In 1972, I created the new field of clinical medical ethics (CME) in the Department of Medicine at the University of Chicago. In my view, CME is an intrinsic part of medicine and is not a branch of bioethics or philosophical ethics or legal ethics. The relationship of patients with medically trained and licensed clinicians is at the very heart of CME. CME must be practiced and applied not by nonclinical bioethicists, but rather by licensed clinicians in their routine, daily (...) encounters with inpatients and outpatients. CME addresses many clinical issues such as truth-telling, informed consent, confidentiality, surrogate decision making, and end-of-life care, while also encouraging personal, humane, and compassionate interactions between experienced clinicians and patients.The goals of CME are to improve patient care and outcomes by helping physicians and other health professionals Clinical Medical Ethics: Its History and Contributions to American Medicine Mark Siegler, Guest Editor identify and respond to clinical-ethical challenges that arise in the ordinary care of patients. As Edmund Pellegrino, Peter A. Singer, and I wrote in the first issue of The Journal of Clinical Ethics, 30 years ago: “The central goal of CME is to improve the quality of patient care by identifying, analyzing, and contributing to the resolution of ethical problems that arise in the routine practice of clinical medicine.” Similar to cardiology and oncology consultations, ethics consultations are a small component of a much larger field, and the process of consultations is certainly not at the core of cardiology or oncology or CME.In this article, I intend to discuss the origins of the field of CME, its goals and methods, the relationship between the broad field of CME and the much narrower practice of ethics consultation, the contributions of the MacLean Center at the University of Chicago in developing the field of CME, and, finally, how CME has improved the practice of medicine in the United States. (shrink)

“Hooking up,” a popular type of sexual behavior among college students, has become a pathway to dating relationships. Based on open-ended narratives written by 273 undergraduates, we analyze how students interpreted a vignette describing a heterosexual hookup followed by a sexless first date. In contrast to the sexual script which holds that women want relationships more than sex and men care about sex more than relationships, students generally accorded women sexual agency and desire in the hookup and validated men’s post-hookup (...) relationship interest. However, in explaining the sexless date, students typically reasoned the woman was being chaste and withholding sex to redeem her reputation whereas they often characterized the man’s abstinence in terms of a pity date. The findings underscore the tenacity of gendered sexual scripts around heterosexual dates and hookups but also reveal fissures and contradictions that suggest some changes to the sexual double standard. (shrink)

Siegler identifies the elderly as a population vulnerable to discrimination as society seeks to contain health care costs by rationing medical care. Traditional decision making by physicians and patients, which is based upon medical indications and the wishes of the patient, may yield to decision making based upon institutional and social expediency and economic concerns. Siegler predicts that as a consequence of cost containment measures, certain groups of patients, of whom the elderly constitute a large percentage, will find (...) their access to medical care limited, and the extent of that care reduced. He suggests that this threat to the elderly can be counteracted by retaining the traditional physician patient relationship, by basing care decisions upon clinical criteria, and by beginnning rationing with those groups of patients best able to defend themselves. (shrink)

Leader behavioral integrity (BI) is central to perceived credibility and thus to leaders’ effectiveness at fostering ethical and other climates. Our research broadens the theoretical foundation for BI research by integrating the cognitive–attributional role of trust in the formation and maintenance of leader BI perceptions. Guided by recent research on trust primacy and prior theories of fairness used to examine ethical behavior, we examine how perceptions of leader BI can be either diminished or maintained through trust velocity following a psychological (...) contract breach. Using a field and an experimental study, we explore the manner in which followers perceive leader’s actions when conflicting interests lead to unfulfilled promises. We found that trust velocity mediates the relationship between a psychological contract breach and leader BI (study 1), and that informational justice moderates this relationship (study 2), suggesting that leaders can attenuate the impact of broken promises on ascribed BI. Our findings offer a pathway for leaders operating in dynamic contexts to preserve BI and also help address concerns that have been raised about the behavioral integrity construct regarding its conceptual overlap with related constructs such as trust, psychological contracts, and informational justice. (shrink)

This book is about the ethical issues that clinicians encounter as they care for patients and is written to assist those who serve on hospital ethics committees as they deliberate about appropriate action in difficult ethical cases.

'Ugly as sin', 'ugly duckling', 'rear its ugly head'. The word 'ugly' is used freely, yet it is a loaded term: from the simply plain and unsightly to the repulsive and even offensive, definitions slide all over the place. Hovering around 'feared and dreaded', ugliness both repels and fascinates. But the concept of ugliness has a lineage that has long haunted our cultural imagination. Gretchen E. Henderson explores perceptions of ugliness through history, from ancient Roman feasts to medieval grotesque (...) gargoyles, from Mary Shelley's monster cobbled from corpses to the Nazi Exhibition of Degenerate Art. Covering literature, art, music and even Uglydolls, Henderson reveals how ugliness has long posed a challenge to aesthetics and taste. Henderson digs into the muck of ugliness, moving beyond the traditional philosophic argument or mere opposition to beauty, and emerges with more than a selection of fascinating tidbits. Following ugly bodies and dismantling ugly senses across periods and continents, [this book] draws on a wealth of fields to cross cultures and times, delineating the changing map of ugliness as it charges the public imagination. Illustrated with a range of artefacts, this book offers a refreshing perspective that moves beyond the surface to ask what 'ugly' truly is, even as its meaning continues to shift. (shrink)

It is a clinician’s cliché that a physician only challenges a patient’s capacity to make a treatment decision if that decision is not what the physician wants. Agreement is proof of decisional capacity; disagreement is proof or at least evidence of capacity’s absence. It is assumed that this asymmetry cannot be justified, that the asymmetry must be a form of physicians’ paternalism. Instead what is at issue when patient and physician disagree are usually two laudable impulses. The first is physicians’ (...) commitment to patients’ well-being: physicians have a professional obligation as well as, ideally, a personal commitment to take care of patients—to do their best to bring about a positive medical outcome. The second impulse is common to much of human life, namely, the urge to find and to understand the source of our disagreements with one another. In this article we argue that, jointly, these impulses justify the asymmetry with regard to examining patients’ capacity. (shrink)

Decision making is a crucial element in the field of medicine. The physician has to determine what is wrong with the patient and recommend treatment, while the patient has to decide whether or not to seek medical care, and go along with the treatment recommended by the physician. Health policy makers and health insurers have to decide what to promote, what to discourage, and what to pay for. Together, these decisions determine the quality of health care that is provided. Decision (...) Making in Health Care is an up-to-date, comprehensive overview of the field of medical decision making. It includes quantitative theoretical tools for modeling decisions, psychological research on how decisions are actually made, and applied research on how physician and patient decision making can be improved. (shrink)

This paper is concerned with the inverted gender roles portrayed in the Middle English Partonope of Blois, and the part played by Urake in realigning them. The relationship between hero and heroine begins with Partonope in a female passive role as a "kept man," and Melior in a male dominating role as a sexually self-assured woman who chooses the man she wants and controls him. Urake, one of the most unusually interventionistic of romance go-betweens, saves Partonope's life and prepares him, (...) both physically and psychologically, to assume his position as the triumphal hero; she also torments Melior into accepting a less controlling form of love more suitable for a medieval woman. In this way the conventional ending to the romance is enhanced by the satisfaction of seeing the inverted gender roles of hero and heroine put to rights. (shrink)

Volume 19, Issue 12, December 2019, Page 1-2.

In November 2018 the American Society for Bioethics and Humanities (ASBH) administered the first Healthcare Ethics Consultant Certification examination to 138 candidates, 136 of whom (98.5 percent) passed and were “certified” as “healthcare ethics consultants.” I believe this certification process is both premature and inadequate.Certification for ethics consultants is premature because, as Kornfeld and Prager state repeatedly in their article in this issue of The Journal of Clinical Ethics, “The Clinician as Clinical Ethics Consultant: An Empirical Method of Study,” there (...) is a lack of “empirical data on the nature of the problems that prompt ethics consultation requests and on the functions required to address them.” These authors proceed to provide a model for the kind of empirical data collection that is needed.Even more relevant, the ASBH model that certifies clinical ethics consultants is inadequate. First, it is inappropriate for a nonclinical organization such as the ASBH to claim the right to certify a clinical process, ethics consultation, involving patients and health professionals. Second, the current certification process requires only a written examination in contrast to the two-step quality attestation process proposed in 2013 by Eric Kodish, MD, and 11 other senior members of the ASBH, including its then president.Third and most importantly, the eligibility criteria for being certified to work on hospital units and to make clinical recommendations for patients and families are minimal and insufficient. The only stated requirements are a bachelor’s degree and 400 hours of healthcare ethics consulting experience. By contrast, practicing physicians and nurses train for many years to gain clinical experience that enables them to apply clinical ethical standards in the care and management of all inpatients and outpatients, not just the small percent for whom an ethics consultation is requested. (shrink)

This article draws upon affect theory to analyze transformations of garage sale sellers through the exchange of their affectively charged possessions. Garage sales are awash with human emotion; they feature used personal belongings suffused with identities, histories, stories, and memories that are moved along with affect. The objects for sale are “sticky” in that they act as vessels and glue for strands of sentiment to reflexively pass between sellers and buyers, transmitting affective orientations, whether positive or negative. The affective elements (...) of garage sale goods are contagious as they can intersubjectively leap from one body to another. (shrink)

The author discusses the activity of deceiving" as deceiving another and as self-deception. he attempts a logical equivalence between the two. the discussion encompasses 'belief'. the author concludes that the statement 'jones is deceiving himself' translates into "'"how could" jones believe such nonsense'?" with the answer built-in: "'he really "can't"'." (staff).

Hymenoplasty is a practice that must be judged from within its cultural confines and not only from outside. It offers women who have grown up within the sexual norms of a Western society the chance to return to their parental culture, with its female-specific virginity expectations. Hymenoplasty allows women to be sexually active prior to marriage, which equalizes the discrepancy between gender norms on premarital sexual experience. Caution is needed when comparing hymenoplasty to female genital mutilation. However, comparing hymenoplasty to (...) other cosmetic genital modification procedures raises unique ethical, social, and medical quandaries that highlight the importance of patient’s autonomy. (shrink)

We, in the rare disease community are grateful to Halley et al. (2023) for highlighting some of the long-overlooked barriers to care. As the parent of a non-ambulatory, teenage boy living with Duch...

It is commonly accepted that conversation is, in some sense, cooperative. This is due in part to Paul Grice’s articulation of the Cooperative Principle, which states that participants should “make [their] conversational contributions such as is required...” (1989, 26). Yet the significance of this principle, as well as the notion of cooperation that is entailed, is up for interpretation. For example, there are several ways of understanding what kind of force the Cooperative Principle is supposed to have: it could be (...) meant as a requirement on the behavior of speakers, a description of the way speakers behave, or an articulation of what speakers assume of one another’s contributions. I consider each of these options, and I argue that the first, which is often seen as a naïve interpretation, is worth considering. Although I ultimately reject the prescriptive interpretation of the Cooperative Principle, it offers a jumping off point for exploring other prescriptions on conversational behavior, such as the Requirement of Interlocutor Responsiveness, which I offer as an explicitly prescriptive conversational principle. (shrink)

Transactions in the U.S. garage sale range from the commercial to the giftlike, in a Maussian sense. As two-thirds of the participants, women create a sense of community through garage sale exchange. This article explores how women, partly differentiated along lines of race and class, solidify their personal relationships, transmit something of themselves with their possessions, transform their own lives in the process, and contribute to a broader spirit of community through the generalized reciprocity and even moral economy that manifests (...) in giftlike exchange. There is an important link, both material and symbolic, between women's relational skills, their association with the home and the moral, and the creation of community in the garage sale. (shrink)

Human diploid fibroblasts have a finite proliferative lifespan in culture, at the end of which they are ararrested with G1 phase DNA contents. Upon serum stimulation, senescent cells are deficient in carrying out a subset of early signal transduction events such as activation of protein kinase C and induction of c‐fos. Later in G1, they uniformly fail to express late G1 genes whose products are required for DNA synthesis, implying that they are unable to pass the R point. Failure to (...) pass the R point may occur because senescent cells are unable to phosphorylate the retinoblastoma protein, owing to the accumulation of inactive complexes of cyclin E/Cdk2 and possibly cyclin D/Cdk4. Senescent cells contain high amounts of p21, a potent cyclin‐dependent kinase inhibitor whose levels are also elevated in cells arrested in G1 following DNA damage, suggesting that both arrests might share a common mechanism. Cell aging is accompanied by a progressive shortening of chromosomal telomeres, which could be perceived by the cells as a form of DNA damage that gives rise to the signals that inactivate the cell cycle machinery. (shrink)

The postconflict Rwandan state has crafted a “we are all Rwandans” national identity narrative without ethnicity, in the interest of maintaining a delicate, postgenocide peace. The annual genocide commemoration period called Kwibuka—“to remember”—which takes place over the course of one hundred days every year, is an underresearched part of this narrative. During the commemoration period, génocidaires’ confessions increase dramatically; these confessions lead the government to previously undiscovered graves all over the country, just as confessions given during the grassroots justice system—gacaca—did (...) in the more immediate aftermath of the genocide. According to a prominent government official known for his prison outreach, the Rwandan government no longer provides incentives for prisoners to confess. Instead, he stated in a 2017 interview, those who speak up over twenty years later are simply “moved by the spirit of Kwibuka.” When confessions are made, memories of past action are used by the state, seemingly toward an ultimate end of reinforcing the national master narrative, to subsume the individual memories of innocent survivors into the national collective memory. This paper explores the questions around the state’s evolving use of prisoner confessions, both how those confessions are obtained, and how they factor into commemoration practices now. (shrink)