Drawing from a social predicament and identity management framework, we argue that procedural unfairness on the part of decision makers places messengers in a dilemma where they attempt to protect their professional image or legitimacy by engaging in refusals and exhibiting distancing behaviors when delivering bad news. Such behaviors however, violate key tenets of fair interpersonal treatment. The results of two experiments supported our hypotheses in samples of experienced managers. Specifically, we found that levels of messengers’ distancing and (...) refusals were greater when the procedures used by decision makers were unfair rather than fair. Additionally, messengers’ perceptions of a predicament mediated these relationships. Implications and future research directions regarding the ethical delivery of bad news in the workplace are discussed. (shrink)

There are several models for delivering bad news, the most important and widely used being the SPIKES protocol. Cultural differences in breaking bad news in different societies with different cultures call for special attention. Muslim societies are examples of communities with special cultural and religious requirements. Then, when collecting information about a person's perception of the illness or the incident, consider his or her view of spirituality and the effect of calamities on human transcendence so as to (...) assess the type and amount of information the patient or the family needs. When preparing a suitable setting for delivering bad news, pay attention to the spiritual needs of Muslims such as the possibility of prostration, recitation of Qur'an, and talking to God in private or even aloud. Be aware of, pay attention to, and respect particular religious views of the patient, and if necessary, correctly exploit such views to deliver bad news. Although some Muslim patients may have no demands for transcendence and human growth at the first stage, but over time and after accepting the condition, they will have demands. Therefore, health care providers must provide the necessary facilities for Muslim patients in terms of the required information, setting, and people present in the setting and provide information appropriate to the culture of these patients so as to give an excellent and comprehensive care. (shrink)

In corporate social responsibility reporting, companies are expected to fully disclose the negative social and environmental impacts of their activities. This study investigates how Chinese companies respond to this challenge by analyzing the representations of occupational fatalities and injuries in 92 CSR reports from 37 Chinese Fortune 500 companies. A move-step analysis was performed on one part of the CSR report, which is the section providing information on occupational incidents. It was found that the negative information was typically disclosed via (...) four rhetorical moves, which are ‘preparing the reader’, ‘delivering the bad news’, ‘mitigating the bad news’ and ‘reassuring the reader’. Communicating bad news through the four moves helps manage the reader’s perception of the reporting company and its CSR performance. The study calls for greater attention to the impression-managing aspects of companies’ self-disclosure of organizational bad news. (shrink)

As a result of the COVID-19 global pandemic, paramedics in the UK face unprecedented challenges in the care of acutely unwell patients and their family members. This article will describe and discuss a new ethical dilemma faced by clinicians in the out-of-hospital environment during this time, namely the delivery of bad news to family members who are required to remain at home and self-isolate while the critically unwell patient is transported to hospital. I will discuss some failings of current (...) practice and reflect on some of the ethical and practical challenges confronting paramedics in these circumstances. I conclude by making three recommendations: first, that dedicated pastoral outreach teams ought to be set up during pandemics to assist family members of patients transported to hospital; second, I offer a framework for how bad news can be delivered during a lockdown in a less damaging way; and finally, that a new model of bad news delivery more suited for unplanned, time-pressured care should be developed. (shrink)

Psychologists and neuroscientists have delivered a lot of bad news about the inner workings of our minds, raising challenging questions about the extent to which we are rational in important domains of our judgments. I will focus on a central case of an unsettling effect on our perception, and primarily aim to establish that there actually is no impact from it on the rationality of our perceptual beliefs. To reach my goal, I will start with a rough review of (...) different ways bad news about our minds might negatively affect our rationality. I’ll then propose a test for when negative consequences would follow from the truth of some bad news about our minds, and I will argue that the test is not passed in a paradigmatic case of influence of bias on perception. I will then close by looking at potential wider implications of the psychological bad news for debates about internalism vs. externalism in epistemology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Am I the Bad Guy?Tavishi ChopraWhat do you do when the 6-year-old patient you have vowed to protect suddenly deems you the bad guy?The afternoon started out like any typical afternoon during my inpatient pediatric rotation. We had finished rounding, grabbed lunch, and began to see our new admits. My residents told me to go see a 6-year-old, Ela, in the ED. All I knew was that she had (...) a burn injury. As I walked to her ED room, my heart sank.Burns from cigarette stumps covered her torso and back. She was holding her shirt off her chest to prevent the excruciating pain caused by her t-shirt rubbing against her skin. As soon as Ela made eye contact with me, she immediately started crying and exclaiming, "Mommy didn't mean to!" confirming exactly what I thought. These burns were inflicted from someone she loved.Ela was eventually admitted into the hospital, and the Department of Child Services was contacted. Little did I know that I would be so conflicted by this decision.DCS launched an investigation on Ela's mom, but during the investigation, Ela's mom was permitted at her bedside. It was very clear that Ela felt protected and loved by her mom. Often it was only her mom who could get her to stop crying during the painful dressing changes. I felt torn allowing Ela's mom to have such a strong presence in Ela's hospital stay. To me, nothing in the world can justify hurting a child so cruelly, and inflicting that pain so many times. However, my job was to help Ela heal. That meant that because Ela turned to her mom for support, I also needed to include Ela's mom in our medical decisions. I buried away any negative feelings I had, and I proceeded to interact with Ela's mom in a professional manner.It was this that allowed me to get to understand Ela's mom a little bit more. She was a single mom [End Page E8] working multiple jobs to help keep her family afloat. She often lived her day on three to four hours of sleep, so she was very tired. The sleep deprivation made her frustrated more easily, and she didn't have a healthy outlet to release her emotions. Unfortunately, Ela was on the receiving end of that frustration.Hearing her story made me even more angry, confused, and upset that a child suffered. I strongly believed that as adults, we should have better control of our emotions, and sleep deprivation and frustration weren't an excuse. I couldn't find it in me to respect Ela's mom, who I shamefully began to avoid.I still wanted to bond with Ela and show her unconditional love. When Ela's mom was at work, I would use that opportunity to go and spend time with her. We would play "princesses," blow bubbles together, and turn dressing changes into a game. We formed a special bond, and I always made it a goal to go and spend some time with her every day.DCS, meanwhile, was actively conducting an investigation. They interviewed Ela's mom, Ela's siblings, and Ela. The findings of their investigation revealed that Ela's mom often would lose her temper, and the kids feared their mom. Hearing this further proved to me that I did not need to interact with Ela's mom. Embarrassingly, it was just as much a priority for me to avoid Ela's mom as it was to spend time with Ela.DCS eventually concluded that Ela's mom would lose custody of Ela for the time being. Because of the connection that Ela and I had, I took it upon myself to deliver the news to her. Our bond was shattered right then and there. She immediately began to cry, told me she hated me, and asked me to leave the room. Anytime I would go into her room after that, she would start screaming and refused to talk to me. In a span of five minutes, Ela's mom made a decision that destroyed their family... (shrink)

The ethics of bearing bad news has not yet been discussed by philosophers. How should the messenger feel? Is she, as Toni Morrison claimed in one of her novels, ‘corrupted’ by the message? And shou...

A ‘companions in guilt’ strategy against moral error theory aims to show that the latter proves too much: if sound, it supports an implausible error-theoretic conclusion in other areas such as epistemic or practical reasoning. Christopher Cowie [2016 Cowie, C. 2016. Good News for Moral Error Theorists: A Master Argument Against Companions in Guilt Strategies, Australasian Journal of Philosophy 94/1: 115–30.[Taylor & Francis Online], [Web of Science ®] [Google Scholar]] has recently produced what he claims is a ‘master argument’ (...) against all such strategies. The essence of his argument is that CG arguments cannot work because they are afflicted by internal incoherence or inconsistency. I argue, first, that Cowie's master argument does not succeed. Beyond this, I argue that there is no good reason to think that any such argument—one that purports to identify an internal incoherence in CG arguments—can succeed. Second, I argue that the main substantive area of disagreement between error theorists and CG theorists essentially concerns the conceptual profile of epistemic reasons—specifically, whether they are strongly categorical—not the ontological question of whether such reasons exist. I then develop an argument in favour of the CG theorist's position by considering the moral error theorist's arguments in support of the conceptual claim that moral reasons are strongly categorical. These include, notably, criticisms made by Joyce [2011] and Olson [2014] of Finlay's [2008] ‘end relational’ view of morality, according to which moral reasons are relative to some end or standard, hence not strongly categorical. Examining these criticisms, I argue that, based on what moral error theorists have said regarding the conceptual profile of moral reasons, there is a strong case to be made that moral reasons are strongly categorical if and only if epistemic reasons are. (shrink)

This study examined correlations between moral value judgments on a 17-item Moral Intuition Survey (MIS), and participant scores on the Short-D3 “Dark Triad” Personality Inventory—a measure of three related “dark and socially destructive” personality traits: Machiavellianism, Narcissism, and Psychopathy. Five hundred sixty-seven participants (302 male, 257 female, 2 transgendered; median age 28) were recruited online through Amazon Mechanical Turk and Yale Experiment Month web advertisements. Different responses to MIS items were initially hypothesized to be “conservative” or “liberal” in line with (...) traditional public divides. Our demographic data confirmed all of these hypothesized categorizations. We then tested two broad, exploratory hypotheses: (H1) the hypothesis that there would be “many” significant correlations between conservative MIS judgments and the Dark Triad, and (H2) the hypothesis that there would be no significant correlations between liberal MIS judgments and Machiavellianism or Psychopathy, but “some” significant correlations between liberal MIS judgments and Narcissism. Because our hypotheses were exploratory and we ran a large number of statistical tests (62 total), we utilized a Bonferroni Correction to set a very high threshold for significance (p = .0008). Our results broadly supported our two hypotheses. We found eleven significant correlations between conservative MIS judgments and the Dark Triad—all at significance level of p < .00001—but no significant correlations between the Dark Triad and liberal MIS judgments. We believe that these results raise provocative moral questions about the personality bases of moral judgments. In particular, we propose that because the Short-D3 measures three “dark and antisocial” personality traits, our results raise some prima facie worries about the moral justification of some conservative moral judgments. (shrink)

Personal reports of receiving bad news provide data that describes patients’ comprehension, reflections, experienced emotions, and an interpretative commentary with the wisdom of hindsight. Analysis of autobiographical accounts of “hearing bad news” enables the identification of patterns of how patients found out diagnoses, buffering techniques used, and styles of receiving the news. I describe how patients grapple with the news, their somatic responses to hearing, and how they struggle and strive to accept what they are hearing. (...) I discuss metaphors used within the languages of hearing bad news. Finally, I discuss implications for a change of focus in the breaking bad news research agenda, that is, from the physician’s “performance” to a patient-focused agenda. (shrink)

In a recent study appearing in Neuroethics, I reported observing 11 significant correlations between the “Dark Triad” personality traits – Machiavellianism, Narcissism, and Psychopathy – and “conservative” judgments on a 17-item Moral Intuition Survey. Surprisingly, I observed no significant correlations between the Dark Triad and “liberal” judgments. In order to determine whether these results were an artifact of the particular issues I selected, I ran a follow-up study testing the Dark Triad against conservative and liberal judgments on 15 additional moral (...) issues. The new issues examined include illegal immigration, abortion, the teaching of “intelligent design” in public schools, the use of waterboarding and other “enhanced interrogation techniques” in the war on terrorism, laws defining marriage as the union of one man and one woman, and environmentalism. 1154 participants (680 male, 472 female; median age 29), recruited online through Amazon Mechanical Turk, completed three surveys: a 15-item Moral Intuition Survey (MIS), the 28-item Short Dark Triad personality inventory, and a five-item demographic survey. The results strongly reinforce my earlier findings. Twenty-two significant correlations were observed between “conservative” judgments and the Dark Triad (all of which were significant past a Bonferonni-corrected significance threshold of p = .0008), compared to seven significant correlations between Dark Triad and “liberal” judgments (only one of which was significant past p = .0008). This article concludes by developing a novel research proposal for determining whether the results of my two studies are “bad news” for conservatives or liberals. (shrink)

BackgroundBreaking bad news to mothers whose children has disability is an important role of physicians. There has been considerable speculation about the inevitability of parental dissatisfaction with how they are informed of their child’s disability. Egyptian mothers’ preferences for how to be told the bad news about their child’s disability has not been investigated adequately. The objective of this study was to elicit Egyptian mothers’ preferences for how to be told the bad news about their child’s disability.MethodsMothers (...) of 100 infants recently diagnosed with Down syndrome were interviewed regarding their preferences for how to be told bad news. Mothers were recruited through outpatient clinics of the Pediatric Genetics Department at Fayoum University Hospital (located 90 km southwest of Cairo, Egypt) from January to June 2011.Results and discussionQuestionnaire analyses revealed nine themes of parental preferences for how to be told information difficult to hear. Mothers affirmed previously reported recommendations for conveying bad medical news to parents, including being told early, being told of others with a similar condition, and being informed of the prognosis.ConclusionsMothers affirmed communication themes previously discussed in the literature, such as being told early, and being informed of the prognosis. Although more research is needed in this important area, we hope that our findings will stimulate future search and help health care providers in different societies establish guidelines for effectively communicating bad news. (shrink)

Are there good arguments from Is to Ought? Toomas Karmo has claimed that there are trivially valid arguments from Is to Ought, but no sound ones. I call into question some key elements of Karmo’s argument for the “logical autonomy of ethics”, and show that attempts to use it as part of an overall case for moral skepticism would be self-defeating.

This article discusses Elizabeth Anscombe's faith and her concept of faith, and the bearing of this on what it is for belief to be reasonable. Reasonableness requires that we make a rough distinction between what can and cannot be taken seriously. At the margin we will rightly be influenced by thinkers such as Anscombe who were well able to appreciate the philosophical consensus but were also prepared to disturb it. She disturbed it in a particular way: by asserting Christian teachings (...) robustly inimical to peace of mind. However she rejected many traditional defences of these teachings as presupposing a faulty understanding of rationality. The article attempts to assess what a more adequate understanding might be. (shrink)

Since the time of Hume, many philosophers have thought it impossible to deduce an ‘Ought’ from an ‘Is,’ or in general to deduce ‘ethical sentences’ from purely ‘factual sentences.’ This is the thesis of the logical autonomy of ethics. I consider a more recent argument by Toomas Karmo in support of the autonomism, but show its limitations in the context of justification skepticism about ethics.

Most healthcare providers work from ethical principles based on a Western model of practice that may not adhere to the cultural values intrinsic to Indigenous peoples. Breaking bad news is an important topic of ethical concern in health research. While much has been documented on BBN globally, the ethical implications of receiving bad news, from an Indigenous patient perspective in particular, is an area that requires further inquiry. This article discusses the experiences of Māori lung cancer patients and (...) their families, in order to investigate the ethical implications of receiving bad news. Data collection occurred through 23 semistructured interviews and nine focus groups with Māori lung cancer patients and their families in four districts in the Midland Region of New Zealand: Waikato, Bay of Plenty, Lakes and Tairāwhiti. The findings of this study were categorised into two key themes: communication and context. Avenues for best practice include understanding the centrality of the HCP–patient relationship and family ties in the healthcare journey, and providing patients with the full range of viable treatment options including hope, clear advice and guidance when the situation calls for it. Overall, the findings of this study hold implications for providing culturally safe and humanistic cancer care when BBN to Māori and Indigenous patients. (shrink)

Herodotos and Thoukydides report on many occasions that kings, polis leaders, and other politicians speak and behave in ways that unintentionally announce or analyze situations incorrectly (misinformation). Elsewhere, they represent as facts knowingly false constructs or “fake news” (disinformation), or they slant data in ways that advance a cause personal or public (propaganda, true or false). Historians attempt to or claim to acquaint audiences with a truer fact situation and to identify subjects’ motives for distortion such as immediate personal (...) advantage, community advantage, or to encourage posterity’s better (if mistaken) opinion. Such historiographical bifocalism enhances the historian’s authority with readers (as he sees through intentional or unintentional misrepresentations) as well as sets straight distorted historical records. This paper surveys two paradigmatic Hellenic historians’ texts, how they build their investigative and analytic authority, and how they encourage confidence in their truth-determining skills. The material collected confirms and assesses the frequency of persons and governments misleading their own citizens and subjects as well as rival persons and powers. Finally, it demonstrates that these two historians were aware of information loss, information control (dissemination and suppression), and information chaos. (shrink)

The rapidly increasing number of cases of Zika virus and limited understanding of its congenital sequelae (e.g., microcephaly) led to stories of fear and uncertainty across social media and other mass communication networks. In this study, we used techniques generic to netnography, a form of ethnography, using Internet‐based computer‐mediated communications as a source of data to understand the experience and perceptions of families with infants diagnosed with Zika‐related microcephaly. We screened 27 YouTube™ videos published online between October 2015 and July (...) 2016, during which the Zika epidemic started, peaked, and declined. We identified three themes: (a) experiencing the news of a diagnosis of Zika‐associated microcephaly; (b) experiencing feelings and expectations of the ‘imperfect’ child; and (c) seeking to understand microcephaly to care for the child. We found that families experienced distressing feelings of shock, sadness, hopelessness, and pain, while dealing with emerging and sometimes conflicting information being transmitted by news outlets, uncertainty about the child's health, and healthcare providers’ lack of clarity to guide the family members. The ‘unknown’ factor of ZIKA was an additional stressful factor in the experience of the families. (shrink)

BackgroundBreaking bad news to mothers whose children has disability is an important role of physicians. There has been considerable speculation about the inevitability of parental dissatisfaction with how they are informed of their child’s disability. Egyptian mothers’ preferences for how to be told the bad news about their child’s disability has not been investigated adequately. The objective of this study was to elicit Egyptian mothers’ preferences for how to be told the bad news about their child’s disability.MethodsMothers (...) of 100 infants recently diagnosed with Down syndrome were interviewed regarding their preferences for how to be told bad news. Mothers were recruited through outpatient clinics of the Pediatric Genetics Department at Fayoum University Hospital (located 90 km southwest of Cairo, Egypt) from January to June 2011.Results and discussionQuestionnaire analyses revealed nine themes of parental preferences for how to be told information difficult to hear. Mothers affirmed previously reported recommendations for conveying bad medical news to parents, including being told early, being told of others with a similar condition, and being informed of the prognosis.ConclusionsMothers affirmed communication themes previously discussed in the literature, such as being told early, and being informed of the prognosis. Although more research is needed in this important area, we hope that our findings will stimulate future search and help health care providers in different societies establish guidelines for effectively communicating bad news. (shrink)

The core doctrine of ethical intuitionism is that some of our ethical knowledge is non-inferential. Against this, Sturgeon has recently objected that if ethical intuitionists accept a certain plausible rationale for the autonomy of ethics, then their foundationalism commits them to an implausible epistemology outside ethics. I show that irrespective of whether ethical intuitionists take non-inferential ethical knowledge to be a priori or a posteriori, their commitment to the autonomy of ethics and foundationalism does not entail any implausible non-inferential knowledge (...) in areas outside ethics (such as the past, the future, or the unobservable). However, each form of intuitionism does require a controversial stand on certain unresolved issues outside ethics. (shrink)

Situationist experiments such as the Milgram experiment and the Princeton Seminary experiment have prompted philosophers to warn us against succumbing to fear of embarrassment and sliding down slippery slopes. Yet it would be a mistake to conclude that situationism is all bad news for moral agents. Fear of embarrassment can often motivate right actions, and slippery slopes can slide us away from wrongdoing. The reason that philosophers have seen situationism as bringing all bad news is that they have (...) focused on the very demanding moral goals of virtuous and autonomous action, while ignoring important moral goals that are less demanding. Fear of embarrassment does undermine virtuous and autonomous action, but that very same fear can help us to act resolutely and rightly, and allows us to manipulate would-be wrongdoers into doing the right thing. This is good news. (shrink)

Arguing that journalism's traditional tenets--objectivity, fairness, accuracy--are no longer sufficient guidelines, journalist Jeremy Iggers challenges the dogmas that have shaped journalism for the last 100 years. He calls for a new code of ethics and a reexamination of the role of the news media in society.

Informed consent to breaking (or waiving) bad news is an important yet neglected topic. It is distinct from informed consent to diagnosis and to treatment, and may be logically and ethically sound, provided patients are competent and that no considerable harm may be caused to others by breaking or waiving bad news to patients. This requires a differential assessment procedure in order to balance patient autonomy, benefit and justice towards others, preferably exploring patients’ values, expectations and needs with (...) them, so that an acceptable decision can be made on whether to act on their consent to breaking or waiving bad news, or to ignore it and act on informed consent by proxy. Future study should attempt to provide a detailed characterization of procedures for attaining informed consent to breaking or waiving bad news, and to test their success in establishing ethically sound health care. (shrink)

Futile medical interventions have virtually no chance of success. Doctors might perform such procedures because of pressure from families or patients. The doctor might also have an ulterior motive of gain or prefer to do it rather than take time to communicate with the patient about a poor prognosis. Established ways to communicate bad news to patients are not always used by managing physicians with time constraints. The SPIKES protocol method is outlined to assist in sensitive communication where further (...) intervention is futile. This review primarily explores various aspects of medical futility. It also explores strategies for effectively communicating with patients and their families regarding futility interventions. A side-effect of futile interventions is burnout in doctors and other health practitioners (HPs). The complex relationship between futility and burnout is described. (shrink)

This paper focuses on the ethical and moral implications of findings from the authors? national survey of television news directors? policies, practices, and perceptions of good/bad news. In light of the potentially negative effects of excessive amounts of bad news on individuals and society, the authors ask whether television journalists have an ethical responsibility?beyond legal constraints and professional criteria?in the selection and presentation of bad news and good news. An earlier version of this paper, detailing (...) the findings of the survey, was presented to the Radio?TV Journalism Division of the Association for Education in Journalism and Mass Communication in August, 1986. (shrink)

Propositional relationalists about the attitudes claim to find support for their view in what they assume to be the dyadic relational logical form of the predicates by which we canonically attribute propositional attitudes. In this paper I argue that the considerations that they adduce in support of this assumption, specifically for the assumption that the that-clauses that figure in these predicates are singular terms, are suspect on linguistic grounds. Propositional relationalism may nonetheless be true, but the logical form of attitude (...) predicates provides no grounds for thinking this to be so. (shrink)

It is natural to assume that we would not be willing to compromise the environment if the conveniences and luxuries thereby gained did not have a substantial positive impact on our happiness. But there is room for skepticism and, in particular, for the thesis that we are compromising the environment to no avail in that our conveniences and luxuries are not having a significant impact on our happiness, making the costs incurred for them a waste. One way of defending the (...) no-avail thesis fits neatly with what I will call the exalted view , according to which the key to human happiness lies in the mental (or spiritual) realm rather than in the material realm. After considering this familiar approach to defending the no-avail thesis, I sketch out a very different approach—one that will, I hope, appeal to those who have doubts about the familiar line of defense. The alternative and novel approach builds on a strand of empirical research on (self-reports concerning) happiness that suggests that we are, in a way, quite shallow, and that our happiness depends on whether we are keeping up with the Joneses. I call this view concerning happiness the worldly view . My reasoning suggests that even if the current rift between exalted pictures of human nature and happiness, on the one hand, and worldly pictures of human nature and happiness, on the other, cannot be repaired, it need not hinder agreement on the plausibility of the no-avail thesis; rather, with the rift come two different routes to the same thesis. I conclude that we should take the no-avail thesis very seriously, and that evidence that we are shallow materialists need not be bad news for the environment(alist). (shrink)

Despite the growing social interest in green products, companies often find it difficult to find effective strategies to induce consumers to purchase green products or engage in other environmentally friendly behaviors. To address this situation, we examined the favorable or unfavorable effects of positive and negative message frames on consumers’ willingness to consume green products in different psychological distance contexts. Through two Studies, we found that the positive information framework played a more pronounced role in context when consumers were in (...) closer spatial distances. More importantly, we found that the emotional factors of fear and hope were intrinsic causes of this phenomenon. Correspondingly, the negative information framework played a better facilitating role in context with farther spatial distance, while shame and pride were the emotions responsible for this effect. Finally, we discuss the theoretical and managerial implications of our work, as well as its limitations and future research directions. (shrink)

Issues in genetics and genomics have been centre stage in Bioethics for much of its history, and have given rise to both negative and positive imagined futures. Ten years after the completion of the Human Genome Project, it is a good time to assess developments. The promise of whole genome sequencing of individuals requires reflection on personalization, genetic determinism, and privacy.

Breaking bad news (BBN) to parents whose newborn has a major disease is an ethical dilemma. In Saudi Arabia, BBN about newborns is performed according to the parental preferences that have been reported from non-Arabic/non-Islamic countries. Saudi mothers' preferences about BBN have not yet been studied. Therefore, we aimed to elicit the preferences of Saudi mothers about BBN concerning newborns. We selected a convenience sample of 402 Saudi mothers, aged 18-50 years, who had no previous experience with BBN. We (...) selected them via a simple number-randomization scheme from the premises of a level III Saudi hospital between October of 2009 and January of 2011. We used a hypothetical situation (BBN about trisomy 21) to elicit their preferences about BBN concerning newborns via a structured verbal questionnaire composed of 12 multiple-choice questions. We expressed their preferences as percentages (95% confidence interval), and we used the Kendall's W test (W) to assess the degree of agreement in preferences. The Saudi mothers preferred that BBN be conducted with both parents together (64% [60-69]), albeit with weak levels of agreement (W = 0.29). They showed moderate agreement in their preferences that BBN should be conducted early (79% [75-83], W = 0.48), in detail (81% [77-85], W = 0.52), in person (88% [85-91], W = 0.58), and in a quiet setting (86% [83-90], W = 0.53). With extremely weak agreement, they preferred to have a known person present for support during BBN (56% [51-61], W = 0.01), to have close bodily contact with their babies (66% [61-70], W = 0.10), and to have no another patients present (64% [59-68], W = 0.08). They showed moderate levels of agreement in their desires to detail, in advance, their preferences about process of BBN by giving a reversible, written informed consent that could be utilized for guidance, if needed (80% [76-84], W = 0.36). In our experience, Saudi mothers' preferences about BBN concerning newborns are varied, suggesting that a "one-size-fits-all" approach is inappropriate. A reversible, written informed consent detailing their preferences about BBN that would be kept in their medical records and utilized for guidance, if needed, may be the best solution, given this level of diversity. These findings merit further study. (shrink)

Clinical simulation is used in nursing education and in other health professional programs to prepare students for future clinical practice. Simulation can be used to teach students communication skills and how to deliver bad news to patients and families. However, skilled communication in clinical practice requires students to move beyond simply learning superficial communication techniques and behaviors. This article presents an unexplored concept in the simulation literature: the exercise of moral imagination by the health professional student. Drawing from the (...) works of Hume, Aristotle and Gadamer, a conceptualization of moral imagination is first provided. Next, this article argues that students must exercise moral imagination on two levels: towards the direct communication exchange before them; and to the representative nature of simulation encounters. Last, the limits of moral imagination in simulation-based education are discussed. (shrink)

When the manufacturer of a medical device alone bears the responsibility for alerting recipients that the device may be defective, there is a certain temptation to gloss over the risk. The story of the Bjork‐Shiley Convexo‐Concave heart valve is a case in point.

Parents frequently attempt to shield their children from distressing prognostic information. Pediatric oncology providers sometimes follow parental request for non-disclosure of prognostic information to children, invoking what we call the stability of the family argument. They believe that if they inform the child about terminal prognosis despite parental wishes, cohesion and family structure will be severely hampered. In this paper, we argue against parental request for non-disclosure. Firstly, we present the stability of the family argument in more detail. We, then, (...) set out the (conceptual, legal, systemic) entitativity of the family and the kind of value the stability of the family argument assumes, before we set on to critically evaluate the argument. Our analysis shows that disclosure of prognostic information to children does not necessarily destabilize the family to a greater extent than non-disclosure. In fact, a systemic perspective suggests that mediated disclosure is more likely to result in a (long-term) stability of the family than non-disclosure. It is in the interest of the family to resist the initial aversive reaction to delivering bad news. In the final part, we draw a set of recommendations on how to facilitate decision-making in face of parental request for non-disclosure. (shrink)

Journal of Political Philosophy, EarlyView.

IntroductionRheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process. The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations.MethodsThe station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with (...) clinically active nephritis about renal biopsy. A trained patient–actor and an evaluator were instructed to assess ICP skills in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form.ResultsCandidate performance varied with ICP content and was superior for potential benefit information but significantly reduced for potential complications and biopsy description. Only 17.8% of the candidates mentioned the legal perspective of ICP. Death was omitted by the majority of the candidates ; after the patient–actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior, but ≥1 negative aspect was identified in 69% of the candidates.ConclusionsEthical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency. (shrink)

Objective To find whether Western guidelines on breaking bad news in a nonemergency department are appropriate for an emergency department of a non-Western country; according to patients’ preferences. Method We designed a 19 items questionnaire of Likert-type scale and interviewed 156 patients in the emergency department of a referral hospital in Iran. Results The patients’ preferences in 9 out of 19 statements were similar to the guidelines. “Using the maternal language” received the strongest agreement. The strongest disagreement was on (...) “encouraging the patients to talk after receiving bad news.” The summative scores of subsection indicated strong agreement for cultural issues, followed by communication skills, breaking bad news session, and privacy. Conclusion The patients’ preferences were not completely consistent with the guidelines. We could not determine if it was a situational or cultural issue. However, it is reasonable to design a new guideline for breaking bad news, considering these factors. (shrink)

White proposes an a priori justification of the reliability of inductive prediction methods based on his thesis of induction-friendliness. It asserts that there are by far more induction-friendly event sequences than induction-unfriendly event sequences. In this paper I contrast White's thesis with the famous no free lunch theorem. I explain two versions of this theorem, the strong NFL theorem applying to binary and the weak NFL theorem applying to real-valued predictions. I show that both versions refute the thesis of induction-friendliness. (...) In the conclusion I argue that an a priori justification of the reliability of induction based on a uniform probability distribution over possible event sequences is impossible. In the outlook I consider two alternative approaches: justification externalism and optimality justifications. (shrink)

The standard reliabilist line on defeat is open to counterexamples regarding its necessity and sufficiency. In this paper, I present three problems for the standard reliabilist line from the recent literature on defeat before arguing that reliabilists can solve those problems by adopting an account of justification that ties defeat to the evidence possessed by the relevant agent. In doing so, I show that there is a conception of having evidence that reliabilists can adopt without giving up on the core (...) commitments of their research program, namely the reduction of epistemic facts and having a psychologically realistic account of justification. My account of defeat draws on the account of propositional justification, transglobal evidentialism, defended by David Henderson, Terry Horgan, and Matjaž Potrč. (shrink)