Advance directives are critically important for capable individuals who wish to avoid the burdens of life-prolonging interventions in the advanced stages of dementia. However, this paper will argue that advance directives should have less application to questions about feeding patients during the clinical course of dementia than often has been presumed. The argument will be framed within the debate between Ronald Dworkin and Rebecca Dresser regarding the moral authority of precedent autonomy to determine an individual’s future end-of-life care plan. We (...) will use a brief analysis of the positions taken in two important papers that come out of the Dworkin/Dresser debate and a hypothetical patient, John, who will be followed from diagnosis of dementia to death, to show how advance directives should apply to key points in the progression of his disease, particularly in relation to food and nutrition. (shrink)

Clinical ethics consultants (CECs) often face some of the most difficult communication and interpersonal challenges that occur in hospitals, involving stressed stakeholders who express, with strong emotions, their preferences and concerns in situations of personal crisis and loss. In this article we will give examples of how much of the important work that ethics consultants perform in addressing clinical ethics conflicts is incompletely conceived and explained in the American Society of Bioethics and Humanities Core Competencies for Healthcare Ethics Consultation and (...) the clinical ethics literature. The work to which we refer is best conceptualized as a specialized type of interviewing, in which the emotional barriers of patients and their families or surrogates can be identified and addressed in light of relevant ethical obligations and values within the context of ethics facilitation. (shrink)

Comparatively little scholarly attention has been given to the question of futility in chronic psychiatric disorders, with the exception of a small body of work on so-called end-stage anorexia nervosa. A review of this literature provides the background for a critical examination of whether the concept of futility has any clinically meaningful, ethically justifiable, and legally defensible application to AN. In this article, the arguments for and against futility judgments in AN are analyzed with special emphasis on determinations of capacity (...) in this serious mental illness. Parallels between the futility disputes in medical and psychiatric disorders, where applicable, will be drawn to further illuminate whether or not the concept that continued psychiatric treatment for AN is ever truly futile. (shrink)

When patients are admitted to the hospital, they are generally expected to remain in or within close proximity to their assigned rooms in order to promote their safety and appropriate medical care. Although there are circumstances when patients may safely leave their hospital room or floor, guidance within the medical literature for the management of patient movement within the hospital are lacking. Excessive restrictions on patient movement may be seen as overly paternalistic, while lax requirements may interfere with high quality (...) care, patient safety and efficient hospital practice. As a result, guidance in the form of institutional policy is warranted. Such policy development should take into consideration the potential clinical, legal, and ethical concerns in balancing the competing values of patients’ preferences and respect for autonomy, while ensuring high quality, safe, and efficacious medical care. This paper will provide a framework for hospitals to create institution-specific patient movement policies that are fair, systematic, and transparent. (shrink)

This article aims to read feminist new materialisms (Barad), together with ‘postulated’ linguistic or cultural primacy of Queer Theory (Butler), to show how both are engaged in similar critical-ethical endeavours. The central argument is that the criticism of Barad and new materialisms misses Butler’s materialistic insights due to a narrow interpretation of Butler's alleged social-constructivist position. There is, therefore, a specific focus on where they both make similar ethical appeals. Moreover, the article relies on Adorno's negative dialectic to highlight an (...) interpretation of Barad and Butler as being part of the same dialectical movement, in which materialism and idealism fluctuate in their mutual criticisms, thus continuing the procession towards 'new knowledge' and emancipation, or freedom, through their motions back and forth. (shrink)

McCarthy, Homan, and Rozier’s presentation of theological anthropology and its contribution to secular bioethics suffers from three primary limitations. First, the article re...

Tertiary healthcare ethics (HCE) consultation occurs when an HCE consultant at a healthcare facility requests guidance from one or more senior HCE consultants who are not members of that facility’s HCE consultation service. Tertiary HCE consultants provide advanced HCE guidance and/or mentoring to facility (secondary) HCE consultants, mirroring healthcare consultation in clinical practice. In this article, we describe advantages and challenges of providing tertiary HCE consultation through a hub-and-spoke model administered by a national integrated HCE service.

The case recapitulates many of the core issues in geriatric ethics that the aging American population will increasingly present to ethics consultation services. The classic ethical dilemma: autonom...

Bianchi and colleagues have written an important article that proposes a harm reduction approach to eating disorders that mediates the ethical tension in the l...

Traditional approaches to human subjects protections in the United States focus on the ethical principles from the Belmont Report: respect for persons, beneficence, and justice. Since research regu...

The definitive book on ethics for chemical dependency treatment professionals.

It is our privilege to be invited to write a commentary on the "Interface of Ethics and Psychiatry: A Philosophical Case Consultation on Psychiatric Ethics on the Ground." The article presents an innovative collaboration between a philosopher and a psychiatrist reasoning together through the ethical aspects of three clinical cases. The case consultation also offers a unique opportunity to reflect on the teaching of psychiatric ethics in clinical settings. This commentary explores those areas of the article from the perspective of (...) a teacher and trainee whose mentoring relationship is grounded in their shared interest in philosophy and psychiatric ethics.A quick search on PubMed and Google Scholar confirms my own... (shrink)

The development of transplantation technology increasingly places before society a multitude of diverse, complex ethical and legal problems. The subject is the more complex because of the various divergent interests involved. There are the interests of the donor of organs, who has a right to protection of his legal position, and those of the patient in need of an often lifesaving organ. There are also the interests of the donor’s relatives, after his death, and those of the transplantation surgeons. The (...) international dimension of transplantation technology makes the picture even more complicated. Though this article is devoted to the European situation, the problems are similar all over the world. (shrink)

The development of transplantation technology increasingly places before society a multitude of diverse, complex ethical and legal problems. The subject is the more complex because of the various divergent interests involved. There are the interests of the donor of organs, who has a right to protection of his legal position, and those of the patient in need of an often lifesaving organ. There are also the interests of the donor’s relatives, after his death, and those of the transplantation surgeons. The (...) international dimension of transplantation technology makes the picture even more complicated. Though this article is devoted to the European situation, the problems are similar all over the world. (shrink)

Terence Irwin's edition of the Nicomachean Ethics offers more aids to the reader than are found in any modern English translation. It includes an Introduction, headings to help the reader follow the argument, explanatory notes on difficult or important passages, and a full glossary explaining Aristotle's technical terms. The Third Edition offers additional revisions of the translation as well as revised and expanded versions of the notes, glossary, and Introduction. Also new is an appendix featuring translated selections from related texts (...) of Aristotle. (shrink)

Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...

Is the procreation asymmetry intuitively supported? According to a recent article in this journal, an experimental study suggests the opposite. Dean Spears (2020) claims that nearly three-quarters of participants report that there is a reason to create a person just because that person’s life would be happy. In reply, I argue that various confounding factors render the study internally invalid. More generally, I show how one might come to adopt the procreation asymmetry for the wrong reasons by misinterpreting one’s intuitions.

Philosophers ask just whose expression, if anyone’s, we hear in lyric poetry. Walton provides a novel possibility: it’s the reader who “uses” the poem (just as a speech giver uses a speech) who makes the language expressive. But worries arise once we consider poems in particular social or political settings, those which require a strong self-other distinction, or those with expressions that should not be disassociated from the subjects whose experience they draw from. One way to meet this challenge is (...) to consider the poem expressive of a plural subject, which frees us from looking for a particular individual whose voice we hear in the work, whether she be fictional or actual. Some lyrics give voice to a group whose experience is attended to in the work. This may be done through a posited fictional speaker, but the ontology of the speaker is shown to be less important. Attending to a group whose concerns are voiced allows us to explain how poems can manage to address our-worldly concerns even when lacking actual persons whose expressions we encounter in the poems. (shrink)

A hub and spoke model offers an effective and efficient approach to providing informed guidance to those who need it. The National Center for Ethics in Health Care (NCEHC) at the Veterans Health Administration, Department of Veterans Affairs, is the largest known hub and spoke healthcare ethics delivery model. In this article, we describe ways NCEHC’s hub and spoke configuration succeeded during the COVID- 19 pandemic, as well as limitations of the model and possible improvements to inform adoption at other (...) healthcare systems. (shrink)

This paper offers a unified explanation for the procreation asymmetry and the non-identity thesis – two of the most intractable puzzles in population ethics. According to the procreation asymmetry, there are moral reasons not to create lives that are not worth living but no moral reasons to create lives that are worth living. I explain the procreation asymmetry by arguing that there are moral reasons to prevent the bad, but no moral reasons to promote the good. Various explanations for the (...) procreation asymmetry have failed to explain the non-identity thesis: if one could create a person with a good life or a different person with a better life, one has a moral reason to create the better life. I argue that reflections on the misfortune of unfulfilled potential allow us to circumvent the non-identity problem. (shrink)

An English language translation accompanies the original Greek text of Aristotle's book about the nature of the state, constitutions, revolutions, democracy, and oligarchy.

Intent and mitigating circumstances play a central role in moral and legal assessments in large-scale industrialized societies. Al- though these features of moral assessment are widely assumed to be universal, to date, they have only been studied in a narrow range of societies. We show that there is substantial cross-cultural variation among eight traditional small-scale societies (ranging from hunter-gatherer to pastoralist to horticulturalist) and two Western societies (one urban, one rural) in the extent to which intent and mitigating circumstances influence (...) moral judgments. Although participants in all societies took such factors into account to some degree, they did so to very different extents, varying in both the types of considerations taken into account and the types of violations to which such considerations were applied. The particular patterns of assessment characteristic of large-scale industrialized societies may thus reflect relatively recently culturally evolved norms rather than inherent features of human moral judgment. (shrink)

We are appreciative of the broad range of commentaries our target article generated. The inquiry into the contingency phase of public health emergencies is nascent and the cl...

Volume 20, Issue 7, July 2020, Page 145-147.

Is there a pro tanto moral reason to create a life merely because it would be good for the person living it? Proponents of the procreation asymmetry claim there is not. Defending this controversial no reason claim, some have suggested that it is well in line with other phenomena in the moral realm: there is no reason to give a promise merely because one would keep it, and there is no reason to procreate merely to increase the extent of justice (...) in the world. Allegedly, some analogs extend so far as to support a unified theory of the no reason claim and the nonidentity thesis, that is, the view that of two persons leading lives of positive wellbeing, there is a reason to create the person with higher wellbeing. I dismantle the proposed analogs and show that they fail to meet various desiderata. Moreover, I refute Johann Frick's argument that the no reason claim follows from the assumption that reasons of beneficence are reasons to act for the sake of people. By criticizing attractive defenses for the no reason claim, I weaken its plausibility. (shrink)

We applaud the spirit of MacNeilage's attempts to better explain the evolution and cortical control of speech by drawing on the vast literature in nonhuman primate neurobiology. However, he oversimplifies motor cortical fields and their known individual functions to such an extent that he undermines the value of his effort. In particular, MacNeilage has lumped together the functional characteristics across multiple mesial and lateral motor cortex fields, inadvertantly creating two hypothetical centers that simply may not exist.

Amyloid beta precursor protein (APP) and prion protein (PrP) are cell membrane elements implicated in neurodegenerative diseases. Both proteins undergo endoproteolysis. Evidence is adduced from the literature hinting that the process in the two proteins could be related, their functions may overlap and their distributions coincide. It is proposed that PrP catalyses its own cleavage, the C-terminal fragment functions as an α secretase and the N-terminal segment chaperones the active site; the α secretase releases anticoagulant and neurotrophic ectodomains from APP. (...) The proposals explain some features of spongiform encephalopathies. BioEssays 23:456–462, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

Der private, sehr gefahrdete Bucherbestand Friedrich Nietzsches gilt als ein besonders interessantes Beispiel einer Schriftstellerbibliothek des 19. Jahrhunderts.