in addressing the profoundly altered landscape of research with humans. Research involving humans is now a global enterprise and often involves participants from resource-poor countries. Rather than being carried out at single institutions by veteran researchers, many studies are now conducted at many locations—including sites that are not academic medical centres—by new and relatively inexperienced investigators. A growing number of projects involve novel agents, based on innovative work in genomics and proteomics. Increasingly, research is sponsored by the for-profit sector. National governments and professional organisations around the globe provide laws, regulations and standards for the conduct of research involving humans. Considerable scholarship also critiques and guides this endeavour.In light of the current effort of the World Medical Association to revise the Declaration, we offer ideas on how to re-conceive the concept of “vulnerability” and its links with the principle of justice and, in turn, redirect the attention of researchers towards those who might be so designated.In the research context, “vulnerability” is associated with an inability partly or totally to protect one’s own interests. Typically, conceptions of vulnerability centre upon characteristics associated with particular groups that …. (shrink)

Over the past decade, feminist philosophers have gone a long way toward identifying and explaining the phenomenon that has come to be known as epistemic injustice. Epistemic injustice is injustice occurring within the domain of knowledge (e.g., knowledge production and transmission), which typically impacts structurally marginalized social groups. In this paper, we argue that, as they currently work, algorithms on social media exacerbate the problem of epistemic injustice and related problems of social distrust. In other words, we argue that algorithms (...) on social media recreate and reify the conditions that lead to some groups being systematically denied the full status of knowers, thereby corrupting the epistemic terrain and, with it, systems of social trust and cooperation. We argue that algorithms do this in two ways—namely, via what we are calling algorithmic targeting and algorithmic sorting. (shrink)

Interoception can be broadly defined as the sense of signals originating within the body. As such, interoception is critical for our sense of embodiment, motivation, and well-being. And yet, despite its importance, interoception remains poorly understood within modern science. This paper reviews interdisciplinary perspectives on interoception, with the goal of presenting a unified perspective from diverse fields such as neuroscience, clinical practice, and contemplative studies. It is hoped that this integrative effort will advance our understanding of how interoception determines well-being, (...) and identify the central challenges to such understanding. To this end, we introduce an expanded taxonomy of interoceptive processes, arguing that many of these processes can be understood through an emerging predictive coding model for mind–body integration. The model, which describes the tension between expected and felt body sensation, parallels contemplative theories, and implicates interoception in a variety of affective and psychosomatic disorders. We conclude that maladaptive construal of bodily sensations may lie at the heart of many contemporary maladies, and that contemplative practices may attenuate these interpretative biases, restoring a person’s sense of presence and agency in the world. (shrink)

The problem of disgust has until recently been neglected in the scientific literature. In comparison to the scientific (psychological and metaphysical) interest that has been applied to hatred, anxiety, and similar phenomena, disgust — although a common and important factor in our emotional life — has been unexplored, or it has been viewed as a “higher degree of dislike,” as “nausea,” or as a phenomenon of the “repression of urges.” We here show how the feeling of disgust possesses a unique (...) and characteristic quality on the basis of a phenomenological investigation. (shrink)

American businesses, their leaders, and the business schools that developed these leaders find themselves under public scrutiny. As a result, business programs have placed increased emphasis on developing and implementing curriculum to address business ethics, which presents practitioners with the issue of how to define, measure, and evaluate business ethics curriculum. The purpose of this study was to examine the business ethics curriculum in AACSB-accredited business schools in the U.S. A framework for defining and examining the curriculum was developed using (...) Lattuca and Stark’s (2009) Academic Plan, and other variables from the literature relevant to the business ethics curriculum were examined. The results indicated that the current business ethics curriculum in most business schools has all of the academic plan elements: an ethics-related learning goal; content in a variety of subjects and at a variety of levels; a sequence that has been applied to it; learners’ needs addressed; appropriate and even innovative learning processes; the necessary resources including faculty; assurance of learning at the program level; and has been adjusted an average of 2.6 times in the last five years. Commonly, business ethics is integrated throughout the business curriculum in addition to having an ethics class available, whether elective or required. Faculty generally create and support an ethical culture and the program’s efforts to include business ethics in the curriculum. (shrink)

Nurses play a crucial role in reducing health disparities and advancing health equity for individuals and communities. The future nursing workforce relies on their nursing education to prepare them to promote health equity. Nursing educators prepare students through a variety of andragogical learning strategies in the classroom and in clinical experiences and by intentionally updating and revising curricular content to address knowledge and competency gaps. This critical review aimed to determine the extent to which health equity concepts are explicitly present (...) in prelicensure undergraduate nursing curricula globally. Of 434 articles screened, 22 articles describing 20 studies met inclusion criteria. Frequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Notably, only two articles described overall well‐integrated explicit health equity content, and there was little attention to whether students transfer this learning into practice. A focus on individualism rather than population and community was noted, highlighting the presence of whiteness in nursing. Results from this review confirm that nursing education has room to improve with respect to health equity in the curricula. (shrink)

A twenty‐person working group convened to discuss the ethical and policy considerations of the controversial intervention called “growth attenuation,” and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.

Research explored methods for “shortening the food links” or developing the “local foodshed” by connecting farmers with food service buyers (for restaurants and institutions) in Colorado. Telephone interviews were used to investigate marketing and purchasing practices. Findings include that price is not a significant factor in purchasing decisions; that food buyers prioritize quality as their top purchasing criterion but are not aware that local farmers can provide higher quality, that institutions are interested in buying locally; that small farms can offer (...) comparable or higher quality produce andservice; and that farmers need to show buyers what the quality of produce and service they can provide. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

Decision-makers increasingly invoke equity to motivate, design, implement, and evaluate strategies for managing flood risks. But there is no objective definition of equity. This pluralistic setting calls for transparency about underlying values, but this practice is uncommon. Here, we review how equity is measured by surveying peer-reviewed publications that explicitly state an interest in equity in the context of flood-risk management. We develop a simple taxonomy for how transparent measurements can be defined. We map reviewed measurements to this taxonomy. Finally, (...) we offer guidance on how the pursuit of a clear and consistent quantitative evidence base about equity can become more widespread in flood-risk research and beyond. (shrink)

IntroductionResearch indicates that body image disturbance is associated with poorer psychosocial outcomes for individuals with physical health conditions, with poorest body image reported for individuals with visible bodily changes. Using White’s theoretical model of body image the present paper aimed to examine the nature of these relationships in two distinct groups: individuals with an amputation and individuals with diabetes. It was hypothesized that body image disturbance would be associated with psychosocial outcomes and would mediate the relationships between self-ideal discrepancy and (...) personal investment in psychosocial outcomes.MethodsIndividuals with diabetes and individuals with an amputation provided details regarding their medical condition, and completed measures assessing body image, investment, self-ideal discrepancy, depression, anxiety, and quality of life. Structural equation and invariance modeling were used to test the model paths and the invariance of the model.ResultsAs hypothesized, body image disturbance was found to mediate the relationships between personal investment and psychosocial outcome, and between self-ideal discrepancy and psychosocial outcome. The predicted paths were invariant across groups, although the model accounted for more variance in people with an amputation than people with diabetes.ConclusionBody image disturbance, personal investment, and self-ideal discrepancy are important factors contributing to psychosocial outcome for individuals with diabetes and individuals with an amputation. These findings not only confirm the validity of the model in these two groups, but they emphasize the importance of targeting body image in future psychological interventions for individuals with a health condition. (shrink)

Public attention on embryo research has never been greater. Modern reproductive medicine technology and the use of embryos to generate stem cells ensure that this will continue to be a topic of debate and research across many disciplines. This multidisciplinary book explores the concept of a 'healthy' embryo, its implications on the health of children and adults, and how perceptions of what constitutes child and adult health influence the concept of embryo 'health'. The concept of human embryo health is considered (...) from preconception to pre-implantation genetic diagnosis to recent foetal surgical approaches. Burgeoning capacities in both genetic and reproductive science and their clinical implications have catalysed the necessity to explore the concept of a 'healthy' embryo. The authors are from five countries and 13 disciplines in the social sciences, humanities, biological sciences and medicine, ensuring that the book has a broad coverage and approach. (shrink)

Did the September 11, 2001 terrorist attacks on the U.S. cause the values of teenagers in the U.S. to change? Did their previously important self-esteem and self-actualization values become less important and their survival and safety values become more important? Changes in the values of teenagers are important for practitioners, managers, marketers, and researchers to understand because high school students are our current and future employees, managers, and customers, and research has shown that values impact work and consumer-related attitudes and (...) behaviors. Further, studies that compared higher to lower performing for-profit and not-for-profit companies have found that higher performing organizations had strong values that permeated their organizations [Collins J. C., and J. I. Porras: 1994, Built to Last: Successful Habits of Visionary Companies (New York, Harper Business); O’Reilly, C. A. and J. A. Chatman: 1996, in B. M. Staw and L. L. Cummings (eds.), Research in Organizational Behavior, vol. 18 (JAI Press, Greenwhich, CT), pp. 157–200; O’Reilly, C. A.: 1989, California Management Review 31(4), 9–25; Posner, B. Z., and W. H. Schmidt: 1996, Public Personnel Management, 25(3), 277–298; Rousseau, D.: 1990, Group and Organization Studies 15(4), 448–460; Schein, E. H.: 2004, Organizational Culture and Leadership. San Francisco, Jossey Bass)]. While one study of adults found value changes, no known studies have explored if the values of teenagers also changed post-9/11. This study filled that research gap by exploring the values of a random sample of 1000 U.S. teenagers in grades 9 to 12 pre- and post-9/11, using a demographic questionnaire and the Rokeach Value Survey. The research results indicated that teenage survival, safety, and security values (a world at peace, freedom, national security, and salvation) increased in importance while their self-esteem and self-actualization values (a sense of accomplishment, inner harmony, pleasure, self-respect, and wisdom) decreased in importance, mirroring the changes for adults. The meaning of these findings for practitioners, managers, marketers and researchers was discussed. (shrink)